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Home Delivery

Restrictions on midwives in Missouri are stringent, but Columbia women do have the option of delivering their children at home
Sunday, May 1, 2005 | 12:00 a.m. CDT; updated 4:14 p.m. CDT, Tuesday, July 22, 2008

In a darkened room lit only by candles, John Hahn cleared away all distractions to create a safe and quiet space for his wife, Jessica, to give birth to their son, Riley.

Away from a fast-paced hospital with its monitors and IV tubes, the Columbia couple opted for the comfort of their home to deliver their second child. After four hours of labor — most spent in a bathtub that only hours before had been cluttered with toddler bath toys — Jessica Hahn, 32, welcomed Riley into the world with the help of a birth assistant. A doctor arrived about a half-hour before full dilation to finish the delivery.

“For me, it was just being in a space that was mine,” Jessica Hahn said. “I moved from the tub, after having my baby, and went right to my own bed. It is just sort of knowing we were at home, I can lie here and relax, and there is no one to unnecessarily disturb us.”

The Hahns’ delivery was attended by Laurel Walter, founder of the Whole Health Family Birth Center in Columbia, the only free-standing birth center in the state and one of 84 in the country.

Walter is one of two Columbia doctors who offer home births. Although there is no official record statewide, according to the center, there are only four other doctors in the state willing to assume the professional risks of delivering babies outside hospitals and medical birth centers. The primary risk is the disapproval of colleagues, which could affect licensure and hospital privileges.

In Missouri, midwives who deliver babies without medical supervision can be put in jail, one of the toughest restrictions nationwide against the ancient practice. That legal limitation severely restricts the ability of women to choose a home birthing environment — a choice that home birth advocates say is preferable because it is a natural way of giving birth.

“We are giving our women the autonomy to do what they feel is in their best interest,” said Rep. Cynthia Davis, R-O’Fallon, sponsor of a bill that would remove the legal prohibition against solo midwifery. “It needs to be the woman’s choice, not the state’s choice or the medical plan’s choice.”

The state House of Representatives approved Davis’ bill on April 19. It now moves to the Senate.

Elizabeth Allemann works part time at the center and also has a private medical practice. For her,the question of where to have a baby is about giving women more control of their bodies.

“Ultimately, the decision for what is the best place for a birth rests with the family,” Alleman said. “Increasingly, those decisions are made by policymakers instead of by a woman.”

Women’s choices, the future of birthing technology, challenges in birth and new ways to face malpractice crises are some issues that will be highlighted today at the Future of Birth Conference at Stoney Creek Inn. Speakers include Michael Odent, an internationally known obstetrician and author of 12 books on birth, and Ina May Gaskin, founder and director of the Farm Midwifery Center in Tennessee and author of “Ina May’s Guide to Childbirth,” as well as area doctors.

Of 76,960 live births in Missouri in 2003 — the most current data available — 549 occurred at home, including 11 home births in Boone County, state records show. That works out to less than 1 percent.

Debbie Smithey, president of the Missouri Midwives Association, said that with only two certified nurse midwives practicing home births in the state, many exist underground because of legal implications.

As long as a midwife works alongside a doctor, home births are available to women. Smithey said although they are not common, they are quite popular.

“Most people realize that pregnancy isn’t a medical event,” she said. “Most responses I get are, ‘Oh that’s wonderful, but I couldn’t find a midwife,’ instead of people thinking it is strange or unusual.”

Home births are not

for everyone

Hahn, an ABC Laboratories chemist, knew she wanted to have her first son, Adam, who is now 1, at the Whole Health Family Birth Center in Columbia. After a positive experience there and encouragement from Walter, Hahn opted for a home birth the second time around.

“Not everyone can do one,” she said. “Some people automatically assume they need pain medication. Birth is scary, and you don’t know what can happen to your baby. I felt that if something was wrong, she (Walter) would make sure we got to the hospital.”

Mothers who desire home births through the Whole Health Center must meet the criteria for low-risk deliveries. The mother-to-be must have normal vital signs, a healthy diet and be willing to attend birth education classes, said Ivy White, the center’s administrator.

During a home birth sometimes a hospital transfer is necessary, and it is always an option. If a woman decides the pain is too great and she would like medication, she must go to the hospital because the center does not bring any drugs to a home delivery; or if the mother or child is in danger and in need of medical attention greater than Walter and others can provide, the family must transfer.

Even if the family is only minutes from the hospital, Tom Holloway, lobbyist for the Missouri Medical Society, said hospital births are safer because complications can arise unexpectedly that need immediate attention. He said the society opposes the midwifery bill because although it requires midwives to disclose their training or experience, anyone could hold themselves out to the public as qualified to deliver babies for profit.

“When something goes wrong during childbirth, it can turn deadly in a matter of seconds,” Holloway said. “And if you don’t have the highly skilled judgment and modern medical equipment to handle that, then you are going to have a death on your hands, maybe two.”

Over the past two years, Walter and Allemann have attended about 95 home births. Such births account for nearly half the birth center’s business. In the same time period, 120 women used the birth center, with just 15 opting for planned hospital births.

Natural labor

Davis, a mother of seven, has had seven Caesarean sections. She calls herself a prime example of how one unnecessary medical intervention during childbirth can lead to many more.

“A lot of medical problems that women develop (during birth) are the result of drug interactions,” she said. “First you start a woman with something to speed up labor and then give something for pain, which slows down labor. Pitocin can cause uterine rupture and after a woman has had several C-sections, they don’t give them a chance anymore.”

Walter established the Whole Health Family Practice in 1999. She has delivered babies at home for the past 15 years in Columbia and calls home births significantly safer for low-risk women.

“Every medical intervention carries a price tag,” she said. “In my experience, medications used to decrease the intensity of the birth experience pose a risk to the newborn. Epidurals are known to increase the frequency of cesareans. Often a heart rate drop will be seen in the baby following the administration of epidural drugs or IV drugs. The drugs used to induce labor are not nearly as safe or effective as a natural occurring labor.”

Though most home births are performed without medication, Walter said she has found comfort measures in lieu of drugs — including warm water, massage, emotional support and changing positions during labor — that keep women from even asking for drugs.

“I personally believe labor and birth is the most enjoyable physical experience of life even though it is intense. It is not unbearable, and the rewards of a natural birth far outweigh the difficulties of labor to both the mom and the baby,” said Walter, who has four children ages 15, 10, 7 and 4 and is expecting another in September.

The literature on home births, said Allemann, shows the number one reason women want to have births at home is to stay connected to their babies. Others cite previous bad experiences at hospitals or find a home birth to be safer and cheaper than the alternatives. Allemann herself chose a home birth for her daughter Heidi, now 5.

Allemann cited a 2001 study by the British Medical Journal showing that the United States has seen a steep rise in C-sections to women with no reported medical risk. From 1991 to 2003, national and state C-section rates have increased significantly, according to the state Center for Health Information Management and Evaluation. National and statewide rates hover around 26 percent of all births, which is more than double what the World Health Organization recommends.

At Boone Hospital, spokesman Lynn Hostetler said C-section birth rate percentages were in the high 30s in 2004 — a figure he said pertains mostly to high-risk pregnancies.

For Guy Clark and Lisa Bruce, the high rate of C-sections in hospitals overall contributed to their decision to have a home birth. It also fit perfectly into their view that nature knows best.

“Nature knows what to do and we know what to do if we pay attention,” said Clark, an organic farmer in northern Boone County. “It’s not all about hospitals and machines and doctors. In the situation in which you do a home birth, you are really allowing the process to happen.”

Though the couple knew from the outset they wanted to deliver their first child at home, their first visit with Walter cemented that decision. She asked them what personal beliefs, ideas and concerns the center needed to be aware of to accommodate their needs.

“That has never been the first question at any doctor’s office,” Bruce said.

The couple, who are expecting in June, has been married for about two years and had not planned on having a baby. But when they found out Bruce was pregnant, they wanted to be as involved in the process as possible.

Both attend classes at the birth center on topics ranging from breastfeeding to parenting. Bruce, a technology writer and water aerobics instructor, also takes prenatal yoga that helps prepare her body and mind for a natural birth.

They have chosen to use a big round tub for the birth, provided by the center and if possible, will designate the screened-in porch as their birthing room. Births in the water are the most common methods used by new clients, according to White.

Despite their hopes and plans to have their baby at home, both are open to the possibility of a hospital transfer if a medical need should occur. And part of their education at Whole Health includes a visit to the hospital where they would have their child if the need were to arise.

Alicia and Thomas Tenney, who are expecting next month, would agree. Moving to Fulton from Oklahoma last summer, the couple found it odd not to see midwives advertised in the telephone book. They had their first child Megann, who is now 15 months, in the presence of two midwives at their Oklahoma home.

Initially the couple thought the idea of a home birth was crazy. After plenty of research and interviews with midwives, they opted for the alternative choice.

“When she came into the world, it was quiet,” Alicia Tenney said. “They wrapped her in towels, and we didn’t take her out of the house for a week.”

The cost of home birth

Expecting another baby girl, the couple plan a hospital delivery next month because the Columbia birth center cannot accept their insurance and traveling fees could cost the couple up to $4,000 out of pocket.

Some insurance companies will cover home births in part, but couples usually end up paying several hundred dollars.

Although they would like to have the birth at home, both of the Tenneys are resigned to the fact that maybe there is a reason they need to be in the hospital this time around.

“We have no problem with going to the hospital because we don’t want to risk the life of our child,” said Alicia Tenney, 25. “But just because you’re pregnant and going to have a baby, you don’t automatically have to go. Hospitals are for sick people, and I’m not sick, I’m just pregnant.”

The Tenneys have been pleased with the care they have received from their doctor so far, but they have noticed a difference between the care Alicia received during her previous pregnancy and the care she is receiving now. Meetings with the midwife usually lasted at least a half-hour, while doctor visits are about five minutes. Their doctor, though, is willing to let them bring in a birth assistant known as a doula and try different positions while delivering.

The difference between a doula and a midwife is that doulas only provide support for the laboring mother, and midwives specialize in natural delivery, White said. Either can be considered a birth assistant.

“Hiring (the doula) was a big turning point because although we were happy with our care, we were still really nervous of having a baby in hospital,” Alicia Tenney said. “He was going to let us do whatever we wanted, but it wasn’t because he had confidence in me and in my body. I didn’t feel that support, and my husband was stressed out because he felt like he was the only one at the birth that did support me that way.”

Dee Dee Farris Folkerts, the doula, will help with emotional support and suggest different positions or ways of breathing to help the delivery instead of drug intervention. Folkerts also works at the Columbia birth center.

Said Alicia Tenney: “It takes a lot of stress off to have someone with the same mindset on pregnancy and delivery that we do.”


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