March 4, 2014 at 12:02 AM ET
There was one thing Susannah Kolstad was sure of when she started planning for her second child: The baby was going to be born at home and not in a hospital. The birth of her first son, Henry, had been nerve-wracking. Hospital staff had pressured her to get an epidural and to induce when they felt the baby was taking too long to come.
“At the hospital I felt like I was talking to the doctors and nurses and they weren’t listening,” Kolstad, 34, said. “What appealed to me most about home birth was that it would be calming and something I’d have control over.”
Women like Kolstad are increasingly choosing to give birth at home or in birthing centers rather than in the hospital, a new government report shows.
Although still relatively rare, births outside of the hospital rose from 1.26 percent in 2011 to 1.36 percent in 2012, according to the report by the National Center for Health Statistics of the Centers for Disease Control and Prevention. And two-thirds of those births are happening at home, researchers reported.
Non-Hispanic white women account for the largest percentage, with one in 49 choosing to have their babies at home or in a birthing center. For these women, there was a jump of more than 70 percent in the number who delivered out of the hospital between 2004 and 2012.
Births out of the hospital were far more common in the Northwestern states: 6.0 percent in Alaska, 3.9 percent in Montana, 3.8 percent in Oregon, 3.4 percent in Washington and 3.4 percent in Idaho. They were far less common in the South and Midwest.
For Sarah Lozoff, home birth meant having control over who was taking care of her and her baby. “In the hospital, how your birth goes and the practices used are much more dictated by the nurses,” Lozoff said. “In some cases they’re fantastic. But if there happens to be a nurse on shift who is not on the same page as you, it can be nasty and demeaning.”
Lozoff’s second daughter, Esme, was born at home with her partner and 2-year-old Naiya in the room. The midwife who had provided Lozoff with prenatal care was there monitoring both mom and baby and to make sure everything was going as planned. If there were any problems, transfer to the hospital, just a mile down the road, was possible.
As more and more women have chosen to give birth outside of hospitals, the medical community has come to a sort of grudging acceptance. In a 2011 position statement, the American College of Obstetricians and Gynecologists said that while it still views the hospital as the safest place to deliver, it “respects the right of a woman to make a medically informed decision about delivery.”
Not long after that, the American Academy of Pediatrics released a set of guidelines for the care of infants born at home.
Surveys have shown that increasing numbers of women are looking for a more natural way to give birth, said Suzanne Shores, director of clinical midwifery in the department of obstetrics and gynecology at the University of Pittsburgh Medical Center.
“Women are looking for something different,” Shores said. “Trends in the U.S. show increasing numbers of families eating organic foods. Everyone is looking at something more natural.”
While she wouldn’t recommend it for all women, home birth can work for some, Shores said.
“But it has to be the right patient and the right health care provider,” she added. “It can be a viable alternative.”
The new CDC report also found that women seem to be self-selecting so that those with the lowest-risk profiles ended up trying home birth, while those with complicated pregnancies chose hospitals to deliver their babies.
And that’s exactly as it should be, said Donna Strobino, professor and vice chair of the department of population, family and reproductive health at the Johns Hopkins Bloomberg School of Public Health.
“There is a small percentage of women who want an alternative to all the technology and hospitals and who want to find what they see as a more natural experience,” Strobino said. “In states where there is good legislation to regulate the quality of home births and the individuals who provide care, I think they are safe. I think the issue for most people is that there is a chance of complications. It’s small, but when they occur they can happen quickly and can have devastating consequences.”
What’s important is having a backup plan in place, Strobino said. “The medical community in many states hasn’t made it easy for there to be a backup.”
Even when doctors might be willing to take on home births that go bad, there are complications, said Dr. Ian Bennett, an associate professor in the department of family medicine and community health at Penn Medicine.
“Over the years I have been asked to be available in case something goes wrong,” Bennett said. “I have always declined because I would not be covered or protected.”
Bennett sees hospitals like Penn trying to make hospital births less impersonal and more “joyful.”
“I think things are changing, but there’s a tendency for health care providers to want to make it into something they are used to,” Bennett said. When you’ve seen something go wrong in a pregnancy, then you want to do everything possible to avoid the same kind of thing happening again, he explained.