More couples opt for natural births at home

More couples opt for natural births at home

By Diana North
Correspondent

Published March 11, 2007

Babies are born every day. But birth is far from commonplace to
expectant parents or the people who help them through the challenging-
yet-joyful process of guiding a baby into the world. While doctors in
hospitals deliver the majority of U.S. babies, some parents, such as
Todd Johnson and Stephanie Politte of Friendswood, choose a midwife
to assist their planned homebirth.

The expectant couple are repeat clients of Friendswood resident
Christine Messarra, a certified professional midwife who helped
deliver their 18-month-old daughter, Aryanna. The soon-to-be-born
baby is a girl, already named Aaralyn. Johnson and Politte are
appreciative of the support Messarra provides and confident in their
choice of midwife-assisted homebirth.

"The joy of a midwife is that she is all yours," Politte said. "And
everything is so much more calm."

Although Johnson admits he was "a little bit nervous" about homebirth
initially, he liked being able to be more helpful and involved
throughout Aryanna's birth.

"It feels more special and it feels less clinical," Johnson
said. "It's much more personal because you develop this relationship
with the midwife and she actually comes to the house and spends time."

Midwives have a long and well-respected history and continue to
assist at births all across the world. In Texas, two types of
midwives are legally authorized to practice — certified nurse
midwives and certified professional midwives. While the path to
certification differs, the goal of all midwives is the same — safe
passage for the baby and physical and emotional support for the
mother.

Jackie Griggs of Harris County has been a midwife for 16 years. She
has also trained other area midwives and provides her services to
families in surrounding counties. Griggs said expectant mothers
should read and educate themselves about the benefits of midwife-
assisted birth.

"The personal care you get from midwives makes a real difference,"
Griggs said.

Griggs said there are about 350 certified nurse midwives and 150
certified professional midwives currently authorized to practice in
Texas.

CNMs receive their degree as registered nurses and then complete
graduate work in a midwifery program. CPMs take direct-entry courses
and get hands-on training through apprenticeship. All midwives must
pass the North American Registry of Midwives exam.

The Texas Department of Health Statement for 1990-2000 states, in
part, "that birth with midwives in Texas has always been a
statistically safer option than birth with either a medical doctor or
doctor of osteopathy."

In addition, the American Public Health Association "supports the
expansion of midwifery to improve access to care, increase health
options and improve birth outcomes."

Even so, most physicians are unwilling to provide support services
for midwives attending births at home.

Dr. Larry Milner, an obstetrician and gynecologist with the Bayshore
Medical Center in Pasadena, said he is the only physician on staff
who provides availability-based back-up care for clients of area
midwives doing homebirths. He says insurance and malpractice concerns
are the reason most physicians steer clear.

"I'm here to take care of the complicated cases," Milner said. "Any
trained person can take care of babies in a normal pregnancy."

Milner said the midwives he supports show good judgment and provide a
service to clients willing to weigh the risks that can sometimes be
associated with homebirth. Also, Milner said the midwives he knows
are more thorough and adept at providing counseling and nutritional
information than obstetricians, who are often extremely busy.

Midwife services typically include all prenatal care. The first visit
is a two-way interview with the couple during which the midwife does
a risk assessment, since only low-risk women willing to take charge
of their health make good candidates for homebirth. Basic lab work is
ordered as needed.

Midwives meet with their clients once per month until the woman is 30
weeks pregnant, every other week until 36 weeks and weekly until the
baby is born. Each meeting lasts about one hour and allows midwives
time to establish rapport with the family and address any concerns.

Parents may make visits to a midwife's home or office or even choose
home visits, which are often more convenient for those with children.
Some insurance plans pay for midwifery services.

The onset of labor means a phone call to Messarra during which she
assesses how the client is doing. She provides constant support for
the labor and birth with the help of her apprentice and another
midwife. The women remain on duty until three to four hours after the
baby is born.

While midwives are trained to care for infants, every family is
instructed to have their baby examined by a pediatrician within 48 to
72 hours after the birth. Messarra checks in on new mothers and
babies weekly for the first two weeks and again during the final
visit at six weeks postpartum.

Safety of mother and baby are of utmost concern to parents and birth
service providers. A recent study by the British Medical Journal
followed more than 5,400 low-risk women who had planned homebirths
attended by professional midwives. The study showed substantially
lower rates of interventions when compared to similar low-risk
hospital births.

One difference between hospital births and homebirths is that
midwives rely less on painkilling drugs, which can result in fewer
interventions and complications.

Birthing at home allows women freedom of movement, access to food and
drink and support of loved ones, as well as privacy. Messarra also
provides a large, deep tub of warm water she calls an "Aqua-dural" to
keep laboring mothers as comfortable as possible.

"The secret about childbirth is not that childbirth is painful, it's
that women are strong," Messarra said. "For women who have had
natural childbirth, the euphoria that they feel is so much greater
than the women who have had epidurals because their senses have not
been blocked."

Statistics show planned homebirths also result in far fewer Cesarean
sections, or surgical births. Texas Cesarean rates are at 30.2
percent of all births, according to the Department of State Health
Services. Griggs said that, nationwide, about one in three babies is
born by C- section.

While C-section birth is sometimes necessary, it carries the same
risks associated with any surgery or use of anesthesia. The National
Center for Health Statistics Web site supports the one-in-three ratio
and states, "some health care providers believe that many Cesareans
are medically unnecessary."

Messarra said she thinks midwife-assisted homebirth empowers women by
giving them more choices and allowing them to give birth in a
comfortable and supportive environment.

"It's so gratifying to see a family come together," Messarra
said. "This is really all about them."