Author: Betsy Denson
When Garden Oaks’ Monique Bennett was pregnant with her first child she considered the option of a homebirth but was somewhat wary.
“I only knew one family who had done it,” she said. “Society says you go to the hospital to have a baby.”
After an unplanned hospital C-section, however, she changed her thinking. During her second pregnancy, she sought out a midwife practice that would accommodate her wishes to have a vaginal birth after caesarean, or a VBAC. She found a good fit with Katy Birth Center and had her next two children at home.
Today, Bennett is a trained doula who works with a pregnant woman before and during childbirth. Through her company, Joie de Vivre Birth Services, she also teaches the Bradley Method, or husband coached natural childbirth, to couples.
Bennett likes to quote the legendary midwife Ina May Gaskin – “Your body is not a lemon.”
According to a 2012 CDC/National Center for Health Statistics study, U.S. homebirths increased by 29% from 2004-2009, from .56% in 2004 to .72% in 2009. They can cost less too. According to the American Pregnancy Association, “an average, uncomplicated vaginal birth costs about 60 percent less in a home than in a hospital.”
The CDC study noted that about one-half of homebirths were third- or higher-order births, compared with 28% of hospital births. Oak Forest’s Kamie Thornton fits that profile.
“I was not satisfied with my previous two hospital birth experiences,” said Thornton. “I wasn’t sure if I was going to have a homebirth or a birth center birth.”
She ultimately chose homebirth. “Having a baby naturally and in the comfort of my own home was an amazing experience and one that I feel so blessed to have had,” Thornton said.
Angela Pennington is another Oak Forest mother whose first homebirth was for her fourth child. Like Bennett, she had a previous C-section and was looking for someone to do a VBAC but “no doctors would even hear me out.”
Pennington said that “gathering supplies was not hard, it was making sure my husband and I were mentally prepared to do this.”
Others opted for a homebirth from the start. “We were fortunate to have several friends who had healthy, happy homebirths,” said Oak Forest’s Rachel Petty. “After much research, we felt like it was the best option for our baby as well.” And Angela Richard in Candlelight Woods had all three of her children at home.
“I had no reason to be in a hospital and I was not particularly interested in a birth center,” Richard said. “Each labor and birth was individual, but all experiences were unified by calm and lack of the feeling of medical emergency.”
What exactly is a midwife?
There are four different types of midwives: a Certified Nurse-Midwife (CNM) is a registered nurse with graduate education in midwifery; a Certified Midwife (CM) has a bachelor’s degree in a non-nursing field and has obtained a graduate-level midwifery education accredited by the Accreditation Commission for Midwifery Education. CNMs and CMs can both prescribe medications.
A Certified Professional Midwife (CPM) takes an exam administered by the North American Registry of Midwives. Lay midwives who are not certified by a national organization may not have a formal education or passed an exam. Neither can prescribe medications.
Kellie Moeller is a Certified Nurse-Midwife who graduated in 1989 from the Baylor College of Medicine’s Certificate Midwifery Program and previously worked with famed Texas midwife Pat Jones. She was the midwife for Angela Pennington among hundreds of others.
Moeller’s pre-natal care follows the same schedule and includes everything a mother would get in a doctor’s office – included a recommended ultrasound – except she takes a lot more time with her patients.
“I spend 45 minutes to an hour,” she said. “Nutrition is a huge emphasis because it’s important for keeping a pregnancy low risk. The time allows people to really talk. We develop a relationship.”
Kamie Thornton agrees. “With a midwife, I received nutritional, spiritual, and physical support. It wasn’t just about how baby was doing, but how I was doing as well.”
For the most part, midwife homebirths are natural ones, meaning the mother does not take any pain medications, but may utilize a birth pool, or massage techniques, to alleviate pain. After a baby is born, the midwife does an evaluation and the APGAR test. She also monitors the mother’s health.
Midwives work with patients who are considered low risk. Mothers with additional risk factors like diabetes or chronic illness will be referred to a hospital, although Moeller tries whenever possible to co-manage a homebirth with other medical professionals.
She says her transport rate – meaning if the mother needs to be transferred to a hospital, or the baby needs to be transferred after for additional care – is a little over 10%, with no transports over the past year.
It is those questions of safety that sometimes give couples, and their loved ones, pause.
“My family was concerned about our birth plan, but that is largely due to a lack of understanding of the process,” said Rachel Petty. “I had them come over for a movie night where we screened ‘The Business of Being Born’.”
Professional recommendations depend on the professional. The American College of Obstetricians and Gynecologists says that while they “[support] women’s right to choose the type of birth experience they want…hospitals and birthing centers are the safest setting for births.”
The CDC study says that more homebirth babies go to term and that their birth weight is higher, but the authors acknowledge that the low-risk criteria for homebirth moms could be a factor.
The training and education of the midwife also plays a big role in a safe birth according to other studies.
Moeller brings an IV, oxygen, and the same medications mothers would have access to in the hospital. She also points out that there are risks with hospital births as well.
“When you begin to learn the statistics of how many unnecessary interventions are performed in hospitals, and how those can affect your baby, we found it to be just as safe at home, if not safer,” said Angela Pennington.
Splitting the Difference
There are other couples who want a natural midwife-assisted birth but don’t want to do it at home for a variety of reasons. Shawna Honeycutt in Ella Lee Forest had her last two children with a midwife – and no doctor – in a hospital.
“[My husband] felt more comfortable knowing that if there was any kind of complication we would already be in a hospital,” she said.
Candlelight Plaza’s Heidi Skiff switched from an OBGYN to Nativiti Birth Center in The Woodlands at 36 weeks.
“I was having a lot of issues with the hospital and felt less and less comfortable,” she said. “[To] be at a birth center was more reassuring to me.”
Skiff’s first birth went so well, she planned to have her second there too. She was in route but the baby had other plans. “My son was born in the parking lot of Greenspoint Mall during a carnival,” Skiff said. “We were all in total shock. It was all over before it started.”
Skiff’s own mother caught the baby in the car and while Skiff says the setting was not ideal, she describes it as an empowering experience.
One that is echoed by Oak Forest’s Sarah Dulin, whose second son couldn’t wait for the trip to the birthing center. He was born with just mom and dad in attendance.
“If no one was in control, then I was in control. It was euphoric,” Dulin said. “I wouldn’t even say I was in pain because it had a purpose.”
Dulin is now getting her nursing pre-requisites to become a Certified Nurse Midwife like Moeller.
“I love the relationship with pregnant women – it gives me a buzz,” she said. “I decided I wanted the catch.”