American Women: Birthing Babies at Home

The push to increase American women's access to home birth reignites the debate over how safe it is

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Liz Rubincam / Reportage by Getty Images

When Hillary McLaughlin found out she was pregnant, she was unable to legally obtain the service she needed. So she looked for an underground contact. She got a woman's name — just a first name — and a phone number from a friend who advised her to destroy the evidence as soon as she made the call. When McLaughlin reached the woman, however, the woman told her she no longer "did that" and that she wasn't willing to risk going to jail for it anymore. Turned off by all the "whisper, whisper, cloak-and-dagger stuff," McLaughlin decided to "jump state lines" from Illinois to Missouri to find a legal provider.

Forty years ago, you might have assumed McLaughlin was looking for an unlawful abortion. Rather, what the small-business owner, 33, sought was a certified midwife who could deliver her baby at home in Edwardsville, Ill. "It's completely ridiculous that I had to do all this because midwives aren't licensed to practice here," says McLaughlin, who delivered her son in April at her parents' home in St. Louis. "I wanted a home birth, but I wanted to do it legally, because I wanted some assurance that the midwife I chose knew what she was doing."

Each year, some 25,000 American women like McLaughlin opt to deliver their babies at home. Although that accounts for fewer than 1% of all births in the U.S., the figure is probably on the rise. From 2004 to 2006, the most recent year for which estimates are available, home birthing in the U.S. increased 5% after having gradually declined since 1990, according the Centers for Disease Control and Prevention. While the recent uptick is not conclusive proof of a trend, home-birth advocates say anecdotal evidence and informal surveys from the field also point to growing demand.

Why? Largely because women wish to avoid what they deem overmedicalized childbirth. Compared with hospital deliveries, 32% of which end in cesarean section, those taking place at home involve far fewer medical interventions and complications. Some women, like McLaughlin, who have had cesareans in the past, elect to have a home birth because they want to attempt vaginal delivery — what is known as vaginal birth after cesarean, or VBAC, a procedure that most obstetricians and hospitals have banned to avoid liability lawsuits.

But midwife-assisted home births are not always easily or legally arranged. Today, just 27 states license or regulate so-called direct-entry midwives — or certified professional midwives (CPMs) — whose level of training has met national standards for attending planned home births. In the 23 states that lack licensing laws, midwife-attended births are illegal, and midwives may be arrested and prosecuted on charges of practicing medicine or nursing without a license. (Unlike CPMs, certified nurse midwives, or CNMs, who are trained nurses, may legally assist home births in any state. But in practice, they rarely do, since most of them work in hospitals.)

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