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By MAUREEN TURNER Special to Valley Kids
[ Originally published on: Thursday, November 29, 2007 ]

Tanya Rapinchuk attended her first birth when she was a preschooler in the mid '70s. She had tagged along with her mother, who went to take photos of a close friend who was giving birth at her home in Springfield. Rapinchuk's mother had wanted to have Tanya at home, but couldn't find a midwife to attend the birth. But some of her friends had their babies at home, and Rapinchuk witnessed several of the births. "That really imprinted on me: that's where people had their babies, at home," recalls Rapinchuk, a local home-birth midwife whose practice is called Sacred Birth Midwifery. "I never really thought people would have their babies anywhere else."

In one way, Rapinchuk's mother's friends were rebels, bucking the cultural norms that said the safe, "normal" place to have a baby was in a hospital, attended by a doctor and surrounded by high-tech equipment. While home births saw a small boost in popularity in the 1970s — thanks to the feminist movement and the trend toward natural births — it was still only a tiny percentage of women who chose this option, and they were largely considered to be on the radical fringe.

In truth, of course, they were choosing the most traditional of paths. For as long as babies have been born, they've been born at home, their mothers assisted by family, neighbors, local midwives. In the U.S., that was the case until the early 20th century, when the medical field of obstetrics arose, and newly minted — virtually all male — doctors began competing with lay midwives, pitching themselves as better trained and more sanitary. Within a couple of generations, hospitals became the location of choice for births. By 1938, only half of U.S. births took place at home; by 1945, that figure dropped to 20 percent. By 1955, the home-birth rate had dropped to one percent, where it remains today.

"Somehow midwifery became 'alternative,' and hospitals became the norm," Rapinchuk says.

Rebekah Brooks of Holyoke opted for the alternative. Home births were nothing new to Brooks; her mother's best friend was a home-birth midwife. Still, when Brooks became pregnant last year with her daughter, Hazelle, she found herself uncertain what to do. Of the women she knew, she says, "Everybody was having their babies in the hospital. It made me think about it a bit."

Brooks and her husband began researching different birth options, and they were impressed by the statistics for home births. Multiple studies show that, for low-risk pregnancies, home births are as safe or safer than hospital births for both the mother and baby, with dramatically lower incidents of interventions such as c-sections and forceps use. Experts maintain that births are easier and faster if the mother feels relaxed and comfortable, like in her own home.

Avoiding the hospital, Brooks says, meant avoiding the "fear culture" that treats pregnancy as an illness and turns birth into a heavy medicalized experience, rather than something the human body is made to handle. "There's nothing wrong with you when you're pregnant, and people act like there is," she says. "You don't go to hospitals for any other positive experience."

Through her pregnancy, Brooks did see an obstetrics practice, which would serve as backup if problems arose during the birth. But the confidence and trust she felt in her midwives helped her look past worries of what could go wrong. "It was making a decision based on faith and not out of fear," she says. "This is a decision about positivity and not negativity. Do I want to think about everything going right or everything going wrong?"

Sarah Rossmassler says fear kept her from following through on her interest in home birth with her first two kids. But when her son Branch was born two years ago, she was ready to try. "We'd sort of been on this path of trying to question things — trying to question what's right, what's necessary. Were we buying into the idea that childbirth is something to fear, that you have to prevent everything from going terribly wrong?"

Rossmassler, a nurse, knows firsthand the "horror stories" that can take place in hospitals: birthing women being attended by an on-call doctor they've never met before, the tensions that arise if the doctor and nurses on duty don't get along. "I worked in hospitals," she says. "I know it can be stressful. If you do enough volume of anything, you get numb to it."

Home births are based on a close, trusting relationship between mom and midwife. Midwives take fewer clients than doctors — Sacred Birth, for instances, works with about three dozen women a year — and spend considerable time with each one, before and after the birth. Prenatal visits are as much about building relationships as monitoring blood pressure. "You feel they know you. You're not just another person pushing out a baby," Rossmassler says. "It wasn't just 'Check the box: Did I have protein in my urine or not?"'

Massachusetts does not offer a license for home-birth midwives. (Midwives who work in hospitals need to be certified nurse-midwives.) That doesn't mean midwives don't undergo significant training, though; Rapinchuk, for instance, apprenticed with midwives in Canada, completed the Massachusetts Midwives Alliance Midwifery Program, where she also student-taught, then did clinical work in Texas before opening Sacred Birth Midwifery. She also holds a midwifery license and certification in Vermont, where it's required.

Home-birth midwives are not able to buy malpractice insurance in Massachusetts. And private insurance companies tend to cover little, if any, of the costs. (In Vermont, Medicaid will cover a home birth.) Rossmassler knew that some persistent families have managed to persuade their insurance companies to pay at least part of the cost, but she had no interest in trying, she says. Sacred Birth offers a sliding scale, from about $2,400 to $3,500; Rossmassler says she paid near the top of the scale. "I was willing to pay that because the experience was so positive," she says. "The idea of sitting on hold to try to beg [my insurance company] to cover it just didn't appeal to me."

Home births aren't for everyone, Rapinchuk says. Clients come to her for all kinds of reasons: They're looking for a more personal birth experience; they want to avoid medical interventions and know that's more likely in a home birth; they know other moms who've had positive home-birth experiences. "Certainly, a lot of stories have come into our office of women who've had [previous] births that weren't what they were looking for and were left sad by their experiences," she says.

Before she takes on a client, Rapinchuk says, she tries to really understand that woman's motivation. "Are you looking for a home birth because you're hoping to really experience the sensations, or because you're terrified of hospitals?" she says. Her practice might decline to take on a client who's motivated by fear alone. "There's got to be more motivation. It's real work," she says.

For Victoria Munroe, the motivation to have her son Max at home two years ago was clear. She'd attended the home births of six friends, she says, "so when it came to be my time, it was a given for me. ... It was the comfort of being in your own space, having your own loved ones around to be the ones caring for you. Comfort was the biggest thing — my pillow, my bed, my things. No one else that I didn't really know [being] in charge."

Munroe gave birth on the four-season porch of her house, in a tub, with her husband, Doug Weihrauch, in the water holding her. Her family waited down the street, ready to meet Max moments after his birth. "It was magical," Munroe says simply.

And, she believes, it never would have happened that way in a hospital. Doctors, she suspects, would have pushed her to a c-section when her labor dragged out over several days. With her midwives, she didn't have that worry. "It was very frustrating and long, but I felt like I was doing everything I was supposed to," she says. "I wasn't scared."

Munroe would advise other pregnant women to research all their options and make the best decision for themselves. Home births are not for everyone, she notes; a woman who's fearful because of earlier problems, for instance, might do better in a hospital. "I think every woman should have a choice about where they birth, and they should do it in a place where they feel most comfortable," Munroe says.

Maureen Turner is a Valley-based journalist who lives with her family in Florence. She has a master's degree in journalism from UNC-Chapel Hill.

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