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Columbus is no stranger to the home-birthing movement, which finds more women choosing to give birth in their comfortable and familiar surroundings. But what happens when a delivery gets complicated?
Erin Johnson and her 1-year-old son, August, play on the same be on which she gave birth.
Dan Trittschuh
The avocado-colored walls of Erin and Ben Johnson’s Clintonville bedroom provide a soothing backdrop for the couple’s queen-size bed. It rests on a fluffy white rug in front of a south-facing window bank. On a lazy summer afternoon, it appears the perfect spot for reading while sipping ice tea under the slowly circulating ceiling fan, or even drifting off for a nap before dinner.
But for Erin Johnson, it was the perfect place to have her baby.
Johnson was neither caught off guard by rapid labor nor trapped by a snowstorm. The birth of her son, August, went exactly as planned using the latest (controversial) trend to sweep the childbirth industry throughout the country and in Greater Columbus—a pre-arranged home birth.
A self-proclaimed homebody, Johnson never had been to a hospital and isn’t particularly fond of doctors—two reasons that led her to consider giving birth in her house. It was a decision her husband, Ben, deputy director of communications at the Ohio Department of Job and Family Services, fully supported.
“It seemed like the most natural choice in all the research I did,” she says. “I’m a personal trainer. My background is in science. The more I read about natural birth and how things happen, the more I realized unnecessary intervention in a hospital setting happens more than it needs to. But our bodies are capable of this. They have been doing it for thousands and thousands of years.”
Johnson admits she hedged her bet. She continued to visit an obstetrician simultaneous to her meetings with midwives at CHOICE—the Center for Humane Options in Childbirth Experiences, an organization in Worthington that assists with many of Central Ohio’s home births.
Whether to birth at home was a “game-time decision,” she says. “Using the midwives was my first choice. But I also knew if something went wrong . . . I could get to the hospital and call the doctor and say, ‘Hey, I’m here.’ ”
While most women pack a hospital bag around the 37th week of pregnancy that includes comfortable clothes, a toothbrush and family photos, the Johnsons instead prepared a birthing box they stored in the basement, which included super-absorbent Chux pads, sheets they didn’t mind throwing away and a bowl to catch the placenta.
Erin awoke at 3:30 am on July 22, 2010, with her first contractions, although they were manageable enough for her to handle a few personal training clients that morning at Move Your Mind in Upper Arlington. By 11 am, things were serious enough to head home.
Her water broke at 1 pm while she was lying on her bed, and she labored alone in the shower until Ben and the midwives arrived about a half hour later. They took one look at her, Ben recalls, and said, “It’s time to set up!”
“It wasn’t necessarily painful,” Erin says. “I think they just heard the rise and fall of my moans.”
By the time Ben had changed out of his work clothes and gathered the supplies, Erin was dried off and in full-blown labor.
August Dylan was born at 2:56 pm, weighing 10 pounds and measuring 21 inches.
Unlike conventional hospital births, where she would have labored on her back, Erin says she was positioned on her side to make a clearer route through the birth canal. She and Ben were left alone with their new baby for 45 minutes—the umbilical cord still attached and the placenta in a nearby bowl. (She, like many home birthers, wanted the cord to stop pulsing before it was cut.)
Her midwives packed their materials and, after cleaning the Johnsons’ house of all birthing evidence, were gone by 5:30 pm. Ben and Erin spent the evening having dinner with family.
“The most frustrating part is people think they need all this help, but they really don’t need it if they just let the doctors stay out of it,” Erin says.
Columbus is no newcomer to the home birth movement. CHOICE, the area’s leading home-birth advocacy and assistance program, has been helping women for more than three decades. Children born in their care often can be found sporting T-shirts that say, “I was born at home by CHOICE.”
Tucked west of High Street in a south Worthington wooded lot, the nonprofit group continues to see its business grow, having attended 148 births in 2010 compared with 56 in 2007—a 164 percent increase.
The local numbers reflect and, in fact, exceed the national trend. A study released in May by the Centers for Disease Control showed scheduled home births rose 20 percent across America between 2004 and 2008, accounting for 28,357 of the 4.2 million babies born—about 1 percent of all births.
CHOICE’s clients come primarily from Merion Village, Clintonville, Worthington and Olde Towne East, but the seven certified midwives will travel about an hour outside Columbus to help women have the home-birth experience they seek. After a free hour-long consultation, those choosing home birth face a two-hour evaluation/history and monthly visits until they turn to weekly the month prior to birth. The cost for consultations and births is $3,100 compared with between $4,000 and $6,000 for doctor visits and an uncomplicated hospital delivery. (Insurance, though, doesn’t pay for home births.) Although CHOICE works with clients for months, helping with prenatal care and monitoring mom and baby, it can’t provide any of the medical support that would bring some mothers greater peace of mind. They also know that as much as they advocate the experience for all, it may only be an option for some.
“It’s not my job to convince people to do a home birth,” says certified professional midwife Tanya Rable-Collins. “They need to come to it. If they are uncomfortable with all that a home birth means, then home birth is not the option for them.”
There is, of course, nothing new about home births. Women have been birthing babies in their most familiar surroundings since humans first walked the earth.
Medical advances in the 20th century shifted the birthing process to hospitals, where monitors, medications and procedures such as cesarean sections and episiotomies cut infant and mother deaths dramatically. They also brought what many women saw as much-needed comfort—first by way of a narcotic-induced twilight sleep and later an epidural pain medication that left moms numb from the waist down, but awake to welcome their babies to the world.
But the onset of such advances is where some 21st century women say childbirth has been pushed in the wrong direction. True comfort, they say, comes from avoiding doctor interference altogether. They prefer to labor and deliver in the peace of their own homes. The best company comes not from nurses and anesthesiologists, but from midwives and birthing helpers called doulas, trained to support, but not get in the way of, the most natural moment in a woman’s life—having a baby.
Doctors counter that medical advances are the reason so many moms and babies now survive the childbirth experience. Home births put babies and moms in unnecessary danger; delivering outside the hospital environment—without trained medical personnel and the latest equipment on hand—increases significantly the likelihood that mom, baby or both will die if a birth faces complications.
That ongoing debate over the right way to have a baby ripples between both camps with the intensity of a labor contraction. “How we birth is such a personal decision,” says Danielle Chappelear, who, when not teaching childbirth education in Columbus, is a birth doula and trainer with DONA International, a doula training and certifying organization. “Somehow, there is a lot of judgment about how we have opted to give birth. A mom who opted to have an epidural with all the trimmings is someone an advocate of home birth may pass judgment on, saying that wasn’t best for her baby. Home birthers are perceived as only caring about their birth experience, and not about their baby’s health and well-being. It is polarizing, because even how we birth is a reflection on how we parent. And no one wants to be criticized about how they parent.”
Jane O’Shaughnessy and her husband, Bob (nephew of Franklin County Clerk of Courts Maryellen O’Shaughnessy) have four children, ages 6 to 13. Three of them, including one who weighed a whopping 11 pounds, were born in the O’Shaughnessys’ bed, but another one arrived early in the morning on the living room floor. “I didn’t want to wake the other kids,” Jane says with a grin.
“We’ve worked hard to make childbirth so scary,” she says. “Childbirth is a normal thing that just happens and is no big deal, is not interesting and Americans have no patience for things that are not interesting and dramatic. We can’t slow down for anything. That’s what this is all about—let’s slow down and have our baby the way our bodies want to have our babies, not the way a doctor wants.”
O’Shaughnessy says she knows the stereotype that comes with a mother who chooses home birth: religious, home schooler, maybe a political radical who buys a lot of granola. As a minivan-driving CPA soccer mom whose kids go to Catholic school, she wants women to know that home birthing is for anyone who wants to take charge of their birth experience.
“The true home birth stereotype is a better educated woman who wants more control,” she says. “For a long time, the baby birthing process was men telling you what to do. My mother-in-law gave me a book her doctor gave her when she was expecting my husband that says . . . ‘When you go into labor, it’s time for you to lay back and let the doctor do his job.’ This is where this movement came from—the idea that you needed to be a nice little woman, shut up, take your medicine and let us get your baby out.”
“Now we know you have to take responsibility for your health and for your children,” she adds, “and you make decisions for you and your children that begin with the moment they are born. You can’t just lie back and let the doctor do his or her job.”
Medical professionals agree that may be a great idea in theory, but they remind mothers that not all births are equal. And there are plenty of babies being pushed in strollers and playing in the park that would not be here without a doctor doing his or her job.
“Women hemorrhage or babies decide not to breathe and precious minutes are lost getting to hospital,” says Dr. Elaine Paul, founder of the Riverside Hospital-based practice Women Physicians in OB/GYN. “I personally would not sacrifice my child’s well-being and my health for the experience of having a home birth.”
Paul’s views were supported in a study by Dr. Joseph Wax and others published in the September 2010 issue of the American Journal of Obstetrics & Gynecology, which showed that less medical intervention during planned home birth is associated with “a tripling of the neonatal mortality rate,” meaning three times as many babies die during the childbirth process.
Paul, who has delivered more than 5,000 babies, says she has personally seen two fetal deaths that resulted from home births—one a breach that got stuck and one that suffered an umbilical cord prolapse, where the cord precedes the baby out of the mother’s body and cuts off the blood supply. At a hospital, she says, such incidents are most often remediable. At home, often not.
“Home birth advocates say unnecessary medical intervention causes problems,” Paul says. “It’s a natural process. But the reason that women do so well today, and we don’t see people dying in childbirth, is because they are at the hospital. We can immediately intervene. Although I would say the vast majority of people deliver fine, and we are glad when that happens, we can’t predict who will and who won’t have devastating complications. Women who are low risk can turn high risk in a second.”
And that quick switch means moms and babies are taking trips to the hospital at the most precarious moments, says Dr. Mark Landon, chairman of the department of Obstetrics and Gynecology at the Ohio State University Medical Center.
Landon cites studies that show 9 percent of women who have previously given birth and 37 percent of first-time women in labor intending home birth end up transferring to a hospital—and, in some cases, that results in an emergency delivery.
“I would respect a woman’s right to choose the place she is most comfortable with for childbirth,” he says. “I would only hope that women are well informed and understand that home birth does carry with it some increased risk, which can have serious potential consequence.”
Another study Landon points to shows that one in 679 home births is associated with a neonatal mortality, as compared with one in 2,286 hospital births. He acknowledges that considering the limited number of home births, deaths are rare, and that means home birth can be viewed as being relatively safe. It simply is not as safe as hospital births, he adds.
“The problem is many people refuse to accept that home birth is associated with an increased risk and reject the available empirical evidence,” he says, “because it doesn’t suit their individual opinion of the birthing experience. I don’t have a problem with well-informed women deciding to have a home birth as long as they understand the risk.”
Rebecca Tien and Brooke Sackenheim understand those risks first-hand.
Tien and her husband, Joe, both researchers at Ohio State University, thought home birth would be the best way to welcome their new baby in July 2010, and they worked with CHOICE midwives throughout her pregnancy to have a water birth in a tub in their tranquil finished basement.
Although her labor began smoothly at 11:30 pm, it did not progress. After 29 hours, Tien felt too exhausted to continue, and her baby seemed in no hurry to come out. “I got scared when labor slowed to a point I had no energy to push,” she says. “I had visions of him suffocating. I had reached my comfort level for what I was willing to risk or not risk.”
Deep enough into her labor to feel her baby’s head, Tien got dressed and she and Joe rushed to the OSU Medical Center at 5:30 am. Taryn, 7 pounds and 1 ounce, was born about two hours later.
She admits some reservations about home birth likely compelled her to go to the hospital sooner than some other mothers-to-be might. “I was never fanatical about home birth,” Tien says. “I was always open about transferring to the hospital if that was what was best for the baby.”
Sackenheim, whose mother is a doula, was a staunch advocate of birthing her daughter, Amelia, at home in 2006. “I was never a proponent of hospitals,” she says. “The ideology in hospitals is they are for sick people and babies aren’t sick.”
Her pregnancy was effortless, but Sackenheim, who lives on the east side of Columbus and works at Yoga On High, started to feel intense back pain. The next morning, she began to notice the first signs of labor and figured her pain was part of the baby’s pending arrival.
She and her husband, Kenny Jones, prepared their home, inviting over Brooke’s mother and another friend and getting the ingredients ready for the celebratory dinner they would soon share.
After six hours of labor, however, the baby’s arrival was no closer. When Sackenheim’s water broke at midnight, the call went out to the midwives, but things went from slow to worse.
The baby was breach. Plans immediately changed.
“The midwives told me, ‘Your baby is bottom down, and we should go to the hospital,’ ” she says. “I thought they were lying. I said, ‘I don’t want to go to the hospital.’ My husband finally said, ‘Baby, we have to go the hospital. You have to listen to me. It’s going to be fine.’ I was naked and I had to get clothes on. I was very freaked out, and I really didn’t want to go to a hospital. All I wanted to do was curl up in a corner and have my baby.”
Rushed to Grant Medical Center, Sackenheim was first given a shot to curtail her contractions and then an epidural, before being wheeled into surgery. Baby Amelia, weighing just more than 6 pounds, was pulled out with the umbilical cord wrapped around her neck. Midwives later deduced that Sackenheim’s back pain came from Amelia flipping upside down, and she got caught in the cord at the same time.
Although her birth experience was not what she had imagined, Sackenheim says it reinforced her belief that sometimes plans are meant to change—and that is not a negative reflection on home birth.
“We knew this was an option,” she says. “And you have to make yourself available to all options. The midwives were very forward about what could happen. And when it was time to go to the hospital, they said, ‘We are going to the hospital.’ ”
“If I had to do it differently, I’d be less excited and less in control of my birth experience and let it happen. You feel like you are prepared, but you are never really prepared. Sometimes you just have to let yourself go and see where the birth takes you.”
Nicole Kraft is a freelance writer.
