Number of home births on rise across nation and in Iowa

At 40 weeks and six days pregnant, Anna Rode felt her belly tighten. It was New Year's Eve, and the North Liberty mother knew this was probably it.

She didn't have a bag packed, though, and she didn't have a route to the hospital mapped out. She didn't wake her toddler. Her husband didn't start the car. She went about her evening, and the midwife arrived about 11 p.m.

Rode is among a growing group of women choosing to have their babies at home. A Centers for Disease Control and Prevention study found U.S. home births have increased by 29 percent from 2004 to 2009.

The number of home births in Iowa also has increased slightly in recent years to more than 500 in 2010, said Megan Day, consumer advocate for Friends of Iowa Midwives.

“Being at home was very comforting,” Rode said. “We didn't have to go anywhere or get ready.”

Rode climbed into the birthing tub about 12:30 a.m. and pushed for only 14 minutes.

“I was able to catch him myself and lift him out of the water,” Rode said. “What I liked about the midwives was they were intuitive. They got to know me. They could tell when I needed them to step in and help, and when I didn't.”

Because state law requires midwives helping in home births to have a nursing education, many of Iowa's home births are being aided by illegal practitioners, Day said.

Iowa has only a handful of certified nurse midwives doing home births, she said, and any Iowa midwives falling outside that category - including those classified as certified professional midwives - are breaking the law and could face a felony charge of practicing medicine without a license.

“So they do so quietly, underground,” she said. “These midwives know they are not legal, so they don't advertise. And every year, we are losing more and more midwives to other legal states.”

The parents would not face charges in Iowa. In states like Nebraska, it is illegal for all medical professionals to attend home births regardless of their training.

Certified professional midwives can legally assist in home births in 27 states, and Day said legislation has been proposed to add Iowa to that list.

Bills sponsored by Rep. Mary Mascher, D-Iowa City, are sitting in committees in the Iowa Senate and the House.

The bills have been opposed, though, by some in the medical community, including the Iowa Medical Association and the Iowa Hospital Association, on safety grounds.

Many medical professionals believe a person should be trained as a nurse before helping deliver a baby, but Day argued that midwives aren't practicing medicine and only deal with low-risk clients. They are the first ones to refer a woman to a hospital if there are risks, Day said.

“And research shows that home birth is equally as safe, if not safer, than a hospital birth,” she said.

That's not what doctors see, said Lynne Himmelreich, a certified nurse midwife at University of Iowa Hospitals and Clinics who does not do home births.

“The doctors don't see the home birth successes,” she said. “They see the things that didn't go well and weren't managed well.”

Himmelreich said women should have the right to choose where to have their babies, and she supports home birth if it's assisted by a trained nurse midwife. She adamantly opposes lowering those standards, saying Iowa can do better.

“In this country, is there any other field where you can receive care from someone who doesn't meet medical standards?” she said.

Part of the reason more nurse midwives aren't facilitating home births in Iowa, Himmelreich said, is because it's difficult to get insurance and “You have to have a big home-birth practice to make what a hospital nurse midwife makes.”

Katie Sullenbrand is a nurse midwife who recently launched a Cedar Rapids-based practice for home births. Since her Eastern Iowa Midwifery hit the scene in the fall, Sullenbrand said, pregnant clients have been lining up.

“I have people booked out through September,” she said.

Sullenbrand said several factors are driving the growing interest in home birth. More women view it as a natural occurrence, not a medical procedure. Because more pregnancies are occurring later in life, some women want to avoid the extra interventions doctors take for women older than 35.

“You have women who have had a career or have been through a lot of education and are used to having choices,” she said.

Most midwives do prenatal exams to make sure the baby is growing well, Sullenbrand said.

“There's this impression that we dance naked by the light of the moon,” she said, “but we do labs and tests.”

Alicia Carr, 22, of Palo, gave birth to her daughter in September at home.

Carr hired a legal midwife but wasn't overly concerned about her credentials because the goal of a home birth is to let Mom do the work. Midwives are just there for support, Carr said.

“I technically delivered my own child,” she said. “I pulled her out of the water. I did it. You don't need to be a nurse to oversee that.”

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