Home births growing in popularity: why some women are choosing out-of-hospital delivery

Debbie LaPlaca

Home births are on the rise and some delivery room nurses are stepping out of the hospital and into midwifery to offer expectant mothers “concierge” care. 

Home birth has ancient roots in every culture.

Most families delivered their babies at home with midwives or family doctors until the early 1900s, when a major push moved birth into the hospital. 

New procedures, medications and technologies were appealing, and soon mothers were led to believe they were necessary. Birth was taken out of the hands of women and placed in the hands of predominantly male physicians, almost exclusively.

Today, less than 2 percent of U.S. babies are born outside the hospital. Yet the rate of home birth is rising according to federal data that says it went from less than 1 percent in 2004 to 1.5 percent in 2014. 

“They are taking back their birth, and some choose to take it home,” said midwife Rachel Blessington, a Certified Professional Midwife offering care in Central Massachusetts.

The 500 or so Massachusetts families who choose to deliver at home each year, she said, receive comprehensive care from qualified midwives throughout their pregnancy, birth and postpartum time. 

Most are Certified Professional Midwives by completing years of study, training, apprenticeship, and advanced training in midwifery at the graduate level to meet certification standards of the North American Registry of Midwives. Some are Certified Nurse Midwives by first training as a nurse. 

Blessington, of Dudley, is married with two children and holds a Bachelor of Science in nursing, and in biology. She was a hospital labor and delivery nurse for two years.

“I left to concentrate fully on midwifery training, as I prefer to work in an environment where I can provide care that is customized, respectful and evidence-based,” she said. “In the hospital, care is often dictated by policies, profit margin, liability and provider preference. I knew I would be free to provide better care outside of the hospital.”

Blessington is a member of the Massachusetts Midwives Alliance along with 27 of the about 35 Certified Professional Midwives in Massachusetts.

She has attended more than 300 births, with about half of those delivered outside a hospital.

One such home delivery was with Melissa Anne Dubois of Millbury, a labor and delivery nurse at Milford Regional Medical Center.

“A lot of people were surprised I was having a home birth because I work in a hospital,” Dubois said. “I don’t believe everybody is a candidate for home birth, but I think it should be a woman’s choice.”

Her 6-year-old son was delivered in a hospital with midwives attending and the experience, she said, was good. The delivery of her 3-year old son, however, went differently. 

“I went to a city hospital and it was the opposite of my first experience. There was a lot of unnecessary intervention and there were extra people in the room that didn’t need to be there,” she said.

Dubois chose the home-birth option for her daughter, who is now 3 months old.

“I have a lot of midwife friends, but I didn’t think I could do it at first,” she said. “Rachel is a former labor and delivery nurse. I felt like the stars aligned. We come from the same place, we have the same background.”  

The midwives, Dubois said, brought with them everything but an epidural and operating room. She had an unmedicated delivery after laboring for three hours in her brother’s pool. 

“The care was incredible. If I had a fourth (child), I would absolutely do it at home. It was the hardest thing I’ve ever done but it’s the best choice I’ve ever made,” she said.

Certified midwives, Blessington said, are experts in caring for low-risk pregnancies, and in identifying when clients need to be referred or transferred to a higher level of care. 

“We are trained professionals providing concierge service in your home,” she said. “It’s more customized care so each family decides their choices along the way.”

Her Worcester-based business Blessing Birth & Bodywork offers individualized maternity care for “birth your way, in your home, supported by a team of skilled midwives.”

“All types of families utilize midwives, but most don’t know it’s an option. Some think of homebirth as hippies giving birth in a tent in the woods,” Blessington said. 

Midwives Alliance of North America promotes a “Midwives Model of Care,” which includes: monitoring the physical, psychological and social well-being of the mother; providing the mother with individualized education, counseling and prenatal care; continuous hands-on assistance during labor and delivery; and postpartum support; minimizing technological interventions, and identifying and referring women who require obstetrical attention.

“Midwives are experts in low-to-moderate risk birth. That’s what we’re trained to manage,” Blessington said. 

Yet, the option comes with out-of-pocket costs that could range from $4,500 to $7,000.

“Most home birth is not covered by insurance yet, which is a shame because it would save insurance companies a whole a lot of money,” she said. “Even if an insurance company doesn’t pay for the birth itself, it’ll often cover some of the care.” 

Jessica Shephard of Worcester, whose daughter is now 1-year-old, said, “This is absolutely the way I would do a second child.”

Shephard self-funded the birth with no help from health insurance but plenty of help from three attending midwives, with Blessington at the lead.

“I gave birth in my bedroom on my bed after I was in and out of water for a few hours. I received a lot of emotional support from Rachel. She was constantly checking on me and I felt safe with her taking care of me and my daughter,” she said. “I’m not too big with hospitals because I like my privacy. Once I met Rachel and got to know her, it felt like the perfect choice for me.”

Massachusetts presently does not offer licensing for Certified Professional Midwifes, and Certified Nurse Midwifes are licensed under the state Board of Nursing. 

Two Massachusetts statehouse bills to change that (H1948 and S1332) titled, “an act relative to out-of-hospital birth access and safety” are presently in review by the joint committee on public health. 

If enacted, the legislation would form under the Department of Public Health an 8-member, governor-appointed board of registration in midwifery consisting of midwives and medical professionals. The board would create regulations and processes for licensure to practice midwifery.