It was quite early in the morning on March 27, 1953 when Alva Cohen arrived at Columbia Women’s Hospital in Washington, D.C. quite late into her labor. So late, in fact, that she started to give birth in the hospital elevator. Even though her labor was going along normally—and quickly—approximately ten minutes before her child was born, she was administered Sodium Pentathol—a drug that has also been used as a truth serum and, in large doses, for lethal injection—as a matter of hospital procedure. When she woke, she had a healthy daughter, Janet. But she had missed the moment of her birth.
Alva would give birth to three children, all in the hospital, and participate in none of their births; Janet would give birth to two, both naturally at home with midwife assistance, and participate in both. “I felt very comfortable with both my midwives,” Janet said recently, recounting the births. “But I definitely had a better idea of what to expect from the whole experience the second time.”
Janet represents a very small minority of women who have chosen home birthing in the United States in recent years. A 2008 New York Times article, “Baby, You’re Home,” reports that “home births have been around as long as humans, but since the 1950s, the overwhelming majority of American women have chosen to give birth in hospitals.” While births in New York hospitals still outnumber home births, local midwives have recently seen their workload has increase. One reason for the change can be attributed to The Business of Being Born, a 2008 documentary produced by former talk show host Ricki Lake, which has become an underground hit among expectant parents.
The Business of Being Born presents some surprising statistics: In 1900, 95 percent of births in the United States took place at home. Then—partially due to a smear campaign against midwives portraying them as unprofessional and uneducated vestiges of the old country—by 1938, only half of all births took place at home. By 1955, less than one percent took place at home; it remains this number today. The Business of Being Born also says that midwives attend over 70 percent of births in Europe and Japan; in the U.S. just under eight percent. Still, the United States has the second worst newborn death rate in the developed world and also one of the highest maternal mortality rates among industrialized countries. Patricia Burkhardt, Clinical Associate Professor at the NYU Midwifery Program, who was interviewed in the documentary, pointed out that “hospitals are businesses; they want those beds filled and emptied,” and Dr. Jacques Moritz, an Ob/Gyn at St. Luke’s-Roosevelt hospital, added, “Midwives do a better job at the normal deliveries than we do. For normal low-risk women, it’s overkill going to a doctor.”
But those New Yorkers who were planning to have a home birth may very well need to change their plans. The recent closing of St. Vincent’s Hospital on April 30 could severely affect the home-birthing trend in the New York Area, as 22 midwives, seven of whom practiced home-birthing, are left without a corresponding hospital. According to New York State law, midwives who practice home births must partner with a doctor or hospital, and St. Vincent’s was the only hospital in the city that supported home birthing.
There are still a few options for natural birth in a hospital setting, such as St. Luke’s Roosevelt Hospital’s Birthing Center, which opened in 1996 and was Manhattan’s first in-hospital birthing center. Birthing centers in hospitals offer some of the freedom and comfort of a home birth with very close proximity to hospital technology and maternal-fetal medicine specialists in case of difficulty during delivery. St. Luke’s-Roosevelt’s Birthing Center, however, does not take Medicaid. On November 6, 2009, the New York Times article “Bellevue Natural-Birth Center, Haven for Poor Women, Closes” points out that Bellevue’s Birth Center, which was considered a landmark achievement for the natural-birth movement in New York City when it opened in 1998, was the only one of its kind that accommodated both affluent trend-conscious New Yorkers and poor women on Medicaid who wanted the option of natural birth. WNYC’s Brian Lehrer pointed out, on “Birthing Options,” on December 10, 2009, that with the close of Bellevue Birth Center, the range of choices in childbirth in New York City directly relates to economic standing. With the closure of St. Vincent’s, the birthing options for low-income women are narrowing significantly.
And still, despite growing strictures, the interest in home birthing continues to grow, especially here in Park Slope. The New York Times notes that home birth is becoming a more popular choice among professionals like lawyers and bankers, and that home birth is no longer just for back-to-nature types. (As a resident of the area, I’m guessing that, in our case, it’s back-to-nature types who also happen to be trend-conscious lawyers). “We believe that women should give birth wherever they will be safest and most comfortable,” said Jada Shapiro, co-founder the Bellevue Birth Center Volunteer Doula Program and co-founder of Birth Day Presence, a service located in Park Slope that provides birth and postpartum doulas, as well as classes in childbirth preparation, breastfeeding, newborn care and infant CPR. “Park Slope residents tend to be highly informed and educated consumers,” Shapiro said. “There are also many women here who would prefer as few interventions during birth as possible. Hospitals are geared toward medication and intervention.” Shapiro adds, “Home is definitely not for everyone, but for low-risk women it may be the best option.”
Diana Kane English, of Park Slope, said home birth was one of the best choices she ever made. “I was so blown away by how spectacular it was that I was really sad for people who didn’t know they had this choice.” Diana was attended by midwife Miriam Schwartzchild, “We don’t clutch crystals, keep our fingers crossed and pray to the goddesses,” Schwartzchild said. “We have medical training; we have to pass a national exam to be a certified midwives. Home births are as safe, if not safer, than hospital births.”
“A woman really doesn’t need to be rescued,” Cara Muhlhahn, Certified Nurse Midwife, says, in The Business of Being Born. “It’s not the place for a knight in shining armor.” Midwives and doulas stress the idea that a woman needs to be an active participant in the birthing process, rather than on her back with her legs in stirrups, a position that shrinks the pelvis and makes it easy for sometimes unnecessary intervention, such as the use of forceps, which can cause damage to the baby and to the mother. This position also makes it more difficult for the woman to use her stomach muscles to push.
“I remember I was in my room, walking around a lot,” Janet Schweig told me over the phone the other day, recounting with sharp lucidity what she had described before as the “amazing” and “surreal” experience she’d undergone without painkillers (and without health insurance) just over twenty-five years ago.
Then she paused and added, “I also just wanted to have it over with.”