Home Births on the Rise for New York Families

Home Births on the Rise for New York Families

By GABRIELLE BIRKNER

As her labor progressed, Jaime St. Peter went to her roof deck for some fresh air. In between contractions, her midwife fed her yogurt as cars whizzed past on the nearby Brooklyn-Queens Expressway. During contractions, Ms. St. Peter would clutch the deck's railing because, she said, "it felt very good to squat and hang."

After 38 hours of active labor—spent outside, in a kiddie pool set up in the dining room, and walking the stairs of her Brooklyn Heights duplex—Ms. St. Peter, her husband by her side, gave birth on the bed to a 7-pound-6-ounce son.

"It's one of the things I'm proudest of in my life," Ms. St. Peter, a 34-year-old attorney, said of giving birth without pain medication to her now 2-year-old son. "I wish women wouldn't shy away from the difficulties of giving birth because I do feel like it's important for preparing yourself to mother: the fear, the pain, the work of it."

Ms. St. Peter is among a growing number of New York residents choosing to give birth at home. Home birthrates nationally, while still less than 1% of total deliveries, have climbed quickly—rising 50% between 2004 and 2011, according to U.S. Centers for Disease Control and Prevention data provided to The Wall Street Journal. And the increase has been even more dramatic in New York state, where home births have grown 71% since 2004. Statewide, there were 2,130 home births in 2011.

But a home birth in New York City—where neighbors live cheek-by-jowl, often in small walk-up apartments—poses unique challenges not faced in, say, rural Tennessee, where home-birth maven Ina May Gaskin started her practice. Will neighbors hear screaming through labor pains? Will creaky floorboards give way under the weight of the birthing pool? How does a laboring mother get down four flights of stairs, in case of a hospital transfer?

The city does, though, offer advantages. New Yorkers are likely to live close to at least one medical center, should a transfer become necessary. And New York state law requires state-regulated insurance providers to pay some expenses associated with a home birth, regardless of whether the midwife is in their network.

Marian F. MacDorman, a statistician who studies birth trends, said that more families are choosing home birth to avoid what they perceive as unnecessary hospital interventions. "Another theme that comes out is wanting control over the birth process, and to share the experience with friends and family—not having five [medical] residents looking at their bottom," said Ms. MacDorman, who works for the CDC's National Center for Health Statistics.

 

As much as some home-birth advocates reject common interventions at American hospitals, opponents of the practice assert—in no uncertain terms—that home birth is dangerous. They cite a 2010 study linking planned home births to a neonatal death rate up to three times that of babies born in hospitals. One of home birth's fiercest critics is Amy Tuteur, a Boston-based OB-GYN who runs the Skeptical OB website. She said the trend is a particularly risky aspect of the culture of "mommy one-upsmanship" that fetishizes everything natural. (Ms. MacDorman said that planned home births might be somewhat riskier than hospital births, but that "the absolute risks of home birth are very low, no matter how you slice it.")

The debate about safety aside, the demand for out-of-hospital births is going up. Yet here in New York, the number of supportive facilities—free-standing birthing centers and hospitals that grant privileges to homebirth midwives—is dwindling due to high malpractice premiums caused by perceived risks of out-of-hospital births, experts say. Birthing centers provide a home-like environment for laboring mothers, and eschew interventions such as epidural pain medication. New York City, home to a handful of birthing centers about a decade ago, is down to just one: the Brooklyn Birthing Center in Midwood. There is also one in-hospital birthing center, at St. Luke's Roosevelt on Manhattan's West Side.

Proponents of home birth also lament the 2010 closing of St. Vincent's Hospital in Manhattan, which long provided a backup option for home birth midwives whose patients were in need of a hospital transfer.

"In New York City, we like to think of ourselves at the forefront of everything, but in terms of birth, we're not," said Ellen Chuse, who teaches a childbirth education course for home birth families. "There are so few options other than hospitals, and the medical-legal environment makes it difficult to have a natural birth there."

, the trend toward home birth is most pronounced in Brooklyn's leafier neighborhoods, where many young professionals see home birth as an extension of their natural lifestyle, according to midwives, doulas and home-birth educators. And it is also increasingly common in the ultraorthodox Jewish communities of Crown Heights, Borough Park and Williamsburg, where large families are the norm. "If you're going to have 12 kids, you can't have 12 cesareans," said Miriam Schwarzchild, a Park Slope-based midwife, citing maternal risks of multiple C-sections.

In May, Rachel Holtzman gave birth to a nearly 10-pound boy in the inflatable tub set up in the narrow space between her living-room sofa and her television. "The point I like to make to people who are incredulous and say, 'Wow, you gave birth in a New York City apartment,' is 'yes, but a lot of New York City apartments are bigger than the average hospital room,'" said Ms. Holtzman, 31, of Park Slope. "You also don't need a lot of space to have a baby; it's a pretty compact affair."

Ms. Holtzman did extensive research about hospital birth, and was determined to avoid intervention or surgery, if possible. (C-section rates near or top 40% at several New York City hospitals, according to the organization Choices in Childbirth, which compiles state data.) "I liked the idea of birthing in an environment that felt more comfortable to me, and really giving myself license to let these natural processes unfold," said Ms. Holtzman, a writer who was influential in starting the Kind Mama Milk Share, a breast milk bank for vegan mothers.

She gave her neighbors a heads-up that she'd be giving birth at home. (Midwives and doulas tell of other home-birth families who have given their neighbors earplugs or a bottle of wine to dull the inevitable noise.) Her labor lasted eight hours, and a man who lives upstairs told her that he heard the whole thing. "He seemed pretty impressed—even honored," to have borne witness to the event, Ms. Holtzman's husband, Larry Gast, 32, said as he rocked his newborn son.

Melissa Bijur, who is planning a Brooklyn home birth next month, said it isn't only a natural childbirth that she is seeking, but also a more intimate birthing experience. "I'm not comfortable with the hospital environment: the light, the white walls, not having interaction with your OB/GYN," Ms. Bijur, 30, said.

An aspiring opera singer, Ms. Bijur hopes to give birth with her husband, her mother, her midwife and her doula by her side. Of her midwife, Barbara Bechtel, Ms. Bijur said, "We've can spend hours together – answering questions and just getting to know each other. By the time she catches the baby, there's a real friendship there."

"It's one of those experiences that I look back on when things get difficult," said Diana Kane English, a 41-year-old boutique owner who delivered her two sons in her family's Park Slope apartment. "I say to myself, 'I gave birth at home, I know that I can get through this.'"

Corrections & Amplifications
In an earlier version of this article, the last name of Larry Gast was incorrectly given as Gest in a photo caption.

A version of this article appeared August 26, 2013, on page A21 in the U.S. edition of The Wall Street Journal, with the headline: Home Births on the Rise for New York Families.