News Local/State

As US Home Births Increase, Options for Illinois Women Limited

By Kimberlie Kranich

Last January, statistics released by the National Center for Health Statistics showed home births in the United States jumped 29 percent between 2004 and 2009. In recent years, an average of 30,000 babies, or 1 percent of all babies, are born at home.  And year to year, the number of home births is increasing. In Illinois, women’s home birth options are severely limited.

When Rebecca Butler, 34, became pregnant with her third child, she was determined to have the baby at home, in Champaign, with her husband, Tom. 
"I couldn’t find a midwife," Butler said. "I somehow connected with the home birth group here in Champaign and there were like five of us and one midwife who was working this entire area and she’s no longer around here."

Rebecca and Tom’s baby girl, Clementine, was born on their living room floor.  Tom delivered her successfully.  No midwife was present.

"I don’t recommend that for everyone," Butler said.  "You know, I recommend whatever feels right to people, but an unassisted birth is not for the faint of heart, I don’t think." 

Abbey Fish, 27, gave birth to two of her three children at home on her and husband Mike’s 1,800 acre farm in Towanda. Scarlett, their youngest, was born last year. 

"The happiest moment of the birth of Scarlett was that I was able to share it with my closest friends and family," Fish said.

Amy Russell, 29, of Bloomington, had her first child by Cesarean section at her local hospital in Bloomington.  The birth was difficult and she was in counseling for post-traumatic stress disorder afterwards. Her second child was delivered vaginally with no drugs at the same hospital.  For their third child, Katie, Amy and husband Ben decided to have a home birth with the assistance of a nurse midwife team.

"And it was just so calm, even in the way I felt internally," Russell said. "I just felt at peace with what we were doing. I wasn’t scared. There was no anxiety.  You just felt like this is the right thing to do for our family.  And it’s just incredible."

All three mothers’ frightful experiences during hospital births inspired them to find alternatives. They learned about home birth, found others who had tried it, and then sought out a midwife.

At first, Amy’s husband Ben was skeptical. He thought it was irresponsible to have a baby at home.

"I think that’s a lot of people’s knee jerk reaction," Ben Russell said. "But the more I educated myself about it, did research about it, the more I started to see that some of the statistics say that it’s safer if have the properly trained medical staff at home."

Fear plays a large role in childbirth in the United States. Advocates of home birth and hospital birth use different statistics to support their notion of what’s safest for mother and child.

Midwife-supported home birth advocates often cite a large study published in the British Medical Journal in 2005 that found newborn death rates in home births were comparable to those in hospitals. Hospital-birth advocates often cite medical opinions about home birth such as the one issued in 2011 by the American College of Obstetricians and Gynecologists which states, in part, that "published medical evidence shows it [planned home births] does carry a two-to-three-fold increase in the risk of newborn death compared with planned hospital births."

These differing perspectives impact a woman’s birthing options.

Amy and Ben Russell of Towanda welcome their daughter, Katie, who was delivered at home with a certified nurse midwife.While planned home births in Illinois are lawful, the only people legally allowed to deliver babies are medical doctors and certified nurse midwives. Nurse midwives are only able to attend home births if they have a written collaborative agreement with a physician.  Only a handful of physicians in Illinois are willing to sign those agreements.

The result: certified nurse midwives, including those in Illinois, don’t deliver very many babies at home. According to the American College of Nurse Midwives, about one percent of certified nurse midwives in the U-S deliver babies at home.

Dr. Jacques Abramowicz is chair of the Illinois section of the American College of Obstetricians & Gynecologists, or ACOG.  He says ACOG is not in favor of home birth delivery by certified nurse midwives.

"I understand that women want to have home births, and who am I to tell them you can’t have a home birth? The only issue is they need to be made very clearly aware that we don’t think it is a safe option," Abramowicz said, "because of the acuity of something bad when it happens. When the woman is pregnant, you have one patient. Once the baby is delivered, you have two patients. And if something goes wrong with the baby and the mother at the same time, which happens, the mother starts bleeding, the baby stops breathing, well, whom do you take care of? I think the main advantage of the hospital from that standpoint is you have a whole team. So I think that certified nurse midwives knowing that, I can’t speak for them, but I think their thought process is, I really don’t want to be placed in that situation."

According to the Illinois Department of Public Health, for every 1,000 live births in Illinois in 2009</a>, 69 died while being born.  2009 is the latest year in which statistics were available.  The maternal death rate for the same year is much lower, about 30 mothers for every 10,000 died while giving birth. These deaths are not broken down by hospital or home.

Though no one has data to compare the safety of hospital births to midwife-assisted home births in Illinois, advocates want more legal options for mothers-to-be to make the home birthing experience as safe as possible.

"The demand is high," says Michelle Breen of the Coalition for Illinois Midwifery, an advocacy group seeking to ensure access to licensed home birth professionals for all women in Illinois.  She says there are licensed providers in fewer than 10 of Illinois’ 102 counties.

"Most of these women are birthing under undesirable circumstances," Breen said.  "They’re birthing with an unlicensed provider, or they’re birthing unassisted without any provider at all, or they actually might be traveling. Sometimes they’re traveling while they’re in labor to a neighboring state to deliver the baby in a hotel room."

The Coalition for Illinois Midwifery would like to see the state of Illinois license certified professional midwives or CPMs, just like they do certified-nurse midwives. 

The midwife who delivered baby Scarlett at Abbey and Mike’s home in Towanda was a certified professional midwife, a specially trained practitioner in delivery outside the hospital.   She was breaking the law because Illinois doesn’t recognize her credentials. Currently, 26 states use the certified professional midwife credential set by the North American Registry of Midwives as the basis for licensing. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital birth. But certified professional midwives need not be nurses. And since they’re not legally recognized in Illinois, finding one can be a challenge.

Dr. Abramowicz said the American College of Obstetricians & Gynecologists does not support the licensing of certified professional midwives here in Illinois because "the standards for education and licensing and scope of practice is minimal and completely insufficient."

According to Breen, "there’s not a single state that has ever rescinded licensure once it’s been established. Twenty-six states rely on this credential to ascertain whether a midwife is qualified to care for women delivering in homes."

Decades-long efforts to legalize CPM supervised home births, opposed by the Illinois State Medical Society and other medical organizations, have repeatedly stalled in Springfield.

Meanwhile, the Illinois Department of Public Health told us they have no position on home births nor have they conducted any studies. They are, however, concerned about the percentage of Cesarean deliveries at Illinois hospitals, which jumped from less than 20 percent in 1997 to more than 30 percent a decade later, according to a report issued by the Department in 2009.  The Centers for Disease Control wants that number to be no higher than 15 percent for low risk first-time births.

Abbey and Mike Fish at home in Towanda.Dr. Abramowicz believes Illinois doctors may perform so many C-sections out of fear of litigation.

"The major reason, unfortunately," he said, "is the legal aspect of medicine. Particularly for obstetrics, there are a lot of lawsuits because a physician delayed a C-section because the baby was born with some distress or brain damage, which is attributed to not monitoring labor well enough or delaying delivery or delaying a C-section. And because of that utmost fear, the physicians tend to say, ‘Well, I don’t want to take a risk."

And it’s that risk of C-sections and other medical interventions, and the experience of not being in the driver’s seat, that lead some women to choose home births with midwife-directed care.

Amy Russell of Bloomington preferred working with her certified nurse midwife at home.

"She’s able to look for the signs that could be trouble, but she’s not waiting for there to be trouble. I just felt this peace with what we were doing," Russell said.  "I wasn’t scared. There was no anxiety in this, you just felt like this is the right thing to do for our family."

When it comes to delivering babies, Dr. Abramowicz says doctors at hospitals do one thing particularly well: handle emergencies.

"And the reason I say that is very often, if everything goes well, there is no complication, the baby is not too big for that particular pelvis, the mother can deliver by herself  in the field as it is done in some areas and everything can go well," he said.  "But, if something does not go well, if something goes sour, it goes sour very, very, very quick and very, very, very bad."

As long as the medical and midwifery models of birthing remain mostly disconnected from each other – women in Illinois wanting home births will be forced to make choices under less-than-ideal conditions.  And given a choice between a hospital or home birth, the families we spoke to said they’d opt for the home birth. 

"From our first experience at the hospital, it was so scary and unpredictable, and we just felt so out of control," said Abbey Fish, the mother from Towanda who chose to use a certified professional midwife unlicensed in Illinois. "I feel like we have done so much work just to make our own decisions and they’ve turned out to be such great experiences and they’ve changed the way we’ve parented."