Sarah Searles had always dreamed of having a home birth, attended by a midwife. After having five children — three in hospitals and two in birthing centers on the East Coast — her dream finally came true. In early 2009, Searles and her husband became the happy parents of Kinsey, a healthy little girl born right in their Medford living room.
"When I first started having kids and was living in Connecticut, home birth was considered taboo and wasn't covered by insurance," says Searles, 27, who moved to Medford a little over two years ago. "It just so happened that my sixth was the first one where I could make it happen."
There are three types of midwives: certified nurse midwife, certified practicing midwife and the unlicensed or lay midwife.
The CNM obtains a nursing degree before completing midwifery school; the CPM is known as a "direct-entry" midwife who goes straight from midwifery school to practice in homes or birth centers. Most states require additional exams and licensing to be a CNM or CPM in a particular jurisdiction.
Certification happens one of two ways: Students can attend a nationally accredited midwifery school or be trained through apprenticeship.
Searles researched her options and found Augustine Colebrook, a certified professional midwife licensed in Oregon. "We chatted; she came to the house," says Searles. "She cared about so much more than just my pregnancy."
After laboring in a swimming pool set up in her living room, Searles gave birth to her daughter. Searles' mother, husband, best friend, midwife and two assistants were present.
"You're in complete control of your birth, which is really important," says Searles, who appreciated the privacy and not having to explain she didn't want an epidural as labor pains got bad. "It's something so natural and so timeless that's happened in every location possible."
Colebrook, who practices in Medford, has been an apprentice-trained, certified, practicing midwife for 10 years and has attended about 300 births.
"It took me five years," she says. "To be licensed you have to complete 42 pages of skills, observe 20 births, assist 20 births, deliver 20 births, assist 75 prenatals, 40 newborn exams and 40 well-woman exhibits. Most apprentices get much more experience than that."
Colebrook saw her first home birth at the age of 8 thanks to a midwife aunt in Colorado. She became interested in pursuing the field while living in Europe during high school.
"It just seemed so normal and intrinsic, and when it's done right, there are some really profound psychological and physical benefits," she says. "When birth is not treated like a stressful, emergency experience to be afraid of, babies actually bond better with their mothers, and they breast feed and gain weight easier."
A home birth may be more relaxed than a hospital birth because the midwife and her team have spent months with the parents-to-be, listening to them and helping them create the exact environment they wish for the birth.
"When birth is done at the speed that this mother and baby work at and breathe at, everyone then feels that this is normal," says Colebrook. "We know women have less pain when they are in a low-tech environment where they can relax. They produce less of the hormones that cause a stressful fight-or-flight reaction. There is this beautiful hormonal cascade that happens naturally."
Many expecting parents choose low lights, pools of warm water, special music and the company of people who make them feel comfortable.
"We have women who want to lie on their own bed, sit on their own toilet," says Colebrook. "Not only is it more comfortable, it's safer because it's your own germs."
While most home births are safe and healthy, Colebrook points out that they are not for everybody. Women with active cancer, high blood pressure, uncontrolled diabetes and certain conditions that exist with pregnancy are not good candidates.
"Everyone's first goal is safety, and high-risk births should take place in hospitals with highly trained gynecologists and obstetricians," says Colebrook.
If a woman does choose a home birth and finds a midwife who suits her style and needs, she can expect many months of one-on-one care. Services usually include preconception counseling, nutritional assessment and education, pregnancy testing, holistic prenatal care by monitoring medical, physical, emotional and social health throughout the pregnancy; childbirth education, partner and family preparation for birth, providing medical supplies for birth and advice on preparing the birth space, attendance at labor, birth and immediate postpartum; assistance in postpartum adjustment, breast-feeding education and support; and providing referrals where necessary.
"I believe that a healthy labor is much more than just healthy blood pressure," says Laura Roe, a certified practicing midwife. "We do the part that happens when you go into the doctor's office: take the blood pressure, the weight, the charts. That takes about 15 minutes. Then we work on nutrition, exercise, being in their best, healthiest place."
Appointments with a midwife last about an hour and a half to two hours and can take place at the midwife's office or at the mother's home. There is usually one appointment each month through week 28, focusing on connecting with the baby, talking about the changing roles of the mother and/or father and establishing healthy pregnancy habits like good nutrition and exercise.
From weeks 28 to 35, appointments happen every two weeks and then increase to once a week.
"The energy usually changes after week 28," says Roe, who's had a private practice in Ashland for 11 years, has attended 400 births and had her daughter at home. "We begin looking toward labor, childbirth preparation and what that woman's family is going to be doing postpartum. It is a shift."
This is when midwives present clients with several choices regarding things routinely done in a hospital at birth, including a vitamin-K injection, eye ointment, hearing screen and newborn vaccinations.
"Choosing a midwife is saying you're assuming the responsibility for how your pregnancy and birth goes as opposed to handing it over to someone else, and we want to educate the parents about what each treatment is, what it does, what choices are available," says Roe. "It's not about uniformity; it's about what do you think are the best choices for you and your family."
A midwife is present at the labor and birth, along with assistants and any additional people the clients have chosen.
"Then we stay on for well-baby and well-mother care for six weeks after the birth," Roe says. "That's part of why most of our mommas nurse their babies successfully: We're coming to them at home and doing the lactation education right there."
Home births can be an experience of transcendence for parents, children and primary-care providers. "How we birth is huge as to how we enter into motherhood," Roe says. "When a woman is really stoked about how her birth goes, she's going to be a more powerful mother."
The process truly does, as Roe's Web site promises, change the world one baby at a time.