When Spokane resident Maren Furlong gave birth to her second child at a hospital here two years ago, she felt there was too much intervention.


Although Furlongs birth plan stated that she didnt want to take medications, a nurse inserted an intravenous line into her as soon as she arrived and asked her repeatedly whether she was ready for painkillers, she says. Her amniotic sac was ruptured artificially, rather than letting nature take its course and waiting for her water to break on its own.


During Furlongs quick deliveryit lasted all of 20 minutesa shift change meant that two different doctors tended to her, she says. One was there for the first two pushes, and the other was there for the second two and to catch her son, Sam, as he was born, Furlong recalls.


It was a little more chaotic than it needed to be, she says. We wanted something a little calmer.


So Furlong and her husband, Jonathon, chose to deliver their third child, Leo, at home with the assistance of a midwife. She says that birth, which occurred in June, was a more subdued, relaxed experience for her and her new son.


The midwife let me do my thing, she says. They didnt become actively involved until I need them for support. It was an amazing, beautiful experience. When (Leo) was born, he was just kind of quietly aware.


Midwives here say a growing number of women are delivering their babies at home rather than in hospitals. After peaking in the 1970s, out-of-hospital births have stabilized across the country, accounting for about 1 percent of all births, but they are slightly more popular in Washington state, says the Midwives Alliance of North America (MANA), a professional organization for midwives. Despite longtime concerns among the medical community and general public that home births arent as safe as hospital deliveries, some midwives here contend that natural childbirth in a home setting is more beneficial for most mothers and their babies.


Home births inch up


The number of babies delivered in homes in Spokane County has crept up slightly in the last 10 years, to 1.1 percent in 2002 from 0.85 percent in 1993, according to the Washington state Department of Health. Statewide, the number of home births fluctuated between 1.3 percent and 1.4 percent during the past decade, the department says. Last year, there were about 78,600 births in Washington state and about 6,400 births in Spokane County. About 1,060 and 75 of those babies, respectively, were delivered in homes, the department says.


Spokane midwives Linda Marks and Beth Morill say the number of babies they deliver annually has doubled in the last three years, to a projected 100 births between them this year. In addition, there were fewer midwives practicing in Spokane three years ago, so the number of home deliveries here likely has grown substantially in that time, Marks says.


Marks and Morill own Spokane Birthright LLC, which does business as Spokane Midwives and operates a birthing center at 127 E. Euclid. The practice, which opened eight years ago, also has an office at 1301 N. Pines, in Spokane Valley. The midwives deliver most of the babies in their patients homes, but the experiences in the birthing centerwhich looks like a house and has a bedroom where the babies are deliveredare very similar, Marks says.


One reason for the increase in home births here is that people want continuity, she says. They want to know who is going to be with them during the birth. They dont want someone whos there because he happened to punch the clock when they went into labor.


Marks also says theres a greater awareness of underwater births today and some women first inquire about home deliveries because theyre interested in that option. Several midwives here bring inflatable tubs to the homes of their patients, or patients use a bathtub at birthing centers. The pregnant women sit in warm water in the tubs and the babies are delivered underwater, which the midwives say is more comfortable for the mothers and a less startling transition to the world outside the womb for the babies.


Tamy Roloff, who owns Nurturing Touch Midwifery Care, of Spokane, only delivers babies in homes.


Your house has germs that are familiar to your body, she says. Its a cleaner environment to you. Its most comfortable to you. Its your house, and youre in charge.


Roloff, who has delivered about 50 babiesincluding Furlongsin her three years as a midwife, says the emotional, spiritual, and physical aspects of the human body work together for a smooth delivery, she says. All of those aspects are better tended to in a home than in a hospital, where the medical staff is trained to focus mainly on the physical side of the delivery, she contends.


When were somewhere where were most secure, our bodies work best, Roloff says.


Washington state recognizes two types of midwiveslicensed midwives and certified-nurse midwives. Licensed midwives complete three-year educational programs at schools accredited by the state and must complete a supervised training period. Certified-nurse midwives are licensed midwives, as well as registered nurses. In some states, but not Washington, what are called lay midwives are allowed to deliver babies, despite not having formal training in midwifery.


Some midwives prefer hospitals


Sharron Bradley, a certified-nurse midwife with Northwest OB-GYN, never has delivered babies in homes, nor does she want to.


Ive delivered a lot of babies over the years and obstetrics can be unpredictable, says Bradley, who has been practicing for 19 years and delivers about 120 babies a year. I can think of several cases where I would have had dead babies if I would have been at a home.


Although complications are rare, they do occur, and often action must be taken quickly to save a babys life, she says. Transporting some-one from a home, where they dont have access to surgeons, an operating room, and a full range of medications and the professionals to administer them, could take too long, Bradley says.


If youve only delivered 100 babies, then youve only seen the tip of the iceberg of what can happen, she contends. Most of the time, its OK. The statistics are good. The problem is when it happens and it could have been prevented.


Dr. Robert Sestero, an obstetrician with Spokane Obstetrics & Gynecology PS, says delivering babies at home increases the risk of complications and therefore also the chances that a person attending a home birth could face a lawsuit.


These days, if something isnt perfect, somebody is going to sue somebody, he says.


His practice doesnt include midwives, but midwives who practice with obstetricians usually are protected by the liability insurance the physicians carry, he says. Most obstetricians paid about $60,000 to $70,000 for liability insurance this year, but those rates could increase to $80,000 to $100,000 next year, he says. Roloff says liability insurance for a midwife practicing on his or her own costs about $6,000 to $10,000 a year.


Sestero has been an obstetrician for 28 years and estimates that he has delivered about 5,000 babies, but he never has delivered a baby in a home.


In a hospital you always have the availability of intervention, he says. You could have a patient who has had two normal deliveries before, but maybe on the third the placenta wont come out, or the baby is stuck, and the patient needs a C-section. At home, youd have to get an ambulance, and that could just spell disaster.


Sestero estimates that 10 percent to 12 percent of all pregnancies involve some sort of complication, either anticipated or not, and 1 percent to 2 percent of all pregnancies involve complications that dont manifest until the delivery.


A normal delivery is only normal after its over with, he says.


Marks, of Spokane Midwives, contends that the belief that home deliveries are unsafe is a myth, as are some other assumptions about midwives.


Everybody thinks we wear Birkenstocks and beads, and were uneducated and incompetent, she says. Marks adds that research shows that home births are safe.


A 1996 study called Planned Home Births conducted by the Washington state Department of Social and Health Services is the most recent such study released here. It examined the outcomes of about 2,050 births attended to by licensed midwives between 1989 and 1994. About 700 of those deliveries occurred in homes, 300 occurred in birthing centers, and 800 occurred in hospitals. The remainder occurred either in homes or elsewhere without the assistance of a licensed midwife.


The rates of poor birth outcomesor births in which the baby died, had low birth weight, or was prematurewas lower in the women who delivered in homes or at birthing centers than those who delivered in hospitals, the study said.


The study points out, though, that some of the poor-outcome hospital deliveries started in homes, but the women were transferred when complications arose. Also, many women whose babies were known to be at risk for poor outcomes would have chosen a hospital delivery early in the pregnancy.


Roloff, of Nurturing Touch Midwifery Care, says midwives have so much experience with normal births that its easy for them to detect when something is abnormal and when its time to seek medical attention from a physician. They also spend more time with their patients than doctors do so they can anticipate problems better, she asserts.


We get to really know people, so if there is a problem we can catch it really early, Roloff says.


A study showing the amount of time physicians spend with patients compared with what midwives spend couldnt be found, but Sestero, the obstetrician, says its reasonable to believe that midwives spend more time with their patients.


If youre doing a lesser volume, then Im sure you can spend more time with patients, he says. And Im sure that would be an advantage. We try not to make it a mechanical experience by any means, though.


Roloff says that families recognize ahead of time that there are times when a mother and her baby could get into trouble during a delivery, and there isnt enough time to transport them to a hospital. Whatever the outcome, those families agree to accept that as whats best in the long run, she says.


For most people who choose a home birth, any risk is way outweighed by the benefits of having the baby in the safety of their home, she contends. The parents know that theres not a neonatal intensive care (unit) in the next room. There is a certain responsibility that parents are willing to take.