Photo by John Borg

Photo by John Borg

December 2008

Homebirths on the Hill

By Sarah Marloff

Homebirth has become a viable option for many pregnant women.  And in the last few years several Potrero Hill soon-to-be moms have opted for a homebirth. As this ancient tradition regains popularity, more people are wondering about the safety of homebirth, particular as compared to a hospital birth.

Birthing at home, with the dedicated care of midwives – there are always two or more present is “actually much safer than birthing in a hospital setting,” according to Kathleen Sampel Morris, one of several homebirth advocates on the Hill.  When she was pregnant Morris wanted to protect her baby from drugs, such as Pitocin, which are routinely used in hospitals to induce labor.  Potrero Hill resident Alaina Goetz, who is six months pregnant, also believes that one of the best arguments for homebirth is that it eliminates the temptation or repeated offers of drugs. She has talked to “many, many friends that have given birth in hospitals in [San Francisco] and so many of them had epidurals, episiotomies and most had C-sections. I would say 80 percent had C-sections! Many of them intended for a natural birth but had very different outcomes.”  

Almost one third of all babies born in the United States are delivered through Cesarean surgery.  In San Francisco the C-section rate is somewhat lower:  roughly one-quarter of births rely on the procedure.  High Cesarean rates are due to a number of factors, including caregivers’ fear of malpractice suits:  some doctors believe that performing a Cesarean reduces their risk of being sued even when a vaginal birth is feasible. “Decisions about hospital care are often based on practice protocols,  which are in turn based on reducing the liability of the hospital, doctor(s) and staff, yet are often not in the best interests of patients,” said Morris, who has worked as a Registered Dietitian at several hospitals in Kentucky and Virginia, as well as at a major teaching hospital in the City.

Karin Hanni delivered both her children—Tara, age three, and Dylan, who is eight months—at her Potrero Hill home.  Hanni chose homebirth for many reasons. Hospitals make her tense, and she was comforted by the idea of staying in one place during the birthing process.  Hanni was also swayed by statistics showing that homebirths are safer than hospital births for women with low-risk pregnancies.  

Nancy Myrick, a Certified Nurse Midwife with Rites of Passage Midwifery, worked with Hanni during both her pregnancies. Before Myrick became a midwife in 2003, she worked as a doula, providing non-medical support during child-birthing, for a decade.  Currently she attends three to four births a month. In the five years she’s been practicing, only once has she transferred a baby, who was having respiratory problems, and a hemorrhaging mother to the hospital by ambulance. They are both fine.  According to Myrick, the biggest risks associated with homebirth are the rare events that present no warning signs. “Mostly, the things that go wrong in childbirth start to show signs of happening long before they get bad. In that case we go to the hospital.” Myrick stressed that homebirth is for  “healthy moms having healthy pregnancies.”  There is always a backup hospital in case of emergencies. Both Hanni and Morris chose St. Luke’s, which has the highest rate of natural births in the City.  Hanni and Morris recommended Natural Resources, a retail store that caters to natural and eco-friendly pregnancy and nursing, located on Valencia and 25th streets, as a great resource for expectant parents.

There are many reasons to have a hospital birth, chief of which is that such facilities provide emergency facilities in case something unexpected happens. “If one of those rare emergencies occur, you are minutes away from surgery,”  advised Myrick.  If the mom has significant health problems, or doesn’t feel comfortable at home, she should be in a hospital. Women who want epidurals need to be in a facility that has access to the procedure.

San Francisco midwives typically charge less than $4,500 for their services, according to Michelle Welborn, an apprentice midwife to Myrick.  This rate covers prenatal and postpartum visits, as well as the birthing process. Some preferred provider organizations offer partial homebirth coverage, but no California health maintenance organizations provide midwives.  As a result, many families pay for a homebirth out-of-pocket. A hospital birth, pre-insurance, can cost from $20,000, with no interventions, to $50,000 if a Cesarean section is performed, with a $300 to $12,000 co-pay, excluding the cost of prenatal visits.  According to Welborn, most midwives want homebirths to be available for everyone, not just the wealthy. Many will accept trade or payment plans as negotiated by need.  Maria Iorillo, Morris’ midwife, started the Help Me Out Foundation to help women gain access to homebirth regardless of their income.

Birth is the bread and butter of the American hospital industry.  But the industry’s grip on babies is starting to loosen.  When Cara Vidano took over Natural Resources three years ago only two or three couples attended her monthly Meet the Midwives sessions. Today these gatherings are overflowing.  At the time of View publication Goetz was still debating where to give birth, though she noted that “95 percent of the women I have talked to about homebirth loved their experience (without drugs), delivered with no complications and would do it again.”


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