By Heather May
The Salt Lake Tribune
SALT LAKE CITY — It appears a growing number of Utah women are choosing to have their babies at home, with few mothers or babies suffering complications.
That’s according to the latest report from midwives who are licensed to deliver at home, which was presented to a legislative committee Wednesday.
Midwives say it should allay fears that woman who labor at home are in danger. And they note the low cost: an average of $1,900 compared to $8,500 for a low-risk, vaginal birth in the hospital.
“We’re seeing some impact from the economic situation, especially if they’re uninsured or have a higher deductible,” said Holly Richardson, a midwife and member of the state midwife board.
The report, which covers births from July 2007 through June 2008, is based on self-reports by the so-called “direct-entry midwives.” It notes that women laboring at home are far less likely than women in hospitals to need a Cesarean-section (3 percent versus the state’s 21.6 percent) or an episiotomy cut to enlarge the vaginal opening (1 percent versus the nation’s 25 percent to 33 percent rate).
But doctors say the comparison isn’t fair. Women laboring at home are supposed to be low risk and shouldn’t need such interventions.
“If they want to say they’re better than the health care system, then we should make sure we’re comparing apples and apples,” said Mike Varner, chairman of a Utah ob-gyn society.
Women who began care with a midwife numbered 371, a 55 percent increase from last year, though this year’s reporting period is slightly longer. About 22 percent of the women transferred care to a doctor or to a hospital during labor either because they had complications that required the switch or they chose to.
No babies nor mothers died during or after labor, though two fetuses died, one from a possible “cord accident” and another apparently from a chromosomal abnormality. Two babies needed to be resuscitated. Another had a severe bacteria infection contracted during the pregnancy and needed to go the hospital; another hemorrhaged between the skull and the skin, which is most often caused by trauma during delivery.
Four women were taken by ambulance after delivery for severe bleeding. In all of the cases, the mothers and babies were fine six weeks after delivery.
Catherine Wheeler, a gynecologist who sits on a rules committee with midwives, said she would like to know more about those problems. The health department or some other group should review the data so that care can be improved, she said.
“We have the people doing the care [and reporting the care] and nobody outside of that group evaluating the data,” she said. “My concern is we take care of low risk women at home who are very unlikely … to have complications.
Nearly all of the babies had an Apgar score, which measures the newborn’s physical condition and short-term prognosis, of 7 or better out of 10.
Last year, the Legislature changed the law to forbid the midwives from delivering twins and babies in the breech position, based on the Utah Medical Association’s concerns that those births are too risky to be performed at home. Before the law went into effect, in May, the midwives delivered one set of twins and two breech babies. Another four mothers with breech babies were transferred to the hospital.
The Utah Medical Association unsuccessfully sought to ban vaginal births after previous Cesarean sections at home. Fifteen women attempted such births, and three went to a hospital for a C-section or a delivery using forceps. The other 12 delivered successfully at home.
Richardson said many mothers deliver at home because they can’t find doctors or hospitals willing to do a vaginal birth after Cesarean because of malpractice concerns, which she said explains the increase she seen in women seeking her care late in their pregnancies.
It’s an important option for women who want large families, because repeated C-sections increase the risk of complications such as emergency hysterectomies at delivery and placenta accreta.
The annual report was mandated by the Legislature when it voted to license home-based midwives in 2005.