HomeNEWSMeet the New One Percent

Meet the New One Percent

By NICOLE FOSTER
Staff Writer

No, not an elite crop of billionaires; the 35,000 babies who will be born at home this year.*
In the United States, more babies are born during the summer months than any other time of year. Next July, nearly 40,000 women will give birth in the comfort of their own home.
Until 2010 it was illegal in New York to have a homebirth without the consent of a physician associated with obstetrics. When the law changed, medical professionals trained specifically in home delivery, known as midwives, were finally allowed to practice independently. With homebirth popularity rising, midwiferies are establishing themselves in neighborhoods across the country, including Pine Hills.
Nestled on the corner of Western Avenue and North Allen Street is a periwinkle Queen Anne style building. Inside are women who work for Sage-Femme Midwifery. They are on-call 24 hours a day, seven days a week and schedule their lives around anticipated labors. Kristen Klein, a licensed registered nurse, is employed at Sage-Femme as a birthing assistant. She is currently training to become a certified professional midwife.
“It used to be that for a midwife to do a homebirth she had to have an OB sign a form saying he would back her up if she needed anything,” Klein said. “The only other way to have a homebirth was illegally. Insurance wasn’t going to cover an unlicensed, illegal midwife.”
Until recently, women who chose to forgo a hospital bed in favor of a birthing pool had to search for the closest midwife. According to the American Congress of Obstetricians and Gynecologists approximately one percent of women give birth at home each year. An increase in interest in homebirths means midwives are in demand and more accessible. Many are now included in insurance plans.
Rana Morris lives in Albany and has had two homebirths. Her first son was born eight years ago, when it was still a struggle to find not just a local midwife but one who was covered by her insurance. Morris and her partner eventually found someone in New Paltz, over an hour away from her home downtown.
“It was not convenient,” said Morris. “Eight years ago it was very hard to use insurance for homebirth.”
Her second birth was a different experience. Not only did she use a midwife who was a block away, but her insurance covered more than half of the expense.
Morris said Capital District Physicians’ Health Plan paid a “pretty good portion of it.” She credited midwives as people who work with their clients to figure out a way to ensure parents can afford their services, with or without insurance.
At Sage-Femme Midwifery, Klein has found at least 70 percent of their clients had their first child in a hospital. Unhappy with the process, they make a different choice for their second pregnancy and seek out a midwife.
“The way women get treated in the hospital is dehumanizing,” said Klein. “Midwives will spend a lot more time with you prenatally. Our appointments here last an hour as opposed to seven to 10 minutes. There’s a lot more of the feeling like you actually are being heard, there’s time to ask questions. We don’t have the need to rush through to get to the next appointment.”
Klein said pregnancy is not an illness or an emergency waiting to happen. She stressed that giving birth is normal and shouldn’t be met with unnecessary testing or scheduled cesarean sections. Klein believes obstetricians feel like they have to make decisions for people rather than allow women to decide what’s best for themselves.
“You’re much less likely to have a midwife say, ‘You’re pregnant so you need to get an ultrasound now,’” Klein said. “Those things don’t necessarily fit everybody. You’re given options to what fits your life and family and values.”
Albany Medical Center obstetrician-gynecologist Paul Burcher knows most of the population questions the safety of homebirth. He said this mentality immediately puts homebirth in a position where it has to justify itself. Burcher wants people to also consider the dangers of having a baby in a hospital.
“Essentially,” said Burcher, “hospital birth is a several-decade-old experiment that hasn’t been justified with empirical evidence. Let’s look at both homebirth and hospital birth alongside each other and look at the merits and risks of each so women can make the best choice.”
Burcher referred to a study that showed a slight uptick in neonatal mortality with homebirths. The deaths, he explained, tend to be concentrated in a few high risk scenarios. First-time moms, obesity, a pregnancy beyond 42 weeks, twins and breeches (the baby’s buttocks or feet are positioned to come out first) post higher risks with a homebirth. According to the OB-GYN, women with these conditions are better off delivering in a hospital.
Before deciding which method is preferred, Burcher wants future mothers to have a realistic appraisal of what both birthing scenarios are like. He suggested women watch home and hospital births on YouTube while considering which experience they prefer.
“Some people are more comfortable surrounded by technology,” Burcher said. “Some are more comfortable surrounded by a midwife and a partner.”
Acknowledging the steady rise in homebirth popularity, the doctor said obstetricians should not feel economically threatened by midwives. Instead, he wants to see the two professions work together to make homebirth safer. Burcher envisions OB-GYN care becoming integrated with midwiferies to form one holistic system.
When a midwife arrives to deliver a baby, they are equipped with an arsenal of medical equipment. Klein said midwives are prepared to handle issues ranging from the mom bleeding too much to an infant needing chest compressions. She brings oxygen and suctioning equipment to every birth and, if necessary, is ready to transport the mother to a hospital.
Klein stays with each mom for about three hours after birth. She examines the placenta, helps establish breast feeding, makes the parents a meal, does laundry, takes out the garbage and gets the mom showered. Midwives make sure the home is a mirror image of when they arrived, pre-birth. Klein also conducts a head-to-toe assessment of the newborn. Before leaving, she tucks the mom and baby into bed and comes back in 24 hours for a check-in.
Pine Hills couple Kim and Vincent Commisso knew from the beginning of their relationship, nearly a decade ago, that if they had a baby, it would be born at home. The couple said they wanted the most calm, peaceful, supportive birth possible and achieved just that a few weeks ago on a sunny September day. Kim had Henry in a birth pool set up in the living room of their apartment.
“Once he was born, the midwife was like, ‘go lay in bed and have your bonding time together,’” Kim said, as Henry napped in her arms. “Right, Vincent? It was just you, me and Henry and we just laid together for hours and hours.”
When the family emerged from the bedroom, they found their apartment had been cleaned and a powerful support system was established.
“They came back the next three days and were always available by text or phone call,” said Kim of her midwives. “I had three different women who I had gotten to know through months and months of prenatal care. I can reach them any time. I was reaching them at night with questions. They’re still coming now and we’re almost three weeks out.”
Next to her on the couch, Vincent said, “I’d never felt more confident in a group of people to do something than I did with this.”
Kim advocates for active births and explained that a hospital bed can be confining because women are hooked up to monitors. A homebirth means no epidural and though she was hurting physically during labor, Kim was grateful to be home. The baby was facing her abdomen, causing intense back pain and relief came in the form of motion: walking around, squatting, resting in various positions and bouncing on an enormous inflated ball.
“Around 2:30 a.m., when they got here, there was some effort to turn the baby,” Kim said about the arrival of the midwives and start of her labor. “The rest of it is really just a haze. I was in a lot of pain, focusing on getting the baby to turn.”
Attesting to the midwives’ abilities, Vincent said, “At no moment did I have a hint of concern. The midwives we worked with, it’s not like they’re living in the 1700s. We went to ultrasounds. If there were major issues, they would have come up way in advance and we would have decided not to do it at home.”
Also present at the Commisso’s homebirth was their doula, Annie Hayden. Hayden described a doula’s purpose as providing physical and emotional care for both the mom and her partner. She meets with parents prenatally to figure out their ideal birth plan. Hayden, who lives in Troy, works independently and is certified by Doulas of North America.
“Usually I meet with people about three times before the due date,” she said. “That time is used for talking about techniques we might use to get through labor and delivery and what they might want that support to look like. Even though most people take child birth education classes, there might be gaps where they have questions about certain things. Sometimes, if it’s not a home birth they’ll still want me to come to the house before they go to the hospital.”
In addition to offering massage and relaxation techniques for the mom, Hayden said doulas are a great tool for the non-pregnant parent.
“A lot of times the partner hasn’t been around birth and might not know as much as a mom who has been doing research and doesn’t know quite how to support her and what’s normal,” Hayden said. “A doula can give a partner suggestions. The mom isn’t going to want to stop and explain.”
Post-partum, Hayden meets with her clients three times. They reflect on the birthing experience and she gauges how everyone is doing emotionally. For parents opting to have their baby at a hospital, Hayden coaches them on how to speak to medical professionals to avoid unnecessary or intrusive interventions such as constant fetal monitoring and pain medication.
Midwife Klein said she has to turn people away regularly because homebirths are growing exponentially in the Capital Region. She works with five or six expecting mothers a month and hopes they don’t all go into labor at the same time. When asked if the midwives refer to the moms as patients or clients, an amused look crossed Klein’s face.
“We call them ladies,” she said.

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