On a cold February night in 1983, Velga Brolis -- who was snowbound in her Arlington home -- delivered a son and then began to hemorrhage. As a registered nurse who works in the intensive care unit of Georgetown University Hospital, Brolis knew how serious such postpartum bleeding could be.
Calmly, Brolis' husband and a nurse-midwife applied ice packs, started intravenous fluids and injected oxytocin -- a drug that regulates uterine contraction -- until the bleeding had stopped.
But really, none of this was startling. With or without the blizzard, this would have been a home birth.
Brolis is one of a handful of women nationwide who chose to give birth at home rather than in a hospital. The National Center for Health Statistics reports that 99 percent of births each year take place in hospitals -- a figure that has remained constant for years.
For Brolis, as for many women who choose home birth, comfort and control are the major reasons.
"Many physicians try to do too much to interfere with a normal birth," she says. "Some of my coworkers said they thought I was brave to do it at home.
"I think they're brave to do it in a hospital."
There's also a practical side to home birth -- it costs less. Home birth in this area, including prenatal and postnatal care, costs between $800 and $1,000. An uncomplicated normal delivery in an urban hospital in the South (an area that includes the District, Maryland and Virginia) costs an average of $1,960, including all medical fees except the anesthesiologist's and the pediatrician's newborn care, reports a 1982 survey by the Health Insurance Association of America.
Many health insurance plans will cover the cost of nurse-midwifery care to the same extent that they cover care provided by a physician, and plans in 10 states (including Maryland) are required by law to reimburse nurse-midwives. In today's climate of cost containment, there is a trend for policies to provide greater coverage for the less costly nurse-midwifery care, HIA reports.
The Brolises are, in many ways, typical of couples who choose home birth, say area midwives. Most home-birth couples in this area are middle- to upper-middle-class whites with at least some college education.
Midwifery services screen patients during an initial interview and throughout pregnancy for medical problems that might make them at high risk for complications during labor and delivery. High-risk mothers are referred to backup obstetrician-gynecologists for care.
The midwives also keep a close watch on possible complications during labor and delivery and, if any arise, the woman is transferred to the nearest medical facility. About 20 percent of women who begin labor at home are transferred to a hospital because of medical problems, say midwives at Family Birth in Annandale and at the Maternity Center in Bethesda, and about 1 percent of those transfers require an ambulance and an emergency admission.
Despite the safety precautions, many obstetricians remain strongly opposed to home birth, even for normal, healthy women.
"Anyone who delivers babies knows you cannot always anticipate when a problem will arise during delivery," says Dr. Constance Bohon, who practices downtown and in Maryland. "The major consideration is that there's not much time if a problem arises."
At Columbia Hospital for Women, where Bohon delivers, a neonatologist can be summoned within three minutes in an emergency, she says. "There is no way a woman delivering at home can get help as quickly as in a hospital. And with a baby, every minute counts."
The American College of Obstetricians and Gynecologists also is opposed to home birth, but does approve of birthing centers that are physically attached to a hospital, says spokeswoman Laurie Hall.
Some older physicians who delivered babies at home before the advent of hospital birth will no longer do so and are "scared to death" of home births. "Once you've seen someone bleed to death," Hall says, "you don't want to see it again."
Not all doctors agree. Three area midwifery services have ongoing consultative relationships with backup physicians who are supportive of home birth but who will not deliver at home because of malpractice concerns and fear of alienating their medical colleagues. A few physicians continue to deliver babies at home, but do not advertise the fact for the same reasons.
Midwives stress that home birth is not for everyone.
"I hope we're reaching the point where we realize that it's okay to have babies in different places," says Janet Epstein-Baden of the Maternity Center in Bethesda. "Some mothers should go to a birth center, and some should stay home. But wherever they go, they need to be medically supported. You can't make a judgment on who's right or wrong. My decision not to go to a hospital shouldn't mean that you get medical care and I don't."