For the past 25 years the hospital has reigned supreme as the unquestioned place to have a baby. Within the last two years, however, there has been an increase in the number of medically supervised home births in the Washington area.
According to the Maternity Center in Rockville, headquarters for a group of certified nurse midwives who oversee prenatal care and attend home deliveries, the number of medically attended home births in the Washington area has grown from about five a month to about 25 a month during the last two years.
Proponents of home delivery believe its attraction is the warmth and familiarity of the atmosphere and the ability of the family to participate in a major family event. Fran Ventre, a lay mid-wife in Maryland, said that the people who opt for home births tend to be "people who are against medical interference when it isn't necessary. Some live in the suburbs; some in communes. It is a middle-class phenomenon only because a lot of people who are well educated and are into alternative life styles are becoming aware of these things first."
For some parents, cost is a factor. At Maternity Center the fee for prenatal care, home delivery, and one year of post partum care is $550, while the fee for an obstetrician's prenatal care and delivery of between $600 and $1,000 for a three day stay.
Prospective patients at Maternity Center are screened for high risk factors. Those who fall into this category are advised to seek the care of an obstretrician and have a hospital delivery. Those in the low risk category receive regular prenatal care and are given a list of supplies necessary for a home delivery. In Virginia, Maternity Center accepts patients only from Northern Virginia.
Two obstetricians oversee the Maternity Center's practice: They are on call should a home delivery patient need to be hospitalized.
Most obstetricians hold negative, opinions on the subject of home births.
"Delivery is the most dangerous trip one takes in life and there is always the potential for problems. The dangers are magnified at home because there aren't facilities to take care of problems that arise," said Dr. James Sites, chairman of the department of obstetrics and gynecology at Fairfax Hospital.
"I'm violently opposed," said Dr. Thomas McGavin, chief of obstetrics and gynecology at Arlington Hospital. "The business of maternity care is to reduce mortality, but if a baby is born that ends up needing resuscitation or if a mother starts hemorraghing and you don't have the facilities to do anything abther or the baby. I never want to be part of a mother's or infant's death.
Home Oriented Maternity Experience (H.O.M.E.), an Arlington based chapter of the national orgainzation of the same name, responds to those views by noting that patients are screened in order to find the high risk mothers who need the sophisticated technology available in a hospital. Ninety per cent of deliveries are normal, they say, and do not require hospital life support systems.
Such statistics as exist are confusing. Neither obstetricians, nurse midwives or public health officials are able to agree on statistics of infant and maternal mortality or morbidity (diseases, defects) related to home versus hospital deliveries.
Dr. Danlele Huntington, assistant director of nurseries at Fairfax Hospital, said, "We have had three very bad experience in the last year and a half with babies born at home. So many things can go wrong so quickly with a newborn. A baby born in the hospital may go to the regular nursery and within 45 minutes need intensive care, but it's available to him. It's just not as simple as proponents of home delivery will tell you. A home atmosphere is very nice but the push should be toward that feeling in the hospital rather than a step backwards. I wouldn't take the risk for my child or myself."
Certified nurse midwives can practice in several health delivery facilities, including hospitals, under the recently amended Rules and Regulations of the Board of Health of Virginia. The board is empowered to issue permits and adopt rules and regulations governing the practice of midwifery. All applicants for permits must be nurse midwives - lay midwives are now illegal.Regulations for practice established in old statutes for lay midwives have been incorporated in the new rules. Permits to practice must be renewed annually.
To qualify to practice, a midwife must be registered as a professional nurse, must have graduated from a school of midwifery, be between 18 and 65 years of age, pass a physical examinattion and have letters of reference from two local practicing physicians.
A birthing center has the life support systems of a hospital but the more personal atmosphere of a home. Generally, nurse midwives provide prenatal and delivery care while obstetricians are on call for emergencies and once-a-pregnancy screening.
"The concept is one that many of us have been toying with for years - an out-patient maternity center for normal uncomplicated deliveries. The hospital is a sophisticated, expensive institution geared to take care of the very sick, and if you could get away from their heart-lung machines and intensive care units, you could cut costs," said Dr. Thomas Gresinger, an obstetrician practicing in Northern Virginia.
Gresinger as involved in the planning of a center for Northern Virginia. Prospective patients for the center would be screened for high risk factors. In general, only local medication would beeeb available during delivery although Gresinger said he hadn't, as yet, ruled out one-shot caudles (a type of regional anesthesias would not be used.
The center, which is in very preliminary planning stages, would be located near one of the three Northern Virginia hospitals providing obstetric care so that any patients who needed to be hospitalized would be near help.
With the trend clearly towards a family-centered childbirth experience, hospitals in Northern Virginia have tempered their institutional approach to childbirth and provide supportive care for family centered childbirth. Fathers are permitted in the delivery rooms at all three hospitals. Arlington has developed a birthing room - the same room is used for labor, delivery, and recovery, and it is decorated to look more like a bedroom than a hospital operating room. Children are allowed to see their mothers and newly born siblings. A candlelight dinner for the new parents is provided at the hospital sometime during the mother's stay. In addition, nurses follow up patients with telephone calls three to five days after the new mother goes home to see how she is managing.
Fairfax does not allow sibling visits, although Gresinger reported that the hospital was talking about the possibility. Fathers, however, are encouraged to visit when their babies are in their wives room in order to hold the new-borns and learn to feed and care for them.
Alexandria, like Arlington, permits child visitation and encourages fathers to visit and help care for their babies. There is a birthing room as well.
One other option for families who are concerned about the safety of home births but object to the impersonal atmosphere of a hospital is an in-and-out delivery. Delivery is at the hospital and, if there are no complications, both mother and baby return home the same day.
"For those who object to a hospital stay it's of great value," said Dr. William Peterson, chairman of the department of obstetrics and gynecology at Washington Hospital Center. He said that between five and 10 patients a month deliver on an in-and-out basis at the hospital.
"If all goes well mother and child return home about five to six hours after delivery," Peterson said.
Obstetricians report that with the improved atmosphere and more flexible approach to individual needs, hospitals are more suited than ever to be the perfect setting for childbirth.
"It's safe, the medical care is unexcelled, fathers can be accommodated in the delivery room and everyone can be together when the father visits," a Fairfax obstetrician commented.