For the past 25 years, the hospital has reigned [WORLD ILLEGIBLE] 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 house births in the 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 are has grown from about five a month to 25 a month during the last two years.
Proponents of home delivery believe its attraction is the warmth and familiarity of atmosphere and ability of the family to particpate in and control a major family event. Fran Ventre, a lay midwife in Maryland, said that people who opt for home births tend to be "people who are against medical intervention where it is not necessary. They live in the suburbs and in communes. It is a middle class phenomenon only in that a lot of people who are well educated and are into alternative life styles become aware of these things first."
For some parents, costs is a factor. At the Maternity Center the fee for prenatal care, home delivery, and one year post partum care is $550, while the fee for an obstetrician's prenatal care and delivery is around $650 plus a hospital fee of between $600 and $1,000 for a normal delivery and hospital stay.
Prospective parents at Maternity Center are screened for high risk factors. Those who fall into this category are advised to seek the care of an obstetrician 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. The geographic area of coverage includes the District.
Two obstetricians are involved in overseeing the Maternity Center's practise: they are on call should a home delivery patient need to be hospitalized.
Most obstetricians hold negative opinions on the subject of home births. Dr. Donald Mcck, an obstetriction on the faculty and staff of Georgetown University and [WORLD ILLEGIBLE] hospitals, said, "They scare me to death. I did four my [TEXT ILLEGIBLE]
Home [TEXT ILLEGIBLE] Ninety per cent of deliveries are normal, they say, and do not require hospital life supports systems.
Such statistics as exists are confusing. Obstetricians, nurse midwives and public health officials cannot agree on valid statistics concerning fetal and maternal mortality and morbidity (diseases, defects) rates in home versus hospital deliveries.
Neonatologists - physicians specializing in the care of the newborn - are generally unenthusiastic about home births, pointing to emergencies and problems which cannot be predicted and which cannot be predicted and which cannot be predicted and which need life-supports systems of a hospital. "Of all the high risk prenancies, 40 per cent will not be picked up by normal monitoring procedures until the time of labor," said Dr. Anne Fletcher, director of neonatology intensive care at Children's Hospital National Medical Center.
"What it boils down to is that things can happen which demand immediate intervention and at home that isn't available. The best equipped nurse-midwife doesn't have all the equipment of a hospital," said Dr. Mary kate Davitt, director of newborn nurseries at Georgetown University Hospital.
Certified nurse midwives practise under provisions of the Joint Statement of the District of Columbia Medical Society and the District of Columbia Nurse' Association. This statement, accepted in May 1973, enables a nurse midwife to practise "within the framework of a health care organization and not as an independent practitioner."
To qualify for practice, nurse mid-wives must be registered in the District as registered nurses; they must complete an organized program of study and clinical experience in nurse midwifery - Georgetown University and Johns Hopkins University both have programes - and must be certified by the American College of Nurse Mid-wives. [PARAGRAPH ILLEGIBLE]
A birthing center has the life support systems of a hospital but the more personal setting of a home. Generally, nurse midwives provide prenatal care and delivery while obstetricians are on call for emergencies and once-a-pregnancy screening. Prospective patients are screamed for high risk factors and in general, only local anesthesia, if any, is used. There is currently a center in New York City, and one is being planned for Northern Virginia.
"The concept is one many of us have been trying with for years - an out-patient maternity center for normal uncomplicated deliveries. The hospital is a very sophisticated, expensive institution geared to take care of the very sick. If you could get away from their heart-lung machines and intensive care units, you could cut costs," said Dr. Thomas Gresinger, a Northern Virginia obstetrie, area hospitals have tempered their institutional approach by providing supportive care for family centered childbirth. Fathers are permitted in delivery rooms at all hospitals in the District, babies can room-in with their mothers, and fathers can usually visit mother and baby together. Several hospitals permit children over three years of age to visit their new baby brother or sister through the nursery window. Some hospitals provide a special dinner for mother and father on the last evening of the hospital stay.
Washington Hospital Center is constructing a birthing room which will be a labor and delivery room decorated to look like a bedroom.
"We are concerned about home births and concerned about meeting the needs of patients who would like to deliver in an un-hospital atmosphere. We look to the birthing room as an answer," said Dr. William Peterson, Chairman of the department of obstetrics and gynecology at Washington Hospital Center.
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 Peterson. He said that between five and 10 patients a month delver 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," he said.
Obstetricians report that with the improved atmosphere hospitals are more suited than ever before to be the perfect setting for childbirth.