Gwinnett Daily Post March 11

Gwinnett Daily Post
March 11, 2001

A Midwife's Story

Dozens of photos for homebirth families cover a bulletin board in midwife Debbie Pulley's Norcross office. Pulley has been delivering babies from low-risk pregnancies for 18 years.

Home Births becoming more popular across the country

Home births are becoming more popular for low-risk pregnancies across the country. Parents like being in familiar surroundings and want more control over the birthing process than hospitals can typically give.

But Georgia's laws, unlike many other states don't currently accommodate home birth midwifery. In fact, it's currently a misdemeanor for most midwives who do home births, including one very established one in Lilburn, to practice in Georgia. The medical establishment claims it isn't safe. Could upcoming legislation make delivering a baby at home a legal choice for parents for the first time in decades?

Lilburn midwife Debbie Pulley holds a stethoscope for Kelley Brookes from Lawrenceville to listen to her baby's heartbeat during a prenatal visit this week.

Born at home

Popularity of home births with midwives rising

By Rachel Forrester
Staff Writer

It’s 3 a.m. on a Wednesday when Lilburn midwife Debbie Pulley rolls over to the familiar middle-of-the-night ring of her telephone. After hanging up, she quickly dresses and heads out to the Barrow County home of one of her soon-to-be new moms.

The labor isn’t a complicated one, but it’s coming fast for a first baby, she says. Her first duty is to calm the laboring woman, who’s anxious because she didn’t expect things to happen so quickly. The mom is headed toward what Pulley calls “transition” — between 6 and 10 centimeters dilation, when she finally can push with her contractions.

above: 8 pounds, 8 ounces, Josephine Hayes McKinney was born in her Barrow County home Wednesday, February 21.

above: Midwife Apprentice Vickie Cleveland, on left, puts clothes on the hour-old baby while parents Alex and Shannon watch.

The mom seems most comfortable on her hands and knees on the bedroom floor for a while. But before long, the pain gets more intense. When Pulley tells her she’s at transition, the woman breathes a sigh of relief, moves to the bed and gets ready to push.

By 9 a.m., after a quick lesson in nursing, the mom is stretched out comfortably in her own bed with her new baby girl at her breast. Her husband is cuddled next to them. Two friends are downstairs cooking breakfast to order, scrambled eggs and grits.
After some resting, the baby gets her newborn check on the bed beside her mom and dad. She’s measured and then weighed inside a soft hammock-like, hand-held scale. Pulley finishes all her paperwork around noon and leaves the new family to rest. She’ll be back in a day or so for a postpartum visit.

Home births on the rise

So goes another successful home birth for Pulley. She’s one of only a handful of midwives in the Atlanta area who handle home births, despite a recent resurgence of popularity. In the 18 years she’s had her midwifery practice, she’s done a steady 25 to 35 of them per year. Lately, her numbers have crept closer to 40, and they’re people you might not expect — attorneys, bankers and even doctors.
Perhaps it’s the list of Hollywood celebrities who’ve had home births that has begun to turn public opinion. Well-known names like Demi Moore and Bruce Willis, Lisa Bonet and Lenny Kravitz, John Travolta and Kelly Preston, Cindy Crawford, Meryl Streep and others are starting to bring the practice into vogue.
Or perhaps it’s the fact that, while hospitals have come a long way from the sterile 1950s, many feel there’s no place like home and having more say in how your baby’s delivery is handled.

“I’m just not a hospital kind of person,” said Linda Williams, twice one of Pulley’s home-birth moms. “I didn’t ever want to lose control of what was going on, which is what happens in a hospital.”

As to the pain of childbirth without anesthesia, Pulley offers other options: she encourages her moms to take warm baths, walk around, try different positions, and of course, breathe properly.

“Your body handles it,” Williams said. “It comes in increments, and your pain threshold kind of moves with it. I won’t say it isn’t bad, but it’s never more than you can stand.”

Homebirthing

Is home birthing for you? It could be if:

	you like the idea of home as a natural birth setting.
	you want greater control during the birth process.
	your pregnancy is low-risk, with no complications like high blood pressure, diabetes, multiple gestation (twins or more), or birth defects.
	you want "natural" childbirth without anesthesia.
	your insurance covers homebirth midwifery, or
	you are willing to pay for a professional midwife (about $2000, vs. $10,000+ for a hospital birth).
	you are willing to educate yourself on homebirth, accepting full responsibility for the choice.
	you can accept the possibility of having to transport to a hospital during labor.

Debbie Pulley has been performing 25-35 home births a year for the last 18 years in the Atlanta area.

Photos by Nicole Finley

Home birthing and the medical establishment
Midwife home birthing is an issue currently riddled with politics. States such as Texas and Florida recognize certifications for all kinds of midwives to deliver at home or at a hospital, so that parents have the widest range of choice. In fact, Florida prohibits insurance companies from refusing to cover midwifery services at home or in a hospital. But in other states like New York, it’s a felony for most direct entry midwives to deliver a baby at home.

In Georgia, it’s currently a misdemeanor for Pulley to deliver a baby. The state does recognize the Certified Nurse Midwife designation, who currently deliver babies almost exclusively in hospitals, but not the one Pulley holds, Certified Professional Midwife, although both go through extensive training and sit for national exams.
The CNM also goes through all the necessary training to become a hospital nurse, while a CPM focuses primarily on home birth as a specialty, with a three- to five-year apprenticeship.

While she’s gotten every other kind of certification available for home birthing, which she practices exclusively, Pulley doesn’t believe a nursing background is necessary. If a patient is in bad enough need for the care of a certified nurse, the woman needs to be in a hospital, said Pulley.

But if it’s a misdemeanor in Georgia, why hasn’t Pulley been stopped?

“Because she’s so well respected in her field and in the community. Everybody knows her and trusts her,” said one doctor (who asked not to be named).
And he added, because Pulley never hesitates to transport a laboring mother to a hospital if she sees trouble ahead.

And it does happen — 12 to 15 percent of her mothers are taken to a hospital mid-labor.

“Our goal is to have a healthy mom and a healthy baby, and if that means we have to have a hospital caesarean with every drug in the book, that’s what we’re going to do,” Pulley said.

Although CNM’s are state-certified, they don’t usually handle home births. Those CNM’s that believe in home birthing have found it next to impossible to find doctors and hospitals willing to back them up. Medical professionals hold fast that home deliveries aren’t safe and that there’s no reason for a woman to want to give birth at home when hospitals have made such strides in becoming comfortable places to give birth.

In addition, peer pressure in the profession is so powerful that, according to at least one source, a medical professional advocating home births would find him or herself a pariah in the medical community.

At the bottom of it all, of course, there’s the money — a hospital birth today will cost $10,000 or more, while a home birth can be had for about $2,000 from start to finish. Because of the savings, some, although a very few, insurance companies are beginning to cover home births.

“But there are people who are going to have their babies at home whether that’s legal or not, and those people need to be protected. By not licensing them, they’re making home births unavailable and, I think, more dangerous,” said Pulley.
When asked why he continues to oppose home birthing, Gwinnett obstetrician Andrew Dott said, “All it takes is one dead mom, or one dead baby. You don’t want to send the clock backward.”

But Dott acknowledged that, in the end, people are going to do what they want. If parents-to-be insist on planning a home birth, it’s important that they flow easily between the idea of home and hospital care, should it become necessary. Being what he called “militant” about childbirth — refusing to go to a hospital in an unsafe situation — or trying to “micro manage” the hospital experience so that safety is compromised, is what gets parents in trouble, he said.

CNM Kay Johnson said she understands, in some respects, the medical resistance to home birthing. “These days, most of them have never seen a home birth,” she said. “All they know about is the women that come in with their disasters, their breeches and hemorrhages, that they have to clean up. So the system is a place that doesn’t give any credit to the midwife for figuring out that they needed to be at the hospital.”

Home births not always best
Pulley agreed that home births are absolutely not for everyone. She requires all her patients to sign a two-page informed consent form asking them to take full responsibility for their home birth choice.

And she only delivers moms and babies she’s determined to be low-risk through a series of prenatal visits much like an obstetrician/gynecologist gives. If health complications such as high blood pressure, diabetes, multiple gestation (twins or more) or birth defects show up, Pulley sends the mom to OB/GYN care and hospital delivery.

And if something begins to arise during labor which she thinks could be dangerous, “I’m the first one in the car” on the way to the hospital, she said.

In 18 years of practice, Pulley has never been sued, and never lost a mom during childbirth. While she has lost babies, “they’ve been births that they didn’t matter where they occurred (the baby would have died anyway),” she said.

Dr. Richard Stewart, one of the only Atlanta obstetrician/gynecologists who has been an open proponent of midwifery and home birthing, said he thinks low-risk pregnancies can be every bit as safe at home as in a hospital. In fact, he estimated that as much as 50 percent of the problems he’s seen in hospital deliveries were caused “by the hospital or institutional rules.”

Legislative changes afoot
“It’s a turf battle,” State Rep. Barbara Mobley (D-Decatur) said recently. “I think that there’s a sense of paranoia by the drug and medical field that’s unnecessary and unfounded.”

Delivered years ago by a midwife herself, Mobley is co-sponsoring a bill that would set in motion a study to see if there’s enough backing for the home birth choice for CPM’s — the certification Pulley holds which the state does not presently recognize. Mobley said that like all other study committee requests, the bill is presently stuck in the Rules Committee, but she expects the bill to be released for a vote this session.
If the bill were passed to have such a study done, public hearings would be held and experts consulted in order to make a recommendation. Then and only then could a bill be drawn up to give CPM’s the state’s OK to practice.

Conversations with co-legislators have told Mobley that reaction to such a bill will be mixed, but there is interest.

In the end, it’s about choice
Johnson summed up the issue with what she and Pulley agree is a balanced approach: “You can make it illegal and thereby create a horrible mess, or you can legalize it and create standards and put rules on who can have it and who can’t, who knows and who doesn’t, and control it to the extent that it’s not casually done,” she said.

“Of course there are bad midwives and there are bad doctors, and you can stand around and talk about how horrible a birth can be in a hospital or at home, but that isn’t the real issue. Nobody is advocating giving licenses to stupid or unlicensed people. I think they’re advocating choices for women with reasonable, research-oriented, educated help.”

Home birth was our first choice

and will remain so

AUBURN -- I was a big talker about home birth.

I liked to tell people it's what I planned just to get a rise out of them.

Their reactions were usually the same: "You're crazy!" or "You're brave not to go to a hospital."

As my due date drew nearer, though, I became more concerned about my abilities to birth. My husband and I had researched our options, discovering that home birth for low-risk pregnancies was just as safe as birthing in a hospital.

It wasn't that we had anything against hospitals. We just didn't feel that was an appropriate place for our child's first impressions of the world, unless absolutely necessary. I believe birth to be a natural process. Our grandmothers knew instinctively how to birth with the aid of midwives or family. I didn't want to go into a hospital with a perfectly normal pregnancy and be told to "hurry up" and birth, or "slow down" because the doctor wasn't ready. It just didn't seem normal to me.

I also liked the prenatal care I received from my midwife. Instead of spending 30 minutes in a doctor's waiting room then getting five or 10 minutes of the doctor's time for a checkup, I often got to spend 30 minutes or more with my midwife and her apprentice monthly then biweekly.

It was a ridiculous notion that my body would not know how to birth. The fear associated with birth is because of the unknown. All we hear from friends, family and well-intentioned strangers is how painful it is. Birth is something an individual woman has to experience on her own and alone.

I described it as walking through a very dark place. While I'd have my husband and labor support lead me up to the dark place and I knew they'd be waiting for me on the other side, I had to go through that dark place all by myself. I wouldn't know how dark it would be or how long the path would be. I would just have to have faith.

And faith is what got me through the early morning of Wednesday, Feb. 21.

The night before I thought I was in labor. I felt contractions until morning then they disappeared. I went about my day as usual and had a visit with my midwife.

That night, my husband and I walked Mall of Georgia for more than an hour, hoping to stimulate labor.

When I woke at 1 a.m. though, what I was feeling was not the labor that had been described to me. I thought I was just ill from perhaps something I ate and that's what I believed until 4 am. when I decided to run warm bath to ease the cramps.

The bath woke my husband, who came in to time my contractions. I had eight in 30 minutes so he called our midwife, who talked to me briefly then listened on the phone for about 15 minutes to assess what stage of labor I was in.

My husband asked, "Is there anything you want to tell Debbie?"

"Tell her to meet us at the hospital." I wasn't joking.

Our midwife arrived at 6 a.m. and her assistant soon after that. I was lying on the floor of the bathroom, holding onto a bathroom cabinet door my husband was sure I would tear from the hinges while I worked through contractions. I said I wanted to go to the hospital a couple more times, but my husband kept encouraging me through contractions.

I had taken two birth classes -one specifically for home birthers to know what was normal and what was not and all I learned in both classes went out the window while I was in active labor.

When my water broke at 7:05 a.m. because the baby's head was low in the birth canal, my midwife suggested that I move to the bed or the birth stool.

I crawled on my hands and knees toward my bedroom, feeling like a lumbering sea turtle, and stopped in the doorway for a contraction. It was then my midwife had trouble finding the fetal heart tone and ordered me on the bed. She was concerned the baby might be in distress, but she found a good, regular heart tone when I got on my bed.

With only 45 minutes of pushing, our healthy baby daughter arrived at 7:50 a.m. and was placed on my chest. My husband cut the umbilical cord and we reveled in this most amazing moment.

What every mother has told me about labor is true: when the baby arrives, the pain stops.

I was relieved and in disbelief - first, that this precious person was finally here and on her due date no less and, secondly, that I had turned myself over to nature and gotten through a monumental physical, mental and spiritual event.

Home birth, for my husband and me, was our first choice and remains so should we have another low-risk pregnancy. Home birth isn't for everyone. It takes great commitment and responsibility on the part of the mother from the beginning of the pregnancy through labor, as well as commitment from those around her. I physically and mentally prepared myself as best I could for the birthing experience.

In the end, I gave birth to much more than a baby. I completed a personal vision and have been greatly rewarded.

Shannon O'Lear is the business writer for the Daily Post.