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More moms choose to give birth at home
This is an archived article that was published on sltrib.com in 2008, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

If Samara Hines had health insurance, she'd deliver her baby in a hospital, away from the demands of her five other children and with help from nurses for the new little one.

But Hines' husband is self-employed and the family can't afford insurance or the estimated $6,000 hospital fees, plus the cost of a nurse-midwife and prenatal care. So in August, the Provo woman will deliver her baby at home, where it will cost $1,900 for everything.

Spending thousands of dollars is "excessive, considering birth is a natural thing," said her husband, Dane. With no history of pregnancy complications and no insurance, home birth is "the most reasonable way to go," he said.

Midwives say the same economic forces that have led consumers to stay home instead of shopping is hitting the birthing business, albeit on a small scale. Licensed home-based midwives say they are seeing a slight increase in interest in their practice, in part because of cost.

A hospital-based birth can run about $8,300. That includes the $6,000 average hospital charge in 2006, calculated by the state health department. Women who want a certified nurse-midwife to care for them and the baby add an average fee of about $2,350.

"The fact people are having a lot of financial troubles is causing people to look for alternatives," said Suzanne Smith, Hines' midwife, who is taking more calls from people who are uninsured or have high deductibles. "Once they look at it they say, 'This is actually a pretty good option and it costs me a lot less.'?"

Smith placed an advertisement in the magazine Healthy Utah , noting the cost of pregnancy and delivery could be as low as $1,000 with supervised midwife students, though the average home birth is a little less than $2,000. Smith also runs a one-room birthing suite -- with a fridge stocked with snacks, a jetted tub and queen-sized bed -- in Orem, called BellaNatal. A birth there costs $2,800, including the midwife's fee.

She said eight women a week are making initial consulting appointments, when the norm in December is three.

It costs $4,350 to deliver at the Birth and Family Place, a birth center in Holladay, including the provider fee. The percentage of women touring the center who say they are attracted by its price has spiked to about a third, according to medical director Rebecca McInnis. "I don't think it's been that high before," she said.

Ann Stuart, who's due in March, would give birth at home, even if she had insurance. The Springville mother has delivered three times in the hospital and once already at home.

"It was so nice just to be in my own surroundings, not have to worry about packing a hospital bag, just be where I could go get food when I wanted it," she said, noting this birth will cost $1,400 because a supervised student will be her attendant. "If I feel more comfortable going one way and it's cheaper, I'd much prefer spending less."

Delivering at home or in a birthing center only makes sense for certain women, midwives say, noting that cost is rarely the only factor. The women must be willing to forgo an epidural or Caesarean section and must able to cope with pain using alternative methods. They must be healthy and have low-risk pregnancies. And they have to weigh the risks and benefits to delivering outside of a hospital.

"You really should be where you feel safe, where you feel good," Smith said. "Nobody's going to go to the cheapest place when it comes to the life of their baby."

That's why even though Shara Sumnall wanted to deliver her son, Jackson, in Smith's less-expensive birthing suite, she ended up in the hospital on Dec. 19 when her labor wouldn't progress.

Sumnall, whose husband works on commission in the sputtering auto industry, has insurance but could have saved money paying out of pocket to deliver at BellaNatal. After 12 or 13 hours of labor, she was admitted to a hospital and tried an epidural and pitocin to move things along. When that didn't work, she had a Caesarean section.

Sumnall hasn't received the bill and is "trying not to stress about it right now. I'm just enjoying my baby. There's a certain level of hope things will pick up with the economy."

Besides the cost, midwives tout the amount of control women can have at home, including the ability to deliver in water or in various positions instead of prone in a bed.

Cost and control were important to Paula Williams, of Provo. She wanted a home birth with her second child after a natural birth in the hospital with her first. Like many women who choose home birth, the massage therapist was dissatisfied with her hospital birth, particularly the rushed delivery of the placenta. She said she was so tired she didn't want to hold her baby.

The price tipped the scale in favor of birthing at home, because Williams doesn't have insurance. In late November, she delivered her son in a tub in her parents' house in Highland. She showered soon after the delivery and was in bed with her husband that night.

"It was a lot better experience. I got to do it my way," she said. "I will be doing it again, not just because of the money."

Birth centers face legal hurdles

In a state with the nation's highest fertility rate, Utah has just two licensed birth centers: One in Hildale, home to members of a polygamous sect, and another in Holladay called the Birth and Family Place. A group of midwives wants to change state rules they say make it impossible to open more.

The state Department of Health requires centers to have a written transfer agreement with a hospital in case of an emergency.

"You're asking your direct competitor for permission to practice. … It doesn't make a whole lot of sense," said Rebecca McInnis, medical director of the Holladay birthing center. It has an agreement with its former owner, University Hospital.

The midwives would prefer requiring birthing centers to have a transfer plan, but not permission in advance.

Keith Tintle, CEO of Timpanogos Regional Hospital, said that wouldn't be safe for patients, according to minutes of a health department committee convened to look at birthing centers.

The health department also requires a physician or certified nurse midwife to attend the birth, excluding home-based midwives who are licensed by the state. Home-based midwives would like to be included as well.

The health department's Health Facilities Committee could decide what to do in February.

At least one midwife has found a way around the rules by opening a one-room birthing suite, which doesn't require a license.

Heather May

Birth centers face legal hurdles

In a state with the nation's highest fertility rate, Utah has just two licensed birth centers: One in Hildale, home to members of a polygamous sect, and another in Holladay called the Birth and Family Place. A group of midwives wants to change state rules they say make it impossible to open more.

The state Department of Health requires centers to have a written transfer agreement with a hospital in case of an emergency.

"You're asking your direct competitor for permission to practice. … It doesn't make a whole lot of sense," said Rebecca McInnis, medical director of the Holladay birthing center. It has an agreement with its former owner, University Hospital.

The midwives would prefer requiring birthing centers to have a transfer plan, but not permission in advance.

Keith Tintle, CEO of Timpanogos Regional Hospital, said that wouldn't be safe for patients, according to minutes of a health department committee convened to look at birthing centers.

The health department also requires a physician or certified nurse midwife to attend the birth, excluding home-based midwives who are licensed by the state. Home-based midwives would like to be included as well.

The health department's Health Facilities Committee could decide what to do in February.

At least one midwife has found a way around the rules: opening a one-room birthing suite, which doesn't require a license.

Heather May

Too pricey » Many cite economic factors when deciding not to deliver in a hospital.
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