Hospital births settings are the norm, but numbers are slowly rising on the number of natural child deliveries, especially in Indiana.
Out of hospital births were common in 1900, but by the 1970s most babies were born in hospitals, according to a report from the National Center for Health Statistics. But starting in 2004, U.S. women began paying more attention to home birth or birth center birth.
Now, Indiana is one of five states where out-of-hospital births account for between 2 and 3 percent of all births, higher than the national average, which is 1.36 percent.
There’s no clear indication why more Hoosiers are giving birth outside a hospital, although women in general are becoming more interested in birth centers and home births as information about child birth options is more readily available on the Internet, according to Kate Bauer at the American Association of Birth Centers.
“More and more women are realizing their options and realizing that they have a choice,” Bauer said.
Goshen Birth Center opened in 2007 and is on track to deliver a record 100 babies this year, according to Liz Gunden, the center’s administrative director. The focus at Goshen Birth Center is on treating child birth as a natural event, she said.
Many parents-to-be find the birth center through Internet searches about natural child birth and, specifically, water birth. Others find the birth center through recommendations from friends.
The center, at 1155 Lighthouse Lane, is nearby Fairhaven Obstetrics & Gynecology offices. Fairhaven midwives attend births at the birth center and even travel with the family to the nearby hospital if they need additional care.
When parents-to-be walk inside the birth center for a tour or orientation class, the first thing they see is the living room. The living room is pretty typical of what you’d see in a family home — there’s a TV, movie collection and fluffy beige carpet — but there are many more family photos displayed than even the most photogenic family could produce.
Every photo in the dozens of frames shows a tired but pleased-looking mother clutching a baby who is clearly just hours old. Many of the photos also include the father and the couple’s other children, gathering around the family’s newest addition.
These are the families who have experienced birth at the birth center and allowed the center use of their photo. The babies are just hours old because families are required to leave the birth center just four to six hours after the baby is born. This is because it’s better for the mother and baby to rest in their own home after giving birth, midwives explain.
New mothers learn in pre-birth classes to call their midwife if they experience heavy bleeding or fever once they get home.
Midwives also do a home visit 24 hours after the birth and then again 48 hours after the birth, just to make sure things are going well.
Besides the living room, the birth center also has three bedrooms, each containing a regular, full-size bed — not a hospital bed — and an attached bathroom with large tub. There’s not much medical equipment in the room either.
During a birth, midwives monitor the baby with a Doppler device, the same device they use to monitor baby’s heartbeat during prenatal visits.
"The only beeping machines here are the bread machine and the doorbell; there are no monitors,” midwife Rachel Johns explained to parents attending a class at the center. “And that’s just fine for low-risk women.”
High-risk women, as defined by the birth center, are those who are smokers; have medical issues such as high blood pressure, diabetes or severe anemia; have a body mass index higher than 36 and are giving birth for the first time; those who are giving birth after a prior C-section and women who are less than 37 weeks or more than 42 weeks pregnant.
Women who meet those circumstances are required give birth at a hospital, because the birth center is not equipped to handle complications that could arise. However, a midwife can still attend their hospital birth.
For low-risk women, the midwife will provide support and encouragement during labor at the birth center.
Midwives encourage women into positions that are right for them during labor, and they also guide the woman’s partner in the best ways to help.
After the baby arrives, the midwife or the woman’s partner will use scissors and a few clamps to cut the baby’s umbilical cord.
They also encourage the mother during her first breastfeeding and help the mother and new baby spend some skin-to-skin time.
Midwives are also able to give the mother a few stitches if that’s needed.
Some women do begin labor at the birth center and transfer to the hospital later, for various reasons. This happened during 13 percent of the birth center’s births in 2013, according to Gunden.
“I don’t have a breakout of first-time moms versus the rest, but in general, it’s the first labor where the need arises for care that is best delivered in the hospital,” she elaborated. “The ‘transfer’ is by car and is not considered an emergency, and ... the attending midwife goes to the hospital and continues to provide care there.”
Even with the expected 100 births in 2014, Goshen Birth Center welcomes far fewer babies into the world than the nearby IU Health Goshen (1,200 births each year) and Elkhart General Hospital (between 1,500 and 1,600 births each year).
Still, out-of-hospital birth is a trend that will likely keep growing in popularity, Bauer thinks.
“It’s still such a small number of births in the United States, but it is growing,” she said. “Women are speaking up for their rights and preferences in child birth.”