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Being Born in the Ozarks: Homebirths and Midwifery or Hospital Births and Obstetricians?

Debbie Smithey, CPM/credit: Debbie Smithey
Debbie Smithey, CPM/credit: Debbie Smithey

When a woman becomes pregnant, traditional thought and custom has led them to the hospital, under the care of doctors and nurses, for nine months until a baby is born. But some women choose a different route: a homebirth with the help of a midwife. KSMU’s Samuel Crowe has this report on one Ozarks midwife and her clients, and why others choose to stay with a hospital. 


[SOUND: Entering home]

Inside the Springfield home of Michael and Stephanie Sparlin is a new addition to their family: seven-week-old baby Emmy.

[SOUND: Baby noises]

Like so many other newborns, Emmy is a healthy, normal baby. But Emmy wasn’t born in a hospital. She was born in her parents’ family room, with the help of a midwife. Stephanie says she’d wanted a homebirth well before she met her husband.

“I worked in the healthcare field for several years at a hospital in town. I loved it, I loved taking care of people, but I kind of found through that process that I was a terrible patient. So I couldn’t have imagined having a birth in the hospital, going through something that big and life changing,” Sparlin said.

Michael, however, was a bit leery at first.

“I was raised pretty traditionally, you know I was born in the hospital. I was opposed because I thought it was a higher risk. I didn’t know much about it. I didn’t know the level of care that we were going to receive with a midwife as opposed to a doctor,” Michael said.

So for the first three months the young couple went to a local OBGYN for pre-natal care, with each meeting lasting no more than ten minutes.

 “And it was always as he was walking out the door, ‘Do you have any questions?’ As first time parents, we don’t know what to ask, we wouldn’t have any idea where to begin,” Sparlin said.

So after those first three months, they made the switch and left their pre-natal care in the hands of Springfield Certified Professional Midwife Debbie Smithey. Smithey was part of a team of women who lobbied in Jefferson City and helped legalize midwifery in 2008. A former president of the Missouri Midwives Association, she says the previous law, which made practicing midwifery a felony, was one of the worst in the nation. After all, she says midwives have been helping women give birth since the beginning of time, long before any laws were put into place.

She says many couples are choosing the midwife route because they get to call the shots and be responsible for their own pregnancy. She says that’s control they can’t get at a hospital with an obstetrician.

“A lot of the times what they want is no drugs and no medicine. They want their own body to do the work, and they don’t want to be forced to lay down with their feet up. They want to be able to be in any position they want, in their own homes, eating their own food, that kind of thing,” Smithey said.

And they want more personal and in-depth prenatal checkups, according to Smithey. She says she meets with expecting moms at her office every three weeks until they’re 28 weeks pregnant, when she meets with them every two. During each hour-long checkup, she checks a woman’s blood pressure and pulse. She also does a urine analysis, she measures the baby and listens to its heartbeat using a fetus scope and a battery powered Doppler. She also talks to the mother about her diet, and says she takes time to ask about any fears or concerns the couple may have.

Early in every pregnancy, Smithey and the family formulate a backup emergency medical plan – what to do if they need to go to the hospital, how to get there and the quickest route. 

At the 36-week mark, Smithey conducts her checkups inside the mother’s home. There, she gets a feel for the home environment and makes sure the mother has all the necessary supplies for birth.

Stephanie Sparlin says one of the biggest selling points for a homebirth is, well, the birth itself – all-natural and what she calls empowering, without the use of epidurals, which relieve pain, or Pitocin, which helps induce labor.

When you go back to your primal instincts, when that intense labor kicks in, I wasn’t thinking about anything. My body just took over. I’m a fairly quiet person by nature, but there was just nothing quiet about that,” Stephanie Sparlin said.

Sparlin says for her and her husband, it was all about the process of having a child from start to finish, not just the end result. She says the care of the baby during pregnancy very much dictates the health of the baby at birth– something she says many women don’t consider when they find out they’re pregnant. 

“I feel like women have become so detached from their birth experience. It’s kind of become, ‘You get pregnant, you become a patient, and you completely submit to whatever the doctor tells you because they’re a doctor and they know what’s best,” Stephanie Sparlin said. 

According to Smithey, the statistics show that in low-risk births, a baby is just as likely to die in a hospital as it is during a planned homebirth.

“Statistically, it’s very reassuring, that you’re not any more at risk at home that you are at a hospital. But in society, if a baby is lost in a hospital, then it happens all the time. Then generally no one’s blamed the way that they are if a baby were to die at home. But it would be extremely rare for that to happen,” Smithey said.

But the risk of a pregnancy, or lack thereof, usually isn’t assured until labor, says Dr. Patricia Dix, an obstetrician at CoxSouth in Springfield. She says that of all the babies born with complications that could cause trauma and even death, 60 percent of the time, those complications aren’t identifiable until labor. And the Certified Professional Midwives, she says, are trained on the mechanics of baby delivery - but not the science.

“Quite frankly, any fireman can deliver a baby. Once the baby is coming, once the baby is crowned, delivery of the baby is reasonably straightforward unless there’s a problem.

And problems do occur, like the ones Scarlett Weis had when giving birth to her now eight-month-old son Raphael. She says she and her husband chose to go the hospital route because they felt it was the safest option.

“We know a lot of friends who’ve had complications with either the mother or child, or both, during delivery, and we just wanted to make sure that we had medical staff immediately present if anything were to occur,” Weis said.

During the birth, things did occur. Raphael was horizontal in her uterus during delivery, so the doctors broke her water and administered the Pitocin. Then, another setback.

“Raphael had his first bowel movement, the meconium, internally, which could be dangerous because while he was still in the amniotic fluid, could have aspirated the meconium into his lungs,” Weis said.

So when Raphael was born, a team from the Neonatal Intensive Care Unit took him away to make sure there was no thick, tarry meconium inside his lungs. The little guy survived, and today he is a happy and healthy.

According to Dix, the drugs commonly used during birth can be a big help to both mother and baby. Pitocin isn’t used just for labor induction; she says almost every woman in a hospital receives a dose after delivery to help the uterine muscle contract around the blood vessels that supplied the placenta. Dix says after a long delivery, uterine muscles are often tired and have trouble contracting, causing a uterus to bleed. This is known as atony, and she says uterine atony can occur after any labor. According to Dix, atony can cause a woman to lose 50 percent of her blood volume in minutes, and since a midwife doesn’t have access to medications like Pitocin, all a midwife can do to prevent the bleeding is to massage the uterus after birth – which Dix says isn’t always effective. 

And as for the epidurals? Dix says that in some cases during labor, a woman’s pain causes her body to tense up so much that it stops the progress of labor.

“She continues to contract, but her cervix does not continue to dilate, even though the passage is adequate, the baby is not too big. She could deliver that baby, but she is so tense, it has stopped the progress of labor. You give an epidural, she relaxes, 25 minutes later there’s a baby who’s well,” Dix said.

Dix says every woman has the option to refuse any sort of medical intervention inside the hospital, though she doesn’t recommend it. All that matters, she says, is that a woman is inside a hospital during labor – no substitute for a more personalized, intimate prenatal care offered by Certified Professional Midwives.

“No matter how normal a pregnancy’s been, labor and delivery may not be normal. Once that’s happened, it may be too late. Once it’s recognized for what it is, it may be too late. It isn’t the midwife who suffers from that, it’s the mother and potentially the baby,” Dix said.

For people like Debbie Smithey and Michael and Stephanie Sparlin, giving birth is safest where they feel the most comfortable- inside the home. But for obstetrician Dr. Patricia Dix, as well as Scarlett and Patrick Weis, it’s the unforeseen problems that can pop up during labor that steer them toward hospital births. But if there’s something both parties can agree on, it’s that the decision should be made solely by those responsible for the child.

For KSMU News, I’m Samuel Crowe.