Nurse-Midwives Deliver Babies in Comfort of Home

Victoria Luskin never was one to run to the doctor for every little thing. It’s the way she was raised, said the 35-year-old insurance agent.

As a child, when she got the measles or came down with a cold, her mother kept her home until she was well. Luskin didn’t even see a doctor when she was born. Her mother gave birth to her at home.

So now that Luskin is pregnant, she doesn’t plan to deliver her baby in a hospital. Instead, she and her husband, Greg, are preparing to have their baby in their Sunland home. With them will be a certified nurse-midwife from Home Birth Service, a Studio City nurse-midwifery practice, which also provides Luskin with prenatal care.

“I didn’t want to be in a hospital,” Luskin said. “Midwives consider birth a natural event. Their job is to deliver a child, not to give me drugs or hook me up to an IV.”

The acceptance of nurse-midwives has increased dramatically over the past two decades, according to the American College of Nurse-Midwives, the professional organization that accredits nurse-midwives and their educational programs. In 1963, only about 275 certified nurse-midwives were in practice. Today, almost 4,000 nurse-midwives practice throughout the United States, with more than 400 in California. Nurse-midwives attended almost 100,000 hospital deliveries in 1987--a 500% increase over 1975.

Only about 4% of births attended by nurse-midwives take place in the home. Home Birth Service is one of a tiny handful of midwifery services in Southern California and is the only state licensed nurse-midwifery practice in the San Fernando Valley offering women the opportunity to deliver at home. The service is licensed by the state Board of Registered Nursing.

“I have a strong conviction that women should have this option,” said Home Birth’s owner, certified nurse-midwife Deborah Frank.

In its 12 years of business, Frank’s practice has delivered more than 1,000 babies and averages about 10 births a month. “We have had the pleasure of attending as many as five births for one family,” she said.

The other certified nurse-midwives on the staff at Home Birth Service are Leslie Stewart and Barbara Pigeon. “Our practice is distinctly different from the traditional OB-GYN medical practice,” Frank said.

“When clients first come to us, we spend an hour and a half or more with them, and at least a half-hour on return visits. Most of that time is spent answering questions, providing information and getting to know them.”

Clients say they appreciate this. “There was a personal level to the visits that I didn’t experience with an OB,” said Martha Johnston, a 35-year-old movie set designer. “They sit and talk with me, and I feel like I am friends with them.”

When her oldest daughter, 6-year-old Reed, was born, Johnston said that she didn’t feel like climbing into a car and going for a drive to the hospital “just when labor started to get serious,” nor did she like being made bedridden by a fetal monitor. “They wouldn’t even let me up to go to the bathroom,” she said.

Her second child, Emma, 3, was born at home. “Midwives allow you to have your birth the way you want it,” she said. “I was up and walking around until the last hour and a half. I could eat and drink.”

Johnston had planned to have her third child at home as well, but due to complications late in her pregnancy, she was transferred to a hospital, where her youngest daughter was delivered Oct. 17 by Cesarean section.

“We don’t take chances,” Frank said. “We have no qualms about transferring patients who need more medical care than we can provide.”

About 7% of her clients are transferred, as Johnston was, to a physician’s care during pregnancy, and another 7% are sent to a hospital during labor, Frank said, adding that the service has never lost a mother or baby during delivery.

Home Birth Service specializes in normal, natural childbirth and prenatal, postpartum and gynecological care for healthy women. Women with medical problems such as high blood pressure, heart disease, diabetes or any condition that puts them at risk for a complicated pregnancy are not accepted. Nurse-midwives do not use forceps or vacuum extraction during delivery, and do not administer pain-killing drugs during labor. Expectant parents promise to attend childbirth classes, eat right, exercise regularly and abstain from tobacco, drugs and alcohol.

“We end up with the cream of the crop,” Frank said.

Home Birth Service charges a fee of $2,700, which includes regular prenatal checkups, patient education, delivery and several postpartum checkups for mother and infant. Laboratory fees and any physician fees are extra. According to Frank, nurse-midwifery services are covered by most insurance carriers.

During pregnancy, patients meet with a board-certified obstetrician-gynecologist for evaluation, consultation and medical exams such as ultrasound or amniocentesis. Back-up physicians are also available if complications develop.

Paul Crane, a Beverly Hills obstetrician-gynecologist on the staff at Cedars-Sinai Medical Center, is a Home Birth Service backup physician. “Nurse-midwives are probably trained in normal births as well as most OBs,” he said.

However, he said, “unforeseen problems can develop where it would be advantageous to be in a hospital. I am not an alarmist, but I feel it is my responsibility to discuss with patients the goods and bads of home births. I point out the potential hazards of out-of-hospital births to make them aware.”

Myra Levinson, an obstetrician-gynecologist on the staff at Valley Presbyterian Hospital in Van Nuys, frowns at the idea of home births. “It is when you need to do something emergent that you will wish you were in a hospital,” she said. “I am looking from a standpoint of disasters that can happen, and I have seen too many that do happen at a moment’s notice. Everything can be going fine, and all of a sudden the heart rate drops for no reason. It’s enough to take 10 years off your life.

“If something like that happens in a home birth, the extra time involved transporting can be the difference whether or not that baby will be brain-damaged,” she said.

Nurse-midwives bring emergency equipment, including oxygen, intravenous fluids, medications for hemorrhage and resuscitation equipment to the expectant parents’ home. Other supplies--such as disposable sheets, gloves, syringes and sponges--are provided to the mother in a “birth kit,” kept ready for use. “But we make it real clear that in no way is this equivalent to what is available in a hospital,” Frank said.

“In very unusual circumstances we might not be able to provide care as well as can be provided in a hospital,” Leslie Stewart said. “But the chances of that happening are very, very small and have to be weighed against problems that can be precipitated in a hospital.” She said that some hospital practices--such as breaking the amniotic sac or administering drugs to stimulate labor--increase risks to mother and baby.

“To me, home birth is safer,” said Susan Alward, a nurse-midwife on the staff at Los Angeles County Women’s Hospital. She had home births for both of her daughters, Emma, age 2, and Lily, born Aug. 18. “If you walk in a hospital, they do all these invasive procedures. OBs tend to be into science and technology. They are likely to slap on a monitor, to augment labor that is going a little slow, to hook up an IV. Even an IV can cause an infection.”

Nurse-midwives say such procedures increase the likelihood of Cesarean delivery. Home Birth’s C-section rate is 2%, Frank said. The national average is close to 25%, according to the National Center for Health Statistics.

“That scared me. I didn’t want a C-section and I didn’t want an episiotomy,” said Mona Balogh, a 33-year-old emergency physician at Kaiser Hospital in Woodland Hills. Balogh discussed her plans for home birth with an obstetrician, who discouraged the idea.

“She told me she was worried,” Balogh said. “I must admit, before I talked to friends who had babies at home--one woman had all three of her sons at home and had a wonderful experience--I was worried as well. It upset me, having a medical background.”

Her home delivery, assisted by Barbara Pigeon, went beautifully, Balogh said. “The nicest part was I was in a calm environment. I walked in my back yard, I paced up and down stairs, I drank fruit juice and hot tea. Barbara made these recommendations to make it more comfortable, to make things go faster. It was a very natural process.”

Pigeon stayed with Balogh and her husband, Andre, for the next 12 hours while Balogh was in labor. “She cared for me, examined me, monitored me and was very patient and encouraging,” Balogh said.

She added: “Of course, a doctor can’t spend 12 hours with a patient. In a hospital I would have been on a fetal monitor the whole time, lying flat on my back and on an IV. I would have been immobile, which would have hindered my labor. It would have been a much worse experience.”

The Baloghs’ daughter, Csilla, was born June 13, weighing in at 7 pounds, 12 ounces. “Being at home was that much more special,” Mona Balogh said. “Being in a hospital is theoretically less risky, but being at home is the ideal. In retrospect, it was the best way to go.”