Home births a part of rural reality, debate on safety continues


The house was small.

Two windows flanked the front door that anchored a petite white porch. It would look like any other ordinary house except for the brightly colored twists and turns that gave way to flower buds painted on the porch pillars, around the door and around the windows.

While it sits empty now, in the 1970s, the little house near the post office was full of life—literally.

“When I went to Cottage Grove, it was with the idea of being a country doctor and that included things like home birth,” said Dr. Tom Duncan. Duncan founded the Birth Home in Cottage Grove in 1975 as an alternative to the city’s hospital maternity ward. But 44 years later, both the Birth Home and the hospital have stopped welcoming babies. In fact, the only way to have a baby in the city limits of Cottage Grove is to purposefully give birth at home or accidentally give birth on the freeway on the way to Eugene or Springfield—the cities closest to Cottage Grove that offer a maternity ward.

According to local administration at PeaceHealth, the hospital’s decision not to include a maternity ward when it was being conceived is a monetary decision—it costs money to adhere to the strict standards of welcoming new life. The hospital, does, however, have the ability to deliver a child if a mother cannot make it to a hospital outside the city or transport the mother in labor via ambulance. However, a child has not been born in the hospital because their mother couldn’t make it for at least a decade.

Jody Rolnick’s child wasn’t born at the Cottage Grove Hospital either.

“I don’t like medical things,” she said. Rolnick, the previous publisher for The Sentinel, wrote about her birth experience for the paper more than 20 years ago.

When her daughter Phoebe was born in 1998, it was in a pool of water—a 150 gallon Rubbermaid horse trough. Rolnick, who suffers from a fear of hospitals, had settled on a home birth but, not quite yet the water until closer to her delivery date. And while she and her midwife Chris Heritage had a practice run at the Cottage Grove Hospital, when the time to have the baby grew closer, they were unable to complete their birth plan there. Rolnick says it may have had to do with insurance but eventually she landed in a bedroom of her home, in a trough, giving birth.

In 2016, 20 years after Phoebe was born, Amy Tuteur wrote for the New York Times, “Why is American Home Birth So Dangerous?” At the time, home births accounted for two percent of births in the developed world. In the Netherlands, the number is much higher at 16 percent. At the time, Oregon provided the best data in the nation for a side-by-side comparison for home births versus hospital births because in 2012, the state began requiring that birth and death certificates include where the birth took place and who attended the birth. The stats were grim placing the death rate for home births that year at seven times the rate of hospital births. But it also showed a difference in the attendants.

Midwife, doula, nurse wife. There is a lot of language surrounding individuals who advertise themselves as guides for homebirths. And around the country, those titles come with different certifications and definitions with one constant: a certified nurse midwife are trained and must have a degree in midwifery as well as training from a hospital. Certified professional midwives do not have to have the same certifications. In 2010, they had double the mortality rate at births they attended. The statistics, then, shifted when dependent, not on where a child was born, but the care the mother received and the certification of the professional present at the birth. However, women are dying across the board in childbirth regardless of where they give birth.

According to a 2018 study, the U.S. has the highest maternal mortality rate in the developed world; and it’s the only developed country where the rate of women dying from pregnancy related complications is rising. The group most affected are African-American women while a study published in Obstetrics and Gynecology showed that 700 women a day die immediately before, during or after child birth due to complications and the reasons range from hospital protocols that fail to deal with potentially fatal complications to allowing for treatable complications to become fatal. A 2017 report published jointly by NPR and ProPublica noted that some doctors in the United States were able to complete their maternal-fetal medicinal training without ever spending time in a labor-delivery unit.

“There are risks at both,” Duncan said of homebirths and hospital births. “Some hospitals have gotten lazy, rushing to get the next baby,” he said. “In 1975, women would lie in a room and labor until it was time to have the baby and then they were wheeled on a gurney into the delivery room which was basically an operating room and strapped down on their back and pushed the baby out while lying on their back. A lot of women didn’t like that.”

So, when Duncan got to Cottage Grove, he founded the Birth Home and allowed women to labor naturally without being constrained. “It doesn’t matter if the baby comes when the mother is on her back or is on her hands and knees or squatting, it doesn’t cause any extra danger to the baby,” he said.

“Well, Tom, he was the only doctor south of Portland who was letting the fathers into the delivery room,” said Gail Hoelzle, owner of a Main Street business who also gave birth to her children in Cottage Grove.

“Your husband couldn’t come in the delivery room,” Duncan said of many area hospitals at the time. “And if you had a c-section, everyone was kept out in the lobby until everything was over.”

In places like Cottage Grove and those that are even more rural in design like Drain and Yoncalla, home birthing is an alternative to driving miles and miles to the nearest hospital.

“30 years before the home birth movement started up again, there were a lot of babies born in houses because the population in those areas was fairly small and spread out,” Duncan said. “So there were a lot of birthing facilities scattered around the valley but by 1955, they were kind of shut down.”

As the natural birth movement grows, so does the debate over home births. A 2015 study published by the New England Journal of Medicine analyzed 80,000 pregnancies in the state of Oregon and found that home births were 2.4 times as likely to end with the death of the child. However, home births showed to be less likely to result in a c-section and mothers had fever augmentations to labor as well as fewer lacerations.

For Rolnick, it was about choice and comfort. But she also did her research and found a certified professional to help her in her home birth journey. For other women, the hospital—even if it’s 30 minutes away—is the right choice for them.

“The argument,” Duncan said, “about home births has gone on ever since 1975 and before when the home birthing resurfaced and it will probably continue.”


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