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While Leah Casarez was in labor with her fourth child, the Ottawa Lake woman walked around her neighborhood, did dishes, and got in and out of an inflatable birthing tub as needed.
Mrs. Casarez also went downstairs to talk with her certified nurse midwife, Linda Johnson, who stayed out of the way until the time came to deliver Oliver, who turned 1 in April.
"It was comforting -- it was nice to be able to know I was doing it myself," said Mrs. Casarez, who also has three older children with her husband, Carlos Casarez. "I didn't feel pressured like I had to have this baby in the next 20 minutes."
More women nationwide are having their children at home, although hospital births still dominate, according to a recent report from the National Center for Health Statistics.
The proportion of home births jumped 20 percent between 2004 and 2008, going from 0.56 percent of all births to 0.67 percent, the highest level since 1990, the report said. Of the nation's roughly 4.2 million births in 2008, home births totaled 28,357, and more than 61 percent of those babies were delivered by midwives, it said.
In Ohio, there were 1,053 home births in 2008, or 0.72 percent of the 148,592 total births, according to the Ohio Department of Health.
Michigan had an even higher proportion of home births in 2008 at 0.74 percent, or 901 of 121,231 total births, according to the Michigan Department of Community Health.
Certified nurse and other midwives, meanwhile, delivered 8.1 percent of Ohio babies in 2010 and 6 percent of Michigan babies in 2009, according to the latest statistics from both states.
Ms. Johnson, who assists pregnant women from Ohio and Michigan, has a birthing center in Bedford Township, Mother's Own Birth Center, which she opened in 2003. Although the majority of mothers in her care initially used the birthing center, that has changed in the last couple of years, and now 70 percent of them deliver at home, she said.
"They just feel more comfortable," Ms. Johnson said. "For some people, it means their kids don't have to get up in the middle of the night. They wake up, and there's a new baby."
Several mothers who used Ms. Johnson as a midwife said they wanted to follow natural childbirth methods, forgoing pain medications, induced labor, and other interventions. Each prenatal visit with Ms. Johnson lasts up to an hour, and the women she attends have low-risk pregnancies, she said.
Mrs. Casarez is among those who said they researched the risks associated with home births before deciding to go that route. Although Mrs. Casarez had a midwife for her first three births, two in a Miami birthing center and one in a Denver hospital, Oliver is the first of her children delivered at home.
"It was a lot more relaxing, and I think that helped with the pain," the Saline, Mich., native said.
Home births, however, are not for everyone.
Jen Thomason of Ypsilanti decided to have their fifth child at home with the help of Ms. Johnson. The midwife, however, did not make it to the birth of Cana, now 2, although in hindsight the Thomasons should have had her in the birthing center, said Mrs. Thomason, adding she is in a payment dispute with Mother's Own.
Her husband, Abel Thomason, and their doula, or birthing assistant, were at the birth, which turned out to be fine. Still, the Thomasons are expecting another child, and she is going to a hospital to deliver.
"There was about 20 seconds there where we had a purple baby who wasn't breathing, and that was enough to shake us into reality," Mrs. Thomason said.
She added: "You have to be really trusting of the people who are doing your birth."
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There are times, said Ms. Johnson, who is on track to deliver 50 babies this year, where she cannot make it to a birth, just as mothers who plan to go to a hospital end up not making it. If Ms. Johnson cannot make it, she advises parents to call 911 for assistance, she said.
Typically, health insurance pays $2,200 to $2,800 of Ms. Johnson's fee of $3,750, Ms. Johnson said.
The U.S. average for a vaginal birth with no complications in a hospital is $9,617, according to the latest statistics from Childbirth Connection.
Midwives also work in hospitals, where they are backed up by doctors if pregnancies or deliveries encounter complications. Toledo Hospital has 16 certified nurse midwives working in a practice called Certified Nurse Midwives of Toledo, which got its start in 1992.
Last year, the midwives delivered 561 babies, while the practice helped a total of 1,325.
Unlike at Mother's Own, most of the women who use the midwives at Toledo Hospital are not as concerned about using natural childbirth methods, a couple of the midwives said.
The Toledo Hospital midwives see pregnant women at the Toledo-Lucas County Health Department's two offices and elsewhere in the community, where they spend more time with women than a typical obstetrician/gynecologist, they said.
"We treat a lot of women who don't have private insurance," said Vickie Hill, one of the midwives at Toledo Hospital. "Sometimes women come to us when they're 37 weeks pregnant."
Some women prefer female midwives for religious reasons, or perhaps because they have a history of being abused, said Corinne Foley-Bojanic, another of the midwives.
The midwives would like to also have a birthing center, but ProMedica has not approved one, Ms. Hill said.
Heidi Swope of Toledo has had both of her children with midwives at birthing centers, the first in Texas and the second at Mother's Own. She and her husband, Anthony Swope, are expecting their third child on Dec. 31, and she plans to deliver again at Mother's Own.
"I've had nothing but joy with the birth of all my children with no regrets," said Mrs. Swope, who herself was one of five children born at home in Texas.
The main birthing room at Mother's Own has a bed, birthing tub, couch, chairs, and a kitchen area. There is a smaller birthing room that can be used if necessary, said Ms. Johnson, who contracts with five others to provide massage and other services.
If a mother decides she needs an epidural anesthesia, or if something about delivery becomes risky, Ms. Johnson will accompany her to a hospital, the midwife said.
That happened with Amelia Pillarelli of Monroe. She said she opted to go to Mercy St. Vincent Medical Center in Toledo after her water didn't break in a long labor with her daughter, Vittoria.
Ms. Johnson made house calls for a few weeks after Vittoria was born in September, 2010, and Mrs. Pillarelli said she would use a midwife again.
"I really would," she said. "I would do it again in a heartbeat."
Contact Julie M. McKinnon at: firstname.lastname@example.org or 419-724-6087.