lundi 8 décembre 2008

Baby, You’re Home

Baby, You’re Home
Liz Rubincam for The New York Times

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Published: November 12, 2008

SQUATTING in an inflatable pool in the open kitchen of her apartment in Astoria, Queens, a very pregnant Alecia White Scharback, nude except for a bathing suit top, groaned in pain. It was 7:30 a.m. on Nov. 1, and Mrs. Scharback, 29, an actress, had been in labor for more than 36 hours. The contractions had been only mildly painful at first, but had grown increasingly fierce as a second night gave way to morning.

At the height of one contraction, Mrs. Scharback closed her eyes, bent forward and rocked her hips back and forth. “It hurts, it hurts, it hurts,” she moaned. Using a stainless steel refrigerator to steady herself, she vomited. Joshua Scharback, her husband, rushed to her side and gently stroked her head.

Mrs. Scharback was giving birth at home because she did not want any medical interventions in the process unless she needed them, she said. But after another four hours, she was beginning to doubt whether she could make it and was pleading with her midwife, Miriam Schwarzschild, for relief. “Oh, Miriam,” she whimpered, “I can’t.” Ms. Schwarzschild reassured her client: “You can. And whenever you’re ready, you can start to push.”

Home births have been around as long as humans, but since the 1950s, the overwhelming majority of American women have chosen to give birth in hospitals, which the American College of Obstetricians and Gynecologists identifies as one of the safest places for the unpredictable and sometimes dangerous process of childbirth. (The group has officially opposed home births since 1975, and this year the American Medical Association adopted a similar position.)

Recently, though, midwives and childbirth educators say, a growing number of women have been opting instead for the more intimate and familiar surroundings of home — even in New York City, where homes are typically cramped warrens of a few hundred square feet and neighbors often live close enough to hear every sneeze and footstep.

Births in New York’s hospitals, where pediatricians are able to check babies immediately for potentially dangerous conditions, it should be noted, still vastly outnumber those in its homes — in 2006 home births accounted for only one-half of 1 percent of the city’s 125,506 reported births.

But local midwives say they have been swamped with calls and requests in recent months, in some cases increasing their workload from two, three or four deliveries a month to as many as 10. (New York health department statistics for this year will not be available until 2010.) Several certified nurse midwives who have home-birth-only practices said they had gotten so many more requests in recent months that they have begun referring pregnant women to midwives in Rockland County, Long Island and New Jersey.

Erica Lyon, the founder of Realbirth, a five-year-old childbirth education center with three locations in the city, said 20 percent of the 160 couples who take her classes each month are planning home births, twice as many as six months ago., one of the biggest online purveyors of birthing pools — deep inflatable tubs with a specially designed built-in seat and handles — said its sales have doubled since last year, with more than 20 percent of its customers in New York City;, another outlet, said it has sold more than twice as many pools this year as last, 25 percent of them to New Yorkers and Long Islanders.

Home birth professionals in New York City have been struck, several said, by the fact that the increase is coming not so much from the dyed-in-the-wool back-to-nature types as from professionals like lawyers and bankers. “People who wouldn’t naturally self-select for home birth are coming in and getting very open-minded,” said Cara Muhlhahn, a certified nurse midwife who has had a home-birth practice for 17 years and is now fully booked six months in advance.

One reason for the change, it seems, is “The Business of Being Born,” a documentary produced by the actress and former talk show host Ricki Lake, which ran in only a few theaters during its theatrical release in January but has become an underground hit among expectant parents since coming out on DVD. (Rentrak, a company that monitors DVD rentals, said that instead of dropping off, as typically happens with new releases, the film is being rented at consistent rates.)

With scenes of several home births (including one in which Ms. Lake delivers her second child in the bathtub of her former West Village apartment), the film argues that women’s bodies are perfectly well equipped to give birth at home and that the occasion need not be a medical event.

Many women are wary of hospital births, both because of a patient’s limited control over the process and because of the growing frequency of Caesarean sections (use of the procedure increased by 50 percent nationwide from 1996 to 2006, to nearly one in three births, according to the National Center for Health Statistics).

“The Business of Being Born” seems to offer an alternative, and “is putting home births on the map in a way that makes women feel like it’s a really legitimate option,” said Élan V. McAllister, founder of Choices in Childbirth, a four-year-old nonprofit educational group that publishes “The New York Guide to a Healthy Birth.” “In your home you’re able to move around and be in the tub or in the shower. You’re able to eat and behave in a natural, more normal way. If you believe birth is not a medical emergency, it is the ideal place because it’s the place you can really let go and follow what your body wants you to do.”

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