Santa Cruz Good Times

Santa Cruz resident Prema Arhih has chosen a hospital birth because it is covered by her insurance. What’s driving some local women to choose home births?
Halfway through her first pregnancy, Doña Bumgarner made a bold move: she decided to give labor and deliver in her own home. Not only was she rising above common cultural fears about the safety of homebirth (what if the baby is breech, or not breathing? What if the mother hemorrhages?), she was choosing to undertake the toughest, messiest, most primal work a woman’s body can do—without monitors and painkillers at the ready.

Her choice was unorthodox even in rootsy Santa Cruz, where a landslide majority of births happen in hospitals. In the 11-year period charted by the County of Santa Cruz Health Services Agency’s 2010 report, a mere 2 percent of babies were born outside of a hospital—and that’s double the national average. The U.S. Centers for Disease Control and Prevention report that nationwide, the percentage of out-of-hospital births has remained about 1 percent for several decades.

To choose homebirth is to stand against a norm. What motivated Bumgarner’s choice? She was driven, at first, by dissatisfaction with her family practice doctor. She wanted holistic care that addressed her needs as a pregnant woman—her health, her emotions, and her questions as a first-time mom—rather than a myopic focus on the baby. “In birthing, there are two people involved,” Bumgarner says.

A graduate student in Green Business and a former project manager for Apple, Bumgarner took the initiative and put her research skills to work. She began by browsing the website for the Birth Network of Santa Cruz County, birthnet.org, which led her to Joscelyn Grote, a licensed midwife who attends homebirths. “We just clicked,” Bumgarner recalls. “Our first in-office meeting was two hours long, versus 15 minutes with my regular doctor. She included my partner Gary and gave us a lot of information.”

Her curiosity was quenched as every follow-up “topic appointment” provided in-depth information and personalized care. “Joscelyn talked about pros and cons, and gave us research so we could make informed decisions,” says Bumgarner. “She gave advice but said, ‘You need to make your own decision.’”

Homebirth midwives tend to the essentials by checking the baby’s heartbeat and examining the mom. They can refer a woman for a genetic screening, ultrasounds, and diagnostics. And they often dig deeper—getting to know the mom’s support system, making nutritional and herbal recommendations, and being on-call 24/7 during pregnancy.

Midwives are on staff at local hospitals, meaning a woman can have a midwife as well as constant high-tech monitoring, painkillers, and OB-GYN care all provided in the same place. Yet, some women feel hospital births involve unnecessary interventions and prefer to labor at home as a result. “Lots of moms’ lives get saved because of surgical interventions and technology,” acknowledges Bumgarner, adding,“[But] in the hospital process there’s Step A, and Step B, and Step C, and if your body doesn’t conform to those steps, they suggest, ‘Maybe you’d like to try this painkiller.’ When you’re in labor, you’re really vulnerable to suggestions, instead of being empowered to say, ‘Here are some other things I could try instead of Pitocin.’”

Cost is another primary consideration when it comes to deciding between a home or hospital birth. An entire home birth package—from prenatal to after-birth care—totals about $4,500, which may or may not be covered by insurance. Sutter Hospital’s perinatal director Jackie Sterling explains that the cost of a hospital birth varies depending on the patient’s insurance coverage, and that the hospital offers a charity care program for patients who qualify.

Grote, Bumgarner’s midwife, believes a general lack of information and awareness leads many to be parents to see hospital births as the more economic option. “People research that new car that they buy, or their computer, or their hair care product,” says Grote, “but when it comes to birth, people have a kind of blind faith. I can’t tell you how many moms deliver at a hospital because they think their insurance is going to cover it, and they don’t know their plan, and their bill ends up being much higher than if they just cash paid for a homebirth.”

For many couples, public assistance can be a clutch factor. Santa Cruz resident Prema Arhin is eight months pregnant; she and her husband Kojo were both born at home and believe in natural childbirth. But they’ve chosen Sutter Hospital as their child’s birthplace for three reasons: it’s homey, with birthing tubs and made-to-order room service; it’s an alternative to their apartment; and, perhaps most important, Medi-Cal covers it.

Arhin feels that hospitals overuse interventions like epidurals and Cesarean sections and “influence women into making those decisions.” But Medi-Cal—which underwrote 51 percent of the county’s births in 2009—doesn’t pay for homebirth. Arhin plans to labor at home as long as possible before delivering at Sutter.

“Birth is going to bring us to our knees no matter what happens,” Grote says. “The integrity of the approach is the only thing we have control of. We’re safeguarding an approach where the woman can say, ‘I made that choice,’ as opposed to, ‘What just happened to me?’”

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