GRAND JUNCTION, Colo. - Ashley Carver described the home birth of her son Evan six months ago as "calm and peaceful." Her husband Jared and a doula (childbirth assistant) were present throughout the night while Carver breathed through her labor pains. When the contractions intensified in the wee hours of the morning, registered midwife Brenda Ramler was called to the home. She was only minutes away.Until last year, Grand Valley women who planned home births were forced to rely on out-of-town midwives, who would drive an hour or more to attend the birth.Ramler, a longtime licensed California midwife, moved to Grand Junction with her husband, Tom, in 2010. In April, Ramler became registered in Colorado and has delivered four babies in the valley since then. Through word-of-mouth, she has seven pregnant clients due in 2012.Ramler, 56, remains licensed in California where she spent two months last year, so she could attend the births of two family members."I delivered my nephew, Scott, and his wife's baby. I had delivered him 26 years ago," Ramler said. She also assisted at her niece's recent home birth - a niece she delivered 28 years ago."I was catching babies of babies," Ramler said. "That's why I went. I was honored they asked me to do that."Ramler hired an out-of-town midwife to come to Grand Junction to provide prenatal care in her place while she was in California. EDUCATION KEYRambler fell in love with birth after her first child was born in 1978 at a California birthing center, two hours away from her home. Her second child was born at home."I had such a good experience I became a childbirth educator; then I was trained by a nurse-midwife to be a labor-sitter (or doula); it slowly evolved into midwifery," Ramler said. Ramler apprenticed with a dozen different midwives over the years, and also studied at the Maternity Center at El Paso with renowned midwife Shari Daniels. Ramler became licensed in California in 1993, by the California Medical Board. She's delivered more than 600 babies at home in San Bernardino and Riverside County, and later San Luis Obispo County.Education is key to a positive birth experience, said Ramler, and she requires her clients to learn everything they can about normal birth and how to facilitate the natural process, as well as recognizing potential complications that can arise. Clients attend regular childbirth preparation classes, and a class taught by Ramler on emergencies and complications.Ramler also requires clients to breastfeed their babies because it's "healthier for mom," and baby, she said.CHILDBIRTH 'NOT A SICKNESS'Leah Speight of Grand Junction said she and her husband discussed home birth before they were even married. Now she's pregnant and planning a water birth at home for their first baby due Feb. 14. Prenatal visits with Ramler are not rushed, "in-depth and encouraging," Speight, 23, said."Almost every time we visit it's an hour or more. She answers all my questions every time," Speight said. Speight said she is choosing home birth so she can be in her own environment, be free to move around, and be surrounded by people she knows well.She said she'd rather deal with the pain of contractions by relaxing in a birthing tub of warm water, than get an epidural, a form of anesthesia involving injections into an area around the spinal cord in the lower back."I feel like my body's going to be more relaxed being in my own environment, and safer not having unnecessary interventions," Speight said. Pain medications are not an option at home births where women and midwives instead rely on walking and changing positions, immersion in water, concentrating on deep breathing and other conscious relaxation methods for dealing with labor discomfort. Carver and her husband started researching home birth after the birth of their second daughter in the hospital. "The hospital births were fine, but we decided home birth was right for us. We trusted birth to unfold as intended," Carver said. "The home birth was amazing. There's no comparison."Even being as natural as possible the hospital still had that medical feel," she said. "Birth is not a sickness."FEWER INTERVENTIONSA report published in the British Medical Journal Online in March 2010, "Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America," found that planned home birth for low risk women in North America who used certified professional midwives was associated with lower rates of medical intervention and were as safe as low risk hospital births in the U.S. Numerous studies have taken place in Canada and the Netherlands that support the safety of home births among low-risk women. The American College of Obstetricians and Gynecologists have long opposed home births, however.Ramler screens her clients for diabetes, bleeding disorders, heart conditions, AIDS and other high-risk factors - women considered high risk are not eligible for a home birth. A woman who wants a vaginal birth after cesarean (VBAC) can give birth at home, with proper screening. Even with careful screening there are times when a woman planning a home birth must be transferred during labor to the hospital. Failure to progress is the most common reason for transport, said Ramler, who's transfer rate is about 10 percent. When hospital transport is necessary, Ramler remains with the woman in the hospital to offer support. Her clients' cesarean rate is 2-3 percent, she said.Ramler works with an assistant and said she never intentionally tends births alone. Last week, Ramler started teaching a 14-week professional midwifery assistant course to six students, each one sponsored by a Western Slope midwife. The sponsoring midwife commits to providing clinical experience so students can observe a number of births, and gain experience assisting another certified professional midwifery assistant. Students must also pass a written exam, and be a certified childbirth educator from an approved program. POSTPARTUMAfter a home birth, Ramler examines the baby at the bedside, and stays until she's confident that mother and newborn are fine. While the mother showers, the midwife or doula remakes the bed with fresh, clean sheets. Someone usually prepares a meal for the typically famished mother while she is tucked into bed with her newborn. Ramler returns for two home visits during that first week, the first one within 24-48 hours. The second post-natal visit occurs within five to seven days, and then she sees the mother again in two or three weeks. The final exam takes place six or eight weeks later. Carver said with home birth "you spend much more time getting to know your care provider than in the hospital. With my first I didn't know home birth was an option. I wish I had."
BellyTalk is a monthly guest speaker and discussion series on topics of interest to pregnant women and their partners, and those considering pregnancy. Grandparents, birth professionals, and anyone interested in birth are encouraged to attend. "Creating Your Ultimate Birth Experience" is the topic for Jan. 28 to be held at The Art Center from 1-3 p.m.It's important for women to understand their options when it comes to giving birth, say organizers.Guest speakers at January's BellyTalk include those who have had a home birth, a natural birth in the hospital, a birth with an epidural, and one who elected to have a cesarean birth.BellyTalk was started by BirthSmart, a "Colorado nonprofit dedicated to empowered birth through education." BellyTalk will meet monthly in 2012 to discuss various topics such as "Choosing Your Birth Advisor," "Painless Birth," "Pregnancy Nutrition and Exercise," and the "Art of Birth."Pabst, who has given birth both at home and in the hospital, founded BirthSmart in 2008, to advocate empowered birth through education.-------------------------------GO&DOWHAT: "Creating Your Ultimate Birth Experience" - BellyTalk guest speaker and discussion series WHEN: 1-3 p.m. Sat., Jan. 28WHERE: The Art Center, 1803 N. Seventh St.COST: $15 pregnant mama and partner; $15 birth professional; $10 general admissionINFO: Tickets available at www.BirthSmart.org; Colorado Baby, 117 N. Sixth St., and at Kairos Children's Boutique, 533 Main St. A limited number of free tickets for pregnant and pre-pregnant mamas are available at Mesa Midwives, 2525 N. Eighth St., Ste. 108. Scholarship tickets are available in limited quantities; birth professionals can attend free by volunteering or sponsoring the event. Details are available at www.BirthSmart.org.