When baby Abigail Snell came home, she was simply carried across the lawn.

Abigail, called Abi, was born May 24 at her grandparents’ home in Red Bank. Her parents, Laura and Ben Snell, live in a small house on Mrs. Snell’s parents’ property.

First-time parents, Mr. and Mrs. Snell chose home birth after deciding against using an obstetrician.

“I had been prescribed some hormones and was just doing research,” Mrs. Snell said. “It was interesting to find how common (hormone treatment) was, and I wasn’t really comfortable with it. I was looking for more natural options.”

During the seven-plus hours of home labor, Mr. Snell acted as support and advocate for his wife, massaging her back and being prepared to eject family members from the room if she wished.

“She was beautiful the whole time,” Mr. Snell said.

“When I look at (Abigail), I don’t remember the pain,” Mrs. Snell said.

During her pregnancy, birth and postnatal care, Mrs. Snell was cared for by midwife Carolyn Drake. Ms. Drake, a Tennessee-licensed certified professional midwife, said she emphasizes the individuality of the birthing process.

“Every woman is different,” she said. “You can’t say ‘this is what a woman is going to do.’”

CELEBRITY BIRTHS

In 2005, the Centers for Disease Control and Prevention reported the United States has the lowest percent rate of midwife-attended births in developed countries (7.4). Only 1.3 percent of U.S. births took place at home.

According to the documentary “The Business of Being Born,” fewer than 8 percent of births in the United States are midwife-attended, compared to more than 70 percent in Europe and Japan.

On Feb. 8 the American College of Obstetrics and Gynecology released a statement on home births.

“While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning, even among women with low-risk pregnancies,” the statement reads.

It goes on to warn women not to let their childbirth decisions be influenced by celebrities. Singer Charlotte Church, actress Joely Fischer and actress Ricki Lake, who is the producer of “The Business of Being Born,” are among the celebrities who have opted for home births. Boxer Laila Ali, daughter of Muhammad Ali, reportedly plans to have a home birth with her first child, a son, in early autumn.

On the flip side, there is the practice of so-called “designer birth” — scheduled inductions, cesarean sections and immediate tummy tucks. Stars including Christina Aguilera, Elizabeth Hurley and Victoria “Posh Spice” Beckham have all been deemed “too posh to push.”

DOES C-SECTION STAND FOR CONVENIENCE?

As of 2005, U.S. C-section rates for low-risk pregnancies was at an all-time high of 30.3 percent, a 46 percent increase since 1996, according to the National Center for Health Statistics.

“For high-risk women needing surgeons to help them, hospitals are the best,” said Ms. Drake. “For low-risk women, the hospital is not always the best place.”

The American College of Obstetrics and Gynecology warns that attempting a vaginal birth after a cesarean section (called VBAC) is particularly dangerous because there is a greater risk of uterine rupture than with a first birth or in a woman who had previously delivered vaginally.

“There is a real additional risk involved in VBAC,” said certified professional midwife Claudia Conn, who said she rarely performs VBACs.

Scott Harnberger, a Chattanooga obstetrician and gynecologist, said he is absolutely against attempting VBAC at home, but is in favor of vaginal birth in a hospital setting, even after a cesarean.

In “The Business of Being Born,” Dr. Michael Brodman of New York’s Mt. Sinai Hospital said C-sections are doctor-friendly because of the convenience factor.

The United States has the second worst newborn death rate in the developed world (behind Latvia) and one of the highest maternal mortality rates of industrialized countries, according to a 2006 study by U.S.-based organization Save the Children.

According to a 2005 study by the British Medical Journal, North American planned home births, attended by certified professional midwives, have the same mortality rate as low-risk hospital births and involve less medical intervention, including episiotomies (a surgical incision through the perineum to enlarge the vagina during childbirth) and cesarean sections.

Currently, certified professional midwives (without a nursing degree) are illegal in 15 states, including Georgia, Alabama and North Carolina. CPMs can practice legally in the state of Tennessee, though not always easily, some say.

“The community in Chattanooga is not the friendliest to home-birth midwives,” Ms. Drake said. “There are some very good, sympathetic doctors ... (who) can’t or won’t provide collaborative care with midwives here.

Several area physicians contacted by the Chattanooga Times Free Press declined to go on record with any statements supporting home birth for fear of alienating patients or colleagues.

THE MONEY FACTOR

The cost of birth can vary greatly, depending on facility, individual needs and insurance plans.

According to Pat Holloway, spokesperson for Parkridge Medical Center, the cost of hospital services for a normal vaginal delivery is about $4,000 and $4,300 for a cesarean section, before insurance claims are filed. This does not include anesthesia or physician fees. The amount a patient ultimately ends up paying is dependent on the individual insurance company.

Ms. Drake said her total cost, including prenatal visits, birth, postpartum and photos is $2300. However she estimates fewer than 10 percent of her clients are able to be reimbursed for their home births.

THE BIRTH EXPERIENCE

Sophie and Emma Fee-Corey climb around their mother, Rachel Fee-Prince, as she is examined by Ms. Conn. Ms. Fee-Prince is due at the end of July.

The 3-year-old twins take an active interest in the process. Sophie tries to climb over the belly, while Emma perches between her mother’s legs and listens with the stethoscope.

“It’s moving!” she exclaims.

The early part of the visit is akin to a therapy session, or even a conversation between friends. Ms. Fee-Prince talks to Ms. Conn about her life, marriage, motherhood and pregnancy. She says she feels emotional and sometimes frustrated.

“There are just a lot of things I can’t do. The belly gets in the way.”

“You tend to lose perspective in this day-to-day life in the fast lane,” Ms. Conn assures her. “This is the time for affirmation.”

Ms. Fee-Prince said in an interview that home birth felt like the only option for her. “I knew that hospitals were for sick people, and I wasn’t sick. I was pregnant.”

Home-birthing the first time around, she said, gave her the ability to bond with her babies immediately after birth, as well as to stay in control of her own birthing process.

“There is a misunderstanding that birth is inherently dangerous,” said Ms. Conn, who has been a midwife for nearly 30 years and is Tennessee licensed.

She said the quality of the birth experience has become very medicalized in the hospital setting.

“Birth is meant to be a very key experience in a woman’s life.”

She said safety issues can be addressed without overwhelming the personal and spiritual aspect of the birthing experience.

FEMINIST “MACHOISM”?

Both Ms. Drake and Ms. Conn work with families ahead of time to establish a birthing plan, including who will attend the birth and what roles they will play.

“In the hour that we spend with the woman (during prenatal visits), we are not rushing her through; we’re finding out what her needs are on many levels,” Ms. Drake said.

Dr. Michel Odent said in “The Business of Being Born” that the basic needs of women in labor, such as the ability to move around and position themselves as they choose, are being overlooked in hospital situations where interventions are frequent. Residents at New York’s Bellevue Hospital said in the documentary that they “almost never” see a natural birth.

Birthing plans include a transport plan, in the event that a woman needs to be taken to the hospital during labor.

Most transports, especially with first birth, are non-emergency situations in which the mother simply becomes tired from a long labor.

Dr. Harnsberger said: “Upwards of 60 percent (of low-risk birthing mothers) don’t need me.” The issue, he said, is that it is impossible to predict which 40 percent will require a medical intervention.

For midwives like Ms. Drake and Ms. Conn, the birthing process is a vital part of motherhood and the parent-child bond. Some medical professionals, including Dr. Harnsberger, see the process of birth as incidental to child rearing and lifelong bonding.

“I don’t view how the baby comes to be as important as how you’re going to raise the child,” he said.

One obstetrician in “The Business of Being Born” referred to natural birth as “feminist machoism,” the desire to be able to say, “I did it myself.”

THE PITOCIN PROBLEM

When Jessica Davenport, of Ooltewah, was pregnant with daughter Shelby in 2005, she always planning to have an epidural. But then: “I realized everything I put into my body would affect (the baby),” she said. She avoided all medications. “It just didn’t make sense to me when I was going through the birthing process to fill my body with drugs.”

Two weeks before her due date, Mrs. Davenport’s doctor informed her she needed to be induced the next day.

“She told me, ‘your baby might die if you don’t do this,’” Mrs. Davenport said. “So of course, when she puts it to you that way, what else can you do?”

The doctor gave very little explanation, she said, just told her to check into the hospital at 6. a.m. the next day. She was induced with Pitocin, which she said was basically ineffective over the next two days.

“When I was in the hospital,” said Mrs. Davenport, “I felt very out of control and scared into interventions.”

Pitocin, a synthetic hormone meant to simulate the effect of oxytocin, secreted during the birthing process, is a labor induction drug that increases and lengthens contractions. There is a higher possibility of fetal distress with pitocin use, sometimes leading to an emergency cesarean section, according to “The Business of Being Born” and the Federal Drug Administration.

After an artificial water-breaking and an episiotomy, Shelby Elaine Davenport was born.

“They put her on my chest for about two seconds, then they took her away,” Mrs. Davenport said.

During her next pregnancy, which ended in miscarriage, and into her next one, she researched birth options. She spoke to a friend who had had two home births.

Mrs. Davenport gave birth to daughter Sadie Margaret at her home on May 7, attended by Ms. Drake. She described the experience as “joyous.”

“I can’t really put it into words. It was everything I had hoped and prayed for in terms of having a birth,” she said. “I felt more in control. I didn’t feel overwhelmed. I trusted my body to do what it was supposed to do. I wasn’t fearful at all. I felt empowered and excited. Everyone there was there for me and what I needed. It was the way I had always wanted my birth to happen. ... It was just blissful, I guess.

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