home from the beginning: Emily Marynczak and her son
in the Living Room—and Under the Radar
many familes, giving birth at home feels safer and more comfortable
than the hospital. But to do that in the Capital Region, they
need to look underground for a midwife
Marynczak’s second child came at “banker’s hours.” Her labor
started around 3 PM, and Arlo was born just a few hours later,
an uncomplicated “VBAC” (vaginal birth after Caesarean section).
Wendy Kelly gave birth to her second child in a tub, called
a “water birth,” after about six hours of labor, half the
time of her first child’s birth. Caroline Sharkey labored
for 37 hours before giving birth to her son. After the birth,
her placenta wouldn’t deliver, and she needed surgery to remove
it. Phaedra Zoe Stasyshyn spent the whole afternoon she was
in labor in a rocking chair, and was so mellow that her mother
didn’t hurry to the birth, and arrived as it was much farther
along than she’d expected. Carolyn Keefe was hoping to have
a VBAC with her second daughter, but the baby kept shifting
into awkward positions, and eventually she needed another
c-section. Mara Afzali is pregnant with her fourth child.
Her first one came nearly two weeks late, but the birth went
Each birth is completely unique. But these six births do have
some things in common: They were all planned as home births,
their labors happened at home, and, except for Keefe’s, the
babies were all born at home.
There’s something else they have in common: If you ran into
one of these mothers or their partners on the street and asked
them who their midwives were, they wouldn’t tell you. In order
to have their babies at home in the Capital Region, these
families had to go underground for their health care.
Home birth is not illegal in New York state. However, to attend
home births legally, a licensed midwife needs to have a supervisory
agreement with a doctor’s practice or hospital that explicitly
allows her to do so. While there are a lot of midwives practicing
in the Capital Region, not a single doctor or hospital they
work for will allow them to catch babies at home. In Ithaca,
New York City or Rochester, families can find a few home-birth
midwives in the yellow pages. In Vermont, Massachusetts, or
Pennsylvania, home-birth midwives are easily available. But
here in the Capital Region, women who want to give birth at
home find their options very limited.
But they seek it out anyway. The most common themes in their
lists of reasons are the comfort of familiar surroundings,
control over the process and who is present, and freedom from
the restrictive rules and invasive practices of hospitals
that are often based more on liability and doctors’ convenience
that the realities of birth.
free movement,” is the first benefit that Afzali (who has
had all of her children at home, but has attended hospital
births) thinks of. “You watch someone at the hospital being
strapped down, which to the hospital is no intervention. .
. . What I do in all of my labors is much more constant movement,
much more range—up, down, in the tub, out. That’s my coping
mechanism. For me, movement is imperative.”
be able to walk, squat, and stretch my arms up and hang on
the shower curtain so I could feel my back and all the vertebrae
separate,” lists Sharkey. “To lay on my bed on my side when
I needed to, to lay on the floor, to get in the pool, to take
a walk outside, to strip all my clothes off.”
There are other benefits to the atmosphere of home. “No monitors,
no nurses, no noises,” says Sharkey, adding that that was
essential to allowing her to take the little cat naps that
let her pace herself through her long labor. “I can’t imagine
being in a hospital and having a bunch of people I don’t know
around, a bunch of distractions,” agrees Kelly.
Hospitals also make a practice of restricting food and drink
during labor, something several women said they wouldn’t have
had the energy to make it through their labors without. “I
can’t even imagine being deprived of liquid and only
being offered chipped ice,” remembers Sharkey. “We had two
cases of water and I drank a case and a half in the 37 hours
that I labored at home.”
other huge difference is you’re the one calling the shots,”
says Afzali. “You go to the hospital, and the doctor says
‘Now this is what we’re going to do’ . . . and at home, you’re
the one. The midwife makes suggestions, and it’s not that
they can’t take control if they need to, but they’re not going
to need to most of the time.”
best thing I love about home birth is after the baby’s born,”
says Kelly. “Being home, not having to come home.” Her husband
Sean adds that not having to leave home and go to a hospital
in the first place is a major plus as well. “I couldn’t imagine
getting into a car [while in labor],” agrees Kelly.
The integration into the rest of their life was important
to Marynczak. Her 6-year-old was present for the birth, and
by 7:30 PM, “here we were all sitting around on the floor,
eating pizza, and he was playing with his new brother, and
then he went upstairs and we tucked him in.”
Several of these families value the opportunity to have older
siblings, even fairly young ones, present for the birth itself.
“It really gave her a connection to him, and she’s very protective
of him and very in awe of him,” says Kelly of her daughter,
who was two and a half when her son was born.
Marynczak’s older son was given the job of taking pictures—he
would wander around the rest of the house when things got
a little intense for him, but he was thrilled to be helpful,
and she says it created a very strong bond between him and
never had any ‘When do we take it back?’ or ‘Where does it
belong?’ or ‘Who’s its mommy?’ or all the things you hear
that kids say,” says Afzali about her older children. “They
get it, that [the new baby] is definitely part of the family.”
Although home-birth midwives are careful to make sure that
expecting parents really want a home birth, and are not just
afraid of hospitals, the fact that hospitals don’t do so well
with normal birth is an undercurrent through every discussion
on the subject. Everyone involved in home birth recognizes
that hospitals and their technology are an essential backup
for complications. They are also careful to acknowledge that
women are going to have a better outcome wherever they feel
safer—and for many that’s a hospital.
But that fact remains that many women are concerned that American
hospitals tend to intervene at rates far higher than recommended
by the World Health Organization or justified by medical evidence.
For example, WHO recommends a c-section rate of 10 to 15 percent.
The United States rate was 28 percent in 2003. Planned home
birth rates are about 4 percent. The WHO says that drugs and
electronic fetal monitoring should not be routine during labor.
In 2000, the U.S. rate of use of drugs in labor was 80 to
98 percent and the rate of fetal monitoring was 83.5 percent.
Planned home-birth rates were less than 10 percent each.
Advocates of more natural birth point out that we’re not getting
anything for all these extra interventions—the infant mortality
rate in the United States is nearly twice that of other developed
nations, and rates of preterm and low-birth-weight babies
have actually been rising.
Women who want to make sure they have a c-section only if
it’s necessary, or who want to keep their systems from being
pumped full of drugs, often decide that rather than fighting
for a natural birth in a hospital setting (which is possible,
but difficult, and only for short labors), they will have
their children at home.
Sometimes the smaller indignities and biases of the conventional
medical system also rankle enough to incline families toward
other options. In Marynczak’s first pregnancy, she recalls,
the OB’s nurse would make a distressed noise “every time I’d
get on the scale. They made me feel incredibly fat and like
things were going wrong and when finally I couldn’t take it
anymore and said ‘What’s the big concern, yeah I’m huge, but
what’s the big concern,’ they said, ‘You might be left with
some extra weight after the pregnancy.’ I was horrified.”
A more common scenario, say local midwives, is that doctors
and nurses will start telling a woman that her baby is too
big for a natural birth—which is almost never true.
Marynczak’s first baby was born by c-section because he flipped
to a breech (feet first) position at the last minute. Although
midwives are trained to deliver breech babies, medical students
are no longer taught how, and many hospitals insist that all
breeches be delivered surgically anyway. But one of the things
that sticks with her beyond having to make the decision, was
how she was left completely alone and shivering in the recovery
room because her husband needed to follow the baby to an x-ray
the hospital staff had deemed necessary.
Keefe says she and her husband were traumatized by her first
c-section because they were deprived of decision-making power
and respect. The doctors waited until her husband was out
of the room to tell her they’d decided on a c-section, cutting
him out of the loop. Her daughter was taken for 45 minutes
after the birth for routine procedures, “screaming the whole
time,” never held or comforted. She had been given drugs to
induce her labor, and had a slow and painful recovery. Many
women choose home birth because they are traumatized in a
similar way, she says.
did it our way: Corey McQuinn (l), Caroline Sharkey
(r) and their son Remember.
Marynczak started shopping around for practices when she was
pregnant with her second child, she knew much better what
to look for. But she couldn’t find it. “I kept coming across,
‘Well it’s a VBAC so you have to have continuous fetal monitoring
and you’ll have to have an IV,’ ” she recalls. “And the conversation
would kind of stop right there because those are both things
that lead to increases in Caesarean sections, and I’ve been
there, done that. . . . There was no indication that my uterus
wasn’t functioning properly, any structural abnormality. So
why would you now strap me in bed and give me an IV and really
reduce my chances of having this baby?”
But what if you are in that small percentage of mothers where
a c-section or other intervention is really medically necessary?
That is perhaps the most common question women choosing home
birth face from their families, friends, and other pregnant
Since every birth is an unknown, and carries some risk, this
is a scary thing for any expectant parents to face. “If something
goes wrong in a hospital, here’s a sense of ‘Oh, it’s so tragic,
we did everything we could,’” explains Marynczak. “If something
goes wrong at home, there’s a sense of ‘Oh you selfish
person. Look what you did.’ ”
But the fact of the matter is that home birth is just as safe
as hospital birth. A large study of midwife-attended home
births released this June in the British Medical Journal
found that mortality rates were equivalent to that of low-risk
Home-birth midwives, including underground ones in the Capital
Region, are not slow to transport to the hospital if it looks
warranted. “We don’t play ‘You must stay home,’ ” says a local
midwife. “We don’t wait. We go when it’s safe.” She says her
practice has a hospital transport rate of about 12 to 17 percent.
“Neither of us are afraid of hospitals. If the baby’s saying
‘I’m not happy’, then OK, let’s get help.”
These midwives encourage their clients to also get prenatal
care at a hospital-based nurse-midwife or obstetrician practice,
so that if they need to transport to the hospital, they will
have a relationship with someone there and not be appearing
out of the blue.
But it is perhaps the stories of the women where something
did go wrong that answer this charge most completely. “I’m
certain that my second Caesarean saved my daughter’s life
and my life,” says Keefe. “But it shouldn’t be the first place
you go.” Although she is disappointed that she ended up needing
a second c-section, Keefe is glad she planned the birth the
way she did, and got to have labor at home, which she found
immensely more pleasant than a “dark little room” in a hospital
where she had to be “disconnected from all these wires just
to go to the bathroom.” But after a few days of on-and-off
labor, she and the midwives decided at the same time that
something was wrong. They went to the hospital well before
there was any crisis.
When, at the hospital, the midwives told her they thought
surgery was needed, they gave her a few minutes to bawl and
“get it out of my system.” Because they had chosen a hospital
and doctor supportive of their approach, she was respected
the whole way through, and even allowed to be the one to apply
pressure on the upper abdominal muscles after the incision
to actually push the baby out. The baby was held the whole
time it was being checked out, and the far shorter time that
Keefe had drugs in her system made recovery much faster. “Overall
it was much more positive,” she says.
Sharkey, also, says having a major complication has done nothing
to diminish her enthusiasm for home birth. She delivered her
son at home, but then the placenta refused to deliver. “My
cervix clamped down, my uterus refused to contract. . . .
It’s a rare condition. The midwives were by no means shy in
telling us, ‘It usually takes such and such time and we think
something’s up.’ . . . Finally, they very sweetly explained
that we know that you want to stay at home, but we think you
should consider transport because we think surgery might be
necessary.” Though she was disappointed, “I was thrilled with
their honesty.” The surgery was successful, and she was released
the next day. “The experience at home had left me feeling
so comfortable and empowered that at no point did my confidence
falter,” she recalls.
Another unusual thing about Sharkey’s experience is that her
midwives helped arrange for a group of friends to bring her
family dinners every day for a month after the birth. While
it doesn’t always take that form, six weeks of postpartum
care—at the house—is the norm for a home-birth midwife. This
is one of the many ways that the care from home-birth midwives
differs from standard perinatal care. Their prenatal visits
are often one to two hours long, and involve the whole family.
They may incorporate anything from support in grieving previous
miscarriages, preparation for parenting challenges, referrals
to family counseling, and even help with budgeting for families
where one parent has decided to stay home with the child.
This kind of close relationship adds to the feeling of safety
for clients—“I felt that she knew me so well, that if I looked
odd she was going to get it almost as quickly as my husband,”
says Marynczak. “She was getting to know us as a family. How
we functioned, what the dynamic is. It just became amazing
in terms of comfort.”
Comfortable and empowering and safe as it may be, home birth
in the Capital Region still means going underground for a
health-care provider, something that, while it doesn’t dominate
the pregnancy experience, is still a weird and sometimes awkward
thing for expecting families.
Finding a home-birth midwife in the first place isn’t always
easy in such a climate, unless you happen to already be in
the loop. Home-birth midwives in the area certainly can’t
advertise, nor can they tell just anyone who approaches them
what they do; though it’s rare, midwives have been arrested
in sting operations by state enforcers posing as a pregnant
couple [“The Midwives’ Tale,” March 7, 2002].
Stasyshyn traveled to several different practices in Amsterdam
and Saratoga Springs before someone suggested that she talk
to some people who turned out to be home-birth midwives. The
process took long enough that she had given up hope and was
considering living with her father in New Jersey for the end
of her pregnancy or traveling to a birthing center in Rochester.
“It was like chaos,” she says. “I had been so discouraged
about home birth at that point. When I came to talk to them
they were speaking on the level of just a doula [labor assistant],
until I went through the whole story and I said my brother
was born at home and it’s what I always imagined. Then they
said ‘Well, is that something you want to do?’ I was blown
out of the water.”
Wendy and Sean Kelly had a similarly hard time. Their first
daughter was born at home in Boulder, Colo., where home-birth
midwives were common and legal. But here they found themselves
going down one dead end after another in their search. Eventually
they called their midwife from Colorado, who was able to connect
them with someone locally. Without that connection, they might
not have been able to make it happen here, they say.
Then there’s making sure you don’t let the midwives’ names
or other identifying information slip in front of the wrong
company. Practicing midwifery without a New York-sanctioned
license and written practice agreement is a felony, punishable
by four years in jail, so their clients take discretion very
seriously. “It wraps [the pregnancy] in a cloak of secrecy,”
says Tisha Graham of New York Friends of Midwives, who had
her fifth child at home in the Capital Region about 10 years
ago. “It makes some women feel very duplicitous.” Graham would
tell people that she was having her baby “in Saratoga, with
midwives.” “People would assume, I didn’t say it, I’m having
my baby at Saratoga Hospital with the midwives [on
staff]. And I would never clarify that one way or the other.”
The climate has gotten a little less hostile than it was in
the mid-’90s, and many families are opting to talk about their
decision and just leave out names or identifying information.
But even then they talk about “living in fear that her name
will slip from my lips,” as Marynczak puts it.
still feel like that, if I go to the park and my kids are
playing and someone asks me how far along I am and then asks
me where I’m having the baby, should I just say I’m having
it at the hospital?” recounts Afzali. “Makes it easy. But
you want to stand up for what you believe in and make it a
normal choice for people. I generally say ‘I’ve had all my
kids at home, I’m having this one at home, I use midwives.’
. . . There’s definitely been times where I’ve had to lie.
And then there’s the negotiations after the birth. Marynczak’s
pediatrician wanted her to get a newborn infant screening
work-up, something usually done right after a hospital birth.
“The amount of phone calls and work it took . . . was hilarious,”
she recalls, “because everybody I would talk to said, ‘Oh
no, no, your baby had that done at the hospital.’ ‘Well, no,
my baby wasn’t at the hospital.’ It wouldn’t even compute.
‘No, your baby’s already had the newborn infant screening.’
‘No, we need to come in.’ ”
Sharkey recalls with a grimace having to tell hospital staff
after her surgery that the baby had come so fast there was
no time to get the hospital for the birth itself. After 37
hours of labor, she says, that was a really tough thing to
say. “I definitely wanted the credit!”
When Sean Kelly went to get a birth certificate for his son,
he had to come back when the one person in the Saratoga Springs
Town Hall who knew how to issue one was in. “I said ‘Here’s
this part about witnesses, what do I do about that?’ They’re
like, ‘Well, who attended the birth?’ and I was like ‘Well,
umm. . .’ The other woman told them ‘If they had a home birth,
they might have had a midwife, but they’re not going to want
to talk about it, so just have him sign it as the witness.’
Returning to a backup prenatal care practice, or to an unsupportive
pediatrician’s office, can also be awkward. When the Kellys
called to schedule their first postnatal checkup, their usual
pediatrician (who had said they could schedule their first
appointment when they were ready) was on vacation, and the
receptionist and the nurse read them the riot act for waiting
more than 48 hours to come in. They held firm. “The whole
reason I have a home birth is to be home,” says Wendy.
Stasyshyn isn’t sure if the practice she visited will take
her back for her second pregnancy, knowing that she had her
baby at home the first time. She also feels bad that her midwife
there couldn’t be a part of her birth. “There’s pictures all
over the wall of babies she’s helped deliver, and I always
felt she went through this whole thing with me and she never
had a part of [the birth] because she couldn’t,” she sighs.
“I called her. She was very nice about it.”
But these concerns fade away when it comes to how excited
these women are about their birth experience. In fact many
say they’ve faced some social awkwardness in having enjoyed
something that is “supposed” to be an ordeal. As Stasyshyn
puts it, “No one ever says about a birth that it was perfect.
[They say to me], ‘Oh, you don’t remember.’ But yes, it was.”
Quietly, these women are spreading their stories to those
who are ready to hear. “I never wanted to play the role of
recruiter,” says Sharkey, but she says women are not getting
to make fair choices if they don’t have all the information,
and she had has taken it upon herself to help people know
what their options are. “Options are all I ever asked for,”
For more information on home birth and midwifery in the state
of New York, visit www.birthnewyork.org.