On a hot day in May in Glen Rose, Texas, Andrea Brannock, was wrapping white Christmas lights around an oak tree on her property. Her four children — ages 7, 5, 3, and 1 — were “helping Mommy,”— splashing in the creek that burbled nearby, swinging on the swings, and chattering excitedly. “That’s for the baby!” Her five-year-old daughter Sienna announced, pointing to the shady spot under the trees ringed with Tiki torches where Andrea’s husband had just laid sod on the ground for the birthing tub.
Andrea was nine months pregnant with her fifth baby. Her two oldest had been born in the hospital with Andrea flat on her back, feet strapped into metal stirrups, surrounded by medical professionals yelling at her to “PUSH!” every time the monitors indicated she was having a contraction.
Though both older daughters were born healthy, her first two medicalized births left Andrea feeling “completely cheated.”
“They were your typical hospital births with the epidural and all the interventions,” Andrea, who is 30 years old, explains. “With my second, the doctor used vacuum suction without even asking me. I didn’t even know he was doing it.”
Two out-of-hospital births later (her third was planned for a birth center but the baby came so quickly she was actually born at home, the fourth was a planned home birth), when Andrea got pregnant with her fifth baby she saw photographs of a friend’s outdoor birth on Facebook. She was totally intrigued by the thought of birthing outside. “I thought, ‘Oh, it would be so pretty to have an outdoor birth… The more I imagined it, the more I talked to my birth team about it, the more I liked the idea.’”
These days over 56,000 babies in the United States are born outside the hospital each year, and the majority of these births — 64.4 percent — take place at home. Out-of-hospital birth in the United States seems to be steadily becoming more popular, especially in wealthier communities like Park Slope, Brooklyn and among Hollywood celebrities.
The Rising Popularity Of Out-Of-Hospital Birth
An increasing number of American women are realizing the health benefits of home and birth center births, which include fewer unnecessary obstetrical interventions, freedom of movement, ability to eat and drink as needed, as well as increased breastfeeding success after the baby is born.
According to guidelines from the United Kingdom’s National Institute for Health Care Excellence, midwife-assisted out-of-hospital birth — at home or at a birth center — is safer than hospital birth, reducing the chance of surgical intervention and infection. Out-of-hospital birth is considered such a good option for women with uncomplicated pregnancies that the UK’s National Health Service is now championing it for low-risk women.
At the same time, the state of Texas, where Andrea gave birth, has one of the lowest home birth rates in the country. According to the Texas Department of State Health Services Center for Health Statistics, nearly 99 percent of all births in Texas take place in the hospital. There is no way to know how many — if any — of the out-of-hospital births (some 5,000 a year) are happening outside but it’s reasonable to assume that that number is very low.
The reasons to choose home birth seem clear enough (full disclosure: three of my four children were born at home), but why would a woman choose to give birth outside?
“My Happy Place”
I asked this question to Marnie McKnight-Favell, a 41-year-old mother of one in Poughkeepsie, New York. Marnie tells me she knew she would have an outdoor birth even before she got pregnant. She explains that her choice was both intuitive and aesthetic. An artist and a healer, Marnie wanted to create the perfect space for the baby she and her husband were welcoming into the world. She kept thinking about her garden and her yard, envisioning herself outside. Marnie’s midwife, who was very experienced, told Marnie she believed birth could happen anywhere, and encouraged her to create a womb-like or tent-like enclosed outdoor space. So Marnie and her husband set up a wrought-iron gazebo on the side patio. It had fabric walls that pulled back to allow full access to the outdoors.
During the 20-hour labor Marnie spent much of the time walking in their suburban neighborhood, leaning on neighbors’ stoops during contractions, looking up at the full moon and admiring the stars in the night sky. When she was about nine centimeters dilated, she went into the gazebo, luxuriating in the warm water in the kidney-shaped agricultural trough she was using as a birth tub, on loan from the midwife. Her daughter, Violet, was born peacefully into the water. Marnie remembers hearing the sound of crickets and frogs in the yard. The birth was just as she imagined it would be.
“She had a shining, smiling, I-did-it look on her face,” Marnie’s husband Charlie remembers. “It was the single most beautiful day of my life.”
Jillian Blakeman, a mom of one in North Richland Hills, Texas, is much more matter-of-fact when she talks about giving birth to her son out of doors two years ago.
“Our house is kind of small,” she says bluntly. “I wanted to do it in my yard because that’s my happy place. I said that to the doula and she said, ‘Oh, I had an outdoor home birth!’”
Jillian, who is 32, gave birth in the hot tub in her backyard with her birthing team, husband, and Patchy, an American quarter horse she has had since she was 14 years old, by her side.
Biased Against Natural Birth?
Though an increasing number of doctors and other medical professionals are themselves choosing out-of-hospital births, home birth is not generally accepted by America’s mainstream medical community. Women planning home births are often met with hostility and suspicion from their doctors. Some are even shamed. When my friend Laurie informed an obstetrician in New York City that she was planning a home birth, he angrily informed her that she would kill her baby if she did and that she would be safer having a C-section. (Research actually shows the opposite is true: women giving birth via Cesarean are more than three times more likely to die than women who have vaginal births, according to this French study of over 10,000 women.)
The American College of Obstetricians and Gynecologists (ACOG) “respects the right of women to make a medically informed decision about delivery,” but advises doctors that women inquiring about home birth should be informed that, “although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.”
But some medical professionals believe birthing out of doors is safer than birthing in the hospital.
“It’s probably cleaner to give birth on a fresh blanket on the lawn than in a hospital room with re-circulated air,” says Deborah Gordon, M.D., a family practitioner based in Ashland, Oregon, who has been practicing medicine for 35 years. “Of course you can do it outside. But you have to be smart about it.”
Elena Tonetti-Vladimirova is a conscious birth advocate based in Paradise, California who has directed an award-winning documentary film, which includes footage of a Russian mom giving birth in a shallow lagoon in the Black Sea, as well as ten other births in natural settings. Tonetti-Vladimirova argues that where a woman gives birth is not as important as the attitude she brings to the birth.
“The only thing that matters is to bring consciousness to birth, whether you do it outside or inside, in a cave, in the ocean, in the bedroom, or in the hospital,” Tonetti-Vladimirova insists. “It’s not about where she gives birth, it’s about how much she is willing to be responsible. If a woman takes responsibility for what they are doing, they can have a beautiful birth outside, inside, on a roof, or in the back seat of a cab.”
A Nature Birth In Alaska
Alaska is one state with the highest number of out-of-hospital births.
“A huge percentage of women don’t go to the hospital in Alaska,” says Tara Elrod, a certified professional midwife whose husband, Glen Elrod, is an obstetrician who attends home births.
“We’re different up here. We do things our own way. People are very natural minded… and more health conscious. We’re active and outdoorsy. People hunt and fish, and that translates to how we live and birth and raise our families.”
That sounds like a pretty accurate description of 26-year-old Audrey Bird, who homesteads with her husband and three children in Lake Minchumina, a 244-square mile island located 150 miles from any road.
To get to the Birds’ homestead, you have to fly in a prop plane from Fairbanks, and then take an hour-long boat ride across the lake.
The Birds felt it would be both more practical and safer to have their third child at home than to arrange transportation to Fairbanks. Their baby was due in July 2014 and Audrey originally thought she would birth in the lake itself. But a torrential summer storm ended up filling the lake with debris. Families who had lived in Lake Minchumina for longer than the Birds told Audrey they had never seen the lake so high — or so dirty — before. She found herself worrying that the water, which was filled with sticks, logs, and dead animals, would not be a safe place to birth. Instead Audrey’s husband Peter built a birch tree mosquito-net covered structure open to the night sky.
Audrey has worked as a midwife and her husband, who used to be a deputy sheriff, went through emergency childbirth training. They had notified the Medivac service in case they needed helicopter transport to a hospital (which would have taken two hours) but they did not have a midwife attend their birth. Audrey’s mother and younger sister were there to help. Audrey describes herself as “very vocal” during labor but feeling calm and happy. Some of the film crew from Lifetime’s Born in the Wild, which aired a show about her birth last March, were not as sanguine. “A few of them were very nervous; it was the first time they had attended a birth,” Audrey laughs.
Audrey remembers enjoying the pink sunset, the glow of the birch and aspen trees, and the view of Mount McKinley in the distance during labor. But despite the idyllic setting and her feeling of calm, she admits that her daughter’s birth was not easy. The baby was facing up and her head was bent at an angle (this is called “posterior and acyclinic”). It took a lot of movement and several hours of pushing to finally get her out.
Audrey believes if she had been birthing in the hospital, she would have had either a forceps delivery or an emergency C-section. “Her positioning would have caused problems,” Audrey explains. “But my body did what it needed to do. It took its time. It resolved itself… Birth generally happens the way it needs to when it is undisturbed.”
Giving birth, when it happens in a loving, supportive environment, can be one of a woman’s most profound and transformative experiences, marking her passage into motherhood, connecting her to her most primal, natural self. The best birth attendants — whether they be doctors, midwives, doulas, spouses, friends, or relatives — are the ones who stay calm and positive, stepping out of the way and supporting the laboring woman by helping her trust herself and her body.
Perhaps the real question is not why a woman would want to birth outside but why she wouldn’t. Being outdoors — naked and in fresh air — makes perfect sense. For some women anyway.
“It really speaks to the origins of humanity, this is how people used to be born all the time,” Audrey tells me. “My daughter was born face up and she saw the trees and the birds and the Aspen glow from the sun. I just love that.”
What about Andrea Brannock? Surrounded by oak trees, out in the open, her older children looking on, and her birth team supporting her, Andrea pushed for just ten minutes before her son Royce — who’s just five months old now — was born peacefully in the birth pool.
“We were all happy and calm. There was no rush,” Andrea remembers fondly. “Even my mainstream friends saw my pictures and were like, ‘Wow, that’s so beautiful!’”
Jennifer Margulis, Ph.D., is an award-winning science writer, investigative journalist, and Fulbright grantee. She is the author/editor of six non-fiction books, including Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family (Scribner, 2015).