When Deanna Kopf was pregnant with her third child in 2007, she planned to use a midwife for a natural delivery at home. But those plans didn’t go quite as expected and she and her husband ended up delivering their son themselves.
“He came very fast and my midwife didn’t make it in time — it was just me and my husband,” said Kopf, of Hampstead, Md. “That was the reassurance that my body knew how to do it and the baby knew how to be born. It was very empowering and made me want to go out and let other people have a similar experience.”
Today, Kopf, 50, is a certified professional midwife (CPM) and has had her own practice, Birthwise Midwifery, in Catonsville for eight years. Her decision to become a midwife was literally born after that home birth of her third child, son Trevor, now 11. Her other two children were born in a hospital.
According to a Reuters Health report in 2016, at-home births are becoming more common in the U.S. The figures from a 2014 study by the Maryland Population Research Center at the University of Maryland in College Park, stated that out of almost 60,000 out-of-hospital births across the United States, 38,000 were home births, and 18,000 took place at birth centers.
Kopf said it took her about five years to become a CPM and to work on her own. Her training was mostly online and self-study, and she also had to attend births — working, observing and assisting another CPM.
She is registered with the North American Registry of Midwives, which certifies midwives for out-of-hospital births. She points out that she is not a certified nurse midwife or CNM, who have nursing degrees, specialize in midwifery and work in hospitals and birth centers.
Most midwives in center of state
Currently, there are only 15 CPMs in the state of Maryland. According to the Maryland Board of Nursing, there are 269 CNMs in Maryland.
“We range in age from late 20s to 70s for those licensed,” said Jan M. Kriebs, CNM, adjunct professor at the Midwifery Institute at Jefferson University in Philadelphia. She said most of the CNMs who practice are predominantly in hospitals; the rest are in birth centers and home deliveries.
“The bulk of midwifery practices are in the center of the state, from Frederick to Baltimore to Southern Maryland—and there are some on the Eastern Shore and north of Baltimore,” Kriebs said in an email.
In 2015, Maryland passed a law allowing CPMs to practice legally. Before that, only a CNM was allowed to assist in a home birth; most CPMs had to work under the radar, Kopf said.
There are strict guidelines for CPMs. They cannot perform cesarean sections or attend a vaginal birth after a cesarean. They cannot deliver twins, breech births or if the mother has preeclampsia, a condition brought about by high blood pressure. They cannot prescribe medication but can carry oxygen and Pitocin, which midwives use to control hemorrhaging.
“We have a lower percentage of intervention rates and C-section rates with home births,” Kopf said. “We are experts in normal birth.”
She said that emergencies are rare but they do transfer to a hospital if something were to happen.
“Our transfer rate [to a hospital] is about 5 percent,” she said.
Currently, Maryland does not require CPMs to carry liability insurance and Kopf said most CPMs do not have it. She said that they practice with the full-and-informed consent of their clients, going over the risks and benefits of a home birth.
“There’s a lot of trust between us and our clients,” she said.
Organizations such as the Midwives Alliance of North American, or MANA, promote the practice of widwifery.
Vicki Hedley, president of MANA, has been a midwife for 11 years and said the organization works to help states toward legalizing CPMs. They also host conferences, workshops and help midwives network.
“We are trying to promote midwifery and to create access to midwives,” Hedley said.
Of equal importance to MANA, Hedley said, is to have more diversity in the field and to get states to add midwife services to Medicaid.
“The low reimbursement rates keep midwifery out of the lower-income community,” Hedley said. Reimbursements vary across the U.S., with New Jersey the lowest at $328, as of 2015, and that figure is for CNMs. Depending on the state, CPMs are not guaranteed Medicaid reimbursement. Currently, Maryland Medicaid does not cover home birth services.
Having a home birth is considered an out-of-pocket expense and is not always reimbursed by insurance. Kopf charges $3,900 per birth.
‘Challenging’ and ‘euphoric’
With more than 600 births under her belt in her solo practice, Kopf also trains other women to become midwives. One of her novices, Tova Brody, 27, used Kopf as a midwife for all four of her pregnancies. Brody said she had always been interested in natural childbirth and got involved in the activism side of midwifery working with the organization Maryland Families For Safe Births, after the birth of her first daughter. But it was the birth of her fourth child, Shifra Brody on June 7, and her experience with Kopf that prompted her to enter the field.
Recently, while her infant daughter slept in her arms, Brody explained her path to becoming a midwife. “It was like meeting a grandmother,” she said about Kopf. “She was someone wise and loving; she had complete trust in the birthing process. I knew this was something I wanted to be a part of. It empowers women,” Brody said.
Fletcher and Lexi Cunniff, who live in Catonsville, expected they would have their first child in a hospital. But although Lexi, 27, is a nurse, she wasn’t sure the hospital experience was for her. Fletcher, 40, said he and his younger brother had both been born at home, and their younger sister was born at a birthing center. After an initial appointment with Kopf, the Cunniffs decided to forgo the hospital birth and have their baby at home.
To prepare themselves for the upcoming birth, the couple attended private birthing classes in Pikesville with a doula — someone who specializes in birth coaching — whose specialty is in hypno-birthing, a philosophical approach to childbirth that teaches relaxation, special breathing and meditation during the birthing process. They also hired the same doula to assist in Lexi’s labor.
“My wife was 52 hours in labor. There’s only so much preparation you can have beforehand,” he said of the experience. He said he was grateful that the doula was on hand to help coach him and to give undivided attention to his wife.
“It was a surreal, extended sleepover,” he said laughing. “There were five of us crammed into the bedroom.”
When their baby daughter, Brynn, finally made her appearance, Fletcher said it was a euphoric moment for him.
“As challenging as it was, we were really happy to have done this at home—I can’t thank them enough,” he said of Kopf, Brody, and their doula.
‘Peaceful feeling at home’
Kopf said she has had clients who previously had hospital births they weren’t happy with. They said they didn’t want all the medical intervention and didn’t like not being able to make decisions themselves.
“They want the feeling they are involved and want that peaceful feeling at home,” Kopf said.
Kopf said she likes to spend a lot of time with her clients, and usually only takes on three to five clients per month. She said she does get a different range of people in different stages of their pregnancy, but most new clients are between 10 and 12 weeks into their pregnancy.
The time she spends with them also includes post-delivery, where she stays with the mother and newborn for a few hours after birth. She follows up again 24-48 hours afterward, then sees them again up through six weeks.
“Taking too many clients means I wouldn’t get to spend a lot of time with them,” Kopf said.
Kopf said clients decide what style of birth they want. Some may prefer their bed, but using a tub, which Kopf provides, seems to be a popular choice.
“They call the tub ‘nature’s epidural’; it feels weightless and lessens labor pains,” she said.
Kopf and Brody don’t whitewash the fact that having a baby naturally will hurt, but they believe that being at home and allowing nature to take over is a beautiful and natural experience.
“If labor is uninterrupted, it increases the intensity that the body can handle,” Brody said. “The pain is never bigger than you because it is you; women can trust their bodies.”
Midwives, including Kopf, also work with masseuses, acupuncturists, chiropractors and doulas to help their clients through the birth process.
“We do encourage them to hire a doula,” she said. “We also encourage them to eat and drink while in labor.”
Kopf said there are no typical scenarios with a home birth; some are short labors and some can be long. She’s attended births that took less than one hour and recently attended a birth that took four days.
“She was a trooper,” Kopf said.
Both she and Brody said that each birth is moving.
“I still cry,” Kopf said.