美国国家公共电台 NPR Home Birth Can Be Appealing, But How Safe Is It?（在线收听）

STEVE INSKEEP, HOST:

Few American women choose to give birth at home, but the number is increasing. In fact, the number of babies born outside the hospital almost doubled in the last 15 years. Is that safe? Lesley McClurg from member station KQED is invested in the answer because she's considering that decision herself.

LESLEY MCCLURG, BYLINE: Last summer when I got pregnant, I initially envisioned a hospital. But then I started receiving messages like this.

JESSAMYN MEYERHOFF: You don't know what you're choosing.

MCCLURG: That's Jessamyn Meyerhoff. She's a home birth midwife and a really close friend. She warned me that doctors were more likely to push drugs to speed my labor, pain meds or an unnecessary C-section. And there are studies to back this up. I heard similar arguments from numerous friends who shared pictures of birthing tubs and living rooms with candle lighting. But my mom freaked out when I mentioned it.

UNIDENTIFIED PERSON #1: You could have a complication where you would need to be in a hospital.

MCCLURG: Just to make sure her point landed, she told me about my older brother's birth.

UNIDENTIFIED PERSON #1: He was blue. They whisk him away to the ICU, and I was afraid that he'd gone a long time without breathing to the point that he might be brain damaged.

MCCLURG: Fortunately, my brother is fine. And my mom credits the hospital for saving his life. So friends on one side, family on the other, I decided to consult a woman who deals with the worst of the worst. Neda Ghaffari is a doctor at UC, San Francisco whose specialty is high-risk pregnancies.

NEDA GHAFFARI: With the things that I have experienced, I would like to give birth in the hospital.

MCCLURG: Ghaffari says a team of practitioners is always just down the hall ready to respond to a drop in a baby's heart rate or maternal hemorrhaging. These kinds of complications are why Ghaffari recommends women who choose a home birth live within 15 minutes of a hospital.

GHAFFARI: It's very hard to determine which patients are going to have an obstetric emergency.

MCCLURG: And about twice as many babies die at home, which sounds terrifying. But death is rare in either setting, though 1 in 5 home births do transfer to the hospital because they end up needing medical services.

GHAFFARI: Being in the hospital is probably safer than being at home.

MCCLURG: So I'll admit my fear was piqued after my conversation with Ghaffari. But then I talked to Maria Iorillo. She's a licensed midwife in San Francisco. She's attended 1,400 births over the last 30 years, most of which unfolded safely at home.

MARIA IORILLO: Birth is not a medical procedure. It is a process of you becoming a mother of this little person meeting you on the outside for the first time and continuing that relationship.

MCCLURG: If a mom chooses to take that journey at home, she will feel the full brunt of the experience.

IORILLO: So in home birth, there's no pharmaceutical pain relief.

MCCLURG: Though, Iorillo does carry an oxygen tank, numbing agents, suturing materials.

IORILLO: I have three big bags of stuff. And my hope is that when I come to your birth, I actually don't use very much of it.

MCCLURG: She compares birth to running a marathon in the sense that they're both arduous, excruciating and rewarding.

IORILLO: You can really kind of tap into, what's a woman's body made for?

MCCLURG: That sense of satisfaction appealed to me, plus I learned that I am a good candidate for delivering at home. I'm not having twins or triplets, and I don't have worrisome conditions like diabetes or high blood pressure. So I found myself rethinking home birth. I needed someone who knew both worlds.

ROBYN LAMAR: Hi, I'm Robyn Lamar. I'm an OB-GYN at UCSF.

MCCLURG: And yet, Dr. Lamar had all three of her children at home. She's drawn to laboring at her own pace in a familiar setting where she's the boss.

LAMAR: When you're on your home turf and you're there with your family, it really does change the dynamic.

MCCLURG: She didn't want to feel pressured to follow hospital protocols. And yet, she stresses that what's best for one woman may not be right for the next.

LAMAR: Wherever you give birth, there's risks. And the risks differ according to the setting that you're in.

MCCLURG: The final factor to weigh is cost. My insurer will cover a hospital birth but not if I deliver at home. And in the Bay Area, a home birth runs around $6,000. So I continue to talk to friends, experts, read studies, tours hospitals.

UNIDENTIFIED PERSON #2: So this is one of our labor rooms. You can go ahead and come on in.

MCCLURG: And now eight months later, I'm still on the fence. All natural, pain meds, comforts of home, emergencies. Either way, this baby is coming and soon. For NPR News, I'm Lesley McClurg.