With her fourth child, Melissa Taylor finally gave birth where she always wanted to — at home. Her oldest son, 4-year-old Marc, held the flashlight for the midwife. The midwife told the kids "how the belly button works." Newborn Addison, now 7 months old, nursed right away. Taylor didn't give birth at her Tampa home to make a political stand. But decisions like hers are increasingly wrapped in controversy. Relations between home birth advocates and women's doctors — never friendly — have reached a new level of acrimony. One side has flung phrases like "father knows best" and "power play." The other: "trendy" and "the latest cause celebre."
Last month, the American Medical Association passed a resolution supporting state laws that discourage home births. The national obstetricians' group also opposes the practice.
Meanwhile, midwives are pushing for licenses in states that don't allow them to practice. They've gained star support with a documentary by Ricki Lake about her own home birth. And they say the AMA wants to outlaw home birth and dictate to women rather than help them.
"This is different because now they're targeting consumers," said Steffany Hedenkamp, communications coordinator for the Big Push for Midwives Campaign. "They're saying, 'We're going to tell you where you can give birth and where you can't.' "
The doctor who wrote the AMA resolution says the debate isn't about paternalism, freedom or the comforts of home. It's about safety, said Dr. Erin E. Tracy, an obstetrician at Massachusetts General Hospital and assistant professor at Harvard University.
"With my own patients, they can have as many people in the room as they want, whatever music, whatever lighting," Tracy said. "But if things go badly, there need to be measures that can be taken to save the life of the mother or the baby."
Whether a mother with an ordinary pregnancy gives birth at home or in a hospital, chances are high everything will be fine.
But the two sides have dramatically different views of childbirth's biggest risks.
Obstetricians worry about the few mothers and babies who run into trouble.
"Ideally we'd like to not do much of anything at all, and just play catcher at the other end," said Dr. Catherine Lynch, who delivers babies at Tampa General Hospital and directs general obstetrics at the University of South Florida's College of Medicine. "Sometimes we need to intervene and play a more active role."
Home birth is generally offered only for women with healthy, low-risk pregnancies. But even then, bad things can happen. The umbilical cord can come out first, or the baby's shoulders can get stuck in the birth canal. The mother can bleed.
Such events are rare, but they can happen without warning and can kill a baby or mother in minutes, doctors say. Time is so critical that hospitals run drills on saving mother and baby.
"In the hospital, we can get baby out in under five minutes if we need to," Lynch said.
A few years ago, a woman having a home birth was brought to Tampa General because the midwife couldn't find the baby's heartbeat. Lynch tried to save the baby, but it was too late.
"Intervention would have saved that baby's life," she said.
While both sides argue that science is on their side, the AMA cites a study showing the death rate for babies born in hospitals is 1.7 per 1,000, but twice as high, 3.5 per 1,000, for babies born at home.
Home birth advocates point to other risks.
"As a woman, I should be able to decide which risks I want," Hedenkamp said. "It should be my right."
A woman giving birth in a hospital has a substantial chance of being given drugs to induce labor or having a caesarean section. U.S. C-section rates are climbing. In Florida, more than a third of babies are born that way.
"The (induction) drugs are fraught with peril," said Char Lynn Daughtry, founder of Labor of Love Birth Centers in the bay area and a member of Florida's midwifery council. "It's a safer environment when they're away from the operative tools and the environment of the hospital."
Midwives are more focused on making each birth the best experience than fearing the worst, Hedenkamp said.
"Some obstetricians will admit: They're trained in what can go wrong," she said. "They're not trained to be with the women and do whatever they need."
Still, both sides say hospitals have changed.
At many hospitals, episiotomies are no longer routine. Babies nurse right away and get their first baths in the delivery room.
Taylor, the Tampa mom, teaches natural childbirth classes and has had babies everywhere.
Marc was born at a birth center. She wanted her next birth at home, but then she learned she was having twins. So girls Lily and Logan, now 2, were born in a hospital eight weeks early.
"The hospital was the safest place for them," she said. "That's why we chose to go there."
Taylor, 32, felt comfortable after she looked at research that said home births were just as safe as hospitals. So Addison arrived in the living room.
While the controversy might make home births more visible, Taylor doesn't think that will affect women's choices.
"I don't think it's an option that many people consider or are even aware of," she said. "But people have always given birth at home, and they're going to do what's best for them and best for their baby. They're not going to do what's trendy."
Lisa Greene can be reached at firstname.lastname@example.org or (813) 226-3322.