Hearing Nanette Gilbertson recount the day her 4-month-old daughter Bailey was born is more like hearing about a relaxing day of vacation than a typical child birth story.

Gilbertson's face lights up as she describes the day's every detail. Meeting her husband, Eric, at the General Mercantile for a cup of iced cocoa. Taking a swim at the Broadwater Athletic Club with her mom, Katherine Smith. Dinner at the Silver Star Steak Co. followed by a nice, long nap.

Gilbertson, 27, had her baby in a home birth overseen by a midwife.

The experience for her was so positive, she says, that she doesn't even remember the pain. Though it was difficult at the time, what stands out in her memory is being in a place that was comfortable, surrounded by people she knew and loved and being able to bond with her new baby in her own bedroom, not a hospital room.

Gilbertson's experience reinforced her long-held feelings that childbirth is a natural process that doesn't need to be done in a hospital setting, an opinion she shares with a small, but committed group of women who wouldn't have their children any other way.

Though there are nurse midwives in Helena who can deliver babies in a hospital setting, there has been no full-time direct-entry midwife, meaning that women here who choose home births have needed to find a midwife from another town.

But in September, Traci Palagi, a direct-entry midwife based in Great Falls, opened a satellite clinic of her Great Falls Homebirth Service in Helena, making her the first certified midwife to have a regular practice in town.

Proponents of home births feel strongly that the practice is safe, pointing to studies that seem to show no statistical difference in safety from hospital births with far lower rates of medical intervention, such as epidural anesthesia, induced labor, use of forceps or caesarean section.

But there are many who have concerns about the safety of home births, and the American College of Obstetricians and Gynecologists officially opposes the practice. Opponents grant that while most births are without complication, the rare cases when emergencies arise can go so bad so quickly that the potential risks outweigh the benefits.

A near tragedy

Crystal Water's home birth was hardly as smooth as Gilbertson's. It nearly ended in tragedy.

Water had a complication called retained placenta, in which the placenta is not delivered after childbirth, causing severe bleeding.

Water, a Helena native who now lives in The Netherlands, delivered her son, Ilan, while visiting family for the summer of 2006 at the Feathered Pipe Ranch near Rimini owned by her mother, India Supera - a 40-minute drive to St. Peter's Hospital.

"My blood pressure went down really low and I had lost quite a lot of blood. About half my blood," she said

Water said she never was scared, despite the frightening circumstances.

"I was mostly just happy to be finished," she said, noting that her labor lasted between 65 and 70 hours. "I was totally exhausted. I was just happy that the baby was perfectly healthy."

And despite her experience, Water said she would not hesitate to have a home birth again.

"I could just walk out in the forest with my husband during contractions," she said. "That was nice. I would definitely prefer that to being in the hospital.

"I didn't regret having the baby at home at all. I really liked being in my own environment. I really liked the freedom of it. There's nothing like home. No place like home."

Medical opinions

Dr. Jack McMahon Jr., a Helena obstetrician and gynecologist, knows that most women who have their babies out of the hospital do just fine and a doctor's presence isn't needed.

But he's also delivered about 6,000 babies, and he's seen just about everything that can go wrong in labor. He knows what he'd advise any woman thinking about having one.

"I would definitely not deliver my baby at home," McMahon said.

McMahon said home births are usually safe, but when something does go wrong, it can be dramatic and traumatic. Often the time it takes to get to the hospital can make the difference between life and death for the baby or the mother.

"I just think there's too many things that can go wrong," he said. "Even if you have one of the disasters happen, you can usually get to the hospital (on time). But there's still that rare chance.

"There's just too many things that can happen. And I just wouldn't do it."

Some of those rare emergencies include:

- prolapse of the umbilical cord, where the cord is delivered before the baby, preventing the baby from receiving oxygen.

- the fetal heart rate drops very low, and the baby must be delivered immediately.

- postpartum hemorrhage, which can be caused by retained placenta.

The British Medical Journal reported in a November 1996 editorial that in low-risk pregnancies and with adequate support and infrastructure, home births are safe.

The ACOG says in its official position advising against out-of-hospital births, however, that studies comparing U.S. home births with hospital births have been limited and not scientifically rigorous.

"Until the results of such studies are convincing, ACOG strongly opposes home births," the report states.

Some women choose to give birth at home unassisted, without a midwife present. The BMJ report states, and medical authorities agree, that is not a wise decision.

Midwife's answers

Palagi said the opposition many doctors have is based on their own prejudice, not the facts.

She monitors the condition of mother and the baby's growth and health throughout pregnancy. She conducts blood tests to look for infections and other complications. She orders an ultrasound when she determines one is needed or one is requested by the mother.

"I think it's important for people to know that midwives are trained providers," Palagi said. "I had a formal training that was very intensive for several years."

Palagi said the training for a midwife is several years long, requiring 1,500 clinic hours and being present for 100 births.

Palagi said the chances of a crisis arising are slim. One in 10 first-time mothers end up at the hospital during a home birth. For subsequent births, only one in 100 must be hospitalized.

Further, she said, the vast majority of those cases are nonemergencies, things like long or stalled labor.

She said by monitoring the baby's heart rate she can effectively monitor the situation to avoid dangerous situations.

She also said she knows her limitations and knows when to let a doctor take over.

"Those kind of incidents are very rare," Palagi said. "My job is to identify when there is a problem and deal with it before it becomes an emergency."

Also, she adds, proximity to a hospital is an important consideration. She won't do a home delivery that is more than 30 minutes from a hospital.

Palagi said in the past, most women who chose home births did so because of a desire for privacy and intimacy they couldn't get in the hospital.

But she said she's noticed a change lately, with many telling her they were unsatisfied with previous hospital experiences.

One such person was Heather Gorman, a recent transplant to Helena who just gave birth to her fourth child in November. Gorman's first three children were born in a hospital - the first two in Minnesota, the third in South Dakota.

She said with her third child, none of her family - not even her husband - was allowed in the room with her because staff at the South Dakota hospital said there was a bad cold going around.

After her baby was born, Gorman said, hospital staff took her baby away and didn't return with the child for four hours, without explanation.

While that isn't a typical hospital experience, Gorman said she decided then that she would never have another hospital birth.

She couldn't have been happier with her choice.

Palagi was Gorman's midwife, and Gorman said she became almost like family. And, Gorman said, knowing she would be dealing with the same person, who was not a stranger, gave her peace of mind.

Cost can be issue

Because home births are not always covered by insurance, it can be cost-prohibitive for some women who would like to deliver at home.

Rachel Donahoe had one of her three children at home.

Donahoe's 6-year-old son Henry was born in the hospital. Since the birth went well and Donahoe is a firm believer in birthing without medication or intervention, she had her daughter Evelyn, 4, at home even though her insurance didn't cover it.

"We just decided it was worth it," Donahoe said. "It was worth it to be in the comfort of our home. The bonding time is so important. It's so much easier when no one's in the room. When you're wanting to do it the natural way, I think home birth is the easiest way to make that happen."

Donahoe gave birth to her third child, 2-year-old Jack, in the hospital, however, because the cost was too much for her family at that time.

Palagi said she has no contracts with insurance companies, but insurance typically reimburses for home births about half the time.

Family traditions

With Gilbertson's family background, it's hardly surprising she would want to have her baby at home. She and her brother, Jed Smith, 30, were both delivered by midwives in home births. Katherine Smith was active in the Legislature in the late 1970s and early '80s to help get legislation passed to allow state certification of lay midwives.

In fact, Gilbertson remembers being active in that political process herself.

"I remember they took me up to the Capitol to testify," Gilbertson said. "I was probably in second grade. I had to wear a T-shirt that said, 'Proud to be born at home.' "

"Back in '77 - that was the year I had my son - there wasn't a lot of home birth in the state, so we were kind of on the forefront of that whole movement back then," Smith said.

"Years before that, before I was married, before I even was thinking about having kids, I was lucky enough to see two hospital births, and something real deep inside me said, 'I don't ever want to do that.' And when I was older - I was 30 when I had our son - I just knew that was a choice I didn't want to make, to go to a hospital."

Smith said that at the time, she was into alternative lifestyle - a hippie is how Nanette puts it - so she sought out others with similar outlooks.

She contacted India Supera, Crystal Water's mother.

Supera flew to Santa Cruz, Calif. - which was the epicenter of the home birth movement in America at the time, Smith said - to recruit a midwife.

The midwife came to Montana and stayed at the Feathered Pipe Ranch. That year, the midwife delivered Smith's son, Jed, Crystal Water and six other babies at the ranch.

All eight babies were fine.

Reporter Joe Menden: 447-4087 or joe.menden@helenair.com.