Homebirth in Rhode Island


On September 4th of 2007, Eva Pirro sat in an inflatable pool as she waited for her baby to arrive.

"The water is wonderful," she says. "I highly recommend it to anybody."

In a home video, Pirro smiles at the camera, her red tank top and black skirt soaked from the water. Behind her you can see a set of bookshelves. That's because she's not in a hospital she's in her spare bedroom. After delivering two daughters at a medical center, Pirro decided she wanted more control over her birth.

"I needed to just have it the way I wanted." Pirro says. "And being in my house, I could go to the bathroom whenever I wanted, I could walk around when I wanted to. My midwives were waiting and knitting, and it was just a natural occurrence."

As the home video continues, Pirro goes from smiling and waiting to the final moments of giving birth. She's still in the pool, on her hands and knees when you can see the outline of a head. One last push and the baby floats into the water.

A pair of hands quickly guide the baby out of the pool and onto Pirro's chest. It's a healthy boy.

Those helping hands belong to Pirro's midwife--at the time, the only person with a license performing home births in Rhode Island.

"It was just awesome," Pirro says, "because it was during my pregnancy that the law passed and it became legal and we were like, this is perfect!"

It's a common misconception that homebirth was illegal in Rhode Island. The truth is, there's no law against delivering a baby at home. The State just went nearly 20 years without a licensed midwife who was willing to do it. Linda Nanni is the regional representative for the American College of Nurse Midwives and director of the midwifery service at Women's Care. She says homebirth in Rhode Island has a controversial past.

"I can tell you that 25 years ago in this state there was a couple of sensationalized home birth cases that were brought to the media," Nanni says. "They were bad outcomes at home that were very difficult for us in our profession."

Nanni is talking about what happened in 1988, when two babies died during home birth. The state punished the midwife by taking away her license. She was the one and only person legally delivering babies at home. And then there was no one.

That's not to say home births didn't happen. For years, Massachusetts midwives have filled the void. Nanni says that's a problem.

"When someone comes across state lines and provides care for women who are is laboring, then it's illegal," Nanni says. "That is fraught with peril."

To keep the midwives from getting into trouble, the roughly 20 women a year had to lie and say their husbands delivered the baby, or claim they did it themselves. Even worse, out of state midwives didn't have official relationships with local hospitals. That made it difficult to coordinate with doctors if anything went wrong at home.

"That laboring woman and her family are on their own," Nanni explains. "And they arrive at the door step of the hospital and explain their story and they're looked at like are you nuts to have done this?"

And then in 2007, right before Eva Pirro gave birth to her son in the inflatable pool, home birth advocates successfully got rid of a state regulation requiring a written agreement from a physician before midwives could deliver babies. Given its complicated history, few doctors wanted to sign their names in support of homebirth. Taking that written approval out of the equation created a small opening for midwives like Mary Mumford Haley.

Mumford Haley meets with her home birth clients in a small office down the street from the Scituate police station. She attends about thirty home births a year, in addition to teaching nursing courses at the University of Rhode Island and delivering babies at Memorial Hospital in Pawtucket. Mumford Haley says there's something subtle and intangible about the value of homebirth. She likes making it an option.

"I think the best thing about it is getting tucked into your own bed when you're done," Mumford Haley says. "And not ever taking away the opportunity for you to get to know your baby the best."

For the past year and a half, Mumford Haley has been the only licensed midwife practicing home birth in the state. When asked what it's like to be the only one doing this, she says:

"It's lonely. If I didn't know I had help coming, I wouldn't do it."

It's a lot of pressure being the state's only licensed homebirth midwife. You represent the entire idea of giving birth outside of a hospital. If something goes wrong, you've given the whole concept a bad name. That's why Mumford Haley doesn't advertise. She prefers to quietly build her reputation as a skilled professional.

"I'm not a particularly flakey, airy kind of person." Mumford Haley says. "I do come across in a way that people will take me seriously if I ask them to. But some patients would like me to be more cuddly and a little bit more earthy wear a few more dresses." She laughs. "But it works. I'm here this far."

Luckily for Mumford Haley, her practice is growing. Recently, a colleague moved to Rhode Island and joined her practice, another midwife will return in June. A fourth assists when needed.

"I think things are actually starting to come together quite nicely." Mumford Haley says. "We needed a couple of us licensed nurse midwives to step up to the plate."

A proposed change to state rules and regulations might also increase the number of professionals delivering babies at home. It's ultimately up to the Department of Health, but Rhode Island's advisory council on Midwifery is exploring the possibility of licensing other types of midwives.

As for Eva Pirro, the mother who delivered her son at home, she likes the idea of more midwives offering home births in Rhode Island, but she'll only let one person deliver her babies--the woman who scooped Pirro's son out of that inflatable pool and into her arms.

"She's in New Zealand right now," Pirro explains. "But I'm hoping she'll come back. I was emailing her and I said, 'You know I might be crazy and have another one, but we're in no way having one without you!'"

For the rest of the home birth community, they say more midwives means more options, and perhaps more respect, for the women who'd rather deliver their babies in spare bedrooms than hospital beds.

Do you have insight or expertise on this topic? Please email us, we'd like to hear from you. news@wrni.org.