Eileen Fruithandler delivered her second child at home with a midwife in 1992 – an era when she and her late husband faced pushback from loved ones about the decision.

“I’m lying to everyone – I had to lie,” said the 66-year-old Denver resident, who splits time between Denver and Palm Beach, Fla. “It wasn’t in vogue when I did it.”

In the three decades since Fruithandler’s secretive delivery, more pregnant mothers-to-be — of all ages, backgrounds and income levels — have followed her path of using midwives.

The number of women who birthed at home from 2020-21 rose 12%, “the highest level since at least 1990” at more than 51,600 births, according to the Centers for Disease Control and Prevention. And, from 2016-21, more certified midwives — who have faced misconceptions about their educations and care historically — have joined the profession to meet the boost in demand.

“We’ve done home births in RVs,” said Jen Anderson-Tarver, a certified professional midwife at New Leaf Midwifery in Denver. “We’ve done home births in 300-square-foot apartments, and we’ve done home births in $3 million houses.”

In Colorado, midwives are seeing the same rise in interest in their services, particularly after the COVID-19 pandemic. The practice is growing because it offers individualized “high-touch” care, a more flexible timeline for birthing, a comfortable setting, access to postpartum care and a cheaper alternative to hospitals, Anderson-Tarver said.

Her services are roughly $5,000 on average for birth, prenatal and postpartum care. To birth a baby in a Colorado hospital, the average vaginal delivery costs close to $10,000, while a caesarean-section costs around $14,000, according to Denver nonprofit The Center for Improving Value in Health Care.

But costs can vary drastically based on the area, particularly in mountain towns, with a C-section priced as high as $40,600 at Valley View Hospital in Glenwood Springs, the nonprofit reports.

The state’s caesarean rate is about 27%, while Anderson-Tarver’s is around 5%. The World Health Organization recommends a rate between 10% to 15%.

Midwifery dates back to the Paleolithic era. “In the early parts of the 19th century, midwifery was the most customary practice for pregnancy care and childbirth” in the U.S., according to Oregon Health and Science University.

The trend changed with the rise of anesthesia and the formal education of male doctors in childbirth, with midwives stereotyped as “lower class.” Today, “Canada and the U.S. are some of the only developed nations with more OB-GYN doctors than midwives,” and Australia and Sweden top the charts for most midwives per capita, data gathering platform Statista reports.

The practice is made up of several types of practitioners, including certified nurse-midwives – or registered nurses with midwifery training who largely work in hospitals – and certified professional midwives with training and education to work in out-of-hospital settings.

Anderson-Tarver highlights two events that contributed to recent spikes in home births: the 2008 documentary, “The Business of Being Born,” and the pandemic. As COVID kept hospitals overcrowded, some expecting mothers didn’t want to worsen their risk of catching the illness or wear masks during birth, she said.

She’s also noticed “a movement” in the insurance sector to offer expanded coverage of home births over the past few years.

Health First Colorado, Colorado’s Medicaid program for low-income health coverage, covers home births performed by enrolled physicians or certified-nurse midwives, but it doesn’t enroll or reimburse certified professional midwives as providers, said Adela Flores-Brennan, the state’s Medicaid director.

But the department is exploring policy regarding the practice of certified professional midwives and their model of care across all birth settings, she said in a statement.

New Leaf Midwifery

Anderson-Tarver originally worked as a doula, a professional often confused for a midwife who offers emotional support to mothers, at a Minneapolis public hospital. After attending more than 100 labors, the positive experience of her first home birth changed her career path to midwifery.

Drawn to it “out of a love for women empowerment,” Anderson-Tarver finished over three years of schooling, an eight-hour board exam and four-hour skills exam before completing her registration and licensing in Colorado 12 years ago.

At a home birth, she brings medical supplies, such as gloves, catheters, oxygen, suturing equipment, IVs – “all of the things that they have at a community birth center.”

She’ll let clients curate their environments by playing music, inviting loved ones to support them or taking naps with their partners throughout the process.

“You would be surprised at the people who are birthing at home,” Anderson-Tarver said, “from Catholic families, to people who do not identify as female and are birthing, to polyamorous families, to traditional heterosexual relationships.”

Whitney Ford, 36, has always wanted a big family with her husband, Damien. A mother of four in Aurora, she called her first birth “traumatic.”

When she was 25, Ford faced complications birthing her son, Landon, over a 38-hour period at the hospital, which resulted in a C-section.

“Nothing went right,” Ford said. “As a first-time mom, I didn’t really get the voice that I felt like I deserved.”

Upfront, it cost $10,000, then “bills upon bills” arrived. “I was like, ‘Oh, my gosh, they’re charging me for warming the blankets? I wish I would have known,’” she said.

Afterward, Ford described herself as “genuinely afraid to have another baby.” So, she sought a midwife for her second pregnancy at 31 years old.

But again, she struggled with complications that landed her in the hospital with another C-section for her daughter, Elaina. “My dreams of having a home birth were pretty much shot, I thought,” she said.

With her third child, she qualified as a “very high risk” pregnancy at the age of 33, given her two C-sections, but pled with her doctor for a vaginal birth at the hospital. He gave her one hour to push her daughter out before they opted for another surgical delivery.

Throwing up, Ford pushed so hard that she birthed Melissa within minutes.

During her fourth pregnancy at 35 years old, she went to Anderson-Tarver for a home birth, although her relatives and in-laws were nervous about the decision.

Within six hours, she successfully birthed Juliana in her bedroom, with Anderson-Tarver using both of her hands to help when the infant got stuck during the process.

“I felt like I was giving birth to my baby with my aunt or my sister,” Ford said.

Costing $6,000, she called the midwife option “the cheapest way to have a baby.” But “I got care as if I’d paid $1 million.”

Paying (and bartering) for midwifery

Samantha Venn, a certified professional midwife at Lakewood’s Meadowsweet Midwifery, is part of a two-woman team serving the Denver area.

“In Colorado, midwives are able to do full prenatal care, full postpartum care, including newborn care up to six weeks,” she said. “We do all normal lab tests within our office,” only referring outside of their business for ultrasounds.

Their clientele ranges “from lawyers and doctors to stay-at-home moms who live on farms,” she said. “You’d never realize that your neighbor had a birth right next to you.”

And they’re choosing home birth for different reasons – because they were born at home themselves, were left “deeply traumatized” by hospital births or suffered losses like miscarriages.

Venn puts the typical age range of their clientele at early-to-mid-30s, as “a lot of first-time moms are waiting a little bit longer to have babies.” But they’ve aided first-timers as old as mid-40s and as young as teenagers, which resonates with Venn, once a teen mom herself.

While they charge on the higher end of Denver’s average price range of between $4,000 and $7,000, Meadowsweet Midwifery offers a sliding scale, with discounts for early payments and repeat clients.

They’ve even bartered for their services. In 2021, farmers “traded us a good chunk of the fee for organic produce and firewood,” and, this year, another client exchanged part of the fee “for website design services and headshots.”

“We have done births for just about nothing for clients who are deeply in need,” Venn said. “We just try to meet people where they’re at.”

“Such a peaceful birth”

In 1992, Fruithandler decided to use a midwife for the delivery of her second daughter, Danielle, after the birth of her eldest child, Sara, went poorly at a hospital.

At the age of 32, she planned for a natural birth without medication, but complications occurred right before Fruithandler’s water broke.

“So fast, they stuck the needle in my back,” she said. “I had the baby by caesarean section, and they cut you open. It was really awful.”

Afterward, she dealt with postpartum depression, which went undiagnosed for months. Fruithandler wanted her next birth at 34 years old to go differently.

Describing herself as a “hippie” in the 1990s, she and her late husband, a chiropractor, took classes with a nurse midwife. When the midwife talked about her childhood spent on a farm delivering baby animals, Fruithandler’s decision was made.

“This woman’s been doing home births her whole life,” she said.

But her best friend, her parents, her parents-in-law and even her neighbors were against it. “If I did talk to other people about it, other people said, ‘No,’ ” Fruithandler said.

Two weeks after her due date, Fruithandler was still waddling around pregnant. Her nurse midwife advised “sex and walking” to spur the labor – and it worked.

For days, the nurse midwife and another nurse studying midwifery took turns sleeping at her house through her labor.

When Fruithandler began to deliver her daughter in her bed, the midwife caught a life-threatening problem: The cord had wrapped around the baby’s neck. She used her fingers to unwrap it as the infant’s head popped out.

“Danielle would have died at home, had she got choked by the cord and the midwife didn’t know that,” she said. “A nurse midwife checks on everything.”

The cost of delivering a healthy baby at home: $3,200. And today, she’s a mom of three, having birthed her son, Austin, at 36.

Although “I don’t think it’s for everyone,” she called the at-home process “such a peaceful birth.”

Factors to consider

While home birth is “available for people who are low risk,” Dr. Jessica Anderson, director of midwifery and women’s health services at the University of Colorado Anschutz Medical Campus, points to “people that shouldn’t or can’t birth out of the hospital,” such as those with medical conditions like high blood pressure or diabetes.

The American College of Obstetricians and Gynecologists recommends against home birth for people who’ve undergone C-sections or pregnancies involving more than one baby – or when a baby moves into an unusual position.

Anderson said midwifery is “more visible” today, with an ongoing public debate of using midwifery as an option to change “our rising maternal mortality rate or rising caesarean section rate.”

She points to more people enrolling in their midwifery program over the years, as it moved to a “more accessible” hybrid model that lets educators teach students in rural communities, different states and more.

Joy Frazer, a certified professional midwife at Durango’s Joy of Life, serves three rural counties in southwestern Colorado – Montezuma, La Plata and Archuleta – along with San Juan County in northwestern New Mexico. She regularly drives one hour in three different directions to reach her clients.

“Very few midwives” practice in the Four Corners region right now – only three, she said. The rural region has fewer hospitals, too.

“We’re limited in that way,” Frazer said. If a hospital can’t be reached within 30 minutes, “then our clients have to be comfortable with that, as far as the emergency care plan.”

The most common reason for transfer of care from homes to hospitals isn’t an emergency, she said, but “a first-time mom having a long labor, who’s getting kind of exhausted,” and seeking medications like an epidural or oxytocin.

“There’s been a lot of propaganda for many decades that a hospital’s safe and midwives are untrained and not experienced and don’t know what they’re doing,” she said.

She charges $5,200 for birth, prenatal and postpartum care, with four visits after childbirth, plus a $200 travel fee for clients outside of La Plata County.

For midwives, “the schedule is quite grueling if you’re a home birth midwife practicing alone,” said Jennifer Barr with the Colorado Midwives Association. “You’re on call 24/7 for large swathes of time.”

Midwives take on a smaller base of clientele than a birth center or group practice, “but it is not an easy job.”

First-time moms

Natalie Baca, a BIPOC certified professional midwife at Arvada’s Holding Light Midwifery, has noticed “more younger or first-time moms looking into home birth,” partially crediting that trend to YouTube videos of home births.

Baca worked as a surgical technologist for two decades, and her years at a hospital informed her perspective on the difference between medical emergencies and non-emergencies.

“There’s so much fear around birth,” she said, but, “truly, emergency C-sections happen really rarely.”

When Baca birthed her son at home in water over a 24-hour period, “I actually hemorrhaged with him,” she said. “My midwife was all over that. She took care of me – I didn’t even know that I was bleeding.”

Her fee for services is $8,500, “but most people can’t afford that.” She charges a cash discount of $5,000 instead, and can sometimes bill insurance for the difference.

Baca served as a midwife for 31-year-old Johnstown resident Nichole Wolfe to birth her first child, Wade, in May.

A month after Wolfe married her husband Spencer last July, she attended a hot yoga class with dimmed lights and lit candles, and thought, “This is how I want to bring a baby into the world” – not yet realizing she was already pregnant.

During Wolfe’s labor, she ate breakfast burritos and berries, showered and even ordered Amazon packages – all while riding out her contractions.

“Pain never was a problem for me – it was more, like, getting exhausted,” she said.

After her spouse and Baca arrived at the house, Wolfe settled into the birthing tub in her living room in front of a crackling fireplace, as rain fell outside. Her husband rotated between offering her a towel, orange juice and water until she delivered their son.

“It was just the perfect setup,” Wolfe said. “I give credit to women who do it in the hospital because I don’t know how you’re doing it.”

The couple’s insurance “pretty much covered the entire home birth” at the price tag of $5,000, leaving them to pay about $500.

She’s since encouraged her friends to try home birth. The practice is no longer relegated to “hippie” moms, although “I think now the term they’re using is ‘crunchy,’” Wolfe laughed.

Would she do a home birth again for future children? “Oh, hell yeah,” Wolfe said.