SALT LAKE CITY — Lauren Lewis has been pregnant six times in the past five years.
It wasn't until early last month that Roman Vance Lewis finally made his debut. He arrived for the most part, safely, following his birth at the family's Sugar House home.
Roman is Lewis' third child, and he was her second to be born at home.
"I was never fearful of giving birth," Lewis said. "I knew I was going to have this baby and as long as it looked healthy on all the ultrasounds and I had no problems with my body, I wanted to let nature take its course."
She said succeeding at something so natural gives her a sense of great accomplishment as a woman.
"It is a miracle, an out-of-this-world miracle," the now-mother of three said.
Home births are rising in Utah — with an 89 percent increase from 2004 to 2013, to more than double the national average — as more and more women are "searching for a natural experience," said midwife Dee Gordon, owner of Heber City-based Genesis Birth Co.
Still, that only accounts for just a little more than 2 percent of total births in the Beehive State. Nationally, just 1 percent of babies are born in a home, according to data from the U.S. Centers for Disease Control and Prevention.
And the American Congress of Obstetricians and Gynecologists considers home births "inherently more dangerous" than births in medically supervised situations (hospitals) because of unforseen complications and unplanned medical needs. Despite trends, the organization believes hospitals are still the best place for women to give birth.
Seeking 'a moment'
Lewis's first baby, a girl, was born in a hospital in New Mexico and the baby was taken away to be monitored after an ultrasound revealed the umbilical cord wrapped around her neck. The issue had all but resolved itself upon delivery, but it was hospital protocol to monitor the baby at least three hours for potential complications.
Lewis said she was sad she didn't get to hold her first baby right after birth.
"I missed that moment," she said. "I'll never get that back."
Birthing the next two at home gave her the experience she believes childbirth should bring — a deep connection with the baby and peace from familiar surroundings, even though her second child's birth was a bit traumatic, lasting three days at home because of how the baby was positioned.
Lewis was also experiencing pain from a hip dislocation at the time and said the labor and delivery was "extremely painful."
"After that experience, I figured I could pretty much pull off anything at home," she said. And after years of trying for a healthy pregnancy, Lewis found herself expecting again and began better preparing herself, physically and emotionally, for the worst.
She knew that the extra preparation would help.
"I just wanted this one to be calm and peaceful," Lewis said, adding that she got exactly what she asked for with Roman, up until the very end.
Midwives
The CDC reports that Utah and Idaho have the nation's highest rates of home births, though they're also two of the fastest growing states in the country by way of the number of babies being born.
Before 1940, nearly 40 percent of births were executed outside of a hospital, but that dropped to 1 percent by 1969, as research and medical technologies became mainstream and more reliable.
In 2015, 2.7 percent of births attended by a midwife were performed at home in Utah, the CDC data show.
But there are two types of midwives.
A lay midwife is educated through various preceptorships and job shadowing. She also is not able to deal with medications and is not considered a medical professional.
A certified nurse midwife is required to receive an accredited university education and obtain licensure in the state where she wants to practice. She must also work under the supervision of a doctor and have formal access to a hospital, as well as abide by state regulations.
Heidi King, clinical director at Valley Obstetrics and Gynecology, which has facilities throughout Utah County and in St. George, said there is "a huge gap in training" between the two types of midwives. The group doesn't employ lay midwives at all, but, in the last four or five years, has increased the number of certified nurse midwives it has on staff.
"We were seeing a lot of patients transferring to areas where they could get treatment from a midwife and figured it was something we needed to look into," King said. The type of care they offer is similar, whether it's an obstetrician or certified nurse midwife offering it, though depending on availability within the hospital, midwives tend to spend more time with the patient during the laboring process.
Recent research shows that younger generations value the extra time and deeper relationships they can form with their midwives, but also like to have things done in their own way. Midwives, including those working in hospital settings, sometimes have more lenient practices.
Gordon said the women she serves often express a desire to select the type of care they want and a setting that is comfortable for them.
"A lot of women want to create a sacred birth space and have it be a spiritual process," she said. As a lay midwife, she encourages women to create their space however they choose, and she advises use of various herbs and tinctures to help with symptoms and laboring, invoking a "natural" labor without pharmaceutical intervention.
Continuous fetal monitoring, intravenous drip, epidurals and medications issued to push labor along, as well as drugs to strengthen contractions are commonly used when women labor in a hospital.
In some cases, these interventions save lives.
Babies are also treated with a variety of interventions upon arriving at hospitals, including routine application of antibiotic eye ointment, vitamin shots, and, more recently, as advised by the American Congress of Obstetricians and Gynecologists, a somewhat delayed umbilical cord clamping for healthy infants.
Gordon said she doesn't like to cut the cord until at least an hour has passed after delivery.
"You have more control over it all in your home environment," she said.
Should complications arise during labor or delivery, however, the hospital is the place to be, King said.
"If there is a complication or a problem, you have a doctor and additional staff at your side immediately," she said of hospital births.
King noted that most hospitals will almost always work to accommodate unmedicated and other alternative birth plans, depending on the circumstances.
Valley Obstetrics sees patients when home births turn awry, but King said time is of the essence when dealing with newborn babies and medical professionals would rather not deal with the delay and urgency involved with transit to the hospital.
Roman is one of a rare few babies born at home, who, because of medical necessity, are transferred to a nearby hospital. He was having trouble clearing his lungs and increasing his oxygen saturation rates after aspirating some amniotic fluid during birth.
"It just wasn't happening fast enough," Gordon said.
And while taking him to a hospital was more of a precaution, it wasn't in the plan for Lewis and her husband, and thus it was a little hard for them to accept.
"It was quite traumatic. He was hooked up to all these devices and there were a million different noises coming from them," said Lewis, 35, who has only ever taken her children to the doctor for routine checkups. "This was so foreign to me."
But, she said, she and her husband, Trevor Lewis, believed it was the safest thing to do for their little Roman. And she believed Gordon was doing the right thing turning care over to better trained professionals.
Weighing the risks
Planned home births or birth center deliveries accounted for about 3 percent of Utah babies born in 2015, according to the most recent available data from the Utah Department of Health.
About 5 percent of those resulted in a hospital transfer, though it is hard to tell from birth certificates whether home births are planned or just happen.
Nationwide, there are about 35,000 home births each year, with about a fourth of those happening unexpectedly or unplanned, according to the American Congress of Obstetricians and Gynecologists. It wants women to know there are increased risks associated with home births.
Lay midwives, Gordon said, will look for symptoms "that fall outside of normal" and she said they are counseled to transfer a mother and/or baby when advanced medical attention seems necessary.
Not all midwives heed that counsel, however, and the outcomes aren't always favorable.
Just last year, a lay midwife in Cedar City was convicted of manslaughter and reckless endangerment after she attempted to deliver a baby when the mother went into labor prematurely. The jury found the midwife did not have the skills or equipment to handle either the mother's situation or the premature baby, and she had told the courts she did not transport them to a hospital because of snowy roads.
Women carrying twins or who have had multiple cesarean section surgeries, uncontrolled diabetes or high blood pressure, as well as babies in breach position, should not plan a home birth, according to the American Congress of Obstetricians and Gynecologists.
And Gordon agrees, saying, "we're not equipped to handle those situations."
A Utah Department of Health study shows that babies born in low-risk situations at home compare well with babies born in hospitals, but results deviate a little when babies are tested five minutes after birth. The study states that more research is needed, given the rising number of home births happening in Utah.
Induced births are also on the rise, doubling in popularity from 1990 to 2006, as well as births by caesarean section, which account for 32 percent of all births in Utah, according to the CDC.
In such circumstances, King said, doctors and hospitals prove invaluable. She said cesarean section surgeries cannot be safely performed in a home and lay midwives are not trained to perform them at all.
Women are encouraged to research a variety of options when deciding to become pregnant and where and how to give birth. Both King and Gordon acknowledged it is important for women to remember that not all births go according to plan.
And while Roman ended up in a hospital for additional testing, Lewis was happy her baby was healthy and able to return home with her that same day.
"I truly feel like women need to be empowered to take care of their children, to use their own intuition rather than listening to just anyone," Lewis said. "Your natural motherly intuition is so crucial to being a mother — emotionally, physically and spiritually for your children."
And giving birth at home, she said, can be so "spiritual."
Lewis said she would do it over and over again, if she could. And she loves telling other women they are capable of it, too.
"It's just magic," she said. "Our bodies are magic."