- The number of out-of-hospital births – which take place either at home or at a birthing center – has grown across the United States over the last few years. And they're particularly popular in Utah.
- Most of these births are safe, but data from the Utah Health Department shows they do carry higher risk.
- Some believe those higher risks are due to Utah's "lax laws" around midwifery.
- FOX 13 Investigates spoke with six Utah families from St. George to Layton whose out of hospital births didn't go as planned. Many said they found the state's laws confusing.
OGDEN, Utah — Each day, a steady stream of expecting mothers with protruding bellies flows in and out of My Family Birthing Center in Ogden.
As a midwife measures their baby bumps and smears them with blue ultrasound gel, the families explain the reasons they’ve opted not to deliver in a hospital: They want water births. A more natural experience. A home-like environment. Fewer interventions. A smaller medical bill.
“They say, ‘Birthing in a hospital is the true experiment,’” says Loretta Shupe, a licensed midwife and the CEO and founder of My Family Birthing Center. "’Birthing at home has been done for hundreds of years. And it must have worked because we’re all here.’”
The move toward out-of-hospital deliveries – whether at home or in a birthing center like this one — has accelerated in recent years, rising 22% nationwide between 2019 and 2020. They’ve become particularly popular in Utah, making up 4.4% of all births here in 2021 compared to 2.1% across the United States.
Data shows the vast majority of out-of-hospital deliveries are safe — especially for women who have normal pregnancies and no complications during labor.
But numbers from the Utah Department of Health show these births do carry additional risk. About one in 10 women who plans an out of hospital birth is transferred to the hospital, whether for pain management or a more serious threat to the health of the baby or mother. And the newborn mortality rate within the first month of life is nearly three times higher than for in-hospital births.
Utah laws that allow anyone to practice midwifery — regardless of medical background, credentials or experience — also leave some parents confused about what to expect from their home birth or birthing center experience
FOX 13 News spoke with six families across the state whose planned out-of-hospital births didn’t go as expected. While all their babies ended up healthy, several women were transferred to the hospital during labor amid complications that put their unborn children at risk.
One woman labored at a birthing center for nearly 24 hours before her daughter was born at the hospital during an emergency Cesarean section with the umbilical cord wrapped around her body.
Another woman says her midwives initially failed to realize her baby was breech. She was transferred by ambulance to the hospital, where doctors quickly cut her open and realized the newborn had kicked a hole in her uterus, causing internal bleeding.
Keira Shae successfully delivered at a birthing center in Utah County as planned in 2014. But she suffered severe tearing during the birth and recalls her husband’s shoes filling with blood as she hemorrhaged and went into shock.
“I’m not even really on the planet,” the 36 year old recalled of the moments after she delivered her second son. “There was a moment in all the shock where I was like, ‘Wow, I think I could die.’”
Shae’s midwife opted not to transfer her to the hospital, instead stitching her up and sending her home a few hours later. But Shae says she didn’t heal correctly and needed reconstructive surgery years later.
“It’s been probably a lifetime of consequences,” she said.
Despite the complications, some of the women said they would consider an out-of-hospital birth again under the right circumstances, and they stressed a conviction that women be able to choose where and how they deliver their children. But they also think it’s important to raise awareness about the risks – and the rules and regulations in Utah — so new parents have a better sense of what they’re getting into.
“I was young, and a lot of mothers are young — and we do have a lot of naïveté,” Shae said. “I hope they’ll hear my story and be able to have a little more of a critical eye on things.”
Watch the video below for an inside look at a Utah birthing center:
"THE CONSUMER HAS TO BE THE WARY ONE"
For a long time, almost all births in the United States were attended by midwives rather than doctors.
That began to change in the early 1900s, as hospitals offered new pain management medications like anesthesia. Efforts to smear midwifery started around that time, too.
"There was an active PR campaign to paint midwives as uneducated hags, long fingernails — I mean, the political cartoons at the time were like what we would consider the Wicked Witch of the West,” said Holly Richardson, a retired midwife who estimates she has attended the births of more than 1,000 babies during her 20-year career. “And we did see a shift.”
Data shows most babies born in Utah today are still delivered in hospitals. Between 2016 and 2021, Utahns gave birth to more than 257,000 children; of those, just over 10,000 were delivered out of the hospital.
But the pendulum has recently started to swing back slightly to midwife-assisted births — with interest increasing particularly during the pandemic, as some hospital policies limited who could be in the room during a birth.
Other families are motivated by a feeling that hospital births have become overmedicalized. They point to rising rates of Cesarean sections and argue that doctors sometimes create a cascade of interventions when they induce a mother or give her an epidural.
“I just want less interventions, deal with the pain,” said Emily Dalton, a 26-year-old from South Ogden who decided to give birth to her first child at My Family Birth Center.
While Utah has a long history of midwifery — dating back to the pioneers — for a long time there were no laws that explicitly allowed for the practice of midwifery in the state. Richardson and other midwives began pushing for that to change after 2000, when a midwife was charged with practicing medicine without a license.
At the time, “some midwives were like, ‘Look, we’ve been out here, we’ve been practicing for decades,’” she recalled. “‘We’re safe. We know how to do things and we don’t want to be licensed.’ And as we talked with legislators, especially Republican legislators, they were like, ‘Look, we’re not comfortable with doing another mandatory license.’”
That's how Utah ended up with laws that allow individual midwives to choose whether they want to obtain state licensure to practice. Minnesota is the only other state with voluntary licensure for midwives, according to CBS News.
Today, state law allows a broad spectrum of midwives to practice:
- Certified Nurse Midwives largely deliver in hospitals. They are licensed by the state and have a nursing background and a master’s or doctorate degree in midwifery.
- Lay midwives, called Unlicensed Direct Entry Midwives, aren't required to have any education or background in the field. Unlike Certified Nurse Midwives, they aren’t allowed to use medications, such as those intended to stop a hemorrhage after birth.
- In between are midwives who may or may not have a nursing degree but who typically are required to obtain training related to midwifery through certificate programs or apprenticeships.
Because all these providers can call themselves midwives, FOX 13 News found it can be difficult for new parents to differentiate between their various credentials — despite a law requiring midwives to disclose details about their backgrounds and licensing status to potential clients.
“Sadly, the consumer has to be the wary one and ask questions,” Shupe said. “A lot of consumers don’t. They assume, ‘Oh, they’ve helped other people. They know what they’re doing.’”
The video below explores the interconnected history of midwifery in Utah and The Church of Jesus Christ of Latter-day Saints:
"HOME BIRTH AT ALL COSTS"
When Shupe looks at data showing higher death rates among children born at home or in birthing centers, she sees a clear line to Utah’s “lax laws” around midwifery.
“In my opinion, there’s no reason why not to license and no reason why not to get certified," she said. “We expect that from plumbers and electricians. We expect that from surgeons and doctors. In Utah, we should expect that from midwives. And I believe those rates would change.”
Of the nine newborn deaths that took place between 2013 and 2015, five were associated with unlicensed midwives, according to data from the Utah Health Department. Three others were associated with licensed midwives, while the last was with “someone other than a midwife.” The state’s death committee concluded that five of the deaths had a “strong chance” of being prevented, while the other four had “some chance.”
Unlicensed midwives are not subject to the same requirements as licensed ones, and sometimes take on high-risk births — such as breech babies or twins – that licensed midwives are not allowed to. FOX 13 found at least two examples of unlicensed midwives who advertised online that they were able to deliver under such circumstances.
“Those are higher-risk births,” Richardson said. "So to say, ‘Look, licensed midwives can’t do these births but I can do these births...’ That can be scary.”
There have been at least two high-profile cases of babies dying in the care of unlicensed midwives in Utah in recent years.
Valerie El Halta was sentenced to 72 months of probation and $78,700 in restitution for her role in the 2012 death of a Moab baby whose mother had already had three prior Cesarian sections. The mother nearly died as well during the “high-risk” birth home birth, according to a probable cause affidavit.
Another unlicensed midwife, Vicki Sorensen, was charged in the death of a baby in Cedar City that occurred that same year, after she’d apparently reassured the parents she could deliver their twins safely. She was sentenced to six months in jail for manslaughter and ordered to stop practicing midwifery.
Richardson said that while there are unlicensed midwives who are “very well trained,” there “are bad actors out there.”
“And that makes me sad, because there shouldn’t be,” she said. “I don’t think any midwife should ever say, ‘It’s a home birth at all costs.’ ... And I know some who do.”
Richardson is an advocate for mandatory licensure but says she doesn’t think there’s political will for it on Capitol Hill. There’s still a “sentiment among legislators that we have too much licensing,” she said.
There's also a contingent that believes Utahns should have the freedom to choose whoever they want at their births – without the state’s involvement.
“I totally am for women’s right to how they want to birth,” said Dalton, though the expecting mom said she chose to work with a licensed midwife due to her more complicated medical history. “And if they want to birth with an unlicensed midwife, that’s fine with me.”
Bryanna Hazelwood, a licensed midwife and owner of Tooele Midwifery, said she's not supportive of mandatory licensure, saying there’s a need for these practitioners to do births that licensed midwives can’t.
“They can do breech deliveries, twin deliveries and vaginal deliveries after three or more C-sections, all of which can be safe to do if the midwife is appropriately trained,” she said. “And most unlicensed midwives specifically specialize in those things.”
But she said she does know of unlicensed midwives who have “unsafe practices,” and said it’s important for clients to “know what to ask and interview midwives before they hire them” for their own safety.
Learn what questions experts say you should be asking your midwife in video below:
DELAYS IN TRANSFERS
Regardless of a midwife’s licensing or training, issues with out of hospital births often arise when midwives delay transferring a mother to the hospital when needed, FOX 13 News found.
Advocates for out of hospital births say data showing that about 10% of women who plan out of hospital are transferred to the hospital — with first-time moms at highest risk — are a sign midwives are being responsible.
Shupe said hospital transfers “can be a good thing.” But she added that it’s “unfortunate” when midwives “wait too long to transfer, and then life is on the brink.”
That’s what happened to Lacie Baum, who chose to deliver her first child in a Utah County birthing center in 2021, hoping for “more control” and a more “personal experience” than she could get in the hospital as the pandemic wore on.
But during the nearly 24 hours she spent laboring at the birthing center, she had a feeling something wasn’t “right.” Her contractions were painful, and she spent much of the night “screaming” in “agonizing pain.”
“It wasn’t normal,” she said, “but they kept telling me it was normal, and I didn’t know any better.”
At one point, she said she made a joke about wanting an epidural, a treatment only available at the hospital. But documents show a midwife didn’t suggest she should be transferred until she’d been there for nearly a full day.
Once Baum arrived at the hospital, a heart rate monitor showed her daughter’s heart rate was dropping, so she and her husband made the decision to have a Cesarean section.
“My doctor told me that if I wouldn’t have gotten there when I did, that my baby would have died the way that she was born,” she recalled, describing the umbilical cord wrapped around her daughter’s body as “like a cocoon.”
After the birth, Baum filed a complaint against the licensed midwife who attempted to deliver her baby. The state investigated but did not to take any public action against the midwife’s license.
The Department of Occupational and Professional Licensing asked Shupe, then the chair of the state’s Direct Entry Midwifery Board, to review the death.
Emails Baum shared with FOX 13 News show Shupe felt the midwife didn’t “understand the natural progress of labor” and said her actions had “compounded the problem." But Shupe didn’t think the state had “any rules that this midwife broke.”
To educate future parents, Shupe urged the couple to write a review of the birth center online, calling it “the biggest help to the community that this couple could do."
Cases like Baum’s show that licensure doesn’t guarantee a positive experience, Shupe said. But it can assure parents that a provider has a minimum level of education, Richardson notes, and it provides an additional layer of accountability outside of the criminal justice system if midwives act outside their scope.
“You know that there has been some process where they’ve had to take classes, where they’ve had to take a test or they’ve had to do clinical work that was supervised,” she said. “So you don’t have somebody who says, ‘Hey, I had a dream that God wants me to be midwife, so now I’m a midwife.’ Those are the ones that really, really concern me.”
Baum said she struggled with guilt for a long time after her birth, feeling that she’d put her daughter at risk — a sentiment shared by several other parents FOX 13 News spoke to for this story.
“It was me who chose the birthing center,” Baum said. “It was me who defended them to my parents, to my husband’s parents, to our family, to our friends every time anyone would question my decision to go to the birthing center. I would defend them and say, ‘You know what? Women have been giving birth like this for thousands of years and what could go wrong?’ It will be fine.”
Years later, she now sees what happened to her in a different light.
“It wasn’t my fault,” she said. “There is a serious lack of information."