The home office of Beautiful Births in Black Forest feels less like a medical zone than the back bedroom of a friend who really really loves kids. Portraits of babies and beaming families adorn the walls, and there’s a bucket of toys in the corner. The exam table looks like a tall single bed, topped with pillows and a flowered coverlet.
When certified midwife Tara Stephen asks 25-year-old mom-to-be Maddie Clarke to “hop up” for a check of vitals, though, the domestic touches only serve to soften the fact this is serious business.
“Every time Maddie gets up on that bed, her uterus contacts,” says Maddie’s husband Niles, 30, making a joke about how “white coat syndrome” might be to blame for the elevated blood pressure his wife has exhibited lately during official checkups. Her numbers have been fine at home, he says, as the midwife inflates the blood pressure monitor on Maddie’s arm.
Whoosh. Whoosh. Whoosh. A long pause, then a long rush of air.
“I’ve got you higher again. One-thirty-six over ninety-four,” says Stephen.
“Maddie!” Niles blurts, reflexively.
Elevated blood pressure isn’t the only potential cause for concern. Though Maddie had had a textbook pregnancy, with normal weight gain and normal fetal progress through the first seven months, in recent weeks the baby’s growth had slowed.
“Babies come in all kinds of sizes. But your little guy is little, and that’s a bit concerning to me,” says Stephen, who’ll be handling the upcoming water birth, in a portable tub she will assemble at the Clarkes’ Fort Carson townhouse once she’s confident Maddie’s time is nigh.
“It could just be that you’re having a small baby,” Stephen continues. “The issue is if your baby is not supposed to be genetically small and it’s not getting the nutrients it needs to grow properly. That could mean there are other kinds of problems.”
But there’s still some time to grow. It’s Jan. 25, and Maddie is 39 weeks pregnant. If she hasn’t delivered by 41 weeks, Stephen recommends another ultrasound.
“So if the baby comes out at 40 weeks and the baby is small, what’s the likelihood we have to go to the hospital?” asks Niles.
The midwife tells him not to worry. The odds of that happening are slim.
A hospital birth experience is not what the Clarkes want. But if that’s what ends up being needed, for the health of mom or baby, Evans Army Community Hospital is just minutes away from their home on base.
“So we’ve got your next visit, Tuesday next week?” Stephen says.
“Already in my calendar,” says Maddie.
She adjusts her mask and tugs on a thick winter coat that wasn’t built for two, and wonders how many more of these appointments lie ahead.
Before the 20th century, giving birth was the most dangerous thing most women would ever do, and almost all did it outside a hospital setting. Discuss childbirth, and “home” was implied.
Thanks to advances in medicine, access and shifting mindsets, by the 1940s home birth rates had dropped to 50%. Soon after the midcentury mark, fewer than 1% of births were happening outside a hospital, and infant and maternal mortality rates had plummeted. Home births saw an uptick in popularity among new generations of moms for several decades starting in the 1970s, alongside a rise in the number of birth centers and professionals offering alternative services, such as midwives and doulas. Then, after a slight decline through the 1990s, came a (relative) home birth baby boom: between 2004 and 2017, births at homes and in birthing centers increased by 77%.
Professional midwife associations report that number has continued to rise, and in many places have reached record levels, as worries about the coronavirus have led more moms-to-be to consider their options.
Maddie always knew she wanted kids, but hadn’t put much thought into the logistics of bringing a child into the world until she found out she was pregnant, in May 2020.
“We weren’t expecting to get pregnant that fast,” Niles said. “We were so excited, then it hit: Oh, no. COVID. We’d obviously thought about it, but it felt different once it was real.”
The idea of a home birth had appealed to Maddie before, but COVID sealed the deal.
“It was just the idea of being in a hospital, with the possible exposure …. And having to wear masks, and not knowing whether Niles could definitely be there in the room with me,” she said. “I know at some point in the pandemic, women’ weren’t allowed to have any support people with them in the room. I knew I needed to have him there.”
Hard to imagine, this was a man who, four years ago, had struggled to get her to go on a date.
It was 2016 and both were fresh transfer students in their junior years, and members of the ROTC program at the University of North Carolina at Chapel Hill. Niles asked her out. She said no. But the two stayed friends and continued to hang out.
“About a year later, she came to her senses and fell for me,” Niles said. “It was all my bad jokes.”
They married at the courthouse in Hillsboro, N.C., in December 2018, with plans to have a big wedding later down the line, after they’d both finished their separate post-graduate Basic Officer Leader Courses. Maddie headed off to Fort Lee in Virginia for transportation officer training, and Niles to Fort Leonard Wood Army Base in Missouri to receive training for engineers.
After Maddie finished at Fort Lee, she joined her husband in Missouri, where Niles had signed up to work an additional 12 months as a basic training platoon leader. Though the couple had planned to wait to start a family, “baby fever struck her hard,” Niles said.
“I had a couple drill sergeants, their wives were pregnant and had babies while we were there,” he said. “We’d been planning a real wedding, for October 2020, but once we decided to postpone the wedding for COVID, the baby decision was pretty easy.”
By the time the Clarkes arrived at Fort Carson, in July 2020, Maddie was two months along.
Home birth not for everyone
A home birth is not right, or safe, for every woman. According to a 2016 report by the American College of Obstetricians and Gynecologists, between 23% and 37% of first-time moms who’d set out to deliver at home had to be transported to the hospital during labor, for reasons including stalled labor, pain, and issues such as fetal malposition.
Other studies have shown that women with low-risk pregnancies can give birth at home as safely as in a hospital, especially if they’re being attended by a birthing professional, such as a certified midwife.
As things worked out, the Clarkes’ midwife almost didn’t make it in time.
On a Tuesday evening, a day after their appointment with Tara Stephen, Maddie was in bed with her husband when she felt her water break.
“I was, like, oh my gosh. That really just happened? No way,” said Maddie, of a signal of impending childbirth that’s far more common in Hollywood than real life.
It wouldn’t be the only thing that didn’t go according to plan.
After Maddie’s water broke, Niles called Stephen, who asked if contractions had started yet. They hadn’t, so Stephen told the couple to keep her updated, and try to get some sleep.
Maddie’s contractions, and doubts about her decision on a home birth, started about 30 minutes later. She was thinking about hospitals, and drugs to help with the pain, but the idea of getting in a car for the brief ride to Evans was unfathomable.
“We timed her contractions for an hour, they were getting pretty intense,” said Niles. “Maddie was, like, I want you to call Tara….” So he did.
The midwife didn’t think things had reached an urgent level yet — and first-time moms usually have a longer labor than women who have given birth before. But she could tell Maddie was struggling, so offered to head over. It was an almost 40-minute drive, and she still needed to set up and fill the birthing pool.
Stephen arrived at the Clarkes’ home just after 3 in the morning.
Levi Clarke arrived about 30 minutes later, a healthy baby weighing 6 pounds, 15 ounces and measuring 21.5 inches long, a “lanky boy,” said his dad.
“He popped out and he went right onto Maddie’s chest,” Niles said. “Tara was great. She checked to make sure he was good, then let baby and mama be together and get in that bonding… while she was focused on delivering the placenta.”
Maddie marveled at the new life, their son, and all that had happened in the last five hours, in the home they all shared.
“I guess it just felt like shock. It’s crazy to say that labor flew by, but it did,” Maddie said. “I was laying in bed ... and there he was.”
After Stephen left, and new grandparents had been apprised by phone of the exciting news, the exhausted now-family of three lay in bed, in the sudden quiet of a new day and a new reality.
“We were just, like, woah….” said Niles.
“...like, can you believe that just happened?” said Maddie.
Someday, they will tell Levi the story of his birth, how it happened not at some big building with an abstract address, but in the house where he grew up. How it happened during a strange and scary time, of pandemics and quarantines.
They hope the latter part of the tale is one their son will struggle to comprehend.
“I hope that when he sees pictures of when he was little, of us with masks on, that that’s a strange thing to him,” Maddie said.