There is a thriving home birth community in the Seattle area. But when asked if she thought home birth was on the rise in the U.S., Simkin answered, "No... I think home birth has a small niche that is really not growing very much... And you know I love home births, so don't get me wrong, but I think home birth is definitely outside the mainstream and probably always will be. Number one, many people don't have a home that they think is suitable for a home birth. They may be living with relatives or in a communal situation, or in a small apartment [with] thin walls. Also, there is a certain amount of inconvenience in getting your home ready for a home birth — a lot of preparation. I think that if there were more birth centers, there would be more people turning to that option. But that is not to say that I think that home birth is dangerous, because I don't. But it's just these other things are encumbrances. Furthermore, home birth midwives cannot attend many births; five or six per month would keep a midwife very busy. We'd need hundreds of thousands of midwives to provide home birth care to the majority of women."

She states, however, that the use of water during labor is increasing, "even within the hospital," Simkin says. "Our hospitals in Seattle began installing tubs for labor more than 10 years ago, but the women were, and usually still are, expected to leave the tub before birth.

Simkin continues, "But as of very recently, a few hospitals began allowing births to happen in the water. A few women rent large tubs that are brought into the hospital and then filled. The women and their partners get in, and some stay right through the birth. I think [physicians] are nervous, and feel a woman in the water is difficult to examine or monitor. They feel a bit out of control, but some have learned that labor and birth proceed well, even if the doctor can't use so many procedures and interventions."

Using warm water to ease the pain of labor is high on Simkin's list of recommended relief measures. Home birth midwives often have their own tubs that their clients can use free of charge, or know of local sources for rental tubs. Some women also buy an extra large-sized child's wading pool with inflatable sides that works very well, provided it is big enough to fit two or more adults comfortably, and deep enough for a seated adult to be immersed.

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