The cramps were the first thing she noticed.

But soon after Abigail Mehrmann blinked awake at 5 a.m. one morning last September, her water broke and she realized the cramps were just the beginning. She was going into labor.

Mehrmann’s worried husband John followed her downstairs.

“Are you OK?” he asked.

Midwife Mell Pulsifer holds a newborn while new mother Nicole Schlacter rests in her home. Contributed / Mell Pulsifer

“Yeah, everything is fine,” Mehrmann said. “Go back to bed.”

There would be no rush to the hospital today. In fact, Mehrmann wouldn’t even need to leave her Auburn dining room, which a pair of midwives would soon transform into a birth station.

Baby Francis arrived at 10 a.m., one of a growing number of Mainers born at home.

The rate of home births in Maine shot up from 1.88% to 2.32% of all births in 2020, the ninth highest rate in the nation, according to recently finalized CDC data. Even as total births in the state declined, the number of home births rose from 222 to 268, a figure that likely undercounts the actual total, according to midwife Mell Pulsifer, who delivered Francis Mehrmann.

The American College of Obstetricians and Gynecologists says hospitals and birth centers remain the safest settings for birth. Yet more Mainers are opting to deliver their babies at home because of the comfort and control that setting offers, said Pulsifer, who runs In The Nest Midwifery & Abdominal Therapy in Brunswick.

“When you’re birthing in your own home, you’re the boss,” she said. “We have our skills, but ultimately those clients are in their place of power.”

Abigail Mehrmann, who was born in a hospital, initially planned on working with an obstetrician when she first got pregnant in 2018. Yet she was drawn to the intimacy and sense of agency that comes with home birth.

“For me, home is a place where I felt more comfortable,” she said. “I wanted to feel I had control over as many factors as possible.”

Mid Coast-Parkview Health has seen an uptick in patients seeking home births during the pandemic, according to Chief Medical Officer Chris Bowe. While the hospital doesn’t have an official policy on the issue, Bowe said its staff supports individuals’ decisions, provided they think through backup plans should emergencies arise.

“Mid Coast-Parkview health system definitely supports women choosing the best care plan for themselves,” Bowe said. “If they think, based on their beliefs and preferences, that they should have a home birth, we certainly support that.”

Abigail Mehrmann during the third trimester of her first pregnancy in 2019. Mehrmann gave birth to her son Henry at her parents’ home in Union. Contributed / Abigail Mehrmann

After researching the topic, Mehrmann became comfortable that working with a midwife would be a safe option.

Though people with conditions like insulin-dependent diabetes or hypertension may not be viable candidates, recent studies have suggested that planned home births may lead to fewer maternal interventions than do hospital births, according to the American College of Obstetricians and Gynecologists.

When complications do occur, midwives, who train for three to six years before obtaining licenses to practice in Maine, work with local hospitals to ensure their patients receive the care they need, Pulsifer said.

Choosing a midwife who has experience working with hospitals, is a major factor in ensuring the safety of a home birth, according to Bowe.

“It is critical for a woman who’s considering a home birth to consider how the delivery will go and what assistance she may need,” he said. “We think it works best if we partner to plan ahead in case a situation arises.”

National rates of home births had already been slowly ticking up for a decade, but the rise of COVID-19 in 2020 brought a major swell, according to a CDC analysis. Home births in the U.S. rose by 22%, with the increase especially stark after the pandemic’s first wave hit in March.

Both patients who feared COVID exposure from hospitals and those who wanted to avoid health center masking requirements sought out Pursifer, who began attending 4-5 births per month instead of her typical 2-3.

For Mehrmann, the choice to deliver her second child at home was partly about ensuring that COVID restrictions wouldn’t keep her husband and doula, a woman trained to assist with births, out of the birth room.

“It was very, very important to me to know that my husband was going to be allowed to be there with me and to know that my doula was also going to be allowed to be there with me,” she said. “I knew that I needed that support.”

Support is a key benefit of working with a midwife, according to Pulsifer. While routine check-ups and tests with an obstetrician often last only about 15 minutes, midwives work to develop trust with their patients through much longer meetings.

“While we follow through the same schedule of care, our visits are anywhere from an hour to an hour and half long,” she said. “That gives us a huge upper hand in caring for our clients because we can see things coming down the pike a lot sooner.”

Mehrmann, who gave birth to her first child at her parents’ home in 2019, said she has valued the trust she developed with her midwives, as well as the control a home birth has offered. Yet she also stressed that it’s just one of many viable options.

“It’s not about going, ‘Home birth is good and hospitals are bad,’” she said. “It’s about people feeling free to make choices that allow them to have a positive experience. The bottom line is that when women feel like their choices are being respected, that is going to lead to more positive outcomes for everybody.”