They miss the obvious here: Some women are giving birth at home because they don't have health insurance and can't afford to pay cash up front for a delivery. That was true back in the 1970s, when I apprenticed as a lay midwife, and it's even more true now.

There's no question that home delivery is much cheaper, and in low-risk births, just as safe when you have a qualified midwife. (For one thing, you don't pick up those antibiotic-resistant superbugs in your own home.) The medical restraints of hospital births can trigger a cascade of complications and interventions that might account for the U.S.'s disgraceful 32 percent C-section rate. The standard line is that American doctors are jumping the gun to avoid legal liabilities, but I think there's more to it than that: C-sections have become so commonly used that most medical students don't ever learn non-surgical alternatives to managing a complication, and thus don't know any other way to treat them.

The argument against home birth is the risk. But why are our infant and mortality rates so bad? We have the worst statistics in the developed world. You can't blame that on home delivery.

The other factor in choosing home delivery is that the quality of prenatal care is usually much higher, since midwives are famously reluctant to chance a high-risk home delivery.

Consider the typical profit-driven OB-GYN "assembly line" visit of 20 minutes or so. My visit with my lay midwife was more likely to last a couple of hours, including detailed questions about my protein intake, any unusual symptoms that might indicate nutritional deficiencies, blood pressure sitting and standing, and internal and external examinations. Midwives also recommend positions to encourage a breech baby to flip. (My midwife diagnosed twins in the last trimester that the woman's OB-GYN had missed. Just sayin'!)

So instead of moaning and wringing their hands as they've been doing for decades now, it might make more sense for ACOG to offer more affordable - and safe - alternatives to women. In England, it used to be that a low-risk woman in labor was provided with a midwife or doctor to attend her (the UK has since moved toward the American model of technology-controlled birth) with an ambulance on call outside her home.

Oh, and by the way? Any kind of universal health care should include supported home birth as an option, because it helps control costs. Hospital-based maternity services are a very lucrative revenue stream.

ATLANTA - Home births rose 20 percent over four years, government figures show, reflecting what experts say is a small subculture among white women toward natural birth.

Fewer than 1 percent of U.S. births occur at home. But the proportion is clearly going up, study by researchers at the Centers for Disease Control and Prevention found. The new figures are for 2004 to 2008. Home births had been declining from 1990 to 2004.

The increase was driven by white women — 1 in 98 had their babies at home in 2008, the most recent year for which the statistics were available.

[...] The increase is notable because doctors groups have been increasingly vocal about opposing home births, The American College of Obstetricians and Gynecologists has for years warned against home births, arguing they can be unsafe, especially if the mother has high-risk medical conditions, if the attendant is inadequately trained or if there's no quick way to get mother and child to a hospital if something goes awry.

Doctor participation in home births declined by 38 percent from 2004 to 2008. The percentage of home births attended by certified midwives and nurse-midwives grew, meanwhile.

You can't really talk about serious health care reform without looking at major changes in the American way of childbirth. The L.A. Times this morning points out that one of the things driving costs ever upward is the U.S. Cesarean rate, a major surgical procedure now performed in almost one-third of hospital births:

Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine. The most common operation in the U.S., it is performed in 31% of births, up from 4.5% in 1965.

With that surge has come an explosion in medical bills, an increase in complications -- and a reconsideration of the cesarean as a sometimes unnecessary risk.

It is a big reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good.

"We're going in the wrong direction," said Dr. Roger A. Rosenblatt, a University of Washington professor of family medicine who has written about what he calls the "perinatal paradox," in which more intervention, such as cesareans, is linked with declining outcomes, such as neonatal intensive care admissions. Maternity care, he said, "is a microcosm of the entire medical enterprise."

As the No. 1 cause of hospital admissions, childbirth is a huge part of the nation's $2.4-trillion annual healthcare expenditure, accounting in hospital charges alone for more than $79 billion.

Because spending on the average uncomplicated cesarean for all patients runs about $4,500, nearly twice as much as a comparable vaginal birth, cesareans account for a disproportionate amount (45%) of delivery costs. (Among privately insured patients, uncomplicated cesareans run about $13,000.)

Pregnancy is the most expensive condition for both private insurers and Medicaid, according to a 2008 report by the Childbirth Connection, a New York think tank.

"The financial toll of maternity care on private [insurers]/employers and Medicaid/taxpayers is especially large," the report said. "Maternity care thus plays a considerable role in escalating healthcare costs, which increasingly threaten the financial stability of families, employers, and federal and state budgets."

Are there other options, other solutions? Yes. Off-site birthing centers and home deliveries have lower C-section rates and healthier outcomes for mothers and babies. For decades, the all-powerful American College of Obstetricians and Gynecologists has managed to prevent any truly rigorous review of statistics here (preferring to use data that counts miscarriages as home deliveries), but the Netherlands have done it for us.

They found that births where women actually prepared to deliver at home (as opposed to precipitous labors where sudden complications forced them to deliver there) were just as likely to have a safe delivery and healthy baby as those who delivered in a hospital under the care of a midwife.

The group who chose to give birth in hospital rather than at home were more likely to be first-time mothers or of an ethnic minority background - the risk of complications is higher in both these groups.

[...] But Professor Buitendijk said the study did have relevance for other countries like the UK with a highly developed health infrastructure and well-trained midwives.

In the UK, the government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was "a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place.

Here are just some of the things you can avoid in a home delivery: Hospital "supergerms"; birthing positions that actually make fetal distress (and thus, a C-section) more likely; the use of powerful labor-inducing drugs that not only increase the likelihood of a C-section, but also of uterine rupture; and an episiotomy that may be painful for years.

I did it both ways: A hospital birth with a doctor and nurse-midwife, and a home delivery attended by lay midwives. (I told my then-husband I would "never" have another child in a hospital after they almost killed my first-born and then bragged about how they "saved" him.) Not only did I give birth at home with my youngest, I was up cooking breakfast for everyone just a few hours later. It was an experience I wouldn't trade for the world. It was better in every possible way.

For more info on home deliveries, see Rikki Lake's documentary "The Business of Being Born" on YouTube.