The first time Angel Bloom had a baby, she did it the conventional way: in a hospital, with an epidural. Though her son, Nicholas, was healthy and born without incident, the experience, she said, left her feeling disappointed and disrespected.

"You're just not in control at all with doctors," she said.

Now in her second pregnancy, Bloom has eschewed an obstetrician and chosen Jeanne Browne, a midwife who owns the Concord Birth and Wellness Center in Concord. Browne, whose clients get long prenatal visits, personalized care and choices about where to deliver their baby - at home, at her birthing center, in an inflatable pool - says she's offering women a more healthy and celebratory way to give birth. During a recent visit, she told Bloom, "it's all about you."

New Hampshire midwives say that business has been growing, thanks to a increasing awareness of their services and a midwife-friendly state legislature that has required health insurers to pay for their services. But nationally, doctors have begun to bristle over the number of births being performed out of hospitals and far from surgeons and emergency support staff.

This summer, the American Medical Association, the doctors organization, issued a resolution warning women that "the safest setting for labor, delivery, and the immediate post-partum period is in the hospital," or in birthing centers on hospital campuses. The resolution said that the AMA would support state legislation designed to promote such births.

Midwives say that the AMA is wrong on safety, and that obstetricians who oppose their work are more concerned about protecting their turf than ensuring the health of women. Geradine Simkins, the president of the Midwives Alliance of North America, called the resolution "arrogant, patronizing and self-serving." But doctors who support the statement argue that women are taking unnecessary risks when they deliver outside hospitals and want to encourage them to avoid bad outcomes that they see as inevitable.

"It's true in any delivery, in a hospital or in a home, things can happen, unfortunately, in completely uncomplicated pregnancies," said Erin Tracy, an obstetrician at Massachusetts General Hospital, who wrote the resolution adopted by the AMA.

"We just feel that for those rare cases where an emergency can occur, why take a chance?"

Beautiful births

The Concord Birth and Wellness Center is in an airy brick building in part of a former sawmill across from the state prison. Inside, patients are seen in a room with a gynecological exam table and a comfortable couch. A "birthing suite" is outfitted like a bedroom, with a stereo system, a large-screen TV, an inflatable "birthing pool" and a trapeze suspended from the ceiling for women who choose to hang while they push. The sofa-strewn waiting room is often occupied by mothers and infants stopping by to visit.

Browne, who wears long curly hair, drawstring pants and rides a motorcycle, loves to talk about childbirth. She said that she became fascinated by the process as a child when she witnessed animal births in the Canada farm where she grew up. With little urging, Browne will produce photo albums showing women in various stages of labor and delivery and edited videos of birthing from start to finish. Nearly every one was a "beautiful birth."

Midwives view births as "beautiful," and natural, and try to minimize their interventions in what they see as a normal, healthy process. Women labor until they are ready to deliver. They are not given medications to control pain.

Browne charges a flat $3,200 for her services, which include 13 prenatal visits, birth assistance, and a series of post-partum appointments. Mothers can choose to add services, like special blood tests or ultrasounds, depending on their health needs. Patients without insurance do not have to pay until after the baby is born; Browne said she has never had a client skip the bill.

Her prenatal visits frequently run as long as an hour and often include freewheeling discussions in addition to physical exams. During a recent visit with 19-year-old Jade Hellings of Allenstown, Browne, her apprentice Kate Talkington, Hellings and two relatives discussed Hellings's back pain, and Browne gave advice about encouraging her fetus into the right position. Browne examined Hellings's belly and listened to the fetus's heart. She checked Hellings's blood pressure and drew blood for testing.

The group also talked about Hellings's plans for her baby's circumcision and vaccination, neither of which she'd thought about much. Hellings said that she and her boyfriend were planning to circumcise their son and were discussing "selective or no vaccines."

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