Right now, there are about 22 licensed midwives practicing in Arkansas who have attended more than 1500 births in the past ten years.
"You are just kind of in a different state of mind," says Katie Opris, a mother in Conway. "Your body is telling you, 'OK, you have a job to do.'"
At 32 weeks, Katie and Elvis Opris are excited to welcome their new son to the family with the help once again of certified doula Nicolle Fletcher.
Katie's in a much more prepared state of mind this time, having already experienced the birth of her 3-year-old daughter Adrielle.
"It was very textbook really," Opris describes.
What's textbook for Katie though, is out of the ordinary for most Arkansans. Katie is among the small percentage of mothers in this state who choose an at-home birth.
"They come to me and we do the same clinical care that you would get at an OB doctor," says licensed midwife Kim Jacob, who delivered Katie's daughter. "We just kind of follow them around and whatever they are comfortable with."
"We did have a water birth. My husband was with me of course," Opris recalls. "As much as labor can be wonderful, it was wonderful."
For Katie, it was an obvious choice. Her mother delivered seven of ten children at home and she prefers the intimacy and low level of intervention. But the choice is not without controversy.
"My biggest fear is the emergency problem because even though problems don't occur that often, when they do they are generally significant and can potentially impact that newborn for the rest of its life," says Obstetrician Pittman Moore.
Moore says infection, possible hemorrhage and dystocia as life-threatening risks for these moms.
"You also need to make sure that that midwife does have some sort of a relationship with an OB/GYN or with a hospital in case it's needed," Moore recommends.
The Arkansas Midwives Advisory Board is working to build those relationships between midwives and physicians.
Mothers who choose an at-home birth must see a physician or health clinic for at least two prenatal visits and must fall into the low risk category.
"Our normals are definitely in a very conservative box. If anything is coming outside of that normal, then we are wanting to go in to get medical support," Jacob says.
Having had the first experience go so well, it was really one of the deciding factors for Katie to do it again with her second child.
"Their experience and confidence and their skill helped me to be confidant in my own bodies ability to know that yes, it is a natural thing. It is possible to do and it can be achieved," Opris says.
Midwives have been licensed to attend home births in Arkansas since 1985 and are regulated by the Department of Health.
If you are considering an at home birth, make sure you are dealing with a licensed midwife who is trained in CPR and has a good relationship with an OB/GYN or hospital.