HARLESTON, W.Va. -- Nurse midwife Angie Nixon hugged her way around a recent meeting of home-birth advocates and moms. She admired the healthy babies held by their beaming mothers and exclaimed over how much they'd changed since she last saw them at their birth.

She shares an intimate bond with these women, who trusted her with their pregnancies and the deliveries of their babies, most of them in their own homes. Since 2003, Angie Nixon's midwifery practice has been mostly home deliveries. She spent her first five years as a midwife delivering babies in a birth center.

"Women choose home births for a variety of reasons. Some want to save money. They expect the birth to be normal and are not afraid. They appreciate the privacy of their own homes."

Trebor’s close friend Michelle Moore holds Stephen while talking with Teresa Stire, who delivered her fourth child vaginally after three Caesarean births, inspired Trebor to give birth at home.

Midwives also deliver in hospitals, but Nixon, who is a certified nurse midwife, prefers a home delivery unless hospitalization is medically necessary. She's delivered about 600 babies, 100 of them home deliveries. About 10 percent to 15 percent of her patients transfer to a hospital for delivery, most often because their labor is not progressing. Only one of her patients has had a Caesarean.

She enjoyed her work at WomenCare Birth Center in Teays Valley and follows most of its strict guidelines in her practice. She left there, however, because she enjoyed the personal relationship she develops with an expectant couple as she sees them throughout the pregnancy and delivery. The birth center employs numerous midwives and patients see whoever is on call.

Nixon, who lives in Scott Depot, makes her own rules. For example, the birth center will not accept patients who have had Caesarean deliveries, but Nixon will work with viable candidates, such as Trebor Sutler.

The number of Caesarean deliveries in the U.S. is on the rise, and West Virginia has the fifth-highest rate of Caesarean deliveries. In 1996, 21 percent of deliveries were Caesarean compared to 31 percent in 2006, according to the U.S. National Center for Health Statistics. West Virginia's rate in 2007 was 35 percent. The World Health Organization recommends a 5 percent to 15 percent Caesarean rate.

"Women need to understand the trade-offs of surgical birth," Nixon said. "They risk future childbearing, infection, surgical mistakes and will have two times as much blood loss. It also impairs breastfeeding.

"This is my opinion, but it's also hard to recover from the sadness and disappointment that a woman might feel from not succeeding with a vaginal birth, if that's what she wanted."

At the home birth meeting, women, several wearing T-shirts proclaiming their support of natural deliveries after Caesareans, added to Nixon's comments.