(AP) Instead of a conventional hospital birth, Heidi Teeple and her husband, Rod, brought baby Logan into the world while soaking together in a freestanding tub of warm water in their living room, with a fire in the fireplace and two midwives at their side.

"It was great," said Heidi Teeple, who lives in San Anselmo, Calif. "It was much more relaxing. There was no anxiety about when to go to the hospital. I called the midwives; they came. They were both very calm and soothing."

The Teeples are part of a small but growing contingent of people choosing to give birth with midwives, caregivers who view birth as a natural, rather than medical, experience, and one that should be tailored to a mother's needs.

The trend has been slow but steady in coming.

The number of women giving birth with a midwife has doubled since 1990, both in absolute numbers and as a percentage of overall births. According to data from the National Center for Health Statistics for 2003, the most recent year for which data is available, 8 percent of pregnant women in the United States gave birth with a midwife compared with 4 percent in 1990. Births attended by a certified nurse midwife, for example, have risen every year since 1975.

Laws governing midwifery vary from state to state, as does insurance coverage of midwife-assisted births.

Generally, many insurers cover midwife care, provided she is licensed according to state law and works in a hospital or approved birthing center. Not all midwives are certified nurses; those who aren't are sometimes referred to as lay midwives. Insurance coverage is spottier for those midwives who are not certified nurses, or who assist home birth or otherwise work outside the traditional hospital setting.

But choosing a midwife is about more than merely selecting a care provider or deciding between birth at a hospital or home. It represents a paradigm shift in how a woman approaches pregnancy, advocates say. Although certified nurse midwives are licensed to administer medication, they generally encourage a drug-free birth and rely primarily on natural methods of care.

At the core, it's a rejection of the quintessential birth scene: the pregnant woman lying in a single bed, a nurse at the ready with a pain-relieving epidural shot and a hospital room full of people yelling "push!"

Still, with pregnancy and birth having some of the highest costs in medical care, families do need to consider whether a midwife's services will be covered.

WellPoint Inc., the nation's largest health insurer, said its coverage of midwifery varies by locality and health plan.

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