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.

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 U.S. 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.

Aetna Inc. said it contracts with midwives who assist deliveries in hospitals or birthing centers but does not cover planned home births, except in New York and Washington or elsewhere in the world where law mandates coverage. One of the insurer's global plans covered 80 percent of Teeple's pregnancy and birth, Teeple said.

UnitedHealth Group Inc. said it covers both hospital and home births with a licensed midwife. Benefits are generally the same for a woman who chooses a physician and hospital as for a woman who prefers a midwife and home birth.

"If you are a consumer, you need to ask if there are midwives in a given market's network," spokesman Roger Rollman. "Some have midwives, and some do not."

In some parts of the country, access to midwife care has been hampered by the rising cost of malpractice insurance. In order to curb costs, some obstetric practices have laid off their midwives in order to save on overhead expenses.

Where midwives are available, the cost of a midwife-attended birth varies by place and practitioner.

"When we were first looking at the cost, it was a lot less to deliver with a midwife," said Christine Louden, a West Hartford, Conn., mother who had her two boys with midwives. "Cost didn't motivate our decision but we saw the cost and thought, 'Wow.' But the decision was definitely motivated by belief systems."

Couples who give birth with a midwife describe the experience with words like "soothing," "romantic" and "calm."

During her labor, the midwives "didn't say much at all," said Heidi Teeple, 31. "As it got closer, they made sure things were going right. It was very empowering to feel like I was doing it on my own."

In a separate conversation, Rod Teeple, who is 41, echoed his wife and said having the midwives there more than anything gave him confidence. He called Logan's birth "the most smooth, amazing experience," one that was "very private."

Some women say part of the draw of midwifery is the freedom to give birth wherever and however they choose.

Rachel Ledoux, a 27-year-old mother from Chicopee, Mass., said she spent a good deal of her labor in the hospital room's shower - with the midwife periodically getting in with her to check her progress. Louden, 36, gave birth to her son in a king-sized bed in a birthing center with her husband David lying beside her.

"Midwives let women be in whatever position they want to be in - on their hands and knees on the floor, squatting, in a tub," said Susan Hodges, president of the advocacy group Citizens for Midwifery. "Without signs of a real medical problem, birth should actually be more hands-off than it is."