My daughter and I, moments after her birth. We're still in the tub she was born in.
I’ve had one successful home birth, and I plan to have another in a few months. Folks often ask me why I opt to go against the grain, and some are worried that I am endangering myself and my baby. Here’s my response: Birth is a safe and natural process. Given that, I believe in the power of a woman to make the choice she feels most comfortable with. I think that giving birth at home is a natural way to go about a natural thing like birth. I’m certainly not anti hospital births; I just believe there’s a place for planned home birth with a qualified midwife on the continuum of birth choice. If things were to go drastically wrong for some reason and I needed care outside what my midwife could provide, I know that she will transfer me to a hospital facility.
I’m not going to pretend that my first birth was all roses. My first baby was born with a low Apgar score. She wasn’t breathing because the cord was wrapped around her neck (which happens in 25% of births), and it took my experienced midwife several minutes of CPR to get her breathing. But I wasn’t frantic. Do you know why? Because the cord hadn’t been cut, and I knew that she was still getting the oxygen she needed. She would be fine because she was getting oxygen the same way she had for the previous 9 months. Now in a hospital, it’s pretty likely that cord would have been cut right away and my baby rushed away . Then I would have had cause to worry. Then my beautiful baby girl may have suffered brain damage from lack of oxygen.
And so, for this second go around, I am putting myself in the hands of a qualified midwife again. I know I can trust her.
Henci Goer observed: “Excellent outcomes with much lower intervention rates are achieved at home births. This may be because the overuse of interventions in hospital births introduces risks or the home environment promotes problem-free labors. (“Obstetric Myths versus Research Realities: A Guide to Medical Literature.” Bergin & Garvey, 1995).
Here are the reasons why I think home birth is a safe, viable option:
• I believe that my body knows how to give birth.
Women have been giving birth since Eve, and I’m pretty sure we know how to do it. Therefore, I don’t view birth as an unnatural thing. I don’t view it as complicated, dangerous business although I know there are risks involved. It’s certainly not an illness, and I don’t need a hospital to fix things for me. I’m going to trust my body.
• I don’t think there is such a thing as a “normal” birth.
Because of that, I don’t think that we should set time limits to determine what is “normal.” I don’t think women need Pitocin augmentation, instrumental delivery, fundal pressure, episiotomy or cesarean section merely because the labor isn’t following a prescribed scheduled. Medical interventions aren’t necessary to keep labor “on track.”
I do think that labor is an emotional, psychological, spiritual and physical experience. I think a woman who is scared, uncomfortable or unsupported will have a longer labor. Fear elicits the production of adrenaline which adversely affects the quality of a contraction, and may be why so many women who are afraid or uncomfortable in a hospital environment experience "failure to progress". I firmly believe that my first labor went relatively problem-free because I believed it would only take 12 hours (and it did). I knew I could do it, and I did. I did it at home, a place I felt comfortable. My daughter was born in a tub of water I believed would relax me, and it did (as much as is possible during labor, anyway).
• Interventions come with risks.
Every intervention, whether it is stripping your membranes, inducing through pitocin, getting an epideral, using pain relievers or receiving an episiotomy, carries some kind of risk. Therefore, if the benefit doesn’t outweigh the risk, I don’t need it. And though I dislike pain as much as the next woman, I think that pain provides my body with valuable feedback and helps me know what to do next. Pain will guide a mother to search for the most comfortable position, and that’s usually the one that will shift the baby into the best position for birth. (It’s certainly not going to be one where the mother is lying on her back with her feet in stirrups, defying gravity! A whooping 70% of women are still giving birth this way.) At home, I can pick my position for laboring; I don’t have to worry about being hooked up to a fetal monitoring system that would limit my movements. The stress hormones produced in response to pain help protect the baby from oxygen deprivation and prepare the baby to breath when it is born. I can continue to eat and drink, bathe and sleep, as I desire. My well-trained midwife will periodically monitor the baby's heart tones throughout the labor. Since she is already familiar with my baby, she'll be well-prepared to assess for signs of distress.
Ever read the informational sheet that comes with pitocin? Adverse reactions to the drug include: anaphylactic reaction, postpartum hemorrhage, cardia arrhythmia, fatal afibrinogenemia, nausea, vomiting, premature ventricular contractions, pelvic hematom, subarachnoid hemorrhage, hypertensive episodes, and rupture of the uterus. Uff-da. Those all sound terrible. At the very least, pitocin-induced contractions are much more painful that those naturally produced by the body and will push the mother toward the use of pain relievers.
And, pain relievers, well they cross the placenta and affect the baby, possibly impairing the infant’s central nervous system and breathing functions. It can also alter neurological behavior and cause the baby to be unable to regulate its body temperature. These problems may result in additional interventions and medications once the baby is born, which come with their own list of side effects. In addition, a medicated baby is a sleepy baby, and sleepy babies often have trouble breastfeeding, which is not only frustrating for both mother and baby but interferes with the baby getting the valuable nutrients that only come from breastmilk.
I have to confess that at a certain point in my labor, I would have given anything for drugs. I think most women are like that. For me, an advantage to home birth is that I had to follow through with my original plan because nothing was available. I’m glad for that.
I learned from my childbirth education, Amy Pass of Birth Pathways, that pain relievers often slow labor, which leads to the use of more drugs to augment labor, which leads to more pain, which leads to more pain relievers and so the feedback loop goes round. In a fair number of situations, this loop leads to a stressed baby, which results in an "emergency" cesarean.
Cesareans carry their own risks (see below), not the least of which is the required use of antibiotics to prevent postpartum infection in the mother. The prophylactic antibiotics go to both mother and baby before the surgery and to the baby after delivery through breast milk. Since antibiotics kill the good bacteria in the body, they leave mother and baby at risk for developing yeast infections and thrush. Thrush is painful for both mother and baby and is very difficult to cure completely. For many mother-infant pairs, this means a foreshortened breastfeeding relationship.
- Induction with drugs and rupture of the amniotic sac increases the risk of having the cord prolapse (a life-threatening complication for the baby), of having the baby in a less than optimal position in the birth canal (often leading to a cesarean section), and of having a premature baby with respiratory problems because the lungs are not mature.
- The common use of drugs (pitocin, for example) to speed up labor is associated with greater likelihood of the baby being distressed, and increases the chance of uterine rupture (which can be life-threatening to mother and baby).
• More babies live in home births than in hospital births.
I think the infant mortality rates most clearly demonstrate that home births are safe. More infants live when born at home versus at a hospital, likely in part due to the fact that midwives won’t take on a birth they feel is too high risk; that type of pregnancy is what hospitals are good at handling.
- A study in 2005 of 5418 women in North America who gave birth at home shows a intrapartum and neonatal mortality rate of 1.7 deaths per 1000 low risk intended home births after planned breeches and twins (not considered low risk) were excluded. The infant mortality rate was 2 deaths per 1000. No mothers died. (See results of study at
http://www.bmj.com/content/330/7505/1416.full)
- The United States is currently ranked at 34th in the world in terms of infant mortality with a rate of 7.07 deaths per 1000 births (1995-2010 data). In 2006, the maternal death rate in the United States was 13.3 per 100,000 in 2006. (I think that’s pretty appalling for an industrialized nation that purports to lead the rest of the world in progress.)
The infant mortality rate (IMR) is the number of deaths of infants under one year old per 1,000 live births. The infant mortality rate of the world is 49.4 according to the United Nations. The intrapartum and neonatal mortality rate refers to the death of a fetus. A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes
• The rate of cesareans is significantly lower.
In a nation where 1 in 3 women give birth via cesarean and 50% or more of those are elective rather than emergency, you wonder what my problem is with such a common procedure. The thing is, cesareans come with a number of risks. It is major abdominal surgery, and carries with it possibility for blood loss, infection, and death. Cesareans also confer lifelong higher risks to reproductive and general health, and leave your next baby at increased risk of complications, including death. The facts show that babies have double the risk of dying after a c-section. (Read MacDorman, M. F., et al. "Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women With "No Indicated Risk," United States, 1998-2001 Birth Cohorts." Birth 33, no. 3 (2006): 175-82.)
In a cesarean birth, the risks for the mother include:
- Infection. The uterus or nearby pelvic organs such as the bladder or kidneys can become infected.
- Increased blood loss. Blood loss on the average is about twice as much with cesarean birth as with vaginal birth.
- Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.
- Respiratory complications. General anesthesia can sometimes lead to pneumonia.
- Longer hospital stay and recovery time. Three to five days in the hospital is the common length of stay, whereas it is less than one to three days for a vaginal birth. Also, mothers who have had c-sections are more likely to be readmitted to the hospital.
- Reactions to anesthesia. The mother's health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
- Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.
- Poor overall mental health and self-esteem, which in some cases lead to depression.
– Psychological trauma, including full-blown post-traumatic stress disorder.
– Chronic pain.
- Infertility, placenta previa, placenta accreta, placental abruption, uterine rupture, congenital malformation, and central nervous system injury
In cesarean birth, the possible risks to the baby include the following:
- Premature birth. If the due date was not accurately calculated, the baby could be delivered too early.
- Breathing problems. Babies born by cesarean are more likely to develop breathing problems such as transient tachypnea (abnormally fast breathing during the first few days after birth).
- Low Apgar scores. Babies born by cesarean sometimes have low Apgar scores. The low score can be an effect of the anesthesia and cesarean birth, or the baby may have been in distress to begin with. Or perhaps the baby was not stimulated as he or she would have been by vaginal birth.
- Fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.
- Not breastfeeding/failure of breastfeeding.
- Sensitivity to allergens.
– Possibly asthma.
• Continuity of care
I appreciate seeing the same care provider every time I go in for a prenatal or postnatal appointment. I know that the person I have talked to about birth and who has answered my questions all through my pregnancy will be the person who delivers my baby. This time around, I am twice reassured. The midwife I am using has already proven her value during my first pregnancy and delivery. I trust her completely. In a hospital, even when you’re using a group of midwives, you’ll be seeing many care providers during brief visits (my prenatal appointments are 45 to 60 minutes long), and there’s no guarantee as to who will actually deliver your baby. With continuity of care (the same midwife seeing the same woman throughout the pregnancy and birth) and their experience with normal, healthy birth, home birth midwives are more likely to notice the earliest signs of any possible problems, many of which can be addressed with preventive care. As a country we’ve been slow to recognize that it costs less and is easier to fix problems before they develop into larger ones.
• Home birth is cheaper
I don’t believe in spending money where you don’t have to. In 1993, nearly 20 years ago, Mothering Magazine estimated that if the US switched to using midwifery care for 75% of births, the country would save $8.5 billion a year. Today, it is estimated that an average hospital birth costs three times that of a home birth. Every drug we use, every procedure we do during birth comes with a pretty high price tag. We should think about that when we make our choices, and save the pricey stuff for when we really need it.
• Hospitals aren’t necessarily safer
I hear this a lot. Why risk it? people ask. Why not just have the baby in the hospital just in case something goes wrong? The thing is, I don’t believe that hospital are safer. I know I am at more of a risk to develop an infection in a hospital. I know I can more easily catch an illness floating around in a hospital (as it is a place where sick people go to become well, a category which, as a pregnant woman, I don’t fall into). And my midwife is trained and prepared to handle the various complications that can develop over the course of labor and delivery. There is not a complication that I can think of that my midwife cannot handle as well as any medical professional. In the case that emergency assistance becomes necessary, my midwife knows how to handle things effectively until help arrives, often the very same way (or better) than the situation would be handled in the hospital until emergency equipment arrives on the scene. My midwife, Jeanne Bazille, has delivered over a 1,000 babies — very few doctors can match that.
“Many people believe that the hospital is “safer” because they are in the medical environment and feel reassured that medical “rescue” is immediately available should it be needed. Yet the 99% of women who give birth in hospitals in the US experience high levels of medical intervention that research tells us is unnecessary and can be harmful to both mother and baby. Woman have reported that it is almost impossible to give birth in the hospital without interference in the normal process of labor and without hospital practices and routine interventions that actually increase the likelihood of complications (see Childbirth Connection’s Listening to Mothers surveys
http://www.childbirthconnection.org/article.asp?ClickedLink=334&ck=10068&area=27).
“Indeed, research shows that where and with whom a woman gives birth is a significant and independent risk factor in whether she experiences increased rates of medical intervention, in particular an episiotomy or a cesarean section. For medical interventions there are actually very wide variations among hospitals and among providers, not explained by medical status of the patient population, although such information is not available to women about specific hospitals or providers. In contrast, a planned birth attended by a trained care-provider in an out-of-hospital setting (home or birth center) results in support for the normal process with a minimum of interference. The midwife is trained to notice signs of complications developing and can assess the need to transport for medical care well in advance, in the rare cases where it is needed. Serious complications almost never occur without some preceding signs that there is a problem. The scientific studies all show that for planned home births with a trained attendant (and access to medical care if needed), perinatal mortality is as good or possibly better than for birth in the hospital, and that there are far fewer interventions and so less morbidity for both mothers and babies.”
That statement in the middle about how serious complications almost never occur without preceding signs is so very, very important, pointed out childbirth educator Amy Pass. In a hospital NOBODY will notice those preceding signs. Even if you're hooked up to a bazillion monitors, they aren't being watched the whole time. Your midwife is there with you, noticing everything about you and your baby throughout the labor. And she's done this with many, many other women. She KNOWS what complications look like because she witnesses normal birth regularly and because she knows you. The truth is that, in hospitals, professionals very rarely witness the process of birth. If the birthing woman has a totally normal, uncomplicated process, very few people will stand around to watch. So, the medical community is not going to be as sensitive as the midwife to subtle changes in the laboring woman and baby. A good midwife will know well in advance that labor and/or delivery are getting complicated and will take appropriate action.
THANKS TO BIRTH PATHWAYS
Thanks to my own childbirth education, Amy Pass of Birth Pathways (
http://birthpathways.net), for educating me on the safety of home birth. Much of this blog post is based on information from her.
RESOURCES
• MN Homebirth Midwife Listing
• The Childbirth Collective
Perhaps you are looking for a birth doula, midwife, birth photographer, massage therapist or a postpartum doula. The Childbirth Collective is the place to connect with a growing and passionate community that cares about how you birth.
• Citizens for Midwifery
Resource for finding a midwife and general midwifery information. This particular page includes many fact sheets and other resources.
• International Cesarean Awareness Network & VBAC Information
This is a collection of fact sheets and information put out by the International Cesarean Awareness Network (ICAN) and other sources. Information includes how to prevent an unnecessary cesarean, Vaginal birth after cesarean (VBAC), how to find resources in your community, information about ICAN, and how to become a part of ICAN.
HOME BIRTH INFORMATION/STUDIES
• Landmark Study Reports Planned Home Births Are Safe
“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson, senior epidemiologist, Betty-Anne Davis, project manager. BMJ 2005;330:1416 (18 June)
• What Does This Mean? What Is “Safe” Enough?
