I recently had the opportunity, along with some local friends and my midwife, to be interviewed for a television news piece on home birth. After the on-camera interview, I wrote up my answers to some questions that were asked by the reporter - questions that she feels represent the public's concerns over home birth. While these may be common questions, I believe they represent a lack of understanding as to the nature of midwifery care. I'm hopeful that the news piece will shed a positive light on midwifery and home birth and help to dispel some of the myths.
Why do I choose home birth? (You must be so brave!)
I choose home birth because it is safer for me and my babies. Hospital births need to follow a certain, predictable rate of progress. Women like me, whose labors don’t ever follow that pattern, are extremely susceptible to unnecessary cesarean sections. Without a doubt, my second, third, and fourth births would all have resulted in cesareans had I been in a hospital - just like my first birth did. Yet, with patient, attentive, supportive care providers, I was able to successfully birth all three of them at home - longer labors, harder labors, and bigger babies.
Cesareans carry significant risks for both mother and baby, as well as for future pregnancies. These are wide-ranging, including, for the mother, death, infection, hysterectomy, hemorrhage, and damage to other organs. In future pregnancies, risks include placenta previa, placenta accreta, miscarriage, and uterine rupture. Babies born by cesarean section are at higher risk for life-long health concerns, including type 1 diabetes, asthma, allergies, gastroenteritis, obesity and some cancers. They are more likely to spend time in the NICU and mothers and babies may encounter difficulties in breastfeeding and bonding.
For me, there is nothing brave about staying home to give birth. In my case, it would be far riskier to choose to birth in a hospital.
Can long labors lead to exhausted mothers?
I’ve had long labors in all four of my births - from a few days of building labor to weeks of prodromal contractions. The biggest difference is that in my first birth, I was working within the constraints of the hospital and doctor’s policies. There was significant pressure to birth within a certain number of hours - so many hours are allowed after water breaks, and so many hours are permitted once you’re in the hospital. There is an ever-present clock ticking, putting pressure on the mother and support people to get labor going. In my case, I spent 36 hours at home walking, walking, and walking - willing myself to progress in labor to ensure the natural birth I’d planned. I became utterly exhausted after two days at home, and had little will to resist the suggestions of the doctors after another 12 hours in the hospital. I doubted my own ability to birth my baby at that point, not realizing that with the final stage of labor comes an endorphin rush to propel the mother to her goal.
In contrast to the clocks of hospitals and doctors, midwives know that the most precious commodity for a laboring mother is rest. A midwife encourages a woman to rest, to be well-nourished, and to work with her body - not to try to force her body to do things it’s not yet ready to do. In all three of my home births, I’ve slept. My midwife has even slept on my couch while I slept in my room, giving me freedom and space to labor as my body needed to. She was able to monitor the baby and me frequently, yet allow us the space and time we needed. Moreover, I had the freedom to relax and rest and birth on my own time - a freedom I never had in the hospital.
I don’t believe that mothers need Pitocin (which does not significantly speed labors) or epidurals to avoid exhaustion, but support, freedom, and the opportunity to truly rest over the span of their labor.
Don't you worry about safety?
I can honestly say that at no point in any of my home births have I worried about safety. Prior to my births, I have thought through emergency contingency plans, discussed them with my husband and my midwife, and written out necessary details in my birth plan. There was never a time, in any of my home births, where I felt any amount of fear or concern. I’ve never run into any issue that my midwives and I couldn’t work through - it turns out their bag of tricks is much larger than an OB’s!
My births have been very challenging, but the care and attention I’ve had has been second-to-none. I knew that the women I had caring for me were extensively trained, highly experienced, and had my best interests in mind. I was able to birth with confidence because I had the utmost trust in my midwives, a trust that had developed over months of hour-long visits, open sharing, and mutual respect.
In contrast, in the hospital I was constantly aware of the threat of procedures being performed without my approval. I was well-read and knew that some things that have been commonplace are not actually helpful and, indeed, are very detrimental (i.e., artificial rupture of membranes, episiotomy). Yet, my relationship with my obstetrician was not one of mutual respect and trust. I couldn’t even be guaranteed the OB I’d been seeing would be the one in the hospital. Rather than being able to focus solely on my laboring, I had to be on guard. I was much more worried for my safety in the hospital than I ever have been at home.
