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Home Sweet Homebirth

By Anne Margolis, CNM

There is an overwhelming cultural belief in the United States that hospitals are the safest place to give birth, regardless of the extensive scientific data that suggests otherwise. Numerous studies around the world have documented the safety of planned homebirth by trained professional midwives, with outcomes at least as good as those occurring in a hospital, if not better.

This is especially true of women who have delivered vaginally before. The total slight increase in newborn mortality risk in home birth is estimated to be 10 per 10,000 babies born at home, and that 1 in 1,000 babies born at home may be adversely affected by the extra transport time in reaching advanced care in the hospital. The absolute risk is small, however.

Although the U.S. spends the most money on obstetric care, with high rates of interventions and operative deliveries, it still ranks among the lowest of industrialized countries around the world in terms of mother and baby outcomes. Our maternal mortality and morbidity rates are the highest as compared to all developed nations and they are increasing, whereas in these other countries— even less affluent ones—rates of mothers dying around childbirth are decreasing. The U.S. ranks comparatively high in newborn mortality and morbidity as well.

Countries that consistently demonstrate the best maternal and newborn outcomes have a large percentage of midwife-led maternity care for healthy women experiencing normal pregnancies, which constitutes the vast majority.

These countries have a higher percentage of homebirth midwifery care with supportive hospital/medical transfer arrangements when needed. Their obstetricians attend to the women with high-risk complications and serious illnesses, which fits with how they are educated as surgeons and medical doctors.

When midwives and obstetricians work together as a team, both using their unique skills, knowledge, expertise, and training, the outcomes for moms and babies are far superior. Midwives are trained in guarding the normalcy of pregnancy, birth, and postpartum, not disturbing it when all is well. They know when to compassionately observe with loving support, and when and how to use holistic remedies, or medical intervention when necessary (as a last resort). They are also educated in prevention, assessment, and treatment of complications, which most times can be managed simply and naturally, but sometimes involve consultation with or referral to an obstetrician.

Although unforeseen events and emergencies can occur in any birth setting (some of which can be best handled in a hospital), a low-risk healthy woman entering the typical U.S. hospital expecting a normal vaginal birth is subjected to a routine barrage of procedures and interventions that dramatically increase the risk of complications and problems, with potential longstanding physical and emotional ramifications for both mother and baby.

When we discuss homebirth with partners and family members, there is often some uncertainty and discomfort with the topic. I believe that this discomfort stems from many women and their families not being informed of homebirth or a midwifery model of care.

Despite the latest statistics showing that a homebirth with a qualified midwife is just as safe as birthing a baby at the hospital, if not safer, many people are still apprehensive about the perceived risks involved.

Even so, women continue to birth at home because they feel the calling within their bodies, within their hearts, within their souls. Many women have shared with me that they desire greatly to have a homebirth experience; it’s what they feel is best for them and for their babies. Many very educated professionals of all career types are making well-researched and informed decisions to have homebirths with a midwife.

Although I am optimistic about healthcare moving in the direction of a more prevalent homebirth midwifery model of care, our society still expresses an opinion that babies are to be born in hospitals—or at the very least, in birth centers.

Aside from safety, there are many other benefits of homebirth midwifery care, which provides an alternative to the impersonal, fear-based, lawsuit-prevention-oriented medical and hospital care prevalent in our society. These benefits include but are not limited to:

  • The power of the human touch and presence

  • Being surrounded by supportive people of a family’s own choosing

  • Security in birthing in the familiar and comfortable environment of home

  • Feeling less inhibited in expressing unique responses to labor (such as making sounds, moving freely, adopting positions of comfort, being intimate with a partner, nursing a toddler, eating and drinking as needed and desired, expressing or practicing individual cultural, value, and faith-based rituals that enhance coping)— all of which can lead to easier labors and births

  • Not having to decide when to go to the hospital during labor (going too early can slow progress and increase use of the cascade of risky interventions, while going too late can be intensely uncomfortable or even lead to a risky unplanned birth en route)

  • Being able to choose how and when to include children (who are making their own adjustments and are less challenged by a lengthy absence of their parents and excessive interruptions of family routines)

  • Enabling uninterrupted family bonding and breastfeeding

  • Huge cost savings for insurance companies and those without insurance

  • Increasing the likelihood of having a deeply empowering and profoundly positive, life-changing pregnancy and birth experience

Getting holistic prenatal through postpartum care, and birthing in one’s own home attended by a skilled midwife, is a refuge for those who want to protect the normalcy and sanctity of pregnancy and birth.

Focusing on the normal, however, does not mean that problems go unrecognized or unattended. Rather, they are viewed as imbalances that need to be righted, not expected or feared.

With that said, certain hazards exist in all settings, whether childbirth occurs in or out of the hospital, and some risks are unique to each setting.

Some of these risks will never be eradicated, no matter what our state of technology or medical advancement. The practice of midwifery, nursing, and medicine are not exact sciences and no assurances can be made regarding the results of examinations, diagnostic tests, treatments, procedures, or interventions.

It is impossible for any provider to guarantee a normal, healthy birth, mother, or baby. However, when poor outcomes occur at home—even if the outcome would have been the same in a hospital—a homebirthing family will invariably be challenged by friends, family, and other professionals as to the wisdom of their choice. This is especially true in the U.S.

Yet when there is a bad outcome in the hospital, people rarely challenge the hospital care and are much less likely to question whether the same outcome would have occurred had the mom birthed at home.

It’s okay to question all options, and we are seeing more of that as women search for an alternative to hospital births.

If Your Partner or Family is Skeptical of Homebirth

I have worked with women who gather as much information as possible and share it with their partner, in the hope of helping them understand where they are coming from. I have also had partners of a pregnant mom who are passionate about having a homebirth, although she wasn’t completely sure.

In my experience, when partners feel heard and validated, they often come around as the months go by and they have had the opportunity to ask questions, get answers and receive support through the pregnancy process. But a woman who is unsure must dig deep, as she will labor best where she feels safe—and that may be the hospital. If her spouse is zealous, yet she agrees only intellectually, I am wary of her being able to relax and give birth at home.

Some extended family have had homebirths themselves, or are very supportive. But some are very against the idea, especially if it’s a situation they don’t fully understand. They may be very vocal about their opinions. If family members don’t have knowledge or direct experience with homebirth or natural birth, it understandably may not sit well with them, and they will have safety concerns.

I have dealt with these situations often. Every situation is different. It is not a time for the pregnant mama to get into debates defending her position. I help empower her to set boundaries and maintain a fortress of positivity around her. In some more challenging situations, after a discussion, we agree that the couple does not need to tell their family they are planning a homebirth at all, or that they will wait until after the birth. They can just say they are seeing a midwife, and mention the backup hospital if asked—end of conversation.

In most cases, I encourage expectant couples to bring their anti-homebirth family members to prenatal visits to ask me their questions and discuss with me their concerns. They see the licenses on the wall and medical equipment for checking blood pressure and fetal heart rate, even if it’s tucked away in the homey office setting. They relax a bit, and often they come around (or at least stop resisting) once we spend time together and they receive answers and feel lovingly validated. Many times I am amazed how they transform to offer support and even excitement around the upcoming homebirth. Some tell me they won’t relax until it’s over and everyone is healthy—but then, after the birth, they become big homebirth supporters, telling everyone how wonderful the experience was.

Listen to Your Intuition

Intuition plays a large role in homebirth. Pregnancy is a special time, and it’s important for women to keep their space sacred during this time.

Here are some ideas for keeping your space sacred:

Create your vision. Find some quiet time where you can close your eyes and relax. Take slow, deep breaths, releasing on the exhale, and use your mind as a clean slate. Envision on that clean slate, the vision you have for you, your baby, and your birth. What does it look like, and more important, what does it feel like? Take notes in a journal, or draw anything that helps to hold this vision. Spend time with this vision every day and hold a feeling of gratitude that’s already been delivered.

Avoid arguments. Share little with those who aren’t in alignment with you. A mama may have her partner, her midwife, her massage therapist, and a few close friends in her circle. Be mindful about whom you share your vision with, because not everyone is able to connect with high energy like this, and that’s okay. It’s important to recognize that everyone is on their own journey, but you don’t have to lower your standards to make others feel more comfortable about your life choices. And you must avoid conversations, and sometimes, people, who lead you to feel inner tension and fear, which will not serve you at all during this most sensitive time. Remember, it is your body, your birth, your baby, and your life—not theirs.

Set boundaries. You may simply need to tell stressful family members that you love them and appreciate their concern, but you are pregnant and sensitive. You are trying to keep positive, relaxed, and upbeat, and you’d rather not get into a disagreement. Many women, myself included, have spent time in life accommodating others. This is not one of those times. Pregnancy can help women shed their fears, limiting beliefs, and negative habits. Pregnancy is a time for a woman to focus on herself and her baby. For some women, this may be the first time in her life when she experiences this. I give you permission to pleasantly exit the conversation, hang up the phone or leave the room if they do not honor your request. Most will eventually learn and stop harassing you.

Surround yourself with positivity. This includes positive affirmations, inspirational birth stories, books, movies, radio shows, podcasts, and people. It’s important for you and your baby to keep stress low and spirits high. Pregnancy provides an opportunity to release unconscious beliefs and emotions, so although it’s rarely a completely smooth ride, it’s one where you can always get back on board your wave of high vibes. Keep negative news media to a minimum, and be mindful of toxic people that don’t need your attention at this time.

Where and how a woman gives birth is her business. Feel confident in listening to your body, your baby, and your intuition when it comes to this very special time. It’s not your job to convince anyone of anything, but only to show up for your own assignment. Strengthen your faith muscles and know that you come from a long line of birthing women. I have helped many women over the years face the critic in their own minds, and once they start listening to the voice of their inner truth, they let go and enjoy the ride.