Considering a Home Birth? You Can Breathe a Sigh of Relief.

If you have read an earlier post on this blog entitled "But What If?", you will know the story of why my mother did not breastfeed her first child beyond 3 months, and why she did not breastfeed my other brother or me.  However, when it came to giving birth, she stuck by her beliefs, that for her, giving birth at home was better than giving birth in the hospital.  At that time, women were given "twilight" sleep and tied to their beds, anesthetized at the time of delivery, and often delivered by forceps accompanied by a large episiotomy (cut made at the base of the vagina to enlarge the space).

Home birth was not as much of an issue when my brothers were born, but it was when I was born.  Her doctor expected her to go to the hospital.  That was not her plan.  My aunt was an RN.  When Mom went into labor with me, she called Aunt Sara to come over.  When Aunt Sara felt that birth was getting close, she called Dr. Lamb and told him that my mother was in labor, but that it was too late to go to the hospital.  He rushed over to the house and delivered me.  My father experienced seeing me born -- a rarity for men at that time. He always treasured that experience and our bond was tight.

The incidence of planned home births dropped to single digit percentage points in the US during the 60s and beyond.  Certified and "granny" midwives still attended births in outlying areas, usually associated with public health department programs.  But by far, most women gave birth in hospitals.  

Midwives almost became extinct via pressure on legislators from physician and hospital professional organizations.  Finally, some women started demanding safe alternatives to what they saw as practically barbaric practices with hospital birth.  Lamaze, Bradley and other childbirth methods became popular.  Pressure was put on hospitals to allow fathers to be present at hospital births because women would go to physicians and hospitals which allowed it.  As we all know, money talks.

With the "all things natural" movement emerging in the 60's and 70's, more women wanted to avoid medications, episiotomies, and forceps deliveries.  They questioned the use of continuous electronic fetal heart monitoring which forced them to stay relatively still and in the bed.  They noticed that the C-section rate was increasing since EHMs were being used.

So, they started looking for someone to assist them with home birth.  A few licensed and also granny midwives were still in practice, but their numbers were dwindling.  As more women began to demand home birth as an option, more physicians agreed to provide back up.  As the statistics began to show that a planned home birth for a low risk woman and her low risk baby was safe AND less expensive, the government allowed for the training and practice of more certified nurse midwives (CNMs) to care for the more economically stressed women.  Even though women from lower socio-economic backgrounds tended to have a poorer nutritional status, their birth outcomes were impressively good.  Women from all socioeconomic levels began searching for the services of midwives, either for hospital births or for home births.

More and more studies have been done as the home birth movement has been growing.  Rikki Lake, an actress and former talk show host, experienced the now almost typical induced labor, epidural tract hospital birth with her first child.  She states that she felt something was not right, and that there was something more to giving birth than what she had experienced.  Lake found a midwife for an at home delivery and a physician who was willing to provide hospital care in case it was needed.  Her birth experience was not easy, but one she found very fulfilling.  After that, she, along with a producer, made the documentary film "The Business of Being Born"  (see last post).

Over the past few decades, more and more studies have been done on the safety of home birth in the United States.  Some studies had serious flaws because they included "accidental" births at home.  Many of these were premature babies.  Sometimes statistics would show that more babies died from home birth, but they were often related to unattended rapid preterm births or birth not attended by a professionally trained midwife.  However some studies did a better job of examining only birth which were planned and attended by a trained midwife or even physician.

This latest study covers 16,924 home births in the US.  The births were attended by certified nurse midwives.  The results are impressive.

To read a synopsis article on the study, click on the following:  Home Birth Study Synopsis Article.

For those who enjoy reading the published study itself, click on this link:  Outcomes of 16,924 Planned Home Births in the United States

Giving birth at home is not for everyone.  It certainly is not for women or babies who have conditions which put them more at risk for complications which can be helped by medical intervention.  Many women prefer to have access to epidurals and other medications to help with the pain of labor.  Some women will find a hospital birth "perfect" while others may look for alternative with a subsequent pregnancy.

Some women have carefully studied both options.  Of these, some will deliver in a hospital and some will begin planning a home birth attended by a certified midwife with a physician available to meet them at the hospital should complications arise which require a transfer.  Obstetrical emergencies are very rare with planned home deliveries because the midwife will notice signs which will cause her to call for transport before an emergency arises.  

Finally, there are no guarantees either way.  I think personal philosophy comes into the mix.  In the DVD "More of the Business of Being Born"  (last post), the women discussed risks of induction and C-sections.  Ina Mae Gaskins said more than once "a mother's children need her to be around to raise them".  From statements like this one, I got the sense that she, and other midwives, felt that risks associated with common medical interventions increased the chance -- still very rare -- of maternal demise around the time of childbirth.  A baby might be lost, again rarely, if the mother does not deliver in a hospital, which might have been saved if it had been delivered in the hospital. However, there are those in the maternal infant health care field who believe that statistics also indicate that a few women and a few babies die because of the effects of some somewhat "routine" interventions.

Deciding where to give birth is not always an easy decision.  Hospitals have physicians and midwives who differ in their approach to obstetrical care.  Some are teaching hospitals where interventions are sometimes advised to allow students to practice doing amniotomies, inserting fetal scalp electrodes, and so on.  Some offer birth centers, which support minimal intervention.  Some physicians will serve as backup for a home deliveries.  Many will not. If a woman chooses to have a home birth but needs some assistance from the hospital, she may be meet with some derision.



This happened to a friend of mine.  She delivered each of two children at home.  Part of the reason was financial, part was personal preference.  Each time she sustained a laceration large enough to require a physician to examine it and then suture it.  I met her in her second pregnancy.  After the baby was born and she nursed it, she went to the hospital for the repair work.  My friend told me the physician was unkind and berated her for having the baby at home.  It was a little surprising to my friend because the physician was a woman.  My friend was very upset at the way she was treated and decided to write a letter to the administrator.  

I think it is good for well done studies to continue on many aspects of maternal health care.  Such research has led to change over the years.  No longer are women subjected to an enema and shaving off all hair at the site of birth.  Neither are low risk mothers and babies required to be tethered to the electronic fetal monitor throughout the entire labor.  The use of episiotomies has dropped significantly.  But, there are still interventions which studies have indicated are unnecessary or which carry risks significant to alter the course and outcome of normal labor.

Home birth or hospital birth?  I once read "If you don't know your options, you don't have any".  Studies like this one helps women to better know their options.  If you would like to see what a planned home birth with professional assistance can be like, you can watch a short video.  The mother's modesty is protected overall in the video.  However, breastfeeding for the first time after birth does go better without any fabrics between mother and baby.

The environment was calm.  The mother was free to move around as she desired.  She birthed on her hands and knees which is a comfortable position for many women.  It allows the tail bone to swing out of the way and the pelvis to spread a little more to make it easier for baby to pass through the pelvis.  Baby gets oxygen via the umbilical cord during the birth. It clears any amniotic fluid and water by itself in most cases.

One can see why some women prefer this type of birth to one in a typical labor and delivery unit.  Again, sometimes a birth like this can be done in a hospital setting if the support is there.  One friend had her first babies at home, using the birth pool.  When she went to China, she delivered in the hospital using a pool.  She was the first woman to do so at that large hospital.  Her doctor and the nurses were so impressed, they started offering the option to other women.  Even her doctor became pregnant and planned a natural birth using the birth pool.

To see the video of a planned home birth, click on
http://www.pinterest.com/pin/104427285083441199/