Home Birth: It’s Not About Location

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Our choice to birth at home was not an easy decision. We did extensive research. We had countless discussions. We did more research. We knew the many benefits; but we also knew the potential risks. It was difficult to make a decision that others (and even sometimes we) might view as crazy, even irresponsible. Would we be putting our lives at risk? What if something went wrong? Could we live with ourselves and our decision? But what if we went to the hospital and something went wrong there? Could we live with ourselves then?

For us, the decision was not about location. It was a conscious debate about whether or not to birth in the current American hospital maternity system. It was not a rash or selfish decision but one based on research, evidence based care and lack of other choices. We wished there was a birthing center close by. There wasn’t. We wished the hospital system was conducive to natural birth. It wasn’t. We wished our certified nurse midwife provider was willing to fully support us in natural birth and only intervene if medically necessary. She wasn’t.

In the end we chose home birth. Here’s why.

I knew that natural birth was important to me. I trusted birth for the normal process that it is. I trusted my body and baby to work together the way God intended them to. But I also knew that birth can be risky and that sometimes even with the best intentions, birth doesn’t go as planned. I was thankful to live in a country with some of the best technology and medical expertise. I was grateful to be in New England with great access to amazing hospitals and top-notch doctors.

So I thought.

Then I learned that the United States has the highest first-day infant death rate out of all the industrialized countries in the world.1 I also learned there are 50 countries with better infant mortality rates than the United States.2 And there are 47 countries with better maternal mortality rates than the United States.3

Maybe it’s that my Dad always taught me to consider all sides of a story and be mindful of the source. Maybe it’s the history major in me that was taught the importance of empirical research and critical analysis. Maybe it was common sense. But I couldn’t help but wonder, if we, The United States, have some of the best medical technology and doctors in the world, why were we ranked so low in birth outcomes?

The answers I found surprised me. We have the technology and we use it. But when it comes to birth, sometimes less is more.4

 

In doing hours of research I learned a lot about the birth process. I learned that:

  1. A women labors best in a safe, supportive, and uninterrupted environment.
  2. Labor progresses best when, as desired, a women is able to move, eat, drink, and seek comfort measures (warm baths, birth balls, massage, dark/quiet room, soothing music, etc). It also progresses best when birth hormones are allowed to work naturally without drugs interrupting ther flow.5
  3. A doula (professional birth assistant) can add many positive benefits to the birth experience. Studies show the presence of a doula decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40% and requests for an epidural by 60%.6
  4. Remaining upright during birth opens the pelvic bone, keeps pressure off the mother’s aorta providing better oxygen flow to the baby, and works with gravity making each contraction more efficient.7
  5. Unless life-saving measures are necessary, procedures after birth should be delayed, allowing for immediate, uninterrupted skin-to-skin time for the first hour of life. Immediate skin-to-skin helps the baby regulate breathing, heart rate, and body temperature. It also is the best start possible for the breastfeeding relationship.8 All necessary procedures such as vitals and general monitoring can occur while the baby remains skin-to-skin. All other procedures should be delayed including cord clamping,9 bathing,10 weighing, measuring, vaccines, drops, etc.

 

At first I thought it seemed simple. We had a hospital midwife provider already. She seemed natural minded and encouraged writing a birth plan. We hired a doula. We would plan for a natural, unmedicated birth in a hospital setting just in case we needed quick access to medical care. But then truths of the hospital started to seep into our plan.

In a conversation about our birth plan I requested minimal interventions and only when medically warranted. Our provider agreed. Then I asked about their food and drink policy, knowing that there is no evidence to support withholding food.11 She said they would provide water, ice chips, Popsicles and jello. I asked if I could eat any solids. Her answer did not align with evidence based care, saying they really prefer you not eat and would not supply it but if you bring food from home in a cooler they couldn’t stop anyone from eating it. I told her access to food (if I even desired it) and drinks were important to me as I didn’t want to dehydrate, weaken and need an IV. She explained that while I didn’t need to receive any fluids or medications unless necessary, I would be required to have a hep-lock line just in case. I knew that evidence did not support this as a necessity – it can lead to unwanted and unwarranted interventions due to ease of access, and in an emergency nurses are well trained to administer meds and insert a line as needed.12 I asked if I could choose not to have it. She responded that they would strongly encourage it upon admission but couldn’t force it into my arm if I refused.

While seemingly minor interventions I knew these were important first steps in assessing how our hospital experience would be and it caused me to delve deeper. So we asked harder questions and received answers that were not supported by evidence based care.

  • Provided everything is still going well will you allow me 42 weeks before discussing induction?13 Well we will reassess and begin discussing it at 40 weeks because we don’t like you to go past 41 weeks.
  • Can I bathe during labor utilizing the many benefits of hydrotherapy?14 No we don’t have tubs but you can shower and if you are still laboring at home you shouldn’t bathe after your membranes have ruptured.
  • Can I choose intermittent monitoring by fetoscope rather than continuous electronic monitoring?15 Well you can choose intermittent electronic monitoring. We’ll monitor for about 20 minutes once every hour.
  • Will you allow my labor to progress without cervical checks?16 Well we will check you upon admission to make sure you are really in labor, if your labor is prolonged/stalled and to ensure complete dialation. Can I refuse to be checked? Well once you are admitted and a triage nurse has checked you, you can work the rest out with your labor nurse and delivering provider.
  • After birth we would like to wait to cut the cord so he continues to receive oxygen while transitioning to breathing on his own and so he receives all his blood and iron stores17 Will you wait for it to stop pulsating? Well that can take awhile but we can wait a minute or so. Just remind us when you deliver so we don’t absentmindedly clamp it.
  • We would like to hold off on his first bath until we get home and in the meantime massage the vernix into his skin.18 Will you support this? Well you can refuse the bath but the nursery staff will strongly encourage you to give one because they can’t touch a baby without gloves until he’s been bathed.
  • Well, do I need to send him to the nursery or can everything just be done bedside? They’ll require a full evaluation in the nursery a few hours after birth but Dad can go with him.
  • We’d like to hold off on vitamin k19 until he’s at least a few hours old and will not be giving him eye ointment20 or administering Hep B21 as I do not have gonorrhea, chlamydia, or hepatitis. How do we ensure nursery staff follow our requests? Legally we have to administer eye ointment and Hep B due to risk of infection but if you insist on refusing it you will be required to sign a waiver after speaking with the on-call pediatrician.

Question after question was answered with less than satisfying responses and certainly not answers that aligned with evidence based care. And these questions were just the tip of the iceberg. So we started to get apprehensive about the care we would receive. We started to ask around. I attended local birth circles and listened to the stories of mamas who had recently given birth, many in the hospital we were planning to use. We talked to our doula about her experience with hospital birth. We spoke to our birth educator. And we received confirmation after confirmation that to achieve evidence based birth and postpartum care would be an uphill battle in our local hospitals, despite research and studies being on our side.

So we started to research our options. We looked up baby-friendly initiative hospitals.22 The closest one was an hour and a half away without city rush hour traffic. We looked into free standing birth centers but the nearest one was out of state and not covered by insurance. The next closest was the same distance as baby-friendly hospitals. And then it happened. We started to consider home birth.

We were surprised to find that despite the medias and obstetricians portrayal of it, home birth was actually a very safe option for healthy, low risk women. Study after study showed that home birth was just as safe as a hospital birth for the baby and safer for the mother – provided a professionally trained midwife monitored the mother’s prenatal care and was present for the birth.23 The truth was, while birth situations can seemingly change quickly, most situations have ample red flags before being an immediate emergency. Midwives are well trained to monitor for these early warnings and transfer if needed. Studies showed that there was actually a benefit to the midwifery model of care.24 Midwives focus prenatally on proper nutrition and activity, preventing many risks from developing in the first place, by growing a healthy placenta, healthy baby, and healthy Mama. For home births, this is an important step in monitoring any potential risks that would rule a women out of safe home birth.

It quickly became clear. If we wanted a natural birth focused on evidence based care to give our baby the best possible start to life, seemingly our only local choice was to proceed with a home birth. And it was safe. I was healthy, low-risk, mid-20s, with no complications and 10 minutes to the nearest hospital. It was statistically just as safe for us to remain home as it was for us to go to the hospital.

But the debate wore on. It was our first baby. We weren’t sure what to expect. We had no prior birth medical history. What if something went wrong? What if I hemorrhaged? What if the fetal heart rate dropped? (It briefly did.) What if the cord was wrapped around his neck? (It was.) What if he had a hard time breathing? What if, what if, what if? But what if we went to the hospital? We heard numerous first hand accounts and knew the statistics. Would we really be able to advocate for the birth we wanted? Did we really want an uphill battle during such a pivotal, poignant moment in our life? Would we even be able to achieve our goals? What if we ended up with unnecessary interventions like so many do?25 What if it led to an unnecessary cesarean? What if our baby ended up in NICU unnecessarily due to interventions? What if we got a fatal infection? What if we couldn’t breastfeed? What if, what if, what if.

In the end, we chose home birth. We chose to trust birth, my body, my baby and God. We chose to trust the statistics and science that proved it a safe and viable option. We chose to trust our team of well-qualified midwives to handle any of the what ifs and to transfer in a timely fashion if necessary. We trusted the team to hold the sanctity of our birth space, to create a safe environment, and to intervene whenever and with whatever was necessary.

Our decision had nothing to do with the physical location of our birth. Rather, it was a conscious choice not to birth in the current American hospital maternity system. It was not a rash or selfish decision but one based on countless hours of research, a desire for evidence based care and lack of other choices. It was a decision made with the best interest of our baby at heart. It was a decision to have the birth we wanted, the birth we deserved.

 

Read our birth story here.

Show 25 footnotes

  1.  http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/
  2.  https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
  3.  https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html
  4.  http://www.sciencedaily.com/releases/2011/04/110413101916.htm
  5.  http://www.takingcharge.csh.umn.edu/explore-healing-practices/holistic-pregnancy-childbirth/what-factors-influence-progression-childbirt
  6.  http://americanpregnancy.org/labornbirth/havingadoula.html
  7.  http://evidencebasedbirth.com/what-is-the-evidence-for-pushing-positions/
  8.  http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Learning-about-breastfeeding/Skin-to-skin-contact/
  9.  http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/
  10.  http://www.givingbirthnaturally.com/bathing-a-newborn.html
  11.  http://www.sciencedaily.com/releases/2013/08/130822141954.htm
  12.  http://evidencebasedbirth.com/the-saline-lock-during-labor/
  13.  http://www.niehs.nih.gov/news/newsletter/2013/9/science-pregnancy/ and http://birthwithoutfearblog.com/2011/08/22/what-acog-has-to-say-about-due-dates/
  14.  http://www.ncbi.nlm.nih.gov/pubmed/12870088
  15.  http://evidencebasedbirth.com/evidence-based-fetal-monitoring/
  16.  http://birthwithoutfearblog.com/2013/06/06/alternative-methods-of-checking-dilation-the-purple-line-and-more/
  17.  http://www.dailymail.co.uk/health/article-2315052/Childbirth-experts-warn-umbilical-cords-cut-FIVE-minutes.html
  18.  http://www.givingbirthnaturally.com/bathing-a-newborn.html
  19.  http://www.givingbirthnaturally.com/newborn-vitamin-k.html
  20.  http://www.givingbirthnaturally.com/silver-nitrate.html
  21.  http://www.givingbirthnaturally.com/hep-b-vaccine.html
  22.  http://www.babyfriendlyusa.org/find-facilities/list-of-designated-facilities–by-state
  23.  http://www.cmaj.ca/content/181/6-7/377.full.pdf and http://www.mana.org/blog/home-birth-safety-outcomes?fb_action_ids=10152159807679706&fb_action_types=og.likes&fb_source=aggregation&fb_aggregation_id=288381481237582
  24.  http://summaries.cochrane.org/CD004667/midwife-led-continuity-models-versus-other-models-of-care-for-childbearing-women
  25.  http://evidencebasedbirth.com/updated-table-on-the-state-of-maternity-care-in-the-u-s/ and The Business of Being Born

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