Very soon after I found out I was pregnant, my partner and I decided that we would find a midwife to provide care and to attend the birth of our child in our own home. I had been reading about children, pregnancy and birth for many years prior to becoming pregnant so it was not a hard decision for us. But I remember when I first read about someone having a baby at home – on purpose nonetheless – I thought: Why would anyone do that?!?? Why take the risk just to be more “comfortable” or “empowered”? Didn’t you just want a healthy baby?!?!
But, as I read more about, I got it. This is an account of my reasons for our decision.
First, being in the hospital is often dehumanizing. I realize that there are some amazing hospitals, amazing doctors, and amazing nurses that treat you like a full person, respect your wishes, and make you feel good. But, by and large, hospitals are a place where the needs of the system often take precedence over the needs of the individuals. You have doctors and nurses you don’t know well, involved in one of the most intimate parts of your life, often overworked, pressuring you, in a hurry, and often using language that implies that there is a threat to you or your child. I understand that many doctors and nurses are doing their very best – I don’t fault them, per se. But hospitals are stressful and intimidating and you depend on luck for a doctors and nurses that are supportive, gentle, and kind. For me, this wasn’t about wanting a “spa-like” birth or something. It was about wanting to be in a place that treated me, my child, my wishes for my birth and my child with basic respect and care. This, perhaps, on its own would not have led me to have a homebirth, but it was a factor.
Second, and most importantly for me, it is difficult to have a birth in a hospital where mother (and child, once born) are not subjected to interventions (or pressure for interventions) which do not improve the outcomes for either mother or baby. (And often actually increase the risk of harm to either mother or baby.) I will not review the research on this, but I spent a lot of time reading articles in medical journals and reading meta-analysis of studies about what interventions are shown to improve the outcome for mother and/or baby. I would suggest that anyone who is considering birthing at home or a hospital, take time to look at the research on outcomes. Read the journal articles, and then read the responses to them. Ask yourself, do the many interventions that frequently take place in hospitals improve outcomes for mother or baby? Do they reduce them? Am I prepared to argue with doctors and nurses about my care while in labor? Do I feel like my wishes will be honored? Will the doctors and nurses respect my right to informed consent on the procedures I am encouraged to undergo? There is no right answer about what is right for everyone, but it does make sense to know what research is available.
For instance, I am not aware of evidence that routine procedures such as electronic fetal monitoring, episiotomies, ultrasounds, labor induction, or pain reduction measures improve outcomes for mother or child although all of these practices are routine and widely encouraged for women in the U.S. There is, however, amble evidence that c-section rates are unreasonably and unnecessarily high, resulting in significantly reduced outcomes for mother and baby. And, we know that electronic fetal monitoring and inductions lead to higher c-section rates which bring with it a range of risks to mother and baby that does not occur with a vaginal birth.
So, while I honor the decisions of mothers and families to birth at home because it feels more empowering or peaceful, for me, I birthed at home because I thought it would be safer for me and my child. The birth situation in the United States is not good. Amnesty International argues that maternity care for women in the United States is a basic violation of women’s human rights, where the maternal death rate has more than doubled since 1987. I felt as thought I was likely to have a better outcome birthing at home with an experienced midwife. We know the U.S. ranks very low among industrialized nations, and often behind even developing nations, in terms of maternal and neo-natal outcomes. Thus, I found a hospital birth, and the accompanying the risk of being subjected to non-evidence-based procedures without informed consent, to be an unnecessary risk to me and my child.
For those considering your birthing options, here are some thoughts, for what they are worth:
*Ultimately, I think this is the decision of the mother and family. I am not saying you should birth at home. I am explaining why this was the best decision for us. I understand why others would make a different decision. I think the key is to be informed about the risks and options of either choice and make a judgement based on your own values. If you are able to be informed, it seems like that is an important step. I do not think you can trust most doctors to make the best decision for you. They 1) often not trained in evidence-based practices that improve outcomes for mother and baby and 2) they are trained to treat people who are sick and to deal with something when it goes wrong. For most births, nothing really goes wrong. They are not trained in supporting mothers so that they can birth without intervention and nothing going wrong. All of this said, I acknowledge that it is difficult to do this kind of research and thus honor families who simply do not feel like they can take this on.
*We were 17 minutes from the nearest hospital. If we would have been much further, I may have considered other options.
*My pregnancy was low-risk on every account. I went to 42 weeks, which may have made some folks concerned, but even the American Congress of Obstetrics and Gynecology acknowledges that post-date is after 42 weeks.
*I did not have two midwives present and I regret this. Things were fine, but if I had it to do over again, I would have requested that there be two midwives rather than a midwife and her apprentice who was less experienced than I realized.
*I found out after my birth that my midwife was a Christian Scientist. I am not sure if this impacted her decisions about my birth, which ended up going fine, but in retrospect I would have asked even more questions about her birth philosophy and philosophy of intervention (or lack thereof). We liked her a lot and she has delivered many babies. I wish, in retrospect that I would have still asked even more questions.
*I recognize that it is a balance between the risk of an immediate, acute danger which cannot be dealt with at home and a range of (typically) less acute risks that are associated with hospital births. Because all indications were for a low-risk pregnancy, our proximity to a hospital, and my own awareness of how difficult it would have been for me to birth in a hospital environment, we opted to avoid the more likely range of risks associated with hospital births rather than the much less likely risk of an acute situation that could not be addressed at home or by a quick transfer to the hospital.
*I recognize that there are many cases where c-sections and interventions make complete sense and save the life of the mother and/or baby. My concern is that most of the time, interventions do not appear fall in this category. Thus, this is what we hoped to avoid.
*I really really hate medical situations where people don’t treat me with respect or care and/or are not aware of the most recent studies about best practices. It causes me extraordinary anxiety to be in these sorts of situations, whether it a birth situation or when my doctor doesn’t understand the risks of a medication he or she is prescribing for me because they don’t keep up with the literature. Which I get is hard for doctors but is nonetheless highly concerning to me. I knew that this would impact my ability to birth well. So that was a factor in my decision. My son was born in five hours and I’m convinced a huge part of that is because I felt comfortable with people who treated me with care and respect and trusted me to know what I needed (which was absolute silence and no one bothering me).
*I am currently within the vicinity of a hospital with an OB who is known to honor mother’s wishes for a natural, intervention-free birth except when interventions are clearly indicated based on knowledge of what improves outcomes for mother and baby. Thus, if I was to have another child while living where I do, I would probably birth a hospital because I know that the doctor and her staff are aware of best practices, would not pressure me, make an effort to honor mother’s wishes, and work to minimize interventions, with attention to the informed consent of the family. All of that is to say, if we could have the best of both worlds – hospitals that practice based on outcomes, providers that respect and care for the mother and family, I am all for hospital births.
*I hope eventually to add a collection of articles and resources to this post that helped me in my decision-making. But for now, those are some of my thoughts for those who are thinking through this issue from a home birth mother who wasn’t very interested in an empowering birth.
No incense or music or aromatherapy for me (although more power to you if you like that sort of thing). Mostly I just wanted a birth where I was healthy, my baby was healthy, and I was treated with care and respect. A home birth seemed like the best way for me to increase those chances.