by Janelle Weiner
Women in the US make a lot of choices before their babies are born, from which foods to eat, to which birth preparation class to take, to how to decorate the nursery. For most, however, there’s no question where their babies will be born: a “bun in the oven” means feet in the stirrups for a delivery in the hospital - accepted as the safe, modern location for giving birth.
But studies show that giving birth at home can be just as safe and can even lead to more positive outcomes for both mother and child.
Afterward, I snuggled under my comforter with my newborn baby huddled against my chest as my husband and our 2 1/2-year-old son quietly admired him. The midwives worked as a team to nourish me with fresh fruit, giving instructions and then quickly and quietly packing up their equipment. I didn’t feel like a hero or that I had taken a risk – two common criticisms of women who give birth outside of hospitals. I felt blissful, tired and, well, normal.
The idea that birth can be a normal experience flies in the face of all the cultural information disseminated on the subject by reality and fictional TV shows alike. Birth is a subject that naturally fits into the dramatic arc that viewers expect, and it is exploited and dramatized for entertainment purposes regularly. We see women swearing, screaming and panicking as they bring their babies into the world. Any woman who has been pregnant also knows that friends and family seem compelled to share their own birth horror stories as her belly grows.
Unfortunately, this view of birth is the only one many women in the United States are exposed to before experiencing it themselves, and the message is clear: birth is dangerous and only the obstetrician can save you. Hospitals are necessary, to be sure, and they are valuable in complicated births, but there is evidence that women who are at low risk for complications – and the majority are – can safely give birth at home.
Women who choose homebirth do so for a variety of reasons. My good friend Tuesday Benavidez is a registered nurse and midwifery student who worked for years in the maternity ward of a large San Diego hospital. She gave birth to her second daughter in her home in October 2005.
“It was mostly to be able to make my own choices,” Benavidez explained. “To have the freedom about where I wanted to give birth, as far as wanting to have water for my labor to relax me and what position I wanted to give birth in, where my baby was going to be after it was born. - I needed to have a relaxing atmosphere. In the hospital you’re in a vulnerable position and at home you’re in an empowered position.”
The issue of choice is often cited as a reason for having an out-of-hospital birth. In the hospital, the obstetrician and a group of nurses usually manage a woman’s labor. How it proceeds depends on the protocol of each particular hospital. In this context the laboring mother often becomes a passive participant in one of the most important experiences of her life. In contrast, the birth process unfolds more naturally and without intervention when a woman gives birth at home with a midwife – and this is without risk to the baby, according to a large-scale study of 5,418 women in the United States and Canada that was published by the British Medical Journal in 2005.
“Planned homebirth for low-risk women in North America using certified professional midwives was associated with lower rates of medical intervention,” according to the study, “but similar intrapartum and neonatal mortality to that of low-risk hospital births in the United States.”
The women in the study who gave birth at home received episiotomies – this is an incision to the perineum, the area of skin between the vagina and anus – 2.1% of the time, compared to 33% of those who labored in the hospital. Only 3.7% of women in the study who planned homebirths eventually had cesarean sections, compared to 19% of those in hospitals. In short, women were receiving interventions in the traditional hospital setting that were apparently unnecessary.
It’s typically believed a hospital takes much of the risk out of having a baby, but the women who give birth there may be taking risks they haven’t considered. For example, shoulder dystocia, in which the baby’s shoulder becomes stuck in the birth canal after the head has emerged, can be caused by the use of forceps or a vacuum – two tools sometimes used by hospitals. Another fact not generally known is that women are three times more likely to die during or from complications associated with cesarean sections than with vaginal births, according to the American College of Obstetrics and Gynecology.
Licensed Midwife Rachel Fox-Tierney of Birth Stream Midwifery in Davis, California notes, “There is always the risk of unnecessary intervention. Walking in the door is an intervention in the process of birth. The birth process works best when women are allowed to follow what their bodies need them to do. When there is a foreign environment, when there are unfamiliar people, procedures and protocols that don’t take into account how a woman’s own individual body works, and a lack of respect for [both] her privacy and faith in a woman’s ability to give birth naturally and normally, the birth process has been interfered with and is [therefore] less smooth.”
One of the problems with giving birth in modern hospitals in the United States is that rising operational costs have led to an environment that is increasingly concerned with efficiency and protocol at the expense of personalized care. Where the health of a mother and infant is concerned, this confusion of priorities can have serious consequences. For example, hospitals routinely give women a drug called Pitocin while they are in labor in order to speed up contractions which can lead to fetal distress, one of the primary conditions leading to C-sections. Ironically, the choice to speed up labor often ends up costing hospitals more in the end.An aversion to the impersonal nature of hospital care is what led Mya Dudzik of Sacramento to give birth to her third, fourth, and fifth children at home. She had nothing against hospitals after giving birth to the first two, but when she found out she was pregnant with her third child, she felt the medical staff treated the pregnancy as a “non-event.” Dudzik decided on a homebirth so “it would be celebrated more,” she says. “I’m not the type of person who thinks I’m going to die in the hospital. I do (homebirth) for my own personal reasons. I felt safe both ways. I was seeking it out not because I hate hospitals. It was a more magical experience at home.”
My own decision to give birth at home was partly personal.
When I became pregnant with my second baby, Benavidez suggested I look into homebirth. I hesitated. No, I resisted. I had fretted throughout her pregnancy because of her choice, especially when she went two weeks past her due date, but then she successfully gave birth at home to a 9-pound, 6-ounce baby with shoulder dystocia – a condition that almost certainly would have led to serious intervention in a hospital. I began researching it.
Even after I decided to give birth at home, though, my intellectual side continued to debate my choice. As one might guess, most of the issues began with, "What if ...?" As I came closer to my estimated due date, though, my anxiety melted away. More and more, I felt the same delicious anticipation that I had felt before my first son’s birth, partly because, over a combined 30-plus years of experience, my midwives were no strangers to complications.
With all the emphasis that homebirth moms place on having a positive birth experience, one might wonder if we have lost sight of the most important thing of all – having a healthy baby in our arms. Most women who choose homebirth, however, do so because how labor unfolds or is managed is directly related to the outcome.
Research has shown, for example, that a negative birth experience can lead to post-partum depression. There is also the difficulty in taking care of one’s baby if a cesarean is involved, as well as the aforementioned risk of maternal death from this complicated surgery. In addition, some pain medications used in labor can interfere with a newborn’s ability to nurse.
In contrast, a positive birth experience can have physical and psychological benefits.
“It is the most powerful experience of your life,” Benavidez said, “no matter how you have your baby – C-section, hospital, home – you’ll gain from that experience strength that you’ll be able to use in all aspects of your life. One can never have too much encouragement in that area. It’s maybe the most powerful spiritual experience and can help raise your self-esteem. Women need that in this society.”
The numbers show birthing outside of a hospital doesn’t have to be the dramatic, tension-filled event frequently portrayed on TV and that many women have experienced in hospital births. A growing number of women are declining the real-life drama of being wheeled into the operating room for an emergency C-section in favor of giving birth in the safety of their own homes.
Groups in the United States such as Citizens for Midwifery are working to increase access to information about the safe and family-centered model of care midwives provide. Fox-Tierney attributes an increased awareness of alternative birth choices to communication between women, partly through the Internet.
“I think that whenever there have been changes in the way [women] have chosen to give birth and who their practitioners are - it is consumer driven,” says Fox-Tierney. “With Internet women can get access to information in ways they never could before. Even if in your neck of the woods there are no midwives, you can hear about Jane Smith in Oregon who had a homebirth. I would hope that women are taking charge of their own healthcare and recognizing the benefits of midwifery care and their own ability to give birth in less technologically driven ways.”
About the Author
Janelle Weiner is a high school teacher and mother of two. She graduated from UC Berkeley with a Bachelor’s degree in English and holds a Master’s in Special Education from Boston University. Janelle has taught in city schools in Oakland, Boston, and Sacramento, where she currently resides.