I am asked a lot why I chose a homebirth last time, and why I am planning a second one this Fall. Usually when asked, I just rattle off some data about safety, or come little blurb about convenience or avoiding unnecessary interventions. But that’s not really the whole picture. So I decided to sit down and really think in-depth about all the many different reasons for my decision. I came up with 5 distinct reasons.
The reasons behind any woman’s personal birth choices and preferences are usually complicated and multi-faceted. There really is no one-size-fits-all approach to birth. I wish I could remember who said “The safest place for a woman to give birth is the place she feels the safest!”
This post is not meant to inform your decision. If you are trying to decide which birth is right for YOUR circumstances, you might want to read this post.
In this post, I’m just sharing MY reasons for choosing a homebirth. So go make yourself a cup of coffee with some good cream, and let’s chat between friends.
Here are my reasons, in no particular order:
1) The Data on Safety
There is this common belief in the US that the safest place to give birth is in a hospital, and that home birth is risky. However, the opposite is more often true! For healthy, low-risk pregnancies, choosing to give birth with a skilled midwife at home means fewer unnecessary interventions, and a far lower c-section rate. And when comparing low-risk women giving birth at home, to low-risk women giving birth in the hospital, the birth outcomes are actually slightly better for homebirthed babies!
My midwife monitors my health and is trained to recognize complications or conditions that are beyond her scope of care. If my health status changed and this became a high-risk pregnancy, I would of course follow the data and transfer care to an OB in a hospital. But for as long as baby and I are both healthy, the research supports our decision to birth simply and naturally at home.
What about emergencies?
Well, first of all we need to understand that in low-risk women, most of the birth emergencies in hospital births are actually caused by routine medical interventions.
For example: a labor isn’t progressing according to the arbitrary timelines allowed for in the hospital policies, so even though baby and mother are handling a long labor very well, the labor is “augmented” with an IV drip of Pitocin. The Pitocin forces to uterus to work harder, increasing the strength and length of contractions to unnatural levels. Mother is now in significant pain and may need pain control options. If mother receives an epidural for pain she is less mobile and can no longer feel and respond to her body’s gentle urgings to move or sway in a certain way to help her baby fit through her pelvis. Baby may be positioned less than ideally for an easy birth. Meanwhile, all this time the dosage of Pitocin has been steadily increased, and the baby is under severe pressure from these stronger-than-natural contractions.
Eventually, the monitors detect that baby’s heartrate is nonreassuring. Now worried medical staff are becoming anxious to get baby out quick. Mother is checked and is told she is “complete” and to start pushing. She is placed on her back with her legs up in the air, one of the worst anatomical positions for pushing as it prohibits mobility of the sacrum and actually narrows the pelvic opening by up to 30 percent! She is then ordered to push unnaturally long, while pitocin is further increased to “get baby out NOW!” The extra force from her coached pushing, in addition to the strain from hours of an augmented labor, finally puts baby into genuine distress. An episiotomy is performed and forceps are used to pull the baby out. Baby is in distress and has low initial APGAR scores, but after some quick medical care soon recovers and has no long-term problems.
Meanwhile, the Oxytocin receptors in mother’s uterus are so oversaturated by the large amounts of Pitocin in her body, that they suddenly can’t absorb any more, meaning that her uterus stops contracting right at the moment contractions are most vital. Her placenta has to be manually removed and she proceeds to hemorrhage badly because her uterus cannot contract down to close the blood vessels. Her life is now in serious jeopardy. Staff works to get her bleeding under control and eventually the Oxytocin receptors in her uterus are again able to absorb more hormone, signaling it to contract. Or, in extreme cases, an emergency hysterectomy may be the only way to save her life.
Phew. Failure to progress. Fetal Distress. Severe Postpartum Hemorrhage. Man, she sure is lucky that emergency medical care was right there!
But what would have happened without the medical care? Usually when a low-risk woman is experiencing a slower-than-average labor at home, her midwife patiently waits. Mother’s vitals and baby’s heart rate are occasionally checked, and as long as both are handling labor well there is no hurry. The midwife encourages mother to rest, eat light snacks or drink honey tea to keep up her energy, and may suggest movement or position changes to help labor along. Her long labor is exhausting, but because her body is regulating the strength of contractions, mother’s pain level stays manageable and baby’s heart rate stays normal and strong. When the birth finally does happen, mother is able to push baby out on her own. Baby is alert and strong. The final pressure of baby’s head against mother’s perineum signals a huge surge of Oxytocin throughout her body, naturally signaling her uterus to expel the placenta quickly and clamp down to control bleeding. If there is excessive bleeding at a natural birth, it is rarely severe and can usually be controlled with natural methods. If extra medical help is needed, the midwife gives a shot of Pitocin, and since the mother’s uterus isn’t already oversaturated, it works quickly and effectively.
Now, these are just two generalized scenarios. Every birth is different. There absolutely ARE rare cases when a true emergency happens at home, and must be quickly transferred to a hospital for a c section. But these are extremely unlikely.
Like all life choices, birth decisions are about deciding which set of risks you are more willing to accept… Potential natural emergencies or potential unnecessary interventions possibly leading to constructed emergencies.
2) The Ideology
We believe that the home should be the center of the family. It breaks my heart to see how unimportant the home has become in our culture. Usually, it is viewed as simply a place to sleep, shower, dress and maybe eat before going back out into the world, where the real living happens.
Every important part of life has been removed from the home!
Our children, even our very young children, are educated and raised outside the home. Our meals are prepared and eaten outside the home. Our sick, infirm and elderly are cared for outside the home. We die outside the home. We are born outside the home. Heck, more and more we are even conceived through medical intervention outside the home!
I know life is busy and complicated. Often things do need to happen outside the home. However, it is still the IDEAL we strive for whenever possible to keep the home the center of our family.
For us, it is only natural that this ideology extend to welcoming new life into our family! As long as mother and baby stay low-risk and have the support of a skilled professional trained to recognize complications, what better way to start out life than in the peace of your own home?
3) Birth Philosophy Model of care
The choice between a hospital birth and a home or birth center birth is about more than location. It is a choice between two distinct philosophies or models of care. The medical and the Midwifery models. Both have their place, and it is up to each woman to decide which is the right fit for her particular circumstances.
For me, the midwifery model of care is an easy fit. If I become high-risk and have to transfer to an OB, the medical model of care will chafe. Badly. 😉
4) The Baggage
This list wouldn’t be complete without touching on this very personal reason. It’s actually hard to write this down, but I know I’m not the only one dealing with this. Statistically, at least 1 in 3 women reading this are facing the same issues.
I am a sexual abuse and rape survivor.
I don’t like to be messed with. I hate vaginal exams and decline them unless there is a situational, evidenced-based reason for one to be performed.
I hate any situations that make me feel vulnerable or under someone else’s control. In order to relax enough to give birth safely and easily, I NEED to feel safe, supported and in control. This is something that is extremely difficult to achieve in a hospital setting. The model of care simply isn’t set up that way. In hospital birth, vaginal exams and episiotomies are often performed without consent, and even in direct violation to the woman’s wishes. It is a sad effect of the way that our culture views birthing mothers; women are often seen as signing away any and all right to bodily autonomy the second they are wheeled through the doors of Labor and Delivery.
Now, not every doctor and nurse behaves this way. There are some very good ones out there. And even the ones who do disregard a woman’s right to make her own body choices in labor don’t do so out of malice, I’m sure, but rather the belief that they know best.
However, if my wishes were disregarded and things were done to my body against my consent, I know I would be deeply retraumatized. As long as baby and I stay low-risk and healthy enough to birth at home safely, the potential of further sexual trauma is a risk I don’t want to take.
(If there is a medical complication that requires us to transfer to a hospital for the birth, I plan on printing out this sign to post on my door or in my room. Hopefully by getting the whole birth team on the same page, and reaching out to them all for help and compassion things would go better. Feel free to download and print it for yourself if you have the same needs.)
5) The Personality (introvert)
I have a strongly introverted personality. I like to be alone. I do not like to be the center of attention. Being in a busy environment stresses me out beyond belief!
The idea of giving birth in a hospital setting, with all the staff coming and going, the noises, the machines, the lights, the rules, expectations and social norms… I just don’t see how I could possibly relax enough to open my cervix and push out a baby!
So there it is, all laid out. MY main reasons for choosing to pursue a homebirth first.
What were your reasons for choosing the birth you did?
In Corde Maria,
featured image via Flickr user Nicolas Torquet found under Creative Commons attribution / share alike on 8/23/2016