Home-birth: Is It Right For You?
by Cecily Arenas
After 24 hours of laboring — moving with each contraction up to the next levels of labor — Luna was about to arrive. I got into our hot tub. I could feel her water bag moving down my birth canal. With one strong push the bag burst. I gently pushed with each contraction and felt my baby move down with my finger. With her father supporting my perineum, she crowned. I let out a moan as I felt myself open completely to this birth. The next contraction came. I knew this was it. With a primal yell, out came her head. The burning and pressure lessened. Her father exclaims, “The head’s out! A full head of hair!” I have never heard such elation in his voice in the 6 years we have been together. The next contraction came. I go into my body and out our daughter slithers into her father’s hands. I hold her. We all cry. We did it! She breathes immediately. No suctioning was needed. No IV’s. No fetal monitors. No crowds. No one giving me orders. Just the power of birth. Just us.
As late as 1900, 95% of all births took place at home in the United States. As the medical profession became more organized, doctors were able to successfully campaign for the eradication of the midwife. Doctors convinced the public that birth was safer with them even though their mortality rates were higher than those of the midwives. Midwifery training ceased as midwifery was becoming illegal in some states. Some midwives continued to practice but in poor rural areas or very discreetly. By 1960, 96% of all births took place in hospitals.
Safety of Homebirth
Midwives deliver 80% of the world’s babies yet in the U.S. they deliver only about 4% of babies. The medical model tells us that birth is inherently dangerous and homebirth is unsafe. Studies have shown otherwise. In the Netherlands, a country with a low infant mortality rate (3rd in 1973), homebirth is the norm. In 1973 two-thirds of all births occurred at home and the cesarean rate was 2.3%. Obstetricians are rarely used and only in high risk situations. In contrast, in the United States, who rates approximately 24th in the world in infant mortality, hospital birth is the norm.
The Farm, an intentional community in Tennessee, compared homebirth outcomes to those of the hospital. 1917 births occurred at the Farm between 1970-1994. Four percent of these births were transferred to the hospital. The cesarean rate was 1.8%. The cesarean rate in U.S. hospitals averages 25%. 1 out of every 4 women undergo major surgery in birth! Some hospitals have a 50% cesarean rate while others have a 10% rate. There was no difference in perinatal death, respiratory distress or birth injuries when comparing home and hospital births.
A study by Lewis Mehl in 1977 shows that homebirth is safer than hospital birth. Of 1146 homebirths in San Francisco the perinatal mortality is 9.5 per 1000 at home and 20.3 per 1000 in the hospital.
There are no studies that show otherwise.
Of course we think about all of the women and babies dying at the turn of the century. This is true. Women and babies were dying because of poor health, disease, and starvation. The medical model says that birth is safer because of their technology and style. However birth has become safer because of better nutrition, better work conditions, prevention, eradication of diseases and overall better health. Women and babies are healthier than ever yet normal birth occurs in the hospital.
Even though birthing at home is not the norm in the U.S. we still have a variety of birthing options. We can birth at home with or without a midwife, at a freestanding birth center or in the hospital.
Birthing at Home
When making the decision to birth at home there are a few things to consider:
- Do I feel comfortable birthing at home?
- Why am I birthing at home? (Your choice should not be based on pressure from others but should be based on what you feel is best)
- Am I healthy?
- Do I eat well?
- Am I willing to take responsibility for my birth and take on an active role?
- Am I able to birth without pain medication? (There are no epidurals at home, however there are plenty of comfort measures that can help you cope with labor)
- Who do I want at my birth?
Some women prefer a professional midwife at their birth. Midwives offer comprehensive prenatal care which emphasizes nutrition, exercise, parental responsibility, education, emotional balance and preventative care. Midwives can serve as a counselor helping moms work through issues so that their birth can be more complete. Because women use less medication with midwives, there are less complications. Drugs interfere with the normal process of labor and harm the baby. Midwives believe that birth is a normal process which is not in need of medical intervention. Midwives are trained to recognize complications and intervene in rare cases. She can deal with emergencies or transport to the hospital.
There are two types of midwives, Direct-Entry Midwives (DEM) or Certified Nurse Midwives (CNM). DEMs or “lay midwives” are trained through apprenticeships with experienced midwives, midwifery courses, and self study. In some states, DEMs are legal and can be licensed by that state. In other states, midwifery is illegal or alegal (midwifery is neither legal nor illegal). DEMs can be certified professional midwives (CPM) through North American Registry of Midwives (NARM) which is a certifying organization run by other midwives. CNMs are midwives who are RNs and have passed the certification exam by the American College of Nurse Midwives (ACNM). CNMs have about 1 year of midwifery specialty training beyond their nursing education. They practice in hospitals and birth centers. Some will attend homebirths.
The cost of homebirth with a midwife varies regionally. Midwifery care is significantly cheaper than obstetrical care in a hospital. The average birth in a hospital costs $3000-$6000 depending on the hospital and interventions. The average birth with a midwife is $2000 which covers all of the prenatal visits, the birth and postpartum visits. Insurance does not always cover the cost of a midwife. Check with your midwife to see if she takes insurance. Some midwives also offer sliding scale, trades, reduced fees or payment plans in cases of financial need.
Other women prefer to birth unassisted. This can be done solo, with a partner, with family or close friends or some combination. Mothers assume a whole new level of responsibility for the birth and often report a strong sense of empowerment. There are numerous reasons women choose to birth unassisted. Some prefer to be left alone without any interference and listen to their intuition. Some feel that birth is an extremely intimate event that should be left to the couple who created the baby. Others do it for spiritual reasons. I birthed my daughter Luna with just her father present. I did my own prenatal care and found that I took a lot more responsibility for my health and my baby’s health compared to when I birthed my son in the hospital. It was a wonderful experience being totally responsible and sharing such an intimate experience with my partner.
Freestanding Birth Centers and Hospitals
Even though studies show that birth is safe at home, we are inundated with technology and all of its glory. Since it is such a big part of our lives, it is difficult to trust nature over technology. As a result, some women just don’t feel comfortable with a homebirth. Some can not afford a midwife. Some have high risk situations.
Freestanding birth centers are an excellent option that combines the freedom of a midwife-assisted homebirth with the “safety” of a hospital. They are independent centers run by midwives, often CNMs and a physician usually supervises. They have all of the comforts of home and support birth as a natural process. At the same time they have access to the technology that can save lives. Most take insurance.
Hospitals have made significant changes over the last two decades. Because of consumer demand, many have added birthing rooms with nice wallpaper, rocking chairs and a place for partners to sleep making it more homelike. More and more are supporting rooming-in and breastfeeding. Some have added jacuzzis with a few adding waterbirth tubs. If you decide that a hospital is best for you, shop around for a hospital and obstetrician who will you give you the birth YOU want.
Birthing my daughter at home was the most amazing experience. When I reflect upon my birth experience I feel such satisfaction. I reminisce the contractions, feeling the pain of labor. Wanting to give up but knowing that she will be here soon. Feeling the ecstasy of her birth. I follow my instincts which help with the pain. Looking around, certain doorways hold a place in my heart for that is where I rocked back and forth during transition. That shower soothed the agonizing hip pain. The birth tub forever reminds me where Luna’s life outside the womb began. I look at her, feeling that intense mother baby bond and feel complete. I am here with my family, my home and the love that surrounds us.