An Evidence Based Look at Why We Chose Home Birth

The decision to have Isla at home was not taken lightly. I researched like crazy for about a year before we were even pregnant, following the data and letting the evidence speak for itself. In my previous post, I discuss why I didn’t want to be in the hospital. On the other side of the same coin, here are the reasons why I did want to be at home.

1) Home birth is safe. Studies can be found here, here, here, here, here and you get the point. One study actual found that home birth has better outcomes than hospital. There are of course studies that suggest the opposite, but every one that I have seen looks at all out of hospital births and lump them into the ‘home birth’ category. That means unplanned out of hospital births like delivering in the car on the way to the hospital or intentional unassisted (no midwife) homebirth are included within the data. This skews the results because there is big difference between a planned, conscious homebirth with trained professional midwifes and a road-side accidental delivery. The ones I have posted here looked only at planned home birth unless otherwise noted. These studies found no negative risks with planned home birth in comparison to hospital birth.

2) The hospital didn’t feel safe to me. After all the research I had done, I did not trust that the hospital was the best place for a low-risk, natural birth. I love my baby more than anything in the world and would only give birth in the place I felt was safest for her. There is good reason for needing to feel safe as well.   Ina May Gaskin is one of the most highly respected home birth midwives in the world. Her book Ina May’s Guide to Childbirth talks in depth about the need for safe surroundings. You hear it all the time: “I got to the hospital and my labor stopped.” Bright lights, unfamiliar people, needing to be checked for labor to be verified- these among many other factors all increase adrenaline in the body. Adrenaline is the opposite of oxytocin. Oxytocin is what causes contractions and dilation. When adrenaline starts to take over oxytocin, labor can stall. Ina May even cites cases where dilation has reversed when women enter the hospital. She goes on to discuss how humans, as mammals, have the same instincts in labor as any other mammal does. She refers to a cat or dog in labor going to find a dark, safe place where external threats are the least present. We are no different. I felt safest at home where I could control my environment.

3) I didn’t want a c-section. Let me first say that I am thankful that c-sections exist. They are necessary and it is absolutely amazing that they can be done so quickly and relatively easily to save a baby or mother’s life. The World Health Organization recommends a community’s rate of Cesarean deliveries not exceed 15% yet the cesarean rates in the US are hovering right around 33%. This means that just walking into a hospital in labor gives the mother a 1 of out 3 chance to being given a c-section. A study conducted by the Midwives Alliance found that the rate of home birth transfers ending in c-section in nearly 17,000 women was only 5.2%. When only 5% of woman needed a c-section at home and over 30% need them in hospital, what’s happening to make the hospital rates so high?

4) Enter the “the cascade of intervention.” I wanted to avoid it as much as possible. This is the term given to the domino affect interventions can cause during labor. Here’s an example:

A woman checks into the hospital in labor. She immediately gets an IV and continual electronic fetal monitoring, which I discuss here because it is standard of care in the majority of hospitals. She isn’t able to get up, change position to something other than lying, or walk around to naturally cope because of the machines she’s connected to. She gets an epidural. The epidural slows down labor so she gets Pitocin to induce stronger contractions. More pain meds to help with the now unnaturally intense contractions and more Pitocin to help with the deceleration of contractions caused by the pain meds. Baby’s heart rate drops because baby cannot handle the stress from the Pitocin. An emergency c-section is performed.

Obviously, this is just an example of what can happen and not every c-section is caused by this or any other cascade. C-sections will be necessary. But every intervention from not being allowed to eat in labor to receiving an epidural can lead down this path. In the home birth setting, most of these interventions do not exist. Midwives periodically check the baby’s heartrate with a Doppler and are constantly observing, charting and analyzing, but for the most part, they let mama do her thing. They step in as needed, but Pitocin will never be given to augment labor, an epidural will never be placed and they will allow and encourage the mother to change into whatever position she feels the best in.

5) I didn’t want cervical checks unless medically indicated. Cervical or vaginal exams during labor (and pregnancy) carry a small but real risk of infection and accidental artificial rapture of membranes (when they break your water by accident). In fact, the Cochran Report has stated that…

“We identified no convincing evidence to support, or reject, the use of routine vaginal examinations in labor, yet this is common practice throughout the world. More research is needed to find out if vaginal examinations are a useful measure of both normal and abnormal labor progress.”

Aside from there being no evidence to support checks, I didn’t want to know how far long I was. I didn’t want to become discouraged or have my confidence diminished if I wasn’t progressing fast enough. During my daughter’s birth, there was indication that I should be checked, and that was completely okay with me. I was informed and consented to the procedure. That was probably 30-ish hours into labor though and I was only at 8 centimeters. I was so disappointed! I may have given up my quest for a natural birth had I been checked 24 hours in and only been at 4 or 5 centimeters.

6) I knew I could do it without pain meds. I wasn’t afraid of the sensations of labor. I believe that women are taught from day 1 that birth is excruciating. Every TV birth scene is an emergency where the women scream out in pain, begging for the epidural and cursing their partners for knocking them up in the first place. Horrific birth stories are passed around at baby showers like appetizer and expecting mothers are left scared of giving birth. I refused to listen to it. I empowered myself my reading real, positive birth stories at Positive Birth Stories and Birth Without Fear and avoided conversations with women who I knew had negative things to say. I tried to forget ever being told that childbirth was painful and focused on envisioning a painless experience.

7) I knew that as a first time mom I was going to be a risk for “failure to progress”. As I mentioned in my previous post, woman are often held to a timetable where their dilatation needs to be completed within a set number of hours. This is called the Friedman Curve. By these standards, a first time mom would need to go from 0 to fully dilated in 14 hours. The finding by Dr. Freidman have been debunked since the time his work was published, yet many practitioners still expect these results from laboring mothers. When dilation is slower than this curve, the mother is labeled as Failure to Progress (FTP). So what’s the problem with this? The label of FTP leads to interventions like induction with Pitocin and in 1/3 of all cases, cesarean delivery.   My midwives alluded to the fact that 24+ hours would be totally normal and expected for my labor and that even 30+ hours would not be out of question. Even the Mayo Clinic says that labor for a first time mom can take as much as 20 hours. When actual FTP arises, (I was probably coming up on it), interventions are a blessing. But all too often, by Freidman or other hospital standards, this label causes unnecessary disruption of the natural labor process.

8) I could eat, drink and do whatever else I wanted at home. The reason for not being allowed to eat during labor comes from the risk of aspiration while under general anesthesia in the event of an emergency c-section. This was first reported back in the 40s. Since then, general anesthesia is no longer the standard of care and techniques have greatly improved. Now, there has been found to be no medical indication why food and drink should be restricted. And you know what? Giving birth is hard work. It’s physically and emotionally tolling. How could any woman be expected to make it through 8 hours let alone 12 or 20+ hours of labor without being allowed to eat or drink anything but ice chips? Eating helps to prevent exhaustion by sustaining the body. This is important because exhaustion can lead to the medically indicate use of interventions like epidurals to provide the mother with a break or Pitocin, if labor has slowed.

9) I wanted my husband to be part of our daughter’s birth. I pull so much strength from him and he is an absolute rock. I knew before going into labor that he would be my greatest support. At home, I could be sure that he would be included and considered. He had a comfy couch and a bed at home, more to eat than jello and crappy hospital food and it would have been almost impossible for him to miss anything. He could (and did) work with my midwives to help them give me the best care possible and advise them on my preferences when I was in the zone. In a very literal sense, I could not picture him being able to help me in these ways in a hospital setting.

10) I wanted to snuggle and bond with tiny new babe in my own bed with my husband immediately following birth. I can pretty much guarantee that this is on every home birther’s ‘pro’ list when considering bringing birth home, and let me tell you, it was so, so amazing. Plus, there is a ton of evidence that supports the benefits of skin to skin bonding after birth for both mother and baby. This practice is especially valuable for establishing breastfeeding which was incredibly important to me, regardless of the type of birth we had.

The other thing I took into heavy consideration is that our house is less than a block away from an ambulance station. It’s also important to note that midwives come prepared for emergency situations. They carry Pitocin and other medicines like Cytotec to control postpartum hemorrhage, resuscitation equipment like oxygen and masks, IVs and tubing and other medical materials like catheters. They can resuscitate a baby and manage blood loss the same way a hospital would. The only thing they don’t have is blood for a transfusion and the capability to perform a Cesarean. They are constantly observing though and will transfer a mother to the hospital in a heartbeat if there is any indication that mamma or baby needs additional help. One of the best things about home birth is that you can transfer to the hospital whenever you want.

Home birth is not for everybody though and while I do wish more women would research and consider it, I do truly believe that all women should give birth wherever they believe is safest. That is in my opinion truly the most important thing.

Why did you decide to give birth where you did? Did you consider other options?

 

 

Gaskin, Ina May. Ina May’s Guide to Natural Childbirth: Discover the Proven Wisdom That Has Guided Thousands of Women through Childbirth with More Confidence, Less Pain, and Little or No Medical Intervention – Whether in a Hospital, Birthing Center, or the Comfort of a Home. First ed. New York: Bantam, 2003. Print.