Is Homebirth a Safe Option?

Last week there was an article released online with a print version due in September of this year in the American Journal of Obstetrics and Gynecology on a new “study” or meta-analysis of the safety of homebirth by Joesph Wax M.D.  The article I linked to is one written by the BBC as an analysis of the original.  The meta-analysis concluded that – “Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.” Meaning that it was concluded that three times as many infants die in planned homebirth than in planned hospital birth.  I have to immediately tell you that even with this statement (though I feel that some of the evidence is purposefully ignored and others flawed), I completely disagree at anyone drawing a conclusion from this “study” that homebirth is not a safe option for low risk pregnant women.  The American College of Obstetrics and Gynecology has long opposed homebirth and has released statements concerning the topic.  I’m not going to counter Dr. Wax’s “study” or the ACOG statement.  That has already been done.  See the recent post at Birth Activist.  What I would like to offer you is a personal evaluation of the decision to have your baby at home.

My first child was born through cesarean surgery with no labor and no medical emergency.  At the time, I didn’t know that suspicion of a large baby was not a reason for induction or cesarean according to ACOG guidelines.  I consented to surgery for that reason with deep regret afterward as my baby and myself suffered side effects of surgical birth that could have been prevented.  When I found myself pregnant again, I knew I wanted to avoid surgery.  I had studied quite a bit about normal childbirth, attended two natural, hospital births as a labor support person (doula), was active in the community’s VBAC (vaginal birth after cesarean) support group, and I knew that I wanted to have a natural, vaginal birth with this baby barring any abnormal complications that would require medical intervention.  This was the choice that made me feel safe.  This was the choice that I felt would result, under my circumstances, in the safest outcome for me and my baby.

The problem was, VBAC was not supported by many hospitals and practitioners  in the area I lived at the time, despite its proven safety.  Because I knew I wanted a practitioner that would support drug-free, vaginal birth for me, I chose a midwife (certified professional midwife) who attended births at home.  My midwife had experienced VBAC herself.  She had received a college education in midwifery and nursing.  She had apprenticed under an experienced homebirth midwife.  She was trained in and comfortable with performing neonatal resuscitation, and my home was only about five minutes from the nearest hospital should the need arise.  I was completely comfortable with my choice, and my experience did nothing but solidify that choice.  The standard of care I received was better than that I had received from the obstetricians’ throughout my first birth.  When hospital transfer was necessary during my birth because of some complications, it was handled calmly.  I was never in danger, nor was my baby.  I would not hesitate to make the same choice again.

The key to my firm belief in homebirth is the midwifery model of care.  A well trained, educated midwife is so thorough in the care she/he provides, that most difficulties in pregnancy and birth are spotted before they become a medical emergency.  Midwives such as Ina May Gaskin have been practicing for thirty or more years with excellent statistics on maternal/neonatal mortality and interventionEven certain midwives of old in colonial England had excellent outcomes.

I am of the opinion, through the study that I have done personally and for my work, that homebirth is absolutely a safe option in many birthing situations when a low risk mother is seen by a fully trained birth attendant.  What I mean by “fully trained” is that the attendant is not only familiar with neonatal resuscitation, but is capable of applying it properly in an emergency situation.  The attendant is aware of the signs/causes of post-partum hemorrhage, and will deal with those cases effectively as they arise.  The attendant is comfortable with their skills in assisting delivery or handling of complicated presentations and birth complications such as shoulder dystocia, prolapsed cord, and surprise breech.  Also, the chosen attendant must be confident in their ability to detect pregnancy related problems and refer the mother to obstetric care when needed.

Recently, a friend of ours and his mother had a surgery in a hospital in our region, and both of them came away with a staph infection that required re-hospitalization and more surgery.  This hospital just completed an ad campaign for their birthing facilities.  Hospitals are not clean environments.  Hospitals are for sick people, or those requiring treatment for ailments, and we can expect them to contain the germs and problems associated with that.  This is not saying that hospitals can’t be suitable or clean enough places in which to birth our babies.  We know that they are and can be.  Our homes too are places, in many situations, that we are adapted to.  Where healthy, normal life events play out.  Why not have them as a place for healthy, normal birth?

In southeastern, Kentucky, we typically do not have access to homebirth attended by a trained, professional midwife.  Fortunately, we do have a large midwifery presence in the area, and obstetricians who readily work with midwives in the hospital setting.  I have to admit, that someday I would love to see a move toward bringing normal birth to the home for those mothers who are most comfortable in that setting.  I would also love to see freestanding birth centers for those mothers who would like a little reassurance, but would like to avoid the hospital.  I’d love to see hospitals and obstetricians actively working with midwives who deliver in the homes and birth centers to provide well-rounded and supported care to those mothers requiring special attention.  It would be optimal for there to be that support so that all birth attendants are properly trained in areas that could create life threatening situations before offering their services to pregnant women.  Why not?  Other countries are doing it with awesome results.

In the meantime, read this post from Talk Birth, which explains in a wonderful way why it is important for women to have options in childbirth and to be the chooser of the type of care they prefer and receive.  This post is in no way criticizing those who choose hospital birth.  It is a matter of situation and your personal comfort level.  It is the norm in our country with only 2% of women currently choosing homebirth.  It is only a matter of options, knowing them, and making birth as safe and healthy for each individual mother and baby as it can be.

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About Kelli

I am Kelli B. Haywood, LCCE, a childbirth educator certified through Lamaze, a birth doula, and prenatal yoga instructor. My two little girls light my life. I am the wife of artist, musician, and teacher - John Haywood.
This entry was posted in Birth Topics, Eastern Kentucky, Healthy Pregnancy, Pregnancy Care Providers and tagged , , , , , , , , , , , , , . Bookmark the permalink.

5 Responses to Is Homebirth a Safe Option?

  1. Carrie says:

    I’ll go ahead and confess that I am nervous about home births for myself. I think you have to place a LOT of trust in someone in a non-hospital environment. Not that you’re not placing A LOT of trust in a doctor in a hospital environment as well.

    I think it should be a viable option for someone, if they choose to go that route however. I think insurance should have to pay any fees, so long as costs are high than an in the hospital birth (and God knows they shouldn’t be). No matter my fears, you should have the right to birth a child as you wish as long as your OB/MW/NP doesn’t forsee any complications. And you need to be prepared to MOVE to the hospital as quickly as possible and be near a hospital if something goes wrong.

    I think its awesome that you are so driven to provide this service for YOUR community. Blessings on you.

    • eastkentuckygal says:

      Yes, Carrie. I agree with you in all points. I think if insurance routinely covered homebirth, and it was a more accessible option, I believe that there would be more consistent training available to those providing that service, and thus make it an even safer option than it already is. Albeit those standards are not more like ridiculous road blocks to women and midwives seeking homebirth, but real standards in quality of care and training of those offering it.
      I did place a lot of trust in my midwife. A lot. I trusted her to have my best interest in her heart at all times. I trusted that she truly cared for me and my baby and that we were more than $$$ to her. She proved that to me on many occassions, including when the birth didn’t go as planned. Homebirth midwives spend a huge amount of time and effort to provide holistic maternity care to women, and I love them for it. We have to trust our care providers no matter the situation we are delivering in to have our safety in mind at all times, not just their schedule, convenience, legalities, and $$$. I think in many cases this attitude causes situations that are dangerous and could have otherwise been avoided. The important thing is that the mother is comfortable enough to relax and birth as she sees fit.
      Thank you for commenting! I so appreciate it. 🙂

  2. m.hope says:

    i want to say i had my son at home and it was the most empowering experience of my life. women who have not had their baby at home don’t know that it is an emotional, spiritual experience that leaves you feeling like Wonder Woman; knowing you are a Goddess participating in creation.

    I go so far as to say that hospital births controlled by men and Western techniques of intervention have on a subconscious spiritual level stolen women’s power by not permitting them to experience giving birth.

    the home IS a healthier environment for many, many reasons. the germs that could exist there the mother is adapted to and therefore the baby. the home is the place where the mother feels most comfortable. birth requires a woman to relax. checking into a hospital, being hooked up to IVs and having people hover around you taking samples of this and that (not to mention, shaving your VAGINA) IS NOT A RELAXING EXPERIENCE. in fact it has the opposite effect. it creates fear. and fear is not the emotion you want to be overwhelmed with when you are about to give birth.

    i have a whole lot to say on this subject, maybe i should post it myself somewhere ( http://whatisawomansrole.blogspot.com , for example) but believe me, if you have your baby at home, it will be the most moving, transforming, important experience of your life.
    g-d bless,
    mhope

    • eastkentuckygal says:

      Thanks so much for sharing that. I am hoping to collect birth stories for this blog, if you are ever interested in sharing your whole story as a guest post. Our advancements in medicine have in many ways blinded us to the capabilities of nature to know and understand what our bodies need. Though we can be thankful for medicine when it is necessary or needed in our situation. My second birth was one of those cases. We can’t guarantee that a birth will end just as we had planned, or that everything will go without a problem. Sometimes, neither nature nor medicine can deter those happenings. Birth carries risk like any other thing in life. But, the great thing is that most of the time, it goes off without serious difficulties. There are some predictable things about it, and yet every time we birth we have a unique experience. Our bodies are equipped to birth, experiencing labor made that concrete in my mind. Even when my contractions were seemingly back to back, I knew my body was doing exactly all it could to bring forth my baby. Home is a fine place for safe birth.

      • m.hope says:

        sure, would love to… it’s one of those stories i tell every woman i get a chance to. i think i should maybe video blog it and then transcribe it. may be more powerful. and i think collecting as MANY STORIES AS POSSIBLE will help to start shift the tide of public opinion that has been dominated by a male dominated society that thinks everything female is weird, alien, witchy see: http://tmh.floonet.net/articles/witches.html , bitchy, sticky, and needs to be controlled, sanitized, and tamed. there’s a reason why midwives have long been vilified as evil (mostly economic). my midwife came close to doing jail time more than once for doing her duty in California, before it was legal. Without her, I could never have had the courage. It took a soothing, calming, confident and experienced WOMAN to help me bring my baby out into the world. I will never forget her, Lani Rose Jeansdottir
        RIP http://www.californiamidwives.org/?page_id=23

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