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Homebirth, Written by, Jane Palmer, Midwife - Australia
HOMEBIRTH Q AND A
Written by, Kate Fawley, CPM – Pennsylvania, USA
Why Homebirth?
For many people homebirth is simply the only option which matches their belief systems. Some have had to endure painful hospital experiences which alert them to the arbitrary nature of protocols in place there. For some it is a gradual education process which begins when the first visits to the local obstetrician end poorly and the family begins to seek other options. Some have several children before finally realizing homebirth was right for them all along. Some want control of the labor process, impossible with managed care; others want control of what happens to their baby in the hours after birth. Some want God to lead the process and others want to be simply left alone.
What bonds homebirthers together, because they come from all walks of life and all income levels and all religions and creeds, is a need to be at home and undisturbed and to let nature take its course gently and easily.
Birth at home is remarkably simple and comparatively easier than hospital birth. 90-95% of the time the baby is born at home and is healthy after a labor which while longer is often more pleasant than the typical medical birth experience. You can labor in water, move around to be comfortable, you can eat. You can let the aches and pains of a healthy muscular system work the way they should, and scream or cry or be totally silent. Your toddler can run around and your husband can be where you both feel safe and protected. To labor in your own big bed, and deliver there, and stay there and spend the night is such a gentle process. No wheeled transport, or little plastic boxes for the baby, your arms do just fine. Midwives clean up the mess and chat about the beauty of what they just saw and leave you comfy and clean.
So the question really isn’t, Why Homebirth. The question really is why in the world would you do anything else?
Is homebirth safe?
Midwifery care has statistically better outcomes in all situations for all populations than any other form of birth care. Homebirth with a trained attendant and access to medical care has the best outcomes for low risk populations. No study anywhere had ever shown obstetrical care to be superior to midwifery care, ever.
Most of the world’ population is born at home with a midwife, and with the exception of those with no access to emergency care, those outcomes are surprisingly good. Most of the industrialized world has better birth outcomes than we do and we lag behind our economic partners in defeating fetal and maternal mortality while leading them in birth interventions.
In our culture, hospital birth is currently the norm, not because it is safer, better or more comfortable but because it is what is done and has been done for the last 3 or 4 generations. Birth in hospital accounts for 3.8 million hospital admissions per year and is the single largest cause of hospital admissions. It is a huge industry, governed by largely arbitrary rules which are not in keeping with any known research or scientific method.
The careful screening midwives do make sure that problems with the mother or child which need hospitalization are there, whether in pregnancy, birth or postpartum. Transports happen but for medical reasons, the outcome is necessary, not routine. 5% world wide will need cesarean sections, and that’s about how many need transport for surgery at home, compared to 25% in most hospitals. Small occurrences like a baby that needs mild resuscitation, or a mother that could use a few stitches, or needs a medication to stem bleeding from the placental site, can all be handled as a matter of course by a trained midwife.
The question really is not: Is homebirth safe, the question really is What is safer than homebirth? There is no response because nothing has ever been proven safer than homebirth for low risk women. That is one of the best kept secrets in the field.
Who comes to the birth with the midwife?
Midwives generally work in teams of 2. There will be a midwife assigned to the mother’s care and a midwife assigned to the baby’s care. Your midwife is the lead midwife and generally her role is to manage the labor and assist the mother, to assisting in delivery of the baby, and then managing the delivery of the placenta. The secondary midwife will assist the midwife, bringing supplies to her and managing the care of the baby after it is born.
Often there will be an apprentice (sometimes 2 with the birthing family’s permission) who observes as part of her education and gives help to the midwives. Under unusual circumstances a consult with a more experienced midwife is suggested, she would attend to guide, give information and assist if needed.
How do they monitor the baby?
In the hospital they used a fetal monitor…. At home your midwife will use a Doppler (hand-held ultrasound device) which register the baby’s heart tones and provide an immediate read out of the baby’s heart tones. Some times your midwife will use fetoscopes or stethoscopes for clients who do not care to have the use of technology in their births. These methods of are better than fetal monitors for home use, because of all the different positions a mother will take during her labor, and a Doppler can be used anywhere, in the tub, on the toilet, upside-down on the hands and knees, or anywhere .Each midwife has her own protocols of how she will take care of a woman in labor.
What if something goes wrong?
Emergency procedures:
While homebirth is safe, there are occasionally unforeseen occurrences that may warrant a trip to the hospital. Access to immediate medical transport and an emergency plan is essential. This will include your back up hospital and back up doctor, if you have chosen one. Each midwife has different comfort zones due to practice style and training. Some midwives may be able to handle almost every occurrence at home while others will transport more readily, you and your midwife will develop the emergency procedures that make you both feel most comfortable
Midwives are professionals who are aware of the scope of normal and the common problems that might occur. Since midwives are specialists in facilitating natural birth, there are many things they do in their practice to make sure that the majority of problems don’t happen in the first place. This is how they provide statistically better outcomes than obstetrical care. Much care is taken to make sure any problems are handled swiftly and effectively. Training, personnel, supplies and emergency procedures are all part of the way they make sure they are prepared for every eventuality. Often people are concerned about what is done at home when the following situations occur:
Cord around the neck:
This is a common situation and an easy to fix situation. Student midwives take great pride in learning to loosen a cord which is loosely wrapped and allowing the baby’s body to “somersault” through the cord. A nuchal (neck) cord can also just be taken over the chin and head like a necklace. If a cord is too tightly wound to loosen, then the cord is clamped, cut and unwound, and the baby born easily afterwards.
Bleeding:
Copious bleeding, called haemorrhage, occurs in about 5% of births. Those who will be seriously affected by a bleed are screened out in prenatal care, and will have to birth in hospital so they have access to a transfusion if they need it. Women who birth at home have sufficient stores and medical history to be able to tolerate the loss of blood common to birth, which while it seems like quite a bit, is usually less than 500cc (a cup). This is not much at all when you consider that a pregnant woman has a 40% greater blood volume than a non-pregnant woman.
About 70% of hemorrhages are due to the uterus not firming up after delivery. Midwives carry various medicines and herbal remedies to fix this situation, and also some physiological knowledge which usually makes medications unnecessary. If a baby is put to breast shortly after birth, the uterus will firm up, and if the uterus is gently massaged it will firm up as well.
Midwives watch their mothers carefully and are very concerned about this complication; midwives work hard to prevent bleeding with careful nutritional and herbal support before birth, and have the knowledge and supplies on hand to deal with it if it does happen at home.
What about the mess?
Isn’t homebirth going to be gross, disgusting and mess up my house?
The mess of a birth can be contained very easily by those trained in how to do it. The amniotic fluid, placenta and any blood loss usually amounts to what would fit in a small-to-medium sized mixing bowl.
The first time I saw a midwife handle a birth at home I was amazed that the entire birth and all the fluids and etcetera fell on to a single chux pad, when it was over, she folded up the single chux and threw it away, leaving the bed perfectly clean. Chux are plastic backed absorbent pads about 18 inches square. They are placed all over the place and right underneath the woman at the time of pushing, and are cleaned up instantly afterwards.
People concern themselves about the mess because in hospital births the woman is at the end of the break away bed and the fluids and other mess fall down into a container underneath. The doctors' gowns, the nurses' gowns and scrubs all seem to get gross in the process. If you spilled a mixing bowl of fluid down the side of a bed into the bucket, there is going to be a huge mess, but at home it is much less messy because of how it is handled--just like the rest of birth.
While I might not put my best guest sheets on the bed I was to birth in, birth at home works on containing the mess and leaving the home cleaner than it was found
What about birth with midwives in hospital or birth center? What about in a hospital with an obstetrician and a doula?
The hospital or birth center makes the rules of protocol. The people who work in a hospital or birth center have to follow the rules, or they are out of a job. No one is foolish enough to risk their livelihood on one woman or one baby, and so occasionally the family’s desires must be sacrificed so that births can occur with the protocols in place. Protocols are based on lawsuits and the assumption of medical risk. While you certainly can have a wonderful birth experience anywhere with any practitioners you like, it is always easier to have a birth at home where you and your invited staff can make the majority of the protocols. Hospital births are managed. They have time limits and protocols for everything. Birth centers are less strict, but if there are deviations from the norm, it must be noted and handled according to protocol. As an example: generally you have 30 minutes to expel a placenta or it will be manually removed. Manual removal of the placenta or pulling on it, can cause tears in the placenta and parts can be “retained” this will cause a hemorrhage because the pieces of placenta still in the uterus keep bleeding. This is ok in a hospital because they can quickly give you an infusion of blood to keep you alive and every few hours around the clock someone checks your blood pressure to make sure you haven’t bled out since the last time you were checked. Since this is a very difficult scenario for the mother, the baby will be kept in the nursery for most of this time.
However, it is a lot simpler to just wait for the time it takes to expel the placenta, standard midwifery practice is up to 2 hours, depending on the midwife and the situation. If you wait for it to detach there will be no bleeding, no hemorrhage and no need for the transfusion. If there is still retained placenta, there can be an appointment made for a D and C with an obstetrician or the emergency care plan can be set in motion. Arrangements can be made for the care of the baby (at home or hospital-family’s choice) and the matter can be handled from the protocols which make the midwife and the family most comfortable. Which is better? It is certainly a personal choice.
For parents who find the responsibility of choice in their care difficult and wish to trust completely in the medical system, hospital and birth centers offer a place to go and place yourself in their care. No need to decide or research options, the hospital or birth center has you covered by a standard of care which is legally infallible, even when it is incorrect. While you will have a degree of choice, standard of care will prevail. Some people have trouble accepting that degree of passivity and try to change the system to fit with personal expectation. However, you cannot enter the house of another and demand that the rules change for you. It is rude at best and not going to get you very far. When in Rome, you must do as the Romans.
If you choose to take more responsibility for you and your family’s medical care you get more choices and a greater degree of control. Along with that power comes responsibility. Why give up that power to strangers? Not everyone will know enough to take control, but the standard of care is always there to fall back on. The standard procedures become a cushion instead of an enveloping mass; allowing you to explore options and develop your support networks before committing to a course of action.
Parenting is a series of decisions of how much responsibility you will take and how much you will give up to others. Will you school your child at home or send them to school? Will you tell them about birth control or will they learn it from others? Will you research your suspicions of autism and find options or accept the diagnoses of experts? Will you give them dietary changes in hopes of curbing their ADD or will you give them medication?
These powerful, life-altering decisions begin at conception, and are explored first through birth. Taking charge and responsibility for what happens to you and your child is frightening and is challenging, but it is your job as a parent and only you can make the best decisions for them.
Kate Fawley, Midwife - United States
HOMEBIRTH
Jane Palmer, Midwife - Australia
(30th July 2001)
Having a homebirth is not a common choice in Australia. Less than one per cent of babies are born at home. This low statistic is indicative of the lack of support and services for women birthing at home. There is no government rebate for women who choose this option. Costs for a homebirth are paid out of pocket. Though some health funds are now providing some rebate for homebirth or midwifery services.
Women who plan a homebirth find that friends, relatives and even strangers react strongly to the choice of birthing at home. Negative responses include: You’re brave! Is homebirth safe? What if something goes wrong? Is homebirth legal? The general population poorly understands homebirth as an option. A planned homebirth is as safe, if not safer, than giving birth in a hospital for most women. Women who are healthy and are considered low risk are the ideal candidates for a homebirth. Women planning a homebirth need to live within a reasonable distance of a hospital, in case a transfer is required. Having the skills of an experienced midwife in attendance is very important.
Showing evidence of safety to family members or friends who feel uncomfortable about homebirth can be helpful. Though women who plan a homebirth may need to stand up for their right to choose the place of birth. Women who successful give birth at home usually have a strong commitment to their choice and trust in their own ability to give birth. Women who plan to give birth at home often take time and energy finding the right healthcare practitioner and research their options during pregnancy and the birth. Choosing where to give birth is a very personal choice. While homebirth is not every ones choice, it certainly is a responsible and safe choice.
Why would you choose a homebirth?
Some women find that having their baby in the comfort of their own home provides a very supportive environment and consequently they have an easier birth. Other women choose a homebirth, as they believe in their body’s ability to give birth and wish to decrease the chance of needing intervention in their labour. A number of different research studies have looked into the safety of homebirth – all found that for women of low-risk, homebirth is a safe option. The
Following is a list of reasons why women choose a homebirth:
- Women have fewer complications in labour
- Decreased need for interventions during labour and less use of medication
- Being in comfortable and familiar surroundings
- Women have the choice of who is present at the birth
- No separation from partner or other children
- No separation from the baby at all
- Less risk of infection during a homebirth – homes generally are not a haven for bacteria, unlike hospitals
- Have the freedom to do what you what – for example; dance, sing, scream, walk around the backyard or submerge in a pool or bath (with the midwives approval)
- Babies have fewer problems after birth
- Increased success rates with breastfeeding
Who can have their baby at home?
Every woman has the right to choose a homebirth. However women who are considered high risk are encouraged to give birth to their baby in hospital. The following is a list of some of the
circumstances where a hospital birth is recommended:
- Multiple pregnancy – twins, triplets etc.
- Breech presentation – baby’s bottom is coming first
- Significant bleeding during pregnancy or during labour
- Pre-eclampsia
- When the baby has not been growing properly
- Premature rupture of the membranes
- Premature labour (labour before 37 weeks of pregnancy)
- Baby becomes distressed in labour
- Problems with the placenta
- Abruption – when part of the placenta separates from the wall of the uterus
- Praevia – where the placenta is located low in the uterus – in front of the baby
Do I need permission from my doctor to have a homebirth?
You do not need to gain permission from a doctor to have a homebirth. Midwives are the specialists in normal pregnancy and birth. If any problem arises during the pregnancy, birth or the postnatal period the midwife will refer you to the appropriate service eg hospital or obstetrician. Midwives are educated to deal with complication should they arise. Currently in Australia midwives are not able to order standard blood or other tests during pregnancy – so a visit with the local hospital or doctor may be required if you need any tests.
Jane Palmer, Midwife - Australia
Web: www.pregnancy.com.au
WHY CHOOSE HOME BIRTH?
Written by Claire Hall, Midwife - Australia
The purpose of this article is not to convince you to have a Home Birth. I firmly believe that the decision to birth at home must come from within you – you must truly believe that you are making the best choice for your individual circumstances. The choice of where to birth remains totally yours. It is important that you consider many factors when deciding if home birth is for you. In the following article I have made several points about home birth - I have not talked about the advantages of Hospital birth because that is the generally accepted place of birth and does not need a voice to let women know that it is an option. I have attempted to give an accurate, honest and unbiased account of what is involved (for more discussion on the safety of home birth see Common Safety Questions Regarding Home Birth) so that you may be able to make an informed choice. But a small caution – nobody can be completely unbiased when presenting information. Obviously, as a home birth Midwife I am passionate about women’s choices and am convinced that home birth is a safe, viable option for women. This bias may be evident in the following points.
Ante Natal Visits - Ante Natal visits occur either in your home or your Midwife’s home. You choose your personal Midwife to attend your needs. Sessions together are relaxed and friendly (sometimes even fun) and can last up to 2 hours when in depth discussions occur. You are free to ask any question without being made to feel silly or receive a “stock standard” answer. Visits to a Hospital Ante Natal Clinic or GP/Obstetrician on the other hand involve long waiting periods for an extremely brief check-up.
Personal Control – At all times it will remain your body, your pregnancy, your birth and your baby. You are in charge of the decisions you make regarding your well being and birthing choices, while at all times receiving full support and care. You can invite as many or as few people as you desire to be present. You also have control of the atmosphere, (lighting, candles, homeopathy, aromatherapy, music) and are free to move from room to room, to be wherever you feel most comfortable. This could be in your bed, birthing pool, bathtub, the toilet, even outside. There is no restriction on what you may eat or drink. Wherever you decide to give birth is up to you; nothing is done without your consent. You have the choice of who is to handle your baby at and after birth and how this will be done – no rough stranger hands. You have the right to accurate information and the right to decide what is best for you and your baby. Don’t let anyone tell you otherwise. Hospitals can seem impersonal, intimidating and disempowering.
Midwife - Your home birth Midwife will be more knowledgeable and experienced in facilitating a natural birth outside of the Medical Model of care. In Hospital, no matter who your care provider is (even if it's a knowledgeable Midwife), you are still bound by hospital protocols and procedures. It is very difficult, if not impossible to have a non-medical birth in most hospitals. A home birth Midwife knows that it is your birth and your work and is not accomplished through any action on her part. A home birth Midwife emphasises that both mind and body are cared for during the prenatal, birth, and postpartum experience.
Continuity of Care - You will have the same Midwife through pregnancy, birth and beyond. [Having the same midwife through pregnancy and during your birth may not be the case in every country.] Hopefully you will have built a close relationship of trust, respect and friendship. The Midwife that is caring for you in Hospital will most likely be a complete stranger and has no control over the number of labouring women that she is caring for in any one moment. Each shift change will bring a different Midwife with different ideals, level of support and ways of doing things. If you are considering the private care of a GP (if they are still insured for Obstetrics) or Obstetrician, it is important to understand that the care they offer is minimal. Pregnancy sessions are brief and very little, (if any,) advice, information or support is given facilitating your empowerment towards a natural birth. They rely on technology, machines, numbers and the policies and procedures of the Hospital to obtain their information. They also rely on the Midwives or Nurses at the Hospital to call them when your birth is imminent, and come to your birthing room at the last minute. Generally, building an empowering relationship of trust takes time that a Doctor cannot afford.
Labour Progression - Your labour will be able to move along its natural progression and not be placed on a rigid time scale, and there is much more scope for individual labours and births.
Avoidance of unnecessary medical interventions – Routine vaginal examinations, chemical pain relief, electronic baby monitoring, induction, artificial rupture of membranes, IV, antibiotics etc are all avoided in a home birth. These procedures can be helpful when needed, but if imposed on a normal birth can have detrimental effects.
Birthing Environment - Most Hospital Birthing Units have listened to the voice of women and have made their birthing units more “homey” and less clinical and sterile. However, it is an environment that you have no control over verses full control at home. Studies show that labour can be compromised by an unfamiliar environment. Discomfort and fear can actually increase the pain experienced in childbirth & the effectiveness of the contractions, while relaxation can diminish maternal stress, improve oxygen flow to the baby and facilitate labour. Your Baby will enter the world in a loving peaceful environment and can immediately be comforted by gentle touches and soft words of reassurance. (Not rough drying because of the cold air conditioning on his wet skin.)
Un-interrupted Labour - The rhythm of your labour will not be interrupted by the uncomfortable and often painful travel to hospital. At home you can labour and birth in privacy and comfort of the familiar surroundings of your own home, surrounded by loved ones, in whatever positions and clothing you find most comfortable. You won't be bothered by shift changes and the endless trek of Hospital Personnel in & out of your birthing room. You will not have to worry about when to go to the hospital since your Midwife will come to you.
Position for Birth - You have the freedom to choose what position to use at labour and birth. Most Hospital Birthing Units are changing in this area, but there is still some way to go. While a minority, there are still Midwives practicing in Hospital Birthing Units that have never assisted a woman to give birth in an upright position.
Birth of your Placenta – Detailed and experienced knowledge of a physiological 3rd stage (natural birth of your placenta without the use of drugs) is rare for Hospital Doctors and Midwives. Most believe that it is dangerous and unnecessary. The cold air conditioned birthing room, hospital interventions, medically imposed ‘time limit’ for the birth of your placenta and nervousness of the staff all contribute to the unlikelihood for the birth of your placenta to be natural. My personal experience indicates that in a Hospital, less than 50% of Mothers wishing for a natural birth of their placenta actually achieve it; while nearly 100% of Mothers at home do achieve it with very little blood loss. There is also marked misunderstanding of when to clamp and cut the umbilical cord. I have even seen a Midwife “disallow” delayed cord clamping until the placenta was birthed, insisting that it be at least clamped before the placenta was birthed.
Bonding – You will be able to spend unlimited time with your Baby for skin to skin contact, nuzzling, breast feeding and bonding rather than have your baby bathed, weighed, measured and examined to suit the hospitals time table. Your initial bonding time with your Baby will not be interrupted by suturing, cleaning, staff traffic and the need to have you “showered and out of the birthing room ready for the next Mother”. Most hospitals will expect you to be out of the birthing room within 2 hours. Staying at home allows Baby to adjust to life outside your uterus at his own pace which will enhance his calm and peaceful transition and his successful breast feeding habits. I have seen Baby-led self attachment to Mum’s breast take as long as 5 hours. This would be completely impossible within a Hospital setting. Dad is able to take a much more active role in the birth of his child. A couple can share in the intimacy of labour and birth without feeling as if they are being watched. Many fathers and even the Mothers themselves "catch" the baby. His (or your) hands are the first to touch your Baby rather than the gloved hands of a perfect stranger. Older siblings can share in the birth as well. They can be present to immediately bond with the baby during those crucial first hours. Also no one has to be separated after the birth. Your older children don't have to be sent off with relatives during your hospital stay. This can be very comforting if you have a toddler or young child who doesn't take well to being away from Mum for very long. In hospital some routine separation of mother and baby is almost unavoidable.
Privacy – Depending on the Hospital and how busy they are, you may be expected to share a room with 3-5 other Mothers with their Babies (and consequent visitors!) Smaller Hospitals may also have ill patients (eg with pneumonia or other infections) on the same ward (but not in the same room.) At home you do not have to share a shower and toilet, nor be restricted to eating hospital food at prescribed times.
Infection - There is less of a chance of infection at home than in the hospital. Each Mother becomes accustomed to her own household ‘germs’ and develops a resistance to them, passing this resistance to her baby through her placenta and later her breast milk. The bacteria present in a Hospital are completely foreign to the Mother’s immune system (therefore no immediate protection for the Baby) and more likely to contain harmful bacteria such as Pseudomonas and resistant strains of Staphylococcus (golden staph). Since fewer strangers are likely to be present at a homebirth than at a hospital birth, the chances of acquiring foreign bacteria are less likely in a homebirth situation.
Caesarean Section - Most home birth studies also show significantly lower rates of Caesarean section than hospitals have. Your chance of having major surgery is one in four (or higher) if you choose a hospital, regardless of your current health status. Home births also have less episiotomies, less tears, fewer hemorrhages, less need for epidurals, and forceps “deliveries”.
Depression - Women who give birth in a hospital are much more likely to experience postpartum depression or even post traumatic stress disorder. Aidan McFarlane, a British physician, notes that while 68% of hospital mothers experience postpartum depression, only 16% of home birth mothers do.
Refusing “Routine” Medical Procedures – As Parents, it is your right to refuse routine procedures for your Baby. (eg injection of Vitamin K) This is true both in and out of Hospital. However, in a Hospital it is likely that you will have to explain to more than one, if not several staff members of your decision, and feel “on guard” to protect your Baby. At home, you can relax, confident that no one will perform any procedure without your express permission.
More Responsibility - Mothers and their partners that choose to birth at home must assume a greater responsibility for their own health: physical, mental, and spiritual. This requires active ongoing participation in decision making in all aspects of your care, and a willingness to accept the consequences of those choices and decisions. You will have to commit yourself to look into all aspects of pregnancy, labour and birth, as well as the “routine” medical procedures that are on offer for both you and your Baby. It is time consuming but wonderfully empowering.
Negative Opinions - Since it is generally accepted by the Medical Profession and society as a whole that Hospital is the safest place to birth, choosing otherwise may result in people voicing strong negative opinions. Family and strangers alike may consider it appropriate to question you and perhaps withdraw their support. Some family members may be active in their opposition. (I once had a Father-In-Law call the Police to see if he could force his Son and Daughter-In-Law to stop their plans for a home birth.) In such cases it takes a strong mind and the ability to disregard the fear-based negativity, as this will impact your labour & birth. Without the support of your family and friends, you will have to think long and hard about how much you want a home birth. Do you have the support to see you through? Do you have strategies in place to avoid the fear and negativity being placed on you?
If Something Goes Wrong - If something goes wrong at a hospital birth, nobody says “it’s your fault for going to Hospital”, or “If only you had of birthed at home this would not have happened.” Unfortunately this is not the case for home birth. People will ignore the poor Hospital statistics for Mothers and Babies and say hurtful things and attribute blame even when it's obvious that the location had nothing to do with it. (Eg the Baby is born with a genetic abnormality or disease.) The Doctor at the Hospital or a relative may even bring a lawsuit or instigate disciplinary proceedings against your Midwife even though she acted reasonably.
Transfer to Hospital – Hospitals are not bad or terrible places. If your labour moves beyond the “normal” you may need to transfer to Hospital. The problem with Hospital interventions is not the interventions themselves, but their inappropriate use on normal labours and births. If you want chemical pain relief, or need a caesarean section or forceps delivery, or require a paediatrician – these are not available at home. Transport to the hospital is necessary for these and other medical interventions. Transport during labour is never comfortable.
Distance to your Nearest Hospital – It is wise for you to consider how far you will have to travel if transfer to Hospital is necessary. Most transfers are not emergencies, but in the occasion of a true emergency, how long would it take for an ambulance to reach your residence? Many Professionals recommend no more than 20 minutes to your nearest Hospital. This would rule out the vast majority of Australians as even in capital cities, the travel to Hospital would be far greater than 20 minutes. It is up to you to determine if you feel a safe distance from Hospital.
Fear - There is a possibility that you may not be able to let go of your fear of being out of Hospital. While most women actually feel more relaxed at home, you may feel more anxious. If this is the case, you need to be honest with yourself. If you feel safer in a Hospital, then that is the place you need to be. You have the right to change your mind about having a home birth at any stage of your pregnancy or labour. Don’t let your decision be based on what others (whom you respect and love) want you to do. If inside yourself you think that Hospital is the best place for you, then you need to listen to your inner voice. Far from this being a weakness it is very wise. Trust yourself.
Post-Partum Support – During your pregnancy, you will need to take care to ensure you have plenty of people to care for you after your baby is born. You will need to arrange friends and family to cook, clean, wash, and perhaps look after toddlers in the all important first couple of weeks. This is especially important if you have other children. You have to deliberately plan your support so that you may rest and recover.
Cost – while absolutely the best value for money, the cost of home birth may not be covered by your Health Insurance, and is not rebated by Medicare.
Complications – Not all pregnancies are “routine”. There are variations of pregnancy that may make home birth a higher risk, and perhaps you might decide that home birth may not be the safest option for you. Some specific examples are if your baby is breech, if you are having twins or if you have had a previous Caesarean birth. It may still be possible to have a home birth in these circumstances, based on your individual circumstances, but this will depend on your own and your Midwife’s assessment. You also need to take your own health and fitness into consideration when planning a home birth. Some health problems could be dangerous during labour and birth. For certain women, obstetric (and therefore Hospital) care is essential.
Claire Hall, Midwife - Australia
COMMON SAFETY QUESTIONS REGARDING HOME BIRTH
Written by Claire Hall, Midwife - Australia
When thinking of having a Home Birth a common response is “Oh, you’re very brave”. The number one reason why women choose to birth their Babies in a Hospital is that they feel safer. If something goes wrong, medical equipment and Doctors are right there to give every possible chance of survival. While both of these statements are true, as with most things regarding your pregnancy and birth, there is more to consider - it is not quite as clear cut as it first seems.
It’s my first Baby – I don’t know if I can do it.
Women of the modern world have been led to distrust their bodies. If child birth was so inherently dangerous for women having their first child, how on earth did the population increase to such an extent in the centuries prior to modern medicine (which claims to save us)? It is true that statistics within the medical system are worse for women having their first babies – there are more complications such as epidurals, caesareans, haemorrhage etc. But there is also far more scrutiny, far more intervention to mould labours into the “expected norm” and far more expectation for there to be a problem. My opinion is that it is the observation, expectation and intervention that is opposed on first time Mums that causes a higher “complication” rate, not the fact that you are having your first Baby. As women, we are designed to birth Babies – why should we assume otherwise without good indication to do so? During your pregnancy read all you can about birth so you may be able to come to a place when you understand that no matter what happens, or where you birth (in or out of hospital) you have the ability not just to cope, but to triumph (!) within you.
Hospitals are safer.
Many couples, particularly those having a first baby, dismiss the idea of having a home birth because they think that it is not as safe as a hospital birth. However, research shows that a planned home birth is safe for healthy women having a normal pregnancy compared with being in hospital. I cannot guarantee you that you will be perfectly safe giving birth at home. Nor can I guarantee you that you will be perfectly safe giving birth in hospital. Please keep in mind that life in general has no guarantees. As Harriette Hartigan says, “Birth is as safe as life gets.” Can you guarantee that your Midwife will not be involved in a serious car accident on her way to see you for an Ante Natal visit? Studies done comparing hospital and out-of-hospital births indicate fewer deaths, injuries and infections for homebirths supervised by a trained attendant than for hospital births. No studies indicate that hospitals have better outcomes than home births. Women are birthing at home as safely as, and with fewer complications than the average hospital birth. There have been several large-scale studies of planned homebirth in the UK and Western Europe in the last twenty years, and it has overwhelmingly concluded that planned home birth is a safe option for women with normal pregnancies. If you are looking to review the studies themselves, please go to
What if I bleed?
Regarding postpartum bleeding, a home birth is more likely to facilitate a healthy pregnancy, natural birth, physiological birth of your placenta, prompt breastfeeding and a suitable warm environment that all reduce the incidence of postpartum bleeding. Fewer haemorrhages occur at home, but if you do bleed heavily, or haemorrhage, first aid techniques (such as compression of the uterus), herbs and homeopathics will be employed and immediate transfer if necessary. In severe cases, an ambulance will start an IV to control shock for the transport to Hospital. It is wise to discuss measures to control bleeding with your Midwife in your ante natal sessions together and have a planned course of action.
What if the Baby needs resuscitation?
Talk with your Midwife about the specialised equipment for resuscitating you and your baby that she carries. Discuss with her the training and experience that she has had with resuscitation – you will need to feel confident that your Midwife will know what to do in such a situation. It is also wise to have her teach you and your partner what to do, so that you will feel more confident. With babies that are slow to start breathing, home birth typically preserves the baby's oxygen supply through the umbilical cord, even while beginning resuscitative efforts. Hospital protocol typically dictates cutting the cord as soon as possible so the baby can be moved to the radiant warmer and resuscitation table – separate from the Mother. Most Babies “come around” with minimal effort, but very occasionally, an ambulance will need to be called for immediate transfer.
What if the Baby gets stuck?
Shoulder dystocia (shoulders of the Baby getting stuck), can be managed at home just as well if not better than in a hospital. Incidents of the Baby getting stuck are far greater in a Hospital because of the positions women routinely adopt for birth. At a home birth, the position of birth is more likely one that facilitates a smooth birth and shoulder dystocia is rare. If the baby does get stuck he/she is more likely to need some level of resuscitation when they are born.
Other emergencies
In most cases, birth is generally a slow process and there is usually ample time to transport even in case of true emergency. Having said that, there are some emergencies that occur too quickly to remedy no matter where you are; sometimes women and babies do die during childbirth – in and out of Hospital. More women and babies die in car accidents than in childbirth. Does this mean we should never travel in a car?
Although safety is usually uppermost in any couple's mind, birthing a healthy baby is not the only measurement of a successful labour. Birthing a healthy baby need not exclude having a positive birthing experience. Childbirth is one of the most intense emotional, physical as well as spiritual experiences for any couple. The sheer power and joy of birth can survive a negative experience, but all too often something is lost. That “something lost” has tragic consequences. In America, 4% of women who give birth experience Post Traumatic Stress Disorder after her birth, and nearly one in five women experience the long-term effects of postpartum depression.(2) Figures in Australia & New Zealand show that 14% of women suffer from post natal depression(8) and up to 7% suffer from Post Traumatic Stress Disorder.(9) These are the cases that seek help and are accurately diagnosed. The real incidence is estimated to be much, much higher.
When your Doctor tells you that the risks are higher for a home birth, ask for statistics and studies. If he has any, take them and go through them with your Midwife. I have only heard of one study done that claimed hospital birth was safer. It included deaths caused by unplanned, unattended births which occurred at home, as well as those that occurred on the way to a Hospital. The medical model views pregnancy as a “condition” that needs to be managed and birth as a medical emergency. It assumes that something is going to go wrong, and interventions are made to prevent such an occurrence. The medical model of Birth says that “we can do it better and safer” for both Mother and Baby. This is not true. The Medical Model justifies its existence not by the good results that it achieves, but by its own insistence that is the best (or only) model of care. It is a relaxed, confident birthing woman and an understanding of natural physiological processes of their care giver that really keep Mums and Bubs safe, not the machines or the medical assessment criteria.
References:
www.independentbirth.com/stats.html
www.orgasmicbirth.com/whatis.php
Williams F. et al., “UK study of intrapartum care for low risk primigravidas: a survey of interventions,” J. Epidemiol Community Health, 1998; 52: 494- 500
www.aims.org.uk/Journal/Vol11No4/reswin99.htm www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10247526&dopt=Abstract
www.midwiferytoday.com/articles/homebirthuk.asp
www.homebirth.org.uk/hbindy3.htm
www.teacher.pas.rochester.edu/phy_labs/AppendixE/AppendixE.html
www.health.gov.au/internet/wcms/publishing.nsf/content/mental-beyond
“Trauma & Childbirth – a Handbook”. 2001; Trauma And birth Stress; Auckland
www.birthsource.com/scripts/article.asp?articleid=120
womens-health.jwatch.org/cgi/content/full/2003/219/1
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15561659&dopt=Abstract
Claire Hall, Midwife - Australia
HOMEBIRTH-ONLY WEBSITE
Created by Jerry Whiting, Midwife - California, USA
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