So You’ve Heard About Home Birth…

Located photo here. Pretty sure it wins for best home birth meme of all time!!

We all know how the story goes, right? Contractions start, our water breaks, we rush to the hospital and the doctor delivers our baby, we stay 2 days and then go home. But what if you wanted a different story?

Women are beginning to reconsider their birthing methods. Each has her own reasons and her own methods. But what we have seen a definite increase in is women choosing to have their babies at home instead of in the hospital.

What do I mean at home? Do they just push the baby out alone on their beds? What if something goes wrong? Why would someone choose to not go to the hospital to have their baby? Isn’t that dangerous?

A home birth is exactly what it sounds like: a woman birthing her child(ren) at home. This does not (always) mean that she is alone or that something is going to go wrong. In fact, studies have shown that “planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.”

Why do women choose planned home births?

If you deliver at home, labor management might differ from what you experience in a hospital setting. During labor at home, your health care provider will periodically — rather than continuously — monitor your temperature, pulse, blood pressure and your baby’s heart rate.

You might choose a planned home birth for many reasons, including:

  • A desire to give birth without medical intervention, such as pain medication, labor augmentation, labor induction or fetal heart rate monitoring
  • A desire to give birth in a comfortable, familiar place surrounded by family
  • Dissatisfaction with hospital care
  • A desire for freedom and control in the birthing process
  • Cultural or religious concerns
  • A lack of access to transportation
  • Lower cost

Now, there are plenty of women who were forced into having an unassisted home by their particular set of circumstances. I know that we’ve all heard of at least one “I didn’t know I was pregnant” story. Many of those women had their babies at home with no attending midwife/doula/doctor/anyone. And the majority of those babies came out healthy. What about the women whose labor progressed too fast for them to get to the hospital and they had their babies at home or in the car on the way? There are also plenty of women who choose to deliver at home with no assistance, for a myriad of reasons. (I actually told my husband that if he didn’t agree to a home birth with our next baby that I was going to do it myself at home. He could choose to have medically trained staff there or not, up to him. Needless to say, I got the go-ahead to plan a home birth.)

I am not one to generally disregard an idea without some kind of research into it. So please don’t think that I was making this decision lightly. For an otherwise healthy pregnancy, an unassisted home birth is likely to turn out safely. I would just personally feel better having someone medically trained there to assist me, no offense to those who choose to deliver without them. I know that I would be capable of it if I had to, I just would rather have the peace of mind of knowing that there was someone with me that would know how to react in an emergency.

For pregnant women considering a home birth, the American Academy of Pediatrics has updated its guidelines with everything that should be in place to ensure the safety and well-being of both mother and baby. And for those who know they’d prefer a home birth, the AAP says it’s best for women who have no preexisting or maternal disease and who can plan to have two medical providers present with the necessary skills and equipment.

Photo by Pixabay on Pexels.com

Are there situations when a planned home birth isn’t recommended?

The American College of Obstetricians and Gynecologists cautions against a planned home birth if:

  • You are pregnant with multiples
  • Your baby doesn’t settle into a position that allows for a headfirst delivery
  • You’ve previously had a C-section

What might cause the need for a hospital transfer?

During a planned home birth, you might need to be transported to a hospital for monitoring or treatment if complications develop. Your health care provider might recommend transfer to a hospital if:

  • Labor isn’t progressing
  • Your baby shows signs of distress
  • Your baby presents in a position other than headfirst
  • You need pain relief
  • You have high blood pressure
  • You experience bleeding

What are the possible risks of a planned home birth?

While most pregnant women who choose to have planned home births deliver without complications, research suggests that planned home births are associated with a higher risk of infant death and seizures than are planned hospital births.

There are several factors that might reduce the risks of these complications, including having:

  • Assistance from a certified nurse-midwife
  • Access to a practicing obstetric doctor
  • A plan for emergency transport to the nearest hospital
Photo by Jonathan Borba on Pexels.com

The Doctor Weighs In

Dr. Robyn Lamar is an OB-GYN at UCSF. Despite her profession, she chose home births for all three of her children. She says she prefers to labor at her own pace in a familiar setting, without medical intervention.

“The underlying belief in midwifery is that birth is a physiological process, which makes sense to me,” Lamar says. “Versus the more medical view, which I’m trained in and I practice, that birth is something that can be high-risk at any moment and it’s sort of a disaster waiting to happen.”

Lamar emphasizes that, at the hospital, a mother is at a higher risk for an episiotomy (vaginal incision) and infection.

Lamar recognizes that what’s best for one woman may not be right for the next.

“Some [women] feel more at ease in the hospital because they know the experts are there. It gives them a lot of security and assurance,” Lamar said. “But, a lot of us feel like a duck out of water in the hospital. It’s very unfamiliar. When you’re on your home turf, and you’re there with your family, it really does change the dynamic.”

She says a mother is more likely to dilate and embrace difficult contractions if she feels comfortable and supported in her surroundings. In other words, feeling safe can not only lead to a more positive emotional experience, but also a faster delivery.

Only about 1 percent of all births in 2018 were home births, according to the Centers for Disease Control and Prevention’s National Vital Statistics Report. About 75 percent of those were planned, and there is rigorous screening for most midwives to take on clients.

Midwives stress that home birth isn’t just a variation of a hospital birth, it’s a different experience entirely. There are no doctors or pain medication, just usually a midwife who is medically trained and delivers the baby, and often a doula who supports the physical and emotional needs of a woman in labor. Expectant couples have to have a high level of investment, preparation and training to labor outside of a hospital setting. “There’s no medicine and that can be a whole different mind-set,” said Lori Bregman, a Los Angeles-based doula who cautions parents to think carefully before doing home birth.

How do I prepare for a home birth?

You can prepare for a planned home birth by:

  • Choosing trained health care providers to assist. Choose a certified nurse-midwife, a certified midwife, a midwife whose education meets specific standards or a doctor practicing obstetrics within an integrated and regulated health system. Make sure he or she has access to consultation with doctors or specialists at a collaborating hospital. If you’re interested in additional support, consider hiring a professional labor assistant (doula). The American Academy of Pediatrics recommends having present at least one trained person whose primary responsibility is caring for your newborn.
  • Creating a birth plan. Will you use any specific methods to cope with pain? Do you want to labor in a tub? Will you breast-feed your baby immediately after delivery? Discuss your birthing plan with your health care provider and ask about supplies you’ll need, such as protective coverings for your floor or mattress.
  • Preparing for a hospital transfer. Discuss with your health care provider the signs and symptoms that might necessitate going to a hospital and how a transfer will affect your birthing plan. Ideally, your home or other planned birth location is within 15 minutes of a hospital with 24-hour maternity care. Make sure you have access to transportation. Ask your health care provider to make arrangements with a nearby hospital to ensure that you can be promptly transferred and treated, if necessary.

Hospitals or certified birth centers are said to be the safest settings for delivery. However, you have the right to make an informed decision about where you prefer to deliver. Keep in mind that life-threatening problems can occur during labor and delivery without warning. In those cases, the need to transfer you and your baby to a hospital could delay care, which could put your lives at risk. Understand the risks and benefits of a home birth before you make a decision about where to deliver.

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