Why Homebirth?

Regardless whatever law may be applied to the surface of women's lives, homebirth is a right. In a nod to this fact, lawmakers have carefully kept their hands off this right and gone after the homebirth attendant instead. Many women have had to go to great lengths to exercise their right, however, and homebirth midwives who are in the minority and sometimes practice illegally, work hard to help preserve it.

Women are becoming increasingly unhappy with their hospital birth experiences as the result of a multitude of factors, in particular the advent of health maintenance organizations (HMOs) and the proliferation of intervention that goes with hospital based modern health care.

The HMO system herds pregnant and birthing women through channels, leaving them without meaningful and conscientious individualized care. One-on-one care provides the physical, emotional and spiritual support so vital to good outcomes in birth, yet mainstream care continues to increase caseloads. This situation pulls away the safety net perfected over millennia and endangers women and babies daily. Increasing reliance on technology causes practitioners to lose the hands-on ability to ascertain what is really going on with a pregnant or laboring woman. The cascade of intervention that follows creates risks and events that would not have otherwise arisen.

Until recently, homebirth has been the natural mode of delivery since the beginning of humankind. It has only been in the last century that out-of-home birthing became the norm, a change engineered by ambitious men during a time when it was believed best to bring the natural world under control. What resulted in the birthing world was a surge into the hospital. It started with a fad, developed into a sign of prestige, then became pervasive when fear took over. With it came the inevitable spiral of cause and effect: the more intervention was introduced, the more it was needed, until birth was no longer recognizable as a natural process in human experience. Instead, it had been orchestrated into an assembly line procedure complete with time constraints, quotas, indifferent workers, procedures manuals, and loss of individual rights and autonomy.

Numerous side effects resulted, among them a woman's decreased ability to endure labor without drugs or direction. Over time the prevailing attitude developed that women did not have the power and ability to birth a baby naturally. Man's technology, it seemed, was better than nature's perfection. The truth is that a woman's body is designed to procreate and give birth. It produces hormones that act as pain relievers, contractions that come and go at intervals to offer respite, and many other perfect physiological responses that ensure a normal birth. Pregnancy and birth are the ultimate state of health!

If intervention arose out of need to "rescue" women from pain, results nevertheless show that under normal circumstances it is safer for mother and child to let the process of natural birth occur without medical intervention. Pain in childbirth is empowerment. Sure it may hurt, but the rewards that women recognize on a cellular level drive them. When all is said and done, that empowerment paves the path to parenthood, which is the ultimate task at hand.
Homebirth as a Viable Choice.

In a homebirth situation, parents accept responsibility and help create the standards and protocols that will frame the birth experience. This prepares the family and the midwife for a natural, uneventful birth as well as for situations like premature rupture of membranes, breech presentation, postdates, twins and so on. In the hospital, those standards already exist, and each birth must fit into that already established framework. A natural process is immediately compromised when required to adhere to rigid structures devised by strangers.

Birth is a time to feel secure and safe. When a woman births at home she is in her own nest and is surrounded by colors, textures, lighting and sounds she loves. Her own bed, where she finds solace in rest and sleep, is available for birthing. She is in the place she will soon share with her baby. What better place is there to relax in the total way she needs to in order to give way to the birth process?

The holistic way to give birth is to let it happen. At home a woman has one or more care providers who monitor the progress of her labor and the well being of both she and her baby. Providing calm, watchful and intimate care, the midwives are there for the entire duration of labor and birth. The birthing woman knows this, depends on it and it helps her feel secure. She may also have her partner and family members with her—they know best what she likes and what soothes her the most.

In the hospital, on the other hand, the laboring woman is attended by strangers. She may not get the doctor she chose and if she does, he or she may go off call before she delivers. No matter how nice the birthing rooms are, the hospital is still an institution that functions in predetermined ways, with rules, standard procedures and time tables to abide by. In order to birth in a normal, healthy way a woman must be able to go within herself, calling up a lot of inner strength for the long process ahead of her. Encouragement is vital. But it is easy to become confused by someone else's procedures and stressed and discouraged when others' time constraints have to be adhered to.

At home, progress is assessed by taking vital signs and by watching the woman's self-paced unfolding. The midwife's presence is constant and she is the caretaker from start to finish. She monitors such things as blood pressure, temperature and fetal heart tones. She makes sure the laboring woman feels fearless and secure. She gives emotional support and offers touch therapies if the woman is comfortable with that. Time becomes secondary. Taking food and drink and getting rest and sleep are encouraged. How can a woman otherwise get through a long labor if she is not nourished and rested? Yet in many hospitals, food and drink are prohibited for fear that surgery and anesthesia may lie ahead. This protocol heads the cascade of intervention that is often inevitable at the hospital: an exhausted mom is given Pitocin to increase the effectiveness of her contractions, and from there it's a collision course of medical intrusions when a snack and a nap may have staved off any problems in the first place.

A woman feels in control of her birth process when she births at home. In the hospital, institutional standards are in control. It's hard to believe that most women would choose the latter. But fear of supposed consequences and fear of responsibility and one's own power seem to discourage a lot of today's expectant women.

One of the main concerns about homebirth voiced by many women is the lack of emergency care readily available if the need should arise. A good homebirth midwife, however, is well trained in avoiding and handling complications and performing neonatal resuscitation. She has the proper tools with which to control hemorrhage if the need arises. She is well versed in normal birth and is willing and ready to transport a woman to the hospital if it becomes necessary. Because she has come to know the woman on an intimate level, having done all the lengthy prenatals herself, she is well equipped to handle emotional issues that may arise during birth. Her intuition and instinct are consciously developed and their use is a priority in the kind of care she gives. She is comfortable with offering massage and hugs and cradling the woman in her arms. When a homebirth midwife follows these simple and practical standards and techniques, statistics on homebirth outcomes look very sweet indeed.

Obstetric Myths Versus Research Realities by Henci Goer presents statistics gathered worldwide that clearly demonstrate the safety of homebirth with a trained attendant. Yet even though research has validated its efficacy, homebirth is still seen as unsafe. Cultural trends, an overzealous media, clever marketing, power mongering, rumors and fear perpetuate that view.
Without a doubt it's time for a paradigm shift. Technology should be used only when it's absolutely necessary and non-interventive, with spiritually based trust in birth as the dominant concept. Practical, experienced midwifery would be the rule rather than the exception. Parents can help achieve this by recognizing and accepting their true responsibility, by reclaiming their right to choice, by educating themselves, being determined and organized, and by choosing a midwife or doctor who will honor and abide by their wishes.

Planning a Homebirth
Compared to the external issues that surround homebirth, the nuts and bolts of homebirth seem easy! Finding the right care provider is the number one priority. A woman can ask her friends and neighbors, look in the phone book, go online or ask other alternative practitioners for recommendations. An initial interview will tell both the midwife and the pregnant woman whether the match will be a good one. In almost all cases a woman will find just who she needs. The care provider will set up regular visits, talk about pregnancy, labor and birth and possibly make referrals to childbirth classes. Classes help a couple learn about birth and parenting and can provide a network of new friends and families who are going through the same miraculous process.

As a midwife, I make a large library of books and videos available to my families to check out. Some people are avid researchers and want to know everything. But there are also those who prefer simply to live the experience. They should be honored for their own way of learning. The parents who don't want any responsibility or say in birth, however, are not homebirth candidates. They need the institution to fulfill their needs. Homebirth is a partnership in which parents and practitioners work together.

Homebirth midwives provide excellent prenatal care, spending an average of forty-five minutes to an hour on a prenatal visit. This gives us an opportunity to attain all the clinical information necessary and still have plenty of time for chatting and getting to know each other. This one on one care builds trust and friendship which will serve the birthing process well when the time comes. We take a personal interest in making each woman's pregnancy, birth and postpartum the best it can be, and because of that, our caseloads are usually small.

On the other hand, typical clinics maintain a high caseload to cover high overhead. Time spent with a client must be kept to a minimum: the average time spent on a prenatal is ten to fifteen minutes. Bonds of familiarity and trust are not a priority; volume is. But low risk is tied to thorough, multifaceted care, and clinics often do not provide it. Homebirth midwives familiarize themselves with both the physical and emotional facets of the women they serve. The acumen they gain through power of observation is an essential tool that keeps birth both normal and safe.

A plethora of instruments, drugs, apparatus, operating rooms, machines and even special clothing await a woman who births in the hospital. By contrast, homebirth midwives travel light. I have a rule not to carry anything I don't know how to use. This defines my standard and parameters of care. For instance, if I do not carry IV setups, then I call in help or transport if the need arises for their use. I personally make sure all my equipment is in proper working order. I check before, during and after births. I make a note of what gets used and what must get replaced. I keep my instruments sterile and ready for birth at all times. I also keep an extra set. I always have plenty of gas in my car. I check my pager to be sure everyone has access to me at all times.

The homebirth parents are well prepared too—it's part of their responsibility and their active participation in the process. By the time the woman is thirty-four to thirty-six weeks pregnant, they have their sterile packs ready and all their supplies in order. Their midwife has provided them with concise lists of what is needed, and together they review everything at a home visit well before the due date. This helps the parents feel ready and relaxed. Lists of phone numbers posted by the telephone ensure that attendants and others are just a call away when the woman goes into labor, and help can be called in an instant should it be needed during the birth. The lists should include the hospital emergency room number, labor and delivery NICU and any doctors who may provide backup.

Birth is a profound experience. While it includes basic physical functions like contractions, dilation, descent and emergence, the emotional and spiritual aspects play a major role in outcome. The two main models of birth—allopathic and holistic—diverge greatly in all these areas. Allopathic care, centered in the hospital, is based on institutional standards which promote separation. Holistic care, based in homebirth, promotes connection in all aspects of its care and ultimately between mother and baby. There are times when allopathic and holistic modalities collaborate effectively, such as in high risk situations. For instance if a woman is transferred from home to hospital she can bring her music or special power pieces if she wishes. She can bring a favorite nightgown, photos, blanket and pillow. She can retain her familiar holistic attitudes and a positive outlook, and stay centered and secure while using technologies that are well applied.

Once a woman is transferred to the hospital, the degree to which a midwife can continue to participate in the birth depends on individual hospital attitude toward homebirth midwives. At the least, she can remain at the hospital as a supportive presence. The midwife can be proactive by staying with the woman and encouraging her while being respectful of hospital staff, not confrontational. She should be familiar with interventions in order to help the woman make choices to take the least interventive path first. She should know the patient bill of rights. She can be most supportive by being nonjudgmental of what the woman may have to experience in order to birth her baby.

In most homebirth cases, birth will simply occur. In most cases of hospital births, the birth will be tampered with to some degree. This is fact. Hospital practitioners are trained to perform—it's commonly held that only action brings about results. At home we believe that if all is well, let it be.

Vital Statistics
Countries with the lowest mortality rates are those in which midwifery care is an integral part of obstetrical care and where homebirth is commonly practiced (see Gentle Birth Choices by Barbara Harper, RN). In the Netherlands, for example, homebirth and midwifery attended births for low risk populations are the norm. More than 70 percent of births are attended by midwives and nearly 40 percent take place at home. The infant mortality rate is 2.1 per 1,000 births. By comparison, in the United States, where the mortality rate is 10.8 per 1,000 births, only 2 to 3 percent of births occur out of the hospital with midwifery care.

This kind of information explains why more and more women are turning to midwives and out-of-hospital birth. Those women who don't rely on research for reasons often know instinctually that homebirth is a safer and wiser choice.
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Going into the new millennium, we have an opportunity and an obligation to create birth change. By educating the public, promoting homebirth, informing one woman at a time, and confronting the media when they get it wrong, we can enhance the homebirth movement and preserve its kind of care. Balance will be a key issue. Keeping birth normal while using technology wisely can become a true art. Guarding choice can become a priority. Midwifery care can expand and progress to answer growing consumer demand. And rightfully considerate care for all women can set the pace for better birth outcomes and healthier generations to come. I may be dreaming, but along with many, many others, I have dedicated my entire life to these visions in honor of and respect for all mothers, babies, families and the future.

References:
Arms, Suzanne. (1984). Immaculate Conception. Toronto, NY: Bantam Books.
Dick-Read, Grantley. (1959). Childbirth Without Fear. New York: Harper & Row.
Ehrenreich, Barbara & English, Deirdre. (1973). Witches, Midwives & Nurses: A History of Women Healers. New York: Feminist Press.
Frye, Anne. (1995). Holistic Midwifery Volume 1. Portland, OR: Labrys Press.
Gaskin, Ina May. (1990). Spiritual Midwifery (3rd ed.). Summertown, TN: The Farm Pub. Co.
Goer, Henci. (1995). Obstetrical Myths Versus Research Realities. Westport, CT: Bergin & Garvey.
Goldsmith, Judith. Childbirth Wisdom. Brookline, MA: East West Books.
Harper, Barbara RN. (1994). Gentle Birth Choices. Rochester, VT: Healing Arts Press.
Wagner, Marsden. (1994). Pursuing the Birth Machine. Campertown, Australia: ACE Graphics.
Ward, Charlotte & Fred. (1976). The Homebirth Book. Washington DC: Inscape Publishers. Regardless whatever law may be applied to the surface of women's lives, homebirth is a right. In a nod to this fact, lawmakers have carefully kept their hands off this right and gone after the homebirth attendant instead. Many women have had to go to great lengths to exercise their right, however, and homebirth midwives who are in the minority and sometimes practice illegally, work hard to help preserve it.