A recent comment on a past post, Are Women Who Choose Home Birth Control Freaks?, got me to thinking. The reader wrote:
Actually, having met one [a home-birthing control freak] myself, I’d have to say a loud and resounding, YES! Not only that, but selfish as well. For as many women that have had a ’successful’ homebirth, I’ve met just as many who’ve ended up with stillborns or major health complications themselves. Whatever happened to healthy mom AND baby being the desired end? If that means ‘intervention’ or ‘hospital assistance,’ so be it! This is not the place to play out our power trips. Save that for the olympics. This is about LIFE.
My response:
I am interested to learn more about your experiences, because they are very different from mine. I am not against intervention at all. It is lifesaving when used appropriately, and potentially life-threatening when used without reason or thought. In the nearly thirty years I have worked in labor and delivery units, I have observed that it is most often the physician or the nurses who are on the power trip, unwilling to accomodate any request that doesn’t fit into their “routine”. As a young nurse working in labor and delivery, I became convinced that home birth was the safest and best place for me to birth my precious baby. It wasn’t about me, it was about keeping my baby safe from many of the things I saw happening in the labor ward, which since that time have been shown by scientific evidence to lack benefit or be actually harmful. The interventions that were commonly used, and which I felt compelled to avoid, included:
- The “triple-H” enema. The triple-H part stood for “high, hot, and a hell of a lot”. The nurse filled a 1 liter bucket with hot, soapy water. The enema tube was inserted into the rectum of the laboring woman, and the bucket is held high in order to force the fluid to run in rapidly under pressure. The soap irritates the bowel and causes a laxative effect. The woman was instructed to “hold” the fluid for at least 15 minutes before she was allowed to go the bathroom and expel it. The stimulation of the intestines by the hot water and the laxative effect caused intense cramping and increased contractions.
- Routine episiotomy. Everyone got one, whether they needed it or not. See my post on routine episiotomy for the story of a horrifying episiotomy I witnessed being performed on a woman after her baby was born.
- Separation of the woman and her partner. Men could not be present during the birth, because they would either faint or they would be unable to enjoy sex with their wives again after watching her give birth.
- Amnesia-inducing drugs. The women were not given pain relief, they were given a drug that would make them forget the pain they suffered.
- Forced labor on one’s back. Women were not allowed to get up and move around during labor.
- No food or fluids by mouth during labor, and forced IV fluids.
- Routine amniotomy for everyone.
- Patients were required to have their babies in the delivery room, an operating-room style room where the woman would be moved once the baby was crowning. Even with the baby crowning, she was expected to move from her guerney to the delivery table, where she was positioned flat on her back with feet hanging from high stirrups and hands strapped down to the side of the table.
- Frequent use of forceps, including high-forceps deliveries of babies, which are now known to be extremely risky.
- Mandatory separation of infant from mother for the first 12 hours after birth. All babies were given sugar water for their first feeding by mouth, before they were permitted to breastfeed. Babies were not allowed to “room-in”.
The home birthing women I have met and served have not been selfish; rather they were seeking to protect their babies from the potential harm that is done by unnecessary and mindless interventions. Although many of the practices noted above are no longer commonly used, other rouine obstetric practices, just as harmful, have taken their place.
Your experience sounds very different from mine. You mention meeting women (plural) who have had stillbirths or maternal complications resulting from home birth. I would invite you to share your experiences with Birth Sense readers. What were the circumstances of their adverse outcomes? Did they have a trained professional assisting at their births? Were they low-risk pregnancies? How were their labors being monitored, and what were the protocols for transferring to hospital care? These are the factors that are generally mentioned when discussing home birth safety.
The bottom line is not what my experiences have been, or your experiences, but what the evidence says. I believe there is more evidence of home birth safety than home birth risks, when it is undertaken by low-risk women with normal pregnancies. For a thorough list of the known research on home birth, see the American College of Nurse Midwives Home Birth Bibliography page.
Interesting. I would want to know more as well, because I know quite a few homebirth moms, online and in real life, and lots of healthy homeborn babies. While I do know of two still births, and one baby that died during a transfer, I can think of well over a dozen happy healthy home born babies besides my own two homebirth babies.
This commenter speaks like a troll to me. It was very nice of you to further explain (after explaining in several previous posts on your blog) some of the reasons why women might choose a home birth.
I know many, many women who have given birth at home or attempted to do so, and all have had healthy babies. All have been open to interventions to support the health of both mother and baby. Some have been transported to the hospital and had either a complicated vaginal delivery or a cesarian section because the midwife and mother determined that was the best course of action.
It is true that sometimes people make health choices that go against the societal grain. Sometimes these choices are questionable to the general population. But to minimize the amount of thought and research a person has put into a difficult decision by calling it “selfish,” “a power trip,” or that the person is a “freak” is xenophobic and closed-minded. Often there are logical reasons with scientific evidence to support these decisions. Sometimes there is emotional or physical trauma in the person’s past which has led them down the path they chose. Whatever the reason, they should all be taken into consideration and respected, especially if you (previous commenter) wish to truly influence the opinions of others. The way this commenter chose to lash out in judgment shows me that he/she doesn’t actually care to be a part of a discussion on the topic of home birth.
I can’t wait for her reply… if there ever is one!
I agree with your reasoning on why a hospital birth is, for the low risk pregnant woman, often more dangerous than a professionally assisted out-of-hospital birth. Although, I think that not most but nearly all the things you mentioned are no longer common practice. That aside, my question is, wouldn’t birth at a birthing center be the safest option? A place that has been purposefully located very close to a hospital in case of the need for transfer, a place that probably has an OB on call if needed, a place staffed by trained, professional midwives and equipped with necessary equipment and medications for use if needed? While a home birth can go perfectly for a woman with no complications, I can’t help but think I’d much prefer the birthing center as the safest out-of-hospital option and I fail to understand why a woman would choose home birth over a birthing center.
A birth center is a great idea. Unfortunately it’s easier to find an abortion clinic then it is a birth center. As well, in a birth center you are still being exposed to unfamiliar germs, you’re in an unfamiliar setting, and you don’t have as much control. I know many women who opt for a homebirth to have control over who appears at the birth. Some older female relatives like to think they can vicariously live through this generation’s birthing experience, others out of bitterness seek to undermine an attempt to naturally birth and will arrive at the birth center uninvited. At least at home you can lock out an interfering, pissed off MIL who has made it clear she plans to “crash” the birth (I’ve heard of four experiences that the subsequent birth was done at home instead of the local birthing center to ensure no crashers).
At the birth center I owned, we had a couple of situations like that. We did lock the doors, and it was not a problem.
The problem with birthing centers can be that they are usually associated with a hospital. In the area where I live, we have top notch hospitals and a very well respected birthing center. But, when I was looking for a midwife, I found that the birthing center had to follow certain guidelines set by the hospital. The hospital would dictate how long the woman was allowed to labor, how long she could go past due date, before having to be transferred.
But, the reason I choose not to go this route was because you would rotate through their 6 midwives during your pregnancy, and you would get the midwife on call for your birth. We choice homebirths for both of my kids. I wanted a relationship with my midwife that I felt we would only gain by seeing her exclusively throughout my pregnancy.
Yes, the hospital’s policies are often a thorn in the side of midwives who want to offer truly non-interventive birth care. An excellent reason to consider home birth.
Kristina,
A birth center doesn’t offer anything in the way of equipment or medication that is not brought to a homebirth–I believe that this was addressed in a previous post on this blog. The only advantage a birth center would offer would be proximity to the hospital.
I live less than a 10 minute drive from the largest hospital in my area, and barely more than 10 minutes from the hospital where my first two children were born. *If* there were a birth center available to me (closest birth center to me is over an hour drive…sorry, I’m not doing that in active labor), the reason I would opt not to birth in it is because I think that the likelihood I would end up needing the services of the hospital urgently enough that the transport time would actually matter is so small as to make it not worth the hoops I would have to juggle in order to birth outside of my house.
What hoops would I have to juggle?
* Arranging “on call” childcare for my older children (my first homebirth I labored entirely while my children slept–resulting in no need for childcare. The next one I sent the kids to a neighbor for less than 2 hours, the most recent I had a friend come to my house for less than 2 hours during labor/post-partum. If I’d birthed in a birth center I would have needed to arrange for someone to be “on call” for childcare for a stretch of at least 12 hours, likely longer–not an easy feat when you have as many children as I do and lack local family members.
* making sure to leave my house early enough in labor to actually make it to the birth center–my last thre labors have had a combined total of less than 6 hours of active labor. I went from 5-6 to birth in less than 20 minutes with my last baby.
* Cost. Since I am low risk, why should I (or my insurance company) pay a few thousand dollars extra to reduce my hospital transport time by at most 5 minutes? Whether my midwife is calling to the hospital from a birth center or my house requesting the staff prep for a stat-cesarean (because yes, midwives can diagnose things that would require a stat-cesarean like prolapsed cord, excessive vaginal bleeding indicative of placental abruption, or serious fetal distress without needing to wait for an OB to assess at the hospital), I’m going to be “decision to incision” in pretty much the same amount of time–getting the OR staff assembled is going be the log jam, not getting me to the hospital.
Something I think that many women don’t really appreciate is that even in the hospital, they may not have “immediate” access to life saving interventions. One hospital in my are does not have their on-call pediatrician or anesthesiologist staying in the hospital when they are on-call, even if there are laboring women. The Dr’s are in a hotel, so if something goes wrong, those Dr’s have to be paged, run to the parking garage to get their vehicle, drive to the hospital where I assume they leave their vehicle parked in the ER lane (give the keys to a staff person to park?), and run up to the LDR on the 3rd floor. How long do you think all that takes? I’d guess a minimum of 10 minutes. I know of at least once case at that hospital where a labor was going perfectly fine, but the baby needed immediate ressucitation, and the properly qualified staff was not there. The baby (now about 3 years old) is profounding disabled–was that caused by the lack of immediate care? We don’t really know–but we do know that being in the hospital did not prevent that event, and in fact, perhaps if the couple had birthed at home with the same midwife (she now only does homebirths) they could have opted to immediately transfer to the hospital with the highest level NICU rather than the hospital where their baby was kept for several hours without a high level NICU, and perhaps their baby would have been better off?
The last birth I was at, the mother was laboring in a hospital on a Sunday morning. After she first requested an epidural it took over 1.5 hours for her to get it. Why? Well because the anesthesiologist was in the OR for a cesarean. The only one OR in the labor unit. If any one of the other women who were laboring while that cesarean was being performed had needed a crash cesarean, how quickly do you think it would have happened? I’m sure the maternity team has a plan to use OR’s in another part of the hospital in situations like this, but it isn’t going to happen quickly! They need to get a second anesthesiologist in-house, another set of nurses, get the equipment counted…it isn’t going to be a quick process. Actually, in that same hospital I was once attending a labor on a weekday–an induced labor so you would think they’d have everything ready to go that might be needed, right?–where the baby’s heartrate dropped to the 60’s for at least 10-15 minutes–I wasn’t exactly watching the clock, I was working on keeping the mother and father calm and aware of what was going on. I kept wondering why she wasn’t being taken back to the OR, as a heart rate like that seemed like indication for a stat cesarean. I later found out that she wasn’t taken back because they didn’t have an OR team ready or the tools counted. The baby’s heart rate recovered faster than the OR could be readied, which is the only reason that she didn’t have a cesarean.
Thank you for this excellent response. I agree with everything you have said. Having owned a birthcenter practice with a homebirth option, I can assure my readers that the only difference between a homebirth and a birth center birth in my practice was distance to the hospital. Since most hospitals have a policy of being able to perform emergency surgery with 30 minutes of making the decision for a c-section, I requested my clients who lived further than 15 minutes from the hospital to birth in the birth center. My protocol was that had I ever had an emergency transfer (I never did, thankfully), one of the assistants would call and notify the labor unit that we were coming in with an emergency which would require surgery, and to prepare the operating room and notify the obstetrician. As I had hospital privileges, too, and was well acquainted with all the physicians, I felt confident we would have a smooth transition if needed. Thus, I could see no disadvantage to being at home or birth center.
As for assistants, any birth I did had to have the same minimum number of assistants required in the hospital, which is one to care for the mother and one to care for the baby. I have even had births in the hospital where we were unable to have the minimum number of assistants because they were so busy. So, in my mind, this is not an advantage of hospital birth. Thank you for your comments!
thanks for the responses to my comment. i get your point that provided your home is within a close distance to a hospital home birthing can be as safe as at a birthing center. i guess the choice between the two will end up being dependent on the home or center in question and which one is better equipped to provide for the needs of the laboring woman.
Ok my two cents…
I think you posted a wonderful response to a commenter that was a bit snarky. I also appreciate all the effort put in to the extended comment about the difference between homebirths and birth center births, and totally agree.
I suppose, in the end, it comes down to choice. We should all make the choice that is best for us. If a woman is not comfortbale with a homebirth, why then she shouldn’t have one! I don’t believe it is anyone’s job to tell others how to deliver their babies. I am not a fan of unnassisted births, but they are the choice of that family. As long as they are aware of the risks, they are free to go for it. The new baby belongs to that woman and family, not to the outside world.
Thanks for all your educated and metered responses Midwife. You do a great job!
I hear this all the time and it drives me nuts because it’s completely illogical. If there are women who do not care what happens to their babies, they are not the women who are embracing the birth experience and wanting to make it as gentle and normal and life-affirming as possible. The two things are necessarily mutually exclusive, because the whole point of the birth itself IS THE BABY.
And half of all homebirths end in death or severe complications? I’d love to see her/him try to back that up. The statistical studies certainly don’t show that. I’ve been involved in homebirth for over a decade and rarely hear of poor outcomes. Sometimes people embellish when they want to convince people of the righteousness of their stance, that’s all this is.
I had a stillborn baby in the hospital. The nurses called him “It.” I would far rather birth a dead baby at home, where the attendants knew how much I wanted this baby, and how much I grieved for his and my loss.
I am so sorry for your loss. At the hospital where I work, we have a wonderful nurse that cares for all of our mothers of stillborn babies and is very kind and compassionate. I have also known of a number of home stillbirths that have taken place, as well as one birth of a baby that we knew ahead of time would not live, due to anencephaly (most of the brain did not develop). That baby was born at home, and love and held, until she died peacefully in her parent’s arms. The way it should be. I’m sorry not all women have this kind of care.