Tuesday, January 22, 2008

Homebirth: Not Just for Hippies

Here's my official announcement that Richard and I are planning a homebirth with this baby. My reasons for posting this information are 1) I'm really excited about it and want to share! 2) To allow you to process the shock and horror in privacy instead of face-to-face, and 3) To attempt to answer the obvious questions, "Why would you do that?! Are you crazy?" "Is it safe?" "Are you turning into some kind of hippy Earth-muffin birth-goddess weirdo?"

We (well mostly I) have done a
considerable amount of reading and research on this topic. If you'll take a look at the link list on the sidebar you'll see a sampling. Neither Richard nor I have made this decision without much thought, prayer, discussion and research. Our conclusion is that giving birth at home is safe, comfortable, convenient, affordable and overall more desirable than birthing in a hospital. So here goes.

First, the biggest reason why most people never consider a homebirth, because it obviously can't be as safe as birth in a hospital. Right? Well, the answer found in numerous recent studies
is that for a woman who
•has a low-risk pregnancy (i.e. no pre-eclampsia or history of incompetent cervix, for example)
•is planning a homebirth (i.e. not giving birth at home because she didn't make it to the hospital in time!)
has a trained, experienced birth attendant with her (i.e. a trained midwife, not a friend or a nurse or a dentist)
and who lives within a reasonable distance to a hospital,
giving birth at home poses no greater risk to the health and life of the mother and baby than in a hospital. Even better, women who fit these categories and who birth at home greatly decrease their risk of surgical and medical interventions like episiotomy, forceps or vacuum extraction, and c-section. The cesarean section rate for attended homebirths in 2000 was 3.7% vs 19.1% for intended hospital births.

Cascade of Intervention

At home, birth is allowed to unfold as nature intended. Because a woman feels safe in her home and is not disturbed by unfamiliar hospital staff and procedures, the hormones of labor are usually capable of moving her labor along naturally without interventions. Many maternity interventions have unintended effects, especially during labor and birth. Often these effects are new problems that are "solved" with further intervention, which may in turn create yet more problems. This chain of events has been called the "cascade of intervention."

This chain of events can change the course of a woman's labor in important ways, yet couples often have little or no awareness that many interventions are used within a cascade of unwanted side effects. In many instances, these interventions cause problems because they disrupt the normal physiology of pregnancy, labor and birth. For example:
•When a woman is exposed to bright lights, unnecessary activity and strangers performing intimate exams the release of both oxytocin and endorphins are inhibited by the overproduction of stress hormones.
•This slows the progress of labor and intensifies the feelings of pain. It is not uncommon for a woman's contractions to slow upon arrival at the hospital.
•This may lead to augmentation with pitocin, a synthetic form of the hormone oxytocin. Pitocin has been associated with poor fetal heart rates possibly due to the strength and frequency of the contractions it causes.
•This apparent stress on the baby often leads to a c-section.
•Furthermore, the intensity of pitocin-induced contractions leaves the majority of women seeking an epidural. Epidurals are associated with maternal fever, and poor fetal heart rates which again leads many OBs to recommend a c-section.
In choosing a midwife-attended homebirth, we are seeking to avoid unnecessary interventions and the complications they often lead to. We know that at times it becomes prudent to transport to the hospital from home and even benefit from some of the above named interventions, and are willing to do that if necessary. (Hospital transport occurs in less than 10% of all intended homebirths.) Most importantly, the decision to intervene is made in conjunction with our midwife, with full explanation of the benefits and the risks, allowing us to be active participants in our care and birth experience.

The Benefit of Midwives
Midwives are guardians and keepers of normal, healthy pregnancy and birth.

They believe that birth is a natural process, not a disease, and trust in the natural ability of women's bodies to birth their babies.

Midwives are experts in normal birth.
Midwives have been educated and have experience in providing individualized, hands-on support throughout the childbearing year (pregnancy, birth, postpartum). They have expertise in nutrition, natural childbirth, breastfeeding and early parenting, as well as in identifying situations and conditions that fall outside the norm (referring to other care providers when necessary). They follow the Midwives Model of Care.

The Midwifery Model of Care

The Midwifery Model of Care is based on the fact that pregnancy and birth are normal life events. The Midwifery Model of Care includes:
  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
The practice of homebirth is very supportive of mother/infant bonding, and indeed midwives strive to protect this most intimate time allowing for the creation and strengthening of the mother-baby bond and unification of the entire family. Babies remain in constant contact with mom from the moment of birth onward. If any assistance is given to aid in baby's breathing it is done on the bed next to mom, where she may touch and speak to her baby. The hospital routine of taking the baby from the mother is not practiced in homebirths.
More Benefits of Homebirth
Continuity of Care
When having a home birth, the care providers remain consistent throughout the entire labor and delivery. There is no change of shift to new caregivers who may or may not understand or value your choices for birthing. Plus, a caregiver who has done all your prenatal work and has been with you throughout your entire labor is more likely to notice potential problems early on and take steps to prevent it or to transfer you to the hospital.

Unlimited Birth Companions
In a hospital, you are usually limited as to the number of companions you're allowed. In addition, none of your other children are allowed, which can be a distraction as you wonder whether the needs of your other children are being met. During a homebirth, children may be allowed to come and go as needed, so that they are still able to interact with their mama as she allows. This can also lessen the burden on the family of securing childcare during a hospital stay.

Safety

Research consistently shows that homebirth only is as safe or safer than hospital birth. There is a documented reduced risk of infection when giving birth at home.

Freedom from Interventions
When birthing at home, no routine interventions such as shaving, enemas, or IV fluids are required. You are not bound by arbitrary hospital policy. You're also able to eat and drink as you choose, which boosts your energy for a lengthy labor. Almost no hospitals allow eating and drinking, which can lead to fatigue and dehydration. Some interventions can still be undertaken at home if indicated, such as fetal monitoring.

Unlimited Labor Choices
When having a homebirth, only your imagination limits your choices for labor. You may labor in whatever positions or environments you choose. In early labor, you can walk around your neighborhood or relax in the tub. You have all the comforts of your familiar home to help maintain the deep relaxation that facilitates a natural childbirth. Plus you don't have to pack up and drive to the hospital while you're in labor! Nice.

Comfort
At home, you are allowed maximum control over your environment, from the clothes you wear to background music or even dozing in bed. A homebirth also offers increased privacy from student nurses or medical interns interrupting your birth experience.


Sorry, I know this has been really long. But honestly, that's just the tip of the iceberg. Three great books I've read expand on the issues of normal, non-medicated, physiological birth versus medically managed, drugged, interventionist-minded birth. I would really recommend them for anyone who wants to have children, is planning a pregnancy, is pregnant or has had children!

The Thinking Woman's Guide to a Better Birth by Henci Goer
Ina May's Guide to Childbirth by Ina May Gaskin
The Birth Book: Everything You Need to Know to Have a Safe and Satisfying Birth by William Sears and Martha Sears

We'd love to talk more about homebirth with anyone who's interested. I knew very early on in this pregnancy that I wanted to birth at home, but Richard said "No Way!" Then I had him read an article, read some book excerpts to him, talked, reasoned, cajoled... and now he's a bigger homebirth advocate than I am! Some friends even j0kingly told him he should become a midwife.

But don't worry, we won't make an offering to the Birth Goddess or chant and light candles and burn incense or make a potion from the placenta (yes, some people do...). We've simply examined some long-held assumptions about birth, hospitals and homes, and feel this is the best option for our family.

1 comment:

Birdie said...

good luck, our homebirth did not work out so well. I do hope yours is safe and uneventful.