Home births: It’s not so simple

Some opt for home birth because they have found the hospital experience distasteful.

Some opt for home birth because they have found the hospital experience distasteful.

Published Oct 27, 2015

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Washington - Giving birth at home is a decision not to be taken lightly.

It goes against the medical advice of our time, which calls for women to be cared for in a hospital with lifesaving equipment and professional safety measures in place.

Out-of-hospital births (including those at home and in birthing centres) have been increasing since 2004, when the rate was less than one percent. In 2012, that figure was 1.36 percent, meaning that nearly 54 000 babies were born at home, the highest number since 1975, according to the centres for Disease Control and Prevention.

Women who choose home birth say they are often considered odd and are criticised for putting their children in danger - five years ago, an editorial in the Journal of Perinatal Education described home birth as under siege. But outcomes between home and hospital births are difficult to compare, and studies offer conflicting information.

One recent study found a higher infant mortality rate for non-hospital births than for those that occurred in hospitals. Another suggested that outcomes were influenced by income levels. The American College of Obstetricians and Gynecologists says that “although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.”

For parents who favour home birth, having control over the birth experience overrides society's disapproval. Jamie Schmidt of Middleton, Ohio, has three children - one born in a hospital, one in a birthing centre and one at home.

Of the three births, she said, her first, which took place in the hospital, was the most traumatic. She was just 17 and, she said, doctors pressured her to agree to induced labor before she felt she was ready. She said that the medications didn't work and she ended up giving birth in extreme pain. Her last birth, however, is the one that is judged negatively by society, she said, because it happened at home.

“I knew who I could and couldn't tell,” she said, “but I still caught wind of people talking about it like I was a crazy hippie birthing on the front porch, hosing it off and going back to bed.”

Some opt for home birth because they have found the hospital experience distasteful. Christine - a Sacramento woman who spoke on condition that her last name not be used for privacy reasons - gave birth to twins at home this year. When she gave birth to a son in 2007, she had planned on an unmedicated, low-intervention hospital birth. But, she said, the on-call obstetrician treated her as if her wishes were ridiculous.

At one point, she said, he told her she could make any stupid decisions she wanted. She described her medical treatment as careless and said she was unhappy that her son was kept in the neonatal intensive care unit simply because of prolonged labor.

“I wouldn't go so far as to say I have PTSD from it,” she said, “but I think my therapist and midwife would say there is certainly a lot of unresolved anger and resentment there.”

So Christine decided to have her twins at home, despite the higher risk that comes with multiple births.

“In the end I just didn't trust that I would be treated as an intelligent person capable of participating in the decision-making process over the course of my pregnancy and delivery,” she said. “I have many friends who have had safe, joyful home births, and many friends who are doulas and midwives. I knew that the experience I would have with them would be mother/baby-centred, and my intelligence, intuition and knowledge of my own body and what is normal for me would be treated as assets.”

Joella Striebel of La Crosse, Wis., gave birth to her daughter by Caesarean section in 2009 and did not want to repeat that. “My first birth experience was one of powerlessness,” she said. “I felt like I had no say in what happened. For my second birth, I wanted a voice in the decision-making. I wanted my wishes to be respected, or at least acknowledged if they couldn't be honoured. Home birth felt like my best chance to be treated with dignity and respect.”

She did months of research, hired a team of well-established midwives and joined local and online communities where other home birthers and professionals told stories and gave advice.

When her water broke on Jan. 22, 2013, Striebel called her midwife, then tried to sleep through her contractions. Excited and jubilant, she had trouble nodding off and early the next morning she had her mother pick up her three-year-old daughter, Delilah, to wait out the birth.

The birth took longer than she would have imagined. Striebel laboured for nearly three days, with three midwives alternating in attendance. She tried relaxing in the birthing pool her husband set up for her. She tried on her hands and knees. She tried sitting down. Exhausted and deeply disappointed, she turned to her midwife. “It's time to go, isn't it?”

Her midwife nodded in agreement.

When they arrived at the hospital, medical staff determined that the baby's head was tilted just enough to keep it from descending down the birth canal, and Striebel had her second Caesarean section. She was thrilled that her son, Canon, was healthy but bitterly sad not only that she had been unable to deliver at home but also that she had been unable to have a vaginal birth. She also felt alone, distanced from both proponents of hospital births and the home-birthing community because her story didn't fit the narrative of that community any longer.

“When you plan a home birth, you build a community around you of like-minded thinkers and supporters, and it gives you a layer of support apart from your friends and family, who may not understand why you are doing it in the first place,” Striebel said.

“And when you transfer to a hospital, these people who had become your friends during your pregnancy make you feel like an outcast. It's very alienating, very silencing. There is a feeling of failure, of being a stain on home birth.”

Later, when she attended a picnic with other home-birth advocates, Striebel said, she was unable to talk about her experience. She encountered what she said was an unspoken rule that you don't discuss it if your plans for a home birth are disrupted by interventions or complications.

“People didn't know how to respond other than looking like they felt very sorry for me,” she said. “We haven't been back to the picnic since.”

Home birthers refrain from talking about interventions, Striebel said, because such stories might diminish the confidence of others planning out-of-hospital births. “Home birth is so highly criticised and stigmatised that discussing experiences that were anything other than successful can be seen as giving fuel to the opposition,” she said, “as evidence that home birth is unsafe.”

Barbara Levy, vice president of health policy at the American Congress of Obstetricians and Gynecologists, said there are medical reasons that argue against home births.

“We need to recognise that childbirth is a natural event, but in the natural state, the maternal and infant mortality rate are astronomical,” she said. “What are you willing to risk with your babies' lives or your life? It's one thing to look at the numbers, but if the incidence of a bad outcome is one in a hundred, is that acceptable?”

The chance of infant mortality in a hospital is less than 0.6 percent, and that number includes emergency home-birth transfers.

Levy said one problem is parents' failure to make contingency plans. Hospitals may not have protocols to follow when dealing with home birthers who end up at the hospital. Registering with a hospital in advance can smooth the way, Levy said, so that doctors and nurses have some background when a patient is rushed in.

“During birth, everything is okay until it isn't,” she said, “and most transfers are because of an emergency. The hospitals haven't been given forewarning and suddenly they go from business as usual to unmitigated crisis.”

Christine, the Sacramento woman, had made a backup plan, establishing a relationship with a hospital in advance. (As it turned out, she didn't have to use it, delivering her twins safely at home.) In addition to working with a midwife, she had checkups with a hospital-based doctor until her 32nd week. Still, she said, she has encountered harsh judgment of the very idea of home birth.

Christine said skeptics constantly warned her that having a baby at home could lead to the death of her or her child. “While they aren't wrong,” she said, “I could also die in a hospital. Nothing in life is guaranteed.”

Levy remains unconvinced that home birth is a wise decision.

“Could you live with yourself if one of your kids die, or if one of them has severe disabilities because of this?” she asked.

The Washington Post

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