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| Photo courtesy Marilyn Nolt |
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Why homebirth?
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Photo courtesy Amber Wismer, CCE |
For many people homebirth is simply the only option which matches their belief systems. Some have had to endure painful hospital experiences which alert them to the arbitrary nature of protocols in place there. For some it is a gradual education process which begins when the first visits to the local obstetrician end poorly and the family begins to seek other options. Some have several children before |
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finally realizing homebirth was right for them all along. Some want control of the labor process, impossible with managed care, others want control of what happens to their baby in the hours after birth. Some want God to lead the process and others want to be simply left alone.
What bonds homebirthers together, because they come from all walks of life and all income levels and all religions and creeds, is a need to be at home and undisturbed and to let nature take its course gently and easily.
Birth at home is remarkably simple and comparatively easier than hospital birth. 90-95% of the time the baby is born at home and is healthy after a labor which while longer is often more pleasant than the typical medical birth experience. You can labor in water, move around to be comfortable, you can eat. You can let the aches and pains of a healthy muscular system work the way they should, and scream or cry or be totally silent. Your toddler can run around and your husband can be where you both feel safe and protected. To labor in your own big bed, and deliver there, and stay there and spend the night is such a gentle process. No wheeled transport, or little plastic boxes for the baby, your arms do just fine. Midwives clean up the mess and chat about the beauty of what they just saw and leave you comfy and clean.
So the question really isn’t, Why Homebirth. The question really is Why in the world would you do anything else?
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Midwifery care has statistically better outcomes in all situations for all populations than any other form of birth care. Homebirth with a trained attendant and access to medical care has the best outcomes for low risk populations. No study anywhere had ever shown obstetrical care to be superior to midwifery care. Ever.
Most of the world’ population is born at home with a midwife, and with the exception of those with no access to emergency care, those outcomes are surprisingly good. Most of the industrialized world has better birth outcomes than we do and we lag behind our economic partners in defeating fetal and maternal mortality while leading them in birth interventions.
In our culture, hospital birth is currently the norm, not because it is safer, better or more comfortable but because it is what is done and has been done for the last 3 or 4 generations. Birth in hospital accounts for 3.8 million hospital admissions per year and is the single largest cause of hospital admissions. It is a huge industry, governed by largely arbitrary rules which are not in keeping with any known research or scientific method.
The careful screening midwives do make sure that problems with the mother or child which need hospitalization are there, whether in pregnancy, birth or postpartum. Transports happen, but for medical reasons, and the outcome is necessary, not routine. 5% world wide will need cesarean sections, and that’s about how many need transport for surgery at home, compared to 25% in most hospitals. Small occurrences like a baby that needs mild resuscitation, or a mother that could use a few stitches, or needs a medication to stem bleeding from the placental site, can all be handled as a matter of course by a trained midwife.
The question really is not: Is homebirth safe, the question really is What is safer than homebirth? There is no response because nothing has ever been proven safer than homebirth for low risk women. That is one of the best kept secrets in the field.
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| Homebirth Q and A |
Have a question that is not listed here? E-mail info@pahomebirth for answers!
You can check our Links page for more info.
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Who provided those lovely photographs of the births on your site?
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Marilyn Nolt,Certified Doula (DONA) Certified Childbirth Educator (ACBE) www.doula.com/marilyn
Her training and experience attending at over 100 births as a Certified Doula, she can offer you and your support person continuous physical, emotional and informational support during your labor and birth. Marilyn also does belly casts which are unique way to honor and preserve the miraculous way your body has changed to create life.
With many years of experience as a photo illustrator, She can get candid, unposed images for you, capturing the moments of your baby's birth day. With discretion and respect of your privacy, She can get images for you and preserve the intimate moments of your baby’s birth.
Amber Wismer, Certified Childbirth Educator (CCE)
Amber Wismer, CCE is a wife, mother, apprentice homebirth midwife, childbirth educator (offering individual customized classes) and an amateur photographer – fortunate enough to be invited to occasionally offer birth support while capturing homebirth memories for families. Amber captured the homebirth sequence shown on the website. Photography is a beautiful, non-invasive way to enhance the memories of your labor and birth. You can contact Amber at amberlee@redjellyfish.net.
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How much will homebirth cost?
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Prices vary and are less expensive in the rural areas. Midwives around Philadelphia get $2000-$5000 for a home birth. Many other payment options exist: with a deposit and payment plans, any birth can be paid for the course of the pregnancy in smaller payments. Some midwives will barter for services and, some midwives take insurance. Successful campaigns have been waged with insurance companies regarding their policies on homebirth, so notify your insurance company in writing and with some effort, you might be pleasantly surprised at the outcome.
Keep in mind that there may be additional costs associated with the birth other than the midwife’s fee. These might include the cost of: a birth kit, supplies for the birth, doctor visits, prenatal tests, postnatal injections (RhoGam, etc.), renting a birth pool, Doula services, and newborn tests (PKU test, blood work, etc). (extra costs courtesy: www.nchomebirth.com)
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Isn’t that a lot of money? I just don’t think my husband/parents/I want to spend that much!
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People spend thousands of dollars and years of planning on a wedding, but typically they spend very little time or money planning for a birth. With the illusion of insurance handling all the fees for a birth in hospital it can seem like birth is “free” in the hospital. However, there ain’t no such thing as a free lunch.
For those having a regular birth in hospital, fees usually start at $5000 and go up from there. Add about $1700 for epidurals needed because birth can be extremely painful when you cannot move around due to the fetal monitors, and various protocols in place, and on average 70-90% of women birthing in the hospital will use epidural pain medication. 1 in 4 women in hospital care will get a cesarean section because of a difference in how women are cared for at home rather than in hospital. A cesarean section can cost $7500 in hospital fees, anesthetic and doctor fees. For those without insurance that is all out of pocket costs.
Ambivalence is typical early on, and you will think of all the wonderful things you could spend the money on, and “Wouldn’t it be easier to just go with the practice that takes my insurance, but disagrees with my belief system”. However, I know personally that I would have paid thousands more dollars to not experience the strain on my life that my first hospital birth experience cost me. The comparative ease of my homebirths were worth 10 times the cost. As a couple, the rift of our hospital experience reverberated through our relationship for years afterwards, teaching us the lessons of the age old midwifery adage: “If Momma ain’t happy, ain’t no body happy”
It is painful for our family to look at the bank book and the positive pregnancy test and make the commitment to a homebirth, even though we pay a very sizable chunk every pay check for our medical insurance, which we carry “just in case” But we do. We have a family joke about how we could spend the money now on the birth or invest it in Microsoft to pay for our therapy later. There are many other life circumstances where it is better to pay now and be happy, rather than be frugal and suffer the consequences. Certain things cannot be judged by how much they will cost, rather what it will mean over a lifetime.
An engagement ring costs 2 months salary, how much more is a baby worth? How much more are good memories worth? For those conflicting with spouses over control of the check book on this issue: How much are you worth? How much more is becoming a family in the privacy of your own home worth? How much more is that pregnant woman in your life worth? As the credit card ads tell us over and over: those kind of things are priceless. Simply priceless. The rest is only money.
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What kind of prenatal care will I get?
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Midwives offer some of the best, most in depth prenatal care in the business. In addition to typical blood draws and lab work, they also will take urine samples at every prenatal. Weight is checked and each midwife has information to give you for each of your visits. Nutritional care is essential and most midwives are very concerned with the dietary needs of their clients, because women who eat well can avoid almost all the common conditions that can develop in pregnancy. Midwives will encourage moderate exercise, plenty of fluids and in some practices herbal and alternative medicines to treat minor ailments and fortify the uterus.
The best part of prenatal care with a midwife is the length of time they spend answering your questions and developing a relationship. This is an important relationship and all important relationships take time.
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What supplies will the midwives bring to the birth?
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The most important supply is your midwife’s training. She will bring her accumulated knowledge along with her for the birth, and that includes the wisdom of her senior midwives. Most midwives bring supplies to suture, give neonatal resuscitation (complete with oxygen (usually 2 tanks) and tools to administer it to adults and newborns), and a variety of herbs and/or medications to handle bleeding. Depending on her training she may be able to give IV treatments, catheterize and give injections of medications to stop bleeding postpartum. Certain herbs and alternative treatments can be used for treatment of labor and delivery difficulties and your midwife may pack those supplies if she is skilled in their use. Different states have different views about which medications your midwife will bring, so that will vary from midwife to midwife.
An important part of interviewing your midwife is finding out what she carries and what she will bring to your birth.
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| Here are sample midwife supply lists |
http://www.dearmidwife.com
See section on equipment, second question down in FAQ. |
Photo credit Amber Wismer, CCE
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Who comes to the birth to help the midwife?
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Midwives generally work in teams of 2. There will be a midwife assigned to the mother’s care and a midwife assigned to the baby’s care. Your midwife is the lead midwife and generally her role is to managing the labor and assist the mother, to assisting in delivery of the baby, and then managing the delivery of the placenta. The secondary midwife will assist the midwife, bringing supplies to her and managing the care of the baby after it is born.
Often there will be an apprentice (sometimes 2 with the birthing family’s permission) who observes as part of her education and gives help to the midwives. Under unusual circumstances a consult with a more experienced midwife is suggested, she would attend to guide, give information and assist if needed.
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| How do they monitor the baby? |
In the hospital they used a fetal monitor…. At home your midwife will use a Doppler (hand-held ultrasound device) which register the baby’s heart tones and provide an immediate read out of the baby’s heart tones. Some times your midwife will use fetoscopes or stethoscopes for clients who do not care to have the use of technology in their births. These methods of are better than fetal monitors for home use, because of all the different positions a mother will take during her labor, and a Doppler can be used anywhere, in the tub, on the toilet, upside-down on the hands and knees, or anywhere .Each midwife has her own protocols of how she will take care of a woman in labor.
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What if something goes wrong?
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Midwives are professionals who are aware of the scope of normal and the common problems that might occur. Since midwives are specialists in facilitating natural birth, there are many things they do in their practice to make sure that the majority of problems don’t happen in the first place. This is how they provide statistically better outcomes than obstetrical care. Much care is taken to make sure any problems are handled swiftly and effectively. Training, personel, supplies and emergency procedures are all part of the way they make sure they are prepared for every eventuality.
Often people are concerned about what is done at home when the following situations occur:
Cord around the neck:
This is a common situation and an easy to fix situation. Student midwives take great pride in learning to loosen a cord which is loosely wrapped and allowing the baby’s body to “sommersault” through the cord. A nuchal (neck) cord can also just be taken over the chin and head like a necklace. If a cord is too tightly wound to loosen, then the cord is clamped, cut and unwound, and the baby born easily afterwards.
Bleeding:
Copious bleeding, called hemmorhage, occurs in about 5% of births. Those who will be seriously effected by a bleed are screened out in prenatal care, and will have to birth in hospital so they have access to a transfusion if they need it. Women who birth at home have sufficient stores and medical history to be able to tolerate the loss of blood common to birth, which while it seems like quite a bit, is usually less than 500cc (a cup). This is not much at all when you consider that a pregnant woman has a 40% greater blood volume than a non-pregnant woman.
About 70% of hemorrhages are due to the uterus not firming up after delivery. Midwives carry various medicines and herbal remedies to fix this situation, and also some physiological knowledge which usually makes medications unnecessary. If a baby is put to breast shortly after birth, the uterus will firm up, and if the uterus is gently massaged it will firm up as well.
Midwives watch their mothers carefully and are very concerned about this complication, Midwives work hard to prevent bleeding with careful nutritional and herbal support before birth, and have the knowledge and supplies on hand to deal with it if it does happen at home.
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Emergency procedures:
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| While homebirth is safe, there are occasionally unforeseen occurrences that may warrant a trip to the hospital. Access to immediate medical transport and an emergency plan is essential. This will include your back up hospital and back up doctor, if you have chosen one. Each midwife has different comfort zones due to practice style and training. Some midwives may be able to handle almost every occurrence at home while others will transport more readily, you and your midwife will develop the emergency procedures that make you both feel most comfortable. |
Will I need a back up doctor or pediatrician?
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| You can use a family physician to deal with some occurrences, and PA has some of the best. For emergency obstetrical care, it can be good to have an obstetrician who has seen you and knows your history. It can be important to have a good relationship with a pediatrician who shares your views. Spend the time to get to know the alternative and holistic practitioners who might be available to you for your birth. |
Photo courtesy Amber Wismer, CCE
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Some people prefer to use the emergency room staff as their back up in case of trouble for either mother or baby. Much of that decision is personal, but the best discussion I have ever seen on back up docs can be found at:http://www.nchomebirth.com/backupDr.html
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What about the mess?
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Isn’t homebirth going to be gross, disgusting and mess up my house?
The mess of a birth can be contained very easily by those trained in how to do it. The amniotic fluid, placenta and any blood loss usually amounts to what would fit in a small-to-medium sized mixing bowl.
The first time I saw a midwife handle a birth at home I was amazed that the entire birth and all the fluids and etcetera fell on to a single chux pad, when it was over, she folded up the single chux and threw it away, leaving the bed perfectly clean. Chux are plastic backed absorbent pads about 18 inches square. They are placed all over the place and right underneath the woman at the time of pushing, and are cleaned up instantly afterwards.
People concern themselves about the mess because in hospital births, the woman is at the end of the break away bed and the fluids and other mess fall down into a container underneath. The doctors' gowns, the nurses' gowns and scrubs all seem to get gross in the process. If you spilled a mixing bowl of fluid down the side of a bed into the bucket, there is going to be a huge mess, but at home it is much less messy because of how it is handled--just like the rest of birth.
While I might not put my best guest sheets on the bed I was to birth in, birth at home works on containing the mess and leaving the home cleaner than it was found.
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What about birth with midwives in hospital or birth center? What about in a hospital with an obstetrician and a doula?
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Photo credit Marilyn Nolt, DONA, ACBE
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The hospital or birth center makes the rules of protocol. The people who work in a hospital or birth center have to follow the rules, or they are out of a job. No one is foolish enough to risk their livelihood on one woman or one baby, and so occasionally the family’s desires must be sacrificed so that births can occur with the protocols in place. Protocols are based on lawsuits and the assumption of |
medical risk. While you certainly can have a wonderful birth experience anywhere with any practitioners you like, it is always easier to have a birth at home where you and your invited staff can make the majority of the protocols. Hospital births are managed. They have time limits and protocols for everything. Birth centers are less strict, but if there are deviations from the norm, it must be noted and handled according to protocol. As an example: generally you have 30 minutes to expel a placenta or it will be manually removed. Manual removal of the placenta or pulling on it, can cause tears in the placenta and parts can be “retained” this will cause a hemorrhage because the pieces of placenta still in the uterus keep bleeding. This is ok in a hospital because they can quickly give you an infusion of blood to keep you alive and every few hours around the clock someone checks your blood pressure to make sure you haven’t bled out since the last time you were checked. Since this is a very difficult scenario for the mother, the baby will be kept in the nursery for most of this time.
However, it is a lot simpler to just wait for the time it takes to expel the placenta, standard midwifery practice is up to 2 hours, depending on the midwife and the situation. If you wait for it to detach there will be no bleeding, no hemorrhage and no need for the transfusion. If there is still retained placenta, there can be an appointment made for a D and C with an obstetrician or the emergency care plan can be set in motion. Arrangements can be made for the care of the baby (at home or hospital-family’s choice) and the matter can be handled from the protocols which make the midwife and the family most comfortable. Which is better? It is certainly a personal choice.
For parents who find the responsibility of choice in their care difficult and wish to trust completely in the medical system, hospital and birth centers offer a place to go and place yourself in their care. No need to decide or research options, the hospital or birth center has you covered by a standard of care which is legally infallible, even when it is incorrect. While you will have a degree of choice, standard of care will prevail. Some people have trouble accepting that degree of passivity and try to change the system to fit with personal expectation. However, you cannot enter the house of another and demand that the rules change for you. It is rude at best and not going to get you very far. When in Rome, you must do as the Romans.
If you choose to take more responsibility for you and your family’s medical care you get more choices and a greater degree of control. Along with that power comes responsibility. Why give up that power to strangers? Not everyone will know enough to take control, but the standard of care is always there to fall back on. The standard procedures become a cushion instead of an enveloping mass; allowing you to explore options and develop your support networks before committing to a course of action.
Parenting is a series of decisions of how much responsibility you will take and how much you will give up to others. Will you school your child at home or send them to school? Will you tell them about birth control or will they learn it from others? Will you research your suspicions of autism and find options or accept the diagnoses of experts? Will you give them dietary changes in hopes of curbing their ADD or will you give them medication?
These powerful, life-altering decisions begin at conception, and are explored first through birth. Taking charge and responsibility for what happens to you and your child is frightening and is challenging, but it is your job as a parent and only you can make the best decisions for them.
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If birth is so easy, what about unassisted childbirth (no midwife present)?
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Sometimes birth happens accidentally unassisted, and typically these babies have great outcomes, so what is the difference if you just have your babies without a midwife there at all?
There is a difference between planning an unassisted homebirth and an accidental homebirth before your midwife gets there. If your midwife is on the way and you are ready to birth as she enters the room or have just finished birthing, there is probably a good chance that everything has gone all right.Babies born spontaneously are one thing, but babies born after an exhaustive labor are quite another. No one knows which birth will encounter certain problems, and while birth does not need the assistance of another to occur, it is nice to be able to rely on others and have their confidence and experience to hold you up if things get rough.
Another valuable part of the midwifery experience is the prenatal visits. While some may object to testing most can be waived, and some tests are very valuable. The real value of a prenatal visit is the counseling, nutritional and emotional, that you will receive. Just being able to talk out the various ups and downs of pregnancy can be helpful and keeping focused on good nutrition will assure the best outcome for mother and baby. Having documented records of your care can show emergency personnel important facts they need to know.
As a midwife and a mom, I have to vote no on planned unassisted childbirth for just about everybody. It is important to have someone nearby who knows what to do if you have problems, and can speak for you at the hospital if you need transport.
Some couples due to personal and religious conviction still will choose this option. These couples must have all of the following in bountiful measure; a bond with your partner that is so strong as to take a fetal demise or poor outcome without blame, guilt or conflict, perfect trust in your ability to give birth, knowledge of how to resuscitate a baby, an understanding of normal birth, and a faith in God (or the process) that is bigger than most.
While it is always legal and always your right, consider just hiring a midwife to standby just in case. Even if she is a telephone call away she can help you, immeasurably. Even midwives have midwives who they call when they encounter something they have never seen before. Statistics are of 40% more complications for unassisted births, but those results are skewed because the uneducated accidental and pre-termed are lumped in to include the educated and knowledgeable.
Unassisted birth is perfectly possible, and by many reports a wonderful experience for those that have great outcomes. However, the feelings of guilt for those who have problems are huge, and that degree of responsibility is a task best shared. If you feel lead to have an unassisted childbirth, read all you can, have an emergency plan ready and enjoy the experience. There is a fine line between trust in God (or the process) and foolish presumption.
However, if you live in PA you should never have to have an unassisted homebirth because you can’t find a practitioner. There are midwives in your area, some of the best might not advertise, so please click here to use our form to find midwives in your area. There will be a midwife who shares your convictions and can support you. Midwives have been known to drive hours to be with a woman who lives in a remote area, especially when they share beliefs or if they know that the family has the strength of trust to try unassisted homebirth if a midwife doesn’t come.
Some websites which support unassisted childbirth:
http://www.geocities.com/Heartland/8148/ucbirth.html
http://unassistedchildbirth.com/
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