Homebirth

A Good Choice for Low-Risk Pregnancies
by Kate McKinney, Charis Midwifery Student

There is much debate surrounding the topic of homebirth. Documented studies, research, and the experiences of many families, however, show that there are advantages to birthing at home with a midwife; advantages that families giving birth in a hospital with an obstetrician does not offer.

In the past, women predominantly gave birth in the safety and security of their own homes. Even today birth is viewed as a normal part of family life in most countries. It has just been in this past century with the advent of obstetrics in the United States that birth has been changed from a natural event into a medical emergency; and this has had a huge effect on how the birthing process was and is handled. Many people currently are led to believe, whether through a lack of information or careful conditioning, that the only safe birth is in a hospital.

Presently in the United States about 30% of women receive inadequate prenatal care. In spite of this, the infant mortality rate has been declining since 1962. However, our relative position and rank among the leading countries of the world has been steadily worsening from 12th, in 1962, to 28th presently. What’s the difference between the United States and the other developed countries that have better infant mortality rates? All other industrialized  countries have some form of a national health program, and midwives provide much of the prenatal, labor, delivery and postpartum care, with the exception of Canada (Gabay et al 389).

Today, statistics in the U. S. don’t support the supposition that a hospital birth is the only safe birth option. According to the Maternal and Child Health Bureau, “Hospitals have never been proven as a better, safer place to have a baby; the US ranks 28th among the industrialized nations for healthy births, at 7.0 infant deaths per 1000 births.” Jill Cohen, in an article discussing the topic of Homebirth says;

“Doctors like to take credit for the rising statistics in the U.S. showing a greater number of successful births in this century. Better nutrition, disease control, hygiene, and information are the reasons for the improved statistics (Cohen).”

By the 1950s, most births in the U.S. were taking place in hospitals. The use of Cesareans, epidurals, and heavy doses of pain medication became normal. These drugs had bad effects on both the mother and her baby. Women didn’t want to feel pain and were told that medication was the norm. Doctors wanted the “easy way” to manage labor. So rather than have an amazing birth experience, women subjected themselves to any and every procedure offered to them towards “managing labor”. They didn’t know any better or different (Cohen).

Things began changing in the 1960s and 1970s. Women started to question and challenge doctors and obstetricians about the birth process. Why was pregnancy considered a sickness? And was birth really a medical emergency? Who gave them the right to tell women how or when to have their babies (Johnson et al 2005)?

A homebirth movement was born and established as women began to reclaim the power and completeness in their bodies to do what they were created to do. Now, in the 1990s and 2000s women are becoming more and more aware of the awesomeness of the natural, normal pregnancy and birth cycle. They have begun making it a family experience, as it originally was in the beginning. Carefully screened and professionally attended homebirths have become a proven, safe and successful alternative for women who have low risk pregnancies (Cohen).  To quote Juliana van Olphen Fehr,

 “In its natural environment, giving birth is like a musical masterpiece, building to its crescendo when the baby enters the world. Just like a symphony pulls its audience into its powerful rhythm; so does a laboring woman pull in her onlookers. All of those present at a birth must be in synch just as all of the instruments in an orchestra must be in synch. This synchronization helps the mother keep her power to create her own masterpiece. Often, in the wee morning hours, when her privacy is assured, her baby is born (Van Olphen Fehr 112) .”

In the book, A Thinking Woman’s Guide to a Better Birth, Henci Goer states that, “Clearly, women with complicated pregnancies should have their babies in hospitals where equipment to diagnose and treat problems is readily available. But for most women, it comes down to a matter of choice. The real question about safety is not, ‘Do you want a pleasant birth outside the hospital or a safe birth in a hospital?’ It is, ‘Do you want to give birth outside a hospital and run the miniscule risk of an emergency that might (but not necessarily would) be handled better in the hospital, or do you want to give birth in the hospital and run the considerably increased risk of infection, certainty of additional stress, and the near certainty of having unnecessary (and potentially risky) interventions (206-207)?” Midwife Henci Goer also points out that at hospitals, diagnostic and treatment equipment is available at any time. There is a problem with this, however. As she so aptly puts it; “Proximity breeds overuse”. This puts into words exactly what happens in many hospitals to countless women. Many hospitals are not able to perform an emergency cesarean at any time, around the clock within 30 minutes of its being needed. People have to be called, equipment prepared, and the woman given pain medicine. These things all take time. Almost all problems during labor and birth can be solved in the home; midwives usually carry emergency equipment and medication should the need arise. According to Goer,

“One intervention tends to lead to another. It produces a ‘cascade effect’. So, for example, electronic fetal monitoring confines women to bed, which may slow labor. Doctors may then give oxytocin, which increases pain and contractions, causing women to want an epidural. The epidural may slow labor again or cause abnormal heart rate patterns in the baby, ending the cascade in a cesarean section for slow progress, failure to progress or fetal distress.”

Many of the people who study and record these labors conclude that birth is too dangerous to do out of a hospital. When they are actually only documenting the many dangers of a hospital birth (Goer 205).

Juliana van Olphen- Fehr, Nurse Midwife and author of “Diary of a Midwife: the Power of Positive Childbearing” reports that she has another problem with hospital deliveries: “The callous and unnecessary forced separation between mother and baby.” She goes on to say that:

“As healthcare professionals, we are obligated to value all human life and see it as worthy of care and protection, but in a hospital nursery that meant only monitoring the baby’s vital signs and thermal environment. But when it came to soothing him, or giving him just the human contact he so desperately needed, there wasn’t time. The nurses just don’t have time, but the mother does (43).”

In the year 2000, British Medical Journal (BMJ) conducted a study in North America including all Certified Professional Midwives. In order for them to be re-licensed they had to participate. The births of 5,418 women in the U.S. and Canada who intended to give birth at home as of the start of labor were reported. This included all home births in the year 2000 conducted by or involving Certified Professional Midwives. The results of this study were consistent with most of the smaller studies of home births done in recent years. Out of the whole study there were no maternal deaths. Intrapartum and Neonatal mortality was 1.7 per 1000. Much lower rates of intervention were recorded for home births, as compared to low risk hospital births:

In this study there were also few transfers, only 12.1% transferred to a hospital Intrapartum or postpartum. Out of this, 5 out of 6 transfers took place before delivery; usually as a result of failure to progress, maternal exhaustion, or the need for pain relief. Midwives only felt that 3.4% of the intended homebirths were urgent transfers. Most mothers reported that they were satisfied with their birth experience, and only 1.7% said that they would choose a different kind of caregiver for any future pregnancies. Also, 90% of mothers were still breastfeeding their babies at six weeks. On average, women who opted for birth at home were older, usually with higher education. They were also of a lower socioeconomic status. African American and Hispanic women were rare in this study (BMJ CPM 2000 Study).

Hospitals, doctors, nurses, and even nurse midwives sometimes argue that homebirth is not safe or  sanitary. However, it has been proven that all mothers have immunities that are passed on to their babies. This means that they have built up immunity to the germs in their own home environment. According Joseph B. DeLee, a prominent obstetrician in the 20th Century, there are so many more bacteria and viruses, in spite of cleaning and an attempt at being sanitary,  everywhere in hospitals. This can cause problems and sickness with newborns as well as mothers still recovering from birth. He goes on to say that he thinks, “Home delivery, even under the poorest conditions is safer than a hospital delivery (Ettinger 9).”

For some families homebirth is not a choice, but a conviction. They believe that God would have them give birth at home where they can control the atmosphere of their home and so that the mother is not exposed to male doctors, and strangers (Barnes 17). A mother that chooses homebirth must have a desire to achieve her goal and trust in her own body. At the onset of labor the mother would call the midwife. The midwife could be involved in the labor from the very beginning, if desired, providing support and encouragement for the mother; or the laboring mom’s husband, close friends, or some other person may be present (Cohen 18).

With continuing advances in technology, and the art of midwifery, it is imperative that we lay before childbearing couples in the United States, and elsewhere; the unbiased facts and differences between homebirth and hospital birth. As S.A. Blevins asserts, “If we want to truly reform our healthcare system we must end the government-imposed medical monopoly- the restrictive licensure laws that require physician approval, and regulation of our practice- that has prevented us from providing the full array of healthcare choices to our citizens (Van Olphen Fehr, xi).”

Midwives or Obstetricians, hospital or home, this subject is full of decisions. As long as maternity care in the U.S. is organized as it is currently, the best way for healthy, low risk women to give birth is to have a homebirth. Women have been successfully having babies since the beginning of time without need for hospitals or medical interventions much of the time. It has been shown, through multiple studies, research, and testimonials that homebirths with a certified, highly trained professional such as a Certified Professional Midwife (CPM), or Certified Nurse Midwife (CNM) is just as safe, if not safer than births in a Hospital.

Works Cited

Barnes, Patti A.
The Ministry of Midwifery, 18
North Carolina, Barnes, 2000

Blevins, S.A.
“The Medical Monopoly: Protecting consumers or limiting competition”
The Cato Institute, Washington D.C. 17 Feb, 2009

Cohen, Jill.
“The Homebirth Choice” Midwifery Today, 17 Feb. 2009

Ettinger, Laura Elizabeth
Nurse Midwifery: The birth of a New American Profession, Laura Ettinger,
Ohio State University Press, 2006
Quote by Joseph B. DeLee, 9

Gabay, M. and Wolfe, S. “Nurse Midwifery: The Beneficial Alternative”,
Pubmed Central, 17 Feb, 2009

Goer, Henci
A Thinking Woman’s Guide to a Better Birth
New York, New York, 1999, 206

Johnson, Kenneth C., Davis, Betty-Anne, “CPM 2000 Study”,
Outcomes of planned home births with certified professional Midwives: large prospective study in North America
British Medical Journal, 17 Feb, 2009

Van Olphen-Fehr, Juliana
Diary of a Midwife: the Power of Positive Childbearing,
Westport, Ct: Bergin & Garvey, 1998, 43, 112

US Department of Health and Human Services:
2002 Statistics and Report from Maternal and Child Health Bureau
 

© Kate McKinney


Kate Mckinney lives in the lovely rural town of Jetersville, Virginia.
She is currently enrolled in the Charis Course for Childbirth Professionals, Midwifery Track
 and stays busy serving her community as a Doula and Childbirth Educator.
In her spare time she teaches piano lessons and cares for goats.
 

 'Behold, I will bring them from the north country, And gather them from the ends of the earth,
 Among  them the blind and the lame, The woman with child and The one who labors with child,  together,
 A great throng shall return there...And My people shall be satisfied with My goodness, says the LORD.'
 Jeremiah 31:8, 14~~~
©2009 Charis Childbirth Services, All Rights Reserved
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September 2009