Saturday, August 6, 2011

The Facts About Home Birth

The following is my letter to the editor of Wise Traditions (which is the quarterly publication of the Weston A. Price Foundation).  This letter was published in the Summer 2011 edition of Wise Traditions.

In 1940, 44 percent of all births in the United States occurred at home. Since 1969, about 99 percent of all births in the United States have occurred in hospitals, according to an article in National Vital Statistics Reports titled, “Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990-2006.” This means that the last few generations of women in the United States have had very little exposure to home birth, either in firsthand experience, word of mouth, or the media. The predominant feelings about birth in our culture are negative, and women have generally bought into the idea that labor and delivery are medical occurrences that need a doctor’s attendance.

In planning to have a home birth for each of my children, the response I typically encountered from others was something along the lines of “what if something goes wrong?” or “you are really brave!” These responses underscore the fact that most people in our society have no idea that home birth is a safe option, and they certainly don’t think labor is something women are designed to handle naturally, without interventions or drugs. In fact, home birth is as safe (if not safer) than hospital birth for low-risk women. The Canadian Medical Association Journal article, “Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician,” details birth trends for nearly 13,000 births.

There were three groups of women in this study: those planning home births with a registered midwife, those planning hospital births with a registered midwife, and those planning hospital births with a physician. The first two groups were attended by the same group of midwives; additionally, all of these women met the eligibility requirements for home birth, which means that women in both of these groups did not have any preexisting disease, significant complications of pregnancy (such as hypertension and gestational diabetes), or multiple fetuses, among other criterion. The study showed that rates of perinatal death (that is, death during the last weeks of pregnancy and up to four weeks following birth) were slightly lower in the planned home birth group (0.35 deaths per one thousand births) than in both of the groups of womenplanning to give birth in the hospital (0.57 deaths per one thousand births in a hospital attended by a midwife and 0.64 deaths per one thousand births in a hospital attended by a physician). This means that there were fewer deaths of mothers and babies in the planned home birth group than in both of the hospital birth groups.

All obstetrical interventions, such as episiotomy, electronic fetal monitoring and assisted vaginal delivery, pose some risk to the mother and baby. The same study showed that “women who planned a home birth were significantly less likely to experience any of the obstetric interventions [that were] assessed, including electronic fetal monitoring, augmentation of labour, assisted vaginal delivery, cesarean delivery and episiotomy.” For instance, 3 percent of mothers in the planned home birth group received an episiotomy, while the women who planned hospital births with midwives and doctors had episiotomy rates of 7 percent and 17 percent respectively. Twenty-four percent of women who planned homebirths had some augmentation of labor (such as rupture of membranes or oxytocin), while the women who planned hospital births with midwives and doctors had labor augmentation rates of 40 percent and 50 percent respectively.

Additionally, women who planned to give birth at home were also much less likely to have adverse maternal outcomes, such as third- or fourth–degree peritoneal tears or postpartum hemorrhage. Furthermore, newborns in the home birth group were less likely to have birth trauma, require resuscitation at birth, or have meconium aspiration. All of these trends make it clear that mothers and babies in the home birth group were safer and healthier than those that planned births in a hospital.

Birthing at home allows the mother to be in control of her birth experience. It allows the mother to give birth as directed by her body’s intuition, not as directed by protocols and rules. It is a safe and healthy choice for mother and baby. It facilitates bonding, breastfeeding, and family closeness. It allows women to experience the true joy of labor and birth. A mother giving birth at home can listen to music, dim the lights, soak in her own bathtub, or even go for a walk and revel in the nature around her home. She also maintains control over important decisions, such as whether or not her child gets vaccinated, which germs the baby is exposed to, and what kind of food and drink she consumes. I am hopeful that someday our society will awaken to the truth about labor and birth, and will let go of the idea that the only place to give birth is in a hospital.

This post is part of Frugal Days, Sustainable Ways, Fight Back Friday at Food Renegade, Pennywise Platter at The Nourishing Gourmet, Real Food Wednesday with Kelly the Kitchen Kop and Monday Mania at The Healthy Home Economist

22 comments:

Megan said...

This is a great editorial, if that's what I call it! And it's all based on fact. I just finished reading "The Thinking Woman's Guide to a Better Birth" by Henci Goer and loved it. It is a must-read for any woman about to give birth, whether at home, a birth center or at a hospital. I had the pleasure of delivering at a birth center for my first and felt completely safe the whole time. We had good outcomes (ASIDE from having a low-birth weight baby, which had nothing to do with the birth center) and if I were not high-risk this time around, I would strongly consider having a home birth. I felt very empowered after my first delivery.

Initially, home birth only scared me because I didn't know if I'd find my home a comfortable place to give birth; I thought I'd be too worried about this or that and distracted by my own chaos, but now that I've gone through labor once I realize that you are so in the zone you don't have time to worry about the little details, and how nice would it be to just stay in one place the whole time? I also love the idea of the older sibling being able to be present (if that's what makes the most sense) to welcome the new baby into the world!!

I only wish more people could get over the stigmas attached to homebirth, for low-risk, healthy women!

I once heard a quote that has stuck with me:
"There is a secret in our culture,. And it's not that childbirth is painful,. It's that women are strong." -Laurie Stavoe Harm

Sarah Smith said...

Wow, what a great quote Megan! It makes me sad that so many women don't give labor and birth a chance to be fun and enjoyable. They go into it expecting it to be awful and painful, and so they experience it as awful and painful; just something to get through. Yes, it is painful at times, but it is also amazing and incredible and thoroughly enjoyable.

Michelle said...

I just discovered your blog and am very impressed with your excellent post! Well done!!!

Sarah Smith said...

Thanks Michelle!

Tom and Juli said...

Love it! I have finally convinced Tom that with our next we will have a home birth, now I can't wait!

I never minded the hospital much and we had 2 good experiences there, but it wasn't as comfortable as home, not to mention that staying there after the baby comes is just depressing especially waiting for doctors and nurses to tell you when you can go home. Not to mention the uncomfortable bathrooms, dirty floors, and beds that are impossible to sleep in! Yuk!

Sarah Smith said...

That's great, Juli!

mygapsmusings said...

Every time I read an article like this I feel absolutely blessed to have been able to have both of my boys at home. They were both about 24 hour labors and my boys were born perfectly healthy. I joke that one was born upstairs (my younger, now 18 months) and one downstairs (my older who just turned 7). DH did great during both labors though he did grumble a bit during the second - guess he knew what was coming!! I had 2 midwives, an assistant and a doula at my first birth and the same midwife and an assistant during my second. Great article Sarah!
Magda

Sarah Smith said...

Thanks Magda!. I am also so thankful that I learned about home birth before I had both of my children.

Anonymous said...

Thanks for the specifics of that study. I had always heard that home birth was safer, but the skeptic in me assumed that the hospital birth stats included higher-risk mothers/babies.

I've had three natural hospital deliveries but would love to give birth at home...mainly because I don't like having to stay in the hospital afterwards. :) I will definitely be sharing this informative article with my husband!

-Brittany

Sarah Smith said...

Great, Brittany! Yes, that was a very well-designed study. Too often, studies are not designed properly to isolate only one variable, and then there is no way to know for sure.

Katie Glathar said...

Love this post. Would never have considered a home birth (had 2 hospital births) but after having one in the car on the way to the hospital we decided that our 4th would be at home. What a wonderful experience. If the Lord wants us to have more I would love to have another home birth. God Bless you!

Ubermom said...

Ironically, I just submitted a post to Fight Back Friday about a related topic! A close friend had her fifth baby and fifth homebirth yesterday afternoon. I went over today to visit the baby and mom and brought dinner and munchies for the kiddos. I think people forget that when babies are born at home, there is no hospital staff to supply food and snacks. I have been blessed to have meals brought to me after each of my ten children and I try to pay it forward. You make excellent points, every one!

Sarah Smith said...

Hi Ubermom,
Yes, having a community of people willing to bring food after a baby is born is really a blessing! It can make things so much easier. We also stocked our freezer with lots of homemade frozen meals, and that helped tons too.

Heather said...

I just had my third baby and second homebirth a week ago yesterday. Both homebirths were babies over 9 pounds, meaning that, especially given that I'm well over 35 and not exactly skinny, I would most likely have had to fight off C-sections in the hospital...but the 9 lb 2 oz boy we welcomed into the world early last Friday morning left me with one tear not bad enough for a stitch.
Ladies, if you are medically a suitable candidate for homebirth, it is SOO much easier and less stressful. You are giving birth in the place you feel most comfortable and powerful, just like every other female mammal does if she can at all. My water broke when I got up Thursday morning, and I had contractions every so often all day long--but nothing that kept me from doing housework (lots of nesting that I was SOO glad the next day it got done, as little man was 2 weeks' earlier than expected & we were not quite ready for him!) and even having company. About 10 pm, after dinner was done and my 4 year-old and 2 year-old were sacked out, the contractions got down to business, we called the midwife to come back (she had stopped by earlier to check on me), and had a baby at 5 after 2am. My other kids were sound asleep just across the hallway and never even woke up, even though I wasn't quiet at the end! But they were delighted to wake in the morning to a new baby brother...

Sarah Smith said...

Heather - Thanks for sharing your great story!

Rebecca said...

THANK YOU! THANK YOU! THANK YOU, for posting this wonderful and informative post!! I am FIRM advocate of home-birthing and recently had my first sweet baby at home (water birth actually) it was a looooong tiring labor (47 hours) but SO SO worth it! If I had been in a hospital they would most definitely made me have a c-section....however, my midwife and doula were very aware of everything going on with me and my sweet girl, and there was nothing to worry about. Everything was fine and she was delivered perfectly! She is now a healthy, happy 8.5 month old little girl! I will have ALL my babies at home....i've always been fascinated with pregnancy and birth, but have now become slightly obsessed with it...especially home births! ha :)

A great book to read if anyone is considering doing home births is Supernatural Childbirth by Jackie Mize! It changed my life and view of home births!

Anonymous said...

i am currently thinking of home birth but my partner isnt realy on board i am torn between hospital and home. i want to be there for my other children and not have toleave them. its my fourth baby and ant tobe comfortable! hmm got sometime to think yet.thank you all fr thecomments and stories they are really inspiring. might just go with what my heart is telling me and have the baby at home!!

Justyn @ Creative Christian Mama said...

I am planning a home birth with a midwife for my second baby (the due date is just two weeks away!). It's always so encouraging to hear about other women who have birthed at home and to see posts about the safety of home birth. I just finished a series on why we're choosing home birth on my blog. Thanks so much for sharing! :-)

Amy said...

I have to say that I would not be here nor my baby if I were not in a hospital to give birth. My first child slipped out with no problems; however my second child was STUCK. He was upside down and was not coming out. His heart nearly stopped beating before they did an emergency Csection on me. If I was at home we both would probably be dead. I strongly recommend talking to your doctor or midwife to have the birthing experience you want, but do it in a hospital.

Nancy said...

I concur with Amy. My first child was an easy birth but my second child was delivered as a C section. I pushed and pushed for hours and was so exhausted, I couldn't go on any longer. I believe my child would be dead if I did not have an emergency C section. Please have a back up plan if an emergency occurs.

Sarah Smith said...

I think that the statistics speak for themselves. Yes, there are bad things that can happen at home or in a hospital. I happen to have been transferred to the hospital after my first home birth because of postpartum hemorrhage (after having a retained placenta); but my homebirth midwives still handled everything well and did a very good job of the manual placenta removal. Sometimes transfer to the hospital is necessary, but that does not mean that home birth is inherently more risky.

There are no guarantees: I have a friend who had a retained placenta with a hospital birth, and the uninformed person attending to her actually yanked the umbilical cord hard enough to invert the uterus (pulled the uterus out of the body); they then had no idea what to do and started to prep her for an emergency hysterectomy. Thankfully, a doctor walked in at the right moment and took matters into his own hands by pushing the uterus back into her body. This just illustrates that, even in a hospital, things can and do go wrong sometimes. I believe that knowing your care provider well and knowing how experienced they are makes a big difference, and unfortunately you don't often have much control over who is caring for you in a hospital.

Denna Engel said...

Hi Sarah!
I just discovered your blog! I love that you talk about birth and nutrition in such an open and informative way. I will definitely be following along!
I had a home water birth with my daughter, and I am so glad I overcame the irrational fear of birth. It was so empowering and I can't imagine wanting it another way.
Looking forward to seeing more of your posts!

I blog about similar topics. I just posted an article about Himalayan Pink Salt if you're interested :) http://gosouthatalbuquerque.com

See ya soon!

Denna Engel