Home Birth is Safe and Healthy

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 we are designed to handle naturally, without interventions or drugs. As an avid researcher of so many decisions in my life, it was surprising that people would think I was somehow being cavalier by deciding to have a baby at home, as if I was potentially sacrificing the safety and health of my unborn child.

In fact, home birth is as safe (if not safer) than hospital birth for low-risk women. A recent study of nearly 13,000 births was published in the Canadian Medical Association Journal [1]. 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. Both groups of women that were attended by a registered midwife 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 (i.e. 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 1000 births) than in both of the groups of women planning to give birth in the hospital (0.57 deaths per 1000 births in a hospital attended by a midwife and 0.64 deaths per 1000 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/or baby. The same study [1] 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% 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% and 17% respectively. 24% 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% and 50% respectively.

In the same study [1], women who planned to birth at home were also much less likely to have adverse maternal outcomes, such as 3rd- or 4th –degree perineal tears or postpartum hemorrhage. Additionally, 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.

This article is part of a series on home birth. For more about home birth, check out these articles:
Why home birth?
Natural birth is optimal and empowering
Home birth allows mothers the freedom to move
Home birth facilitates bonding and breastfeeding
Home birth works cooperatively with the Sphincter Law 
Home birth is great for siblings 

Are these home birth statistics surprising to you?  How was your birth experience?

Reference
[1] “Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician”, Patricia A. Janssen PhD, Lee Saxell MA, Lesley A. Page PhD, Michael C. Klein MD, Robert M. Liston MD, Shoo K. Lee MBBS PhD, Canadian Medical Association Journal, 15 September 2009, Volume 181, Issue 6-7.

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! 

A Nutrient-Dense Diet During Pregnancy Saved My Daughter's Life

I wanted to share a story that shows the power of a nourishing, traditional diet during pregnancy. When I got pregnant during the summer of 2006, I had spent the previous few months following the pregnancy dietary recommendations on the Weston A. Price Foundation website, including plenty of grassfed beef, pastured chicken and eggs, butter, raw milk and cheese, fish eggs, homemade chicken stock, sprouted and/or soaked whole grains, fruits and vegetables, and of course the daily dose of cod liver oil. I planned to have a homebirth with midwives, and one of the focuses of midwifery is the diet of the pregnant mother. Throughout the pregnancy, my midwives were amazed and pleased with my diet that was so outside the norm.

Towards the end of the pregnancy, there was some concern because my baby seemed small and my blood pressure was getting quite high. Nonetheless, my husband and I decided that homebirth was still our most prudent course of action. After an enjoyable labor, Alina was born at home on March 17, 2007 at full term. She was 18 inches long, but we were all surprised to see just how skinny she was, weighing in at just 4 pounds. The cause of her low weight soon became apparent as the placenta was only half of normal size with large portions that were not properly formed. Alina was so small because nutrient flow through the placenta was severely limited. The placenta was unlike any ever seen by the senior midwife, who had attended over 2,000 births.

My midwives told me that told me that I was able to maintain the pregnancy only because of my exceptional diet during pregnancy, and that such a compromised placenta would generally lead to miscarriage. Besides being skinny, Alina was born perfectly healthy, and was able to gain weight faster than any low-weight baby the midwives had ever seen (which is saying a lot considering they had both worked in neonatal wards). With lots of nursing, Alina doubled her birth weight by the time she was 8 weeks old.

Why the placenta was malformed remains a mystery. My theory is that it is related to over ten years of birth control pills prior to pregnancy in combination with the fact that, according to my fertility awareness charts, my hormone levels were abnormal when Alina was conceived (even though I had been off the Pill for 7 months). Regardless, I owe the life of my daughter to the nourishing, traditional diet recommended by WAPF. I am so thankful to have learned about the research of Weston Price early enough to save my daughter's life.

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

Home Birth is Great for Siblings

This article is the last in a 7-part series on home birth. For more about home birth, check out the Pregnancy and Parenting Index.

Becoming an older sibling can be difficult for children as they adjust to their new roles and the necessarily divided attention of their parents. Birth can be a time to welcome the new baby, and allowing the sibling to be present at the birth can help to ease the transition. In a study of parents whose children were present at birth [1], certified nurse-midwife Christina Krutsky found that “the children’s presence added to a feeling of family unity.”

When a mother gives birth in the hospital, it can be traumatic for the siblings. Young children are typically not allowed to be present during labor and delivery. Additionally, the siblings are separated from their mother during the hospital stay. My daughter is accustomed to being with me most of the time, and she was still sleeping in our family bed when her brother was born. It could have been very difficult for my daughter had I given birth to her brother in a hospital rather than at home.

Although my daughter slept through my rather quick second labor, she woke up immediately after my son was born and was able to take part in welcoming her brother to the family. It was such a special moment when, at around 2am, we all sang “Happy Birthday” to her new little brother. At nearly three-years-old, my daughter was excited to be able to help by getting a hat for the baby and then watch as he was measured and weighed.

Birthing at home allows siblings to take part in welcoming the new baby to the family.  In our society where birth is looked on with fear and negativity, having siblings present at home births can also be a great way to show children what a normal, natural occurrence birth can be.




Reference
1. “Siblings at birth: Impact on parents”, Krutsky, C., Journal of Nurse-Midwifery, September-October 1985, Volume 30, Issue 5, pp. 269-276.

Home Birth Works Cooperatively with the Sphincter Law

This article is the sixth in a 7-part series on home birth. For more about home birth, check out the Pregnancy and Parenting Index.

As described in Ina May’s Guide to Childbirth [1], the vaginal and cervical sphincters operate just as the excretory ones do. “Each sphincter’s job is to relax and expand so that it can open comfortably and wide enough to allow the passage of whatever must move through” [1]. Since the cervix and vagina are sphincters, they operate under the Sphincter Law. This means that they do not respond to orders (such as someone telling a mother to push), they work best “in an atmosphere of familiarity and privacy”, they “may suddenly close when their owner is startled or frightened”, and they are more easily opened when the mouth and jaw are relaxed. Furthermore, “the presence of a strange person in the birth room, especially if the person is male and not an intimate companion of the laboring woman, frequently (although not always) slows or stops labor” [1].


The atmosphere while birthing at home naturally works well with the Sphincter Law. The mother is comfortable with her surroundings, and the only people present are those that she knows. She is less likely to have fear as her midwives will generally treat labor and birth as a natural occurrence rather than as a medical situation that must be managed. Since the mother will be comfortable and have less fear, she may experience labor as a more joyous process, possibly even smiling and laughing which would further allow her body to work with the Sphincter Law. I certainly would not have felt as comfortable birthing in a hospital as I was at home, and the Sphincter Law shows that the mother’s comfort level is intimately connected to how smoothly her labor can progress.

Reference
1.  Ina May’s Guide to Childbirth, Ina May Gaskin, 2003, pp. 141 and 170-179.

Home Birth Facilitates Bonding and Breastfeeding

This article is the fifth in a 7-part series on home birth. For more about home birth, check out the Pregnancy and Parenting Index.

photo via igotmompower

Bonding between the newborn and mother may be disrupted in hospitals since, in many hospitals, babies are separated from their mothers for at least part of the time. The baby may be whisked away to be cleaned and weighed immediately after delivery, taken away from the mother for vaccinations, or not allowed to sleep in the same room as the mother. An advantage of birthing at home is that the baby can stay with the mother as much as desired.

In hospitals, there are numerous ways that breastfeeding can be compromised. According to So That's What They're For!: The Definitive Breastfeeding Guide [1], “babies born to women who’ve had drugs during their labor may be more sluggish than those born to women who did not have drugs. They also may have sucking problems.” Additionally, if the baby is not given the opportunity to nurse in the first hour following delivery, breastfeeding may be more difficult. According to Swedish doctor Lennart Righard MD [2], “Immediately after birth we often deny normal newborn activity by taking the baby away from the mother, thus disturbing the baby’s normal searching for the breast. Often the baby is exhausted by interventions in labor… In natural birth without any interventions, sensitivity is much higher. Being laid on the mother’s abdomen… the newborn baby is given warm intimate contact that stimulates the senses, especially touch and smell. This contact helps the alert newborn baby to actively search for the breast, to breastfeed. Breastfeeding in this early stage is made possible by intuition and inborn reflexes, and of course, this sensitive process should not be disturbed by unnecessary interventions.”

The widespread use of pacifiers and bottle-feeding in hospitals may also disrupt breastfeeding. In a study to determine if pacifiers contributed to breastfeeding failure [3], the conclusion was that “to promote successful breastfeeding and to reduce nursing problems… the use of pacifiers should be avoided or restricted.” Mothers are also more likely to feel pressured to try formula or to give up nursing in a hospital, whereas home birth midwives are generally supportive of breastfeeding.
In my own experience, I was able to cuddle and bond with both of my babies right away. They were both born eager to nurse, and it was amazing to see how they instinctively knew how to latch on immediately after delivery. Being at home allows mothers the freedom to bond with their baby during the alert period after birth, to breastfeed as much as desired, and to easily control whether or not their baby is exposed to a pacifier or bottle. 

This post is part of Pennywise Platter at The Nourishing Gourmet, Fight Back Friday at the Food Renegade and Monday Mania at The Healthy Home Economist!

References

1. So That's What They're For!: The Definitive Breastfeeding Guide 3rd edition, Janet Tamaro, 2005, p. 61.

2. “Helping to Maintain Natural Behavior at Birth”, Righard, L., Birth, March 2010, Volume 37, Issue 1, p. 84.

3. “Breastfeeding and the Use of Pacifiers”, Righard, L. and Alade, M. O., Birth, July 1997, Volume 24, Issue 2, pp. 116–120.

Home Birth Allows Mothers the Freedom to Move

This article is the fourth in a 7-part series on home birth. For more about home birth, check out the Pregnancy and Parenting Index.

It is commonplace for women laboring in hospitals to be confined to beds, often times as a result of IV’s or electronic fetal monitoring. However, as described in the book Active Birth : The New Approach to Giving Birth Naturally [1], “women have easier labors and births when they move about and assume upright positions… There is more than sufficient evidence that upright birth positions – kneeling, sitting, standing, and squatting – are more advantageous to both mother and child.”

My own experience certainly agrees, as I found movement to be invaluable during both of my labors. I labored with my firstborn for about 16 hours, bouncing on an exercise ball and singing along to music during the early stages and then, as things progressed, standing up for each contraction and pulling on a doorframe. During the couple hours of passive descent, I laid down to rest in between contractions but was compelled to stand up each time a contraction approached. When the urge to push finally came, I squatted on the floor, pushed a few times, and out she came.

My second labor was much different, with my son being born just 2 hours and 15 minutes after my first contraction. It was the middle of the night, but it felt imperative for me to stand up and walk around between contractions, and then lean on a counter while moving my hips around and moaning during contractions. Things progressed quickly, and I very soon needed to wake up my husband so I could lean on him during each contraction. The apprentice midwife was the first to arrive, and I felt my first urge to push just after her arrival.  She requested that I lie down to slow things down while we waited for the midwife to arrive. Lying down made the contractions seem much harder to handle, even as I lay with my husband for encouragement and support. As soon as the midwife arrived, I toddled to the bathroom and my son was born in a couple pushes while I squatted over the toilet.

Overall, movement really helped me feel like I was going with the flow of labor. Moving around helped me tremendously, and I cannot imagine having been confined to a bed. Active birth “is the way that a woman behaves when she is following her own instincts and the physiologic logic of her body. It is a way of saying that she herself controls her body while giving birth, rather than being the passive recipient of a birth that is managed by her attendants… An active birth is instinctive. It involves your giving birth quite naturally and spontaneously through your own will and determination, having the complete freedom to use your body as you choose and to follow its urges” [1].

It is no wonder so many women seem to feel the labor is too intense and out of control; if they could only get up and move with the flow of energy in their bodies, they could labor much more on their own terms.

Reference
1. Active Birth : The New Approach to Giving Birth Naturally, Janet Balaskas, 1992, pp. 1-3, 13.

Natural Birth is Optimal and Empowering

This article is the third in a 7-part series on home birth.  For more about home birth, see the Pregnancy and Parenting Index.

Natural, drug-free birth is undoubtedly what nature intended. There are risks associated with the use of any drugs to augment labor (such as pitocin which is used to speed up labor, or epidurals which are used to numb the mother to pain), and it is known that babies exposed to drugs during delivery will be affected by those drugs. Even for a mother who strives to have a natural, drug-free delivery, birthing in a hospital setting makes that outcome less likely.

In a hospital, there are certain protocols that must be followed, and these often include restrictions on how long women are allowed to labor, what positions they may labor in, and even whether or not they are allowed to eat or drink. Additionally, women are offered drugs as a solution to the perceived problem of labor, when in reality labor is a normal bodily process and not a medical problem for most women. Birthing at home allows mothers to follow their bodies’ instincts and to do whatever they need to accomplish the task of having a baby.

In the words of Ina May Gaskin [1], “your body is not a lemon.” Your body was designed perfectly to give birth naturally and spontaneously. When you follow your body’s cues and give birth naturally, you are left with a profound respect for your body. During my first labor, I reached full dilation but did not feel the urge to push until a couple hours later. My daughter was still high up in the birth canal, and my body used a couple hours of passive descent to move her down. During this time, my contractions became less frequent, giving me the opportunity to rest for about 10 minutes before each contraction. If I had been in a hospital, it is likely that I would have been instructed to push as soon as I reached full dilation. This could have resulted in me expending lots of energy and getting quite worn out. By being at home, I was able to relax while my body naturally did the work of moving the baby down, so that when I did feel the urge to push she was born in just a few pushes.

After both of my labors, I felt that I had accomplished something vitally important. I was left with a feeling of deep empowerment and connection to all the other women who have given birth.

Reference
1. Ina May’s Guide to Childbirth, Ina May Gaskin, 2003, pp. 141 and 170-179.

Why Home Birth?

This article is the first in a 7-part series on home birth. For more about home birth, check out the Pregnancy and Parenting Index.

In 1940, 44% of all births in the United States occurred at home. However, since 1969, about 99% of all births in the United States have occurred in hospitals [1]. This means that the last few generations of women in the United States have had very little exposure to home birth, either in first-hand 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 to be attended by a doctor.

Growing up, I never heard of home birth. I heard of midwives, but never considered that there could be an alternative to birthing in a hospital.  I had always heard of birth as either an awful experience, or just something you have to get through to have a baby, but never something that could be enjoyed.
I have now birthed two children at home, and each labor was an amazing experience. I am saddened that so many women will never get to experience labor and birthing as such a joyous and empowering experience. This is not to say that women birthing in hospitals will never feel the joy and empowerment of birth, but those emotions are generally not associated with labor and birth in our society.

Birthing at home allows the mother to be in control of her birth experience. She is free to enjoy the comforts of her own home. She can have as many or as few guests as she likes. She 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 can also easily control things like whether or not her child gets vaccinated, what germs the baby is exposed to, and what kind of food and drink she can enjoy. Home birth adds a sense of history to the home, as children are brought into the home they will live in.

Home birth is a liberating choice. It allows the mother to 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. 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.


Reference
1. “Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990-2006”, Marian F. MacDorman PhD, Fay Menacker Dr. P.H. C.P.N.P., Eugene Declerq PhD, National Vital Statistics Reports, 3 March 2010, Volume 58, Number 11.