I received some encouraging feedback after posting my birth story. It led me to write a more detailed post about some of the reasons that we decided to birth at home. It’s hard to summarize such a complicated and emotionally-inspired topic, but here are some preliminary thoughts…
Why We Chose a Homebirth
I wasn’t always comfortable with the idea of birth. Like many, I was indoctrinated into a culture that presents birth as something painful, terrifying, and prone to disaster.
I closed my eyes when we were shown a video of a hospital birth in 8th grade health class.
I remember another teacher returning after maternity leave and explaining that, “No, birth was not fun, it was like pushing a watermelon through a donut hole.” I tried to imagine this, but the donut always fell apart…
I thought I probably would not have children as a young adult. If I wanted kids, maybe I would adopt. Having babies naturally seemed like it was just too much to handle.
Until I thought about getting pregnant myself, I don’t think I had ever heard a single positive birth story.
And then I watched “The Business of Being Born”. The scene of a woman swaying in water, her older child and husband standing nearby, is still fresh in my mind. Suddenly, without any sound, without any indication of anything really, she reaches down and pulls up her baby. My mind was blown. Birth did not have to hurt. And certainly birth did not have to be traumatic!
As I went on to read more and more about birth, I came to realize that our culture has an unhealthy view of birth. What can be the most empowering, influential, life-changing, and natural time in a woman’s life has become something to be avoided, afraid of, and highly medicalized.
Yes, things can go wrong in birth and we should be very thankful that we have life-saving procedures for when things go wrong. But I began to realize that it is too often the medicalization itself that leads to poor outcomes for women – it is turned to too quickly and relied on too frequently instead of trusting women’s innate abilities to birth.
In 1965, the United States had a cesarean rate of 4.5%. The World Health Organization suggests that, typically, life-saving c-sections will occur about 5-10% of the time, and that rates over 15% are harming women and babies more often than they are helping. In the U.S., we now have a c-section rate of over 30%. One in three women will have major abdominal surgery that potentially impacts the psychological and physical health of both her and her baby. This is a major surgery that could often be prevented or avoided.
Is it because women are choosing this more or there is something physically defective with U.S. women, maybe because they are birthing later in life? No, it is more often because we have not adequately empowered women about birth, we too often push medical interventions that are unnecessary, there is not much awareness of how many complications can accompany c-sections, and sadly, this choice is often more convenient for healthcare providers.
It has been observed that c-section rates rise before holidays and long-weekends. Other important events may also lead doctors to suggest unnecessary cesareans. One of my new-mother friends mentioned that her doctor called a few days after her due date looking to schedule a cesarean. He was, after all, supposed to leave for a conference in another day and wouldn’t be able to deliver her vaginally if he was gone. Thankfully, she went in to labor that night and avoided the surgery.
Some women who have had a medicalized birth that ended in c-section will speak of how their child’s life was saved because of the intervention. However, there was often an intervention to begin with that cascaded into increasingly complex treatment. Again, I acknowledge that this can be a life-saving procedure, but too often it is turned to prematurely, or becomes necessary because other interventions were pushed due to impatience and/or fear of the natural birth process.
Even with my own birth I imagine that had I been in a typical hospital scenario, my birth could have easily led to intervention. After 20+ hours of labor (if not sooner!), I likely would have been offered pitocin. Pitocin would have altered the frequency of my contractions and could have led to altered fetal rhythms that may have ended in a “life-saving” c-section that was completely avoided by giving birth at home. (Also see other negative impacts of the very commonly provided pitocin: Pitocin Side Effects and Risks).
I came to learn that other common hospital interventions like forceps use and episiotomy were surprisingly uncommon and seen as unnecessary in home and birth center births. (For an impressive example, check out The Farm midwives’ statistics in the Ina May Gaskins book, Guide to Childbirth. They are extremely impressive.) Furthermore, I wanted to avoid pain management drugs and experience birth naturally to avoid risks to my laboring hormones, breastfeeding, and body associated with interventions like epidurals. Additionally, the psychological and self-esteem benefits of a natural birth were extremely appealing and seemed more feasible in the comfort of my own home than in a hospital.
As with most life-changing situations, birth is undeniably risky. Things can and do go wrong. However, I came to these conclusions:
- The things that can go wrong in birth that lead to mortality or other extremely negative outcomes are very rare. The things that can go wrong with a hospital birth are common.
- My midwife had birthed over a thousand babies and would know when it was appropriate to suggest a transfer to a hospital. She could monitor the baby’s heart rate during labor and she also brought emergency supplies like pitocin (it does help in dangerous situations where the labor must be sped up or the uterus must contract to expel the placenta) and resuscitation equipment. The stories of when she had transferred previously comforted me (because she was very cautious to suggest this at the first indication of a problem), as did her low rate of c-sections (she could count them all on one hand).
- If anything above and beyond what we could handle at home happened, I had a relationship with midwives in a hospital-based practice, and an emergency room was a 6-minute drive away.
- I was willing to accept the consequences of my homebirth because I had prepared for it and determined that it was the safest, best, most wholesome, and life-affirming choice for my baby and me.
I will not lie and say that this was easy to do. We were in our 7th month of pregnancy before we officially decided to go forward with a homebirth. We had the idea in our minds the whole time as the ideal (we had interviewed a different homebirth midwife when we were 6 weeks pregnant), but we were also seeing a midwife group that worked in a hospital. They had a room with a waterbirth tub and promised lower rates of intervention. It seemed like a good compromise for our first birth, especially considering the taboo nature of homebirth (only 1% of women choose this option) and some close family’s hesitancy that made me feel fearful of this choice.
However, as I got further into my pregnancy, it became apparent that the hospital-based midwives were still very much dependent on the medical model of birth (even if this was not what they wanted, they have doctors to whom they must report). I didn’t feel that they respected my wishes, and often felt like they couldn’t really hear what I was saying about my pregnancy and birth choices. If a group of midwives who claimed to be “holistic” were acting this way during my pregnancy, how would they respond if anything were to be “off” during my labor and delivery?
I was concerned that they would resort to the conventional medical approach to childbirth rather than the patient, woman-centered approach typical of homebirth midwives. Furthermore, upon touring the delivery room that was touted as being so very holistic, I realized that it just looked like a large hospital room with a tub. I still felt that it was just a room within a building that held sick and dying people – not a place for a pregnant woman on a life-changing journey.
Had a freestanding birth center been available, I might have gone with that option. However, I also felt that, given my desire to have a natural birth and peaceful entrance for my baby, I would be most able to do this in the comfort of my own home surrounded by my unique belongings, smells, pets, and conveniences. As I spent time meditating on my birth outdoors, I observed birds and squirrels and reflected on their fear-free births. I began to experience the overwhelming feeling that yes, indeed, birth is totally natural and does not need to happen within a hospital.
Furthermore, when I imagined giving birth, I pictured myself on my hands and knees in my family room, not on a hard hospital floor; I saw myself in a comfortable large tub, not a hard, sterile one in the midst of a hospital; and I saw myself surrounded by candles, cats, dim lights, and my birthing affirmations. I pictured my baby emerging into a warm, dimly lit environment free of stress. I also saw my new family spending the day in our own bed, eating our own food, and getting cozy together without ever leaving home. And this is how it was. And it was beautiful. And empowering. And I learned to trust birth and my body.
I do not think homebirth is for everyone, and I think that it is very important to find a competent midwife and to be a healthy, low-risk woman who is aware of potential complications. However, homebirth can be a great option for many looking for an empowering birth experience that welcomes a baby in peace.
Perhaps more importantly, however, I hope for a future where all births, regardless of where they occur, are as intervention-free as possible with c-sections occurring only when necessary. I hope that wherever women birth that they feel empowered, that they have control over their environment and what happens to their bodies, and that their babies are born into peaceful, calm, and loving hands. In the event that emergencies occur, I pray that every woman has access to a talented obstetrician that can save either her or her baby’s life. Perhaps in the future we will have access to more freestanding birth centers that both minimize intervention while functioning to utilize medical technology if necessary. Mostly, I pray that women will again come to understand birth as a beautiful, empowering, and life-affirming process that should not be feared.
In the last month of my pregnancy, I had finished nesting around the house and had some extra energy. I created a list of birthing resources to help others interested in this topic. I’m not sure what will happen with this resource in the future, but there are links to some excellent sources! Check it out here.