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Hi! I'm a "midwife-to-be" and the founder of Indie Birth. I'm a homebirth mom and am most passionate about educating, supporting and lovin...
 
 
 
 

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What's Really Keeping You From a Homebirth?

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I want to know why more women don't choose homebirth.

I don't know many women outside of my little circle that do choose homebirth.  Still, these women are highly educated women who seem aware of their options, and many have even elected to have natural births.  So what is keeping them from wanting what I consider the "optimum" birth experience?

There are studies touting safety-showing homebirth is just as safe, if not safer than hospital birth- if that's the concern.  There is all kind of support, if you look for it, and birth stories and birth videos to get a peek at what it might really be like.  If you ask the right people in your community, you can find out who the homebirth midwives are and interview them, ask them about all your questions and concerns.  But why aren't most women doing these things?  Why do they just choose the default option,  hospital birth?

So, if the "facts" about homebirth are convincing and available, it seems to me that women are choosing hospital birth from an emotional, instead of practical viewpoint.  Women are more emotional it seems, at least compared to men, so this makes sense.  What bothers me is that the "emotion" is fear.  

Let me back up here.  I am not fearless in the face of pregnancy and birth.  But I am not fearful.  

I view birth as something to be respected, not controlled.  I respect birth as the miraculous process it is, but I fully recognize that it is not always what we want, need or hope it to be, and there are risks just as there are with anything in life.  On the other side of life is death, and we must respect that.  Because I respect birth, I do not and would not try to control it or relinquish the responsibility of my body or my baby to anyone else, regardless of the situation.

I think that choosing hospital birth is relinquishing this responsibility, and the sad fact is I think many women consciously choose this path over homebirth because the respect for birth is not there.  

And ultimately, many women also do not want the responsibility that comes with birth.  

You can't really rid yourself of this responsibility of course, but you certainly can transfer it, and this is my definition of hospital birth.  But still I ask, why would any women want to transfer the responsibility of her own health and her baby's  health to anyone else?  

It really comes down to informed consent.

It's not about knowing it all, or tuning out information or a scenario you don't want to hear.  It is about being provided all of the options and information, and making your own decisions and your own choice.  And here lies the crucial difference between homebirth and hospital birth and also the reason I think most women choose the latter.

They don't know that informed consent exists, and ultimately they don't want to have to do the work to make their own choices and live with them.  They choose "the doctor says" over what their body is telling them to do, and there is no worse place for that than in birth.  

To put a positive spin on this dire situation, I challenge you to ask yourself a few really hard questions during your pregnancy that only you know the answer to.  For many women, the way to a homebirth comes after soul-searching and connecting with the innate ability we all have to give birth naturally and with minimal interference.  

How do I view birth?  What experiences have I had that have influenced this view?  

Deep down, do I feel like I need "help" in having a baby?

Am I willing to truly accept the responsibility that comes with being pregnant, giving birth, being a parent, even when and especially when I cannot control every aspect of these things?

Do I feel like I have to be socially acceptable in my birthing choices (often choosing hospital birth)?  How important is it to me to make a choice that everyone else agrees with?

Watch birth videos, home and hospital.  Close your eyes and visualize what you want for your baby.  What do you see?

The greatest power we are given in pregnancy and birth is the ability to examine our fears and make

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StudioAly 5 pts

My first born was "delivered" via "emergency" cesarean (that is a long story in and of itself, suffice it to say I do not believe it was an "emergency" because the doctors were seemingly planning this mode of "delivery" the entire pregnancy).  I actually wanted to have him at home and in the water, if that's what I felt like at the moment. After several years of therapy (I felt violated by the surgery), I was comfortable getting pregnant again. So, I found another midwife who was supportive of my drugless VBAC. Side note: I never believed in drugging myself during labor. Even when they induced me for the surgery, I refused to take pain killers (I endured the excruciating pain for over 2 hours!). Anyway, I had my VBAC, sans meds and I felt so empowered. I actually slept through the majority of my labor. I was absolutely relaxed and loving every moment of the process. Unfortunately, I am not sure if I will ever get the opportunity to have a home birth because of the surgery since it is so heavily regulated (despite extensive research). I wish my uterus didn't have laws attached to it.

She Who 5 pts

Many of them have been alluded to, here. Home birth attendants are hard to find, expensive to train and difficult to insure. Their services are not covered by many insurance plans that cover other kinds of birth. That, alone, puts them out of reach of many mothers. Additionally, the home-birth provider may exclude a mother, for any number of reasons.

In addition, people (including mother people) have various attitudes towards authority figures and institutions like hospitals. As the granddaughter of a hospital administrator, I grew up very comfortable in hospitals, but not reverent towards them. But people have varying levels of comfort with hospitals, and with certain hospitals. These things have to be taken into consideration, and it isn't always just the mothers who are part of the decision-making process. Dads, friends, and extended family make have a big impact on a mother, as she tries to balance only one of the first of all the different ways to piss off people becoming a mom will provide her with. ;)

I've had a number of friends who I would not support in a home birth, some I would not have supported in ANY birth (not that they ask me, lol), and some I thought would be fine mommies, eventually, but lousy at dealing with the birthing experience. For those last, particularly, a nice stern traditional hospital with bossy nurses and an autocratic surgeon at the delivery would be just the thing.  My mother, by the way, absolutely ADORED the doctor who delivered us, although I know I would have loathed him. She also disliked green olives, also a mystery to me. ;)

For me, a home birth was the only real alternative, and the fact that it was illegal to attend me I considered an outrage. Nonetheless, I had 4 lovely home births and one freestanding birthcenter birth which I did in order to share the birthing experience with a friend who happened to operate it. We were both a little sad to acknowledge, afterwards, that even their mild restrictions on me had made it a poor fit, and now we know I wouldn't do that again.

I hope for my children homebirths such as I've had. But I trust I'll cope if another option suits them better.

Breastfeeding is non-negotiable, however. :D

http://www.blogher.com/blog/she-who

Southerngirl 5 pts

When I went to birthing classes we were asked what we wanted at the end of labor and delivery.  My answer was a healthy baby.  I preface my next comment by saying I was a home birthed child delivered by the same midwife that delivered my mom and 5 of my 11 aunts and uncles.  Talk about history.  But I did not want nor need that experience.  I wanted drugs, rest and a healthy baby.  I did the hospital thing 3 times loved it.  Met wonderful kind caring nurses and loved loved the man with that neddle that turned me into a woman willing to marry him on the spot!  Truth be told all of the information and stats in the world caould not convine me to birth at home even though I had the option the first time around as my insurance covered it and sent me tons of info on my birthing options.   As one poster said OWN your choice.  My mom was totally agaist the epi and I was all gung ho for it.  I told her she had her chance and and this was my turn.  We did not agree but she respected my decision.  That is what we all need to do.  Respect that others make different choices and they are THEIRS and THEIRS alone to make. Birthing is such a beautiful experience if you are knocked out immediatly after like me the first time or you happen to not get to have the nice man put the neddle in your spine and you scream sweat and grunt your way through it as I did the last time. Each time I went home with a child that I cannot fanthom how I ever lived without.  I did not meant to rant but I said all that to say the beauty of it is it was MY choice.  I really resent the implication that I was not willing to take responsibility for my health and the wellbeing of my kids so I GAVE that responsibility to someone else by going to the hospital.  My goodness do we not have enough crap literally to deal with as parents?  Then we get to have each of choices analyzed. As my friend Stacie is fond of saying, "That is why I have my own kid and you have yours" I say when your check gets here you get an opinion otherwise......

Michelle

I blog at http://www.mommycan.blogspot.com/

jennydecki 5 pts

I am a woman. With a birth history going back as many generations as anyone else :)

The things a woman should do before deciding on homebirth:

1) Call your mom and ask what her birth experiences were like.

2) Lather, rinse, repeat with all other female family members.

If you have had previous hospital births analyze if there were complications and if there were - were they caused by things the doctors did or did they just happen and the doctor or nurses saved the situation. Is it something that might happen again?

Do you want to have a baby at home or do you feel safer in a hospital? 

Whatever your decision, own it. Be proud of your decision whether it be homebirth or hospital birth, c-section or vaginal, epidural or medication free. 

I am planning a homebirth for September of this year (2009) and it is comforting to know there is a hospital less than a quarter mile away if something does go horribly wrong. I don't think I'll need it - but you know - things happen. 

The thought of giving birth in my bed and sleeping in my bed with my baby after birth is ... indescribable. It feels like home both spiritually and literally. 

Since most of my hospital birth experiences (have 2 that were hospital born) involved nurses yelling at me to get back in bed and lay down already...plus being mocked for not having pain medication...makes it a logical choice for me. Oh, that and the ultrasound always shows 10-11lb. babies so they insist on inducing. Even though the resulting children were 8 and 9lbs. - logic does not prevail, LOL

But I would never fault anyone's decision for their birth. We are not statistics, but individuals with VERY different medical histories, family histories, and birth histories. Those are what should be taken into consideration, not a bunch of numbers compiled from "other people's" history and experience.

The only time statistics should be offered from either side is when a woman does not know her history and has to try and make an informed choice based on something. If you know your family and are able to ask them, you have way better information to pull from. 

jennydecki

Beyond Mom Blog ( http://beyondmom.com )

TheFeministBreeder 5 pts

I've had a cesarean and a VBAC in a hospital, and I never want to give birth in a hospital again.  However, it is seemingly impossible to find a homebirth provider in Illinois who will assist a homebirth for me.  Insurance will not cover providers who attend homebirth VBACs, even if you've had a vaginal birth already.  In fact, many midwives practicing in hospital settings will not/can not attend VBACs.  Also, CPMs cannot legally practice here.  Only CNMs and Physicians are allowed to attend home births, and most cannot find insurance to cover them even in a first, low risk pregnancy.  A lot of home births here are done "under the table."  There is a bill in Springfield right now that should turn this around, but so far nothing has changed.

That still may not necessarily stop me from birthing at home... but it will force me to do it unassisted, which I'm not thrilled about.  Insurance forced me to deliver with a cut-happy doctor last time, which led me to a 38-hour brawl with the hospital staff and my doctor(s) to prevent them from cutting me open again.  I got my VBAC.  But it was the hardest fight I've ever fought in my life.  I'd rather stay home and take my chances.  An ambulance is just a phone call away.

The Feminist Breeder
http://thefeministbreeder.typepad.com/

Molly70 5 pts

I had two other children at home and I was afraid that they would be climbing all over me, making their usual demands on me etc. when I really needed time alone with the new baby, to bond uninterrupted. I doubted if any number of grandparents or aunts could truly distract my kids from me immediately after a birth. Another good reason for not birthing at home: we live in an apartment building and I didn't want my neighbors to hear my yelling, screaming!

Amy TuteurMD 5 pts

Either you have statistics to show that homebirth is safe or you don't, and I know you don't. That's because all the existing scientific evidence shows that homebirth increases the risk of neonatal death.

You wanted to know what's keeping women from homebirth; the risk to their babies is what is keeping them from choosing homebirth.

Homebirth with a direct entry midwifes is a fringe of a fringe movement. It currently accounts for less than 0.25% of births in the US and the proportion has not changed in the past 25 years.

American homebirth midwives are grossly undereducated and grossly undertrained. They could not be licensed in any other country in the industrialized world. MANA is hiding their own statistics about the safety of direct entry midwifery.

An interesting fact: If homebirth with a DEM were to increase to only 10% of American births, homebirth would vault to one of the leading cause of neonatal death among term babies in the US.

Amy TuteurMD

indiebirth 5 pts

  I've seen your posts, Amy, and I am not going to get into a statistics war with you.  To me, it's about responsibility and the fact that women often choose hospital birth because they think that relinquishes them of any.  Birth is as natural as death-we don't need someone to tell us how to do it, yet we do need to take responsibility for our choices.

And homebirth is a valid choice--one that will become increasingly popular.

Women are strong and will get back to their roots.  But it is going to take some self-reflection, hence the point of my article.

Maryn

Indie Birth 

Maryn Leister
Indie Birth
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Amy TuteurMD 5 pts

All the existing scientific evidence, as well as national and state data, show that homebirth increases the risk of neonatal death. The only people who appear to be unaware of this are homebirth advocates.

The widely quoted quoted Johnson and Daviss BMJ 2005 study claims to show that homebirth is as safe as hospital birth, but it ACTUALLY shows that homebirth has a neonatal death rate more than
3 times higher than hospital birth. In 2000, the neonatal death rate
for low risk women at term in the hospital was 0.9/1000, substantially
less than the homebirth neonatal death rate. Look at the paper. Where
is the neonatal death rate for low risk women in the hospital in 2000?
The authors left it out and compared homebirth in 2000 to hospital
birth in out of date papers extending back to 1969. The authors have since acknowledged this on their own website.

The US government has begun collecting statistics on place of delivery and birth attendant. The first dataset, covering 2003-2004, shows that the most dangerous form of PLANNED birth in the US is homebirth with a direct entry midwife. Once again, homebirth with a direct entry midwife appears to have a neonatal mortality rate approximately triple the neonatal mortality rate for low and moderate risk hospital birth.

MANA (Midwives' Alliance of North America), the trade organization of direct entry midwives, has been collecting statistics from its members from
2001-2007 and up through the present. This database probably contains
somewhere in the range of 30,000 deliveries. We know that
the data is available because MANA is offering it to pre-approved
individuals who sign confidentiality agreements preventing them from
sharing the data with anyone else. MANA refuses to release the information to the general public. It does not take a rocket scientist to surmise that MANA's own data shows that homebirth increases the risk of neonatal death.

Homebirth advocacy is made up is mistruths, half truths and outright deceptions. One of the outright deceptions is the claim that studies show that homebirth is as safe as hospital birth. That is completely false. All the existing scientific evidence, as well as government figures, shows that homebirth has an increased risk of neonatal death.

Amy TuteurMD

betsy.yates 5 pts

Hiya,

We are having our baby in a hospital due to a blood clotting disorder I have in which I am at  risk for bleeding to death during delivery. But if not for that, I would SO want a home birth!

ExcruciatinglyNormal.Com ( http://www.excruciatinglynormal.com )