Find Out If A Homebirth Is Right For You

A woman births best where she feels safest and most supported. Regardless of what anyone says about advantages or disadvantages of home vs. hospital birth, the fact remains that birth is a process of the body opening up to allow the baby to emerge. Anything that increases tension, fear, or discomfort will act counter to this process, so it's important to keep this in mind.

As you consider where to give birth, ask yourself where you will feel most supported, safest, most uninhibited. For many women, this place is at home. If you can relate to any of the following, home may be the best place for you, too.

Before the Birth

Women choose homebirth for a variety of reasons. One of them is the quality of care that leads up to the birth. Women who choose midwife-assisted birth enjoy hour-long prenatal visits with the same familiar caretaker. There is plenty of time for the mother-to-be to ask questions and just have time to bond with the person who will be there during such an intimate moment in a family's life.

The focus of prenatal care for homebirthers is on the health and well-being of the mother and baby. As a rule, homebirth midwives demonstrate more confidence in the mother's and baby's ability to move through the process of pregnancy and birth in full health and without incident. Pregnancy and birth are approached as natural human events, not as medical conditions requiring intervention.

If you have a similar confidence in your body's ability to carry a baby and birth, you may find that many facets of medically-oriented care run counter to your instincts and desires. For example, prenatal care for hospital births tends to involve more testing and ultrasounds. In other words, there's quite a bit of checking to see if they can find something, anything at all, that has gone wrong.

For some people, this can be reassuring. For others, it's intrusive, undermines their confidence in their own body, and leads to more fear (and possibly more complications resulting from their bodies' response to that fear) than they would normally experience. Excessive testing can result in inaccurate conclusions based on partial or unclear information. Educate yourself on prenatal testing and ultrasounds to get a sense of your own position on this spectrum. A wonderful resource from the homebirth perspective is Ina May's Guide to Childbirth by Ina May Gaskin, a renowned homebirth midwife.

By contrast, homebirth midwives emphasize testing less and are very willing to take the time to discuss testing information and options. Homebirth midwives are not part of an economic system that includes expensive labs and testing (although they can easily refer mothers to them for testing as needed), so they don't share an economic incentive to increase income through more intervention. If a homebirth midwife recommends a closer look at the baby, it's because she genuinely feels one is needed, not because she is part of a system that requires practitioners to maximize income.

Some babies take longer to ready themselves for birth than others. When a mother has crossed over the 40-week mark in her pregnancy, she can begin to feel pressure from more medically-oriented practitioners to undergo pharmaceutical induction. Homebirth midwives tend to have a broader perspective on when healthy birth can occur and will do a biophysical profile if necessary to confirm that all is well with the baby. If they determine that induction is desirable, they are well-versed in natural methods to bring on labor (such as taking castor oil or having sex with your partner) that can be attempted first.

Labor

When the big day arrives, women who birth at home (about 85-90% of those who have planned to do so) experience no dramatic transition to the hospital in the midst of contractions. There is no decision needed about the optimum time to go. Your attention can remain focused on your own experience without distraction. The process of birth can flow naturally with little interruption.

Many women opt to set up an inflatable birth pool to give comfort during labor, and some choose to remain in the pool for a waterbirth. The soft sides are ideal for supporting the body comfortably. Hospital facilities for and policies about laboring and birthing in water vary, but at home the conditions you create are up to you.

If having a natural birth is important to you, it's important to realize that in a hospital, you'll be in a place where using drugs during birth and being subjected to interventions is a cultural norm. At home, you'll be surrounded by people who see birth as a natural process centered on you and your baby, not as an event that necessitates chemical or surgical intervention.

At home, you'll have more control over the conditions that affect your state of mind and therefore your body's process. You can decide about lighting, noise level, and the people present during your labor. As wonderful as hospital nurses can be, you don't know the nurse until you arrive, and he or she doesn't know you. Even if you succeed in quickly establishing a good rapport with a nurse whose approach to birth happens to be compatible with yours, shift changes and the needs of multiple patients can interrupt this process.

Your homebirth midwife and her assistant will be there for the duration of your experience, so there is no need to worry about interfacing with strangers during moments when you have little attention to spare. You will have discussed beforehand what kind of care to expect during birth and how you and the midwife prefer to handle things, right down to the kind of conversation and support you prefer (some women like praise while others find it distracting), so there is far less potential for unpleasant surprises.

Should a normal birth variation occur, such as a breech position or shoulder dystocia, you will be in good hands. Homebirth midwives are specifically trained to handle these situations efficiently without drastic intervention, often by a change in the mother's position. They have more skill and experience in handling normal variations without immediately resorting to more dramatic measures. Should transfer to a hospital become necessary, homebirth midwives are practiced in anticipating the best time to make such a decision.

In a hospital, the more common pattern is for a doctor to call for a surgical birth (cesarean) because she has less experience in dealing nonsurgically with these situations and because there is more of a precedent for cesareans being viewed as medically appropriate in malpractice situations. In other words, doctors feel personally safer from litigation when they turn quickly to surgical solutions.

Women who choose homebirth tend to experience more patience and willingness to wait on the part of their caregiver. Homebirth midwives have fewer clients than doctors and hospital midwives, so they are not as distracted by other births or pressing needs elsewhere. They are committed to seeing each mother and baby through their process.

When labor progress is slow, homebirth midwives are experienced in either letting it be or recommending gentle techniques to help mothers and babies move on to the next stage. Homebirth midwives are in general less fearful about and more experienced with the skillful and gentle handling of normal birth variations, so this allows mothers and babies the latitude to do what they need to do in their own time in the absence of the time-is-money attitudes that can permeate hospital settings. At home, there is no pressure to accept pitocin to increase contractions, no threat of surgical birth in the immediate future.

Birth and Beyond

In the last stage of labor and during the birth, one of the most wonderful things about homebirth midwives is that they know when to stand back. A homebirth midwife recognizes that coaching is not necessary unless that is the mother's preference or need during the moment. The body squeezes and pushes all on its own. Baby and mother work together in ways that are uniquely suited to them. A homebirth midwife can offer all the encouragement or advice that is needed, or she can take a less active role and allow you to stay in your centered place as you and your baby experience birth.

If you would like children or others present during the birth, you can involve them as much or as little as you like. The regulations that exist in your home are your own. The situation of the midwife and her assistant being guests in your home changes the power dynamic in very beneficial ways compared to what some women experience in a hospital.

Immediately after the birth, you'll find that the priority is on keeping you and your baby together in close physical contact. Interventions that are required or usual in the hospital, such as Vitamin K injections and antibiotic eye ointment, are optional at home. Your midwife will stay with you long enough to see you comfortably settled and to complete any necessary clean-up.

In the days immediately after the birth, the homebirth midwife will return to check on mother and baby, often at one and three days. She can offer nursing assistance and parenting advice and is available by phone as needed. Mother and baby can nestle at home with no need for car rides or new places until they are both ready.

Is homebirth for you? Of homebirth mothers surveyed in a 2005 British Medical Journal study, only 1.7% said they would choose differently for future births. Take your time, weigh your options, educate yourself, and make the choice that helps you feel safe, nurtured, and supported.