Is Homebirth Right for You?
Imagine a room lit only by dim candlelight, a man and a woman lying on their own bed, side by side. A woman in a rocking chair — a grandmother herself — is gazing with wonderment at her daughter in labor. I quietly turn to her and whisper, “It is almost time!” We see excited gazes immediately turn to the woman on the bed.
In a matter of moments, a bald little head emerges amongst his mother’s loud voice and protests against the pain. And in one push, out comes his wiggly body and into his mother’s warm and waiting arms. Up to her chest the baby boy goes, everyone crying — the grandmother, the father and mother, and now the 2 little girls who are here to meet their baby brother, still attached to his cord just moments after birth.
No, this didn’t happen 200 years ago. This happened recently. And it was my best friend who was that woman on the bed, with her mother and daughters at her side. Surrounded by love, support, encouragement and her midwives, she gave birth to her fourth baby completely unlike the way her other three babies came into the world. And she will never go back…
Her first three babies had been born in hospitals — the first, a cesarean, because of a poorly run induction. A baby with bad heart tones, a uterus too tired to complete the task, and a woman giving up against her will. Of course, she thought, I must be defective. I couldn’t give birth by myself. If I was born in the last century, she thought, I probably would have died during childbirth. The baby was big, they said, 8 pounds 13 ounces. It ate away at her day and night until she became pregnant and was ready to give birth once again. Determined not to repeat this process, she sought other caregivers who were supportive of “natural” childbirth and VBAC (vaginal birth after cesarean).
Just over a year later, her second baby was born vaginally under the influence of pain medication and Pitocin, a drug used for induction. She was just over nine pounds. But although she was a vaginal birth, it still was so medically managed that she forgot she was in charge of the process. She was merely a passenger on a bad amusement ride. Fraught with fear, uncertainty and pain, once again she allowed others to take advantage of her vulnerability. She slipped into postpartum depression.
Two years later, this woman became pregnant yet again. Returning to the medical model of care, her pregnancy became one of high risk, bordering on pre-eclampsia, a condition of edema and elevated blood pressure which afflicts only pregnant women. For months, she was told only to “cut out salt” and that “there is nothing you can do for it,” despite her protests that there must be something — anything — to keep herself and her baby healthy. When she was “delivered” of her baby at 36 weeks and he spent time in the NICU with respiratory difficulty, she vowed never to go this route again.
The first time I spoke with Rebecca, she was five months pregnant with her fourth baby. Once again, she was flirting with pre-eclampsia. At twenty weeks, she was showing signs of swelling and tremendous weight gain, quickly rising blood pressure and placental problems. She was told, “You will not make it far with this one.” We changed her diet and her supplementation radically. As a team, we brought her tired and stressed body back into alignment. Within a week, her symptoms began to subside. Given choices, information and the confidence to grow this healthy baby and give birth to him herself, Rebecca gave birth to Garner at 40 weeks gestation, weighing a whopping 10 pounds 8 ounces. I was only the guardian of the process. There was a moment during the birth where I saw her confidence in herself waiver, and the bad experiences come back to haunt her, so I sat at her feet and whispered positive and affirming words in a soft tone to her. Ultimately she did it through her own power. Garner was the healthiest little creature we had ever seen.
After Garner’s birth, Rebecca and I struck up a friendship unlike any other I had known. We talked extensively about her past experiences, both during and after the birth, to release the hold they had on her. I reminded her that she had been responsible for eating the right foods, taking a really good vitamin to supplement her eating, and exercising with yoga for peace and relaxation. She had meditated on positive and affirming words, spoken within herself and from her affirmation tapes during the pregnancy. And she had relied on her body to do the work of gestation, labor and birth, three things that I knew she could accomplish if given the right support and information. It is a journey that all of us — but especially Rebecca — will never forget.
The question is posed to me quite often: Why homebirth when we have perfectly good hospitals to catch anything that can go wrong? Simply put, a hospital may or may not be the best place to have a baby. I am a statistician and factual person by nature. Realistically speaking, the hospital may be the best place for some mothers and babies in high risk situations, but the sheer numbers alone show that home birth is the safest place for low risk mothers.
According to the World Health Organization (WHO), the United States ranks 26th in the world for its maternal and perinatal outcomes. What this means is that 25 other countries lose fewer babies and fewer mothers than we do. Sadly enough, being the world’s wealthiest nation does not help us to overcome our propensity to lose life during childbirth. Although the specific countries which top this list change annually, all of them embrace a completely different perspective on childbirth. The majority of their births — upwards of 75% — are attended only by a trained, qualified midwife without a physician present. In our country, approximately 10% of our babies are born with a midwife in attendance, and of that approximately 2-3% are outside of a hospital. Contrary to the popular perception that hospitals make for a safer birth, statistically speaking, 8 in 1,000 babies from low risk pregnancies die in a hospital setting. In studies of similar low risk pregnancy populations, the death rate for at home births is as low as 2.1 per 1,000 with a trained attendant.
In addition to its relative safety, there are many other reasons why a family would choose a home birth. Midwives spend a tremendous amount of time with their clients — typically 30 minutes to an hour or more per visit — and educate women in all areas of childbearing. Generally speaking, they get to know the families including siblings, and therefore understand best how to serve them. During the birth process itself, most midwives will stay with the family, one-on-one, for the duration of labor and into the postpartum period. They do not rely on other staff, faculty members or machines to sit by the laboring mother; rather, it is their face that a woman sees and her voice that she hears when she is at the height of discomfort.
While most midwives have general guidelines they follow in their practice, they are more able to be flexible and individually tailor their routine to the benefit of each client. It is a team effort to make decisions regarding care. Labors do not follow a curve but rather a rhythm. Dancing to this rhythm will be the mother, her baby, often her mate, and her midwife in harmony. It is truly a beautiful site to behold.
The language surrounding medicalized birthing can be so disheartening — incompetent cervix, pelvic disproportion, distress, dystocia, failure to progress. All too often I hear that a woman “was delivered” of her baby. Just like Rebecca’s first three births, many women feel defective, unable to birth, and completely unempowered during this most precious and wonderful time in their lives. It is no wonder we don’t see this experience as it should be! A woman can “give birth” to her baby, flow with her powerful uterus and “blossom” when her baby is born. The words are only part of this language as the rest is unspoken through the body language of those around her, feelings of support and understanding, and the language of love. A woman can feel ripe, full of life, strong, beautiful, sensual. Birth will shape the way we feel about ourselves as women, as mothers and as mates.
Birthing at home with a midwife is all about choices and identity. A woman is afforded the luxury of wearing her own clothing, to labor in her own home rather than a strange and noisy place, and to choose who is in the room instead of having strangers coming and going constantly. Often candles and soft music accompany her labor; sometimes drums and dancing will inspire her. She can choose what positions feel best and provide the most desired results instead of being strapped to a table with monitors and IV’s hooked up to her continuously. The doors to her room may be open so she hears what is going on in her surroundings, or she may close them to create a feeling of safety and nesting. She may create a birth plan with her wishes and desires spelled out, but often the midwife with whom she has entrusted herself will know it by heart. While pain medication has its necessary place in occasional births, many women choose to forgo it knowing the consequences of its effects on the unborn. Alternate discomfort relief can include warm water, massage, upright positions, acupressure and lots of encouragement to help women in trusting their bodies to birth naturally.
The practice of laboring and delivering in a tub of warm water is making a huge and marvelous comeback. It gives me such joy to see a woman go from complete discomfort to total relaxation in just moments through the buoyancy of water! We often remark that we should take a picture of her face when she hits the warm water, although I am not sure it would tell the whole story of her deep sigh of relief, her ability to take control once again of her labor, and of her newly relaxed state floating weightlessly in a big tub of water despite her huge belly and contractions. Tension from the pain of labor can cause adrenaline to be released into the bloodstream, slowing the labor and also making it more painful. The relaxation that water affords allows the mother’s body and uterus to work more effectively. A woman’s partner may also climb into the tub to support her while she rests, to whisper love and encouragement into her ear, and to be an integral part of his baby’s birth.
Babies also love the water. The transition from womb to world is easier and less stressful when a baby is birthed directly into water, providing time to adjust to the world outside the womb without trauma. Floating in the warm water with their mother, babies quite often do not cry but will open their eyes and look around the room. Experiencing this sight for the first time, they unfurl like a tiny rosebud amidst their new surroundings. Watching “waterbabies” come alive and sweetly announce that they are here is indescribably precious. Once the placenta is released, the mother and her baby climb out of the tub and into their bed for some snuggle time.
Who Is A Candidate For Homebirth?
Almost any low risk woman who desires to take control of her birthing experience can have a home birth! Midwives will ask health questions that may screen out some of the higher risk population including health history, surgeries including cesarean sections, hormonal or endocrine problems, heart disorders, certain illnesses and the like. The midwife will most often ask about nutrition, lifestyle and exercise habits, although these can be worked on during pregnancy to improve a woman’s health and well-being. Of utmost importance is a woman’s ability and desire to take control, assume responsibility and to understand that she — not someone else — is her baby’s prenatal caretaker. She will be responsible for eating right, taking excellent care of herself, and birthing the baby in the healthiest of conditions.
Finding A Midwife And More Information
Midwives are trained birth attendants. There are many different routes of entry into midwifery, and several different certifications available. Nurse midwives obtain their education from a university setting and having a background in nursing. Certified or licensed midwives come from a variety of educational backgrounds, but most commonly train through apprenticeship modes. They must comply with testing and practical examination through their state or jurisdiction for licensure. Some states require testing through the national standard of the North American Registry of Midwives (NARM) for the title of Certified Professional Midwife (CPM). There are also traditional midwives, commonly called lay midwives, who apprentice as licensed midwives but do not pursue licensure or certification. Many midwives overlap various educational programs, apprenticeships and other forms of education to create a well-rounded midwife with excellent academic and practical skills.
The most important question a midwife must answer is “What if…?” A skilled midwife must know how to handle a variety of situations and emergency challenges in an appropriate, knowledgeable and speedy manner. Depending upon what type of midwife she is, many will carry certain medications, most carry oxygen and other resuscitation equipment, suturing supplies, suction mechanisms, and a way to easily listen and closely monitor the baby’s heartbeat during labor. Certain midwives will also carry herbs, homeopathic remedies, and other alternative ways to deal with circumstances as they arise. A viable back up plan is essential if transport to a medical facility is necessary. The bulk of the training a midwife will undergo is how to handle the situations we hope will not arise but will surface sometime during her career.
There are many web sites available to search for midwives in each state, and many midwifery organizations will have their own sites as well. A good place to start the search could be the state’s midwifery organization, health food stores, breastfeeding support groups, as well as asking for references from other women who may have had home births. Listed at the end of this article are some national sites in which one may gain information about midwives, laws in particular states, and reference articles about home birth. Looking in the phone book may also yield some good results.
Ask questions of each midwife you inquire about. Tell her you want to understand her practice protocols, what she expects of you as a client and what her background and training are. Is she licensed? Is licensure available to her? What are her back-up arrangements? How many births has she attended? What percentage of her births require transport or referral? What types of things does she carry in her birth kit to handle emergencies? As you interview her, take note of how you feel: are you feeling safe and nurtured? Do you resonate with this midwife’s philosophies? Can you birth in confidence with her? Ask for referrals to clients who have used her services.
When I was pregnant with my first child, I chose a hospital birth with an obstetrician. I was extremely healthy, nourished and in a wonderful state of mind. I had complete confidence in myself and my ability to give birth. Although I had a completely natural childbirth, I vowed that there must be a better way as I carried my newborn son out of the hospital a few hours later. With my second baby, I chose a home birth with a midwife. It was the most amazing experience I could imagine — everything a home birth (and for that matter, birth anywhere!) should be. This midwife forever changed how I felt about myself and my experiences. She transformed me into the midwife I am today. My third baby was also born at home, with my husband and two children in attendance. We talk of her “birth day” often and with such fond memories since she was brought into this world with such love and gentleness. Somehow, and in some way, I try to create that same special experience for every family that I touch. So far, I think we are succeeding quite nicely…
Adrian Feldhusen is a New Hampshire Certified Midwife (NHCM) and Certified Professional Midwife (CPM) attending home births for families since 1992. Her practice spans most of central and southern New Hampshire, as well as northern and eastern Massachusetts. Her new birthing center, The Birth Cottage, is located at her home in New Ipswich, allowing families even more choices in childbirth. Adrian is married to her husband, Jim, and has three children, two of whom were born at home. Call 603-878-2900 or visit her web site http://www.birthcottage.com for more information.