Why I decided not to have a home birth

This blog post has been in the making (in my head at least) for months if not years. Normally I write a blog post in 10-15 minutes after having thought about it for a while, but this one has taken me way longer. It has had different titles and different angles, but I think this is the final version.

When I was pregnant with Little Brother I was debating whether to have him at home. I wanted to blog about that process but I was afraid that my search of where to give birth would turn into a heated debate and I didn’t feel like putting on my meat pants. So I kept this search to myself. I do however want to share the process after the fact.

“Why would you consider a home birth?” one might ask. I think for the majority of women having a home birth in the US it isn’t about putting videos of your birth on YouTube. It’s about looking for an environment where you feel safe and have your wishes respected where possible. I considered a home birth for what you might call selfish reasons: wanting to sleep in my own bed after having given birth, not wanting a nurse to have to take my temperature while I was pushing a baby out because that was exactly an hour after she had last taken my temperature, not having to drive to the hospital while already in labor, because otherwise contractions might stop on the way in. So I asked my midwife (CNM, not CPM) at my first visit when pregnant with Little Brother whether she thought a home birth was an option (the CNMs in this practice attend births at a hospital, not at home). She told me that even though she thought I would be a good candidate (young, healthy, relatively smooth first birth), she couldn’t refer me to any CNMs because there are no CNMs attending home births in my area.

So I turned with my question to the lady who was my doula at BlueEyes’ birth. She was also the person who gave a child birth class, not hindered by much scientific knowledge (for example explaining how the cervix is a sphincter, which it’s not). And, as an important aside: this is what I hate about the current “child birth industry” as you might call it in the US: it is nearly impossible to find people to educate you about what kind of choices you can make regarding birth, and especially unmedicated birth, that are driven by scientific evidence rather than personal opinions.

So my former doula sent me an email with a bunch of names of CPMs in the neighborhood. I googled them and found some of their names on a listserv talking about learning to suture at someone’s kitchen table. And since I had a third degree tear with BlueEyes birth, that was too difficult for my midwife to suture and required the trained hands of the head of OB/GYN at the hospital, I started to get a bit hesitant about having a home birth attended by someone who learned to suture at someone’s kitchen table.

-For those of you who are going to say that if I wasn’t in the stressful environment of the hospital I wouldn’t have had a third degree tear: I don’t think that was true. I was laboring on my knees without anyone telling me how to push (which seems to be better for your urodynamic factors) but BlueEyes came out in one push with his hand next to his face. Little Brother’s birth taught me that even with very gentle pushing, a super comfortable environment, and my midwife having her hand on my perineum, a hand next to the face still meant a second degree tear in my case.

Also: what would I do if I switched to a CPM for a home birth but my baby would be breech or it would otherwise not be a low risk birth anymore? Then I could probably not easily switch back to my wonderful CNM practice. And would I trust this CPM to know if my baby was breech? And, the most important factor in my decision: you can’t argue with data. The recent release of the home birth death rate shows the home birth death rate in the US is 450% higher than hospital birth. (although these data weren’t there yet when I was deciding whether to have a home birth or not).

Another important reason was that in The Netherlands, where many low risk births happen at home, a significant proportion of women need to transfer at some point during or right after birth (sorry I can’t find this stat anymore, will keep looking to link to it!). What would happen if I would need to transfer in a country where this isn’t happening on a daily basis? Would the CPM dare to go to the hospital or would she be hesitant to take me there because of her fear of a law suit? Would I be in time? And how would the OB on call react to someone having attempted a home birth? What would my insurance say?

I have no answers to these questions because this is where I stopped my search and decided to have Little Brother in the hospital, with the same midwife practice as BlueEyes. It is a great practice where they encourage you to express your wishes and try to adhere to them as much as possible within the boundaries of science and reason. Looking back I don’t even know why I went on this quest of deciding to have a home birth or not but I guess it was necessary to feel that I made the right choice. I might have decided otherwise if I had lived in my homecountry or if my midwifery practice hadn’t existed.

Unfortunately, my midwifery practice is having a hard time staying in business. Not because they have too few patients -they are flooded with patients- but because apparently hospitals are hesitant to have women come in with birth plans and doulas. As Emily Willingham wrote better than I can say it:

“The obvious solution to the controversy is to offer choices that reduce perinatal stress, minimize interventions, and personalize birth—the great appeal of home birth and midwives—while ensuring a safe outcome with well-trained attendants and access to emergency facilities. The absence of options in the United States leaves this solution elusive, especially where hospitals lack a homey, low-stress environment and local midwifery care fails to meet the gold standard. Strange, isn’t it, that our nation, in the 21st century, can’t offer more uniformly safe choices for a low-risk pregnant woman seeking a healthy, low-stress birth for her child … and herself?”

I really wish the kind of care that I had was available for anyone.

I avoid the words “childbirth experience” because it makes it sound like you’re looking for the thrill of a rollercoaster ride instead of the safe and supported process of having a baby. I also avoid the words “natural childbirth” as a synonym for a pain-mediation free birth because what is natural these days? Can you drive your car to the hospital for a natural childbirth? Can you eat GMO-containing food after your natural childbirth and still call it that? I think it’s a weird word. 

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15 Comments

Filed under baby, birth, cultural differences, decisions, doula, health insurance, pregnancy, safety, science

15 responses to “Why I decided not to have a home birth

  1. Thanks for sharing! I too struggled with the same decision and came to the same conclusion that you did. My thought process was that I would rather end up with an over medicalized OB than with an overly “crunchy” (for lack of a better word) midwife. I had such a hard time sorting through all of the misinformation out there, it was very frustrating. Ultimately, I was very glad I had an established relationship with an OB when my water broke at 33 weeks.

  2. I had a very low risk pregnancy with Kiddo. I was young, healthy, exercised, etc.That was until I went into labor and Kiddo had suspicious late heart decels.* I was glad that I was in a hospital where if everything went sideways, Kiddo could have been out in less than 90 seconds with a NICU team in place. I say this to emphasize that even women with low risk pregnancies can have complicated births. I completely understand the urge to want to give birth in a safe-feeling place, though. The hospital can be very chaotic and strange.

    *The decels weren’t enough to warrant a C-section, just careful monitoring of his heart rate. The doctors leaned more on the side of letting me labor rather than do a section as long as Kiddo remained in the safe range. I ended up with a vaginal delivery with a (thankfully unneeded) NICU team on standby. And Kiddo was/is completely healthy.

    • Yes, I completely agree with you that there is no way of predicting how your labor and birth will be beforehand. And that sometimes things can go from normal to very problematic faster than an ambulance can drive you to the hospital…

  3. Corie

    My friends had a home birth. I originally had planned on having one. But then my buddy went to visit my home birth friends. When my buddy got there, shortly after birth, they were “cleaning up”. I immediately changed my mind!
    Just had number 3, in the hospital, on Valentines Day! With a terrific midwife!

  4. I haven’t even deliberated. Like the comment above, I want transit time in case of an emergency to be measured in seconds. I am giving birth at the hospital in town (as long as all goes smoothly), so it’s not a huge hospital. But they do have a helicopter with major NICUs in close range. I’ve never even debated homebirth — the thought of cleaning up alone makes me cringe.

    I’m also going with my ob/gyn, but that’s mostly because I have been seeing her for 4+ years. I always feel more comfortable having people I know in a nervous situation.

    • I understand that there are many people like you who never even think about having a home birth. But I also know that there are many women who for whatever reason are hesitant to give birth at a hospital. I wrote this post to illustrate the reasons I had for either option and the choice that I made. I hope your birth goes the way you wish.

  5. GMP

    After 3 kids, I consider delivery to just be that — a way to get a healthy baby out to a hopefully healthy mom. Everything else — my comfort, my birth plan, any other preferences I have, whether they listened to my ideas, all these things are ultimately irrelevant. I would not go for anything that reduces the chances of survival should things go awry, no matter how warm and comfy the idea might seem. Gimme cold, impersonal, medicated, whatever, as long as that gives the best chances of taking home a healthy living baby.

    • I don’t think these things are irrelevant. Being less stressed and for example having continuous support during delivery leads to more beneficial outcomes for both baby and mom. This is not just in people’s heads and/or about being selfish.

  6. GMP

    I am speaking from my own experience, I promise I am not trying to be obnoxious. The first time around, I was scared and it was good to have my husband with me. With my last two kids, my DH wasn’t there because he was at home with older kid(s). Honestly, I preferred it; I was in pain and wanted to be left alone, not having to worry about other people being tired or freaked out, worried about me. It was painful and all I wanted was to get it over with, and the fewer people I had to interact with the better. I don’t understand the concept of support during childbirth — it’s just me, going through this very uncomfortable experience, and anyone trying to soothe me or touch me unless absolutely necessary or whatever would just further piss me off; unless you are bringing pain meds, get out of my face.
    I admire people who can tolerate or even want a doula, I can’t imagine wanting anyone like that around me. I was perfectly happy with doctors/nurses doing business as usual, being professional and aloof. My insides are splitting open, I actually don’t want anybody emoting with me in any way during the process. (Feel free to think I am some sort of emotionless freak. 🙂

    • But then you wanted things to be a certain way too right? Because that is exactly my point: that it would be great if birth could be personalized within the hospital so that it is low-stress, safe and healthy for everyone.

      • GMP

        The thing is what I wanted just happened to be well-aligned with what hospitals are set up to provide (impersonal, but safe); it wasn’t ideal, but I don’t care — I got my babies and we are all alive and kicking.
        From what I gather, most women object that the whole ordeal cannot be personalized enough. I am not sure a high degree of personalization is even realistic to expect, as it may be incompatible with the hospital MO; still, one shouldn’t fail to appreciate the safe part.

  7. I considered home-birth this last time around, but the fact that there aren’t any CNM, only CPM, kept that from happening. There probably isn’t going to be a third baby, but if there were, I would consider it again– mainly because there was a constant worry that I would deliver the baby before getting to the hospital. My husband got extra lessons on how to deliver a baby by the side of the road, just in case.

    I really wish there were something around like what my mother had with my sister– a CNM practice attached to a hospital. I actually looked to see if that was still around– I thought maybe I could spend the summer in Santa Barbara. But it had just gone out of business after decades.

    • That is exactly what my midwife practice was: their office wasn’t even in the hospital but in an apartment where they had been since the 70s. I wish there were more practices like this in the US.

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