My first child was brought into the world by a 100% All-American unneCaesarean, after the usual hospital routines (including forced withholding of food) gave me a migraine, which somehow led to the decision to give me an epidural, and the rest was pretty much typical of what happens with a cascade of interventions. And I had a nurse-midwife!

My second child was a hospital VBAC miserable enough that I perceived it as a rape. (We’d already picked out a direct entry midwife who had experience with the Amish, but severe gastroenteritis triggered premature labour, which I didn’t know about until the paramedics insisted on taking me to the maternity ward – the maternity ward! – where I was told that I was ten centimetres dilated and coming out of transition. Oops. the less said about what happened next, the better.)

My husband caught our third child in the bathtub five minutes before our midwife and doula arrived. That was easily my best birth.

We’re expecting another baby in August, and planning to birth the baby at home again. Of course.

I’d like to clarify a few things, because your comment may be taken by some readers as a backhanded argument against home birth.

I found your story in Mothering magazine, and from what I can tell, your baby died in the hospital, not at home; and it seems likely that she would have had the same sad fate even if you had planned on a hospital birth.

I agree with you: it’s useless to speculate either way. All we can say is that (a) some babies die during birth (whether at home or in the hospital), and (b) low-risk babies die at the same rate in hospital births as in planned, attended home births. (See references, above.)

Carol, your story is moving, powerful and sad. In the end, though, I’m sure you’d agree that mothers-to-be should be driven by data, and not by anecdote. Your birth story is sad, and my home birth story is happy; but both are irrelevant to a pregnant woman who is deciding how to birth her child.

Thank you for posting and for furthering the discussion.
- ron

Editor’s note: See Ron’s response below.

There were some complications(!), but the midwives handled them perfectly.

But I do now realize that there’s one major disadvantage to a home birth: I never got to speed to the hospital without any regard for traffic laws. I can honestly say that I’d been looking forward to that for many years.

Both of my births were in the hospital, with not too much intervention, but I’m not so sure I would make it to the hospital the third time! (I’m not pregnant right now, but thinking of the future). I want to make sure I am totally ready for a home birth, and who knows, by then maybe I will have decided to go with a midwife. In Manitoba they are covered by health care, so I wouldn’t pay a cent!

My first birth was quite traumatic for me, and I believe it was due to the Demerol that they gave me. I did ask for it, so it’s not like it was their fault, but if I had known that I would only labour another hour or two til I was ready to push, I never would have taken anything.

With my second, I was already 7 centimeters dilated when I got to the hospital, and that was after only 1 hour of labour, so I knew I didn’t have time for any intervention, which was totally fine by me! My second baby came into the world after 3 hours of labour and 10 minutes of pushing. I have an amazing family doctor though, who reminds me far more of a midwife. She knew to tell me to only give little pushes, and to let my body do most of the work. She calmly talked to me the whole time, holding my hand.

The one thing I would like to change is that for both births it was so intense that once I lay on the bed, I really couldn’t move to get up again. I would like to try squating in a birthing pool. In our hospital, if you have a midwife assisted birth, you can use a pool, but a doctor assisted birth, you can’t. So, I might have to do something about that!

Thanks for informing me even more. I’m going to continue my research.

When I worked as a doula, I had one client whose doctor was late. The nurse assigned to her just happened also to be a homebirth midwife (who worked with my own). Unlike any other hospital birth I attended, the mother was comfortably seated on her husband’s lap, the baby was guided out with only a small tear, and there was silence in the room. I looked up to see a horde of L&D nurses in the doorway, spellbound. They all rushed to the scene after hearing the nurse would handle the delivery; not one of them had ever seen a birth like that.

My midwife handled my friend’s fourth birth, a footling breech in a birth pool at home. She called for emergency assistance (another common misconception is that midwives somehow do not know when to transport for medical intervention), but as the fire truck arrived, the baby was born. The firemen congratulated the family and took all the small children in the house for a ride on their truck. Renowned obstetrician Michel Odent says that the only way he will deliver a breech is if the woman is upright- in other words, there are techniques other than cesarean for delivering unusual presentations, if a practitioner is properly trained.

In Australia, if you receive private care from a midwife (i.e. care from a midwife that is not an employee of the hospital while you are a patient there) then you bear the entire cost. Medicare doesn’t pay anything and health insurance (with few exceptions) doesn’t pay anything.

In contrast, if you book into a public hospital for your care, which is overseen by doctors even if you have many of your pre-natal visits with midwives, then the government pays for everything. With my first child my only out of pocket costs were for my prescriptions and the parking.

For what it’s worth, we verified today that our medical insurance does cover home birth when attended by a certified midwife. Our midwife is out-of-network (are any midwives in-network?), which means we’ll end up paying 30% (or about $1500) of the cost out-of-pocket.

Wonderfully worded article. I love to see this written from the father’s perspective. One thought in response to comment #2, last paragraph. It appears at first glance that a hospital birth (after insurance) is less money out-of-pocket than a homebirth (if the homebirth isn’t covered by insurance), but I have found this not to be the case for many women. I have seen women pay far more in the 10% insurance co-pay for the unnecessary (that is to say, preventable) hospital interventions, including epidurals, C-section, NICU stay, spinal tap on the baby, medicine for the “sick baby,” Bili-lights for the jaundiced baby (due to epidural sleepiness & not being allowed to nurse early & often), etc. Had they known from the beginning how much that hospital stay would cost them, both monetarily and in unnecessary risk, pain, and suffering, they might have gladly pursued that very affordable homebirth, even if it were 100% out-of-pocket.

Incidentally, the insurance co-pay (our out-of-pocket pay) for my non-medicated, intervention-free, non-complicated vaginal hospital birth of my 1st child in 2002 cost about the same as a homebirth would cost 100% out-of-pocket, in my area ($2500-3500). Luckily, my homebirths were covered 80% by our insurance (would have been 90% but my MW was out of network) so my homebirths cost $600 out-of-pocket.

[Ed. Note: Thanks for giving our friends the benefit of the doubt, but that's clearly not what they meant.]

Thanks so much for your comments – we erred in not including CPMs along with CNMs. (I’ll try to get the webmaster to edit that. )

We intentionally left out unassisted homebirths, simply because all of our references and source studies were limited to homebirths attended by either a CPM or CNM. Thanks for pointing out that twins and breech can be safely delivered at home. In our particular situation, (I think) our midwife will deliver twins at home, but she won’t do breech births at home – I think it varies by midwife? Thanks again!
Sara

1) cnms and cpms are not the same thing. if i chose a midwife (as i did for my second child) i would choose a CPM [Certified Professional Midwife] over a CNM [Certified Nurse Midwife] any day. a personal choice, but everyone should know that the name midwife doesn’t always mean the same thing.

2) planned homebirth is not always attended by a midwife. for instance, i homebirth unassisted. my births are planned and safe.

3) twins and breech babies are often safely born at home. most DOCTORS do not know how to birth breech babies vaginally, it is true. but many, many, many an unnecessary cesarean has been given for both twins and breech babies. being at a hospital makes this almost inevitable. in many states you can find midwives who will help you deliver your breech or twins, or breech twins!

anyway, i’m not just looking for something to disagree with, i promise. a very nice entry that i will surely pass on to others. -tabitha

Birth is so mis-represented in the mass media (think of all those movies where the couple rushes to the hospital when the woman has the first contraction). Combined with the dislocation of the family and the fact that women are having fewer children than in the past, most people only have very limited exposure to what real birth is. Therefore they are highly susceptible to anecdotes, dramatizations, and scare tactics. Often these scare tactics are used by doctors to press their patients into complying with the interventions they recommend, but more often they are used by well meaning friends and family who just don’t know better.

“Something could go wrong…” – well, yes, but something could go wrong at any point in your life and most people do not deal with that risk by living in a hospital. They go to the hospital once something is starting to go wrong.

There is a huge misconception that if you use a midwife as your primary carer that you cannot have access to a doctor. People who plan a home birth also prepare a backup plan, that includes what hospital to go to in an emergency and what doctor to call. In fact, in Australia, where some people live very far from medical services, midwives will advise against a planned home birth if there is no hospital nearby, recommending instead that women relocate near a hospital for the time around the baby’s due date specifically because the midwives know that there are circumstances that require the intervention of a doctor and that they cannot responsibly do their jobs unless they make sure their patient is within reach of those services should they be necessary.

Many people think that obstetricians are trained to deliver babies, but that is actually not true. Midwives are trained to deliver babies (or “catch babies” as many prefer to say). Obstetricians are trained to deal with births where the mother or the baby are unwell. They are trained to deal with emergencies. They are trained to do surgery. When birth is not an emergency (which is largely the case) then they are unnecessary, but if you entrust your labor to an obstetrician rather than a midwife, then it is likely to be treated as if something is going wrong. When you have a hammer, everything looks like a nail. You have done a good job of documenting that above.

Furthermore, the method of dealing with emergencies is shifting more and more towards cesarean sections as doctors get less and less experience learning how to use forceps, vacuum extraction, and other age old techniques of coaxing babies down the birth canal. It is a common misconception that you can avoid the pain of childbirth by having a c-section. It is true that you may not feel labor pains, and you will almost certainly avoid tearing of the perineum or an episiotomy, but you will also endure major surgery, with risk of significant blood loss and infection, and a four to six week recovery period, all when you are required to provide round the clock care for your newborn baby. There is no doubt that the c-section is a valuable tool, but not one you want to endure unnecessarily. The New Yorker ran an interesting if slightly annoyingly celebratory article on the history of the c-section (apologies for all the adverbs there).

It is worth noting that most women remember their birth stories very clearly, and generally feel they did what they had to given how their bodies reacted to being pregnant, but often women are duped into believing they failed labor and their doctor saved them, when in fact often it is the contrary case of the doctor’s actions creating medical complications that then need further medical intervention. Naomi Wolf’s book Misconceptions provides a detailed analysis of how the medical profession has disempowered women and midwives in the US over the past century.

Finally, most births are attended by a midwife. The obstetrician whizzes in a few times for a few minutes while the mother is in labor and may be there for 20 minutes or so when the baby is actually born. The rest of the time it is midwives who are caring for the mother and helping her to progress the labor. If anything, having a doctor who expects you to respect that he is a very busy person interrupt this intimate and timeless experience creates tension when it is least appreciated. So avoid the tension, and the risks of intervention. Avoid the hospital rules (which neither of us has touched on – but are often used to force a woman into an intervention that she would otherwise decline). Have your baby at home.

Caveat: there are a large number of conditions that really do require specialist medical treatment in pregnancy. If you happen to have one of these (multiple gestation, diabetes, etc.) then home birth is probably not appropriate for you – the important thing is to determine which category you fall into (and it’s not always straightforward).

One last thing: the mingling of the medical and insurance industries have colluded to make home birth more expensive to the mother than a hospital birth, even though the actual cost of a home birth is much lower. This acts as a disincentive to women who might otherwise consider home birth. By reducing the incidence of home birth, the industries have kept home birth on the fringes of people’s consciousnesses, minimizing its ability to threaten the supposed supremacy of the medical industry.

What a resource for others looking into homebirth! Especially those that need help convincing a husband or partner. This is a great place to start…. Read this, keep an open mind, do your own research.

I had a hospital birth because I couldn’t relieve my husbands anxiety over homebirth… and I wish I had had an article like this- it would have helped. I was fortunate to find an alternative I was comfortable with… otherwise I would have pushed him for the homebirth. But the environment I found for our birth is (sadly) extremely rare amid the hospital culture.

Homebirth is an extremely viable option. The only other good alternative is to create major change in hospital birth and culture– or in most cases, go in armed with information, support, and ready to demand respect for the birth experience that should be ‘normal’. Birth should not be a battle, but so often, in a hospital a woman wanting a normal natural birth has to be ready to fight for that right, and those that are not prepared are often taken advantage of. That’s how I felt my first birth experience went, and the 2nd time around I was much more aware of the choices and options I had.

I didn’t let that happen a 2nd time, but again, I shouldn’t have had to do so much to arm myself against our birth culture

Jessica jessjgh1