Monday 6 July 2009

Why homebirth

It was recently suggested on a (mainstream) pregnancy forum that those who birth with a midwife at home or in a birthing center do it only for the “experience”, and that the safest place to give birth is in a hospital “just in case” anything goes wrong. When I replied that midwife-attended homebirths were statistically safer than OB-attended hospital births, I was asked why that was. So, in my typical concise fashion (ha!), I replied.

An obstetrician's training is in the pathology of pregnancy - finding and treating the things that go wrong with pregnancy. A midwife's training is in normal birth. The difference in training focus typically means a difference in the way the two caregivers approach birth.

OBs who provide maternity care for healthy women often apply unnecessary interventions to those healthy women, rather than solely to the complicated pregnancies for which said interventions would be appropriate and necessary. This is the case both during routine prenatal care and during the labour and delivery itself. These interventions often lead to complications that otherwise would not have arisen.

Midwives provide a far more holistic maternity care, viewing pregnancy and birth as a normal and healthy part of life rather than something to be micromanaged and intervened with. Intervention happens only when medically necessary, and midwives are trained to recognize complications which require transfer of care to an OB.

Family doctors typically have lower rates of obstetrical intervention than OBs do. (A family doctor was my caregiver of choice for my first pregnancy. A midwife is my preference this time, with temporary care being given by a family doctor as we are currently in between cities for the summer.)

North America is unique in its common use of obstetricians to provide prenatal care for routine low-risk pregnancies and deliveries. Most countries use OBs only for high-risk cases, with the bulk of prenatal care provided by midwives. These countries, incidentally, have lower maternal and newborn death rates.

Aside from the use of OBs in normal, healthy, low-risk pregnancies, the hospital environment itself is not conducive to the safest birth experience for the typical pregnancy. Fortunately, steps are being made to improve that, with some hospitals far ahead of others, but the typical hospital birth still involves being denied food and drink, having continuous fetal monitoring which requires being in bed during the labour and delivery, and giving birth lying down on your back with a doctor directing your pushing and breathing (the most inefficient way to give birth, but the most convenient way for the doctor). Episiotomies, forceps deliveries, and vacuum-extractor deliveries are all performed with little restraint. Pain relief is encouraged even though it commonly leads to problems with the delivery (inefficient pushing, fetal distress, etc) and thus in turn leads to a disappointingly high number of unnecessary c-sections. Time limits placed on the length of labour, coupled with the pressure of doctor hours, result in drugs frequently given to speed up labour, which again leads to more unnecessary c-sections. Any unnecessary surgery introduces risks that would otherwise not be present.

None of this is to say anything of the emotional state of a woman labouring in a hospital versus labouring at home. Most often, the woman feels that she and her labour are under the control of her doctor, becoming a passive participant rather than empowered to direct her own labour. The L&D room is often full of various nurses, residents, and doctors, any of whom may interrupt the labouring woman at any time. She labours under the constant threat of interventions and, ultimately, “failure to progress” (AKA, in many cases, your doctor wants to go home). None of this promotes the sense of comfort, security and focus that enables a woman to labour efficiently. Unfortunately, the connection between a woman’s state of mind and the ability of her body to labour is often ignored in the hospital setting.

Finally, there is concern about the safety of many prenatal tests and postnatal procedures performed, both for the mother and the child, as well as the difficulty a woman often has in declining any of those tests or procedures.

Any one individual midwife is not guaranteed to provide holistic maternity care, nor is any one individual OB guaranteed to encourage unnecessary interventions on a normal healthy pregnancy/birth, but the trends are there nonetheless. I am wholly confident in the care that a good midwife can provide, as I am wholly confident in my body to be capable of doing what women have been doing since the very beginning. On the (very low) chance that something does go wrong, I am grateful that hospitals are there to provide care where care is needed - in cases of disease and trauma, not in cases of normal, healthy, life-giving events.

So no, I have not planned a homebirth for the experience, for my own personal satisfaction, or because all the cool pregnant ladies are doing it. I have a planned a homebirth because for my low-risk pregnancy, a homebirth is the safest option.


  1. Very well written,Cynthia!!! Thank goodness my hospital birth wasn't unplesant. My birth plan was specific and they did not do anything other than we requested. Tammy was a big help and Cindy was too. Since she's a Certified Nurse Midwife,she's a lot different!

    It's sad OBs look at pregnancy as a condition. I am just thankful I have Cindy for now,until we decide to do a homebirth.

  2. Bravo! This was so well written (as usual) and SO right on. I feel empowered just reading it!

  3. Bravo, indeed.

    I'm curious (and feel free to email me a reply if you don't want to waste your own space!), what are the OB vs. midwife points of view on breech babies, and VBAC? You know my history, so I'm sure you know why I'm asking :).

  4. Very well said!

    When I first got pregnant with DD, I had no ideas about my options. I did what most people did: called the hospital, got an OB. Granted, I ended up having a good experience with the hospital birth, with no intervention and most of my wishes respected, partly thanks to my wonderful doula (except that I did, indeed, gave birth lying down). But since then, I have learn a lot, and truly believe in homebirths.

    I am considering it for my next pregnancy - however, I'm also a rather nervous and slightly neurotic person who did have a high(maybe mid)-risk pregnancy last time around, so I'm not sure yet... In any cases, I am going with a midwife, which could attend the birth in a hospital, so I'll be at peace that if something does go wrong, I am right there.

    But homebirths ARE safe - I know that. Plus my last labour was extremely quick, and by the sound of it, I need to prepare for the eventuality of a homebirth. I never had a first latent period - went straight into active labour, no transition phase, pushed only for about 15 min. DD was out within 6 hours! On average, labour time can be cut by half for subsequent pregnancies, and considering that I didn't have much warning... ;-) Also, the prospect of giving birth at the hospital (35 min away), then being discharged merely 2 hours later to free up the room (I'm technically not a patient there, after all), and so having to pack-up (let's admit it, labour is messy, and your quite achey after - not really in for a car ride!!) and drive home, with this teeny weeny baby who likely won't appreciate the car seat (thoughts of how that might disturb the skin-to-skin initial contact and breastfeeding comes to mind) is something to consider.

    I think that finding a midwife who will acknowledge and respect these contrasting opinions, and help me trust in my body, not be nervous, encourage me, and remind me that should anything happen, midwifes are trained to notice it much earlier on and arrange the transfer, is key!!

    I'm assuming that you homebirthed your son? I'd love to hear about your "experience"! (not to make a bad pun! lol)

  5. linked to you from my blog... I just wrote my own "why homebirth" post as well.