When I found out I was pregnant, I hadn’t planned on giving birth at home. I'd wanted to labor at home as long as possible and then head to the birth center when it was time. The birth center was just 5 minutes away from a hospital, all of it super close to where we lived. But many months into my pregnancy, we had to move.
I loved my midwives, and I didn’t want to change providers mid-pregnancy. There was no birth center near my new home, and the only option was a hospital birth, which I also didn't want. Traveling more than an hour to the birth center while in labor didn’t seem like fun, so all of a sudden, home birth became the best option.
So in those final months, we planned for a homebirth.
Finally, after two nights of almost no sleep (thank you prodromal labor), true labor began when I was putting my 2-year-old to bed. I knew this was it when moving around didn’t stop the contractions. Neither did drinking water or having a snack.
I labored through the night, sometimes standing, sometimes on all fours.
My midwives showed up around 5:30 a.m.
My water didn't break until I started pushing. I pushed while kneeling in the living room and holding onto my husband. I clearly remember the first view I had of this baby, my second, gently tossed through my legs after my midwife caught her (a very different memory than the one I have of Baby No. 1 being taken away from me at the hospital).
I mentally compared the risks and benefits of homebirth with the risks and benefits of hospital birth.
I was exhausted, sore, and also elated to be able to see for myself that she was a girl and that the hard work of labor was over. I didn't even notice she wasn't crying. My midwives told me to put her down on the floor, and they started putting a newborn-sized air mask on her tiny little face. That’s when I realized something was up. There I was, in my living room in rural New Hampshire, a 30-minute drive from a maternity ward, with a baby who wasn’t breathing.
Maybe it was the endorphins, but I wasn’t scared. Actually, I was more frustrated that I couldn’t get into a comfortable position to hold my baby yet (the cord was still attached). My midwives calmly but feverishly checked her heartrate (which was good) and gave her oxygen. I rubbed her skin, they rubbed her skin. I talked to her and let her know I was there and that I needed her to breathe.
I looked up and my husband was holding his head in tears walking back and forth. I said to him, “it’s OK, she’s OK,” and I really believed it. I mean, how could she not be?
Fast forward a few weeks to when I was questioning whether homebirth was the right choice or whether it had been dangerous and thoughtless. I mentally compared the risks and benefits of homebirth with the risks and benefits of hospital birth.
Here's what I reminded myself about hospital births:
1. Higher risk for a c-section
Midwife-attended births in the U.S. have a c-section rate of 4 to 6 percent, while the c-section rate for low-risk women who choose a hospital birth is 19 percent (in some states, it's closer to 30 percent!). The morbidity and mortality rates are the same.
I know I’m not the only one that is uncomfortable giving birth in front of strangers.
2. Higher risk of other interventions
The thing about interventions is that one leads to another (which leads to another). So something as seemingly benign as continuous electronic fetal heart rate monitoring (EFM) can trigger other problems. EFM restricts moms' movement and ability to labor in whatever position feels best, which can make labor more difficult and painful (and potentially cause the need for an epidural). EFM may even lead to an unnecessary c-section or instrumental birth.
In a Cochrane review, EFM reduced the chances of a newborn having seizures (which is incredibly rare) but didn’t reduce the chances of cerebral palsy or infant mortality. At the same time, EFM increased the risk for c-section and instrumental birth. Intermittent fetal heart rate monitoring (using a doppler every so often, as midwives do) is the evidence-based choice for monitoring heart rates, because it can catch problems without causing unnecessary alarm. But many hospitals don’t even have a handheld doppler.
3. A hospital setting would disrupt my birth process
Birth is a normal, natural process regulated by hormones. When labor starts, oxytocin stimulates contractions and endorphins are released to ease pain. Oxytocin helps mom go into the primal, meditative birth state that allows her to instinctively know how to give birth to her child. Adrenaline, on the other hand, is released when we are scared (like in a scary hospital setting with people we don’t know telling us to take our underwear off). Adrenaline interferes with the cascade of birth hormones and stops or slows labor. In nature, this is a great thing, because if you’re out in the woods and laboring and a pack of wolves surrounds you, it’s better to stop being in labor and get the heck out of there. In the hospital, doctors take this as a stalling labor and begin suggesting (and sometimes pushing) Pitocin, breaking the water, etc.
The risks of homebirth for my low-risk pregnancy came nowhere near the risk of having my baby at the hospital.
I didn’t want anything to interrupt my natural birth process and cause need for interventions, since, as I said, one intervention often leads to more. I know I’m not the only one that is uncomfortable giving birth in front of strangers and having them around, coming and going, would have upped my adrenaline, I'm sure.
The obvious risks of a homebirth are that there isn’t advanced medical intervention available immediately, if it’s needed. But one thing that many people don’t realize is that having a homebirth with a certified midwife is not the same as having an unassisted birth. Midwives are trained professionals who are able to recognize when a labor starts to complicate and will recommend a transfer to the hospital well before things turn to a high-risk situation. True emergencies, like the one we narrowly escaped, are incredibly rare and midwives are trained to deal with them.
My midwives were competent and professional and, after a few minutes of oxygen, our baby was breathing and crying normally. Her APGAR score went from 4 to 8 (then a 9). My midwives were very close to calling 911, which I didn’t realize at the time because of how calm and collected they were.
Pregnant women will undoubtedly hear stories of how being at the hospital with access to immediate medical intervention saved a baby’s life. Interestingly, the evidence suggests that the complications that are supposedly addressed only because mom was in a hospital are, more often, caused by the hospital itself. In fact, studies show that newborns are more likely to need resuscitation at birth (among other things) if they are born in the hospital, not at home.
So what happened to my baby was a rare occurrence, especially for an out-of-hospital birth.
My conclusion? The risks of homebirth for my low-risk pregnancy came nowhere near the risk of having my baby at the hospital. Homebirth was the right call for me.
But I’ve been contemplating what this all would mean if my baby had not recovered so well. Would I still feel the same way? I like to think I would. Many people would, of course, blame the homebirth had the outcome been different. But I would know that I did what was best for my child and that some things in life are completely out of our hands.