Part 1 of our story about choosing where and how to birth left off at making the choice as a couple to deliver our baby at home in the water using midwives. I realized that it may have come across that we chose this path and the midwives solely on a feeling. I don’t want to gloss over the fact that this is not the case. I did extensive research ahead of time and prepared an exhaustive list of questions for our midwife interviews. A home birth, after all, is still a birth and while it is the most natural thing on the planet, birth can be complicated. I needed to know their experience with complex deliveries. I needed to know how it would work if things took a turn for the worse. I needed to know how it would be if we needed more assistance than they could offer in a home environment. I needed to know my baby and I would be safe under all circumstances. Here are just a few questions from my list:

  • What is your education and training as a midwife?
  • How many years have you been practicing? How many deliveries have you attended as the primary caregiver?
  • Do you participate in a peer review group?
  • What is your experience with breech births? Posterior births?
  • How do you manage your schedule to ensure you’re not “double booked” when I go into labor?
  • What is your policy on post dates? What is the earliest you will deliver a baby at home; what is the latest?
  • What do you consider a high risk pregnancy?
  • Under what circumstances will you transfer me to a hospital? What is your transfer rate? If I transfer, will you stay with me at the hospital?
  • What is your episiotomy rate?
  • Do you use birthing equipment?
  • Are you permitted to administer any drugs/medications during labor?
  • How soon do you clamp/cut the cord after delivery?
  • Do you take insurance?
  • Have you ever had to resuscitate a baby?
  • Has a baby or mother ever passed away under your care?

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After our decision to have a home birth was made, Missus Scooter turned into a home birth advocate. She read Ina May’s Guide to Childbirth (and even put her own highlights in the book). She watched the Business of Being Born and got teary eyed at the touching stories, and furious at the statistics of labor-related interventions and correlating C-section rates in the United States. She told everyone we knew about our choice for a home birth and defended it when people looked at HER like she sprouted a second head. It was very sweet but more importantly it felt great to be on the same page.

Aside from a very strong feeling that a home birth was my path, there is a lot of research out there supporting the premise that a home birth provides a more comfortable and natural setting for the laboring woman, thus creating a “better” labor and delivery experience (I hate using the words “better” or “worse” because they just don’t seem applicable to a birth). The guiding principle is that birth is a normal physiological process. Somewhere along the way in the United States we have turned birth into a medical procedure that is dangerous and that most women couldn’t possibly handle it their own. In Ina May’s Guide to Childbirth, she stresses why the births she and her midwives attend have such low intervention statistics, and the mind-body connection is at the heart of it. The wrong environment can stall or reverse labor. In fact, the presence of people who are not attuned with the mother’s feelings can in some cases stop labor! It has been found that there are large hormonal components to birth: both good and bad. When we expend a lot of physical effort, endorphins rise, especially when we are not frightened. Endorphins are good because they actually block the reception of pain. Women who are afraid tend to secrete other hormones that delay or inhibit birth. It’s not to say that being at home will be a direct correlation to not being frightened (or vice versa), but it certainly has many factors in its favor that support a woman being comfortable. Here are a few:

  • First and foremost, you are in your own environment. It is reasonable to assume you are the most comfortable in your own home. It smells like you, it has everything you need or want, you can do anything you want in your own home. You know what to expect there.
  • Privacy. With a home birth, you are in control over who is present at your birth. No one will be there that you don’t know or that you don’t want there. In other environments, there can be a parade of nurses, doctors, lab techs, anesthesiologists, or various other personnel (aka strangers) coming in and out of the room. What if someone comes in at a particularly painful or vulnerable moment? What if you’re naked and on all fours and the new nurse who just came on for shift change walks in to introduce herself? I know how I would react. I would be thinking about covering myself, quieting myself, and making sure I remembered my manners. All of these things could inhibit labor.
  • The Labor Continuum. When labor starts with a home birth, it goes uninterrupted because you start and finish in the same place. This is a very common scenario: a woman goes into labor at home. She labors there for a little or a long while, wondering constantly “when should we go to the hospital?” She will be watching the clock, timing contractions, and trying to gauge whether they’re getting more significant. When it’s decided to go to the hospital, there are many tasks to deal with just to get out the door: grabbing the hospital bag, making sure the house is taken care of, dealing with a pet, making phone calls, etc. Then the woman must make her way to the car and sit in the car which, in the midst of labor, may not be a position she wants to be in. After a drive, she must get out and get checked in, including an intake procedure with questions she must answer. If she’s lucky enough to be as far along as she thinks she is and not be sent home because she’s too early, she will make her way to a room, get changed and get hooked up to monitoring equipment. Then she can get back to laboring. Whew! I’m tired just writing it all out. It is safe to assume that labor probably won’t progress or even stay on the same trajectory through this transfer process. It doesn’t mean she can’t labor successfully in the hospital; the vast majority do. But it could stall or reverse the progress she may have made previously.
  • Pressure to perform. When at home, there are often no time pressures to adhere to. At many hospitals, once a woman is admitted into the hospital, an unspoken “24 hour clock” begins. Many hospitals want a woman to deliver within 24 hours of admittance and may use interventions to speed things up if labor is not going as fast as they would like it to. At home, there are no clocks, no deadlines to meet. Sometimes birth takes a long time. So long as other factors look good (fetal heartbeat is strong, fluid is abundant, mother is strong, etc), the home birth philosophy says “this baby will come when she’s ready.”

With all of that said, ironically, I don’t believe a home birth is for everyone. Everything about the home birth way made sense to me. Everything about it made me feel comfortable. And being comfortable and secure, I firmly believe, are THE MOST important elements to choosing where and how to birth. If a woman is not comfortable, she will be insecure and her body will protest. According to Ina May, Sphincter Law says “labors that don’t result in a normal birth after a “reasonable” amount of time are often slowed or stalled because of lack of privacy, fear, and stimulation of the wrong part of the laboring woman’s brain.” In other words, she’s not comfortable.

Birth is about being as open as you can both physically and emotionally. It’s is a time to “get out of your head” and surrender intellect to allow your body to lead the way. When we feel safe, comfortable, and sure of ourselves, we can allow our minds to rest and enable our hearts and bodies to take over. It just so happened that I felt safe, comfortable and sure of myself with the choice for a home birth, but it doesn’t mean other women would. The point is not that a home birth is better than a hospital birth, the point is that no matter how and where you choose to birth, you be the most comfortable. Every woman’s definition of “comfortable” is different and unique. The challenge is being open to exploring our own inner feelings about birth and how we imagine it happening then being committed to honoring that vision and making it a reality. Whether that’s at home, in a hospital, in a birthing center, or anywhere else!

From the moment we left our midwives’ office on that crisp September afternoon, I knew we made the right decision about a home birth. We brought our midwives on board when I was 12 weeks along which is early by most standards but I wouldn’t have changed it for the world. It gave Missus Scooter and I lots of time to get comfortable with our plan. It gave us time to nourish ourselves emotionally, physically, and spiritually. We all cultivated a relationship (the midwives’ office cat included). We talked a lot about pregnancy and how birth really works. Our visits were thorough and personal. I learned through our sessions to trust my body, trust myself, and the baby will come when she’s ready.

What are your thoughts on home birth?