The Virtual Birth Center

Subscribe now to The Compleat Mother!

Do you find very little support for your parenting style? Invite your Mother home to visit! The Compleat Mother is for all of us extended breastfeeding, non-circumcising parents out there.

Try a 1 year subscription:

Home Birth

This paper was written by Melanie Goette ©2000 and may not be reproduced without her express written consent. It appears on Virtual Birth Center with full permission of the author. To contact her, email mgoette@yahoo.com.

Home birth has been an important part of history for centuries, yet the increase in medical care has led to a decrease in this birthing choice. Many criticize mothers who choose home birth. They believe that these mothers are putting their safety and their babies' safety at risk. Yet, these critics are overlooking the many benefits of home birth and the fact that statistics show that this birthing choice is very safe. While there are risks in giving birth at home, there are also risks in birthing the baby in the hospital. When the facts are seen objectively, it is clear that home birth offers few risks and infinite benefits to healthy, educated women.

Home birth involves the mother giving birth generally in either her home or her midwife's home. Home birth in the United States generally involves the parents either unassisted or assisted by a midwife or nurse-midwife. In other countries, either doctors and midwives can attend home births. Women are encouraged to have a "birthing party," which is made up of people who can support the couple in preparation of the birth and help with their postpartum needs. All of those in the birthing party are not necessarily in the room where the birth takes place, but they are in the house ready to help in whatever way necessary. For instance, they may help by making phone calls, getting supplies, or even doing laundry. This birthing choice takes much determination on the part of the parents, especially because family and friends are more likely to criticize home birth versus hospital birth. However, if the mother is committed, determined and, most importantly, supported by her husband, this birthing choice can be extremely successful.

Using a midwife for prenatal care, delivery, and postnatal care is a popular choice for American couples choosing home birth. Some couples feel that midwives who have direct-entry to the field (do not train as nurses first) are the best choice for them. Others feel that nurse-midwives provide better care. The advantage of nurse-midwives is that they have medical background that could be used in an emergency. However, direct-entry midwives' main focus is birth as a non-medical event that should not be considered a disease or illness. These are only some considerations that couples must ponder when choosing who will assist them in the birthing process. Many mothers visit obstetricians during the pregnancy for prenatal care and use them as emergency backup. Midwives also offer prenatal and postnatal care. Many midwives visit the couple in their home for prenatal visits, providing a large benefit to home birth. This care is often more personalized and comforting than that of an obstetrician. For instance, the average visit with a midwife in the United States lasts forty-five minutes; conversely, the average obstetrician visit lasts six minutes (Birthing the Future).

Some women only have two options: give birth unassisted at home or have a hospital birth. Many of these women visit obstetricians during their pregnancies but opt for an unassisted birth at home rather than have to undergo hospital regulations that go against their beliefs. Yet, having a birth attendant is preferred by many because, if properly trained, he or she can recognize signs of complications as well as offer emotional support for both the mother and father. The birth attendant becomes someone the couple can depend on and trust. A midwife can teach the mother effective ways to speed labor as well as ways to deal with the discomfort. For instance, sounds made during labor, vocalizing, can encourage the baby to move down into the vagina. Many use this technique to vocally match the intensity of the pain. It helps the jaw relax, which relaxes the birth canal. A midwife also encourages the woman to move into positions that are more comfortable for different points in the labor process. She will teach the mother to use her inner resources, concentration, relaxation, and breathing to endure the pain.

History contains countless stories of home birth from all centuries. From the beginning of time, women gave birth at home. Women who were older, wiser, and had experienced birth themselves aided the younger women while they delivered their children. Complications came about and morbidity rates were sometimes high, especially in times when clean water was not readily available. At the beginning of the 1900s, the population's choice of birthing place changed from the home to the hospital, largely due to the fact that the medical community began to put pregnancy under its umbrella of sickness and hospitalization. But, through time, society has learned a great deal about the process. At the start of the twentieth century, ninety percent of United States births occurred at home; by 1950, well over half occurred in the hospital (Gilgoff, 22). As author Alice Gilgoff states about the history of home birth, "what recorded history does not show us is the slow evolution of birth in this country from a woman-dominated, family experience in the home, which was not usually very safe or pleasant should a serious complication of labor or delivery present itself, to a male-dominated, medical experience in the hospital which is not usually very safe or pleasant if a serious complication of labor and delivery does not present itself." (Gilgoff, 20).

Advances in medical technology, especially the use of anesthesia, led doctors to convince women that they could provide the superior experience for birthing. Eventually, this led to hospital births being seen as a sign of status. After all, many women could not afford a hospital birth and the image of midwives was increasingly negative due to doctors' opinions shared with their patients. At this point in history, babies were taken away from their mothers (who were unconscious during the birth) and the mothers were in the hospital for weeks after the event. During this time, they rarely cared for their own babies, muchless spent time with them while in the hospital. And drugs used during delivery were not necessarily safe for mother or baby.

As stated above, by 1950 over half of American births occurred at the hospital and medical professionals quickly took credit for the drop in mortality for both mothers and babies. However, they cannot be the only ones responsible when these decades also saw the establishment of prenatal care, blood banks, improved diet, and the introduction of antibiotics. And over and above these new discoveries, home birth still had lower mortality rates than hospital births (Gilgoff, 23).

Currently, home birth is legal in every state. However, nine states including Ohio prohibit midwifery through statutory restriction (Media Max Productions). However, midwives practice in these states as well as all over the world. Midwife Shay Huffman, who practices in West Virginia (a state restricting midwifery) and has assisted more than 200 births, cannot take money for labor and delivery services; she can only take payment for pre- and postnatal care (Nyary, 77). Countries less developed than the United States, where deliveries are primarily done by midwives, have lower percentages of death from childbirth. This makes people question why the United States is so against the practice of midwifery. The economic pain doctors may feel from the loss of patients choosing home birth may be a good part of that answer.

Statistics show that at least ninety percent of childbearing women are capable of giving birth at home safely (Gilgoff, 21). In the first half of the twentieth century, women too far from hospitals as well as those too poor to pay hospital charges, gave birth at home. Home birth services were in operation to help these women; two of the most well-known were the Chicago Maternity Center and the Frontier Nursing Service of Kentucky. These women had several high-risk conditions, many faced because of their low income. Yet, "a 1932 report prepared by the Metropolitan Life Insurance Company on 10,000 births covered by the Frontier Nursing Service, for example, showed an infant death rate of 9.1 per 10,000 live births, while both the national average and the Kentucky state-wide average during the same period was 34 per 10,000 live births." (Gilgoff, 23). At this time, maternal mortality rates due to hemorrhage, infection, and other conditions were lower at home.

The increase in women's liberation of the 1960s also led them to take control over their own bodies. Women searched through their birth alternatives more heavily and wished to have a larger voice in what interventions were being done to them. When childbirth preparation was more accepted in hospitals, it led women to realize that they could significantly change their birth experiences with preparation and education. This, logically, led to a revival of home births in America. The Lamaze and Bradley methods helped pioneer this education of birth. Books written by midwife Raven Lang, Nancy Mills, and Suzanne Arms, as well as many arrests due to midwives practicing without licenses, brought media attention to the cause. As support groups entered the American culture, articles showing home birth in a favorable light entered both magazines and medical journals. The general public was now beginning to see the benefits of home birth.

In general, women who give birth at home are more educated about the process than those who choose hospital birth. The reason is likely because women who choose hospital birth are told by the obstetricians how things should happen and have little reason to question their medical professional. However, women who give birth at home are more likely to receive criticism from family, friends, and society; stronger education in the risks and benefits helps them to debate the harshness of those less knowledgeable. Also, these women play a bigger part in their deliveries. They tend to use methods of childbirth that use education to perfect, such as the Bradley Method, the Lamaze Method, massage, and hypnotherapy.

Personal concerns about the differences between hospital and home encourage many women to choose home. The belief that birth should not be a medical act leads this list. History has shown that labor and delivery is a natural process and only requires hospital care when complications exist. Many situations and personal beliefs lead women to home birth. Negative past birth experiences lead women to choose home birth for subsequent births. Lack of decision-making ability, as well as the use of intervention lead many away from the hospital setting. Stress can create a more tense and unproductive setting for a birthing mother. Many women can deal easily with the stress of a hospital delivery and many do not even recognize the hospital setting as a stressful one. However, others feel this stress can only create a less positive environment for both them and their babies.

Many couples wish to include their extended family and especially their other children to be witnesses to the birth. This is accepted at some hospitals and by some doctors, but hospital rules still apply, which stifles the interaction between the couple, their newborn, and their family. And many hospitals simply will not allow it. Even when hospitals allow husbands to be present for the birth, many feel alienated from the process. One woman I surveyed stated that she felt as if she were turning her labor over to the doctors rather than being allowed to experience it and endure it naturally.

Many people feel that couples who choose home birth are against medical technologies. However, they are truly supporters of such advancements, they just believe those interventions should not be overused. Not only are they normally unnecessary, but many lead to complications. The concern of an unnecessary cesarean section is a major risk in choosing a hospital birth. Of four million births, 800,000 are cesarean; 500,000 of these are unnecessary (Birthing the Future). Many hospitals encourage this when labor has continued longer then twenty-four hours, even when the baby is not at risk. Society has accepted cesarean easily, not taking into account that a cesarean is considered major abdominal surgery and increased recovery time is not beneficial to the mother or child.

Many women who choose home birth do so in part because they feel belittled by the whole hospital experience. The ritual of a hospital birth does not facilitate the birthing process; in many ways, it works against the body's natural way of dealing with delivery. Many women choose home birth to avoid the hospital ritual: having their waters broken, having their dilation measured by the hour, having to have pitocin if dilation does not follow the textbook, and being given a certain amount of time after full dilation before the baby is born or having to endure either forceps of vacuum extraction delivery.

Induced labor is faster and more intense than natural labor and many women who have had both induced and non-induced births said that their labor was much more painful when induced (Kitzinger, 21). The drugs used in hospitals tend to be encouraged but are not always safe. At home, midwives use other techniques to help women deal with the pain of childbirth. For instance, cold compresses, relaxation techniques, aromatherapy, and herbs can be used effectively and at no risk to mother and baby. These practices are frowned upon at hospitals, even when they could encourage a positive birth experience.

Kitzinger states the subtle interventions of hospital delivery as well: "having to put on a hospital gown, being put to bed as if you were ill, not being able to eat and drink when you want to, the constant checking of the progress of labor against the clock, being surrounded by strangers who talk over you and about you, rather than to you, being treated like an irresponsible child who is not given any control, and the whole emphasis on pathology--detecting things that might go wrong--instead of on supporting the spontaneous flow of labor." (15) And one aspect that can encourage or discourage labor is the environment the woman labors in, something she has little to no control of in the hospital environment. The mother is not the only one treated as a patient; the baby is treated that way as well. The procedures babies must endure cause a painful adjustment to their new surroundings.

Women who birth in hospitals are often treated as if they should be able to make no decisions in the birthing process. These women can end up feeling "degraded, abused, and mutilated" (Kitzinger, 11). The powerlessness of a hospital birth can lead women to feel more fearful, can slow labor, and can lead to a negative birth experience. However, women who retain the power over birth, be it in the hospital or at home, can create a positive birth experience. The advantage of a home birth is that this power is more easily given to the woman. In hospitals, this power is normally given to the doctors, who manage the birth for the woman, whether she is comfortable with that or not.

Risks are the biggest reason most Americans think home birth is dangerous for the baby. Because transport is necessary in a small amount of home births, the baby could be in danger in certain situations. However, these are lessened when an experienced midwife is present. For instance, when a prolapsed cord is present, an experienced midwife can detect this early enough that the mother can be transported to the hospital in time to have an emergency cesarean and the baby and mother will both survive. Without the proper equipment to resuscitate if the baby has problems breathing at first, this could put the baby at risk. However, midwives are trained at dealing with such situations and such situations do not normally create excess concern. These complications occur with a small percentage of births, making home births an option in most cases.

Risks to the mother are also discussed by those against this birthing choice. There is a chance the mother will have to be transported to the hospital, and most areas do not have an organized transport system or quality obstetrical backup. Many doctors have negative feelings about midwives to the point that they will not treat a woman who they know is planning to deliver at home, which disallows the woman to get the best care possible from both professions. This can be a concern when a problem arises late in the pregnancy and a home birth cannot successfully occur. The laws of the United States do not support midwives; therefore, many women are giving birth assisted by unlicensed midwives, which can increase the risk of home birth. While home birth can be less expensive, it can also be more costly in many cases because of the lack of insurance coverage.

Many women feel the lack of anesthesia is another disadvantage to home birth. A woman must be dedicated to a delivery with no anesthesia if she delivers at home. Women who praise the pain relief of epidurals feel home birth would have prolonged their pain when it can be helped with this form of medication. However, home birthers realize that epidurals are not as safe as doctors claim, because the drug can pass through to the baby and cause fever in one or both, slower dilation, and an increase in forceps or vacuum extracted delivery.

There are many benefits to home birth and the benefits begin with those affecting the baby. Drugs used to ease the mother's pain in labor are not used and therefore do not negatively affect the baby. In hospitals, these drugs are commonly used and the mothers are told they are harmless when, in fact, many do affect the child. The bonding experience between mother and child is much more successful and encouraged in the home environment because the baby is not removed from the mother instantly once he or she is born. The child also benefits from sharing his or her first days with both parents, which encourages fraternal bonding better than hospital birth situations.

These benefits extend beyond the baby and affect the mother as well. In hospitals, mothers are put on their backs with internal and/or external fetal monitors attached to them. At home, she is able to move freely. This has been proven to be the worst position for birthing. There are countless other benefits to home birth. The familiar and comfortable setting of home seems to move labor along more quickly than a hospital setting. Policies and routines common in the hospital are not adhered to at home, which can decrease the anxiety factor many mothers face. The mother can be with only people who know her, love her, and support her, rather than hospital staff who may or may not know what she intended the birth experience to be. Fear, which can increase the pain factor, is minimized. The mother makes the decisions rather than the doctors and nurses, who may encourage intervention. Mothers can often avoid episiotomies. Some women tear but many claim that a tear heals better than a cut. Others use perineal massage during delivery and do not need the procedure. Woman-to-woman contact (here between the woman and her midwife) helps to ease the discomfort felt during labor. Vocalizing, which can increase the success of labor, can be done without concern of nearby patients. The hurried pace of the hospital is not felt in the home; birthing mothers are more able to allow the labor process to progress naturally. Contrary to what uneducated people might suspect, the risk of infection is lower at home (Sears & Sears, 44). As stated earlier in terms of the history of home birth, the cost is generally lower.

Women who birth at home tend to have a feeling of empowerment from the experience. They realize what their bodies went through and rejoice in the fact that they overcame the pain and did it the way they planned. This experience often raises a woman's self-confidence. When a woman gives birth in her own home, she is comfortable and the chances of a positive birth are increased. When negative birthing experiences happen, women fear the birthing process more heavily and the joy of childbirth is overshadowed with fear and self-doubt.

The story of home birth is continuing to be written. As women take more control of their health care, it is likely that home births will increase. And the criticism that comes from the uneducated with subside; at least, that is what home birth supporters hope. Eventually, society may realize that healthy women can successfully give birth at home with little risk. Hopefully, they will realize that hospital birth is not the right choice for everyone and that hospitals can provide their own birthing risks. As women become more educated, more independent, and more in control of their health, birth in America will be less and less frightening and more and more empowering.

References
Ackerman-Liebrich, U. (1996). Home versus hospital deliveries: Follow up study of matched
pairs for procedures and outcome. British Medical Journal, 313, 1313-1318.
Birthing the Future (Producer) (1998). Suzanne Arms' giving birth: Challenges and choices
[Videotape]. Durango, Colorado:Birthing the Future.
Crawford, C. (2000). A model mother. Redbook, 194, 124-126, 128, 158, 160.
Ford, C. (1991). Outcome of planned home births in an inner city practice. British Medical
Journal, 303, 1517-1519.
Gilgoff, A. (1989). Home birth: An invitation and a guide. Granby, MA: Bergin & Garvey
Publishers, Inc.
Goer, H. (1999). The thinking woman's guide to a better birth. New York: Berkley Publishing
Group.
Harper, B. (1994). Gentle birth choices. Rochester, VT: Healing Arts Press.
Injoy Productions (Producer). (1988). Special delivery: creating the birth you want for you and
your baby [Videotape]. Boulder, Colorado: Injoy Productions.
Kitzinger, S. (1991). Homebirth: The essential guide to giving birth outside of the hospital. New
York: Dorling Kindersley, Inc.
Media Max Productions (Producer). (1994). A guide to home birth [Videotape]. Jensen Beach,
Florida: Media Max Productions.
Nyary, S. (1995). The working life of a rural midwife: Laboring for love. Life, 18, 76-80, 82.
Remez, L. (1997). Planned home birth can be as safe as hospital delivery for women with
low-risk pregnancies. Family Planning Perspectives, 29, 141-143.
Sears, W. and Sears, M. (1994). The Birth Book. New York: Little, Brown, and Company.
Woolpert, L. (1990). Birth options. Whole Earth Review, 68, 68-70.