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for trial of labor’s blog tag: your homebirth questions answered September 21, 2007

Posted by guinever in : birth, health, home birth, homebirth, midwifery, pregnancy , trackback

Dear Trial of Labor blogger: I’d love to answer your homebirth questions!

Have you considered homebirth as an option for labor and delivery with a previous/upcoming birth?
Yes, I have had 2 homebirths after having had 3 hospital births. My birth stories are linked below.

Why did you (or did you not) consider homebirth?
Before ever being pregnant, I always thought I would have a birth center birth then a home birth. Well, when I was expecting my first baby, there were no birth centers around, so I opted for a hospital birth with a CNM with my first two births. For my third birth, I looked into homebirth, but ended up switching midwives and hospitals (traveling nearly an hour) instead of having a homebirth. It was a lot cheaper for us to have the hospital birth since insurance covered it and finances in the end were the deciding factor for me. After that birth, I started attending births as a doula and decided I never wanted to have a hospital birth again. So my fourth and fifth babies were born in the comfort of my living room.

bellym

What do you see as the major advantages for homebirth, and what are your justifications? I don’t know where to start. Labor and birth are so much more comfortable at home. I don’t have to worry about when to go to the birth place since I’m already there. I don’t have to experience active labor in a moving vehicle (that was always a drag for me especially for my second birth when I did transition in the car). At home, I’m in charge. No one takes my baby away to the nursery. Labor doesn’t slow down because I’m at the hospital. No paperwork (well, there’s a little, but it’s not reams). Only people I want at my birth are there. (no never ending parade of nurses and residents) I can birth my baby where ever I want–in a tub, in the kitchen, in the living room, bathroom, outside–and I can be in whatever position works at the time–standing, squatting, sitting, lying down, on all fours. Pretty much, anything goes. No stirrups. No bright lights. No threat of an episiotomy. No drug pushers disguised as labor nurses. My chosen midwife looks at me, the laboring mothering, listens to me, watches my body language for an indication of where I’m at in labor instead of looking to the EFM and pushing for constant cervical checks. No beeping machines, no IV’s. My midwife quietly and gently checks baby’s heart tones where I’m at. (I don’t have to go lie down in bed for the nurse’s convenience) No shift changes. My midwife and doula are here for me. They won’t go home because they’re off the clock.

What do you see as the major obstacles for homebirth? For me, it was the legality for the midwives. Technically, in my state, only licensed midwives can do homebirths, but the state stopped issuing licenses in the 1970s. Very lame. Legally, CNMs can do homebirths, but most don’t. Some malpractice insurance companies won’t let them or they would lose their policy. There’s only a few doctors who will backup midwives who do homebirths. So I think this is an obstacle.

Was your husband “on board?” Definitely. In fact, after our first homebirth, my husband said, “Why didn’t we do this before?”

That’s the answer to all your questions, but I did want to add that for me, part of having a safe homebirth was having a back-up plan in case transfer was required. My husband and I met with a doctor who knew our plans for birth and he was willing to take care of me if I needed to go to the hospital. He said his main concerns were shoulder dystocia and hemorrhaging after the birth. I didn’t tell him that I was prepared for either option. We would do the Gaskin maneuver (not many docs know about this, but it works everytime for getting those big shoulders out!) And for possible bleeding, I had an herb on hand to use for my first homebirth and for my second, my midwife carried pitocin. Also, my hematocrit was right where it should be so bleeding out was unlikely. I was all set! We also had oxygen.

I’d also like to address the common concern that many people have. So many who aren’t familiar with homebirth say, but what if something happens and you’re not at the hospital? Shouldn’t you be in the hospital in case something bad happens? My answer is that its not safer in the hospital. Most birth “emergencies”occur because you’re at the hospital. One intervention leads to another. If you’re at home, you’re less likely to have a mom or baby in distress. If something does happen, all you have to do is call the hospital and they can prep the OR and be ready for you. They’d have to do this even if you’re at the hospital. Maybe you’re going in because you’re just exhausted and want the pain meds.. most women have to wait about 45 minutes for an epidural, so its not like the instant a woman wants drugs, they’re being pumped into her back. So it doesn’t really save anytime if you’re already there.

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Comments

1. msovoice - September 22, 2007

Guinever, I really enjoyed your responses to my questions. And thank you for also addressing the common concerns as well. People just don’t know WHY they’re not safer at the hospital or that just because you’re IN the hospital doesn’t mean that response time is any better. In fact, some folks say that emergencies that come into the hospital are dealt with quicker than in-house emergencies. (I can’t give you any evidence of that, but I probably read it in one of Goer’s books or in Marsden Wagner’s book.)

I’m off now to read your stories and your pelvis post. I myself ended up with a diagnosis of CPD… I’m 5’10″ and my baby was a mere 8lb1oz. CPD my a$$!!!!

=) Labortrials