Home Birth: A Different View

baby

Anybody who knows me, or who has spent any time reading my blog, will know that I am a big advocate for home birth. I have experienced both the standard hospital birth (thankfully a different story to US hospital birth, but still not ideal) and the all-natural home birth, and the latter was just… wonderful. Not only was the birth amazing, but the postnatal period too.  Home birth is pretty darn awesome.

I have wholeheartedly thrown myself into the online world of natural childbirth advocacy and have met some very inspiring women along the way. However, up until now I have neglected researching The Other Side –
The people who insist that homebirth is dangerous.

Don’t get me wrong; I still very much agree that home birth, for low-risk, healthy mothers and babies, is a safe and indeed preferable option. Should I get pregnant again someday, and all goes well, I will certainly be planning another home birth.

What needs to change is the terrible state of maternity care in the US that forces women to make choices that are unsafe for their babies, because they feel that they and their babies are more unsafe in the hospital.

However, after looking at all of the viewpoints through balanced eyes (rather than my usual headstrong, my-way-or-the-highway vision), I am starting to rethink the whole ‘trust birth’ mentality.

Birthie sisters, let me explain before you abandon me. In my opinion, women’s bodies are designed to give birth. When everything goes to plan, the woman’s body and the baby work together to bring baby safely into the world. However I can’t help but feel that some of the hardcore natural childbirth advocates ignore the fact that, although birth is generally safe, it can be dangerous especially when there are risk factors involved.

What bothers me is that there only appears to be two camps that are making regular noise about birth. There’s the hardcore homebirthing doctors-are-evil types, and the Dr Amy Devotees who seem to think that birth is incapable of happening safely without the guiding hand (or iron fist) of a doctor. The latter think that women choosing home birth are selfish because they care more about their own experience than the baby’s safety – this really couldn’t be further from the truth.

I’ve met women online who have taken massive risks in order to get the home birth they desire. However, the vast majority of us choose home birth because we truly feel it is the safest, and best option for our whole families – including the unborn.

Yes, there definitely are some women who get overly hung-up on the experience. I’ve met women online who have taken massive risks in order to get the home birth they desire. However, the vast majority of us choose home birth because we truly feel it is the safest, and best option for our whole families – including the unborn. Furthermore, the women who do get hung up on The Experience need our support and love, not to be chastised. They likely feel that way because they have endured horrific trauma in the hospital. Birth trauma is real and serious, no matter what many callous Dr Amy Devotees say. And sufferers of birth trauma need professional help to deal with what they have unfortunately gone through.

Furthermore, the Dr Amy Crew, even with all of their expertise (many of them are doctors with a background in obstetrics) seem to neglect the fact that the interventions they believe are nothing but useful can be responsible for many problems in the postnatal period, as well as the birth. The repercussions of birth choices do not end once the baby is out – a traumatic birth can affect bonding and breastfeeding also, which will have a knock-on effect on the child’s future health.

When I was planning our home birth, I became very preoccupied with The Experience. I told the midwife that I would stay at home should I go into labour at 36 weeks, rather than going to hospital as the midwives recommended before the 37 week point. I refused a growth scan after a fundal measurement was a little on the low side. I told my midwives that I wanted completely hands-off care. I don’t regret any of these decisions – each one was carefully researched, weighed up and agonised over. However, I don’t think at the time that I really took on board the risks of birth – instead, I was charging blindly ahead, convincing myself that birth would be totally safe as long as the infernal purveyors of modern medicine stayed out of my way. It’s very easy to convince yourself of that when you hang out in an echo chamber of others believing the same thing, where the negative outcomes are censored.

I think natural, home birth is wonderful and I’ll always, always support those who want to do it. However, the current state of maternity care in the US is preventing many women from making a safe choice for themselves and their children. Access to hospitals is a zip code lottery; some women are lucky enough to be nearby a hospital full of wonderful, respectful OB’s and L&D nurses whereas others get lumped with the exact opposite. Many women feel that they are in a position where home birth is their only option, even if that’s not really what they want.

I am very concerned about the fact that MANA (Midwives Alliance of North America) are hiding their data on homebirth death rates. Surely if the statistics showed that home birth in the US is as safe or safer than hospital birth, they would be shouting it from the rooftops?

Again, in my opinion home birth is safe for the majority of women and babies. When deciding to birth at home, you need to take on board your individual situation – do you have any risk factors? How far away from a hospital are you, should something bad happen? How experienced are your midwives? The problem with CPM’s is that some of them will happily take on high risk home births with seemingly no concern for the level of danger involved. I hate to admit it but I can’t help but worry when I read stories of women giving birth to breech twins at home with a CPM – to me, that is way too risky. That’s not to say that there isn’t a whole load of wonderful CPM’s out there – there are. But there are also plenty who are underqualified, underexperienced and take too many risks.

Ignoring the fact that sometimes things go wrong at birth, even totally natural home births, is irresponsible and ignorant. Furthermore, I am very concerned about the fact that MANA (Midwives Alliance of North America) are hiding their data on homebirth death rates. Surely if the statistics showed that home birth in the US is as safe or safer than hospital birth, they would be shouting it from the rooftops? Instead, they are withholding the data and only allowing access to those who can prove they will use it for “the advancement of midwifery”.

I cringe when I read stories of CPM’s advising mothers to refuse GBS testing, lest it come back positive and end their chance of a home birth. Why do we think that midwives are somehow immune to greed? We’re all very happy to assume that doctors only care about lining their pockets, but when a midwife advises against testing that could save a baby’s life, coincidentally preventing the mother from having a homebirth and paying the midwife for it, nobody bats an eyelid.

As I’ve said before, home birth here in the UK is a very different kettle of fish. Our NHS midwives are highly qualified. They attend births in hospitals, and are dispatched to home births also. I felt we were completely safe in the hands of my midwives because I knew that they would suggest a transfer the moment they thought things were going awry. For me, this was important because we live 30 minutes away from the hospital. I needed to know that the minute things were looking hairy, they would be honest with me and get me transferred.

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I am not saying that home birth is dangerous and irresponsible in and of itself. Home birth is wonderful, and I so hope that our circumstances allow for it with the next baby. What needs to change is the terrible state of maternity care in the US that forces women to make choices that are unsafe for their babies, because they feel that they and their babies are more unsafe in the hospital. Hospitals need to focus on allowing high-risk mothers to have gentle, dignified, natural births if that is what they desire.  Ironically enough, for home birth to truly be safe, care led by experienced and professional midwives needs to become the norm.

At present, women don’t have a choice. Home birth should be chosen because it is right for the individual family involved, not as a last resort – and certainly not with a provider who is happy to take unnecessary risks in order to get paid.

I am still forming my own opinion on all of this, and I’d love to hear what you think. Please share in the comments!

Comments

  1. says

    I’ve always felt this way about homebirthing, even though it was a viable option for me. It certainly isn’t for everyone which is why it is so important than the maternity care system in Canada (where I am) needs a crucial re-vamp. Our medical community needs to take in consideration the needs and desires of their pregnant women and adopt evidence-based care. There is no reason that women who birth in hospitals are not able to have natural, gentle births.

    • says

      Absolutely. Don’t get me wrong, I felt absolutely safe at home and I really do feel it is a safe, fantastic option for many women. I just… I don’t think I can get on board with gunning for homebirth when you’ve got lots of risk factors that could mean a baby could die, you know?

      Thanks so much for your positive comment. I can’t help but feel like i’m going to get a lot of flack for this.

  2. whitney says

    I take much offense to some of your comments. I was a licensed and certified midwife for a short time before I started to have children and decided that I needed to focus on family. I don’t think I’ve met a CPM like the ones you seem to imply are the norm. There is no convincing women, there is only informed choice and education. Education (as well as recommending women to do their own research) is an extremely important part of midwifery. Furthermore, I know very few midwives or midwifery clients in the extreme side that you speak of. Most of us are really level headed about what exactly birth is, and weigh the risks accordingly.

    • says

      I absolutely agree; informed choice and education is paramount for ensuring a safe and healthy birth experience. All I am trying to say is that it is very easy to get wrapped up in the thinking that doctors are evil and hate women, and midwives are 100% infallable which just isn’t the case. I would absolutely choose midwife-led care over obstetric care when I fall pregnant again, so please don’t think I am somehow against midwives – I’m not. Maybe I just didn’t explain myself very well. I’m certainly not implying that selfish, money-driven CPM’s are the norm, not by a long shot. It’s just that recently I have read a few birth stories that involve abusive, unprofessional and downright dangerous midwives and it just made me realise that nothing is black and white.

      Like you pointed out, informed choice and education is what the focus needs to be on. Hospitals need to put their focus on women and babies rather than hospital policy, then more women would feel able to birth in hospital. I have met many, many women online who chose home birth because they felt they had no other option.

      Thank you for your comment; I’m sorry you felt offended by my post. As a homebirthing, midwife-loving mama that really wasn’t my intention :)

  3. Marie says

    We attempted a homebirth, but in the end transferred to hospital. I had been labouring for 25 hours was 8 cm dialated but contractions were tapering off and irregular. (He was spine to spine) it took me a while to agree to go into hospital as I didn’t like the idea of being bullied by the hospital system into doing things unnecessarily. However it was great and with my team and some syntocin I had a beautiful safe birth. I had an obstetrician however waiting at the door who had put a time frame on my labour saying I would b prepped for a ceaser. (no stress to baby or me at any point just hospital protocol apparently) so my recommendations r arm urself with a private midwife with plenty of experience so she can advise u of what is necessary and what’s not. As doc don’t always advise what’s best for u or baby sometimes it’s what suits them.

    • says

      Thank you so much for sharing your story! I think it’s important to read stories such as yours, that show it’s totally possible to have a safe and dignified experience in a hospital. All you ever seem to hear is stories of evil slice ‘em and dice ‘em OB’s and I just can’t believe that they are all like that.

  4. says

    This is a great post. I was born at home. My mom planned it that way and thank God, there were no complications (other than the fact that she was in hard labor for 24 hrs). I was her first child and I was born in July, in a tiny upstairs apartment, with no AC! I used to roll my eyes at my birth story…until I became a mom. I have such great respect for my mom now that I know what pain she went through to have me :) Her second two daughters were born in a wonderful hospital (where I later birthed my own two children) and then my mom had her last daughter at home again and I got to watch the miracle happen (I was 10 years old and very mature). Having a baby is such a beautiful experience. I have heard so many different sides. I have an aunt who went to “the best of the best” and had to have an episiotomy (sp?) which they screwed up royally and ended up getting sued! My stepmother went to the same hosptial I love and almost bled to death (thank God the ppl there knew what to do). It is always risky, IMO, whether you are home or at a hospital. It is a major event to give birth to a child. I personally would never do it at home, because I am a scaredy cat and a very negative thinking person, but I have nothing against the brave mommies who want to be home.

    • says

      Thanks so much for sharing your experiences! How amazing that you got to witness a birth as a child. I think my brother was taken into the delivery room as I was being born and his reaction was “Ewww, GROSS!” :D

      I’m glad you had access to a great hospital when you had your children. I agree that it is definitely a major event. It’s one that will likely go smoothly if left to progress without interference but like everything in nature, it doesn’t work perfectly 100% of the time.

  5. Michelle says

    Wow… As a homebirth advocate I have to say that I found this post a little confusing. I actually think it was a great critical analysis of the mainstream medical antenatal/prenatal care both here in the UK and more notably in the US but had little to do with actual event of giving birth to a baby at home versus giving birth in a hospital. Women want home births because they truly understand that birth is something the pregnant mother and her unborn baby are completely in charge of – birth is not something that can be done to you (I suppose this is where the term “delivery” comes in – as in who will deliver my baby? vs who will I grant the honour of catching my child in the rare event I can not myself?).

    Something that you have really touched on here is the worrying fact that more and more unhealthy / non holistic health conscious or educated men and women are getting pregnant everyday. The fact is a ridiculously high percentage of birth risks or complications can be prevented through pre conception nutrition and holistic wellness care/support.
    Mainstream medical (majority of NHS) antenatal/prenatal care has sadly become boiled down to a bunch of diagnostic tests – looking for things that are wrong when this is one of the main time in your life when biology (if not interfered with) will insure that everything goes right.

    The problem I think most people have the phrase “trust birth” is the fact they do not know how as they have never been expected to nor instructed how to trust their bodies before and thus end up not trusting themselves when they start the life changing pregnancy journey.

    Sorry for the essay but I am quite passionate about this topic and your post is very thought/birth & life philosophy provoking =)

    • says

      You raise a really good point about being in charge. When we were planning our homebirth that was one of the things our midwife said to us – at home, you’re in charge and we [the midwives] are guests in your home. I feel it’s so important for a woman to feel in charge of her body and her birth.

      I totally agree that better prenatal health has a huge impact on possible risk factors. We certainly have lost touch with how to properly feed and nourish our bodies.

      I don’t think I explained myself very well. It’s not that I take issue with trusting birth, birthing at home or trusting women to make the right decisions regarding their care. I just think it is beyond terrible that high risk mamas feel the need to birth at home, sometimes even without a midwife at all, because they don’t feel safe in the hospital. If a mama wants a HB or even a UC because it’s right for her family, then good for her! But the fact that the state of maternity care has her feeling as though she has no other choice is shameful.

      Please don’t apologise for the long comment! I really appreciate it when people take the time to share their opinions as you have done. Thank you :)

      • Michelle says

        I can see your point I guess I think you are focusing on the wrong part of the problem. My question is why are there so many “high risk” pregnant women in the first place? My answer is that we (human beings) as a global society are more unhealthy than ever before and this trend does not seem to be slowing down. The other part of the equation is exactly who is (or should be) assessing a pregnant women’s risk in the first place? According to your article neither these women nor many skilled home/natural/psychologically normal birth midwives are capable of doing it for themselves; so I guess they should hand over their care and decision making capabilities to the most qualified and experienced obstetricians without pause or question of other options?

        I think that making decisions for other peoples’ (namely women’s) lives because you are “qualified” in maternity “risk assessment” is incredibly dangerous and basically equivalent to gambling with peoples’ (again primarily women’s) personal liberties and freedoms. I can not believe that a woman who is educated on ALL of her holistic options and most up to date information on “risks” for herself and her baby would not make the best decisions for her pregnancy. But this is the main problem with medical obstetrical “care” – it is, by it’s very creation, not concerned with informed choice or the best outcomes for a mother and baby, it is a lucrative and unrelenting institutional machine that all those who truly understand avoid as much as they can.

        Finally, I heard the most profound quote and it is so very true – if people want to avoid the possibility of encountering death they should not become involved with the ‘business’ of birth. Mums and dads need to know that their babies will die one day but if they work with (as apposed to against) their biology and ‘nature’ then this will happen when their children are 104 years old and not within the first moments of life.

        • says

          “According to your article neither these women nor many skilled home/natural/psychologically normal birth midwives are capable of doing it for themselves; so I guess they should hand over their care and decision making capabilities to the most qualified and experienced obstetricians without pause or question of other options?”

          …what part of my article gave you this impression? The point I was trying to make was that women need to be informed and empowered to make these choices for themselves.

          That quote is very, very true. Death is a natural part of birth, I appreciate that. It is the most tragic outcome possible, especially when that death was preventable.

          • Michelle says

            “That’s not to say that there isn’t a whole load of wonderful CPM’s out there – there are. But there are also plenty who are underqualified, underexperienced and take too many risks.”

            “I cringe when I read stories of CPM’s advising mothers to refuse GBS testing, lest it come back positive and end their chance of a home birth. Why do we think that midwives are somehow immune to greed? We’re all very happy to assume that doctors only care about lining their pockets, but when a midwife advises against testing that could save a baby’s life, coincidentally preventing the mother from having a homebirth and paying the midwife for it, nobody bats an eyelid.”

            These two quotes above as well as the general tone, were where I got this impression/confusion. True midwifery is NOT part of the medical industry. It is set apart as a chargeable service, where the midwife and pregnant woman/family work in partnership to facilitate that pregnant woman/family’s needs. There is actually very little money to be made in true midwifery and all midwives must be aware how much delight that some individuals would take in their arrest that they wouldn’t do their jobs unless they were comfortable with the risks involved. It is not like gynecological care is on the fringe in the USA, if a woman agrees to the ‘risks’ of midwifery partnership and care – is it really anyone else’s business?

            Modern and international midwifery is so different these days that I believe both midwives and mothers to be are confused. Some people say that this confusion began when ‘men’ or ‘the man’ (e.i. the state/government etc) became involved with and are still trying to take over something that has long been considered ‘women’s business’. Perhaps this is all just part of our evolved natural selection process? I don’t know. After all I believe that nearly half the world’s pregnant population do not have access this ‘invaluable, non evidence based, homogenous, expensive, western, modern maternity care’ and yet manage to give birth everyday.

            I guess what I am confused on is who you believe birth belongs to? Who should have the final say in it? This post just seems to be a strange one in light of the rest of your blog/ FB page/your views on other things :)

          • says

            I don’t believe that birth belongs to anybody. Birth is birth. It is what it is, and it is an unpredictable animal. I felt I was very clear in my message that women should be in charge of their own bodies and of their choices regarding birth – my point was that the care providers that women seek should be competent.

            Heh, yes I suppose this post does come across as being in a different light to the others. I am still very much an advocate for gentle birth and women’s rights to birth where they want – it’s just that I have only really recently learned of the flaws in midwifery in the US and I feel strongly that women should have access to competent care (be it medical or more holistic).

        • Becky says

          “My answer is that we (human beings) as a global society are more unhealthy than ever before and this trend does not seem to be slowing down.”

          We are more unhealthy than ever before? Even with longer than ever life spans? Far easier access to a nutritious and varied diet? When a child born today has a greater chance of living to adulthood than at any other time in recorded history?

          • Michelle says

            I suppose if you view health as just being alive (breathing/moving/feeling/thinking) and the amount of time you spend doing those things then perhaps we are more healthy.

            However my opinion/statement is based on what I call the quality of our life experience – this includes physical/emotional/psychological/spiritual/etc well being. For example, how many of the elderly population have no medical complaints what so ever, as in no reason to visit a doctor on a regular basis. Today we have increasing numbers of teens are on anti depressants or committing suicide; one in five couples are suffering with infertility; ever increasing rates of obesity in all ages groups; newborn babies are now found to have 100+ chemicals in their cord blood; dramatic rise of childhood cancers and autism; increasing maternal mortality rates… The list goes on. And I guess what shocks me the most is that these things are happening to us (humanity) at a younger and younger age and we are requiring more and more medical assistance to sustain and prolong our lives.

            Whilst many privileged people have “…easier access to a nutritious and varied diet…” we are more unhealthy than ever due to the fact that half of it is actually very toxic to the human body (GMOs/white sugar/commercially harvested & prepared wheat etc). Also the fact that we waste so much and there is STILL a population of our world that actually does not have enough to eat or regularly starves unnecessarily is unacceptable and incredibly unhealthy.

            I guess to me dying is healthy – it’s part of our life cycle. Using any conceivable means possible to sustain life to the detriment of our personal ‘freedom’ and quality of our experience is not healthy and to me down right terrifying!!

          • says

            I have to agree with you on this one. Yes, we are living longer but as you said, we seem to be requiring so many more drugs and medical assistance in order to live comfortably (and that in itself is up for discussion). As a species we are struggling with so many health issues and I’m sure this wouldn’t have been the case hundreds of years ago… I mean, surely if the rates of diabetes, obesity, cancer etc were the same or similar, we would have been dropping like flies thanks to lack of appropriate medical care and certainly wouldn’t have survived as a species.

            Thank you for posting this; I came here to say pretty much the same but you said it better than I could have, I’m sure! :)

          • Becky says

            “I mean, surely if the rates of diabetes, obesity, cancer etc were the same or similar, we would have been dropping like flies thanks to lack of appropriate medical care and certainly wouldn’t have survived as a species.”

            Some of these — type 2 diabetes, cancer, also heart disease — tend to be diseases of age. We now live with them for a much longer time, or even triumph over them, but even without treatment they wouldn’t prevent the population from reproducing and surviving, it would just mean drastically shortened life span. Obesity depends on easy access to food, and is a disease of affluence. Malnutrition was far more common in the past.

            I don’t think our health is perfect now, but it never has been. I don’t believe there is any actual evidence that we were healthier at some time in the past — it is simply that now we can live with things that in the past would have killed us quickly.

  6. says

    Bravo!!! *standing ovation*

    Your observations are 100% accurate… right on… exactly what I’ve been saying for a long time and am only just now getting much louder about it.

    There are absolutely CPMs that are undereducated and underskilled. If we had a standardized system as you do in GB and in Canada, it’d be a whole lot different around here. But it isn’t. We’ve got a mish-mash of education routes and an endless supply of incestuous apprenticeships that perpetuate (what I call) black holes of knowlege that are only discovered when something goes awry.

    I also believe homebirth can be a safe and wondrous option for women and babies. I *do* believe there are limitations to that safety and women need to suck it up that they can’t always have The Experience they want.

    That said, the hospital often SUCKS when it comes to SERVING women during their births. If I could re-vamp hospitals, the main thing I would do is re-teach the whole staff how to treat women with love and respect, creating a true atmosphere of informed consent and autonomy in birth. I truly believe that if women weren’t birth abused in hospitals, more women wouldn’t feel homebirth under any circumstances was their only “choice.”

    Really, really… keep your thoughts flowing. You are right on, woman. Absolutely. Right. On.

    • says

      You have no idea how much I appreciate your comment! I am a huge fan of your blog. Thank you so much! :) I feel like the point I was making was missed by many, which is likely due to my own writing skills, so it’s really great to know that somebody gets it- especially someone I have a great deal of respect for.

      Thank you :)

      • K says

        I thought the same as the above commenter. I think you are more than correct. I agree that MANY hard-HB women in the US take incredibly undue risk because they are so afraid of being abused in the hospital. Then you have the other side calling those women a host of names because the medical staff is obviously superior to any other option. I also agree that there are two distinctive sides to the issue, at least in the US, and there seems to be very little balance or harmony between the two.
        I think women who see hospital mistakes and abuses do feel the only option for not being abused is to homebirth no matter the risk.
        I am 100% a supporter of HB and any natural option for childbirth. I like that you seem to have some clarity in the research path. My issue with researching anything so controversial is that there seems to be little research that produces true, reliable evidence. Research seems to reveal that HB is totally safe or fatal. I wouldn’t even know how to find research where someone stood back and looked at healthy, low-risk birth scenarios at home and in hospitals and reported their findings. I know neutrality and lack of bias are myths and unattainable so it is very difficult to know when/if I’ve found a study which has produced reliable results either direction.
        I recently engaged in an argument with the daughter of a nurse where another friend and I were on the side of natural birth. I could see from our conversation we were clearly talking circles around each other because either side were assessing completely different health/risk factors. Her concerns were over complications of birth and issues with fetal death occurrences. Our concerns focused on drug administration, immunization and other doctor v parental will issues. I quickly realized that we could never see eye-to-eye because our sources of concern would never converge.
        This is such an interesting issue. I simply hope that whenever the time comes that I will be able to have a home birth with all children I may have.
        Thank you so much for your insights. I sincerely hope I remember to continue reading your blog :)

  7. April says

    I think the point is more that woman should feel competent (not undermined) to choose what is right for them and their babies, rather than pressured from one side or the other. In the media, we are usually only presented with a black and white view of things, rather than, ‘here is your rainbow of choices’. We need support for all sides, not polarization.

  8. says

    I think you have a lot of great points and I agree with almost all of your sentiments…except the blanket CPM statement. I see the CPM credential getting a lot of flack lately and I find it frustrating. I think we should focus less on the credential and more on the bad apples who do things they shouldn’t. The CPM credential is still the ONLY credential that REQUIRES experience with out-of-hospital birth. I am certain we can all agree that there are vast differences in home and hospital births. Is this a guarantee the CPM knows what to do in XYZ situation? No, but neither is an MD or CNM credential.
    I thoroughly enjoyed reading this and appreciate the dialogue. Thanks for writing/posting!

    • says

      I thought I was very careful to make a point of not tarring all CPM’s with the same brush, but you’re not the first who has gotten that gist from my post so I think I may have failed. Next time I write about a controversial topic like this, I will be sure to take extra care to get my point across correctly :) Thank you so much for your thoughtful comment, I really appreciate it!

    • says

      Sorry, Summer… the credential has a huge hand in creating some of the “bad apples” as you call midwives who damage and ruin lives. CNMs and MDs see a zillion more variations of the norm AND abnormal before they ever start practicing on their own. A CPM has seen a *few* typical variations, but if they haven’t ever seen the nuances that can lead to tragedy, how are they supposed to recognize it? I’d love to see a CPM pre-req be attending 100 hospital births. That way, women would be able to see, not only technology-caused problems, but also learn to cooperate with hospital personnel, something *every* midwife will have to do eventually. Even the intervention-caused complications are wonderful teaching tools for students/apprentices. Sometimes, seeing that crap is a fantastic learning experience.

      It’s far, far easier to learn to sit on your hands than it is to recognize and manage the slew of silent-to-deafening complications that can -and do- arise in even the most normal of births. Not often… maybe even not rarely… but they can happen.

      Preparation is never a bad thing. Neither is more education and experience.

  9. says

    Even as someone who is planning a home birth with two CPMs for my next child’s birth in January, I can say that I agree with most, if not all, of the claims that you make here. I think what resonates with me most is the implicit critique of the idea that “because X is a midwife, her judgment is pristine and always, infallibly in the best interest of me, my baby, and birth in general.” (And I also take issue with the “opposing” sloppy generalization about OB’s!)

    Each birth attendant brings her/his own set of skills and experiences and even prejudices to a birth, and s/he has the responsibility to be up front with her/his clients about these skills, etc. What’s more, each birth carries its own unique sets of circumstances and risks, some greater and more severe than others. To ignore this seems…well, irresponsible to me. (To be clear, I don’t think that MOST women choosing home birth ignore these possibilities and circumstances.)

    I also completely share your frustration about the ways in which some women feel *forced* to choose between a hospital birth that doesn’t respect their often legitimate wishes and a home birth or even unassisted birth that might respect their wishes but that might not be ideal for their particular situation. Like NGM, my sincere hope is for hospital staff to better accommodate some of the simple wishes and desires that women have for their births–including “high risk” women! In my mind, it all just comes down to RESPECT. Plain and simple, *respect*.

  10. Jennifer says

    I have to agree with you on this one! :) Here in the US there IS a sort of war going on…and that is what makes all people concerned act the way you described. I myself gave birth at home, and did so knowing all the facts and risks surrounding my situation-but you are right…there are women giving birth at home, unassisted even, without taking into consideration their personal situation. Of course we are talking about a few, and certainly not a majority, but the point is that they are doing it because they feel trapped. Because they know what a hospital birth will be like, they take the risk, hoping that whatever their outcome is, that it be better than being in the hospital. I understand how they feel 100%. I’m not saying that I would take unecessary risks, but I get why they are doing it. I think there are quite a few midwives that act as you described too. Again, not a lot. They are few and far between…but even here is the large city that I live in I know of 1 or 2. Again I think that it is just their ideals that they want so badly to show as true. And really, their (our/my) ideals are true in general, and we DO want as many people as possible to know how awesome homebirth is…but we (and the midwives) can’t do it at the expense of putting mama or baby at risk. However…I think risk can be in the eye of the beholder. I had a HBAC…which many women in my local ICAN group thought was too dangerous. All these women were aware of all the same statistics that I am…it was just a matter of how we interpreted the data, and the strength of out personal faith. So I can see a midwife recommending not testing for strep B…after seeing statistics and knowing how to handle a situation, I’m not sure I would necessarily care if I were + or -. Anyway, I’m rambling now, but I am totally with you that ALL care providers, OBs or midwives should only be concerned about the health and hapiness of their clients, and give opportunity for true, complete, informed consent. <3

    • Becky says

      “Because they know what a hospital birth will be like, they take the risk, hoping that whatever their outcome is, that it be better than being in the hospital.”

      Do they? I think this may not always be true. They may know what a hospital birth CAN be like, either from their own experience or based on stories they’ve heard, but honestly most of the women I know have had good to great experiences in the hospital. I also think that it behooves us to try to understand the hospital/OB system’s rationales for their interventions and procedures, because many times the evidence for and against these interventions is more nuanced than I’ve seen the home birth crowd acknowledge.

      I’ve used a family doctor, CNMs, a CPM and am using an OB this time. There are positives and negatives to all types of care, and I’m using the hospital again because I feel it is my best bet, in my current situation and region, for safe care, even if the experience may be less than ideal.

      • Becky says

        I was trying to point out that a hospital birth can in fact be a good experience, if not as personal as home or birth center, but I guess I forgot to state that explicitly.

  11. Vanessa says

    I’m another passionate homebirthing mama, and my first child was born under the care of a wonderful, experienced CPM who had lots and lots of training and had worked in a hospital setting before. When I moved to a new state, though, where midwives must practice illegally to attend homebirths, I found my attitude changed. Midwives must hide here, practice underground, have no access to advanced training or emergency equipment/pharmaceuticals, many are untrained altogether, and frankly, it scares me. I got a lot of crap from the natural birth groups when I voiced my opinion, but this kind of homebirthing just isn’t safe! But then again, our hospitals are no cup of tea, either, with a very high c-section rate and vbacs nearly impossible. Women here have a depressing choice between the two. I do think that recognizing a CPM licensure would be a HUGE step for our state. It may not be perfect, but it’s a heck of a lot better than the many, many women I know who are putting their babies and lives in the hands of inexperienced, untrained homebirth care providers. My second babe was born here in the hospital, and my third will be later this summer. I truly long to have another homebirth, but as long as we live here I don’t consider it a viable, safe option.

    • says

      Goodness. What an awful situation to be in! Recognising CPM licensure would truly be a positive step; forcing midwives underground is not going to help anybody.

  12. says

    Thankyou so much for this article, just when I needed to read it most!
    This is baby #3 for me, and after having 2 awful hospital births I desperatly wanted a homebirth this time round. So much was my desperation for the “experience” that I have been blindly convincing myself it will happen, although with my medical history (and it seems, reoccurance of cholestasis) it is now highly unlikely!
    I cant help feeling a little duped, as we have agreed this will be our last child and I know I will not have to opportunity to experience a homebirth again. When talking to people about it, I get the same answer “well so long as the baby is healthy, it doesnt matter where you give birth”. But to me IT DOES MATTER!!!!! I would never put the health and safety of my baby at risk and if this means having a hospital birth, then so be it, but surely I am allowed to feel a little Pi**ed off that I cant have it the way I want?
    This article has made me realise the HB is not the be all and end all, and so I will now focus on planning to make the hospital birth as holistic and natural as it possibly can be. Thanks again, lve reading your blog! xx

    • says

      I’m sorry that things aren’t looking like they will go to plan; I will of course still hope that you are able to have a home birth! Of course you have every right to grieve over the loss of the birth you wanted. Birth is important, I don’t care what anybody says, it’s not just a means to an end. Good luck planning your hospital birth; there’s no reason why you cant have a truly wonderful experience in the hospital <3

  13. Kate Robinson says

    I think you definitely need to flesh out a bit more of what you’re trying to say here. For example, in response to one of the comments, you say that women need to be informed and educated, etc. The deal is simple: women need to be educated to make informed decisions. That can be stated in capital letters, actually. If they want balanced education, women need to search information themselves! This is a responsibility, one you can view as the first step of responsibility taken on as you become a parent.

    You also run a close line in what you have to say about “endangering” the life of a baby for the desire/choice of the mother. This gets close to arguments about abortion rights. Whose “life” is it anyway? Of course no mother wants to put her baby at risk, however, what is “risk” is also up for some interpretation since there definitely is a whole “camp” of people happy to argue that going to a hospital has its own just-as-scary risks. And, if we’re talking just the U.S. here, which we must, otherwise the entire issue is confounded, women DO have a choice in birth, including “arguing” their way through a hospital birth with a doula present who will assist them in advocating for what they want versus what the hospital/nurses/doctors want. That way, they get their experience (as you call it) and the safety net of the location.

    Would you take away the right of a “high risk” woman to birth at home? That’s a good question to answer. You say that women want “The Experience” and that they put their babies at risk for it. Isn’t this freedom of choice, enacting civil liberties and personal decision-making? I’d just play devil’s advocate and say that you can say the same thing in the opposite direction: would I deny a woman the right to an epidural? If she does NOT want to experience childbirth, and is fine with putting her baby at risk for an epidural, isn’t that o.k.?

    I agree that the birth culture needs to change. I also think that we compare apples and oranges with birth/death rates for fetal and maternal morbidity and mortality. We can’t compare these against countries with a lower average maternal age, universal healthcare throughout life, less access/use of fertility enhancement procedures, etc. I think this is where everything gets mired and messy and tangled.

    And, I do not see too many women (and I’ve been a doula, midwife’s assistant, and been involved in advocacy and have lots of friends who are doulas and midwives, so I’m “in the mix” of birth consistently and have been for over sixteen years in Massachusetts) being “forced” into choosing home births as you claim merely to avoid what was going on in hospitals.

  14. says

    I think your post is being misunderstood. To me you are not saying ALL CPM’s are bad. I also have to agree that there needs to be more requirements and education available for midwives. I’m 90% sure we will be planning a homebirth for our next baby, so I’m not pro hospital birth. I agree with everything you have said, and I agree with Navelgazing midwife’s comments too. Thanks for sharing, and I thought you were clear in your points.

  15. Courtney says

    I think this post is great. I’m going to respond but think I should be clear that I am a “Dr Amy devotee.”

    First – I’d like to address that fact not all Dr Amy devotees (and I don’t think even Dr Amy herself) feel the entire labor and birth process needs to be guided by an iron fist in all cases. To generalize about my opinions, and that of many Dr Amy devotees, I would say that we feel strongly that many woman are being mislead about the actual safety of homebirth and the risk of complications of hopsital birth. You point to a fine example yourself – GBS testing. When a birth ‘professional’ tells a woman she doesn’t need to worry about GBS, doesn’t do testing, or tests and suggests treatment with garlic and/or hibclens she is misleading that woman about safety. You mentioned the echo chamber yourself – I don’t believe it’s possible to be ‘educated’ by an echo chamber, particularly when many of those creating the echos have little or no formal training/education themselves.

    I think that your take on the current situation of maternity care is going to be come increasingly more important over the next several years. Homebirth does come with real risks, but for some those risks are acceptable and in line with their lifestyle and beliefs. That’s OK, and those woman should be able to find SAFE AND LEGAL providers. Woman looking for a homebirth midwife should be able to have confidence that the midwife they choose is experienecd, educated, safe and legal. Woman looking for homebirth midwives should be able to trust that negligent ‘bad apple’ midwives are being sanctioned appropriately for bad outcomes and/or failure to transfer in a timely manner. Woman looking for a homebirth midwife should have access to statistics related to homebirth outcomes of indivual midwives – just like you can for doctors. For all of the CNMs and CPMs out there who are safe, legal, and realistic about risk please do not take this as personal criticism.

    Now the harshest blow – and someone needs to say it: Some women, no matter how badly they want to homebirth, will unfortuantely not be good candidates for a homebirth. A commenter above said something about “Well what about the high risk mother who wants a homebirth?” I hate to be insensative to a woman at a vulnerable time – but if you’re having breech twins after a C-section you should not be at home. You should be in a hospital. I do think it’s important to empathize with women who are not good candidates for the birth they way (be it at home, or a VBAC). Of course we are all humans, and we all have desires, and those can lead us down slippery slopes. I think sometimes women who start out low risk end up in situations where a little thing comes up, maybe a few little things, maybe a big thing… and they so badly want their home birth/VBAC, and they are so emotional and vulnerable that they can not see that the risk is increasing. Those women need their midwife to say: I’m so sorry but now that you are 41 weeks and your baby is breech we need to prepare for a hospital birth.

    AND OF COURSE… we need to make sure that woman be treated with respect and dignity when they arrive at the hospital for their birth. And that goes for every woman: the elective C-section, the planned hospital birth, the woman who risks out of homebirth, and the emergent homebirth transfer. Dignity and respect for all woman and mothers.

    • says

      “Homebirth does come with real risks, but for some those risks are acceptable and in line with their lifestyle and beliefs. That’s OK, and those woman should be able to find SAFE AND LEGAL providers. Woman looking for a homebirth midwife should be able to have confidence that the midwife they choose is experienecd, educated, safe and legal. Woman looking for homebirth midwives should be able to trust that negligent ‘bad apple’ midwives are being sanctioned appropriately for bad outcomes and/or failure to transfer in a timely manner.”

      This is EXACTLY my point. Exactly. Thank you for saying so eloquently in one paragraph what I attempted to say in almost 3 whole pages ;)

      It’s a very difficult topic because I do feel as though, if the 41 week breech baby mother CHOOSES to stay home to birth, that’s her decision regardless of the level of risk or how uncomfortable it makes her midwife. It is then a very difficult decision by the midwife as to whether to continue to attend her despite her worries (And to be fair, it would probably be okay), or to put her hands up and call it quits, possibly putting the woman at even further risk. Women need to be able to choose how to birth but they need the right information to be able to do so.

      Thank you for your insightful comment!

  16. maryann says

    I do follow Dr. Amy’s blog, and I do agree with a lot of what she says. That said, I don’t think homebirth should be “outlawed” or anything like that. And I don’t think she really does either. I think she just wants to see higher educational standards, etc. Anyhow, I’m not here to defend here; I’m sure she can handle that herself.
    Homebirth just wasn’t something I wanted to do. I really like my family doctor, who served as my OB. I have a good relationship with her, trust her and feel respected by her. I wanted to work with her, so hospital was the only option for that. And it was truly a wonderful experience. The nurses were kind and supportive. Everything went well, and there were thankfully no complications. No interventions were forced on me in any way. If we decide to have another child, we’d opt for the same hospital and doctor, no question.
    The reason I’m sharing this is not to invalidate negative or traumatic experiences. I understand they are real. What I’m saying is it doesn’t have to be that way, and maybe one of the best ways to serve the interests of everyone concerned is to make sure that all families have access to the type of care I had: Highly-skilled, educated, compassionate, respectful care.

    • says

      How wonderful to hear that you had a great OB and access to a wonderful hospital.

      I feel a little guilty for my digs at Dr Amy’s blog and the regular commenters there; I have just often come across the attitude there that birth trauma isn’t *real* trauma, but just a bunch of women whining about having to have an IV or not being allowed to burn candles in their delivery room. This kind of attitude is dangerous, so thank you for pointing out the reality of birth trauma and that it is indeed valid.

  17. Becky says

    “I don’t know. After all I believe that nearly half the world’s pregnant population do not have access this ‘invaluable, non evidence based, homogenous, expensive, western, modern maternity care’ and yet manage to give birth everyday.”

    And the perinatal, infant and maternal mortality rates in places where women do not have access to modern medicine are truly atrocious. Does the modern medical system have to be an uncaring assembly line? No, it doesn’t, and we should fight for individualized, respectful care. Does every birth require multiple interventions? No, but modern medical interventions, when used as medically indicated, have drastically reduced the mortality and morbidity of mother and child. Far more women and children in the world today die due to lack of intervention and lack of medical care, than are harmed by overuse of those same interventions. That doesn’t mean we should condone overuse, we should instead strive for balance, but we should be damned thankful that we live when we do and we have access to the medical care that we do.

    • Michelle says

      I can see your points but philosophically disagree with many of them. And I guess that is the one thing that I am “damned thankful” for… That I am ‘free’ to disagree with you and anybody else that thinks differently about a subject than I do.

      I guess that is at the heart of why I really dislike this post, because I believe women, especially vulnerable pregnant ones give too much of their power away to both medical personnel and medically minded midwives. This is no surprise as pregnancy and childbirth has been heavily medicalised in our western culture and thus taken out of each woman’s personal control. However childbirth is not a medical emergency, it is a wellness state. Women do not ‘need’ to defer to their care provider. Their care provider should not be guaranteeing them a particular outcome (safe birth/live baby etc) providing they do as they say. Given correct information and support women can take care of their own pregnancies and births. Support, even support that is paid for, is not control.

      Obviously this is completely different to having an illness where it would be wise to look at your medical options and in some cases even accept the fact that there care provider knows more than they do and they can trust their judgements.

  18. Ellen Harris-Braun says

    Interesting discussion. I’d like to comment on your mention, far above, of the Midwives Alliance (MANA) dataset. You said: “.. MANA (Midwives Alliance of North America) are hiding their data on homebirth death rates. Surely if the statistics showed that home birth in the US is as safe or safer than hospital birth, they would be shouting it from the rooftops? Instead, they are withholding the data and only allowing access to those who can prove they will use it for “the advancement of midwifery.” This is an ongoing misunderstanding of how responsible research works, and what the Midwives Alliance is actually doing by collecting data.

    First, a bit about what the Midwives Alliance dataset is for (from the MANA Web site): “The MANA Division of Research’s goals include facilitating understanding of the range and value of care provided by midwives as well as the safety and efficacy of various birth settings. Rigorous research on the safety of homebirth and outcomes with midwives can only be conducted with a carefully-designed, robust dataset such as this. This rich nationwide database is unique to the Midwives Alliance; no other entity collects this kind of data to the extent and depth that we do. There are also several hospital-based midwives contributing their data to the project. The DOR provides midwife contributors with their own practice data for the purpose of provision of informed consent to clients, quality assurance, health services planning, and educational projections.”

    The Midwives Alliance is collecting data using a registry model (rather than for any one specific study), to be analyzed by professional researchers who have applied for access using a standard data-access process (similar to data-access policies for other large collections of data). As careful stewards of this data, the Midwives Alliance would be really irresponsible if it “shouted from the rooftops” or allowed access to any person who merely asked what was in there. All participating midwives have full access to their own data, while the combined data is available to qualified researchers only (as the Midwives Alliance promises midwifery clients when they ask for consent to include their data in the dataset). All researchers must have their projects approved by Institutional Review Boards that check the project’s methods and ethics; researchers must understand the Midwifery Model of Care; and researchers must follow the Community Based Participatory Research model, which makes sure that researchers share results with the people being studied, among other principles (more on that at http://www.icts.uiowa.edu/content/9-principles-community-based-participatory-research-model).

    As far as the advancement of midwifery, certainly midwifery can (and should) be advanced not only by showing its benefits but also by finding any weaknesses or limits and sharing those clearly with the midwifery community (practitioners & clients & related caregivers).

    The Midwives Alliance welcomes applications from qualified researchers (one study is underway already) as it continues to collect high-quality data on midwifery care. The midwifery community needs more studies to be done on a variety of midwifery topics.

    More information, including links to all the documents for research applicants, can be found at the Midwives Alliance Web site: http://mana.org/statform.html

    Finally, here is what the Midwives Alliance tells the midwives’ clients, when asking if their information can be included in the dataset (clients can say no): “To protect your identity, your midwife will create a distinct code for each birth rather than using your name. With your consent, your data may be used in MANA-sanctioned research studies. In addition, statistics based on your data may be used by qualified midwifery organizations to advocate for or improve midwifery practice within their region. Data that includes your information will not be released except under strict guidelines of the Division of Research, and will not be used for commercial purposes.”

    The guidelines about releasing the data are meant to protect the subjects by handling the data responsibly, following research standards for access to this kind of dataset. They aren’t meant to hide bad results. Accusing the Midwives Alliance of hiding bad results is kind of like accusing Vital Records (the birth certificate entity in the US) of hiding bad results because you can’t call them up out of the blue and find out how many deaths are in their database for the year.

      • says

        I don’t! It’s not ANY information you can’t get almost verbatum from the MANA website.

        Why “share” ANY statistics with BJM and then tout the “studies” as demonstrating how fantastic homebirth is? Why are you permitted to “share” SOME statistics, but not ALL statistics?

        I get the randomness of the statistics. I’ve DONE the statistics! I totally know the subjectiveness of the statistics, that they are midwife-biased… that one person’s shoulder dystocia is another person’s normal second-stage… that if a midwife was confused about a second and fourth degree tear and didn’t send the woman in for repair but she needed reconstructive surgery on it 6 months later because of bowel incontinence… (true stories each)… then the “statistics” are skewed to the better.

        While I would *love* to see the cumulative results MANA has, I place zero weight on what they have to say.

  19. Emilee says

    When we announced to my family that I would be having a homebirth, the question that I was not prepared for was whether or not my midwife was certified and experienced. Well, obviously! But apparently not so obvious a question that everyone looks into.

    In my ideal world, I would be giving birth in a birth center. But there are none in any kind of reasonable distance. The closest hospital with a midwife is 2 hours away. The closest hospital that delivers babies is 45 minutes away, and that is my back up if anything during my pregnancy or labor should indicate that I am high risk or would need a hospital.

    Because of where I live, I was limited in my birth choices. But I have still carefully researched the choices I have and have made a decision based on what I feel is best for me right now. That doesn’t mean what’s best for me won’t change before or during labor.

  20. E Murray says

    Hi ladies,

    I am from BBC Radio York and we are doing a piece on home births next week. Would any of you be able to talk about your experiences of home birthing on the radio – especially if any of you are in the North East of England. We really want to delve deep into this divisive issue and explore the many view points that people hold.

    Number is 01904622033 or email – emma.murray@bbc.co.uk

    Cheers

  21. says

    I think this is a brilliant post. I totally agree–some births ARE safer in hospitals, and it’s terrible that women feel compelled to birth at home because even high-risk births are safer there because of the interventions they’re going to get in hospitals.

    However, I don’t think most CPMs would ever accept a high-risk client just to make more money. Think about it–the risk/benefit ratio for them is ludicrous. Make an extra $2000 and risk being sued and/or going to jail? Trust me, they can find clients who are lower risk. I think the reason some midwives attend high-risk births at home is because the women are so committed to getting the hell out of the hospital. My midwife attends births that most midwives won’t, because otherwise those high-risk women would be birthing unassisted at home. She’s willing to take risks (sometimes) that could REALLY backfire for her in order to help women who are so scared of the hospital that they refuse to go there no matter what. At least that’s the impression I’ve gotten from talking with her about it.

    I do think it’s odd that you bring up GBS, though, since testing for that isn’t standard in the UK. Or has that changed? My midwife doesn’t require testing for it because the risks are statistically low and the overuse of antibiotics is such a big concern. She certainly doesn’t push you not to test, though. And she lets you decide what to do with the results if you take the test.

  22. 5tella says

    Yes the statistics need to be open. All variety of them.
    Those who graciously share their information for study did so understanding that it could be used to help others. So that needs to be made good on.
    For a good education in what social security numbers are and how they work, just look up key word phrases like “birth certificate traded on world market”.
    I doubt that many “doctors” will listen when told to not give the baby its slavery security number. They probably just report it without permission from parents….otherwise he probably doesn’t get paid by the ins co.
    Anyone tried to refuse ever ?
    I’ll definitely do a lot more homework on this. :)

  23. Lil says

    I had a wonderful home birth (in the UK) for my seventh child. The birth was fast, easy and I was far more relaxed (as was my husband) than I have even been at one of my previous hospital births. On the face of it, as long as no one asks any questions, it sounds like the perfect low risk birth.

    …..however, the truth is I am labeled high risk on so many catagories, that on paper it honestly looks like I was either stupid or selfish to even labour at home let alone give birth! So the list (with my reasoning and thoughts)…..I’m epileptic (although I haven’t had a seizure for nearly 16 years and have been off meds for longer than that); I’m obese (which actually means I apparently have to have a C/S according to my hospital); I have high BP….which refuses to behave under medication (and gets worse in hospital, and if it sinks down to the desired ‘normal’ my body panics and acts as if I have dangerously low BP…my body honestly has got used to it being high); I am old, apparently (the OBs assured me that anything over 34 is too old and over 36 is just unacceptably ancient and obviously our bodies become senile and we forget/lose the ability to birth at this magic age!); one of my previous babies was born ‘face to pubes’, another decided to be breech (luckily, older siblings can’t teach younger siblings ways to annoy parents until *after* birth, and besides they seem to like throwing in new things each birth just to keep me on my toes!); my BMI is over 30, way over ! ( why this needs to be a seperate risk factor is beyond me, surely me being obese covers the BMI comment? But apparently not); maternal weight is greater than 100 KG (again, why the seperate risk factor? One ‘delightful’ OB did tell me it was a concern because I might not fit into the morgue ‘slots’ and should maybe see if I needed to arrange to birth at a hospital that had larger morgue facilities! She was convinced I was going to die because I was refusing to follow her advice….and no, I’m not as big as she made me sound….and I didn’t die either! ); I have had 2 previous c/sections ( the breech birth I mentioned, which the hospital insisted couldn’t be delivered normally and then the next birth on the ‘once a c-section always a C-section’ basis…..you can imagine how upset I was to remember after deliver, once my brain started working again, that plenty of people birth breech babies fine, and how much more upset I was to discover that repeat C/sections aren’t just unnecessary, but also increasingly dangerous – especially for those women who are obese, have a BMI over 30 and a weight of over 100kgs!!! I no longer trust OBs and insist on checking all info they give me! Midwives I trust more, but still like to check info …..just in case they got their info from an OB!); one previous pregnancy I suffered from gestational diabetes (ONE pregnancy, my third to be precise, and again she has failed to persuade any other subsequent sibling to cause that level of trouble during pregnancy….and I have tested comfortably negative in each subsequent pregnancy, but apparently I may still have some devious strain of GD that manages to get pass the tests, not let me exhibit any signs *and* not pass on any signs to my baby, such as high birth weight…..each OB has always insists I must have GD and try ignoring any facts like test results!); my babies are increasing in size with each pregnancy (…dum…dum..dummmm…..so, like they do for most people then? Okay, seven pregnancies for one woman is more than most OBs are used to, but you can usually see the same trend in someone who has had 2 or 3 babies, it’s just mine is more obvious due to getting a tad further down the line! Besides, I only had stitches for my first, and that was only because the doctor insisted it was mandentory to cut me and I was still at the ‘Believe everything a doctor says’ stage.); I had never gone into spontaneous labour (because 5 times an OB decided to induce me and the sixth time it was a C-Section….left to my own devices, I actually went into labour on my due day, after uttering the words as I went to sleep ‘well I won’t go into labour tomorrow, no-one gives birth on their due date!’ 4 am and baby decided to make prove me wrong!).

    So that is one heck of a long list of risks…..but I will say that only the fact that I was a HB2AC worried me. Even then, research shows that not only did my risks sit at 1:200 (the same as a first time mum) of uterine rupture, but that the uterine rupture they counted in ranged from unnoticeable small tears that required no repairs to the catastrophic ruptures the OBs inform you will almost certainly occur, and everything in between. There are no statistics for just the uterine ruptures that were at a level where they were dangerous to the mother and/or child. Logic dictates that if I was at a 1:200 risk all types of uterine ruptures, then my risks of a dangerous uterine rupture were lower….2 OBs refuted my logic! They claimed that not all uterine ruptures are recorded in the UK ( correct, as small tears may go undetected) and not all VBACs were recorded as such (correct, as if there are no problems they may go unrecorded….if there is a rupture, then yes it would be recorded!)…. So, my new conclusion was that my chances of catastophic uterine rupture were far lower…the OBs were not happy! I admit, I did get nightmares about the baby popping it’s head out of my scar like some horrific alien style horror! But I felt I was left with little choice, as the hospital was ademant that if I set foot in their grounds prior to the baby appearing, they would automatically do a c/s even if I was in advanced labour!

    I really did love my home birth, and I would love to do it all again (and hopefully will in 6 months or so), but I do worry for those who are also forced into a home birth to avoid undue interventions, but have real complications from their risk factors or who don’t live as close to a hospital as I do ( officially 15 minutes, but we’ve done it in 7 minutes when we had a sick child! And an ambulance can do faster by making traffic move out of the way!).

    I agree that there needs to be a middle ground where mums can labour and birth within a safe place, without fear of interventions, scare tactics or out right lies from OBs and other doctors, yet be within reach of help should help be needed. All maternity staff need to be reeducated to learn that breech, twins and other complications shouldn’t mean an automatic c/s, and that nature should be given every chance to do it’s thing….many, if not most, complications are caused by or exasperated by interventions such as inductions. Midwives are often just as much to blame for peddling these interventions as an easy option.

    As to the American information on home births, it’s my understanding that in some states they cannot publish such info, as they are not allowed to assist at a birth, it being the law that a doctor must ‘catch’ the baby. In such circumstances, the midwives may be hiding the statistics of happy out comes, because they would actually face prosecution if they admitted to attending such a birth, whilst a very bad outcome would be rather obvious, as it would involve the death of mother and/or child. I have heard of midwives having to leave patients on hospital doorsteps unattended because they can’t do a hospital transfer the way we can in the UK. I find this disgusting and unacceptable…..but the system needs to change so these midwives can actually start putting the interests of their patients first….and then we are more likely to get a more accurate set of statistics.

    I am so grateful we have the NHS, it may not be perfect, but it certainly has a lot of really great things going for it….and trained midwives are one of those things. The two midwives that attended me were amazing. Okay, I didn’t know which two would turn up when I went into labour (we have a large team that covers our area), but I knew who ever turned up would be the same as if I was in the local hospital and had close connections with the hospital had I have needed to transfer due to problems.

  24. says

    Greetings. I enjoyed reading your post, as you made many important points. I’m grateful you are able to consider alternate perspectives in OOH birth. Balance is healthy, and unfortunately too many moms who are being “educated and informed” are being indoctrinated in its place. I agree with you that home birth should be an option, but I do think there is much room for growth in terms of safety. Not every mother, pregnancy, or baby can SAFELY deliver outside a hospital. The message of trusting birth at all costs is misleading. I live in MI where there are no laws, and no standards for the practice of midwifery. There is no data reported or shared on outcomes. It’s essentially a free for all. I hope OOH birth can remain an option, and I hope the profession of midwifery itself can step up to more professional standards. I had many thoughts as I read your post, but this one jumped out most:

    “Birth trauma is real and serious, no matter what many callous Dr Amy Devotees say. And sufferers of birth trauma need professional help to deal with what they have unfortunately gone through.”

    Birth trauma is real and serious. That goes for those who experience horrifying births at home too. There are too many of us, and no support from the community we once believed in, and NO professional accountability measures for the midwives that attend these births. That’s the world I live in. And yes, there are many, many CPMs in our state who are practicing dangerously, proudly advertising breech and twin deliveries, despite numerous losses of both moms and babies. They can take risks b/c there are no laws to protect the people. They sell the idea in the name of “choice”. Thank you for writing this post.

  25. kara m says

    wow! Thank you for posting this. I am a childbirth educator and occasional doula who has had one homebirth (my first) and one hospital birth. I 100% agree with everything in here and have wished, throughout my own pregnancies and my education, that the “birth community” in general could be a little more centrist and accepting in their opinions on both home and hospital birth. I have witnessed many births as a CE and seen beautiful experiences both at home and in the hospital. I had a very traumatic birth (due to existing complications, not hospital procedures or protocol, they were actually very accepting of my planned homebirth, subsequent planned transfer and induction, and request for very hands-off care) and was glad to be there. I likely would have died if I had insisted on giving birth at home, as I originally planned. I have known women who have had traumatic, difficult homebirths and also women who have insisted on homebirthing despite complications that would cause me, personally, to think twice. In the end, to me, the key thing is having the choice to birth wherever you want to, not whether home or hospital is “better.” There is a time and a place for both and I think to deny either as a valid choice is to ignore the reality of the experience and the women making the choice.

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