Homebirth: Reasons Why It's Safe

I think that every birth blogger has written the following at some point or other... probably multiple times. In fact, I probably have done so as well! (And most likely will again.) But here goes anyway.

I was watching a friend's thread on Facebook today... she made a comment about homebirth and how great it was. Unfortunately, she got plastered. After reading some of the posts, I had to come blog about it.

Why is homebirth a reasonable and safe option for birthing women?

(1) Midwives attend only healthy, low-risk women

We're not talking homebirths for out-of-control-diabetic women who have pre-eclampsia and placentia previa at the same time. Midwives accept only women who are healthy and do not have predisposing health factors that would make homebirth unacceptably risky.

(2) Midwives offer the same prenatal care that OB/GYNs do

Yes, really! Midwives perform the same routine tests that OBs do (urinanalysis, blood tests, weight, fundal height, fetal heart tones, blood pressure). They also offer the choice for other prenatal tests (ultrasound, gestational diabetes screen, GBS, etc.). The only difference is that homebirth midwives provide highly superior prenatal appointment times, in that they typically give clients one hour of time per visit, as opposed to 5-10 minutes for the usual OB visit.

During these prenatal visits, midwives have the same opportunity to diagnose complications that OBs do - and when diagnosed, at-risk clients are either referred to OBs for "co-care," or risked out completely and sent to an OB for obstetrical management and hospital birth.

(3) Many in-hospital emergency scenarios during labor are iatrogenic (doctor-caused)

Some common examples:

- Labor is induced, baby goes into distress from failed induction, cesarean done for non-reassuring fetal heart tones

- Elective cesarean done too soon results in a premature baby who needs time in the NICU

- Doctor breaks a woman's water too early in labor when the fetal head is high in the pelvis, resulting in a cord prolapse, necessitating an emergency cesarean

Hospitals also commonly utilize routine procedures that are harmful to healthy, physiologic birth. Some examples: lack of privacy for the laboring women, routine and frequent vaginal exams, continuous electronic fetal monitoring, time limits on labor, episiotomy, directed pushing, prone pushing positions, premature cord clamping/cutting, etc.

Whereas....

(4) Most naturally-occurring problems during labor are slow to start and are non-emergency in nature, i.e. there is plenty of time for both diagnosis and remedy

Examples:

- A truly obstructed labor

- A pattern of non-reassuring fetal heart tones

- Maternal blood pressure rising

- Maternal exhaustion

All of those allow plenty of time to diagnosis, think through, attempt at-home remedies, and transfer safely if needed.

Two real-life examples:

- A friend of mine planned a homebirth with one of our local midwives. When she started laboring, her blood pressure started to rise. The midwife kept an eye on it, and after a couple hours of labor she said, "Okay, that's it. Your blood pressure is going outside of my homebirth protocol limits, and we need to head into the hospital." So the mother got dressed, they packed up their things, hopped in the car, and went to the hospital. (As a matter of fact, she got horrible treatment in the hospital and probably wasn't any better off than at home! But that's a different story.)

- Another friend of mine planned a homebirth, but during her labor got stuck somewhere around 8 centimeters. After a reasonable amount of time, her midwife said, "I think we need to transport, and I want us to go in now, before we run into problems with exhaustion." So they packed up, hopped in the car, and went to the hospital, where after a couple more hours of labor, my friend did end up with a cesarean for true cephalopelvic disproportion (CPD).

In both of those cases (and most homebirth transport cases are similar), the midwife and the family realized that they needed to transport, but in a non-emergency manner.

(5) Midwives are equipped to deal with emergencies

Homebirth midwives are completely equipped to deal with common obstetrical emergencies such as shock, hemorrhage, shoulder dystocia, and neonatal depression.

Example: Our last baby was a slow starter - his heart tones took a dive in second stage and he didn't start breathing automatically. Our midwives went right into action with suctioning, stimulation, warming, etc., and he was fine. If it had been more serious, they would have moved into more advanced techniques of neonatal resuscitation (bagging with oxygen, etc.). They are prepared!

(6) Homebirth midwives utilize techniques that facilitate safe and straightforward birth

A few examples out of many:

- Respecting the laboring woman's right to undisturbed concentration and privacy

- Using a variety of mother-led positions during labor and birth

- Delayed cord clamping and immediate skin-to-skin for baby and mama

- Water for labor and birth

- Continuous attendance by midwife, instead of constantly rotating strangers

- Continuous observation by midwives so that problems can be caught early

- Upright positions for labor and birth

- Perineal massage, perineal compresses, etc. rather than episiotomy

- Letting the mother push when she has the urge to push, rather than rushing or demanding pushing once she is completely dilated

(7) There are some risks no matter where you birth

Are there occasionally babies/mothers who die at home who would not have died in-hospital? Yes. It's extremely rare, but it has happened occasionally. The other side of this issue, however, is that there are also babies and mothers who die or are injured in-hospital who would not have died had they been born at home. We saw an example of this two weeks ago with the Miracle Mom story, in which a baby and mother were nearly killed due to an epidural side-effect. Other examples are babies who spend time in the NICU unnecessarily because an elective cesarean was done too soon, babies who have died or been injured in Cytotec-induced/augmented labors, mothers who have died due to cesarean-related aftereffects. This is not a blame game. This is simply the reflection that there are risks to wherever a mother chooses to birth - it's a matter of examining one's choices and deciding which risks one wishes to live with. Unfortunately, culture is on the side of hospital birth - in other words, a hospital-birthing mother whose baby dies due to hospital care will be told, "It's not your fault; you did the right thing," while a homebirthing mother whose baby dies will be told, "It's all your fault - you risked your baby's life." Not true, but it's the cultural norm right now.

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There is a lot more to be said, and sometime I'll probably write a longer article on it. However, the main point is this: For healthy, low-risk women, homebirth has been repeatedly shown to be as safe or safer than hospital birth, and with significantly fewer interventions and intervention-caused morbidity, and much higher patient/client satisfaction. Homebirth bashing may be culturally acceptable, but it has no basis in fact. Hopefully at some point we can, as a culture, reach a point in which homebirth is widely accepted, both culturally and medically, as a viable and safe option for birthing women.

Until then, I'll keep blogging.

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Comments, questions, things to throw? Let me know! Please keep all comments civil, polite, and kind.... I love dialogue, but only within the rules of common civility!