Breaking It Down

 

Recently I was challenged to explain why I consider homebirth safe.

I realized that it is so much more complex than most medical professionals realize. I think sometimes they tend to see this issue as very black and white. Hospital = SAFE and Home = UNSAFE. Period.

But it goes so much deeper for us moms and for me it is much more complicated and difficult to explain! As I started to try to explain I couldn’t even do it in an organized and cohesive way. So I wanted to get it all down here in as organized a fashion is as possible.

1. I think that the most important aspect of the homebirth choice is Birth Philosophy.

• First of all, it must be accepted that all of life is risky. People die. Bad stuff happens. There is risk in everything we do. Including birth. There are situations in which a baby born at home may die because it was home and not hospital. There are also situations in which a baby born in the hospital may die because it was the hospital and not at home. It is about weighing the risks and benefits and understanding that birth is risky whether at home OR in the hospital. Some of the risks are different depending on location – also worth considering.
• In the medical community, birth is (most often) an unpredictable and dangerous medical event that must be controlled and managed in order to be safe.
• In the homebirth community, birth is considered:
• natural
• intimate
• private
• incontrollable
• powerful
• something which to respect and trust that the mom and baby know instinctively how to do
• best left alone in order to be safe

Think of things that we do all the time that are private and/or intimate. How would you feel if you had an audience for these simple, natural processes? the same principles apply to birth. It is a private natural event that God perfectly designed us to do, usually without outside assistance. Women GIVE BIRTH. Women deliver their own babies! Doctors and Midwives DO NOT “deliver” babies. Moms do all that and maybe the professionals might assist, but I hate the phrase “Dr. X delivered the baby.” I suppose when a mom is unable to push the baby out or needs a c-section it is more accurate to say that the doctor “delivered” the baby, but for a normal un-medicated birth, it’s just not appropriate to let the doctor or midwife take credit for that.

2. Homebirth midwives take much more Preventative Measures than your average medical doctor and treat the client as Holistically as possible. They acknowledge that there is much more to a person’s health and well-being than just the condition of the physical body.

• Prenatal appointments are typically 1-2 hours long
• A strong and trusting relationship is built between the midwife and birthing family
• Topics are wide and varied covering every aspect of the whole health of the women such as:
• diet/nutrition
• exercise
• nutritional supplements to optimize health
• herbal teas and infusions to further boost mineral and vitamin levels and to tone the uterus and prepare the body for labor and birth
• How to healthfully prevent common pregnancy ailments, conditions, and complications
• alternative healthier remedies to common pregnancy ailments
• chiropractic care, acupuncture, massage, to name a few.
• emotional well being, stress levels, spiritual well being, etc.
• optimal fetal positioning which is crucial for a safe and easy delivery
• Hemoglobin is tracked prenatally and supplements are taken prenatally to ensure a healthy blood supply and to prevent post partum hemorrhage
• A back-up plan is made in which the midwife and parents agree which hospital would be best in case of transport and how to most quickly get there etc.

3. Homebirth midwives bring much more with them than many seem to realize. Midwives come equipped to handle most complications.

I cannot tell you how many times I’ve heard, “Well my baby would have died if we’d had a homebirth because……”

In almost every case the end of that sentence is something that is absolutely untrue because a midwife would be equipped to handle it.

Meconium aspiration? Midwives carry suctioning for precisely that reason. Baby didn’t breathe right away? Needed resuscitation? Midwives carry resuscitation equipment (and oxygen) and are trained to use it. Severe Post Partum Hemorrhage? Midwives carry a variety of anti-hemorrhage drugs to stop hemorrhage or at least stabilize it in order to safely transport to the nearest hospital. Needed fluids during labor or after? Midwives carry IV supplies and can start a line if necessary. Retained Placenta? Believe it or not, they are trained to handle that as well. It’s not pleasant (not pleasant no matter where you are!), but can be handled safely. If not, you would be stabilized and transported safely to the nearest hospital. Midwives are also prepared to handle tears and have sutures and the necessary equipment and drugs to do it as comfortably as possible.

Yes, there are a few very rare horrible complications that could happen and would be awful no matter where you are. But there is no guarantee that the outcome would be any different in the hospital. A few that come to mind are placental abruption, cord prolapse, uterine rupture… all extremely rare. And babies sometimes die from these complications-- even in the hospital. There are no guarantees in life.

The only things I feel a homebirth midwife cannot do are:

• surgery (if you need a c-section or if your baby needs surgery the order of events would be: stabilization and transport.)
• blood transfusions. If you lose enough blood to require transfusions, you would again be stabilized (probably including IV fluids and obviously meds to stop the bleeding) and transported to get the blood you need.

And again, these are things that midwives and their clients work very hard prenatally to prevent and thus, they are rarely necessary.

4. At a homebirth it is also vitally important to homebirth families and their midwives that the baby is always handled gently, respectfully, kindly, and with love. So the Postpartum Care is also drastically different from in the hospital. This part may be THE most important aspect to me (but that’s hard to pinpoint).

• So long as baby comes out vigorous and pinking up nicely, the baby is given directly to mama (or the mama catches her own baby and keeps the baby in arms immediately following birth!)
• The cord is not cut until the family wants it to be. There are many benefits for baby to receive all of his placenta and cord blood. This makes for stronger healthier babies and a gentler transition to having to take that first breath!
• Even if there are signs of a problem the cord is not cut as that would cut the baby off from his sole supply of blood and oxygen which can keep the baby safe from brain damage longer than if it is cut immediately and the baby is unable to breathe right away.
• Also, if there is a problem with the baby, the baby is still placed on mom’s tummy/chest as the midwife does what is necessary to resuscitate, suction, or stimulate baby to breathe.
• Mom and baby are encouraged to bond and breastfeed uninterrupted immediately following birth for as long as the family desires.
• Once the family is ready, the midwife may perform the routine newborn checks either in Mom’s lap or on the bed in front of mom with the family looking on. Baby is weighed, measured, listened to with a stethoscope, temp taken, joints are checked, mouth is checked, reflexes are checked, etc etc. Mom is also checked for tears/blood pressure/excessive bleeding etc.
• No routine shots, eye drops, sugar water, formula, is given to baby so long as everything is normal and healthy. The family may choose to give the baby vitamin K orally if that is what they desire or feel is needed, but it is not a requirement.
• Under normal circumstances, baby is never separated from mom. Ever.
• After everything is checked out and signed off, the midwife and/or her assistant(s) clean up, start laundry, make sure mom is eating and drinking well, make sure breastfeeding is initiated and going well, gather up all their equipment, and leave the family to bond and rest alone in peace.
• Many follow-up visits are made in the following days and weeks to make sure everything continues to be normal and healthy and to help mom with breastfeeding if necessary.

5. Many homebirth moms feel that having their baby in the hospital setting is riskier than at home. Here’s why…

• Unwanted interventions are rampant in hospitals. Just call your local hospital and ask for their rates (if they will honestly give them to you, many won’t!). But some of these rates can be found in various places online. Rates of induction, pitocin, c-section, epidural, just to name a few.
• Unnecessary procedures and routines are often considered a requirement. Some require continuous fetal monitoring despite studies that have shown no improvement to outcomes and that intermittent monitoring is better. Some require IV. Some require an enema, IV, and pitocin upon admission. (There is a hospital near me that actually requires this. I’m not just making stuff up!)
• Strange surroundings, unfamiliar people, and medical equipment invading your space while you are in labor could upset your rhythm and cause your labor to stall or at the very least become less functional- this often ends up requiring pitocin to get you back up to speed. In the hospital they generally don’t want you laboring there for too long. You are on the clock. Along with pitocin comes IV and continuous fetal monitoring. This greatly limits your mobility and most likely tethers you to the hospital bed. That may cause you more pain and you may need pain relief…. etc etc. We call this the cascade of interventions and it can start with anything whatsoever. You may never know what triggered it. But it can very well end up in c-section or at least a very medically managed labor and birth.
• Hospitals are not sterile. The germs in your home are YOUR germs and will not harm your baby. The germs in the hospital are foreign to you and your baby and you are more likely to pick up something harmful there than in your own home. Remember, hospitals are generally for sick people!
• Hospitals are unfortunately most often not very supportive of natural, intervention-free birth and may make that difficult. If you are motivated and determined you can usually work around this. However, most OBs will not allow you to birth in whatever position you like and many nurses will not like it if you are out of bed or changing positions. Especially if they require continuous fetal monitoring, those monitors don’t stay put very well if you are moving around and some nurses get annoyed with this! (Ask me how I know…)
• Doctors are not as likely to let you go over your due date. Due dates are arbitrary and often not accurate, but they want to see babies come out on or before them. Most doctors in my area will not “allow” (I HATE that term) a mom to go more than 1 week past her due date. There is no evidence that supports this practice. It is fear-based medicine. Inductions are extremely overused and pushed on moms by using fear tactics.

 

Well, I’m gonna go ahead and post what I’ve got here, but it’s not as concise, organized, or as thorough as I would like, but I plan to come back and work on it continually- would even like to add some sources eventually! It’s a start…

I also need a new post of updated favorite homebirth articles and links! Haven’t done that in a while either!