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February 10, 2010

What is the appeal of home birth?

I've never understood why anyone would choose to give birth at home, rather than in a birthing center attached to a hospital. a) Why not go somewhere where you don't have to wash the sheets? b) If there's even a remote chance that you need emergency surgery, why not arrange to be seconds away from an operating room rather than minutes, or longer? 

I know that childbirth isn't a disease. On the other hand, if I had a non-disease where there was a small chance that I'd need emergency surgery within the next 72 hours, I'd prefer to park myself as close to an OR as possible. 

I understand that every woman has the absolute right to make her own decisions about where and how to give birth. I'm not trying to influence anyone else. (Hivemind, be nice to each other, okay?)

Just to reassure people, like my mom, who might be following along at home, this is a purely academic question for me. I ask because Jill & Emjaybee's blog is thought-provoking.


I feel like, in the hospital, it is a battle over control. The doctors want to control and actively manage the labor and delivery for various reasons (not necessarily based on evidence-based medical literature) and Mom goes in with a 'birth plan' that would allow her to feel like she is in control. It's no surprise to me that in a hospital setting control is taken away from the mother - if she gets to walk around or eat and drink in labor, it's because the hospital 'allowed' her to do so.

With midwives, mom is more likely to be given autonomy & control in any decision making process and, in a home birth situation, not only is she in control but she is also free to give in to the labor and birth, to give up control of her body, because of the environment and the relationship of trust she has with her midwife, without unnecessary interventions being used to manage her birth for her.

I have yet to give birth but once the time comes I will find a midwife, providing I'm healthy and have a low risk pregnancy. If I do end up going into the hospital, I'd want a doula with me every step of the way. What would be even better in the US is if my midwife were to have hospital privileges!

Hi Lisa-

I'm so glad to hear you asking mothers instead of making presumptions like a lot of other writers have done.

I've had two children, and my reasons for choosing home birth were slightly different for both. With my first, after considerable research, I was worried about unnecessary medical intervention, and about hospital protocols about "failure to progress." Meta-analysis of a number of studies indicates that most first-time mothers progress much more slowly than the hospital timeline. I know my own personal proclivities would lead me to be very uncomfortable around medical professionals, which itself interferes with the hormones that keep labor progressing. Unfortunately, after several days in labor with a posterior baby (makes labor more slow and painful), I transferred to the hospital for pain relief. My hospital experience ended, unsurprisingly, with a cesarean because I did not progress according to the hospital timeline, notwithstanding the fact that I had almost reached total dilation. Neither my child nor I were ever in any danger.

For my second, I chose to birth at home because even though I have the privilege of living in a place that offers VBAC in hospitals (in name at least), the barriers to VBAC are insurmountable for most women. In short, most of the required protocols are actually antagonistic toward healthy progress in a birth. The mother must consent to continuous fetal monitoring, which seriously restricts movement. The mother can't eat or drink, which promotes dehydration and exhaustion. A labor that is not progressing is augmented with pitocin, which can cause a life-threatening uterine rupture.

I would like to have more than two children, so avoiding a second cesarean was important to me for that reason (in addition to the fact that major surgery when awake is pretty scary). According to the research that I did, the best way to avoid a second cesarean is to put as much space between yourself and hospital protocols as possible. My home is less than a mile from a community hospital with an ER, and about 2 miles away from a tertiary care facility with a NICU. I understand that there is a risk in any labor, and that there is a very, very small chance that I could have catastrophic complications in any setting. In my particular situation, if I were in a hospital, I'd still have to wait for an OR, an OB, and an anesthesiologist if something went wrong. If something went wrong at home, we could call ahead and the hospital would have the team assembled by the time we got there a few minutes later. Compared to that very, very small chance of bad outcome is the very BIG chance that I would end up with a repeat cesarean in a hospital. And the surgery carries its own risks, particularly cumulatively. While some people know people who had complications in home birth, I know people who have had very serious complications of repeated cesareans, and that's something I feel I could personally mitigate by doing my best to avoid surgery.

I feel that in part because I was mostly unobserved and could move and change positions and eat/drink as I needed to, and because I had access to a tub in which to relax and let my body work, I had a short, uncomplicated, "easy" labor. it was attended by a CNM with over two decades of baby catching experience and with the confidence that she can immediately make the call to transfer if something goes wrong and not risk her practice that having hospital practicing privilege gives.

I felt safe and supported rather than the sort of skeptical supervision women delivering VBAC in hospitals get.

There's the additional factor that as a legal practitioner, I have read a LOT of cases where women who are firm about the same things I intended to be firm about are compelled by court order to submit to surgery, and a growing amount of anecdotal evidence from women tells me that some doctors are abusing the child protective system, calling CPS in order to force acquiescence. These are in the minority of births, but it becomes much more common in VBAC. I'd rather avoid that fight and only go to the hospital if it becomes necessary. I realize this is a luxury of living in an urban area and having a car, and count myself lucky to have access to both.

I had 3 pleasant hospital births and chose to have my last baby at home. We don't have a birth center nearby. Surprisingly there wasn't much clean up. And I was very happy to be able to birth my placenta on my own (a big reason I disliked how my 3rd birth went). It was the perfect choice for me and my family.

I found that most often a midwife will be aware of possible emergencies or complications with plenty of time to get to the hospital if it can not be handled at home.


Why, because Ricki Lake did it, of course!

BUT SERIOUSLY, folks. Everyone else's answers completely cover my own rationale: the safety of home birth versus fighting the cascade of interventions at the hospitals. The risks of the latter put me over the edge. I won't rehash what others have covered so eloquently. Essentially, for me as an individual:

1. While it is technically possible to battle your way through a hospital birth, refusing intervention after intervention, protocol after protocol, arguing policy, fending off negative attitudes by way of the crapshoot re: which L&D nurses you get (some are great, some are not, almost all are overworked), I decided that I would rather not spend my whole labor - the birth of my child - fighting with strangers.

Your mileage may vary, and not ALL hospitals are like this. But it's fair to say that in this current state of maternity care, the odds make me wary indeed, even if you chose the perfect care provider (who may not even be the one who ends up attending you, due to the nature of group practice).

2. By the time I got pregnant, I had both read and heard firsthand SO MANY crappy hospital experiences for a first birth followed by a wonderful, healing, life-affirming experience with their second birth at home, that I just decided, "Well . . . why don't I just skip the crappy hospital experience?"

And I did.

Final note on the matter of cleanup - as others have said, it's really nothing. So you stain some secondhand sheets and toss them, and chux pads take care of the rest, if any. It's a cinch. OR - buy or rent a birth pool and have a waterbirth! Issue = moot.

For me it is about power more than safety or convenience or comfort. There is a major power imbalance that exists between a birthing woman and the institution -- I didn't want to entertain it. I didn't trust that I could hold on to my power in the hospital, without an army and a fight neither of which I wanted to bring into my birthing space. I also knew I wouldn't be able to hear my instincts about what my babies and I need over the noise of the fear and the people almost none of whom I would know or trust.

Being vertical is safer and more comfortable but instead most women are still giving birth against gravity with their pelvis in their narrowest position -- there is no evidence for it, except doctor convenience. Informed consent is a rare commodity. I do post-partum/breastfeeding support for 100s of moms a year, what happens there is frequently abuse.

If I truly needed the services of the hospital I would go there, but only if I knew in my gut that I needed it.

My 1st was a straight forward 6 hour home birth. But in the last 2 of my 3 pregnancies, I had no "in between" choice like a birthing center, because I was "high risk" due to twins (yes 2 sets). The level of fear and medical intervention considered the standard of care for twins is significantly greater than it is for singletons and yet the vast majority of routine procedures are not supported by the obstetrical literature even with multiples. My first set of twins included a breech first presenting baby... I would have had a c-section in the hospital as routine procedure. My midwife stayed with me against regulations, and both babies and placentas all arrived in less than 3 hours. The last time, no midwife would touch me as regs were tightened even more. So I stayed home with my husband and a friend and again 2 babies and placentas arrived this time in less than 2 hours. I am confident that staying home is the safest thing I did during all of my births.

If what happened in hospitals was anything close to evidence based practice (and there are wonderful exceptions to the rule) and women were treated as the experts about their bodies and babies and their instincts and wishes were respected... maybe I would park myself there "just in case" -- but I'm not holding my breath.

I chose home birth because just by parking myself as close to an OR as possible (in a hospital), I would have increased the risk of having to use it! ;) That alone is reason enough for me.

I did both. 1st hospital and 2nd/3rd home. At home you can go for a walk, leave the room, know everyone present, have distractions, a sense of normality etc. All these things make the pain sooo much easier to deal with. Afterwards you are in your own bed, with all your own stuff and access to your kitchen. Your parter and other kids don't have to go to see you, drive, park etc. The baby didn't take you away and visitors are not in your space when you just want them to leave - at home you can leave the room....

"a) Why not go somewhere where you don't have to wash the sheets?"

Because whoever ends up washing the sheets, it's not the birthing mother. It's really not a hassle for the midwife to throw a load in on her way out the door. They don't get that icky anyway (we use disposable pads just like in the hospital); and nobody besides me, my husband, and children have ever slept on MY sheets. You want to go someplace and give birth on sheets that other people, complete strangers, have given birth on? And washed with a bunch of other sheets, some of which were used by sick people? Yuck!

"b) If there's even a remote chance that you need emergency surgery, why not arrange to be seconds away from an operating room rather than minutes, or longer?"

In terms of access to c-section, there is no statistical difference in outcomes between laboring in a hospital vs. laboring within 30 minutes of a hospital. But while only 2%-5% of homebirth midwives' clients end up having c-sections (the vast majority of which are not true emergencies), 30% - 40% of those giving birth in hospitals these days do so by c-section. And at least half of those c-sections are unnecessary and/or iatrogenically caused. Add in the fact that c-sections greatly increase the likelihood of complications and death for both mother and baby, and, well... Feel free to give birth where ever *you* feel most comfortable.

you can read my answer on my blog, if you'd like.

Having a hospital birth for a normal, low risk pregnancy is like hitting a nail with a sledgehammer. It's overkill, and you're likely to do a lot of unnecessary damage. Midwives are experts in normal birth. OBs are experts in pathological birth. If you're having a normal pregnancy and want a normal birth, why would you choose an OB? And why would you choose to give birth in a dirty hospital? Seriously? I'm a RN, and there's no way I'd give birth again in a hospital if I have a choice. Not with all of the MRSA, VRE, ESBL, C. difficile and other nasty infections floating around. The general public has NO IDEA how filthy hospitals are. Even ones that have great housekeeping services.

I encourage you to read:

It's a huge study from British Columbia comparing the safety of home birth versus hospital birth. Take note of the rates of perinatal death, obstetric intervention, and complications. Also notice that the hospital birth group was a MATCHED SAMPLE, meaning, they would have qualified for a home birth if they had wanted to go that route. (So the low complication rate in the home birth group cannot be attributed to the mothers being in a lower-risk category).

Lots of studies out there showing that a healthy woman with good prenatal care has far less risk of infection, morbidity or mortality giving birth at home with capable attendants rather than in a hospital. "Active management of labor" is the standard in hospitals and that means not trusting women's bodies and intervening with all sorts of procedures. In grad school I researched the use of electronic fetal monitoring and found that it is absolutely NOT an accurate predictor of fetal well being. A shockingly large amount of obstetrical practice is not actually statistically based on good science but rather on a mix of what the OB's teacher did and what is convenient and offers legal coverage for the hospital.

To take that from the abstract to the personal - my first child was born in a hospital. She was considered late so I was induced - first gel, then pitocin + internal fetal monitoring (electrode in the baby's scalp), IV, epidural and of course ending with a c-section when I did not progress fast enough by their timeframe.

I'm a small woman and my OB told me she'd give me a trial of labor with baby number 2 but she expected I'd need another section. At that point I was in the midst of the research mentioned in the first paragraph and found myself a pair of wonderful homebirth midwives. I had better, more detailed prenatal care with them - hour plus visits rather than the 15 minutes with the OB, advice on things like nutrition and balancing the needs of my toddler with coming baby as well as more detailed monitoring of my chemistry than the OB's practice. The midwives were with me for the entire labor - with an OB you're lucky if your doctor is there for the birth and shift changes can give you a rotating cast of caregivers through a labor. To make a long story short both second and third children were born at home and not only was it a wonderful experience which brought my husband and I far closer because he was such a wonderful support to me but it showed me how strong and capable I am. My hospital birth was all about being out of control, pushed around, forced to follow arbitrary procedures which are for the hospital's convenience and not for the mother's safety or comfort. My only regret is not having my first child at home. I won't take the space here to go into detail but will add that there can be long term bad consequences from the scarring from a c-section - it's not risk-free.

When it came to my own childbirth preference, I was strongly pro-hospital for the reasons listed above. As far as comfort goes, the hospital also offered appealing amenities such as spacious rooms, air conditioning, sound-proofing, and (relative) privacy—all of which are in short supply in our older, high-density neighbourhood of row houses. I think if the 20+ households within earshot of our windows had had their evening BBQ's interrupted by a woman in active labor, they would have called an ambulance. Still, this had me chuckling:

Why not go somewhere where you don't have to wash the sheets?

This is how I felt, too—and then the hospital actually did run out of sheets, for the babies, anyhow. Heck, they ran out of beds. I spent my first night on a gurney in the kitchen. Yay, Canadian health care.

I had a wonderful home birth with my son Gabriel. Some of my reasons were that there is less chance of unnecessary intervention (pitocin, epidural, c-section), it is so much more comfortable to be at home in familiar surroundings, you are allowed to move around (which helps labor) and eat and drink if desired, and I got to hold and nurse my baby immediately and as much as I wanted. Also, I did not have to wash my sheets, the midwife and her assistant took care of everything. And home birth is proven to be at least as safe as hospital birth, if not safer!

That's like saying you're going to park your car in front of the emergency room every day all day and all night in case you have a heart attack. in MOST cases, a midwife will catch that you need to be transfered to a hospital setting before it becomes and emergent situation. and in pretty much ALL cases, a midwife is trained to keep any condition stable until the woman gets to the hospital and gets the medical attention she needs. I'm a doula, and I've seen doctors diagnose a prolapse cord WAY AFTER I myself knew what was about to happen, let alone a trained and certified midwife. It takes them up to about 20 minutes + to prep the OR for surgery anyway. Call ahead, let them know you are coming in for an emergency c-section, and by the time you get to the hospital you are wheeled right in. That way you only have to travel seconds instead of minutes to the hospital. The point about staying home is that in a lot of cases there is no such thing as a birthing center attached to a hospital. I have never lived anywhere (and I'm military so I've lived a lot of places), where a birth center was available to me. Usually the midwives and your partner/birth attendants wash the sheets for you after you have given birth, cook you a meal, make sure you have a nice shower and generally care for you like you are the queen of sheba. The only thing I was allowed to do was sleep and nurse my baby. Lastly, who wants to sleep in a hospital bed right after they give birth when you can snuggle up in your own bed, your own smells, your own GERMS you've been around for months and are likely less harmful than those at the hospital.

I could say a host of things about the value and benefit of homebirth, and even tell you why it's so important in my personal situation with my medical history, but you've already received so many comments on homebirth itself that I thought I'd touch on the statement, "I've never understood why anyone would choose to give birth at home, rather than in a birthing center attached to a hospital." The short answer: most women don't have the option that you're implying.

A TRUE birth center attached to a hospital is VERY rare. Most of the ones you know of are likely L&D wards with a nice-sounding name and some hardwood floors. Protocols are typical, across-the-board, and there is rarely a separate area for those seeking a natural birth and/or fewer interventions.

I actually live near a true birth center attached to a hospital. It is completely separate from regular L&D, with different protocols, nurses and equipment. Moms have a regular queen-sized bed and other regualr furniture and lighting in their rooms. A 6-ft jacuzzi tubs under dimming lights is in each of the private bathrooms, in which moms are free to have a waterbirth. Their are no monitors other than dopplers. Other than Nubaine, there are no pain meds available. Moms are free to order food from the cafeteria during labor. Birth balls and breast pumps (for nipple stimulation) abound and are actually voluntarily offered by the nurses.

This birth center is 1 out of only 9 like it in our entire country. It's a great option for many women in the area, but most women in other areas don't have this kind of option. And even so, this birth center has a 20% transport rate, which is pretty high for being right down the hall from an OR. Personally, I don't want to take the risk that some little, manageable hiccup in my pregnancy or labor will get me transferred to the regular L&D, equipped with all the typical protocols and restrictions.

I still prefer to give birth at home, and in the event that we start to see a yellow flag in my labor I live 15 minutes from the hospital. With the OR (if necessary) being prepped on the way over, I'm not likely to have any more delay in a necessary intervention than if I was already at the hospital. And if I do spend the rest of my labor in L&D for something else, then it's a decision *I* made that *I* feel is justified.

And, by the way, I've had 3 homebirths, and NEVER have I had to clean up ANYTHING or do ANY laundry. The midwives don't just walk out the door once you have the baby and wish you luck. They take care of you. :)

lets just say that after 3 "natural" births in a hospital i finally got it right when I had my 4th at home with a midwife. I was so empowered and in "ahh" of the whole birth process. It was for me the "true" birth. It was amazing for me to experience a birth that was completely free of outside stimuli. It was just me and some warm water swirling around my belly and I was totally in touch with my strength and my baby. I knew where she was at all times and could actually feel her rotate and "slide" into my birth canal. It restored my faith in the womens ability to birth as nature intended.

To say you knew a woman who almost died during a homebirth is a weak argument - Lots of women and babies have *almost* died during hospital births as well. Scientific studies are backing up homebirth as being as safe or safer than hospital birth.
Also, the bedsheet argument is one of the silliest things I have heard. 1. I was *no* where near my bed when I laboured and birthed at home (2 times) and I had plenty of old sheets and towels to put down on the floor, but most of them didn't even get dirty. 2. Also, my partner did the laundry.
Choosing homebirth, for me, was not about putting comfort over safety. I chose to birth at home because of *scientifically founded* increased safety for myself and my children.

So, I am gathering that from the way you wrote your question you have never given birth? Hopefully my assumption is correct. :)

For that reason I find the appeal of a home birth difficult to convey to you. I've had two wonderful calm hospital births, but when I say "calm" I mean they were as calm as they could possibly be in a highly medical environment. The discomfort of labor is the kind that must be worked with. Sitting stationary makes it MUCH harder to cope with, but in MOST hospital/ birth center settings, you are bound to certain standards of protocol to protect the facility. For me, birth has been inherently instinctual, and listening to those instincts served me very well, but I still spent 90% of both deliveries having to ignore what I wanted to do for the safety of hospital's legal team. :)

As far as delivering at a birth center goes, we don't have access to the type of birth center you are describing, which is a factor, and the birth center my midwife runs has a facility fee that my insurance more than likely will not cover. If they had, we probably would have gone there, but this birth center looks very much like a B&B (except for the Olympic sized tub) and would essentially be like going to a really awesome house to have a baby.

All in all, it's hard to put in to words my draw to having a home birth. It's an innate desire, that
I am blessed being able to fulfill. It isn't for everyone, which is ok with me. I believe that women should be able to give birth where and how they choose. That statement can(does) lead to a whole other discussion on accepting personal responsibility for our choices, but we'll save that for another time.

I chose to have a homebirth for a couple reasons.
1. We do not have a birth center where I live.
2. I wanted to be in control of what my body wanted to do, who I wanted to have there, and I did not want my babytaken from me, for any reasons other then medically neccessary.
My first home birth experience was wonderful. Although my midwife was out of town and her substitute delivered my son, it was still a calm and relaxing experience. I was able to have all my family and friend I wanted to be there.
However, I do have a friend who found an OB who worked with her birth plan (her own clothes, music and no IVs). Luckily she was able to have a good laboring experience, although she ended up with c/s anyway because the baby wasn't coming down quickly enough. Another reason I choose to stay out of hospitals.

I second the thought of a previous commenter, the questions is rather, why would you have a birth in a hospital when you can be comfortable and (more) infection free at home.
Our hoem birth kit contained plastic sheets and shower curtains and we purchased $2 towels from Wal-mart which we threw away after he was born. No washing of anything needed. He was born at 10:07 and we were all asleep by midnight in the same bed.
I am currently 34 weeks pregnant and will have this one at home as well. I would not have it any other way.

My first baby was born in a hospital with a whole plethora of interventions that lead directly to the OR followed by me not being "allowed" to have my baby even near me for 8 hours after he was born. My second baby was born by planned c/s since we were petrified of what had happened before. It was a little better. I got to have my baby with me pretty much continually, but I had severe PPD following the birth since I had no labor (hence no natural oxytocin release). So, when we got pregnant the third time, we knew we wanted to do things differently. We chose homebirth because it was where I felt safest and felt that I could have the most success at birthing my baby vaginally. We believe that the risks of giving birth elsewhere are exponentially higher than giving birth at home. My grandma did it 6 times and no one thought anything of it! It was the most wonderful experience of my life! I didn't need to fight anyone on anything! My baby never left my side. There were no bright lights or strangers poking and prodding him. We are having another baby in July and will be having another homebirth. I can't wait! I wouldn't get in a car in labor again if you paid me! I always say that if you want to torture a woman, drive around in a car with her while she's in labor!

As the mother of a home birther who had two C sections 40 years ago, I must say that I might have opted for the Canadian model of midwife plus OBGyn plus home birth option after seeing how it went with my daughter. I think it's the midwife added to the mixture that makes the difference for me. The personal attention, the additional information and the presence of a trained individual who is focused entirely on the birthing mom makes a huge positive addition to the birth process. When my daughter had her first son and the midwife said - "too long, now we go to the hospital", she was correct in her judgement, she left sufficient time for a safe hospital birth, and the relationship between the hospital doctors and the midwife were positive, respectful and professional. When my daughter gave birth the 2nd time, the midwife was present and all went well - no trip to the hospital and everyone was totally happy with the process. It's always a personal call for what the parents to be are happy with, but hospital or home, I support the Canadian mid-wife/doctor team system.

I agree with Susan, why you would want to be in a hospital is beyond me, unless of course you know there are risks beforehand. Both my deliveries were 2 weeks late (figure that's how long I take to make a baby) and even though I had a midwife, the pressure on them and me to induce was pretty intense.
I would say on the whole Midwives are very cautious and if there is any risk they are the first to suggest a hospital delivery. And possibly, midwives have more experience caring for women through the whole process of labor and delivery in comparison to a doctor who, you may or may not have met before and, who generally isn't there for the labor and hopefully shows up for the final stage. For my first delivery I had to be transferred to a hospital because my giant headed baby was stuck and I was certainly pleased to have that option but when I arrived they peppered me with questions about what course of action I wanted to take with little explanation and had my midwives not been there to tell me in plain terms what it all meant I would have been waiting hrs for and epidural (the suggested course of action, and likely precursor to a cesarean) my midwife told me local freezing would be much faster and probably enough to do the trick. (it was) Also, home births allow you to give birth in water, not true for hospitals(here) not sure why it makes a difference but it does seem to make things go more easily, at least baby # 2 thought so.

One of my sisters has a masters in medicine (she dual mastered out of a phd/ma program) and had two home births.

Reasons why:

1) Birthing centers of the type you describe are non-existent most places
2) Birthing at home for a low-risk pregnancy has (a) slightly better (but not to the level of statistical significance) outcomes for the child, and (b) statistically significant better outcomes for the mother
3) If you start to be in distress, the amount of time it takes to get to the hospital is negligible

Reasons why hospitalized care is bad:

1) Uneccessary medical intervention and deception about what the mother/child needs. A few of the oldest tricks in the book: (a) Induce labor with pitocin--problem--this only actually works if you are about to go into natural labor, result: more c-sections because they freak out that the labor is not in process, (b) the epidural heart-rate game, step 1, give mother an epidural, step 2 make her lie on the bed with a fetal monitor, step three, freak out when the baby's heart rate drops (WHICH IS A KNOWN AND NATURAL SIDE AFFECT OF THE EPIDURAL), freak out to the mother and say the baby's heart rate is dropping, step 3, get freaked out mother to "consent" to an unneccessary c-section.

2) Things that have happened to women in my family (all of whom were biology majors with some medical training, too) in hospitals while giving birth: a My mom--almost needed a hysterectomy at 23 when the resident who delivered her child tugged on the placenta to speed along its delivery after the birth of my sister. That's right. She almost needed a hysterectomy at 23 to SAVE HER LIFE. That doctor is really lucky that the statute of limitations ran years ago, because ever since I heard this in my teenage years, I thought she should sue the motherfucker. b My sister--lied to about her child having Staph B (which is a big fucking deal) had her child and her husband removed from the room, and her husband was lied to and prevented from talking to my sister because they wanted to put my nephew through unneccesary, painful medical procedures. Fortunately, my sister, despite having just given birth is an assertive lady and she finally managed to get ahold of him and put a stop to the nonsense (because hey, once the child's actual parents got to speak to eachother, and consider the informed consent materials that they were trying to pressure my brother-in-law to sign, they were able to make a thoughtful medical decision that ended up being the correct one, too. But they were stressed the fuck out.)

3) Don't even get me fucking started on episiotomies. Or the stupidity of fetal monitors, and requiring women to labor on their backs, which is the most uncomfortable and positionally awkward way to give birth. (A small minority of women prefer it, but almost all, given the chance, prefer to move around, change positions, squat, possibly get in tubs--all things that are not allowed if you have a fetal monitor strapped to you.)

You're right, I had no idea how rare birthing centers were. This discussion has been a eye-opener. I just assumed that birthing centers were a standard thing nowadays. They seem like such an obviously good idea.

Before ever getting pregnant, I researched birth for months. I read the full studies comparing the safety and outcomes of low-risk homebirth versus low-risk hospital birth (they all agreed: perinatal and maternal mortality were the same, perinatal and maternal morbidity were HIGHER for the hospital. Homebirth is safer). I talked to every woman I could about her experience. I watched homebirth and hospital birth videos. I reads books and watched documentaries.

I looked up the common hospital interventions, their rate of use, and their risk/benefits. I had no idea until then how risky many interventions are, how little their use is based on evidence, and how one intervention leads to another to another, until finally, the OB has to "save" your baby with an "emergency" c-section - all caused by the interventions in the first place. For example, electronic fetal monitoring has been shown to increase c-sections WITHOUT improving outcomes for mother or baby. Pitocin often leads to fetal distress which then leads to c-sections. Epidurals can cause maternal fever and low blood pressure - the latter can in turn affect the baby's O2 levels. There is no evidence that pushing in the lithotomy position improves outcomes for mother or baby, but there is evidence that pushing in other positions can help turn a malpositioned baby, prevent tears, is more comfortable, etc. And on and on.

I've been present for hospital births, I've seen how a woman gets put on what amounts to an assembly line of interventions and care. I've seen how random nurses come in to hook you up to more machines, how the doctor is not present for most of the labor, etc. How so much of what they do is based on "hospital protocol" rather than a woman's individual situation, wants or needs.

There is really such a complex issue, and there are so many reasons I chose to birth at home, that this post could go on for pages and pages. Instead, I'll just give a few more reasons in random order:

Decisions in hospitals are often made for legal, financial, and convenience reasons rather than because they are based on evidence.

Birth is normal, physiological process. I trust my body to perform it. My body is strong. I don't need to be monitored constantly, my vagina is not a danger to my baby. If an actual medical problem had arisen, THEN I would have sought medical help.

I was never, ever, not once, separated from my baby. She spent her first minutes, hours, and days, in my arms, not the arms of a stranger, cold, alone, crying under lights as she was checked out.

I never had to get in the car while in labor. Instead, I ate homemade chicken soup, drank what I wanted, walked around my neighborhood, joked with my neighbors and husband.

I was in my home, I had absolute say in who was present, the light levels, whether is was bustling and noisy or calm and quiet, whether music was playing and what kind. I could get in the shower, I could lie on my own bed, I could go for a walk. I wore my own clothes.

My midwives assumed my pregnancy was normal, unless there was evidence to show otherwise. They follow expectant management. OBs, in my experience, assume everything is wrong until proven otherwise. They follow active management.

I labored and delivered in the positions I chose. I chose based on what was most comfortable. Standing up worked. Lying down was EXCRUCIATINGLY painful. Standing up helped turn my baby into the proper position so she was born easily rather than getting stuck or not progressing.

I know, with 100% certainty, I would have had a c-section had I been in a hospital or an attached birth center. My labor progressed WAY outside the normal curve most OBs use to determine if your labor is "failing to progress," which is usually 1 cm dilation an hour. They would have intervened after all the hours I went without progressing at all - instead of waiting when that final hour kicked it in to high gear and she came all at once. I would have been forced to lie on my back and push, and she didn't move at all when I was in that position. I would have been one of those cases where the women is told, implicitly or explicitly, that her body couldn't birth her baby.

The OB backing up my midwife insisted I needed to be induced at 39 weeks because I had been diagnosed with gestational diabetes. She said the GD diagnosis meant my baby would be too big. There is no evidence that inducing labor due to GD, in the absence of any complications, improves outcomes -and a lot of evidence that induction increases risk of infection, c-section, cord accidents, breathing problems due to immature lungs, etc. The ACOG does NOT recommend induction in my situation. It is not an evidence-based course of action. My blood sugar never went above 100 (120 is the high range of normal) and neither I nor the baby showed ANY issues. I refused the induction. The OB tried to pull the big, dead baby card. I still refused. We found a different back-up doctor. My daughter was born at 40 weeks - all perfectly healthy 6 pounds, 6 ounces of her. Who knows what other non-evidence based, risky interventions I would have been pressured with had I been under the full time care of an OB.

My midwives cleaned up after the birth. My house has never been that clean.

We ate more soup and birthday cupcakes right after the birth. My husband, my baby, and I all got to snuggle into our own bed, with our own (clean) sheets, and sleep.

The labor and birth was calm and unhurried. Fear was absent. Someone else's timeline or policies were irrelevant. I was surrounded only by people who loved me or who I had specifically allowed to be there.

There are so many more reasons, but I'll stop there...

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