Guest Writers, Home Birth Safety

Home Birth: “Brave” Has Nothing To Do With It

147 Comments 29 March 2010

Morgan, co-director of North Metro Birth & Breastfeeding Coalition

Guest post by Morgan A. McLaughlin McFarland

When hearing the news that I had my last baby at home and am planning to have this one at home as well, the first response from most people is, “You’re so brave.”

This has to be one of the most irritating things that people say to homebirthers. The implication is that birth is dangerous and that we are willing to take on a tremendous risk to do it anywhere but a hospital.

It negates the research and planning that we’ve done to come to this decision. It makes the choice about balls, not brains. After all, homebirth is “dangerous.” Hospital birth is “safe.” Therefore, it must be bravado alone that would lead a woman to choosing such an option. Right?

In 2003, over 20% of women had their labors induced, with a rate closer to 40% in many hospitals, while that rate should not exceed 10% (and has remained at 10% in most industrialized nations).

Inductions are approximately 5 times more likely among planned hospital births than planned homebirths. An 1999 American Journal of Obstetrics and Gynecology “Green Journal” review of 7000 inductions found that 3 out of 4 of the inductions were not medically necessary.

Inductions are performed unnecessarily for estimated size of the baby (too large or too small), going past the estimated due date, amniotic fluid levels that are low but not critically low (correctable in nearly all cases by rehydration of the mother), rupture of membranes without immediate start of labor, the mother being dilated/effaced but not in active labor, or scheduling reasons on the part of the mother or care provider.

Approximately 40-50% of inductions fail (depending on the induction method used and the mother’s Bishop score), and most failed inductions end in cesarean section. Inductions increase labor pain and length, and create, among other problems, an increased risk of fetal distress, uterine rupture, and cesarean section.

But homebirth is “dangerous.” Hospital birth is “safe.”

Over 30% of women in the US have cesarean sections, while overwhelming research has led the World Health Organization to set an ideal standard rate of cesarean sections at 10-12%, with 15% being the rate where more harm is being done instead of good. Cesareans are performed at a similar rate across all risk groups, low to high. The cesarean rate for planned births at home or in an independent birthing center is approximately 4%.

Cesarean sections increase the likelihood of maternal death by as much as 4 times, and have other immediate and long-term heath risks for mothers that include, but are not limited to, infection, bowel or bladder perforation, hysterectomy, future infertility, and increased risk of uterine rupture for future pregnancies.

Risks for the baby include respiratory distress, fetal injury, prematurity (if result of scheduled section or failed induction), and breastfeeding difficulties.

Four of the greatest causes for the increase in cesarean section are overuse of interventions during labor, concern for malpractice/liability on the part of care providers, failed labor inductions, and “failure to progress” (labor not progressing fast enough or regularly enough for care providers).

But homebirth is “dangerous” and hospital birth is “safe.”

The ACOG and AMA have both come out against homebirthing, calling it a dangerous trend and referring to it as a “fashionable, trendy, [...] the latest cause célèbre,” and they paint a horrible picture of complications arising in low-risk pregnancies with no warning that cannot be handled anywhere but the hospital.

Despite that, the most thorough study ever done on homebirth safety, Kenneth C Johnson and Betty-Anne Daviss’s Outcomes of planned home births with certified professional midwives: large prospective study in North America, BMJ 2005;330:1416 (18 June), found that the outcomes of planned homebirths for low risk mothers were the same as the outcomes of planned hospital births for low risk mothers, with a significantly lower incident of interventions in the homebirth group.

The Lewis Mehl Study of home and hospital births, which matched couples in each group for age, parity, education, race, and pregnancy/birth risk factors, found the hospital group had 9 times the rate of episiotomies and tearing, 3 times the cesarean rate, 6 times the fetal distress, 2 times the use of oxytocin for induction/augmentation, 9 times the use of analgesia/anesthesia, 5 times the rate of maternal blood pressure increase, 3 times the rate of maternal hemorrhage, 4 times the rate of infection, 20 times the rate of forceps use, and 30 times teh rate of birth injuries (including skull fractures and nerve damage).

Breastfeeding success rates are higher and postpartum depression rates are lower for planned homebirths.

But homebirth is “dangerous” and hospital birth is “safe.”

The United States spends more per pregnancy/birth than any other country, the vast majority of women in the US give birth in hospitals, and yet the US’s maternal death rate is the worst among 28 industrialized nations and the neonatal mortality rate is the second worst.

The Netherlands, where 36% of babies are born at home, has lower maternal and neonatal mortality rates than the US. Denmark, where all women have access to the option for a safe and legal home birth, has one of the lowest maternal and neonatal mortality rates.

But homebirth is “dangerous,” hospital birth is “safe,” and Brutus is an honorable man.

I didn’t choose a homebirth because I am brave. Bravery has little to do with it. If anything, I believe women who choose to give birth in US hospitals are the brave ones, because knowing what I know about our technocratic obstetrical system, I can’t imagine voluntarily choosing an obstetrician and a hospital for anything but absolute medical necessity.

My decision to homebirth wasn’t made in a void, but based upon years of research. I wonder how much research the average woman puts into her hospital birth?

Considering how many times I’ve heard someone say “I’m glad I was in the hospital because…” and then given as her reason a non-emergent situation (such as fetal size or nuchal cords), I’d say not that much.

Call me stubborn, because I wasn’t willing to accept out of hand the culturally held belief that hospitals are safer.

Call me an idealist, because I believe that birth can be a positive, safe, and empowering experience for child and mother.

Call me a nonconformist, because I choose to birth at home in defiance of a powerful technocratic system.

Call me outspoken, because I can’t keep my mouth shut when I hear about yet another iatrogenic birth calamity.

Call me a “birth nazi,” because I believe it’s the right and responsibility of every woman to educate herself about birth and take ownership of her birth experience.

But brave? Don’t call me brave. “Brave” has nothing to do with it.

Morgan is a freelance writer and co-director of North Metro Birth & Breastfeeding Coalition. Email Morgan at morgan@mcfamilies.com

Read Morgan’s follow up article, “Birth Safety as a Binary Condition.”

Your Comments

147 Comments so far

  1. SC says:

    @Gerri When the child needs medical attention, the child will get medical attention, even when birthed at home, and fairly immediately – unless home is multiple hours from any hospital. Midwives are trained to deal with many many complications that may arise during a birth. While they do not do caesarian sections, midwives (at least in the State of Washington) do carry oxygen and various other tools to help both mother and child during birth. For example, they bring drugs to help stop post-natal bleeding in the mother, to be used if the need arises. *And* midwives are trained to spot problems as they arise. The midwives that attended my birthing of our child went so far as to call the sheriff when I went into labor just to alert them that a home-birth was happening and at what location, so in case of an emergency, the ambulance etc would already know the location of my house and not have to spend precious moments figuring out where it was. Talk about planning for many possibilities!

    Keep in mind that midwives, at least none of the many I know, won’t do a home-birth if they feel it would be dangerous to the mother or baby. The home-birthers and midwives I know aren’t advocating for ‘home-births only and for everyone whatever their circumstances or health history’. We’re advocating for safe, reasonable, empowering, healthy births and for home-birth to be seen as the safe, reasonable, empowering and healthy birth option that it is – instead of being criticized by people whose comments are that of Sarah who just posted saying home-birthers are stupid. (BTW, Sarah, in my opinion, your comments are both offensive and ignorant of the realities of home-birth. Many women choose home-births specifically *because* it’s statistically safer for the baby.)

    All this said, the place in which the birthing mother feels most comfortable and safest is the place for the mother to be – at long as midwife/MD agrees that it’s the safest. No one is suggesting that mothers who object to being at home during birth, or who are for whatever reason afraid to be at home during birth, should be there. That would be against the grain of one of the ideals home-birthing advocates: the empowerment of the mother. If you don’t want to be at home, far be it from anyone to force you to, which would strip you of your power as birther.

    We are advocating for mothers and fathers and partners to educate themselves as to their birthing options. The hospital/medical model is not all it’s cracked up to be. The point is not to blindly accept (and therefore be abdicating your responsibility and power over your own health and your child’s health) what the medical model tells us. *Certainly* there are examples where the medical model is the answer – and also where a very natural birth in a hospital can happen. Education and conscious choosing are the goals here, not blind prescription of one way or another. It should go without saying, but based on some of the comments here, it doesn’t seem to.

    Thanks for this post Morgan and BBH! I fully support continuing this conversation in all arenas. The more it’s discussed and looked at, the closer we get to healthy and empowering births for all, in whatever form that means.

  2. Kate says:

    I agree Morgan McFarland… one of the reasons I object to people telling me I am brave for planning a homebirth is largely to do with the tone…
    As a previous commentator said, it would be ‘silly’ to be offended if labelled as brave but so far, when it comes to my HB plans, the tone has been largely patronising and I suspect this is because I am a first time Mum… It seems that these people assume I have not made an INFORMED choice that is right for baby and me.

  3. Kara Patterson says:

    Great article, and I agree with it wholeheartedly except for the title. My birth was *extremely* painful and in addition to that home birth is illegal in Ohio. So it would indeed require me to be extremely brave to have a home birth, where I’d have no pain recourse and be risking legal ramifications. I personally did a lot of research into my hospital birth, finding one that was very sympathetic to my desire for a natural-as-possible experience. While that isn’t normal, it was the case for me, and I did it very thoughtfully. I do wish more people knew the pros and cons though, because there are definitely both, especially if you can’t pick your own hospital.

  4. Jody says:

    Morghan ~ so often I skim through birth blogs looking for information that will support or challenge my beliefs. So often I don’t make it all the way through them. I was so compelled to read this straight through to the end and thank you for such a valuable presentation. I have accompanied many women through birth, who are like deer in the headlights waiting for someone else to make a choice for them or tell them what to do, too frightened to believe in birth.
    Sarah ~ Your comment is really just childish without offering any information or insight to back up your statement. Morghan has presented thorough research and statistics and you come back with “stupid” ….. really???

  5. Erin says:

    Homebirths these days ARE statistically safer and have less interventions because of the screening behind them- no midwives will deliver prems, multiples, or any high risk pregnancies at home (for obvious reasons). So of course statistics will reflect this.

    My feelings on this aritcle and others like it are echoed by Elizabeth above when she said: ‘I don’t think women who birth at home are brave any more than I think women who choose to have their babies in a hospital are wimps, or uneducated. Articles like this just cause grief. Home birth is wonderful, but it is not for everyone. No woman should be put down, made to feel less than, or snubbed because of her choice. Anyway, being called “brave” should be something that is embraced, not vilified. I love to be called “brave”. It’s a compliment. Being offended by it is silly. ‘

    I also had a premature baby who wouldn’t have survived if born at home, but I in no way feel like less of a woman or ‘uneducated’ for having a hospital birth.

  6. Alyssa Jackson says:

    Beautiful. Thank you for writing this!

  7. Morgan McFarland says:

    Erin,

    No one is calling women who give birth at the hospital uneducated (or if they are, I disagree with them). My point, which I hold is valid, is that many women who give birth at the hospital do so out of a sense of cultural normalcy or out of fear (based on lack of education on the alternatives) of birth outside the hospital, not because they have made the educated decision that the hospital was their best bet.

    Knowing what I know about the increased risk of unnecessary intervention in a hospital setting, it would take a lot of bravery for me to go to the hospital to give birth, even if I had a medical reason to do so. I would go if my health or my baby’s required it, but it would take bravery. I’d have to overcome fear in order to do it, fear based on both research and personal experience. There was no fear of homebirth for me to overcome, however, so there wasn’t any bravery involved in that choice.

    The word “brave” isn’t being used as a compliment by homebirth detractors. It’s being used synonymously with “foolhardy,” “crazy,” or “selfish” (as we’ve seen in other comments). If someone genuinely believes I had to overcome fear to give birth at home, I wouldn’t be offended, though I’d be quick to explain that wasn’t the case. Those aren’t the people I’m addressing in this essay.

  8. Morgan McFarland says:

    Girleeee,

    You said, “That being said, IT IS BRAVE to have a child at home. NOT because you are willing to feel the pain of childbirth, but because you are willing to put the safety of modern medicine aside and do it your way.”

    This is exactly the sort of misunderstanding about homebirth that I was trying to address in this essay. There is no surrendering of safety of modern medicine by having a homebirth. About the only things a homebirth midwife cannot do in a birth emergency situaton are perform a cesarean section or give a blood transfusion. A homebirth midwife also spends more time with her client, meaning she is likely to spot a true birth emergency early and transfer her client in time for necessary medical treatment that can’t be provided at home.

    Many of the “emergencies” treated in hospitals are iatrogenic — caused by doctors. Hospitals often start what is known as the “cascade of intervention,” where one small intervention leads to a larger intervention leads to Pitocin, pain medication, cesarean section. The Pitocin praised by another commenter can lead to severe complications for both mother and baby, including fetal distress, uterine rupture, and amniotic fluid embolism.

    Can you have a safe birth in the hospital? Of course, with the right care provider. Can you have a safe birth at home? Of course, with the right care provider. Homebirth and hospital birth outcomes for low risk women are similar, with nearly identical mortality rates and lower intervention rates at home.

    It’s not about doing it “my way.” It’s about doing it in the way that is safest for me (a low risk mother) and my child (a health baby). Home birth is the safest choice for someone in my position.

  9. Amanda says:

    wow. This was beautiful. Thank you so much for sharing this. I am so excited for my first homebirth in early July!!!

    much love
    Amanda

  10. Kasie says:

    I try not to get offended when people make comments that women who give birth at home care only about the “experience”, and not about the safety and well-being of their babies. But, it’s hard not to sometimes. Because the safety of my child was my number one concern when I was planning my home birth. I had a very traumatic hospital birth with my first child almost 10 years ago. Both my son and I suffered for it. I am convinced that we would have been much better off had I been at home. But I was young, scared, and uninformed. Home birth did not become an option for me until 8 years later, when I was pregnant with my fifth child. I had three years of research under my belt by the time I gave birth 11 months ago. I did not throw caution to the wind and hope for the best, in the name of some “hippie-granola-I’m-out-to-prove-how-awesome-I-am” experience. Yes, the experience was incredible, and one I am so happy I was able to have. But the safety of my son was always at the forefront of my mind. And for someone to suggest otherwise, when they don’t know me, or know what I have been through, is really well, rude. Disagree with me? Fine. I’m a big girl, I can take take it. I have plenty of friends who would not choose a home birth for themselves, but respect my decision. I would never judge another woman for choosing to birth in a way that’s not for me. I only ask the same in return.

  11. Tara says:

    Great post, Morgan!

  12. t.gray says:

    i am simply an advocate of educating & empowering women when it comes to giving birth.
    to choose what is best for them & their family; to embrace a positive birth experience that will define them for a lifetime.

    we all walked the journey of life differently – at a different speed, stopping setting up camp at different times & places. yet, “no one is an island entirely by themselves. we are all a part of the main. any man’s life diminishes me because i am a part of mankind”. let’s attempt to hold hands & guide each other with love and compassion along the way. i refuse to be disrespectful and critical at another’s path, especially another birth’s choice.
    we are all bold, courageous, and BRAVE; motherhood, in & of itself, is an act of bravery. these are little human lives trusted to us – for if that alone is not brave, i am afraid to know what is.

    lastly, i agree with elizabeth’s words:

    I don’t think women who birth at home are brave any more than I think women who choose to have their babies in a hospital are wimps, or uneducated. Articles like this just cause grief. Home birth is wonderful, but it is not for everyone. No woman should be put down, made to feel less than, or snubbed because of her choice. Anyway, being called “brave” should be something that is embraced, not vilified. I love to be called “brave”. It’s a compliment. Being offended by it is silly.

  13. Christy Lindsey says:

    Thank you so much for an excellent article! I have had three natural births, first in a birth center and the others at home. The last one only had myself, husband, and other kids home, which was by far my favorite. I firmly believe that if a lady does not fear birth and is left alone to do what she wants, her body will naturally do exactly what is needed to give birth. I realize that birthing at home alone without any attendants or midwives is considered even more dangerous than choosing homebirth with midwives. But, this attitude just shows how far removed we are from what is natural and normal. Birth is not a medical emergency! It is a normal bodily process for which women are well designed to do. It is precisely the routine interventions into labor that create the emergencies. Induction now occurs with most pregnancies. This is asking for trouble! The baby will come when he or she is ready! The typical protocol is induction, generally followed by “failure to progress,” often followed by a c-section. I hear it over and over from people I know. In fact, I never hear of any ladies who don’t get induced, except for the rare ones who choose homebirth. Humans are mammals, and mammals will only birth when they feel safe. Is it any wonder that most women do not feel safe in a hospital environment? Strangers, machines, interventions, exams, bright lights, noise, hospital odors, confined to bed, stress, and fear all make for a very threatening place. How is a woman supposed to relax and do what she needs to labor and birth?

  14. Gloria Bauta says:

    Brilliant essay. Your beautiful and powerful words remind me why I’ve chosen this path.

    Would you mind if I repost with credit?

    Bright Blessings.

  15. Morgan McFarland says:

    Kasie,

    I also had a traumatic hospital birth experience with my first son. My pregnancy and labor were normal, with the exception that I didn’t dilate fast enough. I was pressured from shortly after admission to the hospital to allow Pitocin and various pain medications. An internal fetal monitor was screwed into my son’s scalp without my consent. I had numerous procedures performed on me in the name of the baby’s safety which I learned, after the fact, are not evidence-based (and are often completely counter to evidence!). Due to deep suctioning of my son, we had a difficult start to breastfeeding, and due to the epidural I had never wanted to begin with, I developed (in the short term) a seeping rash and (in the long term) a sensitivity to caine-based anesthetics.

    Due to the size of my babies (9lb, 8lb 3oz, and 9lb 4oz) I am labeled with the “risk” factor of “macrosomia” on any obstetrical chart, despite having had no difficulty birthing these large babies. When I was seeing an OB during my second pregnancy, for shadow care of my home birth, my membranes were swept without my consent during the only cervical exam I allowed during the entire pregnancy…at 37 weeks (due to a bad car accident, ruling out some problems). I realized then that, for me, the greater risk is in hospital birth and obstetrical care. Returning to that care provider for the remaining two visits prior to the uncomplicated unassisted home birth of my second son was probably one of the bravest things I’ve ever had to do.

  16. lauren says:

    I had a home birth with my first this past September. I too was told that I was brave for doing this and I would always reply with, “I don’t think I am brave, I feel safer in the hands of midwives that give me their undivided attention and that being in a hospital for an uncomplicated healthy pregnancy seemed too medical for something that I trusted my body to do”. I think education is everything, and whether you as a family decide on a home, birth center or hospital birth the experience will be all yours and there is no need to judge the other.

  17. Lisa says:

    I agree. I have 6 girls and the 1st was in the hospital, 2nd in the car and all the rest were born at home. Unassisted, even. Real, natural honest childbirth is much safer than the fear and interventions women are subject to in hospitals.

  18. Melissa says:

    Hooray for stubborn, nonconformist idealism!

    I’ve had four healthy homebirths, and I’m planning a fifth this summer. I’m not brave, and I’m not “lucky” that my births have been healthy (that’s often the next comment I get after refuting the “brave” one).

    I’m not lucky, I’m typical. Most births need no intervention. Yes, some do, and that’s why my midwife carries emergency medications and equipment. That’s why we have an emergency transfer plan.

    I take responsibility for choosing my care provider, my place of birth, and the interventions I do or do not receive. Given that those choices are research-based and carefully deliberated, I don’t think that makes me brave. I just think that makes me an educated health care consumer.

  19. Meow says:

    Fantastic article!

    I am 23, and luckily for me, better informed than most women – I am planning my first birth in July, in 3 months time, and I am planning a homebirth.

    Why? Because the thought of giving birth in a hospital scares me no end. I have spent months – even years – researching this, night after night, not only reading studies and research but also reading other women’s stories as they recall their hospital births, talking about how they ended up with a c-sec and the lead up to it, but not even recognising the cascade of intervention which LED to that c-sec. They are fully convinced that their *distressed* babe was given the best delivery possible, and are often completely blinded to the truth.

    Thankfully, I am not, and I am surrounded by strong women who support and encourage me. I am also lucky to be ‘low risk’, which makes my homebirth a possibility in the first place.

    However, unluckily for me, I live in Australia – a country in which homebirth with an independent midwife has been illegal since 2001, and in which the government has just taken steps to crack down on this ‘dangerous practice’. My homebirth, which is still going to happen, is going to technically be ‘illegal’. It’s just tragic that a country like Australia could consider homebirth so threatening (and the current government has a lot to do with this). I will be giving birth at home, though, with a fully trained midwife professional who is putting HER neck on the line to do so for me, and for many other women, who still choose homebirth even in the face of our government’s ridiculous laws.

    I didn’t choose a homebirth because I am brave. But I certainly consider myself lucky to be having one :)

  20. Kiki says:

    Great post. I loathe the brave title as well. (Martyr and crazy tend to get under my skin, too).

    Curious about the comment of Ohio being illegal to have a hb as I am now on #3. I guess I’m breakin the law!

  21. Morgan McFarland says:

    Kiki, in no state is it illegal to have a home birth. Ohio does not, to my knowledge, currently certify CPMs, and that may be where the confusion arises. Whether or not the midwife attending your birth is licensed by your state, your homebirth is legal.

  22. Kathryn Patterson says:

    Wonderful article, Morgan!

    While I had a high-risk pregnancy and needed a hospital, I do believe that women need to be told about the home birth option, with real information and not fear mongering. I hope that more people read your article and realize that for the vast majority of pregnancies, a home birth experience is possible.

  23. stella says:

    awesome awesome awesome. but i have to say – i had to quit reading this post half way through because i’m about to have a seizure trying to read this screen!!!!!!!! this white on black is sooooo hard on the eyes.

    this is really important stuff. great post. kudos to you.

  24. Sarah says:

    I didn’t read every response in between, but wanted to state that homebirth is NOT illegal in Ohio. I’m not sure what might have given a previous poster that impression. I know direct entry midwives AND a Certified Nurse Midwife who all attend LEGAL homebirths in Ohio.

    I really identified with this post. I had an unmedicated hospital birth w/ my first baby (had to learn the hard way… iatrogenic problems w/ 3rd stage and postpartum), then had 3 home waterbirths with midwives BECAUSE of my research, BECAUSE my hubby and I believed that a planned homebirth with midwives was safer for us.

  25. Diana says:

    Homebirths or birthing in a birth center are a great alternative for many women. But just because they work for most, it doesn’t mean that they are always successful, always perfect, always wonderful.

    I wanted to birth at a birth center because with a first baby I did not feel totally comfortable being 45 min away from the nearest hospital… you know, just in case something happened… Well, while I had a PERFECT pregnancy, and an easy labor until I reached 9cm, things went downhill from there. I stopped dilating, my cervix tightened, and to make a long story short, ended up in the hospital (across the street), had 2 epidurals (the first one caught only of half side of my body), a C section, and went under general anesthesia. So not expecting anything wrong, I ended up having the very worst of all happening to me.

    The WORST part about it, though, was not giving birth in a hospital. It was receiving poor care from the midwives at the Center. I KNOW THIS CONTROVERSIAL for women reading this site, but please hear my story…

    When I felt like pushing, I was not checked to see if I had dilated enough. I had FOUR midwives in the course of 12 hours, including the backup of the midwives’ backup (2 of the midwives were on vacation!) It turns out my bones are NOT made for birthing, being too narrow to allow any baby larger than 6 lbs to pass through (mine was 8lbs). This SHOULD have been observed while doing a regular checkup by the midwives, but no one noticed….

    I’m NOT sharing my story in order to cast a negative light on all midwives. I’m just saying that just as women educate themselves about hospital births (and which hospital may be a better choice than another), women should also check to make sure that the care they receive from midwives is adequate, and not just believe that just because it’s a more crunchy place, they will receive excellent care.

    I did not file a lawsuit in my case, although there was definitely an option to do so. But as I researched the case in more depth after I healed from the trauma of birth, I found out that another baby had recently died in the same birth center. Clearly, my case and this one represent a very small percentile on when things go wrong, but nevertheless, there is that small possibility.

    I would still recommend birthing at home and in a birth center, but don’t accept it blindly as the best alternative for you. To be quite honest, I’m tired of everyone saying that your bones are always made for birthing. They are not always… and that midwives are well trained and prepared for any emergency… they are not always. This has not been my experience, even as I wished with all of my heart that it had been more positive.

    And because it is important, just fyi, the hospital where I birthed has some of the lowest C section rates in the nation, the medical staff was WONDERFUL, and the 4 days in the hospital felt like being in a warm womb, peaceful and protected. It was the exact opposite of what I had expected, and what I thought I would get at the birth center.

    Hope my story is useful to some of you. Don’t walk blindly into any situation. Trust your body, but know things could go wrong. Have people around to support you. Check references. Have back up plans. And when it’s all said and done, rest knowing that you’ve done your very best to prepare for the best and the worst case scenario. Lastly, say a prayer and look forward to the moment when you hold your baby in your arms for the first time.

  26. Mollie says:

    I had a freestanding birth center waterbirth for my son. I, thankfully, started researching about a year before I became pregnant and, when that line showed up, knew where I wanted to give birth. My mom had worked in L&D (25+ years ago! and not as a nurse) and was not supportive AT ALL of my decision to have an out-of-hospital birth. One of her arguments was “The rooms at the hospital are much nicer than they used to be.” Unfortunately, at the time, I didn’t/couldn’t verbalize the comeback of midwife vs. medical model of care. Now, I can. Like another poster said, I prayed and prayed for my low-risk pregnancy to continue to be so-I was worried about having to transfer. But, after a 13.5 hour labor (including early labor!), I had him in the birthing tub and it was just perfect. I never got the “brave” line but recently my mom told me how “extra special lucky” I was that my labor had progressed normally and we had no complications! I said “I wasn’t lucky. Actually, I was pretty normal and average”. My son will be 16 months old this week. For a second baby, I’ll be going back to the birth center and, if ever we can buy a house and stop renting, wouldn’t mind trying a homebirth at some point. It’s just that at the birth center, you don’t have to clean up the bed. :)

  27. Mary says:

    Wonderfully written!
    @Sarah – I had a baby die at home. There were many other mean-spirited people who tried to blame me for her death, too. I wonder if we met face-to-face if you would tell me I caused my daughter’s death. Perhaps it’s easy to be so aggressive in cyber-space where you can remain anonymous. Believe me, I take FULL responsibility for that birth. It was a beautiful experience, though the outcome was unexpected and not what ANYONE wanted. The medical examiner, hospital doctors, our midwives, heck , even the dept. of public health in the state she was born all determined that she would likely have also died in a hospital setting. Death is natural, and is a part of birth. What I can tell you is that our family was treated with dignity, respect, compassion, and love. I’m not sure most families would be treated the same in a hospital in a similar situation. And I can tell you that our baby was LOVED by all who cared for her – I went on to have another beautiful homebirth following our daughter’s death – it was the right choice for our family, and for me. It’s not selfish for a mother to choose what’s good for her – she’s the one birthing! With our 4th baby, I made the informed decision to birth in the hospital by c-section – and that was a lovely, peaceful birth, too.

  28. Chris says:

    THANK YOU. I am a “Birth Nazi” also and so many have called me brave as well. I consider myself fortunate to have lived in a community were prior to getting pregnant a few friends of mine had already had successful homebirths. When my turn came and I began having the “routine” appt.’s with an OB/GYN assigned by my insurance plan, after only 2 visits I was thoroughly disappointed, I felt “pushed through” as if on a conveyor belt and completely ignored by the Doctor I saw for a total of 3 seconds for each visit where he stared more at my chart than in conversation. I immediately started looking elsewhere and was excited that not only did my insurance cover a midwife but it also covered Homebirth! I began interviewing area midwives and friends who had homebirths for who I would want to put my trust and care in the hands of. I researched and asked the important questions and landed with my perfect match. I love my midwife! So when my second pregnancy came along I was in a new state and the whole process started over. Again I asked around, searched the internet and interviewed. I found another good fit for me and my family. You have touched on everything that anyone in their right mind should consider when making the decision of where to birth. Being a “Birth Nazi” I too felt compelled to write an article. Feel free to read and enjoy.
    http://eripadesign.wordpress.com/2010/03/16/homebirth-versus-hospital-birth%e2%80%a6do-your-own-research/
    Thank you again

  29. TandLMom says:

    Personally, I take the idea that “moms who birth in hospitals probably haven’t done their research” offensively. I researched obsessively. Where I live, I have access to six hospitals and also was introduced to one homebirth midwife although she wasn’t “legal”. I chose the hospital that had posters all over the halls in the maternity wing showing ways to relieve labor pain without meds, that had whirlpool tubs available to relax laboring moms as well as showers designed for laboring moms to be able to sit inside with warm water running over them for relaxation. I chose the hospital with special c-section operating rooms directly inside the maternity wing, not in the hospital’s regular OR so that should something go wrong, and a c/s would be necessary I would never have to leave the baby. They have it set up that way because they believe that even in a c/s, mom and baby should never be separated. I chose the hospital that told me on my tour, “When it comes to epidurals, we ask once. If you say no, we never bring it up again.”

    My first hospital birth was a medical emergency for ME, I was very sick and it had nothing to do with the pregnancy but I needed a fast induction because I needed to be whisked off to surgery for unrelated illnesses. My second birth was completely uneventful but knowing my health history I felt it best that I be in a hospital just in case anything went wrong with ME. Not the birth, with me.

    It’s wrong for people to assume that if you chose a homebirth you are an idealist, silly or brave. But I think it’s just as wrong to assume that hospital birthing mommas are blindly following a cultural norm without thinking for themselves.

    Some of us do our research and still conclude that the hospital is our best bet.

  30. Janice says:

    Years ago when I was having children, I was also a certified childbirth educator. This gave me free access to local labor and delivery suites. I viewed many births; some were good experiences, some were bad experiences for either baby or parents, or both. I had two of my children in hospital settings because of medical considerations, and two of my children at home with trained attendants assisting, which went beautifully.

    Research indicates the primary factor to consider in the overall safety of a birth experience is the well-being of the mother, which is affected by her attitude of trust toward her caregivers. Women who trust an attendant who uses medical technology statistically do just as well as women who trust their home birth attendants.

    Personally, I believe that considering only the process of birth itself, women would fare better without a lot of intervention and manipulation. As seen in the domesticated animals among us, letting nature take its course results in a healthier outcome for both mothers and babies in the vast majority of cases. One rarely gets such an opportunity like this in a hospital setting. The very act of transporting a woman in labor is the first interruption of natural processes. Picture a farmer transporting to a veterinary hospital a prize dairy cow experiencing a normal delivery. We would call him stupid. Actually, he wouldn’t even consider doing such a thing. So, why does our society think it normal to treat our women in such a way? I agree that giving birth at home is not the “brave” thing to do, with all it implies. Under normal circumstances, it is the safer choice.

    Yes, it would be good to consider the intelligent research and loving concern of the baby’s parents before making a rash statement questioning their birthing decision. Unfortunately, most people in our society aren’t given to a lot of wise consideration before drawing conclusions. As in many other types of situations, an intelligent response kindly delivered could have a positive impact on our society. We can influence our world for the better.

  31. What a great post! Course I’m one of those people who would probably have said, “you are brave!” without thinking (now I definitely won’t, lol). I feel more educated about how moms who decide to give birth at home think now, though.

    I wanted a home birth, or at least a water birth, for my first baby, but circumstances changed (I moved and didn’t have the support I felt I needed), so ended up having my baby in a hospital. I really liked my doctor, but when I look back I really am not happy with the way it went. In my opinion, women who have hospital births are brave! I was induced even though I don’t think I needed it (I think my doctor was leaving soon and he wanted to deliver fast). There are other things that bother me now that I look back, though my experience wasn’t a total nightmare.

    Also, I think one of the reasons people say “brave” is because they want to have a doctor there “just in case”. It has nothing to do with you really. It’s because they would fear it. But I’m glad you shared your thoughts on this! I’m definitely going to consider other options for my next baby. :-)

  32. Robin says:

    I was unable to have anything but a doctor hospital birth as I am a Type 1 diabetic, and I do not know what I would have chosen if I had any sort of a choice (I could not even choose which OB’s I would use).

    I do think the a home birth is the right choice for many people. However I want to point out that the statistics for how wonderful a home birth is are some what skewed. Midwives will not allow anyone to have a home birth if they have an increased risk for complications. So no diabetics, folks with pre-eclamsia, obese etc folks have an in home birth, which means there is less risk of a c-section or other problems.

    The reverse applies as well. A friend of mine once pointed out that our local hospital has a very percent of births that end in c-section. However our hospital also has the only high risk OB care for all of VT and much of NY.

    -Robin

  33. Dominique says:

    Excellent article!
    I have often come across the comment of being ‘brave’ for choosing homebirth and it irks me because it means that the person saying it has little understanding about alternative choices in maternal care.

    Those that birth without looking into the options are accepting the outcome. They choose their own experiences. I chose my own and I am mature enough to accept the responsibility for it and don’t blame or venerate those that are present during the birth other than myself. In the end, no matter the place, it’s the mother who essentially has to birth that baby regardless of caregivers or drugs. If she is ignorant to her options or doesn’t question the caregivers she CHOSE, then she has no one else to blame but herself for her birth experience. It isn’t up to others to educate them about their options, they can do their own bloody research. There really is not excuse for ignorance anymore since information is readily available. If your doctor isn’t giving you the full scoop, look into it yourself.

    Personally I am not one to go out of my way to convince a person of the safety or benefits of my choice of birth place unless I know they will genuinely listen and not dismiss me out of hand. I find it exhausting trying to explain it all to another person. They haven’t done the same research so are not aware of the information I have come across. They are usually relying on what they ‘already know’, as little as that may be. People tend to want you to pull statistics out by wrote, on the spot, as if you would memorize all available information on the subject. Then you ask them to provide stats on their opinions and they can’t deliver but don’t think that they need to since to them it’s ‘common knowledge’. It’s irritating.

    I usually end up telling them to do some research on the subject first and then we can have a genuine conversation. I don’t feel the need to use up what little energy I have (being seven months pregnant as is) explaining my choices to anyone.

  34. Georgia says:

    AWESOME!!!!!Im planning on my 3rd to be a homebirth with my first 2 in hospital. It was fine with no complications or drug interventions so I think why not just keep it home next time and save the hassle of asking to go home early and not being allowed to because of stupid policies.

  35. Morgan McFarland says:

    “I take the idea that ‘moms who birth in hospitals probably haven’t done their research’ offensively.”

    TandLMom, I am sorry that this is what you took from my essay, though I’m glad you acknowledge that the offense was your perception rather than my intent. I do not have a low opinion of women who give birth in hospitals. I certainly do not have a low opinion of women who make educated choices about where to birth, whatever their choice happens to be. I do feel frustrated when women who have not put any amount of thought or research into their birth choices question my own birth choices, however, which I arrived at through extensive research and careful, honest introspection about my needs and abilities.

    In the United States, we have a very birth-ignorant, birth-disengaged culture. The “normal” pregnancy involves reading What to Expect When You’re Expecting and having a hospital birth with an OB. I honestly do not believe that the majority of women who have hospital births do so because they investigated all their options carefully and arrived at the hospital as the best choice for them. I think most women give births in hospital because it is culturally normal. It doesn’t make them bad people. It doesn’t make them bad mothers. It doesn’t make them unintelligent. It just means that they haven’t yet arrived at the place where they question whether “normal” is “normal” because it’s ideal or because it’s just the cultural habit into which we’ve fallen. Unfortunately, some of those women find the idea of birth outside of hospitals frightening or threatening, perhaps because they cannot relate to the amount of preparation or research that goes into most homebirthers’ choices. Those are the women to which I am referring in my essay.

    I do know women who decided on a hospital birth through careful research and weighing of their options. You are clearly one of those women. I don’t think women like you are in the majority, however. You say, “Some of us do our research and still conclude that the hospital is our best bet.” I agree completely with that. *Some* women do their research before choosing a hospital birth, but many give birth in hospitals because that is just “how it’s done” and they don’t see a need to seek out alternatives.

  36. Linda says:

    Erin wrote: “Homebirths these days ARE statistically safer and have less interventions because of the screening behind them- no midwives will deliver prems, multiples, or any high risk pregnancies at home (for obvious reasons). So of course statistics will reflect this.”

    First, it is frankly offensive that you would assume that homebirth advocates are stupid enough for this to not have occurred to them. To the contrary, most of the studies that have been done are *matched population* studies, meaning that the comparisons are done only between similar groups, e.g. low-risk and planned to be in one place or the other. This is important *precisely so* that the statistics are not unfairly skewed.

    Second, it is incorrect that homebirth midwives do not attend in the kinds of situations you listed above. Whether they do depends on the state and on how these things are defined. I know midwives who will and can legally attend births (for example) as early as 35 weeks, multiples, breech, and “post dates”, slightly elevated blood pressure, obesity, and maternal age over 35.

    “Articles like this just cause grief. Home birth is wonderful, but it is not for everyone. No woman should be put down, made to feel less than, or snubbed because of her choice.”

    Again, another assumption, that the point of presenting this information is to make people feel bad. Can you really not think of any other possible reason for it? And do you really advocate for *not* making the information available for the sake of not hurting people’s feelings? And no, of course homebirth isn’t for everyone. That you would imply that that’s what is being argued here is a straw man.

  37. Linda says:

    Diana, you make a very powerful case for being informed about *any* decision one makes. You are absolutely right that midwifery is not a panacea. Midwives, just like doctors, have varying beliefs, training, and styles of practicing. It’s not a homogeneous profession. I found this out with my first homebirth, which was an unnecessarily traumatic experience and I think I was very lucky to have stayed out of the hospital (where it certainly would have been a c-section.) It does women a disservice to perpetuate this mythology of midwife as wise woman; really no different from the mythology of doctor as god.

    That said, just because the medical establishment saved you, I would be wary of accepting their assessments as fundamental truth. Doctors generally have an emotional bias against midwifery and that informs their statements; it is also easy enough to blame an inability to give birth on the woman’s body rather than the environment, when really the doctor has no idea why the birth failed to happen normally.

    You say you weren’t checked for dilation; did you know that current understanding of physiological birth supports *not* checking? This is for two reasons: First, it is largely ineffective as a diagnostic tool (“complete” does not mean the body is ready to push, and the body sometimes needs to bear down before “complete” in order to help dilate the cervix and position the baby, in which case trying to keep from pushing is counterproductive) and Second, it is distracting and uncomfortable thus interfering (as many things can be) with the hormonal process that allows the cervix and pelvis to open.

    Pelvic assessment is not an exact science. If it were, all of the women who have been told their “pelvis is too small” and made to have c-sections would not have gone on to birth *bigger* babies in a setting more conducive to normal birth (see ICAN and Mothering.com for a plethora of these stories.) If it were, your hospital attendants would not have given you a further trial of labor before your cesarean. That’s not to say that I believe you don’t have true CPD, but it’s exceedingly rare in women who don’t have a genetic or disease-caused deformity, and it’s exceedingly common for doctors to use as an excuse for why women didn’t give birth vaginally (as if there aren’t a whole host of other reasons the body can fail to function properly.)

    Were you, by the way, laboring for any length of time in a reclining position? Do you know that in upright positions the pelvic volume increases by 30%? I don’t mean to sound condescending, but most people don’t know this. It was part of the reason that getting my first baby out was so incredibly difficult. Other reasons had to do with the distracting environment, the awareness of being observed and judged, and the managing/directing of the birth rather than allowing it to be instinctive. See Michel Odent if you are interested in reading more about the effects of these things.

  38. Linda says:

    TandLMom said: “Personally, I take the idea that “moms who birth in hospitals probably haven’t done their research” offensively. I researched obsessively.”

    The key word there would be “probably” — in other words, it *isn’t* personal. It isn’t about you. It is about all the people (the majority) who don’t think, regardless of what it’s about, who just go along with whatever the mainstream norm is. Homebirthers are more likely to have thought it out (unless perhaps they are part of a subculture where homebirth has *become* the mainstream norm) simply because they are more likely to be challenged and judged harshly for the choice. People (this is just human nature) tend not to make unpopular choices unless they feel they have *very* good reason to do so.

  39. Teri Lynn says:

    Sarah,
    Homebirth is not stupid…hospital birth is not stupid. They are choices. Both can be good choices if they are informed. I have been a labor and delivery nurse for 10 years and am currently in graduate school for midwifery so I think that I can confidently state that I know a lot about birth and the safety issues surrounding it. I also know alot about what happens during hospital birth. I have seen very few babies that were “saved” by a hospital birth. Most complications can be anticipated, whether at home or in the hospital.
    I had 4 great hospital births, but investigated homebirth for my fifth. I have read every bit of research that I know is available regarding homebirth. I have read anti-homebirth info too, investigated their claims with an open mind and ultimately felt very comfortable having a homebirth. I am not stupid, I am informed. I would never purposely put my child in harm’s way. I respect the right for women to choose hospital birth, even though I have seen human errors cause an emergency c-section. I would never label that mother stupid for birthing in the hospital. I respect your difference in opinion, but that is just what it is…opinion. A more respectful dialogue would be appreciated.

  40. Leigh says:

    Excellent essay…..thank you for those of us who also don’t like to think of home birth as an act of bravery.

    I just wanted to add that it is the responsibility of every woman to analyze each of her pregnancies as a journey unlike any other, meaning that she should be intuitive with her body and trust her instincts in regards to where to birth. I’ve given birth in a birth center, a hospital, and at home, and I can say that all three times, my intuitions about what baby and I needed were right on the money.

    I think the solution to lowering our crazy hospital intervention rates that lead to statistically proven complications, is to replace surgeons with midwives for normal, healthy pregnancies. With this simple act, hospital birth would look very, very different.

    You shouldn’t HAVE to choose home birth to have your needs met as a birthing mother. Those needs should be met no matter where, or with whom, you choose to deliver your baby.

  41. Lindsay says:

    I always say, “I think you have to be brave to go to the hospital.” And then if they ask why, I can explain.

  42. Melanie says:

    Excellent article, Morgan.

    I’ve often heard the argument that homebirth isn’t safe because something can go wrong. I recently had my first homebirth after two hospital births, and something did go wrong, but it was handled beautifully. My baby turned out to be 10lbs, and ended up with major shoulder dystocia (where the shoulder is stuck behind the pubic bone). Her head came out and then she was really, really stuck. This is often used as an example of why homebirth isn’t safe, but I thank God that I was at home. My midwife has had 30 years of experience in normal birth, and knew just what to do to get the baby out. It was scary and traumatic, but I firmly believe that being at home minimized the physical and emotional trauma to me and my baby. If I had been in the hospital, I am certain this would have been a forceps delivery with a big fat episiotomy (if they hadn’t sectioned me first for macrosomia). And had I had an epidural, I would not have been able to move and turn in the ways I needed to to help the baby rotate. As it happened, the midwife was able to release the shoulder, and I didn’t even tear. She was prepared with oxygen if we needed it. The baby had an arm injury that has already healed, but would likely have had a broken clavicle and bruising on the face if she had been forceps delivered.

    The point of my story is that birth doesn’t always go as expected…its not always perfect…but that still doesn’t mean homebirth is unsafe. CPM’s are VERY skilled and are quite able to detect and handle emergencies. Sometimes handling it means transferring to the hospital, which is exactly what its there for.

  43. Katy says:

    After I shared this on Facebook today, I got this response from a PRE-med student.

    “Once again total bunk.. come to me when you have had a baby. as for the c-sections why do OB/GYNS go to school for 15 years??? oh that’s right there the professionals.. what traning does a mid wife have.. none.. and OB/GYN has more traning than any mid-wife will get in their total careers.. I’m a pre-med major. I know the risks and I know of them is stupidity.. which home briths are.. high or low risk. stick to the medical professionals and let them do their jobs.. its ideas like this that have raised mal-Practice insurance so high for any doctor let alone OB’S becasue some person gets the idea that a c-section they had was not neccessary.. I would of liked your little article to provide with me more proof.. all it said was that inductions were at a higher rate.. state what they were for.. whether it was by choice or doctor advice. I cite experience in this department. not useless stats. ”

    Nice to know the application to med school can only be sent off after a 4 year degree in arrogance.

  44. Renee Erickson says:

    Amen and Thank You Morgan!
    After Three hospital experiences which I ‘endured’, (oh the insanity) and after lousy prenatal care(“just drink some orange juice lady” with a “quit complaining” attitude, about my extreme low blood sugar passing out episodes), I finally did the research, and learned how to receive great prenatal/prevention care and HOW to naturaly give birth. The sweetest, out of this world, experience of JOY. Amazing and wonderful. I continued with three more home deliveries. I remember with my sixth, we had insurance that would cover all but two dollars for a hospital birth. We were financially tight, and I tried hard to go that direction, but the ‘risk’ was just too great. I couldn’t do it. Two midwives heard about my dilema and volunteered their services! A wonderful miracle for us…and our first girl was born with five brothers close by…busily cookin up the birthday cake!

    By the way, my last child, was born in the hospital, with a C section. She has Downs Syndrome, was quite ‘tied up’ and feet first. It felt right, we did it and I’m grateful for the expertise. I was in my 50′s. …still in my 50′s by the way. She’s our angel baby….with a ‘lil stubborn streak.

  45. mb says:

    it has less to do with you being brave and more about the majority of our culture makes decisions based on FEAR.

    well said. and i’d also like to say that there is a place for everything and everyone. the world is finding it’s way and through even the labor pains of watching managed birth is well…painful…it will soon be born into something new and free. this i have faith in.

    your words matter.
    thank you.

    mb

  46. Morgan McFarland says:

    Katy,

    Yes, we encountered some similar criticism from a pediatric oncologist friend of my husband. It’s best to not even engage with them on the topic. I’ll have discourse with someone with an open mind or even one who disagrees with me, but the Physician As God mentality isn’t one I’m willing to take on. No amount of studies will convince them that they aren’t divine. No amount of evidence will convince them they aren’t above reproach.

  47. Dr. Kurt says:

    Thank you for writing this. I wrote a blog at the end of last year titled ‘When Nature Calls.’ Here’s the link if you care to add fuel to your worthy fire. http://drkurtrant.blogspot.com/2009/10/when-nature-calls.html

    Dr. Kurt Perkins

  48. Erbivrus says:

    Home birth is not illegal in Ohio, unless it has recently become so, with no announcement, without my knowledge. 2.5 years ago we had one, complete with midwife and all technical paperwork, which we presented to out local courthouse in Ohio, with no repercussions. I’m quite curious as to exactly what this commenter it talking about? Anyway, SUPER post. Really. I could NEVER be brave enough to step into a hospital for ANYTHING. Let alone arguably the most important day of my life.

  49. carmabella says:

    Beautifully expressed! I love it. After my own three homebirths and the joy I experienced knowing I had made an informed choice that felt right for my family, and after the sorrow I have felt when speaking to women who clearly felt the had no choice or had not known it was even safe to make a choice of their own, I feel fortified with the strength of your words. Let women know they can own their experience for themselves and their families!

  50. jennifer says:

    I started telling people that they were brave for having a hospital birth… after four vbac’s at home people still tell me that!


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