you plan on having your baby WHERE?

I'm not too shy about telling people that we're planning a home birth for this baby. I get a wide range of reactions, but for the most part people are pretty polite about it, even though it's quite obvious that they would never ever consider that approach for themselves. That's great, I don't expect everyone to agree with my point of view-- but rude people do bug me. So for those of you who think we're crazy but have still been respectful of our decision-- THANK YOU. That said, I figure it's time for me to share a little bit of the rationale behind our choice.


I've always been fascinated by pregnancy and birth and was blessed with a mother who had a firmly held belief that our bodies are beautifully designed to grow and give birth to healthy babies and that less interference in the process is generally for the best. Years of research and experience have only strengthened that belief for me.


You may be surprised to find that NO well-designed study has ever found that home births for low-risk women, attended by trained and competent caregivers is more dangerous than a hospital birth. Not a one. Yes, there are women who most certainly should not give birth at home: women with clinical (not gestational) diabetes, or heart disease, or with certain STDs, to name a few. But the majority of American women fall into the low-risk category. Equally as important as being low risk is being sure that the birth will be attended by an experienced and competent caregiver-- someone who is well trained in recognizing and resolving potential complications, as well as knowing at what point a hospital transfer needs to be made, if necessary.

In all honesty, I should note that there was a study a few years ago that on the surface seemed to show that home birth was more risky than hospital birth. A closer look, however, showed that their sample of home births included unplanned home births, unattended home births and even women who had miscarriages at home-- hardly a representative sample. When reading up on any scientific study, it's always important to take a look at the methodology. Who knew that I'd be glad I took statistics in college?!


One of the best studies out there examining the safety of home birth was published in the British Medical Journal. (find the article here) It looked at the birth outcomes of all 5418 U.S. women planning home births with certified professional midwives in 2000 and concluded that (quoting from the article):

Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention
but similar intrapartum and neonatal mortality to that of low risk hospital
births in the United States.

Translation: My baby and I are at no greater risk of dying from our home birth than we would be from a hospital birth. Maternal and infant mortality rates are not the only measure of safety during birth, so if you're not convinced, note that only 1.3% of the home birth babies in this study had Apgar scores of less than 7 at 5 minutes postpartum-- meaning that the majority of home birthed babies not only survive their births, but do very well.


"Well, what about complications?", you might ask. Funny thing is, that complications seem to happen less frequently during home births than they do in the hospital-- I believe as a result of the overuse of medical interventions in our hospitals today. But yes, complications do still occur at home. Fortunately, most are not life-threatening and can be resolved with simple measures like patience, rest, position changes, and adequate hydration. I'm fully confident in my midwife's ability to take care of the things she can and recognize the situations that need urgent hospital attention. My midwife is current in her Neonatal Resuscitation Certification, though she rarely has to use it. (she's also a Certified Professional Midwife and licensed through our state)

I chose a home birth this time because it's important to me to give birth in an environment and with a caregiver that trusts my body's ability to give birth. I love the continuity of care that I get from my midwife. I've seen her at every prenatal appointment (all of which are scheduled for an hour so I've had plenty of time to get to know her) and know that she'll be the one to attend my birth, start to finish. I don't have to worry about which care provider in a practice is on call when I go into labor, or having to deal with nurses' shift changes and the like. I want to be able to move when and where and how I feel like and I love that my midwife will monitor the baby's heart rate wherever I am and not make me periodically move back to a bed to be strapped up to a fetal monitor (which, by the way, has not been shown to improve outcomes for babies), or even stay there for the duration of my labor. I chose home birth because I feel safe here.

My goal with this post was not to convince all the moms I know that they should have their babies at home too, but rather to help those that care about us realize that we take my safety and that of our baby very seriously and that we're not making a rash or irresponsible decision. We are thrilled with our choice to have a home birth and my hope is that you can be excited for us too. I'm happy to answer any questions and I won't be mad at you if you don't agree with me.

If you're intrigued and interested in doing a little more reading, here are some great places to get started:

Evidence-Based Maternity Care. Would you be surprised to find that the most common maternity care practices (either the practice itself or it's overuse) in America are not based on sound scientific evidence? That the United States spends more per capita on maternal care than any other nation, and yet has some of the poorest maternal and neonatal outcomes in the developed world? This is a really interesting and well-written paper that examines evidence-based maternity care in the U.S., why most women don't recieve it, and some of the consequences.

The Thinking Woman's Guide to a Better Birth, by Henci Goer. This book is chock-full of the scientific research available on birth and it's accompanying procedures. Lots of solid information to help moms (and dads) make the best decisions for their unique situations.

Ina May's Guide to Childbirth, by Ina May Gaskin. I wish every pregnant woman could read this book. The first half is full of inspiring birth stories and the second is full of wonderful information and plenty of birth wisdom. Yes, Ina May is a self-taught "hippie" midwife, but one look at her statistics would tell anyone that this lady shouldn't be written off. She's really amazing. In fact, she's the only midwife in history to have an obstetrical maneuver named after her. (in case you're wondering, it's the Gaskin maneuver and it involves getting the mother onto her hands and knees to aid the passage of a baby with shoulder dystocia-- stuck shoulders)