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Special Delivery: Is a Home Birth Right for You?

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Jennifer Winther always wanted to give birth at home but “never had the courage to plan it.” So she delivered her first child at her local hospital, believing that it was the responsible thing to do for her and her baby’s safety. When she was pregnant with her second child, she planned to repeat her first birthing experience at the same hospital, even though she had lingering dreams of a relaxing labor at home. Sometimes you have to watch what you wish for. 


“My second was born at home, my husband attending, because the labor was so fast! … I was literally in the bathroom and started pushing while he was getting our two-year-old in the car. I started screaming, and when he came in, he said he saw the head crowning. It happened so fast … so I guess I got my wish!” Winther exclaimed. 


Well, perhaps she did, but had she been able to plan a home birth with a midwife to support her and her husband, the delivery would have been calmer and wouldn’t have required her to go to the emergency room afterward. The moral of this story, however, is that both Mom and Baby were just fine. 


While many debate the safety of delivering anywhere other than a hospital, a large study published in the British Medical Journal in 2005 (“Outcomes of planned home births with certified professional midwives: large prospective study in North America,” by Kenneth C. Johnson and Betty-Anne Daviss) determined that home births monitored by certified midwives were safe for low-risk women. This survey of more than 5,400 women whose deliveries in 2000 were all attended by certified professional midwives didn’t report one death; rather, researchers noted that there was less need for interventions at home than was typically found at hospitals. (Interventions include the need for induction drugs like pitocin, vacuum extraction, or cesarean sections.) 


This is all good news. But how can women considering having their baby at home determine if they fall into the “low-risk” category? For more information, I turned to the American College of Obstetrics and Gynecologists (ACOG). ACOG is sternly against home births, citing that complications “can arise with little or no warning even among women with low-risk pregnancies.” 


Acknowledging that women may choose to give birth at home regardless, ACOG warns that all women should hire midwives certified by either the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB). ACOG also states that midwives cannot perform “live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.” 


During my most recent pregnancy, I happened to fall into the moderately high-risk category due to a number of factors: a previous medical condition, getting chicken pox, preterm labor that required me to be on bed rest for two months, and my age. So for me, there was no question: I had to be in a hospital for an IV drip and a not-so-surprising emergency C-section. I am grateful for the care I received there, but I’ve also always been fascinated with the idea of planning a calm birth at home. 


Doctors state that women need monitoring at a hospital so that conditions such as fetal distress can be controlled. But midwives insist that they monitor for fetal distress and check the position of the baby for breech or other signs of distress in Mom as well, and many women who have had home births say their midwives would have taken them to the hospital at the first sign of distress indicating the need for a cesarean. 


I tend to agree with this assessment, especially if your midwife is certified and has plenty of experience. It all comes down to determining whether you are considered high risk for complications. Typically, a woman’s medical history can shed light on what risk category she falls under. According to Kaiser Permanente, the following factors constitute a high-risk pregnancy: 


  • You have a long-term health condition, such as diabetes or high blood pressure.
  • Your baby has been found to have a problem, such as Down syndrome.
  • You have a pregnancy-related health problem, such as high blood pressure (preeclampsia) or issues with the placenta, the organ that gives food and oxygen to the baby.
  • You had a problem in a past pregnancy.
  • You are younger than seventeen or older than thirty-five.
  • You are pregnant with two or more babies at once. 


The bottom line is that you need to weigh the pros and cons before taking the plunge into home birth. If you don’t have medical insurance, expect it to cost between $1,500 and $3,000, depending on the midwife you hire and the city you live in. Typically, this amount will pay for prenatal care, birth, postpartum checkup, and newborn checkup and screening. ACOG strongly encourages pregnant women to still seek the care of a physician to ensure that they undergo all the tests they need to and to determine that no preexisting conditions, such as asthma or depression, are exacerbated during the pregnancy—causing Mom’s or Baby’s health to be compromised. 


If you’re uninsured and can’t see a doctor, be sure to discuss any medical conditions you have with your nurse-midwife, and check in with her if you experience depression or excess swelling so that you can thwart preeclampsia if it begins. Also, make sure you’re tested for strep B, as one-third of all women develop this condition while pregnant; if you do, you’ll need an IV drip of antibiotics to make sure that your baby isn’t born blind or with other complications. 


Winther also suggests that all women who are considering a home-birth plan ask their pediatrician to come to their house during the final stages of the delivery—or, if not, about an hour after the birth—to check on the baby. 


With all this to consider, I realized that a home birth just wasn’t right for me, due to medical considerations during both of my pregnancies. Still, after talking with women who have had home births, I have to admit that I envy their experience, the intense bond it created with their partners, and their bravery. 


For instance, Sarah Flynn of El Segundo, California, delivered two of her three children at home and described the experience as “magical.” Here is a snippet of her story, which she shared with me via email: 


“My last two labors were about four hours each. Much of that time was spent on the toilet, in the shower, and then on my bed. I was supported by my husband, and he was supported by the midwife and her assistant. They stayed quietly in the background, checking on me periodically and offering words of encouragement, while I concentrated on giving in to what was happening inside me. I can’t even explain the energy in my bedroom as it became clear that the baby was getting ready to come. Warmth, excitement, support, joy, knowing … I knew my midwife had done this many times before, and I felt comforted by that. But you would have thought that my child was the first born to the world. It was that joyous. I felt like I had just completed a marathon and that this was my cheering section. I was exhausted but high on the feeling of success and empowerment. 


“I am so proud of my home birth. I am in awe of myself and what I can accomplish. I relish telling people I’ve had home births. I love the look on people’s faces and I love answering all their crazy questions. My midwife is my hero, as is every other mother who has given birth at home. I feel a common bond with them, woven out of bravery and self-confidence.” 


While I teared up reading Sarah’s story, I have to remind myself, especially when looking at my two gorgeous boys, that whatever birth experience you have, the end result of a healthy baby is the magical goal for all of us. Best of luck with whatever choice you make.

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