Home sweet home birth

Perhaps you were shocked when you first heard someone say she was having a home birth. Why, you wonder, would anyone want to have a baby at home — far away from the epidural your friends have raved about and the medical care that might be needed in an emergency? Why would someone choose a birth with more pain and (seemingly) less safety?

In our society, hospital birth is the default — the way most assume it will happen. Toronto midwife Vicki van Wagner, an associate professor in Ryerson’s Midwifery Education program, says the majority of people haven’t even considered home birth.

“There are a small number of women who know they want a home birth even before they get pregnant,” she explains. “That’s usually because they’ve had some exposure to the idea — perhaps a sister or friend had a home birth. The majority haven’t really thought about it, but once the midwife or a friend presents it as an option, they may decide it’s right for them.”

Read on for some of the reasons women make that choice.

Fewer interventions

“One thing almost all women who choose home birth have in common is the desire to have a natural birth and to avoid interventions and medications,” says van Wagner.

Hospitals, many mothers find, make that tougher. Amie Boudreau of Kemptville, Ont., had her daughter Isabelle in hospital four years ago. “It went well in the sense that I had a vaginal birth,” she says. “But my instincts were constantly challenged. The nurses would tell me to lie down, and I’d say no. Every time I got into a good flow with the contractions, they’d interrupt. I felt like I was constantly fighting everything.” She ended up having an epidural.

Once Isabelle was born, Boudreau says, “they took her away and cleaned her and wrapped her up, and then they gave her to my husband, not me. I kept saying, ‘Please give me back my baby.’ As soon as I got her, I unwrapped her so I could look at her and hold her skin to skin.”

Two years later, with her second baby on the way, Boudreau says, “I started to really think about what had happened during my first birth, about how much I had to fight, and about how upset I was when they took my baby away. I wanted to be respected in labour and have my choices heard.” Of course, she was also concerned about safety: “My husband and I are both scientists, so we read the research and became convinced of the safety of home birth. Many people don’t realize the equipment and training that midwives have. Once I understood that, I knew I’d have my next baby at home.”

Boudreau had a long labour with her second daughter, Hazel. “The midwives were with me for about 10 hours,” she recalls. “Near transition, I had this rush of adrenalin and started walking around, then my body was ready to push her out. I could see my belly pushing down. The midwife said, ‘Oh!’ — and three pushes later, Hazel was out. She never screamed; she was never taken away from me. The midwife checked her over while she lay on my chest, and she was nursing within five minutes. Nothing was rushed, everything was very calm.” Just what she’d wanted.
The research does show that birth at home significantly reduces the level of interventions. A study published in 2009, for example, compared almost 6,700 Ontario women planning home births to a similar number of low-risk women who opted for hospital births. Rates for all interventions were significantly lower in the home birth group and the Caesarean section rate was about 40 percent lower.

That was important to Lee Rego of Mission, BC, who wanted a home birth with her first baby. “I read a lot during my pregnancy and home birth really resonated with me,” she says. But when her pregnancy went past 42 weeks, her midwives recommended going to the hospital for an induction. “The labour was moving slowly and, in the end, I had a C-section,” she says. “My baby wasn’t in any distress, but I felt like they just gave up.”

When she became pregnant again, Rego studied the research and concluded that being at home would improve her chances of avoiding another surgical birth. “I knew my midwives would support me in the hospital, but they are also subject to the institutional policies and routines, and I didn’t want that,” she says. Her next two babies were both born at home.

“I’m not rejecting the hospital for the sake of rejecting it,” she stresses. “The hospital has a very important function, and it’s good when you need it. But being at home feels more dignified, more intimate.” She adds that her husband, who felt like an onlooker in the hospital, provided more support at home because he was more comfortable and confident.

Familiar surroundings

The desire for the comforts of home and the support of loved ones, which Rego describes, are other common reasons for choosing home birth. Calgary childbirth educator Deb Grasza says, “Many women choose home birth because they know their home will provide the privacy that they desire to birth uninhibited. Being in a comfortable, familiar environment helps them to let go of their left-brain thoughts and follow their bodies. At home, they feel like a woman giving birth — not like a patient being monitored.”

When the first out-of-home birth is positive, it can give the mother the confidence to have her next baby at home. Jennifer Welch of Saint-Laurent, Que., had her daughter Catherine in a free-standing birth centre six years ago. “I was a bit less confident about birth then, so I was glad to go to the birth centre. I had a completely natural birth, no interventions, and Catherine was born in the birthing pool. It was incredibly empowering for me and I felt very strong.”

However, she also realized that she didn’t like having to move from one place to another while in labour, and that the comfort of her familiar surroundings would help her relax.

Unfortunately, when she had her second baby, Felix, her membranes ruptured and no contractions followed, so she went to the hospital to have labour induced. “I really had to grieve the loss of the birth I’d hoped for,” she says.

When she became pregnant for the third time, Welch again planned a home birth, and this time she felt ready to accept whatever happened. “Labour started just after lunch, I called the midwives around suppertime, and Sarah was born at 10:30 p.m. I had a birthing pool set up in my bedroom, and that’s where she was born. She was born in the pool, and then I climbed out with her in my arms.”

It’s not just about the familiar bed and wallpaper on the walls — it’s also about the people. In hospital, you’re likely to be cared for by nurses you’ve never met before. Students and staff may show up at various times.

At home, you’re in control of the crowds. You can have whomever you want with you — your partner, of course, but also your mother, your best friend, your older children, or nobody at all except your midwives. Matthew Pitman, who has supported his partner, Esmeralda, through three home births, puts it this way: “Birth at home is more like a gathering of friends, all there to support you. And then, in the end, they go home, and there you are with your new baby. It just feels peaceful. I like that.”

“It just feels right”

Pamela Mitchel of Whitby, Ont., says she didn’t really think of herself as a home birth type of person until she had a hospital birth with her first baby. She says, “For a hospital birth, it was a reasonable experience, but it wasn’t right for us. We had never been crunchy granola types, but hospitals did not seem to fit as a place of birth. As we saw it, they are for injury, illness and disease.” Her next two daughters were born at home.

She describes her third birth this way: “There was phenomenal energy in the room. It was all exactly as it should have been. My doula kept saying soothing things in my ear and stroking my head and shoulders. My husband caught baby Lauren, and my first daughter announced the sex, but my second daughter backed out of cutting the cord once she saw what it looked like. The atmosphere was so wonderful, and I really felt empowered. After a couple of weeks, I realized how emotionally healing the experience had been.”

The mother-baby connection

Some women choose home birth for what happens once the baby is born. Alison Barrett of Alliston, Ont., was fully dilated when she arrived at the hospital to have her first baby. “They had called the anaesthetist in, and when my baby was born, they handed him to the anaesthetist! I held my hands out for him and managed to touch him with my fingertips before they passed him over.” That moment still feels painful to her today.

With baby number two, also born in hospital, Barrett was determined to hold her baby first. She did, but still felt “this territorial thing. They made me wear a hospital gown and wouldn’t let me wear my own PJs. You feel powerless to disagree with them.”

Her third child was born at home. “All those things people say about home birth are true. Everyone there was an invited guest, and nobody took my baby away or told me what to wear or do. You don’t ever get that time back with your new baby. I wanted to make the most of it.”

And more

Some mothers choose home birth because they feel stressed in hospitals, they are concerned about the risk of infection or they aren’t eligible for health insurance and find home births a cheaper option.

There are no bad reasons for choosing a home birth, says midwife Vicki van Wagner, but it’s a topic that always needs exploring. Parents need to be prepared for the possibility of complications during pregnancy or labour that may change their plans. She says, “It’s important to make an informed choice, and know the risks and benefits.”

Is home birth safe?

In short, yes. Two recent Canadian studies (one conducted in BC, one in Ontario) both showed that for well-screened, healthy women with normal pregnancies, home birth is linked to fewer interventions, fewer problems for the mother and no increase in fetal mortality. The Society of Obstetricians and Gynaecologists of Canada supports natural childbirth with a skilled attendant (such as a midwife) and acknowledges that home birth can be an option for women with a low-risk pregnancy. Midwives have training and criteria to help them determine which women are good candidates for birth at home, and when a transfer to hospital is required.