Homebirth: Making it happen
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If you have thought about delivering your baby at home, you probably have a lot of questions! Are you wondering what exactly a midwife is, and whether midwifery care is right for you? What about homebirth -- is it safe? Is it legal? Is it what you want? This article, an excerpt from "Homebirth: Making it Happen," will help you find answers to these questions -- and more.
Arguments against homebirth, and how to respond
One likely reason that more women don't opt for homebirth is the wealth of misinformation that circulates about it. Add to that society's disapproval of anything outside the norm, and you have a recipe for more hospitalizations and the continuing belief that birth is, and should be treated as, a medical event.
So if you've decided, after careful investigation and research, that homebirth is the right choice for you, you may still need to convince those around you of the sanity of what you're doing. This "cheat sheet" gives you some of the most common questions and arguments against homebirth -- and the answers you can give.
What if something goes wrong?
Even with the miracles of modern medicine, a hospital does not guarantee a perfect birth and/or baby. A hospital is not a magical environment where nothing goes wrong. Women in the hospital, for example, are more likely to have unnecessary c-sections. Avoidable operations can bring on a host of problems for mother and child, not the least of which is the introduction of drugs into both their systems.
A midwife is trained to spot potential problems early on. She will either act to prevent the problem, handle it or determine that you need to be transferred to the hospital. By calling ahead and alerting the hospital to your arrival, your midwife will help to ensure that a team is ready to treat you when you arrive.
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What if the baby isn't breathing?
Just as at the hospital, the midwife will resuscitate the baby. She will do this in precisely the same way a paramedic would -- in fact, in some cases, midwives and paramedics take the same neonatal resuscitation class. Talk to your midwife about the equipment she carries. She should have oxygen with her and she should be trained in neonatal resuscitation. Have her explain the procedure of resuscitating an infant ahead of time. That way, if she needs to do it at your baby's birth, you'll know what is going on.
Isn't it safer to give birth in a hospital? (Also asked as: Don't you think you're putting your baby at risk?)
At risk for what? Again, most serious problems are detected during pregnancy. You're not putting your baby at risk of developing any conditions by virtue of where you give birth. Remember: A hospital is merely a building. Giving birth there doesn't automatically mean that your baby will be born perfect and that the very human staff isn't capable of making mistakes.
More interventions are used in a hospital setting, often unnecessarily. There you're also likely to face an overburdened staff, lack of continuous care during labor, shift turnovers, impersonal care, and so forth. This is in marked contrast to midwives, who attend you throughout the birth process, know you and your body well, and are familiar with normal birth (and therefore are especially attuned to dysfunctional labor/birth).
It's important to note, also, that a hospital houses sick people. Yes, precautions are taken to prevent the transfer of germs from sick wards to the nursery, but mistakes happen. Your baby is at greater risk of coming into contact with foreign germs in a foreign environment. Doctors, nurses, orderlies, maintenance staff, parents on tours, and parents and siblings of other babies (to name a few) will come into contact with you and your baby in the hospital, directly or indirectly. Your home and your family pose the least threat to your baby's fragile new immune system.
Who will check the baby out after birth?
Your midwife is trained to examine the baby at birth. She does the same newborn exam that a doctor does in the hospital. She'll record her findings and include them in the chart she turns over to you at your postpartum appointment. You can learn more about the specifics checked at birth in the "Immediate Postpartum" section of this book.
Most midwives advise that you schedule an appointment with your baby's pediatrician for three to five days after the birth. But do ask the pediatrician ahead of time -- she may want to see your baby sooner, especially if this is your first child. If you are very lucky and have great insurance, your pediatrician may make a house call -- but don't count on it.
What if the baby is breech?
Your midwife should be able to tell the baby's position (by palpating your abdomen and location of the heartbeat) by about 34 weeks. If she is unsure, she may suggest an ultrasound. Babies usually don't have enough room to turn around from vertex (head down) to breech after that point, although some do. If your baby is breech, your midwife may suggest exercises to coax the baby to turn vertex. The Webster Technique uses trigger points and adjustments to alter the condition of the mother's pelvis. This technique is often successful in rotating breech babies and relieving a fetal posterior position.
If by 36 weeks the baby has not turned, you will need to talk about your options with your midwife. Not all midwives will deliver a breech baby at home.
What if you hemorrhage?
A few minutes after you give birth, your midwife will encourage you to breastfeed your baby. This will stimulate your body to produce the naturally occurring oxytocin that causes uterine contractions. You may not think contractions are a good thing right after you give birth, but they really are: They help the uterus begin to return to its normal size and prevent hemorrhage.
If your baby is too sleepy to nurse, your midwife may suggest you manually stimulate your nipples. If you continue bleeding uncontrollably, your midwife will follow the same procedure the hospital staff would: Administer oxytocin and/or methergine, insert an IV to open a vein and deliver fluids, encourage you to drink, and/or promote urination. She may also offer some homeopathic remedies. If necessary, she will perform bimanual compression, a technique which forcibly contracts the uterus, stopping bleeding. She will, of course, monitor you closely and transport you to the hospital if need be.
Under normal circumstances, people do not hemorrhage and die in a matter of seconds. Generally, the signs and symptoms are clear and gradual enough to give your midwife time to treat you properly and/or transport you to the hospital.
