Friday, November 7, 2014

20 Reasons I Will Always Choose Homebirth


I recently came across this amusing list of 45 Reasons NOT to Have a Home Birth and it inspired me to make my own list of why I will always choose homebirth (obviously I'm assuming my future pregnancies will be healthy and low risk. Of course I would have a hopital birth and/or c-section if it was medically necessary!)

I also came across this opinions piece on a local mommy blog that irked me because it urged families to reconsider homebirth, VBAC, and natural birth based on her personal opinion and experiences. So I decided that my list would be full of personal opinion too, just from the opposite side. (Although I do link to research on some points)

I  know there's tons of "Reasons To Have A Homebirth" blog posts around the internets, so feel free to move on if this is old news to you.

Disclaimer: Unlike the NICU nurse blog post linked above, I DO NOT think I know the best birth place for everyone. Two people can look at the same data and decide very different things, or have other factors to consider. This list is not a judgement of anyone's choices, it is not meant to fuel the so-called "mommy wars," and is not meant to convince anyone to birth anywhere. It is just a list of personal reasons why I choose homebirth. Similar to choosing to go to a Lutheran Church on Sundays or eating a dairy and gluten filled pizza on a Friday night may be the best choice for me, that does not mean I judge anyone for being an Atheist or avoiding animal products. Nor does it mean I'm trying to convert anyone to Christianity or junk food.

Without further ado, my list:

1) I don't want strangers at my birth. Even if you get your care provider of choice, which may not happen if you give birth during their "off" hours, you will definitely get one or more nurses you don't know. I spend 6 months getting to know my midwife during hour long prenatal visits which means we know each other pretty well and I am comfortable with her and her practices.

No strangers here, just my husband, mom, and midwife.

2) I don't want to be bombarded by a million stupid questions during admittance to the hospital and annoying typing sounds as they enter the information into the computer. "Did you take your prenatal vitamin today?" clickity clack clack "When was the last time you ate something and what was it?" clackety click click "Are you allergic to any medications? Oh now I see on your chart that you're not" clickity click clack "Ok, now it's time for me to shove my fingers into your vagina to assess your 'progress.'"

3) I don't want to leave the privacy and familiarity of my home during labor and go into the bright lights and cold, clinical atmosphere of the hospital. Car travel while dealing with contractions sounds like a nightmare. And privacy and familiarity are often important in order for your cervix to dilate. Giving birth is like pooping. No one wants to be constantly monitored by strangers in an unfamiliar place while they are pooping.

Laboring in the comfort of my own home. Ryan is doing the rebozo technique to encourage baby to change positions (she was posterior) and for my comfort during contractions.

4) It's WAY cheaper! I know this isn't the case for most people with good insurance, but I'm on the bare minimum insurance with super high deductibles. It would actually cost us MORE for a natural birth in the hospital than it does for a homebirth midwife. Especially considering all the prenatals and postpartum visits homebirth midwives provide.

5) I want evidence based fetal monitoring. Intermittent auscultation (listening occasionally with a fetoscope) is shown to be better than even intermittent doptone or efm (electronic fetal monitoring). And there's no ultrasound used with a fetoscope. See here for information on evidence based fetal monitoring.
Palpating for baby's position, after which my midwife used a fetoscope to listen to baby's heart tones.

6) My child(ren) deserve to be present during the birth of their sibling(s). I suppose a sibling attended birth may be possible in a hospital but in homebirth it is often expected and even encouraged.

7) I want a waterbirth. Waterbirth has many documented benefits for baby and mom and is safe. See here. It's possible to plan a hospital waterbirth but it's much more likely to actually occur at home as you aren't competing with other women for use of the tub or getting 'risked out' for reasons that may not be evidence based.
Shortly before Audrey was born in the water

8)  I want to push when my body tells me to, not when someone else tells me to. Hospital staff often tell women to push HARD as they count to 10 and to do so 2 to 3 times during a contraction. They may also want you to start pushing as soon as you reach 10 cm dilation even if you don't feel the urge yet. Partly because they see mostly medicated births, where the woman often can't feel the urge to push, and also because they want you to hurry up and have this baby now. My body is perfectly capable of knowing how and when to push and I don't want to be put on someone else's timeline.

9)  I want to be free to instinctively choose the position for pushing my baby out which may be squatting, kneeling, standing, lying on my side, or something else. The most common position for a woman to give birth in the hospital is lying on her back, which is actually the worst position physiologically. It's what we're used to seeing in media and it is convenient for the staff. The woman is often too tired and away in "labor land" to be able to assert her desires to move and then actually do so. Plus she is often on her back already for the EFM and vaginal exams that are frequently performed.

10) Speaking of vaginal exams, I prefer none. I know it sounds crazy to not want another person's hand up in your who-ha. But there is no good reason to do them during pregnancy (see here) and I trust my body to know when to push my baby out. I may decide to have one done before I start pushing if there's concern that there is still cervix left, or in the case of variations like a long labor, but that will be one exam likely done at my request. Not several exams every few hours by various nurses and doctors. Labor is MUCH MORE than mere cervical dilation!

11) I want to be snuggled in my own bed after birth and will likely not be moving (except to go to the bathroom and take sitz baths) for a good many days afterwards. I imagine in the hospital you are constantly interrupted by well meaning nurses. We were during Audrey's hospital stay at least. I also don't want to be kicked out of my birth place 4 hours after giving birth, as is done in a birth center.

So comfy in our own bed! And she's looking at us for the first time.

12) Snuggled on top of me in bed will be my newborn. Yes that's right, I sleep with my babies.  I don't think the hospital staff would take kindly to that and I would prefer not to have annoying conversations about bed sharing. On the other hand, my midwife actually encourages bed sharing. Isn't bed sharing super dangerous you ask? Short answer is no, if you do it intentionally and make your bed safe. See here and this book by LLL for more information.


About 24 hours old, enjoying skin to skin and sleep with Mom.

13) I don't have to remind anyone about my birth plan or risk it being ignored. Many times, mom's desires for a natural birth are respected and encouraged. Not so much for the third stage of labor if she doesn't want them yanking out her placenta or doing aggressive uterine massage. After 6 months of hour long prenatal visits my midwife is very familiar with my desires for birth. And her philosophy of birth and subsequent practices are mostly what would be on my birth plan anyways.

14) My family should be able to bond with each other after the baby is born (me and baby especially) and not be interrupted by random people we will never see again. I don't want my baby rubbed dry with towels, a hat shoved on his head, the cord clamped after it's "done pulsing" at 30 seconds, or  strangers chatting around us. "Oh what a lot of hair!" "Now she's crying good!" "You did so great!" Barring an emergency, I want us to be left alone.
 
15) Baby led breastfeeding. My baby knows how to latch immediately after birth and we don't need a nurse to swaddle her hands up, grab my boob, and shove her on. Information on baby led/laid back nursing

Laid back nursing

16) In the case we have a boy, I don't want to be asked about circumcision or risk having his intact penis forcibly retracted. My midwife, as are most homebirth midwives, is a strong supporter of leaving babies intact. Who knows what the hospital staff's position is! To quote author and urologist, Dr. Adrienne Carmack: "No, it's not ok to cut your newborn child's genitals. Period." Curious about circumcision and why people are against it? See here, here, and here.

17) Homebirth means continuity of care. In the hospital the OB or midwife is usually done with baby care the minute the cord is cut and after the woman is discharged from the hospital her next appointment is usually at 6 weeks postpartum. A homebirth midwife views the mom and baby as one unit, even postpartum (often referred to as "motherbaby") and will continue to provide postpartum care throughout 6 weeks postpartum with many in home visits.

Newborn exams and measurements, which were done a few hours after her birth.

18) If my midwife suggests an intervention or even hospital transfer, I trust that she's not wanting to be home for dinner, needing to adhere to hospital policy (which may or may not be evidence based), or unskilled in what may be a normal variation of birth. Since she is an expert in normal, natural birth I can be pretty sure that said intervention or transfer is actually necessary.

19) On the subject of complications and variations, homebirth midwives are very skilled and knowledgeable on how to handle many of these. You don't need to have a picture perfect birth in order to have your baby at home. During Audrey's birth I actually had several 'complications': long labor lasting 3 days (during which I'm sure my cervix wasn't making any "progress"), meconium stained waters, hemorrhage, and a nearly 3rd degree tear. All of these were dealt with by my midwife. And they would have been dealt with differently in the hospital in a way that likely wouldn't have been as holistic, natural, or respectful of me or Audrey.

20) Lastly, and most importantly, I believe that natural birth is a normal bodily function that happens best when not interfered with and is only rarely a medical emergency. Birthing at the hospital does not give you a 100% guarantee that everything will go right. Just like in everyday life there are risks involved. Most people decide the benefits of getting out of bed to go to work is worth the risks of leaving their house (they may be hit by a car! Or catch a deadly disease from a stranger! Or get gunned down by a co-worker!) The same considerations of risks and benefits apply to birth. For me, the benefits of homebirth far outweigh any risks. And the cons of hospital birth far outweigh any potential benefits. See here for research on the safety of homebirth.

Once again, I will make the disclaimer that this is a personal, biased list of reasons why I choose homebirth. Should you decide to have a homebirth now, based on my list? NO! Go out and do your own research! Interview homebirth midwives; a comprehensive list of MN midwives can be found here: http://www.mfmidwifery.org/, and listen to your own intuition. You can have an amazing and safe birth experience at home, hospital, or birth center, especially if you do your research and are prepared. "Homebirth is not for everyone, but informed choice is." Dr. Stuart Fischbein (homebirth OB)

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