Worthwhile Reads: Home Births

Home Birth: Increasingly Popular, But Dangerous, on The Daily Beast.

A few decades ago, home birth in the United States was mostly limited to insular religious communities like the Amish and to dedicated members of the counterculture like Gaskin, whose husband founded The Farm as a commune in the 1970s. In recent years, though, it’s moved toward the mainstream, spurred by the rise of attachment parenting, a reaction against a dysfunctional medical system, and pro-midwife documentaries like The Business of Being Born, which featured producer Ricki Lake giving birth in her bathtub. Though still quite small, the number of home births is increasing—according to the Centers for Disease Control, it grew 29 percent between 2004 and 2009, to 29,650.

Home births are a big thing in the conservative homeschool world where I grew up. I even had one friend who delivered a little sibling because the midwife didn’t get there on time. My friend was in high school.

About Libby Anne

Libby Anne grew up in a large evangelical homeschool family highly involved in the Christian Right. College turned her world upside down, and she is today an atheist, a feminist, and a progressive. She blogs about leaving religion, her experience with the Christian Patriarchy and Quiverfull movements, the detrimental effects of the "purity culture," the contradictions of conservative politics, and the importance of feminism.

  • Noelle

    I did a rotation once with an OB in a rural town. He got lots of Amish referrals (for hospital births of tricky cases, not home births). He said home births were popular amongst them for financial reasons. They don’t believe in health insurance, and home birth with a midwife is less costly. Also, it was the norm. If everybody else is doing it, why go out of your way to see a physician if you believe you’re having a healthy pregnancy? And all the little munchins running around were home birthed and they’re ok.

    The OB did not approve. There were too many cases he could name where things did not go according to plan and could’ve been remedied easier and more safely had the woman had more ready access to modern medicine and facilities. Also, the midwives attending these home births are often not the same as a nurse midwife who works in a hospital. A certified nurse midwife has a traditional western medicine education and certification. She (or he, there are some hes) goes through the same rigorous training and is held to the same high standard by national boards across the country, much like a physician. Other kinds of midwives do not have this same training or a national governing board to assess their skills. The latter is the kind most likely to be doing home births.

    The American Academy of Obstetrics and Gynecology’s stance: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Planned_Home_Birth

    Really, the 2-3 fold risk of higher neonatal death in a home birth should be enough to go to the hospital

  • http://www.ayoungmomsmusings.blogspot.com Melissa @ Permission to Live

    I had 4 medically supervised and safe home births. I was low risk and close to the hospital and took all nessacary precautions. It can be safe, it’s not the best choice for everyone, but I think it can be a valid choice if approached safely. In Europe home birth has been more common than it is in the US for much longer, because it costs less and is supported by the mainstream medical system there. And the hospitals haven’t alway been a friendly environment for safe birth, my grandma remembers giving birth in the 60′s strapped down by her wrists and ankles to the birthing table. Women used to have no choices when it came to pregnancy and birth, and I see choice as a good thing.

    • Dianne

      my grandma remembers giving birth in the 60′s strapped down by her wrists and ankles to the birthing table.

      Funny, my mother gave birth in the 60s and doesn’t remember anything like that happening.

      • http://www.ayoungmomsmusings.blogspot.com Melissa @ Permission to Live

        Possibly because my Grandma was in the south? It really varies from state to state.

      • Dianne

        I was born in Louisiana, my sister in Virginia, so not a north/south issue per se. Possibly hospital to hospital.

    • http://elliha.blogspot.com Elin

      ‘In Europe’ is very vague. Home births are not very common in all of Europe. Holland has a high number and the UK as well I think but my country Sweden has a very low number of homebirths. In most parts of the country you have to pay for a home birth while hospital births are free which has not made home births more popular either (we are not used to paying more than a symbolic fee for health care). Women who have them or have considered having them are often seen as irresponsible or crazy (I know this for a fact since I have considered having one and would consider it again if I choose to have more children) despite many having studied the facts back and forth to a much higher degree than most women having a hospital birth. I do not think that the choice of a hospital birth or home birth should come down to finances whether it is here in Sweden or in the US but I honestly prefer it the way it is here because a woman with an at risk pregnancy will never have to take a chance at being able to survive a home birth because of financial reasons when hospital births are free.

      • Paula G V aka Yukimi

        In Spain they are pretty uncommon but they are starting to be a fad. Personally I wouldn’t risk my life or the life of my potential children trying for a homebirth. You never know if you are going ot be the one person with a complication and in a hospital they have the equipment to solve most complications. Also, the fact that hospital births are free here helps matters very much.

      • Caravelle

        It should be noted that the Netherlands that have a high number of homebirths also have a high perinatal mortality compared to European countries. (how linked this is to homebirth may be another issue; Dr. Tuteur on Skeptical Ob often makes the point that this higher rate of homebirth is linked to higher mortality, but this article that came up on google when I thought to look for myself doesn’t bring up homebirths as a factor for the rate :
        http://www.demographic-research.org/Volumes/Vol11/13/11-13.pdf
        They bring up older mothers, higher rates of multiple births, and the number of non-western mothers. Of course that doesn’t mean that homebirth isn’t itself linked to some of those factors, or that the authors didn’t just miss it for some reason).

        I’ll also note that the main problem with birth, that I can tell, is that while most of the time it goes fine when it goes wrong it can go very wrong indeed, and you can’t always tell in advance how things will go. It’s a bit like wearing a seatbelt – 99.99% of the time you won’t need it, but the one time you do need it you REALLY need it and you can’t tell in advance which time is which. That’s why it’s a good idea to wear one as often as possible.

        And while doctors and hospitals can be horrible and dehumanizing – that is often the case, and it’s a very bad thing that should be stopped, but unfortunately it isn’t a problem that’s limited to childbirth, and we generally consider it a poor choice to refuse surgery or chemotherapy for those reasons. Understandable, yes, often, but that doesn’t mean it’s the best option. (then again the average outcome of refusing chemo or surgery is probably much worse than that of homebirth so there’s that).

      • Anat

        Years back I looked up some information about the Netherlands’ system of home birth, and one thing I remember is reading about obstetricians being concerned that the number of women electing hospital births was on the rise (the doctors attributed the trend to the increase in immigrants among the population of mothers).

        In a place like the Netherlands, where midwives have medical training and there is communication and collaboration between midwives practicing in the community and obstetricians I would have loved to go for a home birth (assuming I was low risk like my actual pregnancy was), but not in a setting where midwives don’t have that kind of training, and definitely not where there is antagonism between midwives and obstetricians.

        That said, there is much to be done to decrease the level of interventions, routine and otherwise, in hospital births. And a big part of that would have to involve a change in the way health insurance and litigation over adverse medical outcomes take place.

  • JJ

    “Because hospitals are businesses that thrive on a high turnover, drugs to induce and speed labor (and that often make it more intense and painful) serve the system by filling and emptying beds at a faster rate. ”

    http://movies.nytimes.com/2008/01/09/movies/09born.html

    I think that the Business of Being Born is a really wonderful documentary and well worth seeing. It may feature producer Ricki Lake giving birth in her bathtub, but it also shows Abby Epstein, the film’s director, having her baby in the hospital. Becuase in her case the homebirth she hoped to have would have been unsafe.

    In the U.S. there has been a growing number of induced labor and elective C-sections and I think this documentary does a good job of looking at why woman who want to should be able to give birth naturally (in there home if they choose), and why it is a good for woman to educate themselves on their options.

    • http://alisoncummins.com Alison Cummins

      Being born is really dangerous. Even if nothing terrible goes wrong, the baby is essentially holding its breath with each contraction — a minute at a time for hours. It’s stressful. (Imagine if I covered your baby’s face and prevented it from breathing for, oh, say, 30 seconds at a time every five minutes. For hours. Maybe days! The baby probably wouldn’t die of this treatment but both you and the baby would be really, really upset. Justifiably.) OBs want the baby out fast because that’s what’s best for the baby. They actually care about the baby. They are fully aware that induction can make labour much more painful, which is why they offer epidurals.

      While a precipitous labour is hazardous, there is no benefit at all to a long labour. None.

  • Dianne

    The home birth movement kind of lost me when they started saying that babies who were born by c-section should have been allowed to die for the good of the species. Because apparently giving birth “naturally” is the only thing that matters. Yes, I know not everyone in the home birth movement shares that philosophy, but quite enough do for me to be quite disgusted with them. Also seeing midwives and doulas make fun of women for expressing pain during labor. Ugh.

  • http://politicsproseotherthings.blogspot.com/ Nathaniel

    I cannot stand the sort of people who worship at the altar of “natural.”

    Here, have some arsenic. 100% natural.

    • JJ

      I don’t think it’s about worshipping “natural” it’s about woman having the option to choose. Some woman would like to experiance a natural birth. They should be allowed to. I think this really goes hand in hand with a woman having a right over her own body.

      • http://politicsproseotherthings.blogspot.com/ Nathaniel

        And no matter how much I may complain a seat belt violates my bodily integrity, the law requires it.

        More options are only a good thing if other options offer different bonuses.

  • http://noadi.etsy.com Noadi

    Both my maternal and paternal grandmothers gave birth at home. I don’t know about my maternal grandmother’s thoughts on this as I never had much of a relationship with her (my mom grew up in foster care so I consider her foster mother to be more of my grandmother than she ever was). My paternal grandmother on the other hand has described what it was like to give birth at home (out of necessity because the nearest hospital was over an hour drive away) and it didn’t always go well, after one birth she started bleeding and my grandfather had to rush her to the hospital (again over an hour away) luckily after a blood transfusion she was okay but it could have ended very badly. Is it possible to have a safe home birth? Sure, most of the time my grandmother’s births went well. I just don’t think it’s a great idea. There is a middle ground between homebirth and hospital birth, birthing centers are becoming more common and they have a more relaxed homey environment but staffed with ObGyns and nurse midwifes and capable of handling emergencies. I think that model is where medicine is (and should be) going in regards to childbirth.

  • Beth

    For me it’s not about ‘worshipping at the altar of natural’ it has to do with the way I’m generally treated by obstetricians and their staff combined with research on birth-related death statistics in and out of hospitals and discomfort with insurance-driven hospital protocols.

    Background context: I’ve had two babies in the hospital with an OB in attendance, both were very fast labors in the greater scheme of things. My first was only 3 hours long, the second only a little longer at 6 hours. I’ve considered it prudent, since my first labor, to be prepared to deliver at home no matter what, because apparently I have a very efficient uterus and it would be just plain stupid /not/ to be as prepared as possible for whatever comes my way.

    After two unmedicated labors, I also have a pretty good idea of how I pattern through labor and what pain management techniques work for me. It’d be nice if an OB practice, for once, listened to what I had to say with a degree of respect for my experience and education, even if it’s not as medically or surgically extensive as an OB’s is. Instead I am almost universally met with condescension and a patronizing attitude about medication especially and doubts about my ability to birth without it and that’s definitely a factor in my decision to pursue a home birth with a highly qualified midwife. I don’t want to have to fend off well-intentioned staff constantly during labor – it’s incredibly distracting and stressful and can make it go on longer than it has to.

    I suppose my ideal birth would be in a hospital or birthing center, where the staff just wait outside except for a nurse quietly sitting in the corner to keep an eye on me. That way all of the necessary emergency help is right outside the door just in case, but no one is interfering while I go about my business.

    • Caravelle

      I really have no place speaking about these things as I’ve never been involved in birth on either side of the issue (…other than the baby side :p), but I have read the Hurt by Homebirth site, and a number of the stories there involve birthing centers, and parents who thought those places [i]were[/i] halfway between hospitals and homebirth and found out that wasn’t the case.

      That doesn’t mean all birthing centers are like that; just one more thing for prospective mothers to investigate carefully I guess :-/

      • Maggy

        I just read the stories on the Hurt by Homebirth website. I can’t imagine the physical and emotional pain these women and their families have endured. Thanks for sharing.

  • Contrarian

    Have you ever considered home birth, Libby?

  • Adele

    I gave birth at home. It was the best choice for me because giving birth in a hospital in the US is actually more risky for normal pregnancies. I am not philosophically devoted to the idea of home birth on principle. The countries that have the best maternity and infant outcome rates do not have the most home births, but they do have midwife-focused care for the vast majority of pregnancies and a much, much lower rate of C-sections. (Note: the US has horrible outcome statistics – we rank #34 in infant mortality rates and #39 in maternal mortality rates according to some studies) An ideal situation, I believe, would be giving birth in a birth center with ready access to a hospital with all its interventions in the rare event that an emergency does arise, but attended by people who understand that childbirth is a normal process that usually requires little or no intervention, that it is actually relatively safe, and that intervening often does more harm than good. Unfortunately, that option was not available to me, so I chose what I felt to be the best and safest option for myself and my baby of those that were available to me.

  • Anat

    One thing that impressed me in the linked story is what appears to be (willful?) ignorance by the midwives mentioned – like ignoring meconium in the amniotic fluid or not checking for presentation (you don’t actually need an ultrasound for that, an experienced practitioner should be able to tell by feel). Of course there is selection bias as the cases presented are where things went wrong. People electing a home birth need to educate themselves about childbirth and screen the midwives for knowledge too, especially in a system that allows non-medical certification.

  • lys

    Personally homebirths scare me because I tend to be obessesively anxious, however, I understand why some women want them and I think they are a viable option for normal, healthy pregnancies. But I think the choice should be up to the mother and her midwife/dr. I have a real problem with communities (quiverfull) who think it is is the only right choice and pressue women to do it even if they have resevations or have a situation where they are unsafe. Rather absurd to me. And it pisses me off when men pressure women to have a homebirth. When you are the one responsible for pushing the baby out you can chime in. If not then you are just along for support. I’m not saying a husband should not have any input but ultimately it should be the mother deciding.

    I delivered 3 of my 4 in a birthing center that was within a hospital. I absolutely loved it! It was perfect for someone like me who desired a birth without medical intervention (unless absolutely necessary) but also wanted the comfort of knowing help was right there if needed. My 4th had to be delivered in the normal labor and delivery unit because the birth center was full. If it has been my first it would have been a nightmare. But since I was experienced I was able to handle the hostility of the nursing staff towards my desire to not be attached to wires, ivs and machines unless necessary. Thankfully my husband and doctor were wondeful advocates. Though some of the nurses were nice, they offered absolutely no physical help or verbal encouragement during my long labor. I was kind of treated like a freak show. Periodically nurses would peek in and stare and ask if I was the woman who was delivering without an epidural. But I was offered no assistance or encouragement. My main nurse pretty much admitted she didn’t know how to help me because she had never assisted in a birth without an epidural. My husband and doctor were awesome though and gave me all the help I needed. I just don’t understand why there has to be such polarity on this issue. Why cant hospitals accomodate those who don’t need and don’t want to have ivs, efms, epidurals (unless necessary or requested)? Its like the whole breastfeeding thing. Can’t we all just respect each other and help each other instead of trying to promote an agenda. Geesh.

  • http://www.ayoungmomsmusings.blogspot.com Melissa @ Permission to Live

    I think the thing that bothers me the most about this sort of train of thought, is that is sounds a lot like the fear mongering I heard have heard many times from the home birth extremists against hospital births! I am pro-choice, I believe that a woman should have the choice to terminate her pregnancy. I also believe that she has the right to make informed choices about how she wants her body to give birth. I get so angry when I hear about uninformed mothers to be, being bullied in hospitals into having interventions they did not want or need. And it’s not because I think that home birth is the best option, it’s because I am a feminist and I believe that women should have power over their own bodies! I have a friend who labored at home for 2 days without real progress, she even requested to go into the hospital for intervention but her caregivers told her that she shouldn’t go to the hospital because her body was created for birth, and then they tried a whole bunch of extremely painful and dangerous tricks to get the baby out, things that never never never should have happened to her unless she was in a 3rd world country with no access to modern medicine. That makes me so angry! She was rendered powerless by her caregivers, her choice was taken away. Why does America have such a history of taking women’s choices away or policing every little choice they might have? From drugging women and routinely and forcibly using forceps back in the day, or telling them they could not breast feed after swirling their milk in a cup and deciding whether or not it was thick enough (not exactly scientific), to modern day attempts to declare a fertilized egg a person, prosecute women for having miscarriages, and make women feel less than for pretty much any choice they make regarding their body and their birth. I thought pro-choice meant education and advocacy and CHOICE for women. Not the exact same fear mongering and bullying the conservative movement does, just in reverse.


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