But What If...? Questions Commonly Asked of Homebirth-ers

[Guest guest]

But What If...? Questions Commonly Asked of Homebirth-ers

By Kim Wildner

As a homebirth mom myself, and then as a homebirth advocate, I have

had many people question the wisdom of birth at home. Sometime by

well meaning but ill-informed friends and family. Sometimes by people

who were just plain ignorant and rude.

Without second thought, people say things to home birth couples that,

were the same comment directed at them in reverse, they would be

highly offended. Here, I would like to address the most frequently

heard comments.

I hope to provide couples who face this opposition every day with

something fairly concise to work with. What I really wish is that I

could buy a copy of Obstetric Myths vs. Research Realities and The

Five Standards for Safe Childbearing for every pregnant couple,

friend/relative/co-worker of every pregnant woman, health care

worker, nurse and doctor. These books are indispensable in dispelling

the myth that there is any sort of scientific justification for the

routine (i.e. in the absence of medical indication) use of technology

in pregnancy and birth. They also illustrate how often the

inappropriate application of technology is actually causative in

compromising the lives of mothers and babies.

Actual Questions/Comments to Homebirth Couples

Question/Comment #1

" But what if something happens? "

Rarely can the questioner think of what actually might happen unless

something traumatic happened in their own birth. This question

sometimes comes combined with " You are so brave (or stupid) to give

birth at home! I could never do it because my baby almost died (or

did die). " In this case, the home birth parent is loath to suggest

that the questioner might have made the unsafe choice.

There are very few medical emergencies of birth that cannot be

handled by a competent midwife at home. Only about 10-15% of

complications that occur at birth can't be predicted in advance

through prenatal care. Of those, a very small percantage will

actually need intervention that will require the surgical expertise

of an obstetrician.

" Why take that chance? " is what some people may ask next. Here's

why...

....because that chance is actually smaller than the chance a healthy

hospital bound couple takes that their baby (or the mother) will be

harmed by the use of technology that was meant for sick babies and

mothers!

Consider this...

In a study entitled " Home Birth Versus Hospital Birth: Comparisons of

Outcomes of Matched Populations " , by Dr. Lewis Mehl in 1976 it was

found that there was a three times greater likelihood of cesarean

operation if couples gave birth in a hospital instead of at home with

the hospital standing by. The data from the hospital population

revealed twenty times more forceps, twice as much use of oxytocin to

accelerate or induce labor, greater use of analgesia and anesthesia,

and nine times greater incidence of episotomy (while at the same time

having more severe tears in need of major repair). The hospital

sample showed six times more infant distress in labor, five times

more cases of maternal high blood pressure and three times greater

incidence of postpartum hemorrhage. There was four times more

infection among newborns and three times more babies in need of

assistance in breathing. While the hospital sample had thirty cases

of birth injuries, including skull fractures and severe

cephalohematomas, there were no such injuries at home. The infant

death rate of the study was low in both cases and essentially the

same. There were no maternal deaths for either population. The main

differences were in the significant improvement of the mother's and

baby's health if the couple planned a homebirth, and this was true

despite the fact that the homebirth participants of this study

included those couples who began labor at home but ultimately needed

to be transferred to the hospital.

All studies done to date have said the same thing...home birth is as

safe or safer than birth in the hospital. Except for one. One study,

done by physicians themselves, not surprisingly, said the opposite.

What isn't often revealed about that study is that in order to come

to the conslusion that it did, planned homebirths with midwives were

not studied, but instead, " out-of-hospital birth " included:

miscarriages after 20-28 weeks gestation (all stillbirths),

accidental births in taxis (on the street, etc.), involuntary

homebirths of impoverished mothers, and homicides by unwed mothers

who did not want their babies and left them to die of exposure.

Hardly comparable to homebirth with midwives.

Sadly sometimes things do happen. But to think that any one place or

caregiver can guarantee a perfect birth or perfect baby every time is

unrealistic. Life itself has a 100% mortality rate. Birth has much

better odds!

Unfortunately, too often if this question of something going wrong is

being asked by someone who has chosen hospital birth for the safety

they think it conveys, the story is something like...

" I needed an emergency cesarean due to cord prolapse (or transverse

arrest, or infection, etc.). "

Definitely no choice but to have a cesarean done and quickly! But,

how distressing to learn that the reason the cord washed down (or the

baby dropped down and got stuck or the mother developed an

infections, etc.) was because someone artificially ruptured the

membranes? (or some other intervention routine intervention was done

that commonly causes complications) Would a life saving operation

been needed if nature had taken it's course? Who can say?

Sometimes emotional reactions take precedence over reason. I had one

mother tell me that she could never have a homebirth because her baby

died days after birth. This baby had multiple congenital

abnormalities not compatible with life (not detected by all of the

tests and ultrasounds she had in pregnancy) and would have died no

matter where he was. It was tragic and I cried with the mother as I

held her while she recounted her anguish. But the facts remain:

technology didn't detect the problems; the hospital could not fix the

problems or save the baby. It would have been no more or less

grievous at home. The only difference is that the parents might have

been able to spend those first and last days loving and saying good-

bye to their little one instead of watching him in a box with tubes

and wires. I respect her decision to not birth at home...it's the

reasoning I don't understand.

Queston/Comment #2

" How could you live with yourself if your baby died? "

The audacity of some people! This ranks right up there with the

comment some reserve for after the birth " She's lucky nothing

happened to that baby or I'd never let her live it down. " The first

comment was actually said by a nurse to my best friend within minutes

of confirming her much anticipated pregnancy, the last was made to

someone in my family by someone in my family after the birth of my

baby.

Does anyone say this to a mother whose child becomes brain damaged

from a vaccine reaction? Or to a mother whose child is disfigured by

a scalpel in one of the millions of unnecessary cesareans? What about

to the mother whose child dies due to a hospital acquired infection?

Or needs to be in NICU for weeks because of preventable prematurity?

A mother doesn't grieve any more or less because she makes the safest

choice for her child, and home is the safest choice for most women. A

loss is painful no matter how or where it occurs. If anything, a

mother who has educated herself to the fullest extent will be more

accepting of a loss, should it happen, because she knows that the

hours she put into researching her options ensured that she made the

choice that held the least risk. Not like the many mothers who follow

the status quo, assuming no responsibility for their health care, too

busy to ask questions or looks things up, who end up saying " If I had

only known! " when/if they find out their complication was

preventable. One has only to read Silent Knife or Open Season by

Nancy Wainer Cohen to read the painful stories of many such women.

She receives thousands.

Question/Comment #3

" How could you put your own comfort above the safety of your baby? "

Other parents aren't usually so brazen as to ask this one. Many

homebirth couples have been asked this by physicians, nurses or other

medical personnel who apparently had no compunction in soliciting

unfounded doubt and guilt. Amazingly, I have yet to hear someone ask

this where it is actually applicable - of a mother who declares that

she will demanding her epidural or Demerol as soon as she steps foot

in the hospital.

The fact is, homebirth couples do not make this decision on a whim,

nor do they make it for such trivial reasons as comfort. By the time

a couple has made the decision to birth at home, more than likely

they have read as much (or more) about normal birth as the average

med student. They have not made the decision because

it's " in " , " popular " or a passing " fad " . Chances are they will take

more heat for this decision than any other choice they have ever made

and yet they will still make it. Why? Precisely because of the safety

of their baby!

Question/Comment #4

" I couldn't do it without the drugs! What if you 'need' something?! "

First the obvious. How can anyone know that they couldn't do it

without the drugs if they never have? Second, this comment fails to

take into account that birth in the hospital is usually more painful

for many reasons. 1. Use of pitocin makes a labor about ten times

more painful (and induction/augmentation with pitocin is epidemic in

our hospitals).

2. Lack of sustenance due to restriction of food and water lowers the

pain threshold.

3. Being tethered to a bed by a fetal monitor or IV restricts the

mother's natural instincts to find a more comfortable position (and

has been proven to do nothing beneficial for the mother or the baby

outside of certain complications).

4. Being in an unfamiliar environment causes stress hormones, such as

adrenaline, to hinder the production of the hormones the mother

should naturally make for birth, making labor longer and, you guessed

it, more painful.

There are many other causes of increased pain perception in the

hospital, and none are medically justifiable. Birth is the hardest

work a woman will ever do. It isn't comfortable. It isn't supposed to

be. There are reasons Nature works the way She does. A marathon

runner would not expect to be comfortable during the last leg of the

race. It's absure to think she could function in her capacity if she

accepted that she needed drugs to dull the pain. Her sense of

accomplishement, not to mention the endorphins her body would produce

as she pushed past the pain, would not exist. Many women simply have

no clue what is robbed of them when drugs are used non-medically in

labor and birth.

There are many non-pharmacological methods of pain relief that are

utilized at home, including (but not limited to) accupressure, herbs,

hydrotherapy (hot tubs), ambulation (walking, rocking, position

changes) and the comfort that comes from loving support.

Question/Comment #5

" Does your midwife carry malpractice insurance? Who pays if something

happens to your baby? "

Sometimes stuff just isn't anybody's fault! This question goes with

the mentality that doctors " owe " us perfect offspring. The mentality

of midwifery clients is different for a number of reasons, so the

assumption that if obstetrics is the most sued profession, midwifery

must also be. Midwifery is not obstetrics! Obstetrics is a surgical

specialty, midwifery deals with normal birth and healthy women. Sick

women go to doctors. But I want to know a couple of things anyway.

How did it come to be that, in our society, someone must always be at

fault and everyone who has something bad happen to them gets to be

compensated?! When there is true cause and effect, or real

negligence, law suits are warranted as punishement for the

incompetent caregiver who purposely hurt someone. I have no doubt

some of these exist, but come on! When do we start taking

responsibility for our own actions and stop placing blame? When do we

admit that life isn't always 100% wonderful, and that humans don't

always have control over all events?

When we hire a caregiver even though we know that provider does (or

does not) " XYZ " but they have promised us they won't (or will)

do " XYZ " to us, and then they insist they must (or mustn't) do " XYZ " ,

and we let them, and we then have a complication due to " XYZ " , why in

the world should they then have to pay us for the choices we have

made?! Why should a doctor or midwife have to pay parents money if

they don't get the outcome that we all want and expect? Midwives and

doctors don't grow babies for people. They are not omnipotent.

Sometimes a complication can be detected and dealt with before it's a

problem, and sometimes it can't, technology or not. Ultimately,

God/dess has the final say. Take note that I am not defending

practitioners who injure on purpose or don't respect their clients

enough to practice informed consent. I'm simply saying that this

thing has gotten way past common sense and decency.

I saw a saying years ago that sums it up, though I don't remember

where. It said " We are midwives. We don't hold life and death in our

hands. Nor do we give or take away life. We facilitate passages and

respect life from birth to death. We are imperfect people with a

perfect calling. We are midwives. "

With cesareans having at least a five times greater mortality rate,

it's ludicrous to say " If only she had had a cesarean, everything

would be fine. " That statement is only possibly true for a cesarean

rate of about 12%. Since in the US our rate of surgical birth is

twice that, the assumption that there is some magic technology that

is instantly available and always supplies a happy ending must be

curtailed or else the practice of defensive medicine will never end.

Question/Comment #6

" How will you know if you and your baby are OK if you are at home? "

This question usually comes out of a lack of information about what

midwives do. Some people are under the impression that traditional

midwives just show up and catch a baby, which just isn't so.

Midwives provide low tech prenatal care to healthy women. At each

prenatal visit they check blood pressure, urine, fundal height,

position of the baby, and fetal heart tones. Assessment of edema,

maternal weight, hemoglobin, and fetal movement are made. Additional

monitoring may be done, depending on the education and experience of

the midwife, but the above are usually a minimum. If the mother or

baby show any signs or symptoms of problems, the midwife will refer

to a physician. Homebirth is only for healthy women and babies.

In labor, all of the same things are monitored. Baselines established

in early pregnancy for pulse and respiration are noted and the mother

is observed for any deviation from normal for her. If a problem

arises, midwives are trained in emergency procedures for use until

medical assistance can be procured. Midwives know normal pregnancy

and birth, but also learn about variations of normal, like breech, or

pathology, like ectopic pregnancy, so that they can recognize them

early enough for a timely referral. Midwifery is prevention!

Question/Comment #7

" Does your insurance cover homebirth? "

While many companies are seeing the value in homebirth coverage, some

will still only cover hospital birth. This shouldn't be unexpected

since (as my own doctor explained to me) insurance companies were not

developed to help people pay for health care, but were initiated by

doctors to insure that they would be paid. Independent companies see

that not only is it less expensive to pay for the homebirth, but

there is less likelihood that there will be subsequent expenses due

to iatrogenic (doctor cause) or nosocomial (hospital caused)

complications. Homebirth parents also tend to make other health care

choices, like breastfeeding, that lead to healthier (less expensive,

in the eyes of the insurance provider) children.

Even if the insurance doesn't cover homebirth, couples are willing to

pay out-of-pocket for the peace of mind the safety of midwifery

provides. Most of the time, because midwives charge so much less than

physicians, the out-of-pocket expense is similar to what the parents

would be paying for their co-pay had they chose a hospital birth

anyway.

Question/Comment #8

" Well, it sounds like it might be nice, but I'd want to have my first

one in the hospital, just in case. "

This usually ends up being either a self-fulfilling prophecy or an

event to be healed. I have had people come to my class with this

attitude. I support the right to be where ever they want to be, but

it still makes me sad to see it happen over and over again.

They may have been promised by their doctor that none of the stuff on

the birth plan is done anymore " Unless it's absolutely necessary. "

More often than not, somehow all of the things that lead to further

intervention and complications are done anyway. The parents feel

cheated and violated. Their trust broken. Especially because it

wasn't going to happen to them...they trusted their doctor. Some of

these women end up trying to get pregnant too soon, so that they can

plan the homebirth that will heal their soul. Their hospital birth

may be what the rest of our culture deems 'normal', but because they

know there's a better way, it isn't 'right'.

Many (at least 24%, remember?) won't get the chance for anything

different next time because they will have a cesarean that will risk

them out of many homebirth practices for subsequent births. At least

half of those will have been unnecessary.

Some will go on to have that homebirth. Are they glad that they gave

birth in an institution the first time? Sometimes. If a true

emergency developed and they really needed medical assistance, or if

they had a hospital birth with good Certified Nurse Midwives and had

an experience that they are happy with. Sometimes not. Because the

two experiences are so vastly different, the sentiment is sometimes

that they regret that they weren't at home the first (or second or

third) time because they can't believe how much easier it was at

home. One woman explained it this way, " Physically, it may be the

same, but emotionally it is so different. It's like being a virgin

and contemplating your " first time " , but deciding you'd rather be

raped first. "

I have been a labor assistant at births where I knew exactly what she

meant! But it isn't fair to put all hospital births in that category.

I've seen some decent ones. Of the ones I witnessed, two couples had

to work ever so hard to keep it normal and go several counties away,

but it was their informed choice to be in the hospital. Another

needed to be in the hospital due to medical complications (one of

those times when hospitals are actually the only place to be!).

Although she had many interventions, she knew that they were

necessary ones that helped her to have as normal a birth as was

possible for her for that baby. She was treated with the utmost

respect and the minimum technology needed to help her and her baby

was used. These three had no regrets as far as I know. I'm afraid

they are the exception, though.

If the people who ask these kinds of questions or make these sorts of

comments spent half as much time actually learning something about

homebirth instead of jumping to judgment, they would never think of

saying something so hurtful. I have been to almost an equal amount of

home and hospital births, and I am admittedly a homebirth advocate,

yet I still would not walk up to a hospital bound woman I barely know

(or that I knew quite well for that matter!) and accuse her of trying

to kill her baby! This is essentially what happens quite often to

home birth-ers.

So, if someone you know is planning a homebirth and has sent you this

link or printed this out for you, please take the time to read a few

books and check out a few links on my home page before expressing

your concern. You may just find yourself being their biggest

supporter!

Reprinted with permission from

Healthy Pregnancy, Safe Birth

www.homepage.lakeshore.net/~kmidwife

*Obstetric Myths vs. Research Realties, Henci Goer. Bergin & Garvey.

The Five Standards for Safe Childbearing, David Stewart, PhD. NAPSAC

International.