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Thinking of Giving Birth at Home? Read This First

Thursday, October 3rd, 2013

More and more women are choosing a home birth experience when it comes time to start, or add to, their families. They say that childbirth is completely natural, that it is not a disease and there is no reason to be in a hospital bed. That their bodies know just what to do; that women have been giving birth at home for much longer than they have been going to hospitals. They say that they are perfectly healthy; maybe they have even given birth before with no complications. And they fear that “interference” from doctors and nurses and machines will mar their birth experience.

Most of this is perfectly true. But here’s something else that’s true. Did you know that the mortality rate is three times higher for babies born at home, compared with babies born in hospitals? The problem is that childbirth is notoriously unpredictable. Even if a woman is healthy and her entire pregnancy has been normal; even if she has already had an uneventful labor and delivery in the past, there is no way to predict some of the circumstances that may arise, or when medical intervention may become necessary.

The birth of your baby is indeed a very special time, and if you can have the experience you really want, that’s great. But remember that you also have a responsibility to keep your baby safe. So, with that in mind, how can you get the birth experience you desire without subjecting your baby to an increased risk of danger?

Choose a Midwife Who Practices in a Hospital Setting

Many women want a midwife to deliver their babies because they believe that midwives offer more personalized attention and try to interfere as little as possible with the natural course of events during labor and delivery. Many midwives practice in hospitals, and this is the ideal setting for birth in case of an emergency – which, again, you cannot predict. Yes, women have been giving birth at home for millennia. But the infant mortality rate is lower now than it ever has been. That’s because most women now give birth in hospitals.

Add a Doula to Your Support Team

A doula is a non-medical support person who can attend to your needs, help make you comfortable, help keep you focused, rub your back, bring you ice chips, and whatever else it is you might need, leaving your coach free to focus on you as well as his or her own experience.

Make the Hospital More Like Home

Get to know your hospital’s maternity floor ahead of time; being familiar with the setting will help you feel more comfortable. And feel free to bring things that are comfortable and homey, like a favorite blanket, pair of pajamas, or mug. After your delivery, you may necessarily be visited by medical personnel who will want to check your vital signs and make sure you and your baby are recovering well – but you can make the most of the times when you, your partner, and your baby are alone together by turning off the TV, dimming the lights, and getting to know each other. Celebrate with a glass of sparkling wine, play cards, decide on a name if you haven’t yet – do whatever you would do at home.

Making some compromises can keep you and your baby safer while still giving you a special birthing experience. Remember that the doctors are not there to get in the way, but to help you, especially if there is an emergency. You can read more about this topic in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Labor & Delivery: Don’t try this at home

Monday, November 30th, 2009

Most women today have no idea how dangerous it once was for a woman to give birth. The maternal death rate today is about eight per 100,000 births.  When home births were in style, the maternal death rate was 83 per 100,000 births – 10 times the number of deaths.

Women today almost never die in childbirth because, when things go wrong during labor and delivery, medical professionals can step in and prevent emergencies from becoming tragedies.

Which is why I want to scream when I read nonsense like the following, from a website calling itself “Born Free.”

“Welcome to Bornfree! This site is based on the belief that childbirth is inherently safe and relatively painless provided we don’t live in poverty, and do not interfere either physically or psychologically. Drugs, machinery, and medical personnel are not only unnecessary in most cases, they are also no match for a woman’s own intellect and intuition.”

The site quoted above advocates for unassisted childbirth at home. No doctor. No midwife. And no professional help at the ready if something goes wrong.

Ordinarily, I wouldn’t get too exercised over an obscure website. But, it’s how I found this website that has me troubled. It was featured in an article on ABC News.com in the “Entertainment” section. The article mostly extolled the concept of women giving birth at home, with neither a midwife nor a doctor present, giving only the briefest nod to the caveats from an ob-gyn.

In the age of reality TV, maybe a piece about women risking their lives to experience “freebirth” makes good copy. Maybe, because it was in the Entertainment section, this quote from a mother who recently gave birth on her own didn’t raise any eyebrows: “…it is not risky if you do your homework.”

But ask an ob-gyn and you’ll get a much different albeit less entertaining quote.

Yes, so-called “freebirth” is risky. And no, you can’t mitigate the risk by doing “homework.” Approximately 40 percent of high-risk patients appear to be low-risk before labor and delivery. No amount of “homework” can prepare a woman for suddenly finding herself among those 40 percent. If she’s at home, without medical attention, she and her baby could be in serious danger.

Most certified nurse midwives are affiliated with hospitals today precisely because the unexpected can and does happen during childbirth and having medical and surgical teams within shouting distance can mean the difference between life and death. The birthing process is still the 11th leading cause of death in women between 15 and 44 years of age.

When I was in the military, we received a stat call about a home birth gone wrong. The woman lost all muscle tone in her uterus after the birth of her child. By the time the ambulance got her to Bethesda, she had bled to death.

So I’ve seen firsthand how “freebirth” can be a recipe for disaster.

– Yvonne S. Thornton, MD, MPH