Midwives Explain What a Home Birth Really Means
The COVID-19 pandemic has presented a unique set of emotionally distressing challenges for pregnant women. From concerns about their health and that of their baby, to the prospect of having to go into labor and birth alone in hospitals, mothers-to-be are facing extreme fear and uncertainty in an already vulnerable time.
With many hospitals operating near or at capacity with limited resources as they take on the flood of Coronavirus patients, many expectant mothers are rethinking their birthing plans—and considering the option of a home birth which, typically, only about one percent of mothers do each year. Midwives are being inundated with home-birth requests. Here, the birthing experts speak on commonly asked questions about home birth, the benefits and potential risks of doing so, and why the decision to have one should be made with careful consideration.
What Is a Home Birth?
"A home birth is exactly what it sounds like—when someone decides to birth their baby in their own home!" explain licensed midwives Robina Khalid and Tanya Wills of New York City's Small Things Grow Midwifery in a shared interview. "People who have a planned home birth, in the absence of complications, will never need to go to the hospital." While someone can birth at home without a midwife, the vast majority of people who choose home birth will work with one. As for who else is present, it varies from family to family; oftentimes it’s just the birthing person, their support person, and a midwife. "In general, home birth is a quiet, intimate experience," explains Sara Howard, a Los Angeles-based midwife and educator at healthcare center LOOM. "Lights can remain dim, music can play in the background, and partners and doulas can provide support no matter where the birthing person wants to be physically, whether that's in a bed, tub, or somewhere else."
What Role Does a Midwife Play in a Home Birth?
The midwife is there to safeguard the health and safety of the birthing person and the baby. While many midwives vary in credentials in the U.S.—there are licensed midwives, certified professional midwives, certified nurse midwives, and traditional midwives, for example—practices are similar. "I’m licensed by the same medical board that licenses doctors," explains Howard. "I carry a doppler to listen to the baby’s heartbeat in labor, medications to stop bleeding after birth, oxygen, suturing equipment, IVs and antibiotics, and more. I’m certified in neonatal resuscitation and infant CPR, as well as trained in advanced fetal monitoring." A midwife may involve herself during birth by "catching the baby" or, during the immediate postpartum, ensuring the placenta is birthed safely, keeping a watchful eye on bleeding, giving stitches when needed, performing a head-to-toe newborn exam (including weight and measurement), and assisting with breastfeeding. "In the best case scenario a midwife is just there to remind the birthing person of their own strength and to help ensure the birthing person feels safe enough to do what only they can do—birth their baby."
What Are Some Benefits of a Home Birth?
"Home birth may be the best chance the average American person has at having a physiologic birth—a birth that occurs without intervention," explain Khalid and Wills. This method has been shown to carry benefits to parent and baby, including a better transition to breathing for the baby, less genital trauma for the birthing person, quicker recovery from birth, increased rates of breastfeeding, improved parent-infant attachment, and decreased incidence of postpartum depression. Planned home births attended by a registered midwife have been associated with reduced rates of obstetric interventions, such as C-sections, and other adverse perinatal outcomes. Plus, there is an inherent bond that's been formed between mother and midwife. "By the time we arrive at the birth, there is a deep understanding of the person, baby, and family we are caring for—there is trust," say Khalid and Wills. "People can birth anywhere they like on their own turf while listening to their bodies and allowing their own innate wisdom to guide them."
How Is Labor Pain Managed During a Home Birth?
"Epidurals are an amazing technology that many people choose to use in the U.S., but there are many other people who place value on the experience of labor and birth as it is," explain Khalid and Wills. "We have a belief in our culture that pain is always bad or wrong. And is labor painful? Yes. But pain is different than suffering, and pain is sometimes instructive." For example, the pair believe that having full sensation when pushing helps people know how to push—and when to back off—which helps people tear less than they would during guided pushing. Moreover, birthing at home gives the birthing person the opportunity to move more freely, as well as take advantage of multiple spaces, such as a bed and a pool of water. "Laboring in a big pool of water at body temperature is probably the most soothing tool we have at all to relieve pain at home," explains Howard. "Virtually all people who labor at home will utilize a birth pool for that very reason." Another way to relieve pain naturally is deep, focused breathing. "When you relax and breathe, your muscles get more oxygen, which reduces pain," she explains. "Whereas when people are scared and tense, their muscles constrict and they feel more pain."
What Are the Safety Concerns Around Home Birth?
In order to be a good candidate for home birth, a person and a pregnancy need to be “low-risk,” which generally means that there are no major medical problems present either before or during the pregnancy, says Howard. Generally, high-risk factors may include high maternal age or previous C-section delivery. The best way for an expectant mother to know for sure is to talk to their doctor, as well as consult a midwife about their specific history and situation. As for unexpected medical emergencies that could arise during an at-home birth, Howard says the most significant risk is the delay in getting from your home to a hospital, which is why many medical experts recommend that an at-home birth should take place within 15 minutes of a hospital. "The majority of problems that occur during labor and birth present warning signs, and midwives are extensively trained in recognizing these warning signs," explain Khalid and Wills. "Our intimate knowledge of our clients, as well as years of observing people's labor while sitting with them for hours on end, gives us the ability to interpret what’s going on, and decide whether staying at home is still appropriate." The pair also stresses that most transfers are not emergencies, and that the most common reason for going to the hospital during labor is exhaustion or a very long labor that might need some augmentation or pain relief.
How Can I Decide Between a Home Birth and a Hospital Birth?
In additional to consulting medical professionals, it's important to gauge your personal comfort level with the idea of a home birth. "Home birth can be an incredibly warm, sweet way to bring your baby into the world—but it isn’t for everybody," says Howard. "There are times when epidurals and surgical births are terrific, life-saving things that we can all be grateful for. Deciding where to birth is personal. Take the time to gather the information and resources you need to ensure that you’ve made the best choice for you and your family. You know best." As far as the timing of a mother-to-be's decision, the earlier the better, especially in the instance of home birthing. "Things get tricky when it’s very late in the pregnancy and folks want to have a home birth, especially because most midwives have small practices that fill up early," explain Khalid and Wills, who released an open letter to address increased interest in home birth during the COVID-19 pandemic. "Moreover, creating trust and familiarity between the midwife and the family over time is key to a safe and healthy experience." Ultimately, the decision to have a home birth is not one to be made out of fear and panic, even in unprecedented times—fundamentally trusting the location of one's birthing is the best way to ensure safety for the mother and child, they stress. "If after diligent and thoughtful research, the autonomy and safety of home birth remains appealing, pregnant people are always welcome to contact individual practices, with the understanding that most practices book up far in advance," Khalid and Wills note in their address.
Originally Appeared on Vogue
