Choosing Home Birth in the Age of Intervention (The stats might surprise you!)

©Abundant Birth Support

By Camille Nyman, GBCE, SBD


 

“Love begins at home…”

-Mother Teresa

 


 

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Shared with permission. Ashly, USA

 


 

“…the most incredible experience of my life.” – Emily, USA

“The best thing I’ve ever done.” – Teresa, USA

“…empowering and emotionally satisfying.” – Ashley, Canada

“I was…so relaxed.” – Michelle, USA

“Best experience so far.” – Kirsten, Australia

“I was…singing through the contractions!” – Louise, Ireland

“I can’t wait to do it again!” – Chelsea, USA

 


 

When you think about “birth”, the quotes above are probably not the kind of phrases that immediately come to mind. Every day across the globe, thousands of babies are being born.

“The UNICEF estimates that an average of 353,000 babies are born each day around the world. The crude birth rate is 18.9 births per 1,000 population or 255 births globally per minute or 4.3 births every second (as of Dec. 2013 estimate)” [1] (emphasis added).

Year after year, medical advancements are made in obstetric and neonatal medicine. New techniques are studied for pain relief, efforts are made to offset lasting injury, and professionals work to lower infant and maternal death rates internationally. Unfortunately, the culture surrounding birth in developed nations has become increasingly fear-based and intervention heavy, with thousands of women receiving interventions in birth whether they need them or not. I decided to investigate –  do women really have choices in childbirth? Is home birth a viable option for positive birth? Here’s what I found.

Choices in childbirth?

In today’s world, 98.8% of women will give birth in hospitals [2]. Of those women, a startling 87% will receive continuous electronic fetal monitoring (despite evidence showing worse outcomes for mothers and babies on EFM [3]), 80% will receive intravenous fluids, 47% will have labor augmented with medications, and 43% of first time mothers are having their labor induced.[4] [5] When 85% of women birthing in hospitals are considered “low risk” [6], these statistics are concerning at best.  Despite continuous advancements in mother-baby technology, even developed nations like the U.S.A. struggle with outcomes for moms, with the CDC showing a marked increase in Severe Maternal Morbidity between 1998 and 2011 – listing cesarean sections as one of the primary causes [7]. For Women of Color, the chance of poor outcomes and increased interventions is even higher. [8]

The evidence proves that thousands and thousands of pregnant women are low-risk, with little statistical probability of complications in childbirth. That being true, why are so many women still birthing in environments designed to handle the most complicated cases? Lack of natural childbirth education resources, an increased cultural dependence on western medicine, and public apprehension toward childbirth in general are only a few factors. Mainsteam media supports and amplifies only the most traumatic and emergent birth stories. State and country laws in developed nations can make it difficult or completely illegal for traditional midwifery to flourish. Hospitals and insurance companies increasingly focus on techniques and standards of practice that allow the “processing” of birth with efficiency and reduction of liability at the forefront. JRSM even published in 2011 that it can take 17 years or more for established, evidence based research findings to make their way into clinical practice [9].


That means that as of the publishing of this article, current best practices may be based on research findings from as early as 2000!  


 

Faced with statistics like these, thousands of women around the world are taking a step back – birthing their children with a minimum of flourish and a maximum of bodily autonomy. As it becomes more obvious that “low risk” does not equal “low intervention”, these women are choosing to reclaim their human right in childbirth to birth wherever and whenever they please, with whomever they decide. For a slowly growing contingent, this means giving birth in their homes.

Home is where the heart birth is.

From 2004-2010, home birth in the U.S.A. saw a 41% increase, with published studies showing that planned home birth can be exceedingly safe, with excellent mother & baby outcomes. [10] Even so, home birth still only represents a small contingent of women- roughly 0.7%  in the United States [11]. So I decided to do some of my own research, and find out first-hand what was going on with home birth experiences from the women who are having them. Over the course of two weeks, I had the opportunity to receive surveyed responses from 374 women in 9 different countries who had previously had, or were currently planning, a home birth. We talked about MANY different aspects of home birth, and many of them expressed unsolicited exultation over their chosen experience.

Before beginning my study, I (like many of you I imagine) wondered who exactly these women were. Having had two hospital births myself, I had many pre-conceived notions of who might be in this “fringe” of society – those women actively separating themselves from the norm and aligning with a commonly discouraged life experience. I chose hospital for my first two children mainly because I didn’t really understand I had any other choices. I pictured home birth moms as skirt-wearing hippies with long hair and flower crowns, dads with beards and man-buns, and woodland creatures attending à la Snow White (well….maybe not the woodland creatures, but you get my drift.) Weren’t they scared? What about the risks? What about the MESS? Even with my experience as a doula and childbirth educator, I had some BIG questions about how one could come to the conclusion that home was indeed the safest place to birth a baby.

Answer after answer after answer, I have been amazed. Amazed at not only the strength and confidence of the women in my study, but of how many of my previous ideas about home birth-ers were totally off base. I hope you will enjoy my findings as much as I have, and read with a curious mind. Home birth is not just for “crunchy moms”, but a choice in childbirth that should be taken seriously and considered for many low-risk women. (Don’t miss the infographic located at the very bottom of this post!)

Let’s talk about [birth] baby!

In creating the survey on home birth I presented, I formulated many of the questions on the survey based on concerns, association, and wondering I’d discussed about home birth with many friends and acquaintances over the years. Many of the results (positively!) surprised me. Here are some of the common questions and misconceptions that arise when I’ve discussed home birth with others in the past, and what my survey found.

Home birth is for hippies, right? Educated women choose hospital births.

Actually, maybe not! A new documentary film currently on kickstarter, called “Why Not Home?” asked this very question, and discovered that doctors, nurses, and midwives who attend hospital births are starting to become more likely to choose home birth for themselves. In my survey, 53% of women had achieved a bachelor’s degree or higher, with an additional 18.8% bearing an associate’s degree or technical/trade school certification, and another 18.4% with some college credits (but no degree yet). They are professors, psychologists, accountants, biologists, social workers, lab technicians, paramedics, nurses, dentists, midwives, cosmetologists, and so much more. In addition, 60.8% had taken some type of childbirth education class and most demonstrated a high understanding of birth physiology and choices in childbirth.

Okay, but how old are they? You’ve got to be a spring chicken to birth a baby at home without interventions!

Wrong again! 83% of women I talked to were age 25 and older. A significant percentage (28.6% actually) were over 30 years of age at their first home birth – without seeing an increase in their likelihood of transfer to hospital for complications.

Well, they’re birthing at home because they must not know how awesome hospital births actually are.

Nope, and nope again! It was more likely for women to choose home birth for their 2nd and subsequent babies than the first time around (only 30.3% chose to birth at home with their first child). When I asked why they chose to avoid the hospital after experiencing it at least once, they were nothing if not sure of their answers.

  • 60.7% said they received interventions that they did not want or did not consent to
  • 41% said they felt rushed to progress (with many including anecdotes about how they made choices because they felt pressure to birth quickly, instead of because they felt it was the best decision)
  • 38.9% listed not being allowed to labor/deliver in the position of their choosing
  • 38.1% felt they had an unsupportive provider
  • 32.8% said they felt unsafe

So why DID they choose home birth? This whole thing is about not making decisions because of fear, right?

Right! The reasons FOR choosing home birth were actually just as numerous and varied as the reasons NOT to choose a hospital birth.

  • 74.9% wanted to avoid unnecessary interventions
  • 62.3% believed that birth is inherently safe
  • 61.8% felt safer at home
  • 31% wanted a water birth
  • 28.2% wanted to maintain an intimate atmosphere with their partner
  • 8.7% said it was more cost effective

What about the risks? You can’t have a home birth if you have risk factors.

Yes and no. While home birth is definitely not the right choice for everyone, assuming *everyone* who home births is inherently low risk is false. What I found in my survey was that three Ps were key- Provider, Prevention, and Preparation. Women reported risk factors and internal challenges ranging from breech babies, multiples, Group B Strep+, Gestational Diabetes, cervical scar tissue, PTSD, VBAC birth, Polyhydramnios, Anemia and more. Of those choosing to home birth while handling these challenges, every single one of them demonstrated the 3 Ps. They were scrupulous about finding a home birth provider with expertise in their area of challenge, they were highly educated on the subject matter they were facing, and they were proactively working to address and prepare for birth, not in spite of their challenges, but as an accepted variation of normal. Ultimately, it was not always an “If you have _______, then you cannot home birth” scenario.

People only choose home birth when it’s easy. I could never home birth because _______.

An amazing 76% had to overcome challenges to achieve home birth! Overwhelmingly, women are NOT choosing home birth because they felt it was “easier”. When asked what factors made it more difficult to choose home birth over hospital birth, here’s how women responded.

  • 52.1% listed out of pocket expense as prohibitive
  • 18.7% had unsupportive family and friends
  • 12.3% were afraid of facing pain or complications
  • 9.7% were unable to find a supportive provider
  • 8.5% felt they were a far distance from a hospital should transfer be required
  • 5.4% felt they had an unsupportive partner

They must be having small babies. I was told my baby was huge so I had to have a hospital birth.

This was probably one of the most interesting survey points. With all these women birthing vaginally at home without intervention, they must be having smaller babies right? Because big babies need help to be born. In the U.S.A., thousands of babies are induced or born via cesarean because they’re just “too big” to be born vaginally. In fact, Cephalopelvic Disproportion (mother’s pelvis is too small to deliver her baby vaginally) is listed as a top reason listed for “failure to progress” in hospital births, yet 65% of women diagnosed with CPD go on to deliver future babies just fine [12]. Improving Birth does an excellent job investigating “The Myth of the Big Baby” stating,

big-baby-dystocia

So how big are these babies being born at home? In the United States, vital statistics lists 9.7% of babies born to non-diabetic mothers as being “big” – over 8lbs 12oz by definition. [13]. In my survey, 59% of women birthed babies at home over 8lbs and 24% birthed babies over 9lbs! Again, choosing to view the size of their baby as a variation of normal vs something to be actively managed as a medical problem.

They MUST be tearing, right? I shudder to think of the perineal tears with women birthing babies that size without medical intervention!

Shudder not, my friend! I have some fantastic news for you – 55% experienced no perineal tearing whatsoever. How is that possible? Well, the evidence suggests their choices in delivery positions and coping strategies made a big difference.

  • 91% chose to labor and/or deliver in a birth pool, tub, or shower. (Research is overwhelmingly positive as to the effects of water on pain management in labor and reduction of perineal tearing [14])
  • 81% delivered in an upright position, such as standing, squatting, hands and knees, leaning forward, supported semi-recline, lunging, or on a birth stool. Upright birth has been known for centuries to assist mothers in delivering their babies safely, even though it’s rare to see in a hospital setting.[15]

Good providers don’t support home birth.

Actually, more and more are coming round to the practice to support their clients. While there is a subset of women purposefully birthing unassisted (as educated and informed as those choosing to birth with a provider!), the majority of home birth moms choose to have a midwife present (94%). Many are also choosing to hire a doula (no doubt aware of the benefits), with 39.1% adding doula care to their home birth experience.

It’s not all coming up daisies. I’ve heard the stories about what happens when home birth goes wrong.

While it’s true (and unfortunate and tragic) that sometimes even the most low-risk births do not go according to plan, those experiences are still a small minority. 11% responded that they required a hospital transfer – but the reasons were remarkably varied. They ranged from perineal tears they chose to have stitched up in hospital and routine wellness checks for bleeding, to the more dire and serious emergencies. I will not sugar coat that transfers do happen –  but the evidence still backs up that with the 3 Ps (Provider, Prevention, Preparation) these are a statistical rarity with home birth. No type of birth situation presents zero risk of complication. It is important to choose your providers carefully, pursue excellent evidence-based education on birth choices and options, and prepare yourself both physically and mentally for childbirth to have the best chance at undisturbed, physiologic birth at home. Results indicated that even with an 11% transfer rate, 98.5% would eagerly choose to home birth again.

What’s happening after the actual birth?

The stats on post-delivery choices were just as encouraging as the stats about the deliveries themselves. 99% chose to breastfeed, with 88.1% initiating skin to skin within the 1st hour. 98% practiced delayed cord clamping (a statistical rarity in hospitals, but with excellent evidential benefits [16]). Many conversations I’ve had about home birth centered around the inevitable “mess” of birth (as in, “I wouldn’t want all that mess in my home!”) but to hear it from the women themselves, the mess really wasn’t a factor. Modern inventions like ‘Chux pads‘ are a staple at home births, keeping those dreaded fluids relatively easy to contain and whisk away. Many related stories about their midwives and birth assistants cleaning so surreptitiously they weren’t even aware of what was happening while they were laboring, and to look at the home the day after it would be unapparent a birth had ever occurred there were it not for the newborn present! One woman even fondly recounted her birth team’s work after she had delivered saying, “My…nurse and midwife did what little clean up was necessary. I had my babies and while I showered and ate they did a load of laundry and drained and broke down the birthing pool.” (Stacy, USA)

In the end, it [really does] matter.

It is vital to maintain choices in childbirth. Birth rights are human rights, and women should be able to make sound decisions about their bodies and their babies. Whether a woman chooses to birth in hospital or at home is not of main importance. Whether she was supported in her decisions and given access to high quality evidence of the risks and benefits of her choice is. Home birth can be a viable, safe option for positive birth and deserves easier access, more positive publicity, and greater research studies.


 

“It is important to keep in mind that our bodies must work pretty well, or there wouldn’t be so many humans on the planet.”
Ina May Gaskin, Ina May’s Guide to Childbirth

 


 

I hope you enjoy this infographic as much as I enjoyed making it! Feel free to post, pin, share, and save as long as the byline remains intact and posts are linked back to this article for context. Thank you!

-Camille Nyman, Abundant Birthworks

 

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5 thoughts on “Choosing Home Birth in the Age of Intervention (The stats might surprise you!)

  1. Jocelyn says:

    I think this is an amazing article. Im 26 years old 4 years ago I gave birth at home unintentionally to my second daughter ( in the shower) just my husband and I it only took me 2 hours to deliver and it was such a great personal experience compared to a hospital birth. Im due with my 3rd baby at the end of this month and unfortunatly I will have to deliver at the hospital because my insurance does not cover a home birth. If I could have it any other way I would choose a water birth in the privacy of my own home😃

    Like

  2. Kathy says:

    I’ve had my five children at home with midwives. Love them all three!! It is about choice. Also, if you want something bad enough you will make it happen. All five times I qualified for prego Medicaid and I chose to suck it up and sacrificed and paid for each home birth out of pocket. Thousands of dollars but would do it all again. Such great memories, now my stomach step daughter who attended my first birth, has gifter us with two babies at home with same midwives, and I’m so proud of her!!

    Like

  3. Barbara Bockbrader says:

    I thought we were turning the tide 20 plus years ago, but obviously the relentless profit machines are much better at broadcasting their messages of fear. Great article Camille, and good luck with your continued studies. Glad you have Ina May for guidance.

    Auntie b

    Like

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