The Natural Birthing option that is finding a new home
You want to do what? Why would anyone choose to give birth at home? Haven’t you heard the stories? Your baby could die and you’d be responsible! Or at the very least you’re going to wish you had pain medicine!
Despite the reactions many of today’s moms face when they announce they’re having a homebirth, more women than ever are choosing to do so. While it may not be mainstream yet, it’s also not the fringe practice it once was.
Seen as the “natural birthing choice” (and not just among “granola” types anymore), this growing trend has become a new luxury item—a status symbol primarily among affluent and educated white women. And it’s not as scary as it may sound thanks to today’s midwives who undergo extensive training to obtain their license.
Recent studies have even shown many more positive maternal and neonatal outcomes for women receiving midwife-led care versus physician-led care thanks to its “high-touch, low-tech” collaborative practice.
To attend a birth, a midwife in Tennessee must be either a Certified Nurse-Midwife (CNM), licensed as an advance practice nurse under the Tennessee Board of Nursing; or a Certified Professional Midwife (CPM), licensed by the Council of Certified Professional Midwifery.
The Tennessee General Assembly recognizes midwifery as a profession in its own right, different than the practice of medicine and has established extensive practice guidelines to ensure safe and competent care to women during pregnancy, labor, birth, and the postpartum period, as well as newborn infant care.
To better understand what a homebirth looks like, I caught up with Michelle Ray, a CPM serving the Chattanooga area who owns Journey Midwifery Services. When I asked her why she thought women were choosing homebirths, she responded by saying, “I believe they want individualized care. Oftentimes they have first birthed in the hospital and realized they wanted something different.”
In fact, it was her own hospital birthing experience (which left her with much to be desired) that propelled her to become passionate about helping other women have a more personal and satisfying birth experience.
“Oftentimes people think homebirth is some backwoods thing,” says Ray when in fact, she explained, the standard of care is much higher. Many people falsely believe that having a homebirth means not having access to things like oxygen, ultrasounds or fetal monitoring.
But as I sat in Ray’s well-equipped office and looked around, she assured me that all of the clinical components were the same. She has all of the same equipment at her disposal and is able to perform all of the same tests that a hospital would; as well as provide the necessary paperwork, birth certificate and newborn screening. The difference is choice.
“I want my clients to make all of their own choices, with fully informed consent,” says Ray, adding that, “I believe it’s my job as a midwife to provide my clients with everything they would get in the hospital, but they get to choose what they would like without being under duress.”
She described her practice as a sort of “concierge medicine” allowing clients to pick and choose anything they would like as long as it’s safe, as opposed to the approach in most hospitals where nothing is presented as an option. The element of choice, and having their personal preferences heard and respected, attracts many women to homebirths.
“Pregnancy and birth seem to be looked at by the medical community as a disease or medical emergency. However, pregnancy and birth are natural processes,” explains Michelle Martin, a CRRN who birthed all three of her children at home. Because the medical profession is fundamentally disease-based and curative, pregnancy is often seen as a medical event that requires a “cure” via interventions.
While there will always be some women and some instances that do require medical interventions, many of the common hospital practices are unnecessary and overused. In fact, things like laboring in bed and using pitocin can actually lead to riskier and more emergent births. The midwife model of care, on the other hand, views childbirth as a natural occurrence and seeks to eliminate or minimize any and all unnecessary interventions.
This lack of medical interventions like Cesarean sections, pitocin, epidurals and such is the primary factor in the cost differences between hospital versus homebirths. Studies have shown that an average uncomplicated vaginal birth in the home costs nearly 60 percent less than one performed in the hospital. Rather than proposing and offering costly pharmaceuticals or procedures, midwives promote and encourage non-pharmacologic methods of pain relief and natural birthing methods.
While the World Health Organization believes births via Cesarean sections should be around 10 to 15 percent, in the U.S. this rate was 32 percent in 2015, according to CDC data. This is alarmingly high and indicates overuse of surgical interventions in cases where labor is simply not progressing as rapidly as expected or desired.
The growing shortage of obstetricians (estimated to be around 9,000 by 2030) does nothing to eliminate this issue as doctors feel increasingly pressured to help speed labor along. And epidurals?
When I asked Ray whether her clients regretted not having pain medication, or the option of an epidural, her immediate response was, “Never. Not once. Nobody has ever said ‘I want to go get drugs’.”
Being allowed to give birth in a comfortable, or at least preferred, position is another contributing factor to women choosing homebirth. In most hospital births women are required to stay in bed on their backs while in labor. “I had nurses offering me pain relief left and right, and acting as if I was an inconvenience for wanting to stand while laboring,” recalls Lucie Birmingham who chose to have a homebirth with her second child after an unpleasant hospital birthing experience with her first.
Midwives encourage women to move around, eat and drink, take a warm shower and when it’s time to push they have options.
“I had a birthing ball my second time around and wouldn’t have made it through without it. It was the only comfortable position for me to birth in,” says Martin. The focus at home is on comfort and individualized care.
“It was peaceful and uninterrupted,” agrees Drexel Bond, another mom who chose to have a homebirth with her second child (she attempted to with her first but required a transfer to the hospital) adding, “the homebirth was so much easier and I was met with zero resistance.” She describes the experience as magical, empowering and beautiful.
The desire for a more personal birthing experience, with less interference and an increased sense of control over their own labor and delivery is what attracts most women to homebirths. But it is also the comfort of their own home, surrounded by their family and personal clothing and items, as well as the desire for immediate bonding with their newborn that plays a role in this decision.
“The most special part was that our son, two-and-a-half at the time, was able to be part of the whole experience as much as he felt comfortable,” Bond says.
Birmingham agreed. Giving birth at home meant she had the comfort of her family (including her daughter and dog) and allowed her to give birth on her own terms and in the baby’s timing. Perhaps most importantly, when their babies were born they are allowed to hold them. Immediately.
“I just got to hold my baby, in my bedroom, and enjoy her first few moments peacefully,” says Birmingham. “After Clementine was born, no one tried to take her away to give her an unnecessary bath, no one tried to inject her with vaccinations or other drugs, no one tried to put antibiotic ointment in her eyes in case I had an STD.”
Among the common hospital interventions that devastate many new mothers, is being denied this immediate skin-to-skin contact with their newborn.
“I can’t imagine not immediately bonding with your new baby in a nice warm herb bath and watching as they are measured and weighed,” says Martin.
“At home when the baby comes out it goes right here,” says midwife Michelle Ray pointing to her chest, “and it stays right there.” She adds, “They get the prize at the end. Every time.”
This is what mothers long for—immediate bonding contact with their baby. “I believe that the safest place to give birth is at home,” says Ray (who does work with an obstetrician at Erlanger should circumstances warrant a transfer of care). “There is just nothing like the comfort of one’s home surrounded by loving and supportive family when such pain and such joy are involved,” agrees Martin.
If their stories and experiences aren’t enough to convince you to at least consider this natural birthing option, then perhaps the multiple studies that have shown how women who use midwives have fewer complications, better outcomes, higher chances for a normal vaginal birth, and successful initiation of breastfeeding will seal the deal.
It’s not for everyone. But it’s worth knowing that the option exists. How do you view birth—as a natural process or as a medical event? Change the way you think, and you may find yourself changing the way you act. Keep an open mind and consider the words of Anna Verwaal: “A woman, as long as she lives, will remember how she was made to feel at her birth.”
After bidding farewell to the structure of the corporate world over a year ago, Robyn Wolfe Fogle now spends her days pursuing the things she loves. Among her passions are free-lance writing, rock climbing and running.