Most births in the United States take place in hospitals. But other developed countries have better outcomes with a higher rate of home birth and midwifery care. What's the deal with home birth? And is it really safe?
When considering home birth, the biggest question seems to be, "What if something goes wrong?" In a minute, we'll talk about some of the most common concerns.
But first, we have to talk about the reality that hospital birth does NOT guarantee safety.
There is nothing, whether total reliance upon intuition or total reliance upon technology, that can guarantee a perfect outcome. Life is inherently risky. Ultimately, nobody but YOU can decide which risks you are comfortable with. But there is a set of biological needs that all mammals (including us) require in labor. Dr. Sarah Buckley calls this our hormonal blueprint.
The birth process is literally driven by our love hormone, oxytocin. It's produced in the brain, and has countless beneficial effects that the synthetic version (Pitocin) administered through an IV does not.
Our brain also helps us flow with labor and reach deeper within ourselves than ever before by releasing hormones called endorphins. This is nature's pain relief and endurance medicine, often referred to as a runner's high for those who run marathons. (The body's signal to release endorphins is disrupted by Pitocin.)
Our physiology is designed such that we release these hormones in perfect timing and rhythm to create a safe and satisfying birth, successful breastfeeding relationship, and lifelong bond with our babies.
What's required for these hormones to work as nature intended? An environment that is...
Dark or dimly lit
Where you feel safe
It is very difficult to meet these biological needs in a hospital, which in turn, can lead to more interventions and complications. So the things you may be afraid of "going wrong" are truthfully a lot less likely to happen when you remain at home with good support.
Let's address some of the most common concerns about home birth...
Is it safe?
First of all, safety and risk are relative. It may feel safer for someone to be near an operating room in labor just in case it's needed, while it may feel safer for another person to be at home where there's no interference with their birthing hormones. Nobody but you gets to decide what is safe.
For a healthy mom and baby, there is a very low risk of serious complications in home birth. Nearly 90% of people who plan for a homebirth are successful. For those who end up transferring to a hospital, the most common reason is a long labor and exhausted mother rather than an emergency. The rate of infant mortality in home births is around 0.17% and maternal mortality even less. In hospitals, the infant mortality rate is closer to 0.59% and maternal mortality rate closer to 0.2%. All these are less than 1%, which is pretty low.
Honestly, you'll probably be fine in either birth setting. But one of the them involves being hooked up to machines and tubes, fingers regularly being inside you, having a time limit, higher risk of intervention, and abiding by someone else's policies.
What if my uterus ruptures?
Uterine rupture is extremely rare, occurring in less than 1% of women according to vbac.com. In the small group of women who do experience a uterine rupture, it is more likely to occur for those who have had a previous c-section and are being administered labor inducing medication (pitocin or misoprostol/cytotec) that increases the rate and intensity of contractions.
What if I have placenta abruption?
Placenta abruption is also extremely rare, occurring in 1% of women according to americanpregnancy.org. In the small group of women who do experience placenta abruption, they have usually already been diagnosed as high risk due to high blood pressure or some other condition. If this is occurring at home, you would be alarmed by the heavy amount of bleeding and simply go to the hospital for additional care.
What if the cord is wrapped around the baby's neck?
Approximately 1 out of every 3 babies is born with the cord wrapped around their neck, and it's not a big deal. Before a baby is born, they are receiving all their oxygen through the placenta via their umbilical cord. The umbilical cord is infused with something called Wharton's jelly, which protects the vein and arteries from being compressed. Baby's body won't switch to breathing air until a series of events occur within their body as they're exposed to gravity for the first time. To learn more about this transition that babies make, click here.
What if the baby gets stuck with shoulder dystocia?
Shoulder dystocia happens when a baby's head is emerging but their shoulder is caught behind your pubic bone. The likelihood varies from 0.2%-3% and is dangerous if not corrected within a minute or two. Shoulder dystocia is not super common but the risk factors that increase the likelihood are gestational diabetes managed with insulin (lower risk if managed with diet & exercise), epidural anesthesia, and Pitocin.
A midwife will be able to tell if shoulder dystocia is occurring because they baby's head will not rotate once emerged and they'll start to turn dark purple. Most often, all that's needed is for mom to flip onto hands and knees. If that doesn't resolve it, the midwife can gently insert her hands and manually rotate the baby's shoulder away from the pubic bone. This is usually dealt with a lot more forcefully in hospitals and can cause injury to mom and baby. I did some research on this here.
What if the baby isn't breathing after birth?
Sometimes babies need a minute to realize that they've been born. If they're not crying right away, the two things they need are warmth and stimulation, simply being skin-to-skin with you and having their back rubbed. Keep in mind, they're still connected to oxygen flow through the umbilical cord. Talk to your baby and help them transition to this plane.
If a baby needs some extra help breathing, midwives always bring an oxygen tank and resuscitation supplies. They can lay baby flat on their back either on your abdomen or right next to you to resuscitate while the umbilical cord is still attached and pumping oxygen-rich blood into their body. (In a hospital, the baby's cord would be clamped and cut, and they'd do this procedure on the warming table.)
What if I hemorrhage?
Hemorrhage occurs in 1-5% of women, and is usually related to cesarean section or medicated birth. The most effective ways to prevent a hemorrhage are to build up your blood supply in pregnancy (nettle leaf tea and iron-rich foods) have a physiological birth without medication, and patience in the 3rd stage (birth of placenta).
Some bleeding after birth is normal, and your midwife will be keeping an eye on it. Placentas are usually ready to come out within the first 5-20 minutes, and there will be a small gush of blood when it detaches from the uterus. Sometimes placentas take longer to be released and that's ok if your bleeding is minimal. Rushing it by pushing and pulling before it's detached can cause hemorrhage, so patience and gentle support are key.
There are things you can do before adding medicine to the mix: go pee to make sure your bladder isn't blocking it, lay down with your baby skin-to-skin, hydrate, eat something, have a spoonful of honey, and start breastfeeding or nipple stimulation. Some people also like to have tinctures on hand, such as angelica or shepherd's purse.
If you feel faint or your midwife is concerned, they always carry pitocin and herbs with them.
Isn't it messy?
Yes and no. Birth is messy, no matter where you are. There's blood, poop, sweat, and all kind of fluids. But germs are a different story. Bacteria is everywhere, but your home is full of your bacteria while hospitals are full of everybody else's.
When planning a home birth, you can prepare to have a bunch of useful items handy, including: ample towels that you don't care about getting dirty, waterproof mattress cover (or some people use shower curtain) to protect the bed, garbage bags, washable waterproof pads that you can later use to sit on naked in bed or give baby naked tummy time on, and maybe a birth tub if you want one. Your midwife or support team can set everything up to protect your floors, couches, and bed. And they clean up afterward, often leaving your house cleaner than before! (Click here for a great example preparation list.)
What if there is a true emergency?
Of course, if there is a true emergency and you need to get to the hospital as soon as possible, your midwife would call an ambulance. It is very rare (less than 1%) that home births require emergency transfer. The vast majority of the time when midwives see a complication, they can correct it early. Midwives come prepared with a medical kit to manage complicated situations, but most of the time, it's just a variation of normal that can be resolved with proper hydration and nourishment. (Click here for a more detailed list of what's in a midwife's toolkit.) (Click here to learn more about home birth transfers.)
For more information about home birth safety, listen to episode 42 of the Healthy Births, Happy Babies Podcast: Is a Home Birth with a Midwife Right for You?
A Few Benefits of Home Birth
Midwives often come to your home for prenatal visits.
Prenatal visits are longer and more intimate than hospital appointments so you really get to know each other and have time to get all your questions answered.
You can labor at your own pace, eat and drink as you please, and birth in any position that feels best (even in water!). You are in charge of your birth experience.
You are in your own familiar, cozy space where you can relax.
Your body and your birth are treated as healthy and integral rather than as a medical emergency.
Undisturbed birthing hormones allow you to cope with the sensations of birth, give you the most blissful feelings of your life, make birth safer, and support successful breastfeeding and bonding.
Your midwife stays for a couple hours after birth to prepare a meal for you, support breastfeeding, clean up and throw in a load of laundry, and tuck you into bed.
What's really unique and special about home birth midwives is that they visit your home for days and weeks after the birth to support the transition of having a new baby. They'll usually come for a visit a day after birth, 3 days, 1 week, 2, weeks, and 6 weeks.
Remember, we are alive today because all of our ancestors survived home birth.
For as long as humans have existed, women have been giving birth at home. Hospitals only began growing in the 1700-1800's but even then doctors were not trained to deliver babies yet. Midwives were the primary care providers for women having babies. And even by the year 1900, only 5% of births took place in a hospital. Gradually, trust was handed over to doctors as midwives were discredited by the institution, and the view of birth shifted. Giving birth in hospitals has been normalized, but it is not normal.
Click here to read more about the history of childbirth and how it came to be viewed with so much fear.
Choose the birth setting and care provider that fit into your ideal vision for birth, not the other way around.
Care providers are not interchangeable; no two are the same. But providers in the hospital system have to abide by a much more strict set of policies than those at home, and with that often comes a more intervention-prone approach.
If you're on the fence about home birth, interview a few midwives and get all your questions answered. Feel them out and see if anyone would be a good fit.
If you still feel safer birthing in a hospital, also interview the care providers there!
Read my second home birth story
Watch my second home birth (video)
Jinti Fell's Home Birth (video)
Midwives' Cauldron Podcast Interview with Dr. Sarah Buckley about the science of our birthing physiology
Birthful Podcast Episode #11 - Why an obstetrician chose a home birth
Healthy Births, Happy Babies Podcast Episode #42 - Is a Home Birth with a Midwife Right for You?
Midwife's toolkit for home birth
Home birth supplies list
Home to hospital transfer information
Healthy Births, Happy Babies Podcast Episode #60 - Pregnancy is NOT a Disease that Needs to be Treated Medically
Healthy Births, Happy Babies Podcast Episode #63 - The Beauty of Waterbirth
What Mothers Have to Say...
"I was able to have an HBAC (home birth after cesarean) and there were many people that would not have let me have a natural birth due to spacing and previous gestational problems. My first pregnancy ended in an emergency c-section at 34 weeks due to severe preeclampsia, and 4 months later we discovered that we were expecting again. There were no doctors in our state that would have let me deliver naturally so we immediately started searching for a midwife that would work with us. We found a highly qualified midwife that was willing to monitor me closely throughout pregnancy to watch for signs of preeclampsia and we trusted we would transfer only if absolutely necessary. We were able to deliver our second girl at home 12 days after due date with no complications."
- Anonymous Badass Mama
"I am skeptical of hospital birth as the environment lead me to receiving unnecessary interventions, interventions that gave me PTSD. My labor slows down in the bright lights, lack of privacy and the medical staff's lack of trust in my ability to give birth. I just can't give birth publicly. My labor stalls and I have ended up with cesareans because the environment sent me into "fight/flight" syndrome.
When I chose later to give birth at home, (3x) is has always gone smoothly without any problems. I need privacy, dark and trusting support people. I need familiarity.
So I am skeptical of hospital birth - for me.
However, for over a century a culture of fear of childbirth has grown to epic proportions. If someone is afraid of birth, has been raised to not trust her body, and the thought of giving birth at home gives her severe anxiety, she should probably not give birth at home. She should be skeptical - for herself."
- Anonymous Badass Mama
If you'd like to share your home birth story on our blog, please send me an email.