It’s risky. It’s painful. It’s messy. It may even cost you more out-of-pocket. Why, then, are some people choosing to forego the safety and convenience of a hospital birth and opting instead to labor without pain meds in a birthing center or at home? And why did I eventually choose this option for myself?
I only started considering an out-of-hospital birth after a few disconcerting conversations with my OB-GYN. She seemed uncomfortable when I asked her how often they use labor-inducing drugs or what their C-section rate is. When I dared to suggest that we skip some of the recommended tests or questioned her nutritional advice, I was made to feel like a difficult patient or one that apparently doesn’t care about my child.
It was after my 9-week ultrasound visit that I started reading up on birthing options. I was surprised to learn that about 30% of Dutch women give birth at home. In America it’s only 1%, but was about 50% in 1938. Why the change? Wikipedia states that, “The decline was due in large part to the expansion of private insurance coverage in the US and taxpayer-funded medical care in Europe and Canada, changes which included policies about where birth should take place. In addition, there was a large population migration from rural to urban areas, an increased accessibility to hospitals, and unwillingness by doctors to attend to women in their homes.” In other words, the shift has nothing to do with hospitals being safer or having better birth outcomes. But hospitals are safer, right? Not according to what I’ve read.
Here are some of the things I discovered about the differences between hospital births and midwife-assisted births outside of the hospital.
Doctor-Assisted Hospital Births Are Riskier Than Midwife-Assisted Home Births
For most people, the words “doctor” and “hospital” conjure up feelings of safety and security, the latest technology, and powerful medications that can cure most ills and ease all pain. But is that really accurate? Is there really less risk in a hospital?
Most of the studies I’ve come across (many are referenced here) show that hospital births are actually riskier than non-hospital births based on many different measures (including death rates). And yes, even for high risk mothers. This discovery really surprised me. Especially considering all of the stories I’ve heard over the years about women being “saved” by doctors due to various medical complications, like a breach baby. I wondered if a midwife is really able to handle these situations.
After interviewing several midwives, talking to people who had worked with them and reading up the topic, I learned that the sorts of conditions that a midwife can’t handle are extremely rare. For example, many people have told me that they *had* to have a hospital birth or medical intervention because of:
- a nuchal cord (umbilical cord around baby’s neck)
- previous C-section (VBAC)
- being past their due date
- baby being in breach position
- large baby
These are all very common situations and ones that midwives have dealt with for centuries (except for VBAC’s, as C-sections are a modern procedure). I’ve included links above to sites that talk about why none of these situations, in and of themselves, necessarily require hospital or doctor intervention. Of course these and other situations may require medical attention and midwives are trained to know how to quickly identify such situations and can then transport clients to the hospital. In my particular case, my home is less than 5 miles from a hospital, so I wasn’t worried about the risk of not getting to the hospital quickly enough, if necessary.
Risky Medical Interventions Are Much More Likely In Hospitals
Another risk that many women fail to consider is the long-term risks resulting from hospital interventions and drugs. For example, babies born via C-section are twice as likely to end up obese than babies born vaginally. They are also deprived of the immune strengthening benefits that come from being exposed to their mothers’ vaginal flora during birth. (Here’s an article about this). Here’s another article that discusses some of the other risks associated with C-sections.
The largest study of midwife-assisted home births, published in the British Medical Journal in 2005, concluded that hospital births have a much higher rate of interventions for low risk women. Specifically:
- Induction of labor with oxytocin or prostaglandins – 2.1% for planned homebirth vs 21% in hospital
- Stimulation of labor with oxytocin – 2.7% for planned homebirth vs 18.9% in hospital
- Episiotomy – 2.1% for planned homebirth vs 33% in hospital
- C-section – 3.7% for planned homebirth vs 19% in hospital
Hospitals also typically conduct vaginal exams and employ fetal monitoring during birth, both of which are controversial methods that some people may want to forego. It is very difficult to opt out of these in a hospital setting.
Many routine hospital practices are also associated with breastfeeding difficulties. These include epidurals, labor inducers, C-sections, separating the mother and baby after birth for exams, and feeding the baby formula. The last one sounds like something easy enough to opt out of, doesn’t it? Unfortunately I have heard multiple stories of hospitals feeding babies formula against the parents’ wishes and/or without the parents’ knowledge.
Home (or Birthing Center) Births are More Convenient
Before I found my midwife, my OB-GYN conducted my prenatal checkups. These took 60-90 minutes out of my day, most of which was spent in transit, in the waiting room or with the nurse. My doctor only spent about 10-15 minutes with me per checkup. In contrast, my midwife came to my house for every checkup and gave me as much of her time as I wanted, typically an hour per appointment. Some of that time was spent on tests (listening to the babies heartbeat, feeling his position, testing my urine, testing iron in my blood, etc.) but the majority of the time was spent talking about topics of interest to me, whether it be optional tests I could take, prenatal nutrition, birth preparation, or even fun topics like the baby shower, baby room preparation, how to introduce the baby to the cats, etc. Not only was the midwife model of care more convenient for me, but in the 5 months I worked with my midwife leading up to the birth, I felt closer to her than after 10 years with my OB-GYN.
Other conveniences of home birth that I enjoyed were:
- I was encouraged to prepare my birthing environment exactly as I wanted it – if that included music, candles, my bathtub, certain food or even the company of my cats, all was ok.
- There was no need to rush to the hospital once my contractions started - I was encouraged to go about my normal business, which for me turned out to mean cooking crepes for Sunday morning breakfast (yes, I know it sounds weird, standing over the stove flipping crepes in between contractions, but standing and walking during early labor is encouraged and besides – cooking is what I love to do, so I’m sure the happy hormones helped ease the pain!)
- I didn’t have to spend the first days with my new baby in an unfamiliar environment or wait for the doctor to tell me when I’m allowed to go home
- My midwife cleaned up after the birth
- I had access to my own refrigerator and pantry – no need to eat unhealthy and highly processed hospital food!
Access to the Midwife’s Network
Something I never considered when looking for a midwife, but eventually came to appreciate is how well-connected my midwife is. Shortly after birth when I was having trouble breastfeeding, she contacted a lactation consultant who arrived at my house just hours after the birth. She also found a breastmilk donor (someone who has a similar diet to mine!) and delivered to me a couple of weeks worth of frozen breast milk to tide me over while I worked with the lactation consultant (thankfully I didn’t need to use any of the donated milk, but it was reassuring to know it was there if needed). My midwife also noticed a potential problem with the baby that she thought a chiropractor should look at, so after a few phone calls, she got me an appointment the next morning with a holistically oriented chiropractor.
Many alternative care providers participate in or at least are referenced in naturally oriented online communities, such as the two Yahoo groups I participate in: NOVA Families for Natural Living and NOVA Homebirth. People speak very freely on these sites about challenges, advice, experiences, and recommendations, including very detailed feedback about practitioners. In addition to being a great networking resource, these online communities are useful for helping you find a practitioner. This is exactly how I found my midwife. Unfortunately many medical doctors these days subscribe to “reputation management” services, which sometimes go as far as to provide legal protection against negative feedback from patients. Personally I just don’t like the idea of working with a practitioner who in any way manipulates or suppresses feedback from clients.
Focus on My Agenda, not the Doctor or Hospital’s Agenda
My doctor sees hundreds of expecting women every year, so it’s no surprise that she has a methodology that she follows with all of her patients. Each visit requires various tests and topics of discussion, like cord blood banking, amniocentesis, hepatitis, HIV and other blood tests, and even measuring patients’ weight (as if we can’t do this ourselves). This is fine and well, but what I really don’t like is the large amount of time devoted to these topics at the expense of topics that are of greater interest to me, like their C-section rate, how often Pitocin is used to induce labor, birthing methods and alternative approaches to managing pain.
As I learned in my Bradley Birthing class, the hospital birth routine is fairly scripted. If the patient “fails to progress” quickly enough, drugs like Pitocin are administered to induce labor. If the mother has previously had a C-section, then all future births must also be C-section. The baby is washed after birth. The umbilical cord is clamped relatively quickly. Hepatitis B vaccine is administered before mother and child leave the hospital (even though this is a sexually transmitted disease – so why not wait until the child is older to administer??). While it’s sometimes possible to convince a doctor to deviate from their script, I learned in my birthing class that it is not easy and comes with a lot of guilt-inducing comments from the doctor, which is the last thing that I would have wanted during one of the most emotional events of my life.
The midwife model of care is very different. First, I am asked prior to any test, procedure or intervention if I want it. Even for something as simple as listening to the baby’s heartbeat, I am presented with stethoscope vs. doppler and allowed to ask any questions I have about the differences and then can select which I prefer. Yes, the midwife will, of course, emphasize those tests or procedures that she feels are particularly important. But the difference is that it’s a two-way dialog versus being told what to do.
Less Pain and Discomfort
Believe it or not, I am not a glutton for punishment, nor do I have a high tolerance for pain, whether it be emotional or physical. I think it’s important to evaluate not just the physical pain from labor and delivery, but also the pain resulting from surgery and drug side effects as well as the emotional pain that may result from any post-birth complications.
But what about the physical pain?? Everyone’s experience is unique and I’m sure that there are a lot of different factors that impact this, but I personally found the pain tolerable enough that it never occurred to me switch gears and go to the hospital. Don’t get me wrong, it was extremely uncomfortable at times – like really intense menstrual cramps. But I think I took some comfort in knowing what to expect and also knowing that I was going through this for good reason as opposed to, say, feeling pain due to an accident, which exacerbates the pain with the addition of negative emotions, like fear or sadness. Even during the final pushing phase, which was the most intense part, I was conversing with my husband and midwife in between pushes. And when the pain was too intense, I just stopped pushing and rested for 5-30 seconds. Then another intense push for 5-10 seconds, then another rest. It was all at my pace. No one was telling me when or for how long or hard to push. It was totally up to me. Despite my age (38), my small size (5’1″, 98 lbs pre-pregnancy, and narrow hips) and my baby’s average size at birth (6lbs 11oz) as well as his odd position (arm around neck, legs in breach position) my perineum didn’t tear. So that also spared me a lot of post-birth pain, which most women who birth in hospitals have to endure. The home birth study I referenced above shows that the incidence of both episiotomies and 3rd or 4th degree perineal tears are significantly more likely with a physician-attended hospital birth versus a midwife-attended home birth.
On the topic if pain/pleasure, I would be remiss if I didn’t also mention the unbelievable rush of euphoria that hit me the second my son was born. I still feel an immense rush today, almost a year after the birth, when I think about the fact that I accomplished something so amazing. No doubt that this ongoing joy more than offsets the pain that I endured for a relatively short amount of time.
The choice of where to give birth is a very personal one and one that I think everyone should decide for themselves. If you’re like me and your gut is telling you to consider birthing somewhere else, even if everyone is telling you to do it one way or another, I hope you will trust your instincts, do your own research and make whatever decision feels right to you.