“So Seamless” – Choosing to Birth at Home
We opened this year’s season of Healthy Birth Workshops with a full room of first and second time parents-to-be, gathered to learn more about home birth. While some were already planning to give birth at home, many more were there with questions, wondering whether home birth might be the right option for them. We were honored to be joined by four new moms who shared their birth stories and home birth midwife Kimm Sun, CNM who answered questions and shared her expertise with our expectant parents.
Since 2004, the number of home births nationwide has risen by almost a third, to just under 1% of all births in America. Research shows that women choose home birth for a variety of reasons. For some a close, trusting relationship with their midwife is a big draw. Home birth midwives often provide especially personalized care, with at least some prenatal visits taking place in your own home. Lying back on your own couch while listening to your baby’s heartbeat can be a magical experience. Other major factors include the desire to avoid unnecessary interventions and to be fully involved in decision making during labor.
When Natalie, the first speaker, was pregnant with her first baby, she and her husband decided to give birth at a freestanding birth center. At six months pregnant, however, Natalie experienced preterm labor, and was on bed rest for the rest of her pregnancy. Reflecting on her experience in the hospital, she realized how unsupported and afraid she had felt: “I felt really invisible that night.” As time passed, she began to realize how much she craved an intimate labor and birth, in which she and her wishes were honored. As she noted, “some of the things that come up during birth are really, really personal.” She was thrilled when she made it to full term and gave birth at home with her chosen midwife.
For her second baby, the decision to have another home birth “felt so natural.” She and her husband carefully prepared their home for birth, choosing candles and music to support the ambience they wanted. When her Braxton Hicks contractions started to feel different one night, she realized this was it. Her labor moved quickly – her contractions going from 10 to 4 minutes apart in the space of just 10 minutes. However, she says, she felt calm and safe. “It was so seamless the way my doula and midwife came and honored the space that we had created in our home and the way that my husband was supporting me.”
An hour after her midwife’s arrival, Natalie gave birth on her hands and knees. Her midwife passed her new son between Natalie’s legs and placed him gently on the floor in front of her. It was their chance to meet their baby. “That stillness and that silence were so profound”, says Natalie. With no hospital staff rushing around and no distractions, “we were able to just really get lost in him and wrap him up in our attention. It was such a gift.”
Ginny, the second speaker at the workshop, had been seeing an OB throughout her pregnancy but was unhappy about the short appointments and lack of interaction. She didn’t want her son to be born under strong lights, in a busy environment and possibly separated from her. After talking with her doula, who had birthed two babies at home, she decided to meet with a home birth midwife. They had a long, detailed conversation covering all the possibilities and scenarios that concerned her. As her worries eased, she realized this was what she wanted.
The day before her due date, Ginny felt some cramping which, as the night went on, started to feel more like contractions. Like Natalie (and unusually for a first time mom), she experienced a fast labor, supported by her husband and doula. She tried different coping methods learned in the childbirth education classes she had taken, ultimately finding a particular vocalization that helped her through. “It was good to have that toolbox to work from,” she said. In particular, she found great relief from the intensity of contractions in the birth pool they’d bought second hand and set up in their kitchen. “It was worth all the money for that little break!” she told us. Indeed, laboring in water is sometimes referred to as “nature’s epidural.” While some women use their bathtubs, Kimm Sun recommends hiring or buying a birth pool, as a depth of at least 18-20” helps obtain the buoyancy needed to support a laboring woman. When her midwife arrived, Ginny was fully dilated and ready to push. A short while later, climbing out of the pool, she pushed hard and caught her new son in her own hands.
The third speaker, Rachel, gave birth to her first baby at an in-hospital birth center, returning to the same practice for her second pregnancy. At 32 weeks pregnant, however, she abruptly learned she had been “risked out” of the birth center due to a slight complication at her first birth (of which she had been unaware), and would instead have to be in the regular labor and delivery unit. Already knowing she could give birth without pain medications, she discussed her options with her doula and met with some home birth midwives.
“There was a world of difference to me in the way the home birth midwife talked to me and answered my questions,” she told us. “She just took it all in stride, even telling me ‘I’d be worried if you weren’t asking me these questions.” 35 weeks pregnant, she made the decision to switch. She felt safer at home, was not seen as “high risk” and would be able to avoid the car ride to hospital in active labor which, first time around, was the hardest part of her labor. As her prenatal visits continued, Rachel realized their long talks were part of her important work of psychological preparation for giving birth. Her Childbirth Education classes too, she felt, contributed to this work of preparing the mind for birth. To protect this psychological space, she and her partner decided not to tell others about their decision to birth at home until after the baby arrived.
Rachel’s labor began on a beautiful, sunny morning with contractions which moved quickly to five and then 3 minutes apart. She labored alone for a while, as her husband took their son to stay with friends and set up the birth pool. She felt “so safe – it was all going to be fine.” Her midwife and doula joined them. “The silence was beautiful.” Her second son was born into water in the birth pool. “It was one of the most profound experiences of my life,” she told us. “Just to have had my son in that calm. I was in the perfect space. I feel lucky to have had that experience.”
Both Ginny and Rachel spoke of the importance of postpartum support, of making sure family, friends or a postpartum doula are in place to help out in the ways that you and your family most need in the days and weeks following your baby’s arrival. Here you can find some ideas for friends and family of ways to best support you during this time.
On occasion, a small proportion of women need to transfer from home to a hospital. Home birth midwives are highly skilled at recognizing when such transfers may be needed and ensuring they take place early. “The thing about transfers,” noted Elana, “is that it’s not usually an emergency situation – and mine certainly was not.” Emergency transfers are in reality very unusual. Most transfers take place with plenty of time and because a woman genuinely needs one of the interventions available in a hospital setting, such as pitocin or pharmaceutical pain relief.
Elana, the fourth speaker, also began her pregnancy under the care of an OB, but felt dismissed when she attempted to discuss her birth preferences. As she and her husband clarified their wishes for birth through their Childbirth Education classes, reading and conversations with their doula and friends, they came to realize that the birth they wanted was not what they would experience in a hospital setting. Elana met with a home birth midwife and talked in detail about her fears for home birth, which she found it helpful to articulate. Her midwife’s biller dealt directly with their health insurance company and got their birth fully covered.
Elana began feeling contractions on and off on a Wednesday night. By Friday evening, her midwife and doula were checking in on her. Over the next couple of days they tried several measures to help intensify her labor, including nipple stimulation, long walks, acupuncture and even inversions to give the baby more space to change position. However, progress remained very slow and, despite baths and medication to help her rest, by Sunday Elana felt exhausted. The possibility of transfer had been discussed a few times by now, and her midwife had been speaking to the attending OB at Elana’s chosen hospital. She and her partner had picked a hospital in case of transfer with which they were familiar, where they had taken a tour and which, importantly, was certified as Baby-Friendly.
The car ride and the shift of energy from the dark and quiet of home to the bright, busy environment of hospital were very challenging. For the first hour, as they transitioned to this new space and pitocin was started, Elana found it hard to stay in her “zone” for contractions. Then, as her doula turned down the lights and put on some music, the mood was reset. They began to sing together, which helped her considerably.
Finally, on Monday morning, Elana was ready to push her baby into the world. It felt good to push while standing and leaning onto the bed, but as the OB was not open to this position Elana’s midwife, who had remained with her, persuaded the doctor to allow her to give birth on her hands and knees. She helped Elana turn onto her back as soon as the head was born, and, seconds later, she was snuggling her new baby skin to skin on her belly.
While many of our speakers happened to have unusually short labors, most labors whether at home or elsewhere take more time. A longer labor by itself by no means precludes a successful home birth. Shorter births are more common with second and subsequent babies, and home birth midwives are prepared for this. Kimm, who aims to be there 4-6 hours before the baby is born, told us: “Sometimes with second time moms, I sleep in the car. It’s January, it’s minus 20 and I’m sleeping in the car.”
For many women, home is the place they feel most safe and comfortable to labor. This does not mean home birth is the right or even the most desirable option for every woman – if you feel more safe and comfortable in a hospital or birth center setting, you can trust your instincts and focus on finding a care provider who will support you in the ways you wish in those settings. For most women experiencing a healthy pregnancy and who wish for a natural, intimate birth, however, home birth is a valuable option to consider. As Natalie put it: “Home is where you feel at ease – it’s safe, it’s comfortable, it’s quiet”. And for many parents to be, it is the space in which they want their baby to enter the world.
This article was written by Milon Nagi, a CiC volunteer and a founding member of CiC’s Program Committee.