Is Home Birth Safe?
Since I am a doula, birth educator and offer prenatal planning sessions I am frequently contacted by people who are mapping out their pregnancy or are already pregnant. One of the most commonly expressed dilemmas is, “I’d love to do a home birth but since this is our first one we want to be safe…" or “We want to do a home birth but what if something happens?”. Of course, I always ask people to explain what they think could happen and ask what would be a situation they’d need to be in a hospital for. It's a difficult question for them to answer with specifics. The concern comes from a place of fear and lack of knowledge about birth. And thats ok, because this is a journey of discovery. Here is an example of a common birth concern, “What if the umbilical cord is wrapped around the baby’s neck?” This is called a “nuchal cord”, it’s when the umbilical cord becomes wrapped around the fetus's neck. Many people don’t realize that babies receive oxygen through the umbilical cord, they aren’t actually breathing through their throats like we are, so an object wrapped around the neck doesn’t affect them like it would an out of womb person. There are techniques to swiftly untangle the cord as the baby is being born. If the cord is in some way truly affecting the baby then the heart tones will indicate that. Typically however; it’s not the cord that is affecting the baby’s heart tones, but the mother’s body position which should be changed throughout labor to bring more oxygen to the baby.
If a pregnant woman is lying on her back, the weight of the womb is more likely to compress the inferior vena cava, decreasing the amount of blood returned to the heart, and because the mom’s blood carries oxygen to the baby, the baby in turn receives less oxygen. This is one of the reasons epidurals, where a mother is sedentary on her back for extended periods, can pose issues to baby’s oxygen intake. When heart tones drop in labor and do not come back up often cesareans are suggested in an attempt to “save the baby”. In order to avoid this during your birth stay active and out of bed!
A (Super) Brief History of Birth
Let’s take a look at a little “home birth” history. Humans have been giving birth at home, or out of hospital, for 200,000 years. The shift to hospital births started in the 20th century. “What happened in the beginning of the 20th century was the introduction of anesthesia for delivering children, and women wanted to have pain-free childbirth” - Margaret Marsh, professor of history at Rutgers University. Women were promised less painful childbirth, however; because hospitals are typically inhabited by ill people with spreadable diseases the outcomes for women weren’t that great. “Lots of complications, lots of infections, it didn’t have the effect that women desired. They wanted safer, less painful childbirth, but in the first half of the century, it was not always safer childbirth.” - Marsh. As hospitals became financially supported by pharmaceutical companies there was a lot of marketing that circulated promising the ideal birth experience happening in a hospital, however; because pharmaceutical companies had such deep financial investment, many other interventions and drugs were also marketed as “necessary” for birth, although they absolutely were not. During the 1940s, 50s and 60s it was primarily male obstetricians delivering all the babies, treating birth as a medical procedure, so the feminist movement of the 1970s revived women’s interest in midwifery care by treating it as a natural process in a woman’s life. “Women once again wanted to control their own childbirth experience,” - Marsh. And ultimately this is how home birth made a huge come back.
What was causing Maternal & Fetal Death? Was it Home Birth?
No, home birth was not the cause of fetal or maternal mortality rates. Remember, we did it this way for 200k years. In the year 1900 infant and maternal deaths were primarily caused by lack of or poor prenatal care. Women also had poor diets, especially in lower income situations therefore they often developed complications like Toxemia that went undetected. Not to mention no testing for Sexual Transmitted diseases during prenatal care. Rising standards of living, including improvements in economic and education levels of families, helped to promote health and access to nutrition during pregnancy. Declining fetal deaths were also supported by women choosing larger spacing between children, smaller family size, and better choices in nutrition for themselves and infants postpartum. Many environmental factors like proper sanitation and introduction of proper sewage systems also affected the rise in positive maternal and fetal outcomes. So it wasn’t necessarily hospitals that made birth safer, but better prenatal care, education and socio-economic improvements.
How does the birthing environment affect the fetal and maternal outcome?
Typically, a home birth environment feels safe for women because they know who will be there, they are also have control over drinking, eating, lighting and a variety of comfort measures that support a sense of ease and security.
A home birth environment feels safe for women because they know who will be there
Through observation and testing of animals during the birthing process, Naaktgeboreen (1990) noted that the environment is of crucial importance to many species. In fact, in all mammalian species a stressful environment can adversely affect delivery (birth). For example, anxiety, fear, removal to an unfamiliar environment, noise, excessive light, overcrowding or the presence of a stranger can prolong or halt labor. This instinctive reaction is part of the primal ‘fight or flight’ mechanism, common to all mammalian species. It is necessary and extremely effective as the temporary cessation of labour allows the vulnerable mother some chance of relocating to avoid the stressor. In the short term this response saves the birthing mammal and her unborn infant. If, however, the source of stress is continuous, the constant conflict between hormones of parturition (birthing) and hormones initiating the ‘fight or flight’ response react adversely and can cause pathological problems for the birthing mammal and the infant.
As noted above, a hospital environment which can stimulate a fight or flight mechanism within women could bring about interventions that jeopardize a successful outcome for the mother and the baby. Through this scope, home birth can certainly be considered safer simply based on the environment it provides for the mother.
So where is the safest place to birth?
There is so much more to write about what true medical emergencies are in labor and birth. In a hospital there is such a magnifying glass on “potential emergencies” that a perfectly healthy woman and baby can sometimes fall victim to procedures that can complicate their otherwise normal birth. Many “true emergencies” or complications people worry about during birth are usually detected way before the day of the birth. If a complicated is recognized during the mother’s prenatal care it is up to her and her team where they would like to continue their care, in some cases the hospital may be this place. A wonderful and important thing to do if you are under the care of a midwife and planning a homebirth is to discuss potential situations where a transfer to a hospital would be necessary. A midwife will not accept a client who is high risk so the challenges a high risk woman may experience at a hospital do not apply to the woman who is low risk birthing at home.
Birth is normal, and a woman who has a normal, healthy pregnancy can have a baby wherever she pleases with very little assistance. Being left to their own devices, much like a mammal in nature, a woman will birth the baby whether she has an IV or not, whether she has the best technology, or whether her doctor went to Stanford medical or not. Go to the hospital if you feel comfortable there, or if you are high risk. Just know you will have much less control over your experience there, and in some cases you are not necessarily “safer”.
Ultimately, a woman who is low risk and receiving comprehensive prenatal can birth at home and experience wonderful outcomes for herself and the baby. Similarly, this can happen in the hospital as well, as long as a woman and her birth team practice informed consent and keep unnecessary interventions at bay. I will write more on how to prepare for a beautiful and successful hospital birth in another post.
If you are pregnant, have been or would like to be and would like to learn more and receive guidance please feel free to set up a Bespoke Consultation via Zoom, HERE. I am available to discuss this and any other topic. Thank you for reading!