There are probably as many different answers to this question as there are women who choose homebirth. But today, I will focus on just one: safety. SAFETY?! Yes, safety. No birth is risk free, no matter where a mother gives birth. Some women feel safer in the hospital (after all, they have all that equipment and personnel RIGHT THERE "just in case"). And no doubt about it, things can go wrong during a birth. Do not let anyone give you a false sense that birth is risk-free.
Yet on the other hand, do not let anyone give you a false sense that birth in a hospital is risk-free either. The problem with a death or injury in the hospital is that it is generally assumed that "it would have happened anyway and I'm so glad they were there to save me." This is a false belief. Many practices that go on during hospital births CAUSE injuries that, tragically, can lead in a small number of cases, to unnecessary deaths, but much more often, to a scary, unsatisfying birth experience that feels more like a TV drama than a normal, natural process. How? The hormones that are responsible for normal childbirth depend on certain conditions: a mother must feel SAFE and LOVED. (Those of you who have taken my birth classes must remember this mantra of mine.) Safety has everything to do with privacy.
Do I feel safe when I am semi-clothed, surrounded by strangers, going through a normal bodily process that I cannot control that might cause me to shout or moan, as blood and other fluids come out of me? I think not. I cannot feel safe giving birth in a strange place, around strangers, no matter how well-intentioned, well-trained, or well-educated they might be. When I do not feel safe, my natural pain killing hormones--endorphins--do not work like they should, so pain increases. As pain increases, I become anxious. When I am anxious, oxytocin slows. Since oxytocin drives contractions, less oxytocin means contractions slow. I become frustrated by the lack of progress. Adrenaline kicks in. Contractions slow even further. I am even more frustrated. Why doesn't my body WORK? I worry that this is taking too long and will I be able to give birth at all? I then get an IV stuck in my arm with artificial oxytocin (Pitocin) that causes me pain. I have tubes coming out of me and monitors strapped to my body and possibly to my baby's head that keep me from being able to get up and move around, something that might help relieve pain and get labor going. More adrenaline. Labor slows or even stops. This is what happens to many many mothers laboring in hospitals.
At home, the only people there are those I have chosen to be with me. I know far beforehand that my midwife has herbs or medication to help me if I begin to bleed after the birth and equipment to help the baby start breathing if necessary. Even if labor goes slowly, I do not feel unsafe. I have my husband with me who cares for me, and my midwife whom I trust. There are no strangers around who might make me feel strange for the volumes of sound I am producing or the fluids coming out of me. There are no strangers coming in and out, asking me questions, looking at machines and checking things as if I am a time-bomb that could explode at any moment.
Endorphins can increase to meet the level of pain I am experiencing. When I feel loved, when my husband holds me and tells me how good I'm doing, oxytocin levels go up. I can move around as I please, and therefore, labor can progress normally, most of the time. And if my midwife thinks it is truly taking too long, we can transport to the hospital if necessary, and I won't have to wonder if I could have done it at home, because I will have tried.
No, homebirth isn't for everyone. Some mothers or babies have legitimate health concerns that make hospital birth safer for them. But many more mothers could give birth successfully at home, surrounded by their loved ones, if they would only try. There would be fewer injuries overall. A helpful comparison is to look at a large set of homebirth statistics--which is available from the Farm homebirth midwives who, in this study, helped 1707 mothers. There was a perinatal (infant) death rate of 1% for these homebirths--this was slightly less than the hospital group, though the difference was not statistically significant. There were no maternal deaths among the Farm mothers.
Unless they need to transfer, homebirth clients birth without any pain medication, which is safer for mom and baby. In the Farm study, over 90% of mothers birthed at home, without any pain medication--this compares to about 90% of hospital birthing mothers who birth with an epidural or intrathecal, according to one local nurse-midwife who asked me not to give her name. (Statistics from mothers graduating from SCBP classes are somewhat better: 50% of moms who birthed in hospital used pain medications--no homebirth moms used pain meds.)
What was statistically significant in the Farm study were the differences in interventions used in the hospital births vs. homebirths. Homebirthing moms hardly ever require forceps or vacuum extraction, in my opinion, because they are allowed to push in the positions of their choice, not those positions "encouraged" by those around them, which are usually less advantageous for birthing. In the Farm study, 2.11% of moms required a cesarean, forceps or vacuum extractor. 26.6% of those mothers giving birth in the hospital needed those interventions. For cesarean alone, only 1.46% of mothers assisted by the Farm midwives required a cesarean vs. 16.46% of the hospital mothers. As a whole group, it is estimated that homebirth midwives (not just the Farm midwives) typically have cesarean rates of less than or around 5%. In the U.S. at large more than 30% of women have their babies delivered surgically.
What about transports to the hospital from homebirths? The most common reasons for a transport to the hospital are not life-threatening complications, but because labor seems to be taking too long or meconium in the waters. Just like in the hospital, baby's hearts are monitored during labors at home---but usually with your midwife's ears, and a handheld Doppler or fetoscope, rather than machines and wires. So if your midwife detects that baby just isn't tolerating labor well, you will transport. In my experience, another common reason for transports among homebirthing mothers I know, is for tears that need stitching (an important skill that I interview for and require in a homebirth midwife before hiring her). To get some perspective, transfers of care were required in 13.5% of Farm mothers, only 7.4% of these during labor. This seems comparable with other homebirth studies. (See this webpage for more.) In other words, most mothers who want a homebirth are able to achieve that homebirth--especially if they have had a baby before. But even most first time moms can successfully birth at home, if they are determined, and have excellent support.
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