This month I had the opportunity to represent the documentary Why Not Home? at the Midwifery Today conference in Mt. Laurel, NJ. Getting to talk shop with all the midwives, doulas and birth workers was such a great experience. I also got to promote my doula co-op, Two Hands Birth Services and meet some local midwives that I hadn't had the pleasure of meeting until now. Getting to talk about home birth and midwifery for the weekend got me thinking about my own path to birth work and where this journey as The Nomadic Doula might lead. I have entertained becoming a midwife in the past but hearing about all these different birth workers journeys make me wonder. It also makes me sad that home birth is such a minority of the births in this country when so many passionate midwives are dedicating their lives to pregnancy, childbirth and home birth. Did you know, less than 1% of babies born in the U.S. are born at home.
The documentary Why Not Home? is an unique perspective on home birth, doctors, nurses and midwives that work in hospitals who choose home birth for themselves. Some of the reasons these medical professionals chose home birth was to avoid the management, activity and anxiety present in the hospital. Some wanted to know who was going to be at the birth of their child and not have strangers present. Many people choose home birth to be more comfortable in familiar surroundings and so their other children can be there. I chose home birth for the birth of my third child for all these reasons, for me I knew I would be more calm in my home and I wanted to have my whole family there. I also wanted to avoid any unnecessary interventions or have to fight for my choices in a hospital because I was advanced maternal age.
Birth in any setting, hospital, birth center or home, can present risks. But for anyone with a low risk pregnancy who feels that they would labor best at home it can be a good decision. To make sure you are a good candidate for home birth it is best to be under the care of a midwife. Home birth midwives value safety and will do anything they can to get a good outcome for both baby and the laboring person. A "low-risk" person is healthy and has no pre-existing or insulin dependent diabetes or high blood pressure. The pregnancy is near term, 37-42 weeks and baby is in the optimal position for delivery. This is 85% of all pregnancies in the U.S. In the United Kingdom home birth is recommended for low-risk pregnancies by the Royal College of Obstetricians and Gynecologists and the Royal College of Midwives. However, in the United States, the American College of Obstetrics and Gynecologists (ACOG) said, "Planned home birth is associated with twofold to threefold increased risk of neonatal death when compared with planned hospital birth." Why is there such opposing views? They are each basing their decisions on different data. If you would like to learn more about the different studies that each is basing their findings check out these videos.
In all births, regardless of the setting, maintaining the health and safety of both the pregnant person and the baby are most important. In any birth there are risks and benefits and the objective is to weigh those out to make the best decisions for you and your family. Home birth and hospital birth each have risks, in a hospital you are at a much higher risk for interventions.
Some interventions like, induction, epidural, forceps or vacuum, episiotomy and Cesarean delivery can have serious complications to the pregnant person or the baby. In the United States 94% of home births result in a vaginal birth with no interventions, in the hospital that number is less than 50%. Once interventions are introduced it is likely that more will become necessary because the natural process of labor has been interrupted. This is known as the cascade of interventions. Pregnant people who have had an induction and an epidural are 6 times more likely to have a Cesarean than those who had neither.
The Cesarean rate in the United States is too high, in 2016 the Cesarean rate was 31.9%. The WHO (World Health Organization) recommends a target of 10-15%. The high rates don't seem to be because of an increased need but increased pressure by hospital staff. In a large study of 40,000 first time Cesarean births the number one reason given was "failure to progress". The midwifery model of care is very different than the hospital model because it is based in the belief that a pregnant person's body will know what to do and when to do it and it can take time. Home birth midwives don't interfere in birth unless there is a clear medical need. Hospitals are pressured by staffing needs, availability of beds and the idea that childbirth can fit into a schedule. Those pressures weigh heavy on some laboring women and cause labor to stall. It is so important that we respect the process of labor and the laboring person and not disturb them.
If a home birth needs to transfer to a hospital, which is 10-30% of home births, it is essential for good communication between home and hospital. A pregnant person may transfer to the hospital for a variety of reasons like, failure of labor progress, desire for pain medication, baby's position or exhaustion. It is really wonderful when the hospital staff can collaborate with the home birth midwife to make an easier transfer. It is not always the case when a home birth transfers to the hospital that it is accepted with open arms. If anyone is thinking about home birth this is something that you should talk to your midwife about so you have a plan in place.
Home birth in the United States is roughly 50% less expensive than hospital birth. This is a rough estimate because of the differences in costs throughout the country in different health care systems. Unfortunately, home birth is not usually covered by health insurance and that parents have to foot the bill may sway some away from home birth. My home birth was $6700. in New Jersey and my insurance company reimbursed for $2500. They categorized this amount as prenatal care and would cover it but the bulk was out of pocket for us. The idea of a home birth meant so much to me, especially after having my other two children in the hospital, it was worth it. Hopefully, as home birth becomes more common and the studies are understood better, health insurance is more likely to provide coverage.
It is my hope as a doula and a home birth mom that more people will consider home birth as a choice. This documentary lets you follow families on thier journey to meet their babies and they chose home birth. For these families and my own it offered so many benefits. As a doula it is my mission to educate families and give them all the information to make the best choices for them. I hope that through this film some people may see the benefits for them and say, Why Not Home?