Having had both of my babies at home, I get a lot of questions about it. Here are some of them, and some answers. If you want to know other things, please post a question in the comments and I will edit and expand this.
Why did you choose a homebirth?
I grew up in a community where practically everyone was born at home or at a birth center. My brother was born at home, and I was born in a birth center. My mom was friends with the local midwives and did birth photography. All of this was in West Virginia, where midwifery (at least for home births) is still sort of barely-legal. A few years ago, before I was pregnant with Silas, my friend Melissa was expecting her first baby. A mutual friend texted me one morning: “Did you hear? Melissa is on her way to the hospital!” Everything in side of me completely tensed up, near panic. I wrote back, “What is going on? Is she okay?” and held my breath until the reply–”Uh, yeah, she’s having the baby.” That was pretty much when I knew I would have a hard time giving birth in a hospital. I think of hospitals as the place where you go when things are going badly. I’m thankful that they are there for those emergencies, but I don’t think of birth as an emergency.
Further solidifying my commitment to home birth, my city moved the hospital right before Silas was born. It’s now twenty minutes farther from my house (so, about 40 minutes total), and you have to go through a wretched intersection where the highway meets the university. I’ve sat through three cycles at that light before; I can’t imagine doing it in labor.
Also, we live only half a mile from the fire station/EMT base for our area, so if we needed emergency help fast, it could be here really quickly.
I’m not good with strangers, and I can’t imagine giving birth in front of nurses or doctors I hadn’t met before. One of my friends had great hospital births and told me that if the doctors or nurses tried to do anything I didn’t like, I would just have to say, “I refuse this procedure.” I’m a conflict-avoider at the best of times. I didn’t want to worry about arguing with someone (especially a stranger) while I was giving birth.
Lastly, they don’t let you eat during labor at the hospital. Not that I had time to eat during either of my labors, but what if one of them had been twelve hours or more? It’s like running a marathon without that freaky power gel stuff. I seriously don’t know how people do it.
So what is so great about a home birth?
Well, first of all, this:
Our midwife (Misty) has become a friend, especially during this second pregnancy. Each prenatal lasted an hour, and there was plenty of time to talk about any questions that I had, to talk about stuff that wasn’t, strictly speaking, germane, to joke around. We had time to get comfortable with each other. When I scheduled the appointment where she came to check out our home setup and make sure everything was ready for the birth, I invited her to bring her family and stay for dinner. I can’t imagine doing that with any other medical professional (even my dentist, who is totally awesome). Having someone I trust and feel comfortable with be present for the births of my babies was a joyful experience for me. I loved that I didn’t have to hope that she’d be the one on call–I knew she would be.
Misty never tried to pressure me into any procedure or test that I wasn’t comfortable with. She explained the risks and benefits and then let me decide. She treated me like a smart person who does her research–an attitude I’ve rarely, if ever, gotten from doctors.
Misty was also careful to make sure she knew exactly what I hoped for with each of my births. She was realistic about the fact that births don’t ever go entirely according to plan (and neither of them did), but she cared about our hopes for them.
JC got to “catch” both of our babies. I doubt that would have been possible in the hospital. Misty was the one who asked if he wanted to catch Silas. We hadn’t even considered the possibility. It means so much to both of us that the first hands to touch them were their daddy’s. Especially during Petra’s birth, JC was much more involved in a hands-on way than I think the hospital would have been comfortable with. At one point, when I was resting with Petra on my chest, Misty asked JC to check the umbilical cord to see if it had stopped pulsing yet. When he reported that it hadn’t, she didn’t double check him.
I loved not having to argue with anyone, or see any strangers. During my first labor, Misty’s assistant didn’t even have time to get there, so it was just the three (and then four!) of us.
I loved not having to GO anywhere. During labor, especially my first, I couldn’t get down the stairs, let alone into a car and across town. I can’t imagine doing that. After the birth, I didn’t have to put the baby in a carseat until I felt ready. Silas didn’t ride in the car until he was two weeks old. Petra went for a short ride at a day old because Misty noticed a deep dimple at the base of her spine and suggested we take her to the doctor to make sure it wasn’t anything serious (it wasn’t). Other than that, she stayed home until I felt ready to take her out.
There are lots of bacteria in a hospital. I didn’t want to risk exposing my baby or myself to any of the bugs (many of them antibiotic resistant) floating around there.
I wasn’t on anyone’s timeline. I didn’t like the idea of a clock that starts ticking when you check into the hospital. I don’t think it’s safe or reasonable to pressure moms to augment labor if things are going slowly. I think that kind of pressure can make the process slower.
Is it safe?
This is a complicated question. Yes and no, really. It depends on lots of factors. In the Netherlands, where as many babies are born at home as are born by C-section in the US, home birth is absolutely as safe, in terms of maternal and neonatal mortality, as hospital birth, and has a significantly lower risk of unnecessary interventions. In the US, homebirth midwives are not generally integrated into the medical system. In some states (like Virginia), they aren’t allowed to carry life-saving medications. In others (like West Virginia), they aren’t even able to be licensed, and can be prosecuted for practicing medicine without a license. Licensing requirements vary from state to state, creating an uneven standard of care. It’s hard to find reliable, large-scale, studies because there are so many factors–many of them have insanely small sample sizes, and they frequently include unplanned or unattended homebirths, which are not remotely the same thing as planned homebirths attended by licensed, experienced professionals.
The best studies I’ve been able to find show that homebirth is, for low-risk women attended by a licensed midwife, about as safe as hospital birth. However, the key factor is the midwife herself. You have to choose wisely–you’re literally putting your life in this person’s hands. One midwife we interviewed (who I believe is not practicing anymore) was so aggressively negative about mainstream medicine that when we left, JC said, “She’d let you bleed out before she’d transfer you to a hospital,” and I think he was right. I know people who have had to transfer during births that Misty attended, and it was fine–she’s not afraid to make that call before things get seriously bad. When we interviewed Misty, we asked her about her training and what she would do in various emergency situations. She had solid answers for every question we asked. As we got to know her, we found her to be incredibly professional and well-read on all things birth-related. We felt safe with her.
Is it expensive?
Again, yes and no. We went into both of the births expecting that it would not be covered by our insurance, and budgeted for the year accordingly. As JC said, every baby only gets one birth. It’s worthwhile to make it as peaceful and safe as possible.
That said, what ended up happening was that, after about a dozen angry phone calls and letters, we managed to get Anthem to reimburse us for about 40% of the cost of Silas’ birth. We are with Aetna now, and we’re waiting to see how the billing works out for Petra’s birth. Misty offers a billing service, which is nice; lots of homebirth midwives don’t.
One thing we did this time is to pay with a Flex Spending Account (FSA). This is a type of account where your employer takes pre-tax money out of your paycheck and puts it in an account that can be used for various medical expenses, like copays and prescription drugs. It turns out that it can be used to pay a midwife. The fact that it is pre-tax is great, because it saves some money. Also, since it is automatically deducted, we don’t have to worry about forgetting to set it aside.
Homebirth could be one heck of a bargain for the insurance companies, if only they would get with the program. They could have fully covered both of my births, and then written me a check for a few thousand dollars just for fun and still have paid less than they would have for an uncomplicated, unmedicated hospital birth. There’s something about politics and money here that I’m not getting, because, in my experience, insurance companies are downright hostile to homebirth.
What about the mess?
There really wasn’t much at all. Petra was born in the tub, so the mess was totally contained. We were able to just rinse out the tub that day, and then later JC cleaned it the way we normally would. No big deal.
Silas wasn’t born in the tub, but there still wasn’t much mess. I had big disposable absorbent pads on the floor, and when it was all over, they went in the dumpster. Boom. Mess solved.
For each of the births, there was one load of laundry that Misty threw in before she left–mostly towels, I think. Nothing ruined, nothing stained. Pretty simple, really.
What if I decide, midway through, that I really, really want an epidural after all?
Hospital transfers are always an option, and in some cases, that’s the right thing to do. Also, midwives, since they don’t usually have medical painkillers to fall back on, are skilled at offering alternative ways to manage the pain. Sometimes just finding a new position can relieve any discomfort. Laboring in the water, I found, was incredibly effective. At one point, I had to get out of the tub for a few contractions, and I couldn’t get back in fast enough–they were so much worse out of the water.
I’ve heard stories of women laboring in the hospital and reaching the point where they felt they couldn’t do it anymore, and then having the baby before the anesthesiologist got the needle ready. Transition–the last bit of labor before you start to push–is often the worst part. In each of my labors, I reached a point where I felt like I couldn’t do it anymore, and when I said so, Misty told me that I was past transition and it would not get any worse. Knowing that the worst was behind me was all that I needed to get through the rest of it.
Did you eat your placenta?
Uhm. No. I also didn’t make art with it. I didn’t bury it under a tree (because I didn’t think we could dig a hole big enough to keep the dog from finding it). I think Silas’ placenta just went in the dumpster. We donated Petra’s to an organization that trains search and rescue dogs.
I told Misty that I would eat some placenta if it would save my life–which it can do, in the case of a postpartum hemorrhage–but otherwise, I wasn’t interested. If you want to, knock yourself out. It just isn’t my thing.
What are the downsides to homebirth?
You have to be committed to it. People will tell you you can’t do it. Everyone you meet will have a story about their friend’s daughter who “would have died” if she wasn’t in the hospital. Especially if it’s your first baby, for whatever reason, people will try to convince you that you can’t do it. They are full of crap, but they are everywhere.
Homebirth also creates something of a real estate problem. After having both of my babies here, I can’t imagine ever selling our little house.
The worst thing for me, this time, was that I had to have everything ready for about a MONTH before Petra was born. Every day, I had to look at the stuff that was all ready for her, and she stubbornly kept not showing up. It’s like planning a surprise party…where the guest of honor could show up any time in a five-week window. You’ve got the balloons, the cheeseball, the noise makers, you’re all hidden, waiting to jump out and shout “Surprise!” but no one is walking through that door. It gets old.