Research shows safe planned home birth, how do we support moms to not fail?

I never wanted to give birth at home. “How foolish” I would think back in the summer of 2012.

And looking back I can pinpoint that I really meant “how scary, unknown, and foreign.”

The the reality is, that was just my culture and lack of understanding talking. Quite honestly, it was also I think a fear within myself that I was not enough or that I was somehow flawed and broken to a point that I must need assistance from within a hospital setting.

I even have a flashbulb memory sitting in the dark at a stoplight in OKC driving home while talking to family on the phone. I remember telling them about the doctor telling me that because of my circumstances I needed to labor at home as long as possible. To which I was asked “give birth at home?” and I laughed saying “NO! I couldn’t do that. I am not ready for that step.”

And I wasn’t ready but maybe the way I said it was my heart telling me that it wasn’t really foolish and that maybe it was just me not ready.

Why do I tell you this? Because most people know that I have had three home births. But I have also had that first hospital birth. In fact, it was a cesarean section and it was with my very first child. My doctor at the time literally told me not to come in until I was in transition.

This would be an absurd and ludicrous thought for most, but I had a Frank Breech baby. A position that is a variation of normal and always has been a normal, even if not ideal, birthing position in human history, but one that now results in a scheduled c-section 99.9% of the time. That’s because most hospitals aren’t equipped to deal with because most doctors aren’t trained to attend them. But my doctor was willing to let me do it, he had experience with delivering many breech babies, and he had successfully attended breech births multiple times.

So he asked me to stay home — for my own protection. He knew if I walked in any early I would have literally zero chance of trying to delivery naturally because they’d rush me into the operating room. So he wanted to give me a fighting chance.

What my OB really did was open my eyes to home birth.

He opened my heart to the centuries and millennia old tradition of bringing babies into the world in the peace and comfort of their own home, with the safety of calm voices, dimmed lighting, warm meals, and the sanctuary that is the home.

But I am not an anecdotal kind of person. I need research to back up every decision I make. So I looked into it, researched, and have continued to be in awe about the processes and sciences behind home birth and what many are calling “community” birth settings.

WOMAN BIRTHING AT HOME IN WATER TUB OR POOL

Science shows planned home birth can be, and is, safe.

So I completely understand that for some people home birth is simply not an option.

I will also very freely say that even with two of my home birth pregnancies, I have gone to the emergency room for some concerning symptoms to get checked out… like the time I traveled for 7 weeks and then had leg pain and thought I had a blood clot — Yes — I didn’t ignore it and I did seek medical treatment. (I think a lot of home birth moms get criticized for being neglectful in some way. But the reality is that I believe we are more in tune with our babies and bodies to ensure that we have uncomplicated and safe births. We have trusted providers who have back up providers and hospitals they work with when needed. And most if not all of us would gladly go to the hospital if circumstances required it.)

I feel like it needs to be said because I think we can all agree that there are instances when hospitals are necessary. My personal view is that they are for emergencies and sick care, not routine health and birth.

The risks and benefits of a planned home birth

A 2015 study in the International Journal of Women’s Health reported that there are lower rates of maternal morbidity including incidences of postpartum hemorrhage, and perineal lacerations. It also concluded that home births had less interventions overall and with few episiotomies or need for transfer for cesarean births.

Finally, they concluded that because of those outcomes and high rates of satisfaction because of comfort and control over both the experience and birthing environment, there should be integrated systems in place to support women who choose home births (but may also need a transfer of care).

Research shows babies born at home have more diverse gut bacteria

I am thankful that in the last ten years so much research has been done on gut health. Back when I first started writing about gut flora and it being the “second brain” it was something novel and a topic most people didn’t know about or understand. However, great strides have been taken in the last decade to know more on our overall health!

Babies start building their immune system and gut health in the womb. The first building block of the immune system isn’t complete until around the age of two and then most children do not have a fully functioning immunes system until age 8! (Citation)

A 2018 study has a long but important quote to consider.

Routine hospital interventions during labor and delivery may include reduced maternal meals, reduced maternal mobility, IV hydration, analgesia, anesthesia, oxytocin, frequent vaginal exams or vaginal cleansing, and episiotomy, along with stressors of microbial transmission such as intrapartum antibiotics, antibiotic eye prophylaxis to the neonate, separation of mother and baby, and early infant bathing. The hospital environment provides both an antiseptic environment for labor and delivery, as well as possible exposure to antibiotic resistant bacteria”
Combellick, J.L., Shin, H., Shin, D. et al. Differences in the fecal microbiota of neonates born at home or in the hospital. Sci Rep 8, 15660 (2018). https://doi.org/10.1038/s41598-018-33995-7

In the same study they link these trends to a concise conclusion that “disruption in early microbiome development is associated with health consequences later in life.”

Women choose where to give birth based on prior knowledge of safe options.

Most of the time, understanding what options are out there and that the local hospital is not the only choice then helps women decide what is best and safest for her family. The key, mentioned in the study below, is unbiased reporting of what options are available.

Can a workshop increase pregnant women’s knowledge of their birthplace options?

The more women know what their options are and the more the have confidence in their providers to advocate for them (Midwife, Doula, OBGYN, or Montrice) rather than just do what is medically easiest, the more they have positive outcomes no matter the location of their birth. ^{Turning the Tide of Childbirth: Are we Still Adrift?}

Let’s de-stigmatize home birth

Women are waking up to the fact that doctors and hospitals work for them and they are not subject to the treatment they have long endured when they would have otherwise not chosen it for themselves. The most common reasons given for wanting to birth at home (assisted or not) were (citation):

safety
avoidance of unnecessary medical interventions common in hospital births
previous negative hospital experience
more control
comfortable, familiar environment

Home birth is culturally stigmatized by the language we use.

Culture is one of the number one factors in a woman choosing where to birth. Whether this is societal culture, community-driven culture, or simply family culture. My grandmother was incredibly worried and apprehensive about my birth because for her she not only was in a hospital but she has no recollection of even giving birth. I believe she experienced twilight sleep in the 40s and 50s, but because of her lack of knowledge, I can also have no conclusiveness.

It was a culture of feeling empowered by not experiencing birth at all. And using a hospital to do all the work for them.

In the Journal of Midwifery and Women’s Health, there was research entitled Community Versus Out-of-Hospital Birth: What’s in a Name? can be quoted as saying that

We recognize that out-of-hospital is commonly used simply out of convenience and not in an overt attempt to otheror rank birth settings. It may seem easier to say “out-of-hospital” than “home and birth center births.” To date, there exists little evidence of significant differences in outcomes between planned home and planned birth center births in high-resource countries.
Melissa Cheyney, PhD, CPM, LDM, Marit L. Bovbjerg, PhD,MS, Lawrence Leeman, MD, MPH, Saraswathi Vedam, CNM, RM,MSN

And they further reinforce the idea that over-intervention as well as “High costs of care, poor postpartum follow-up, and a concentration of disrespect and abuse in hospital births also influence decision making around birth setting” for pregnant women. When we focus on community-driven births with qualified midwives, the standard of care is high, likewise outcomes are positive and successful.

Unassisted birth is on the rise

If we support women, they don’t have to do it alone!

I personally am not a proponent of unassisted births for my own family as I believe in having high quality, trusted care.

But I don’t fault any woman or family who chooses this path for themselves because I know what it’s like to have a traumatic birth experience in the hospital and the distrust I have for how my birth plans might be ignored. For me it wasn’t my doctor, but the nurses.

In fact, that’s how I landed on home birth. I saw things go like clockwork at home and I saw it all grind to a halt in the hospital because of uncaring nursing staff.

“Based on hospital birth experiences, home birth was chosen for subsequent births where they had perceived they would have greater control and opportunity for empowerment.” (Citation)

But many, because of insurance companies not granting coverage for home births or because of state laws, are choosing to free birth to escape the medical system. If we don’t work to stop this, more women will choose underground birth options.

Experiences of women who have planned unassisted home births: a systematic review protocol