Home Birth--With or Without a Midwife
Soon after my third home birth, I was telling another new mother the story of my daughter’s birth—a story that I told with delight and in glowing Technicolor. The other new mother began to look very uncomfortable, even faint and dizzy, and all but turned green. Her own memories of childbirth were far from joyful; they were memories of a painful and frightening ordeal.
Mothers who give birth in hospitals usually prefer not to talk about their birth experiences, and anything that brings the birth experience to mind is likely to make them feel queasy and faint. I felt the same way after my first child was born in a hospital. Three years later, I was watching one of those videos on birth in a college home economics class and nearly passed out while the prospective mother was still folding the baby clothes to pack to go to the hospital.
A home birth, on the other hand, is recalled with joy and pleasure. I’m not going to try to tell you there isn’t pain, but it’s more like the pain of a runner who’s crossing the 10K finish line. There is physical pain and exhaustion, but there is also a sense of accomplishment and empowerment—but a proportionally greater sense of empowerment that comes from one of life’s peak experiences. And make no mistake, giving birth is—or should be—one of life’s peak experiences.
My three youngest children were born at home, after I had given birth to other children in the hospital. Two previous hospital births were so-called “natural childbirth.” In fact, there was little that was “natural” about these births.
My experience was that “natural childbirth” in the hospital means that, while you may refuse anesthetics and pain-killers, pitocin will still be administered in the delivery room, in the IV. Why? Because no one want to wait around on the truly natural birth process.
In a home birth without any drugs whatsoever, delivery occurs gently, and without the crunching pain of the powerful pitocin-induced contractions. It also occurs with the hectic and disturbing delivery-room drama.
At home, you are relaxed and comfortable (or as comfortable as it’s possible to be during labor). You are free to have a drink of water and a snack if you feel like it, and to make pleasant conversation with your selected birth attendant.
So—speaking of that—who exactly is your selected birth attendant? And how do you get one?
MY DECISION TO GO WITH UNASSISTED HOME BIRTH
My first home birth was in 1987. At that time, midwives who would attend a home birth were out there, but they were difficult to find. I spent weeks calling various health professionals to try to find such a midwife, and came up empty. Eventually one of the health professionals referred me to a woman who was a local home-birth activist, who referred me to another local woman who had written a self-published book on unassisted home birth.
The woman was Marilyn Moran, and her book was titled Birth and the Dialogue of Love.
In my first telephone conversation with Moran, in which I wailed that I could not find a midwife to attend my planned home birth, she replied, “You don’t need a midwife.”
I was shocked! I wasn’t sure I had quite heard her right—or, at least, that I hadn’t understood her right—until she explained her philosophy of childbirth.
Moran’s philosophy of childbirth was that babies should be delivered by their fathers, according to the model of the Holy Family’s nativity.
Okay. I admit that this concept is a bit…uh…unorthodox. Or maybe it’s a little overly orthodox. Tough call on that one.
However, I bought her book. I still have it 25 years later.
HOME BIRTH RESOURCES
While I am still not convinced that Moran’s reasoning about the Holy Family as a model for childbirth is air-tight, I will say that her experiences with the unassisted home births of her own children gave me confidence. And, as a home-birth activist of some note, she had published two other books consisting of the unassisted home-birth stories of dozens of other women. The stories were as joyous and empowering and my own stories would later be. Moran’s book of unassisted home-birth stories is still available under the title Happy Birthdays. Moran’s book, Pleasurable Husband/Wife Childbirth: TheReal Consummation of Married Love, billed as “the culmination of nationally known childbirth author Marilyn Moran's 25 years of wisdom and insight about husband and wife birthing,” is also still available, but a bit pricey.
Moran’s Birth and the Dialogue of Love is long out of print, and few copies are available (and those at high prices), but others have taken up the standard of unassisted home birth. More recent and widely available books on unassisted home birth include An Act of Love, by Lynn M. Griesemer, and Unassisted Childbirth, by Laura Kaplan Shanley. An internet search will bring up many websites and forums about home birth.
Several books of interest are listed at http://www.birthjunkie.com/birthbookstore.html.
One of my own favorites on home birth is Special Delivery, by Rahima Baldwin.
Special Delivery was originally published in the 1970s, and updated in 1986. This book is notable for providing statistics showing that planned home birth is far safer for both baby and child, compared to hospital birth.
Another excellent book for the home-birther’s library is Emergency Childbirth, A Manual, by Gregory J. White. When I purchased my copy in 1987, the book was inexpensive, and copies are now very costly. However, it is available for free as a printable PDF file at http://www.theperfectbirth.com/Emergency-Childbirth--A-Manual.html.
PLANNING FOR A HOME BIRTH
I should stress here that “unassisted home birth” does not mean unplanned home birth. While many women will prefer to have a midwife-attended home birth, where this is possible, an unassited home birth is, I believe, equally safe, with careful planning.
Since, even with careful planning, it is possible (though rare) for things to go wrong with a birth, so you should have a backup plan in place for going to the hospital, if necessary. Such a backup plan could be as simple as having someone on hand to call an ambulance.
A careful study of White’s Emergency Childbirth, A Manual, is a must for both the expectant mother and others attending the birth.
Moran’s Birth and the Dialogue of Love provides many practical procedures for ensuring a sterile birth—which is a matter of considerable importance. One of the most common complications of childbirth, in the days when most women gave birth at home, was peurperal fever, or “childbed fever,” a staphylococcus infection caused by the failure to ensure an antiseptic environment.
Moran suggests preparing for the birth by putting a plastic sheet over the mattress, making the bed up with clean linens covered by another large piece of plastic (a clean shower curtain or plastic tablecloth will do), and then covering this second layer of plastic with a sterilized fitted sheet (fitted to hold everything in place) on which the mother will give birth.
The purpose of the double layer of sheets? After the mother has given birth, the soiled sheet and the top layer of plastic sheeting can be removed, so that mother and baby begin their new life together in a bed already made up with fresh linens.
To sterilize bed linens (and also soft absorbent rags that may be needed during the birthing), simply fold linens and rags into neat bundles and wrap in brown paper, tied with string or masking tape. Place the bundles in a 325° oven and bake for 1 ¼ to 1 ½ hours. Place a shallow pan of water on the bottom shelf of the oven to prevent rags and linens from getting scorched. (Re-sterilize weekly, if birth is delayed.)
You will also need a pair of white infant shoelaces that have been boiled for ten minutes in a covered pan, ironed dry, and placed in a plastic bag until needed. These are for tying baby’s umbilical cord in two places. Scissors for cutting the cord must also be sterilized by boiling for ten minutes.
The birth attendant—Dad, per Moran’s advice—needs to wash his hands and arms with Betadine soap and trim and clean his fingernails, in preparation for the delivery.
The above is definitely not intended to be a complete guide for all the preparations for a home birth—far from it—but to give you an idea of the ease with which a sterile environment a may be had. It’s not rocket science.
It’s also a good idea to prepare several days’ meals ahead and freeze them, as the new mother may not feel up to cooking for awhile after the birth.
In many cases, arrangements will have to be made for older children to stay with a sitter when Mom goes into labor. My first home-birthed child was born on Easter Sunday, at 1:30 a.m. We took the two older girls (and their Easter baskets) to the sitter on Saturday afternoon and rented a couple of movies. One of them was “Zulu Dawn,” which somehow seemed fitting.
Some expectant mothers may wish to have prenatal care, even if they’re planning an unassisted home birth. (A midwife normally provides prenatal care, if you’ve engaged one.)
Prenatal care is probably a good idea, even if you’ve given birth to children before—and I would strongly advise it, especially if this is your first child. You will want to be checked for such problems as gestational diabetes (which is becoming increasingly common) or high blood pressure (pre-eclampsia). Experienced mothers will be pretty sure the baby is positioned right, as birth approaches: You know the baby is head-downwards if she/he is kicking you in the ribs. But it doesn’t hurt to make sure.
My first home-birthed child was what is called a “posterior”—what the old-time midwives call “sunny-side-up.” Most infants are born facing downward if the mother is lying on her back during delivery. A “sunny-side-up” baby is born facing upward when Mom is lying on her back. Such babies are often the product of longer (though not necessarily more painful) labors. I was in a gentle, painless labor for two days before this first home-birthed child was born, and the birth itself was an easy one.
EXPECTATIONS AND CONCERNS
One thing I would definitely like to mention is that the media and/or the medical profession—or someone—seems to have been intent on presenting childbirth as a process in which three is a lot of blood, and/or that the baby is born covered in blood. In the reality of my experience, there is hardly a speck of blood on the newborn and little maternal blood loss at birth.
Another issue that some may find worrying and disturbing is the notion that the delivering mother is likely to defecate during delivery. Some hospitals give the mother an enema during early labor; other hospitals don’t bother with this. This was never an issue in any of my three home births—or in the hospital births in which I was not given an enema. And, actually, I received an enema during labor in only one out of four hospital births.
Frankly, one is inclined to suspect that this representation of birth—that the birth process involves a hail of blood and shit—or that there is indeed any likelihood that any such thing will happen—is a pure misrepresentation. My babies didn't cry when they were born, either. They simply looked a little surprised.
Another issue to consider is the Rh of mother’s and father’s blood. I can speak from experience on this subject. I am Rh negative, and the children’s father is Rh positive. Since Rh positivity is a dominant genetic trait, this usually means that the unborn child is Rh positive—in other words, that there is Rh incompatibility between the mother’s and child’s blood.
The conventional view of this issue is that, if your baby’s blood leaks into yours during pregnancy or at birth, your immune system will start to produce antibodies against the baby’s Rh-positive blood. If that happens, you'll become Rh-sensitized — and the next time you're pregnant with an Rh-positive baby, those antibodies may attack your baby's blood.
If you have had children before (or a miscarriage, abortion, or ectopic pregnancy), you may have become Rh sensitized, and you should probably have a blood test to make this determination—and you may want to make arrangements to receive Rh immune globulin shortly after the baby is born.
My story: I had had four pregnancies prior to giving birth at home for the first time. I received an injection Rh immune globulin after each birth. During my researches about home birth, before the first home-birthed child was born, I learned from talking with midwives that Rh incompatibility is rarely an issue with home births. The problem of mother’s and baby’s leaking into each other during birth simply does not occur with home birth.
I asked the midwife why this is the case.
Her reply: “It’s probably due to the brutality of the typical hospital birth.”
The Rh issue, I would say, is an issue you should be aware of and make your own judgments about. I received Rh immune globulin after the first home-birth child was born, but I later had two more children at home and didn’t bother with it. But you may want to have a blood test to find out whether you’ve already become Rh sensitized. If you have, this may be yet another reason to avoid a hospital birth in which there is a greater likelihood of the mixing of mother’s and baby’s blood.
Anyone undertaking home birth—with or without a midwife—should make a thorough study of the subject of birth and take all possible precautions, just as you would prepare for any other event of great importance in your life. Almost nothing is more important than the birth of your child.
There are quite a few hard practical reasons for avoiding hospital birth. One of these is the increasing presence of “super bugs” in hospitals—that is, antibiotic-resistant bacteria. Another is the extremely high rate of cesarean sections in the United States. According to Wikipedia the current C-section rate in the United States and Canada is nearly 32%.
At the time I was having my own children at home (1987-92), the C-section rate was around 25% and was considered scandalously high.
Another issue related to hospital birth is that, in the hospital, the baby's umbilical cord is usually cut too soon after birth--as early as one minute after birth. Before birth, fully one third of the infant's blood supply resides in the placenta. Waiting as little as 2-3 minutes increases the newborn's blood volume appreciably, and reduces the likelihood of iron deficiency. After a baby is born, much of its blood is still in the placenta. Cutting the cord too soon amounts to reducing the newborn's blood supply.
Some doctors are beginning to concede that the umbilical cord should not be clamped until it is no longer turgid with blood and has stopped pulsating, which takes only a few minutes.
A normal childbirth is not a medical event. During the years in which the highest rates of maternal death were recorded (around 1900-1930), the rate of death in connection with childbirth was about 6-7 per thousand births—in other words, a little over one-half of one percent. The largest single cause of maternal death (40%) during those years was puerperal fever, which is easily prevented by sterilization and cleanliness.
Bear in mind that I am not advocating home birth in those instances in which complications in pregnancy, leading to likely complications at birth, may make a particular childbirth a medical event. Such complications can usually be foreseen—as with an incorrectly positioned child, or ill health in the mother. And in cases in which some unforeseen complication occurs, a trip to the hospital is, of course, in order.
Like skiing, childbirth can become a medical event.
Childbirth is a highly significant and powerful personal event, and I feel that depersonalizing and medicalizing birth involves a tragic loss of the joy, self-determination, sense of power and competence, interpersonal bonding—and joyful memories—that childbirth should create.
Childbirth is not supposed to be a frightening ordeal, and your recollection of your birth experience is not supposed to make you feel ill, go pale, and change the subject. Childbirth—despite the pain (which I don’t want to minimize)—should be an event that is recalled with wonder and joy.