There is no shortage of evidence to support the fact
that home birth is safe, satisfying and empowering for
women and their families. It is also a much-neglected
option for childbearing women in Western society today,
often because women and their partners are unaware of
the issues or choices which are available to them.
This article seeks to discuss modern-day attitudes to
birth and present the arguments for midwifery care and
home birth in an accessible format.
It must be stressed that different caregivers have
different philosophies in relation to birth. Their
philosophies are generally referred to as the 'midwifery'
and 'medical' models, although it is not accurate to say
that all doctors believe in the medical model and all
midwives in the midwifery model. The medical model
sees childbirth as inherently dangerous and suggests
that all women should undergo routine interventions to
ensure safety and give birth in hospital, and the
midwifery model uses a more holistic approach and
assesses women on an individual basis - a process which
often enables women to give birth in their own homes.
Although the medical model has been the dominant model
of birth in our society for a number of years, researchers
in all fields are now showing the midwifery model to be
more accurate in the way it sees birth. Moreover, more
women are seeking to reclaim the spiritual and developmental
aspects of birth which have historically led this to be
viewed as a 'rite of passage' rather than a potentially
dangerous medical event.
Many women approach a 'medical model' practitioner for
care during their pregnancy, although this is not necessarily
the best option. While family doctors, obstetricians and
hospitals have a part to play in the care of women with
serious medical conditions, or who develop a problem
during pregnancy or labour, research shows that the
vast majority of women might be better served by choosing
a midwife for their care. Equally, this majority of women
would also be well-advised to consider home birth as an
option, due to its many advantages over hospital care.
Some of the advantages of home birth with a midwife are
cited below:
WOMEN EXPERIENCE LESS PAIN AT HOME
It is well understood that sensations of pain in labour
are regulated by hormones released by the woman's body.
During the labour, oxytocin - the hormone which causes
contractions and helps the baby to be born - works in
harmony with endorphins - the body's own pain relieving
hormone. During a home birth, the woman's body will release
these hormones according to her needs and she will usually
cope well with the sensations of labour.
However, when a woman attempts to give birth in another
environment, such as a hospital, this process may not work
as well. Even if a woman feels rationally that hospitals
are 'safer' places in which to give birth, her subconscious
mind knows that this is not the case, and she feels insecure.
This causes her body to secrete the hormone adrenalin,
which causes the levels of both oxytocin and endorphins
to drop. She experiences far more pain than she would in
her own home and this has several other effects on her labour
which are described below.
WOMEN EXPERIENCE LOWER LEVELS
OF INTERVENTION AT HOME
There are two main reasons for this. The first concerns
the hormones described above. In a hospital environment,
women often produce the hormone adrenalin in response to
subconscious or conscious fear. This inhibits the release
of the hormone oxytocin and labour may well slow down.
Although this slowing of labour is a natural safety
mechanism, designed to let the women know she needs to find
another environment, it is interpreted by many medical
professionals as 'failure (of the woman's body) to progress'.
Rather than suggesting that the woman talk about and work
through her fears, or finds a different environment, they
will turn instead to drugs to 'speed up' the labour.
This drug (usually syntocinon or pitocin) can cause distress
in the baby, among other effects, and often itself leads to
a 'cascade of intervention' which may result in an instrumental
delivery or a cesarean section.
The second reason is that hospitals are systems which need
to run efficiently. They need to have procedures in place
for workers to follow so that chaos does not ensue!
Unfortunately, this often means that hospitals have policies
where a certain number of interventions are carried out on
all women who choose to give birth there. Often there is no
evidence to support these interventions, and many of them
(eg electronic fetal monitoring) are known to be harmful
when used on a routine basis.
Every intervention is useful to a small number of women
when used appropriately - but when applied to all women,
they often cause far more harm than good. Women's choices
are not sought and it is often difficult for staff to offer
individualized care, because they feel restricted by the
'hospital policy'. They may not be 'allowed' to walk around
and adopt alternative positions which are known to facilitate
effective progress in labour.
WOMEN HAVE MORE AUTONOMY AT HOME
There is another major difference between giving birth
in your own environment or in someone else's - that in your
own home you are 'in charge'. You would not feel you needed
to ask permission to make a drink in your own home, or visit
the bathroom, yet that is exactly how many women feel in
hospital. And the effects of feeling as if they need to ask
permission to do everyday things can lead to women feeling
that they are not in control. This may then have an impact
on a woman's labour, because labour is a time when women
need to feel very strong and powerful within their own bodies,
not as if they were small children who needed to ask if
they could pee!
Eating and drinking is another important aspect of this.
In your own home, you are free to eat and drink whatever you
feel like. Although women often do not feel like eating in
strong labour, the choice is there. Many hospitals still
refuse women food and drink in labour, even though all of
the research evidence shows that this restriction is harmful
rather than beneficial. Consequently, women become
dehydrated and have low energy levels - at a time when they
need lots of energy. Hospital staff may site an iv drip to
replace fluids but this is not ideal - it limits the women's
movement and adds to the feeling that she is 'sick',
rather than experiencing a perfectly normal event.
OTHER RISKS OF HOSPITAL BIRTH
A recent article in the journal of the Association for
Improvements in Maternity Services, cites a number of
other risks of hospital births.
These are summarized in the following list:
· Midwives may be looking after more than one woman in
labour and individual women are not able to receive the
support they need. This can also mean they are more likely
to be 'tied' to fetal monitors rather than having the
midwife listen to the baby's heartbeat intermittently.
· Hospital birth deprives the woman of contact from her
family and friends. Being with other support people,
particularly female relatives or friends, has been shown
to have a very positive effect on labour and birth.
· Continuity of care is rare in hospitals - although you
would have the same midwives throughout a home birth,
especially if you chose to employ an independent midwife,
shift changes in hospitals mean you may see a large number
of carers during your birth. Some women report that,
as soon as they have built up a rapport or relationship
with one carer, she goes off duty and they have to
'start all over'. 'Knowing your midwife' has been shown
to have very beneficial effects on labour.
· Levels of medical staff may also be low. It is a
common fallacy that being in hospital is safer 'if things
go wrong'. In fact, as long as you are not a huge distance
from a hospital, you may well be treated more quickly if
you are transported from a home birth than if you were in
hospital in the first place! The sort of emergencies
which need truly immediate action are extremely rare and
are almost always preceded by signs which your midwives
will pick up and act upon.
· In hospital, decisions about your labour will sometimes
be made by very junior medical staff. (You rarely have a
choice about which staff care for you in hospital.)
These people may have little experience in birth and
certainly far less than midwives who specialize in this area.
They are also unlikely to trust that your body knows what it is doing!
· Hospital and medical care, as discussed above,
takes place in a philosophy where staff are 'looking for
problems', rather than ensuring that things are progressing
normally. This seemingly small difference actually makes
a big difference in the approach that different carers
take to the women and her labour and birth. Would you
rather have a carer who trusts that your body knows what
it is doing and either reassures you that all is going well
or helps you if there are any problems, or a carer who
is always checking to make sure that your body is 'working',
while at the same time doubting your ability to actually
give birth? As before, not all hospital midwives or nurses
take the latter attitude, but the environment of the
hospital itself tends to perpetuate this philosophy.
WOMEN ENJOY INCREASED SATISFACTION
WITH HOME BIRTH
The proof of this pudding is in the eating, or the asking!
Over 99% of women who have experienced both home and
hospital birth will tell you that they would choose to
have a home birth in the future.
But don't take my word for it - ask some!
ARRANGING A HOME BIRTH
If you are thinking of having your baby at home,
talk to a midwife! She will be able to tell you what
is on offer in your area, and the kind of care she can
offer you. She will also be able to help you to make a
realistic assessment of whether home birth is right for you.
In general, the only women who are truly better off
in hospital are those with chronic medical problems,
such as insulin-dependent diabetes, or those with a
very small baby. But women need to be considered
individually, and their unique circumstances taken
into account.
Remember that, in our society, there are many people
who do not 'trust birth', and some midwives are among
these people. If you encounter opposition to your plans,
then seek a second opinion. You may have to interview
several midwives before you find the one that is right
for you. You may also want to seek support from other
women who have made this choice.
The final thing that I would like to remind you of is to
remember that women have been having babies for millions
of years - without the aid of hospitals or medical intervention.
And if birth didn't work, then we wouldn't be here now!
Women's bodies are designed to have babies.
Trust your body. Trust your baby. Trust birth.



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Yeah, she'd dealt with babies with cords around their necks and breechs and no running water and all sorts of fun stuff at home. She's also dealt with getting mothers to the ER - mostly for failure to progress, I don't think she had one complication that was really bad while working as a lay midwife [some 1000 births], possibly a few while working at the birthing center, as you're training to deal with more stuff, more might come up.
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