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Home Birth Sounds Nice, but...

As a doula, I meet a lot of pregnant people and their partners. I always ask them where they intend to have their baby and whether they're considering a home birth. These are a few common responses I hear.

"I would, but my partner isn't sure/is totally opposed".

"I'd love to have a home birth, but I think we'll have the first one at the hospital".

"We feel safer going to the hospital".

"We have a really small house/lots of neighbours".

"What about the mess?"

First I'd like to acknowledge that, unfortunately, home birth with a medical care provider is not an option for everyone in British Columbia, because of the lack of trained midwives and limited resources. The Midwives Association of BC is working with the federal and provincial governments to address this. If you are in an area without access to midwifery care, you can fill out a form here. Especially for Indigenous families, it is important that we all work together to bring birth back to the community. Please follow and support the National Aboriginal Council of Midwives in their vision to see Indigenous Midwives in every Indigenous Community.

Now, to address those other concerns, for folks who have access to home birth with midwifery care.

1. "I would consider having a home birth, but my partner is against it."

I get this. You are a pair, a team, a partnership. By the way, this one could go either way: the birthing person or their partner could be the one who is unsure about home birth. You've done a lot of things together up until now, including creating this baby. You want to do this next big thing as a team, and if one of you is uncomfortable with something, the other will likely agree to stick to the comfort level of their loved one. Your partner may be feeling protective of you and your baby, and they have been brought up to believe that birth is a medical event, and that it should take place at a hospital.

Take a look: what would you believe was best for you, your baby, and your family, if you hadn't been raised in a culture where birth was medicalized (which started only about 100 years ago)? What if you both took the time to unpack the lifetime of stories you've heard about birth, starting with what you know of your own births, moving right up until the most recent birth you've seen on tv? Would you notice a theme? If you recounted all of the stories of your friends' emergency c-sections, would you begin to wonder why so many of them ended up that way? Would you recall any stories or examples of birth being beautiful, or powerful, or a transformative experience? Would you begin to recognize why you believe what you believe about birth?

What if, after looking at all of that, you took the time to seek out some powerful birth stories, and to watch some videos of undisturbed home births? What if you sat in stillness together and felt into what was possible for you? What if you tapped into the awareness that your body knew exactly how to grow this baby, from two cells to four, to eight, to sixteen, to the amazing tiny functioning human body it is now, with organs and fingers and ears? What if you realized that your body knows how to birth this baby, just as readily as it knows to nurture it as it grows? And then, knowing that, what would feel possible?

2. "I'd love to have a home birth, but we'll have the first one at the hospital."

Again, I hear you. All your life, you've been socialized to believe that the hospital is the place for birthing. You want to have your first one there, just to get an idea of what birth is all about, and then you'll have the confidence to have your next baby at home. But here's the thing: having a baby at the hospital will probably give you less of an idea of what birth is truly all about. It will likely give you a clear understanding of what birth is like when it is managed, measured, interfered with, medicalized, slowed down, artificially sped up, closely observed, and finally, treated as an emergency that can only be solved with major abdominal surgery. (This cascade of interventions is not the case every time, but it is becoming more and more common.)

In the Fraser Health region of BC, we currently have a c-section rate of around 40%. That's getting close to half of all births! The World Health Organization says that a rate of 10-15% is ideal. It is a fact that in some cases a surgical birth is safer for a birthing person and/or their baby, and thank goodness we have obstetricians ready and available to safely help those families who need it.

Birth is a physiological process. This means that it's something our bodies do that is one of our healthy and normal bodily functions. Unless you have any health issues that require a closer medical eye on your birth, you can trust it to happen without needing any extra 'help' or interventions. And the bonus is, you can still have a trained medical eye on yourself and your baby at a home birth if you choose to have midwifery care instead of obstetrical care! (You can learn more about the difference here.)

3. "We feel that the hospital is the safest place to have a baby."

Here's where we can look to the research. Now, it's tricky to conduct a randomized controlled trial comparing home birth safety to hospital birth. This is partly because you'd need a HUGE sample size, since perinatal mortality is relatively low (around 1 in 1000) for folks having healthy pregnancies in developed countries. So you'd need tens of thousands of participants to begin to see any differences. Also, not a lot of people agree to have their place of birth randomly assigned for them. However, there have been some studies done here in Canada.

They found that the risk of perinatal death associated with planned home birth attended by a midwife was low, and wasn't much different from that of planned hospital birth. They also found that people who planned a home birth were at reduced risk of obstetric interventions and adverse maternal outcomes.

They concluded that:

"The available evidence suggests that planned home birth is safe for people who are at low risk of complications and are cared for by appropriately qualified and licensed midwives, with access to timely transfer to hospital if required."

So. We got the research bit out of the way. What does this mean for you?

It means that maybe you want to pause and take a look at what safety means to you. Does it mean a healthy birthing parent and healthy baby? The research says that the chances of that happening are pretty much equal whether you're at home or at the hospital. And, at home you're actually less at risk for adverse outcomes (excessive bleeding, infection, etc)! Do you feel safest having access to medical care providers who can handle any minor complications that come up during your birth process? Again, that is possible in either location. Registered midwives are trained and prepared to handle many of the things that can come up, and they set up an entire resuscitation station at home births in case the baby needs any help with their transition. (Here is a great video showing what Canadian midwives bring to a home birth for the health and safety of birthing people and their babies.) Also, midwives know when to recommend a transfer to the hospital, if anything is happening that can't be handled at home.

Think of it this way: if you are at home during your birthing process and you suddenly no longer feel safe there (maybe something has come up and the midwives recommend a transfer, or you decide you want medication for pain management), it's easy to transfer into the hospital to complete your birthing journey. Your midwives will even go with you! On the other hand, if you're hoping for a no-intervention birth at the hospital, but suddenly you're there and things are happening and you no longer feel in control, it's a lot more difficult to say, "I'll just go home now and have my baby."

4. "We have a small home/close neighbours..."

Ahhh, yes. The worries about other people. Know what, folks? It's time for you to prioritize what YOU want. You've spent enough of your life working around other people's needs and wishes. This is the only single time you are going to have this baby. If there's a niggling little "home birth would be nice..." feeling in your bones, there are work-arounds for all of the practical little things.

Worried that your midwives would feel crowded in your cozy home? You will learn how adaptable these amazing humans are. They need a small table or counter cleared for their equipment (remember the resuscitation station we talked about?), and an electrical outlet for their laptop, to take notes on as they monitor you and your baby. But other than that they'll work with what you've got. And if you want a waterbirth, there are pools of various sizes to suit your space, if you don't have a bathtub.

If you're worried that neighbours might hear you, you can rest assured that most often people instinctively make low moaning noises in the birth process. These sounds don't carry as much as high-pitched sounding might. But if you know that you want to be free to make as much noise as your birth requires, a great idea is to bring your closest neighbours a little gift when you reach your due season. You can explain to them that you're planning a home birth with midwives in the next few weeks, and that if they hear anything unusual, they don't need to be alarmed. I recently attended a basement suite birth, and the upstairs neighbours had two teenaged kids. I met the father in the driveway as I was leaving, and he asked me to come and tell his family the happy news. They were all very excited that a baby had been born that night in their very home! (And, for the record, they didn't hear any of it.) You never know, your neighbours might be excited as well!

5. What about the mess?

Okay, folks. I had my baby at home. I do not recall any mess, AND I definitely did not clean anything up. It felt like magic. Now that I'm on the other side of birth, as a doula, I see how quickly and easily the "mess" can be handled. There is a list of home birth supplies that the midwives will ensure you have ready beforehand, including disposable chux pads. These will be used wherever you happen to be throughout your birthing process- on the couch, on the floor, on the stairs, on your bed- to catch any fluid that's ready to come out ahead of your baby. As you're birthing (if you're not in the water) these pads will be laid underneath you again, to catch whatever fluids come out with your baby. The pads can be easily folded up and put into the big garbage bag you will have gotten ready weeks before, and quickly replaced with fresh ones. If you give birth in the water, then that's where the fluids will be contained, and your amazing homebirth-loving doula will take care of it once you're tucked into your bed with your newborn.

After looking at some solutions to common homebirth concerns, what do you think? Has anything shifted for you? Maybe it doesn't feel so out of reach? Maybe you're feeling more like, "Home birth sounds nice."

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