Goshen News, Goshen, IN

June 2, 2013

WHOLE FAMILY: There’s no reason to be afraid of home births


EMMA — Though only an estimated 1 percent to 2 percent of U.S. women deliver their babies — intentionally — outside of a hospital, home birth usually makes the national news a few times a year.

Yep, home birth. As in having a baby in your bedroom. Or living room, hallway, kitchen or the oft-popular bathroom. I welcomed two of my own babies at home births and have assisted at scores more — nearly 200, last I counted.

About a month ago, the American Academy of Pediatrics issued a statement about infant care at home births, a statement that bothered some because it seemed to endorse having a baby in your bathroom as long as a person trained and experienced to help a neonate is there.

And, in our own state, direct-entry midwives were just granted permission — with guidelines — to facilitate home births legally in Indiana via Indiana House Bill 1135.2 That’s a big deal, by the way, as the DEMs have been working on having the law here changed for some 20 years. (Certified nurse-midwives — CNMs — have enjoyed “legal” status for some time.)

Here in your own local newspaper, IU Goshen Health’s Terry Neufeld wrote in the “Fit Families” column May 22 about home birth, noting that “Women and men of all socioeconomic, educational and professional backgrounds tend to have strong ideas about home birth vs. hospital birth.”

I appreciated Terry’s column, where she lays out some facts about how parents and health-care providers look at home birth. I thought I’d augment her words with my own.

As a home-birth person — meaning a proponent, a birthing mother, an attendant — I get a lot of questions. And criticism. Some people are openly hostile, as was one woman once when she barked at me that she would NEVER put her baby in such dire danger but not delivering at the hospital. Others are just curious, as I was at first: “Home birth? Wow. You can DO that? How does it work?”

To the hostile woman I was quiet. No point in trying to tell her I was, also, ensuring my babies’ safety; her mind was made up. To the curious people I have to be careful to not gush, to take it slowly and answer one question at a time. They may or may not listen.

SO, HERE’S a little more about home birth in our area as I see it, of course.

First and foremost, a planned home birth with a healthy mom, healthy baby and skilled attendant — please note those distinctions — is not inherently dangerous. Birth is not inherently dangerous. Are there dangerous complications that can arise? Sure. But that’s regardless of the setting and, in fact, a lot less likely when you have in place those things I mentioned: prenatal care and planning, healthy mom and baby and skilled attendant. And frankly, dangerous complications might be more likely to arise when you have all or some of the medical interventions that often happen in a hospital.

Terry is correct to note that longitudinal studies on home births can be inconclusive. Some data sets throw in all “home births” — like the ones where mom was headed to the hospital and dropped the baby in the driveway on the way out, which is not the same as a planned home birth. But one cannot find a reliable statistic that says planned home births are any less safe than hospital births. For those of us who weighed our options carefully — Me, me! — many of us would tell you we actually felt SAFER at home.

I do contract work for three, sometimes more, CNMs in Michiana. I can tell you their transfer percentages — meaning women who need to transfer to the hospital during labor for complications — are in the single digits, nowhere near the higher 40 percent number Terry notes is possible. If I were a home-birth CNM and my transfer rate were near 40 percent, I’d be doing some serious work to assess why and drastically change my practice.

Most transfers happen long before there’s anything emergent happening — say a malpositioned baby, a labor dystocia — and not all result in cesarean sections when the receiving hospital or physician is friendly and open to a minimal-intervention-to-get-the-job-done approach. While few or no doctors or hospitals locally have official relationships with home-birth midwives for transfers — yet — IU Goshen Health is one such friendly facility, by the way, and enjoys one of the lower cesarean rates and highest vaginal birth after cesarean (VBAC) rates around. It was my own choice for transfer had I needed it.

The scores of people I know who choose home birth don’t choose it for some sort of sentimental reason, either. Most are very well-educated about their bodies, their babies, how birth works in general and what their options are. I told a group of student nurses a few months back, “These (‘natural birth’) patients are going to know a lot more than you. Don’t be intimidated by that. Be grateful and learn from them.”

The last line of Terry’s column reads, “No matter the setting, the goal for each birth is a healthy mom and baby.” Agreed. And I would note that no one — No one! — could want that more than a mother herself. Even — or especially, depending on how you look at it — when she chooses to birth at home.

Goshen News columnist Stephanie Price is a wife, mother, teacher, childbirth educator, midwife’s assistant and nursing student from Elkhart. Contact her at wholefamily@goshennews.com, 269-641-7249 or on Facebook at the page “Whole Family Column by Steph Price.”