Home birth, a very safe alternative!
By Anna Verwaal

What is the difference between going to have your baby at a labor- and delivery unit of a hospital versus having a birth center or homebirth?

The words we use to describe the experience actually speak for themselves.

In a hospital setting women are being delivered by a medical system that views birth as a medical problem, which needs to be treated. The healthy mother automatically becomes a patient and the obstetrician takes charge of the process.
At a birth center or at home, midwives who trust the process of labor and working on their own terms try not to guide births along a path determined by unnecessary medical interventions but wait patiently, nurture, support and allow a woman to give birth, the way her body was meant to, successfully keeping medical interventions to a minimum.

Women in America are told these day's that having your baby in a hospital is the safest way to give birth. Statistics show that this is profoundly untrue.
Japan, Sweden, Denmark and Holland, countries who's healthcare systems are not profit driven, have the lowest infant- and maternal mortality rates of all industrialized nations in the world and support the midwifery model of care either in a hospital setting or at home. It is estimated that 75 % of all healthy low-risk mothers could safely give birth at a birthing center or at home.
The US, where most women have their babies in a high tech hospital setting, ranks 21st on this list, showing us that all the precautions, safety procedures and medical interventions do not lower these numbers. As a matter of fact studies done over the last two decades have shown that the continuous use of an external fetal monitor has no significant value when used on a normal healthy woman during labor.
According to Naomi Wolfs excellent book Misconceptions, in 1996 85% of laboring women in America were monitored continuously in spite of ACOG's (American College of Obstetricians and Gynecologists) recommendations that continuous fetal monitoring be dropped from the standard of care.
The use of an external fetal monitor can be harmful to the mother in terms of the interventions they encourage. They are however a great defensive benefit to the hospital because they produce a visual record that can be used to protect a hospitals legal position in the event of a lawsuit.

A very large percentage of births in America are either being induced or augmented (speeded up) which contributes to so many women needing to be monitored continuously there for no longer having the freedom to move in labor. This makes coping with the contractions so much more difficult, which contributes, to so many women feeling the need for drugs in labor and ending often in very medically assisted type of deliveries.
The sooner women are given pain medication or epidurals the more likely it is she needs further interventions. An epidural requires an IV, a catheter to keep the bladder empty, frequent blood pressure checks, sometimes the need for oxygen and being monitored continuously.
Studies show that the longer a woman has an epidural the greater the risk of maternal fever, leading to their babies being removed from them after birth for a medically unnecessary septic workup and possibly being treated with antibiotics as well.
The use of epidurals increases the need for episiotomies, the risks of severe perineal lacerations, vacuum- or forceps deliveries and C/Sections. In the US more than 870.000 women are delivered by C/Section each year. Research shows that in more than half of these cases they may have well been medically unnecessary.
An episiotomy, a routine cut in the perineal area that widens the birth outlet, is done to 50 to 80% of all first time mothers in the US. In England fewer than 1 in 5 women end up with an episiotomy but according to Naomi Wolf's book when obstetricians deliver the baby the rate can soar to 90 %. In Holland where over 30 % of all births are still done at home less than 1 in 10 first time mothers end up with one.

What is a birth center or home birth?

This is a birth where an attitude of being responsible for your own health and in charge of your body is paramount. A home birth is not negative or anti hospital but an affirmation of a woman's ability to give birth.
Midwives, well trained professionals offering complete prenatal, birth and post partum care, encourage women to give birth in their own time. They remind women to trust their body's wisdom throughout the pregnancy, labor and birth. Offering a big range of non- epidural pain management techniques that make a labor at home a very doable labor of love and support. Allowing a woman to be in whatever position her body is guiding her to be, unopstrusively gathering her data to ensure mother and babies safety, she is responsible for the good, low intervention outcomes we see in midwifery assisted births. Midwives encourage women in labor to drink lots of fluids and eat light meals to support the hard working uterus with the calories it needs to perform, knowing that the woman herself will stop eating when her body tells her to. Midwives know that when a woman's labor slows down or her uterus stops contracting for a while, it is not because she's having a dysfunctional-uterine-contraction-pattern that needs augmentation but that mom and baby need a rest and encourage the mother to take a well deserved nap until labor starts again on it's own.
They allow a woman to birth in whatever position feels good to her, knowing that a drug free mother usually chooses to be upright, standing, squatting or on all fours to push her baby out, there for opening her pelvis with an additional 30 %, reducing the length of the pushing stage significantly and lowering the need for an episiotomy or an accidental tear.

Over the last few years working as a doula assisting women during births at birthing centers or at home I have seen and photographed women smiling while pushing their babies out because mother nature does not leave women bereaved in labor but triggers an hormonal exchange and the release of endorphins to help ease the pain.
Because the midwife waits patiently and let's the babies' head do the stretching of the skin; I have seen babies of all sizes, from 6 to 11 pounds being born over an intact perineum.
I've noticed the partners become more involved with nurturing than observing their wives during labor because they them selves felt supported by the guidance and wisdom the midwives brought to the birth and there were no monitors to watch.
Babies that are born drug free in an environment of love versus fear and don't experience routine separation from their mothers, cry far less and breastfeed with more ease.There is no uncomfortable ride to the hospital during active labor and baby can be kept out of the car seat a while longer.

During the many years I worked as a labor and delivery nurse I realized that many couples did not get the experience they hoped for and where often not well prepared to deal with the reality of being in a hospital. People need to inform themselves about the pros and cons where to birth long before they start taking their childbirth classes.
Find out what your doctor's procedures and hospitals policies are. For couples who have been willing to look at where there fears about birth come from and decide that a hospital is where they feel the safest know that there are several options to choose from. From having a midwifery model of care in the safety of a hospital to some wonderful, supportive, kind obstetricians that encourage intermittent fetal monitoring, allow a woman to eat in early labor and let her squat to push the baby out. But finding them might take some work. Staying with your kind gynecologist does not guarantee that he or she is the best obstetrician for the kind of birth experience you hope for.
Not long ago I assisted a couple that was given permission from their doctor and hospital to bring a birthing tub into the delivery room to attempt a VBAC (vaginal birth after cesarean) in water. The care and assistance we received from the medical staff was heartwarming and encouraging. Things seem to change however slowly. Taking an active role in educating yourself will result in being more satisfied with the outcome.



Anna H Verwaal RN, CLE, is a maternal-child health nurse, certified lactation educator and doula.
She received her nursing degree in her native Holland in 1984. For many years she worked as a labor- and delivery, post-partum and newborn nursery nurse at a hospital in Los Angeles. She now works as a birth consultant helping pregnant couples make informed decisions about the journey of labor and birth.
She can be reached at 310-455-0108