Flashback Friday: Home birth letter

As Gary and I prepared for the arrival of our daughter in the latter part of 2006, our decision to plan a home birth was met with some resistance.  I wrote the following letter to ask my family members for support and understanding. More than anything, I am sure the process was valuable for me to organize and fortify my beliefs about our decision. I know it is kind of long, but you birth-story junkies out there may find it interesting.

Dear Family,

As I’m sure you recall preparing joyfully for the arrival of each of your children, this is a very important and exciting time in our lives.  You have probably heard by now that Gary and I have chosen to plan to give birth in our home.  In our culture today, the home birth option is not widely esteemed or even understood.  We believe that our labor experience and the outcome of our baby’s birth depend on being surrounded by a positive support structure.  That is why I am writing a letter to our loved ones.  I want to shed some light on the reasons we have chosen to plan for a home birth, share some information regarding the safety and normality of an attended birth at home, and ask for your help in creating the positive environment that we feel is important to our birth process.

First I want to emphasize that there is nothing wrong with giving birth in the hospital, and we do not have any disrespect for or animosity toward families who feel more comfortable with that option.  We hope that we would receive the same respect for our choice, which is a very personal one.

I hope to clarify when people inquire, “You’re going to give birth at home?” that the answer is “Maybe.”  Deciding to plan to birth at home is just that, a plan, or a desire to give birth at home.  But the goal is not a home birth at any cost.  Midwives are thoroughly trained and experienced in monitoring for indications that a transfer to the hospital would be best for mother and/or baby, usually long before an emergency would occur.  Planning for home birth includes being open to all possibilities, including one in which the baby is born in the hospital, even by cesarean birth if necessary.  The ultimate goal is a healthy mom and newborn, and if the benefits we associate with a home birth can be enjoyed in reaching that goal, then that is the plan.

The Philosophical Assumptions of Home Birth Parents and Attendants

• Because pregnancy and birth are natural physiological events, normal birth does not belong in hospitals (and wasn’t placed there until the last century, and still isn’t in many cultures).
• The natural course of labor is already perfect, and should be interfered with as little as possible.
• Pain is part of an essential and healthy feedback mechanism in labor, which women can learn to cope with, with proper encouragement and support.
• Medical management of pregnancy and birth should be limited to those which are medically complicated.
• Unnecessary medical interventions complicate normal labor, creating additional risk and the need for more intervention.

Adapted from Birthing from Within by England/Horowitz

In addition to these underlying assumptions about birth, here are a few of the advantages we feel are gained by laboring and giving birth at home:

• A quiet, peaceful environment which we can control to a certain extent
• A sense of comfort in our familiar surroundings means being “at home” psychologically, to  encourage relaxation and release
• The innate, miraculous process of giving birth is allowed to unfold on its own
• There is no schedule or rush to force labor to progress
• Constant availability of our personal birth attendant, no shift changes or sharing of nurses
• No pressure to accept unwanted pain medication or drugs (which might be easy to give in to in the middle of labor!)
• If a problem should arise that requires medical support, we will not wonder if it was caused by routine, unnecessary, or ill-timed hospital interventions
• The midwives philosophy is not centered around such interventions, so if she advocates them, it will be easy to trust her endorsement
• Ready availability of family and friends during labor and birth, if desired
• Access to our hot tub, our own food, a walk around the neighborhood for fresh air, and other comforts available at home
• The freedom to labor and birth in the locations and positions that I choose, and confidence to do whatever my body tells me is necessary at the time
• Studies indicate a tendency toward shorter labor at home
• The joy and empowerment of bringing our baby into the world naturally, and in her own home
• Immediate, close contact with our newborn baby girl

Home birth is not the option for every family, and we completely understand that.  In addition to the important aspect of personal preference, it is also essential that a couple seeking a home birth meet certain general criteria in order to be considered.  It is a long list, but examples include having good physical and mental health, adequate social supports and a positive emotional environment, a pregnancy with no complications, and the baby positioned properly for vaginal birth.  Couples choosing this option also must be willing to take an active role in giving birth, cope with the pain and hard work of labor without drugs, and take responsibility for the outcome of their choices.

In many cases, midwives may be trained more thoroughly in “normal” birth than obstetricians, whose education focuses considerably on managing complications and emergencies.  We feel comfortable with the benefit of having access to the best of both worlds: safe home birth with modern midwives trained to identify and manage minor problems, and the availability of appropriate hospital technology if necessary.  As mentioned before, our ultimate goal, as well as that of our birth attendants, is a safe birth, not a home birth no matter what. 

It may come as a relief to learn that transfers to a hospital rarely involve a labor emergency.  Most of the time problems in labor develop slowly, with early signals alerting the midwives of their approach.  Usually transfers to the hospital are made for non-emergency reasons, such as a prolonged, exhausting labor, or failure to progress in dilation.  Another little-known fact is that home birth attendants are skilled in handling most common birth “crises,” and carry much of the same equipment to handle them at home as what is available in the hospital.  For example, the midwives carry sterile instruments for birth and suturing any tears, basic resuscitation equipment for mother and baby, ultrasound stethoscope for fetal monitoring, drugs for postpartum maternal hemorrhage or bleeding, IV equipment, oxygen, antibiotics to treat infection, and more.  Midwives are not only trained in medical procedures, but also in ways to comfort and assist the laboring mother, such as natural pain coping techniques, methods to encourage progression of labor naturally, and in practices to help avoid tearing.

Many studies have been conducted to compare the safety of birth at home vs. in the hospital for comparable low-risk pregnancies.  One recent study involving over 5400 planned home births, published in the British Medical Journal in 2005, concludes the following: “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”  One of our midwives has been attending births at home and in the hospital for over 30 years and has never lost a baby or mother at home. 

In summary, our birth attendants are trained to recognize any warning signs of problems early on, and then take appropriate action to deal with those problems.  If an emergency does arise, they have the knowledge and skills to institute basic emergency care to either resolve the problem, or stabilize the mother and/or baby until we reach the hospital.

As very important people in our life, I am asking for you to help our family in three specific ways:

1. Please try to understand a little bit about home birth and open your mind to it as a normal, viable birth choice.  Showing an interest lets us know that you care.  If you have questions or concerns, let’s discuss them together!
2. Please recognize that planning to give birth at home should not imply that we don’t understand and appreciate reasons to choose to give birth in a different setting.  We do not feel that a home birth is better or worse than a hospital birth.  It depends on so many individual factors, and in the end is a very personal choice.  Our baby may be born in a hospital as well, and we find nothing wrong with that. 
3. Please try to maintain a positive attitude toward our decision, both when we are and are not around.  If you are involved in or overhear conversations we are having about the impending birth of our baby and the circumstances surrounding it, you can show support by getting involved in the conversation in a positive way.  Even subtle negativity or apathy may not only hurt my feelings, but also may have an effect on my mental state in preparing for labor and birth.  Also, I hope that your support will be genuine, because insincerity can be just as hurtful. 

These requests may seem silly, but I feel that having the support of our loved ones throughout the upcoming weeks is essential.  For many of our own personal reasons, we are electing to plan to give birth at home.  Whether you would choose this path for yourself or not, we hope that you will be able to support us in our choice, as we believe we will always do for you.  We believe that it will take concentration and positive mental energy to accomplish this miracle of childbirth in the empowering manner we are planning.  It is important to me that I am surrounded by the same attitudes as I approach this life-changing event.  I believe that it could be detrimental to our birth experience and outcome if I am self-conscious about our decision, feel unsupported, or harbor fear that if things do not turn out as we hope that I will have to face “I told you so” from those to whom I would wish to go for support and sympathy.  I hope you will understand that I am requesting your help because you are among the most important people in our lives, and soon in Madelyn’s life.  A foundation of understanding, love and encouragement is what we need most right now.

Thank you for taking the time to read my thoughts.

All our love,