Home Birth

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**Note: Homebirth is a beautiful and SAFE experience for babies everywhere. Babies used to be born at home and still should be. The U.S. has the highest rate of interventions of any developed country -- AND the highest infant mortality rate. Parenting is all about choosing what is best for your baby and home birth, for many moms, is it. Even if you would not be comfortable at home, and would not choose home birth, please don't insult the moms who do. They have carefully studied their options (no matter what their age) and have chosen what is absolutely best for them. Please be respectful in your comments even if you disagree. **

If you've read Daniel's birth story at the beginning of this blog, you already know he was born at home. So, clearly, I am pro-home birth. But why? Why would someone choose to have a home birth? Is it safe? Where would you find attendants? There is a lot to consider when you are thinking about having a home birth.

First of all, you should birth where you are most comfortable. For some people, that truly is the hospital, because they feel too nervous about the "what ifs" involved in childbirth and/or they like an environment where they really don't have to worry about anything, they are taken care of. But for a lot of people, home is the most comfortable environment, because home is what is familiar. For those women, they should be able to birth at home, and should have access to midwives so they can do so safely (I'll be discussing the issues surrounding midwives and home births from a legal standpoint in another post).

If you are considering a home birth, the first thing you should do is find a qualified midwife. This does NOT necessarily mean a nurse-midwife; there are also certified professional midwives. In some states CPMs are legal, and in others (including here), they aren't. If you ask around, you'll probably find the same few names coming up over and over. There's a community of "natural" parents, including home-birthers, in every major area. Some are luckier than others though! You can also look at DONA or NACPM (National Association of Certified Professional Midwives), or NARM (North American Registry of Midwives).

Sit down with the midwife you've chosen and ask LOTS of questions. Here is a brief of things you really must ask, but add to this list anything you're wondering about, including your attitudes towards birth, fears, desires, etc.

1) How much training have you had? Do you have any certifications? Which?
2) How long have you been a midwife?
3) How many babies have you delivered?
4) What are your birth statistics (inc. hospital transfers and reasons why, any maternal/neonatal deaths and causes, average birth weight, c-sections, etc.)?
5) Have you ever had any unusual birth situations (cord prolapse, unknown breech, etc.)? How did you handle them?
6) How and why do you recommend a woman to go the hospital? What happens if I need to go?
7) What happens if you are unavailable for my birth? Do you have a back up?
8) What is your philosophy on birth?
9) What is your role in my birth? How much control will I have? What about writing a birth plan?
10) Do you do water births? Hypnobirths? (Or any other type you want)
11) What happens in an emergency, if we can't drive to the hospital? Are you trained in CPR or other resuscitation? Do you bring any equipment with you?
12) What do I need to supply for the birth?
13) Do you have any reference families I can contact?
14) How often will I see you? Will you do prenatal care for me?
15) Do you use a back-up doctor or do you recommend I see one? If so, who?
16) If I need to go to the hospital, do you recommend a particular one?
17) Do you do any routine testing or exams? What type?
18) Do you have any limits on who can attend my birth? If so, why?
19) At what point do you consider me full term? What if I go into labor early?
20) Is there anything else I need to know about home birth or you?

Make sure that you get a sense of your midwife's attitude towards birth. Hopefully, you will find one who is very open to your ideas and wishes in birthing, is well-trained in CPR and resuscitations, can do basic prenatal care, is cautious and willing to refer you to a doctor at any point if you become high-risk or if there are any problems or concerns at all (from either of you). The midwife should be willing to allow whoever you want at the birth, be certified and well-trained (having attended no fewer than 30 births, which should occur during training). The midwife should carry equipment with her in case of emergency (oxygen) and be familiar with what to do for cord prolapse, hemmorhage, etc. She should do routine testing for hemoglobin levels, and for protein/sugar in your urine, but most other testing is unnecessary. Although, she should know where to go in case you would prefer to do other testing and be willing to work with you on that. She should not perform internal exams up until labor unless there is a problem, in which case she should probably refer you to a doctor. She should recommend a particular doctor(s) and hospital in case of emergency, and officially say a back up doctor is fine, even if she does not require you to have one. The most important thing is that you feel comfortable with her, and feel that she is trained, can handle your birth and any complications (hoping for none) and that her attitude and philosophy meshes well with yours.

In some states, if the midwives are legal, they will be able to actually attend your birth in a hospital, if you require transfer. In others, where midwives are NOT legal, they will function as a doula or labor coach in the event of a transfer. This is still desirable because midwives can discuss options with the doctors and advocate for you. This way if the doctor says "You really need..." your midwife, who is experienced, can advise you on whether that treatment is really necessary (in many cases it will be, because you don't go to the hospital from a planned homebirth for no reason, but still, it's good to have a midwife to help you sort through your options). It is also important to note that some midwives consider you full term at 36 weeks; others at 37. Most will not attend a birth prior to whatever they consider full term, and will send you straight to the hospital for any premature labor.

You should see a midwife as often as you would otherwise see a doctor. That is, monthly from 8 - 28 weeks, bi-weekly from 28 - 36 weeks, and weekly from 36 weeks - birth. You should also have a home visit from your midwife around 36 or 37 weeks, so that she knows how to get to you, and so that she can verify that you have all your homebirth supplies and that you are ready. Because after this point, you could go into labor at any time!

At each midwife appointment, you should meet for a full hour, or at least a half hour. The appointments shouldn't be 5 - 10 minutes like a doctor's, because your midwife should spend time getting to know you, your husband, your children (if any), and to learn as much as she can about what you are looking for in your pregnancy and birth experience. Early in your care, your midwife should take a detailed history on you. If you have any previous obstetrical history, your midwife should ask you about it in detail. She should also ask about your mother and sisters. If you have had any previous complications, your midwife will want to know what, and why. For example, if you've had a previous c-section for a breech baby, this is unlikely to occur again and is not a concern. But if you've had preeclampsia in the past, this is a concern and could disqualify you from home birth. In general, your midwife should screen you early in your pregnancy to see if you are a good candidate for home birth. The following may disqualify you:

*A complicated gynecological history (frequently missed periods for no reason, PCOS, etc.)
*Multiple miscarriages
*History pre-term labor
*History of pre-eclampsia or HELLP syndrome
*Uncontrolled or difficult diabetes
*History of gestational diabetes
*History of c-sections for circumstances likely to repeat
*Previous hemorrhage
*History of neonatal complications
*Any indications of high-risk pregnancy (multiple miscarriage scares, bleeding, unusual cramping, threatened pre-term labor, etc.)
*Multiple pregnancy (twins, triplets)

Some midwives will disqualify you just for having diabetes, including gestational, or any c-sections (they don't want to attend a VBAC). You may also get disqualified late in pregnancy due to a breech baby (though some will keep seeing you in case the baby turns). Some will attempt a twin birth at home, but it depends on the position of the twins near term; most won't attempt higher multiples at home. It's possible that, if you have a history with this midwife, she will care for you even with some problems because she knows your history, whereas she would not take you on as a new client. If you are potentially high-risk, the midwife should recommend that you see a doctor in addition, so that you can transfer your care if necessary.

At each appointment, you should discuss any problems, questions, or concerns that you have. Your midwife should weigh you, or at least ask if you've weighed yourself (this is more important towards the end of your pregnancy, because a rapid weight gain can signal the beginning of pre-eclampsia. Some women do not want to be weighed in the first half of their pregnancy, and in healthy women, this can be okay -- ask). Your midwife should also take a look at your diet and advise you on how you can eat better for your baby (she should recommend 80 - 100 grams of protein per day, among other things). Your midwife may recommend a particular "pregnancy tea" (containing oatstraw, red raspberry leaf, alfalfa, and other herbs) and possibly a prenatal vitamin. If your hemoglobin is low (below 12), she may recommend spirulina to bring it up. Your midwife should also do prenatal care: listen for baby's heart tones (with a doppler or fetoscope), feel for baby's position, and after 20 weeks, measure fundal height. Your midwife should also have you check for any protein or sugar in your urine, and if any is found, follow up with further testing (it can be a sign of gestational diabetes or preeclampsia). Some midwives will also have you test your blood sugar at home for a week while eating normal meals (and will advise you on the proper way to do this testing) to determine if you are at risk or showing signs of gestational diabetes, and will recommend follow-up testing if necessary, or perhaps a diet change. The ACOG now says that for women with no history of diabetes who are under 25, no glucose testing is necessary anyway.

Your midwife will also attempt to assess your ideas, thoughts, and feelings about birth and all related issues. This means if you are a victim of abuse (sexual or otherwise), your midwife will attempt to discuss this, work through it with you, and refer you to a counselor if necessary. If there are family members or friends putting pressure on you because they do not agree with your choices, she will discuss this with you too.

Your midwife should also give you her immediate contact information: phone number and email (preferably cell phone) so that if you have an emergency, or if the baby is coming, you can call her and reach her immediately. This is IMPORTANT. I have heard many stories of people I know personally, just in the last few months, of having their babies in 15 min. - 2 hours after the first contraction, and in many cases, the midwife didn't even make it! For this reason, you and your husband should also attend a birthing class (your midwife should recommend one, and/or teach you this information) to learn how to deliver a baby, just in case you are alone when the baby comes.

You will also need to buy birthing supplies. Many midwives will put together birthing kits that you can buy directly from them, or from a source they will provide you. You are also able to go and buy your own supplies. A basic list includes:

*Chux pads, large and small (20 - 30)
*Latex gloves
*A birthing pool with liner (if desired)
*Several towels, sterilized (your midwife should tell you how, but seal them in a paper bag and bake for 2 - 3 hours at 200 degrees)
*Baby hat
*Nasal aspirator
*Peri bottle(s)
*Sterilized washcloths and hot water in a crockpot (for perineum compresses)
*Ice packs (for after)
*Mattress pads
*Large trash bags
*Cord tape
*Straws
*Juice/cereal to snack on
*Large bowls (for placenta, and in case you get sick)
*Pads for after the birth (like menstrual pads, but big)

Your midwife may have a different list of supplies. She may also require additional items that you already have around the home (extra sheets for your bed, blankets to wrap the baby in, etc.). It is important to gather ALL the supplies that your midwife requests, organize and label them, and have them in the room you intend to birth at least 4 weeks before your due date. You may also choose to have additional supplies that you want: camera or video camera, special outfit/diaper for after birth, music to play, candles to light, massage oil, birthing ball, special outfit for you, etc. Select all these in advance and put them near your birthing supplies. If you want certain pictures, make sure you have someone who is NOT coaching you who can take them, and that they understand what you do -- and DON'T -- want pictures of (i.e. "don't take a picture of me naked!" or "don't get the head crowning!" etc.). It may be a good idea to invite someone you trust just to take pictures, if this is important to you.

If you want a birthing tub, you can rent one (usually around $200). This is fine...but you can also buy one. There are pools from $30 - $1200. We bought a kiddie pool called the Aquarium pool for $30 and it was just fine. It was strong, had 3 separate inflatable rings (important, so you can adjust the height as necessary) and the sides were strong enough to lean/lay on. The pool should be 22 - 28" deep, and it depends on your height. The size of the pool matters, too, depending on whether you want your husband in with you. 6 ft. in diameter should be big enough for a second person, but talk to your midwife about specific recommendations or ask others who've had water births.

If you have older children, you must decide whether or not they will attend the birth. If the birth occurs at night, a lot of people will let their children sleep; if you have children who are much older (7 or so), they may want to be woken for the birth. It is a good idea to have a helper for the child(ren) who can be present for the birth if the child(ren) wants to be, but is willing to leave if not. We called our friend, Lindsey, to come and watch Bekah during Daniel's birth, which worked out for the best. Next time we will probably allow her to watch -- if she wants to. Some children really just want to be with their mothers and observing the birth is in everyone's best interests; it can also foster a strong bond between siblings. However, some children are a distraction or cannot stand to see their mother in pain and do not want to witness the birth. Either way, children can come back as soon as the baby is born and meet their new sibling in the first moments of his/her life, which is equally special. This is an issue you should discuss thoroughly with your midwife, but remember to be flexible. We had assumed Bekah WOULD want to witness the birth because we thought if she were downstairs and knew I was nearby, she would throw a fit about not getting to be with me. But it turned out she was quite happy to play with friends, and much fussier and clingier when she was with me (which I didn't need right then!).

It's important to note that, in labor, you will probably have a point where you say "I can't do this anymore!" If you MEAN it, your support people should be willing to take you to the hospital, even if nothing is really wrong (you are just exhausted). But be aware that nearly every woman says this, and it means you are either in transition or right around the corner from it. Also, no matter how logical you think you are at this point, you are not. Trust your support people and if they try to convince you to stay home, and talk you through a few more contractions, give it a shot. It may be just what you need.

I said that -- "I can't do it!" I thought I was logical. I said "I'm not making any progress; if I were I could do it. But I'm not. So it is logical to want to go to the hospital and get help. I am nowhere near transition." My husband and midwives had a little pow-wow in another room that I learned about later, where he told them I didn't mean it (although I did, the idea of actually having to pack a bag, get in a car, and then be away from my home and my daughter for a day seemed overwhelming and wrong) and then he coaxed me into the pool we'd set up. It turned out I entered transition right after that and my son was born only an hour or so later. It is important to let people help you! And listen to them even if you don't really want to!

Finally, READ everything you can. Read birth stories. Talk to other people who've had home births. Talk to midwives (even if you aren't totally sold on the idea). Write down all your thoughts and fears (I did). Read books on natural child birth and relaxation techniques. Learn all you can about birthing naturally, and it may put your fears at ease. Honestly, having given birth both in a hospital with an epidural, and at home with no drugs, I would have a baby at home tomorrow (even though I am tired right now...I would STILL be happy to be in labor, to be in pain, to be exhausted again...because it is amazing!). I would be eager, and excited to do it. Really! But I would never want to do it in a hospital again. I can't wait until I have another baby, at home.

Here are a few resources for you:
In His Hands (birth supplies; we ordered mine from them)
Mama Goddess (birth supplies)
Your Water Birth (water birthing supplies)
Home Birth Forum (at mothering.com)
Johanna's Birth Story (at Keeper of the Home)
Home Birth Stories
Birth Stories

I have two more exciting things to tell you!

In the next few months, I'd love to post encouraging, natural birth stories. If you would like to submit yours (they don't have to be home births, but drug-free please), email it to me (leave a comment with your email, which will be hidden, and I'll send you my email then). I think we all need that encouragement!

Also, I am currently working on a cookbook that will feature Real Food recipes and cooking tips for cooks new to cooking and Real Foods. The sales from this book will benefit women who do not have the means to pay for midwives and doulas and other alternative birth care. Most of this will be going to CHOICE (these are the midwives I used). So, look for more details on this book and please consider buying one to support this worthy organization! The book will come in January, and there is a true need for money to support this type of organization right now. More on why in a couple weeks.

Where did you have your babies? Were you satisfied with your experience? Have you had a home birth or would you consider one?