This is a preprint of an article accepted for publication in Midwifery Today Copyright © 2009 Midwifery Today, Inc.

Home Is Where My Heart Is: 15 Reasons to Consider an Out-of-Hospital Birth
By Melissa Possley Taylor

When most people think about giving birth, a hospital is the location that automatically comes to mind. And although most US women choose to give birth in a hospital, there are other options: a birth center or at home. There are situations when a hospital is the best location for a woman to birth, but for many women, a birth center or home may be a better choice. I’ve had the unique opportunity to give birth in all three types of locations and, as a natural childbirth educator and natural birth advocate, I’ve heard stories from women in each setting. I have found that the biggest influence on a woman’s birth experience is the care provider and birth setting she chooses. Here I would like to share my own experience as well as reasons why every low-risk pregnant mother should consider an out-of-hospital birth.

First Impressions
At the age of 22, fresh out of college, I worked my first “real” job as a graphic artist. My boss, the Creative Director, was a rather eccentric fellow. He told me once that he and his wife were seeing a midwife and were having their third child at home. It all sounded a bit crazy to me. A midwife? Do people still use midwives? At the time I had never heard of anyone giving birth outside of a hospital and probably the newness of this idea combined with the fact that I already thought that my boss was a little different led me to believe that this was a bad choice. I made a mental note that when it was time for me to have children, I would have them at a hospital like a normal person.

Fast forward five years, I was married and we were getting ready to start a family. I had mentally planned that when we had our first baby, we would do so at the hospital that was very close to the spot where my husband and I met and got married. This was a romantic thought, but when I became pregnant, it was time to examine my choices and really think about the reasons behind them.

Trial and Error
When I first became pregnant, I knew nothing about pregnancy, labor and delivery, so I started reading as much as I could. I knew I wanted a natural birth and, at my prenatal appointments, I began asking questions about some of my preferred options. I wanted to eat and drink during labor, avoid an IV, be mobile, etc. I had chosen my OB based on proximity to my house rather than on her commitment to natural birth and, although she seemed like she would go along with some of the things we wanted to do, there were other things that she felt she couldn’t compromise on. By the time I was 20 weeks along we began to see some of the other doctors in her group practice. We met with one doctor who had her hand on the doorknob the entire time my husband and I were talking to her. She made us feel like we were inconveniencing her by asking questions and, for us, that was the last straw. We decided to tour our local birth center.

The local birth center was in a quaint and inviting office park and felt more like a cabin in the woods than a medical office. The midwife there felt like an old friend. After talking to her about her training and skills as a midwife, and the safety of out-of-hospital births we decided to switch care providers. The birth center also offered homebirth as an option. My husband, who was incredibly supportive through all this, asked me if I wanted to birth at home. I am adverse to change and my natural reaction is to immediately dismiss new ideas until I have had some time to absorb them. I said no and made some comment about not wanting to clean up the mess afterwards. As I continued going to my prenatal appointments it occurred to me that there was really no difference between the type of equipment that was at the birth center and what would be available at home. The birth center was, after all, basically just a house and the midwife could bring all her equipment with her. The only difference I saw between the two, was that I would have to get in the car and drive to the birth center during my labor, and then drive back afterwards with our newborn baby. After mulling it over I decided I did want a homebirth.

Things don’t go as planned
We planned for a homebirth but at 36 weeks I was in labor. Our biggest concern was that I would have to transfer to a hospital. Our midwife examined an ultrasound from 20 weeks gestation and, based on the ultrasound, I was 36 weeks and 5 days. The consulting OB suggested I go to a hospital but also said he would approve a birth at the birth center if we wanted to stay. My husband and I discussed it and we decided that my body knew what it was doing and, since I was in labor, our son Marc must be mature enough and ready to come out. I had not had a home visit with our midwife yet (she usually visits the home of homebirth clients to make sure they have adequate living conditions. Our home visit was scheduled for that week but Marc was coming early.) Our midwife also had some prenatal appointments at the birthing center that morning which made it necessary for us to birth there and not at home. Although not what we planned, we had a wonderful birth at the birth center.

Next Time Around
With my second pregnancy we again planned a homebirth. At 21 weeks we chose to have an ultrasound scan. The ultrasound technician put the wand on my belly and we looked at the monitor. My husband said (sort of kiddingly), “Hey, it looks like two heads!” The technician told us that two heads was exactly what we were seeing and that I was pregnant with twins. The pregnancy turned out to be high risk because my identical girls were not sharing their placenta evenly. One baby was 25% smaller than the other. Because of the risks of carrying multiples, plus the added risk of the placental problems, a birth center or home birth were not safe options for us. We worked hard to find a supportive birth team and had a natural birth in a hospital. Our daughters Lily and Logan were born at 32 weeks. They spent 4 weeks in the NICU but had no major health problems; they just needed some time to grow.

Third Time’s a Charm
With my third pregnancy we again planned a homebirth. I was a bit concerned with my history of preterm labor; I needed to make it to 37 weeks to have my homebirth. I did a lot of positive visualizations of my pregnancy continuing past 37 weeks. Either it worked or I shouldn’t have worried because our daughter, Addison, was born at home at 40 weeks and 2 days. We finally got our homebirth. It was wonderful being at home where I felt comfortable and I loved that our three older children were able to participate in the birth. The birth was a wonderful experience for our whole family.

Making Your Decision
Wherever you choose to give birth, make sure you are making choices for the right reasons. My original idea of choosing a setting based on where it was located, and its proximity to where my husband and I got married, was not a good reason. It’s important to make thoughtful choices rather than to choose a setting based on proximity or because you know someone else who had their baby there. Also remember that looks can be deceiving. For example, a hospital might have beautiful birthing tubs, but are they ever used? Find out how often women actually use them for labor, what restrictions exist on their use and if they are used for delivery. It is important to do some research and put a lot of thought behind your decision.

Let’s think about buying a car as an analogy… Mandy & Doug want to buy a minivan. They could buy an X or a Y. The price is the same, both can seat eight people, both have twenty-six cup holders and both are rated equal for safety. Mandy and Doug are positive they want an X. Three of their friends just got an X and are happy with them. Mandy & Doug have never seen a Y, they don’t know anyone who drives a Y and, until they saw something about it on TV a few months ago, they didn’t even know brand Y existed. Yet, how can they make their BEST decision without ever seeing a Y? How do they know they are getting the right car for them? Why not just look at a Y? If nothing else, it will reaffirm the fact that the X is the right car for them. And who knows, maybe they will like the Y. Maybe they will see something in the Y car that they never even considered before! Also, think about how much time and energy a person puts into researching the purchase of a new car: internet research, going to car lots, going for test drives. Having a baby is a much bigger deal than buying a new car. A person should put more time and energy in selecting a care provider for the birth of their baby than they do in selecting a new car to purchase. Even if someone doesn’t think an out-of-hospital birth is right for them, they should consider touring a birth center and/or interviewing a homebirth midwife so they are fully aware of their options and can make the best possible choice for their situation.

So What’s a Birth Center Anyway?
A birth center is a freestanding facility where women with a low-risk pregnancy can receive prenatal care and birth their babies with the help of licensed midwives. For low-risk women, birthing at a birth center is equally as safe as birthing in a hospital; however, the woman who births at a birth center is much less likely to receive medical interventions. Where it is typical for a hospital to have a c-section rate of 30-40% or even higher, most birth centers have very low rates, 3 - 8% is typical1. It is also important to note that cesarean sections cannot be performed at a birthing center. In the event a woman does need a cesarean section, she is transferred to a hospital. Also, epidural anesthesia and narcotics for pain management are not available at a birth center. Women who birth at birth centers do so without pain medication and rely on techniques such as relaxation, visualization, movement and water for pain management.

Do People Really Give Birth At Home?
The other option for an out-of-hospital birth is a homebirth, which is also attended by a licensed midwife. Home is the environment where most women feel the most relaxed and in control. All other mammals birth in places they feel safe and secure, it makes sense that women would choose to give birth at home. Studies have shown that for low-risk women home births are also just as safe, if not safer, than hospital births.1, 2 As I mentioned, there is nothing at a birth center that can’t be brought to your house. Homebirth midwives pack all the necessary equipment including oxygen, IV fluid, antibiotics, pitocin (in case of hemorrhaging after the birth), and neo-natal respirators in case of need.

What are the Benefits of Birthing Out-of-Hospital?
There are many benefits to mom and baby of birthing out-of-hospital and there is a quality of care you can get out-of-hospital that you might not get in-hospital. The following list offers examples and advantages that you might get out-of-hospital and includes some personal experiences and some experiences from other mothers. These are generalizations and may not be true 100% of the time but should spark some questions for interviewing care providers.

1. Less Risk of Medical Intervention. One of the biggest reasons women choose to birth out-of-hospital is to avoid unnecessary medical intervention. Epidurals, narcotics and labor-inducing drugs are not an option at an out-of-hospital birth. C-sections are not performed out-of-hospital. Because these are not even options, a mother who chooses to birth out-of-hospital is not likely to receive any of these medical interventions, and WILL NOT receive them unless she is transferred to a hospital.

The World Health Organization (WHO) has suggested that a country’s c-section rate should be between 1-15% and that the best results seem to be somewhere around 5-10%3. What this means is that if a country has a c-section rate of less than 1%, moms and/or babies are dying who might have been saved if a c-section was available. It also means that if a country’s c-section rate is over 15% (the rate in the US is currently about 33%4) that some of the c-sections being performed are unnecessary and are doing more harm than good. Remember, if a procedure is done unnecessarily, all of the risks still exist but you get none of the benefits.

Out-of-hospital providers are likely to have a c-section rate in the 1-10% range.5 Although the average c-section rate in this country is about 33%, some hospitals have rates that are much higher. Locally, in 2007, an area hospital had a c-section rate of about 43%6 and an area birth center had a rate of about 4%. If we think of this in reverse, at the birth center, 96% of women had a vaginal birth and at the hospital, 57% of women had a vaginal birth. If you were gambling, would you rather place all your money on something with a 96% chance or with a 57% chance? No matter what the parents do to prepare, take classes, hire a doula, read books, etc., if they want a natural birth and go to a place with a 43% c-section rate, they are making it harder on themselves.

2. Trusting Your Care Provider. I had a mother call me once to tell me that she was bleeding from her vagina and I told her she needed to let her OB know. She said she was scared to call her OB because she was worried he’d want to induce her labor. Whenever a mother withholds information from her care provider, there is a possibility that she is compromising the safety of her baby. I’ve had other mothers tell me that they lied to their care provider about their last menstrual period, or did not tell their care provider that their bag of waters broke until labor was well underway. If a mother feels the need to lie or withhold information from her care provider, it is a sign that she has not chosen the right person to provide her with prenatal care or to help her birth her baby.

Many women who plan natural births in a hospital feel that they are fighting an uphill battle. When labors are routinely induced days after a due date, when over 90% of woman at a particular hospital receive an epidural, when more than one in three women have a surgical birth, what are the chances that a mother planning a natural birth is going to get the support she needs?

Sometimes interventions are necessary. If a woman is with an OB who performs a c-section 43% of the time, and this OB tells her that she needs a c-section, is the woman going to believe that this is what she really needs? When the OB says it’s “for the safety of the baby,” the woman is probably going to consent to it because she wants her baby to be safe, but afterwards, she may question whether it was really necessary. There’s no doubt that there are some unnecessary c-sections preformed in this country; what is that doctor telling the women in these situations? How can you be sure that you won’t be one of these women? If the mother starts out planning an out-of-hospital birth with a midwife whose c-section rate is less than 5%, and this midwife tells her that she does need a c-section and explains why, the mother will trust her midwife. This mother is going to get her questions answered and make the best choices she can in her situation.

Birth is a natural and instinctive process and if a woman feels she is in an unsupportive, unsafe environment, this can hinder the process. Trust is an important part of feeling safe. Feeling unsafe or unsupported can cause the body to release adrenaline which can slow or stop labor. Also, if a woman feels unsupported, she is less likely to listen to her body and trust her instincts as to which positions to choose for labor, which can also slow the progress of her labor.

3. An Expert on Normal Birth. Many hospital care providers have never seen a natural birth from start to finish. Many have no idea of what a natural birth can be like. Obstetricians are highly trained surgeons and are experts on what can go wrong during labor. Many OBs treat a pregnancy as a medical condition that must be managed and treat a laboring woman as a surgical patient. They may introduce one intervention, and then need to introduce another one to compensate for the side effects of the first. Marsden Wagner, the former director of Women's and Children's Health for the World Health Organization, states in one of his books, "Having an obstetric surgeon attend a healthy birth is like having a pediatric surgeon baby-sit a healthy two-year old. Both are going to be tempted to apply medical solutions to everyday situations, such as using drugs to stimulate normal labor or narcotics to put a fussy toddler to sleep. Unfortunately, using highly trained surgeons to handle normal life experiences, such as childbirth, increases unnecessary and risky interventions, decreases women's satisfaction, and wastes huge amounts of money."7

Where OBs are experts on surgery, midwives are experts on normal labor. A midwife must attend at least fifty births before taking her national exam. Ironically, many doctors finish medical school having only attended one or two births. In general, midwives differ from OBs in that they view birth as a normal process instead of a condition that needs to be managed. Because she is an expert at normal birth, the midwife can give the kind of support a mother needs during her labor, and at the same time empower the mother to listen to her body, trust the birth process and have the birth she desires.

4. Individual Attention. I transferred to a midwife’s care during my first pregnancy because our OB didn’t take the time to answer our questions. When we made the switch, we felt that our midwife would take any amount of time we wanted to answer ALL of our questions. Generally, midwives allow much more time for prenatal appointments, and are eager to take the time to answer any questions a couple might have. A midwife is also more likely to take the time to talk to the mother about diet and exercise, about any emotional issues that might impact labor, and about how the mother is preparing both mentally and physically for the birth.

Studies have shown that during labor, continuous one-to-one emotional support is very beneficial to the mother and results in less use of medical interventions.8 In a hospital, unless the couple hires a doula (which is a great idea) they do not have continuous one-to-one support. The labor and delivery nurse is there supporting them but she has other patients to care for and there is often a shift change. The doctor checks on the mother a few times and is updated by the labor & delivery nurse and may not even enter the until the baby’s head is crowning. A midwife is with the mother throughout the labor offering emotional support and physical comfort.

More individual attention could ensure a safer birth experience for mother and baby. I know a mother who had a cesarean section and after she returned home, she felt that her pain level was telling her that something was not right. Her husband called the OB and they were told it was normal and that she wasn’t on strong enough pain medications. It turned out she had a blood clot forming under her incision and she had to be re-hospitalized. If this couple had not trusted their instincts and been persistent, it could have been much more serious than it already was. Because a midwife offers more individual attention, she is more likely to take a client’s concerns seriously and act if there are signs that something is not right.

5. Easier to Avoid Induction and Avoid Pressure to Induce. Labor begins when the baby is fully developed and it is believed that when the baby is ready, he or she sends a signal to the mother’s brain and the hormone oxytocin is released thus starting labor. The lungs are one of the last things to develop and one risk of inducing labor is always a baby who is not ready to be born; not fully developed and more likely to need help breathing.

Pitocin is the synthetic form of the hormone oxytocin and is often used for inducing labors. Induction of labor with pitocin makes contractions stronger, last longer and come more frequently, all of which are harder on mom and harder on baby. Because contractions are so strong, the mom on pitocin is more likely to request an epidural than a mother laboring naturally. Risks of pitocin are it doubles the odds the baby will be born in poor condition; it increases postpartum blood loss and increases newborn jaundice. Also, because pitocin is harder on the baby, the baby is more likely to experience fetal distress, so when a mother is induced with pitocin, it increases the likelihood of a cesarean section.9

It’s not unusual now for doctors to induce women a couple of days past a “due date”, whereas midwifes, depending on the state in which she practices and the laws of that state, will care for a women until she reaches at least 42 weeks. (Some states have strict guidelines and require a midwife to transfer a mother’s care to that of an OB once she reaches 42 weeks.) It’s important to remember that without intervention, the average first-time mom delivers at 41 1/7 weeks.10 The out-of-hospital midwives are more likely to consider the last due date (sometimes mothers will have several due dates: one based on last menstrual period, one based on ovulation, and one (or more) based on an ultrasound.) If a mother is getting close to the 42 week point, out-of-hospital midwives are more likely to suggest gentler ways of helping the body to go into labor such as herbs, acupuncture, chiropractic, reflexology, etc.

Another common reason women are induced is if their bag of water breaks and labor doesn’t start or doesn’t progress as quickly as their doctor would like. (Good nutrition, especially adequate amounts of Vitamin C in the diet, can help build a strong bag of waters and reduce the likelihood of premature rupture of the membranes.) Once the bag of water breaks, the main concern is infection, so it’s best to avoid vaginal exams especially if you are not in labor. According to Marsden Wagner, if the bag of waters breaks, “watchful waiting is a good approach that is underused. With no signs of infection, it is usually safe to wait at least forty-eight hours before considering induction.”11 However, once the water breaks, many OBs want labor to start right away and some will insist the baby be born no more than 24 hours after the membranes rupture. At an out-of-hospital birth, midwives commonly use the ‘watch and wait’ approach and, if things aren’t happening, suggest more natural ways to get labor started such as herbs, positioning, nipple stimulation, etc.

6. Easier to Avoid Pain Medication. I had a student who, on the first day of class, told the other students that one reason she was planning an out-of-hospital birth was because she did not want an epidural during her labor, and that she knew if an epidural was available, she would ask for it. Sure enough, during her labor she demanded to be taken to the hospital so she could get an epidural. Her partner and her midwife encouraged her and told her she was doing great, and she birthed her son at the birth center. After the birth she was just thrilled; she was so proud of her accomplishment and so glad she did not go to the hospital.

At an out-of-hospital birth, a mom has an easier time avoiding pain medication simply because it’s not available, but also because there is no one there suggesting she might need it. Out-of-hospital, there is no one there questioning whether she is capable of laboring without pain medication or suggesting that she’s crazy for even wanting to labor without pain medication. At a hospital, a mother might get comments such as, “I don’t know why you would want do this to yourself,” or “you don’t have to be superwoman.” These types of comments are dismissive of the mother’s goals for her birth and make an unmedicated birth seem an unobtainable and/or selfish goal and it certainly is neither.

7. Monitoring During Labor. Monitoring during labor refers to checking the baby’s heart tones during the labor and this is done both in hospital and out-of-hospital. However, there are different methods of monitoring and different types of monitoring devices. Constant or continuous monitoring is when the monitoring occurs during the entire labor, and intermittent monitoring is when the baby’s heart tones are checked periodically. Studies have shown that both types of monitoring have the same outcomes for babies (meaning both are equally as safe); however, a mother is much more likely to deliver via cesarean section if she is being continuously monitored.12

Types of monitors can also affect how a woman labors. Electronic fetal monitors used at a hospital require a mother to wear two belts around her abdomen, one belt has a sensor to monitor contractions, the other has a sensor to monitor the baby’s heartbeat. The belts are tethered with wires to a machine that records the readings. The belts themselves can be irritating but they also restrict the mother’s movements since she can only walk as far as the length of the wires. Also, mothers on electronic fetal monitors are sometimes encouraged to be still because when they move, the monitors slip and the nurse has to come and reposition them.

During an out-of-hospital birth, a hand-held doppler is usually used to intermittently monitor the baby. Often, this is not an option at a hospital simply because of the patient-to-nurse ratio – monitoring with a doptone requires 1:1 care. The intermittent monitoring with the doptone allows the mother more comfort, more freedom of movement and decreases the likelihood of a cesarean section.

8. Eating & Drinking During Labor. Labor is like running a marathon. Imagine running a marathon on only ice chips. Yet hospitals do not let a laboring woman eat, and most also do not let her drink – it’s ice chips only.

Usually women are hungry early in labor, and it’s a good idea to eat something easily digestible. Later in labor, most women are not hungry; however, a woman might have low blood sugar and need a pick-me up. In this case, honey, hard candy, lollipops, sports drink, juice, etc. are good choices. It’s also important to stay hydrated during labor because the mother will experience less pain and the hormones progressing her labor will be released most efficiently if she’s properly hydrated. Becoming dehydrated can cause a lack of energy and inefficient contractions.

In a hospital, food and drink are restricted because the mom is being treated as a surgical patient in the off-chance that she needs an emergency c-section with general anesthesia. (Most c-sections are done with spinal or epidural anesthesia and not general anesthesia. General anesthesia is only used in a true time-critical emergency. Most so called “emergency c-sections” aren’t actually time-critical.) If an emergency does occur and general anesthesia is used, if there is food in the mother’s stomach, there is a chance that she could vomit and then aspirate on her vomit (get it in her lungs.) This is not a very likely scenario. It is true that aspirating on vomit could be dangerous; however, it is unlikely and anesthesiologists are trained to deal with it.

During an out-of-hospital birth, mom is encouraged to eat and drink throughout her labor. During a long labor, mom may certainly want a snack. She is encouraged to eat if she’s hungry. Mom is also encouraged to take fluid by mouth.

9. Freedom to Move and Choice of Positions. During labor and birth, the baby moves down the mother’s pelvis and out of the birth canal. In order to do so, the baby needs to turn and navigate through the pelvis like a key in a lock. A mother can help by listening to her body for determining what positions to use for labor – often the position that feels the best is the best one to help the baby move down. Walking early in labor is great because the motion helps open the inlet of the pelvis and helps the baby enter the pelvis. Squatting later in labor helps open the outlet of the pelvis and it’s a good position to use for pushing. Activities such as lunging and stair walking can help open one side of the pelvis and can help the baby’s head straighten out. A hands-and-knees position can help a baby turn if he or she is facing out instead of in towards the mother’s spine. The mother who is tethered to the bed with an IV and monitors doesn’t have the freedom to use these positions. The mother with an epidural cannot use these positions because she is temporarily paralyzed from the waist down.

Of course it is possible to move and use different positions in a hospital setting and women should be encouraged to do so, but often they are not. An out-of-hospital setting usually has more room for a mother to move around. A mom in a hospital can walk the halls, but this is not very private. At a birthing center or her own home, there may be larger areas of private space she can utilize. Also, out-of-hospital care providers, being more familiar with normal birth, will encourage the mother to listen to her body and choose different positions, or even suggest positions that can help the baby move down.

In a hospital, a drug or intervention is more likely to be recommended than changing position if things are not progressing “normally”. Pitocin is often suggested to speed labor instead of walking, trying different positions or just letting labor happen at its own pace. One mother was at a hospital and her baby was having heart decelerations during her contractions. Her doctor wanted to give her a drug to slow her contractions. Instead she tried the hands and knees position and the baby’s heartbeat recovered and she went on to have a wonderful vaginal birth. The doctor commented that the position was “not very lady-like.”

Other mothers have wanted to push in a squatting position, or a position other than the classic semi-sitting position that is the norm for a hospital birth. Several of these mothers were told by their doctor that they had to push in the semi-sitting position because that’s the only way the doctor knew how to deliver a baby. A midwife is more likely to support a woman pushing in whatever position she feels comfortable in.

10. Less Risk of Infection. Hospitals are for sick people. A pregnant woman is not sick. Being a “sick house”, a hospital can be home to some pretty scary bacteria such as antibiotic-resistant bacteria. It is less likely that a birth center or a home would carry these dangerous types of bacteria. Many feel home is the safest place to birth because a woman is used to the bacteria present in her own home and is less likely to develop an infection. Also, a woman is more likely to develop an infection after a surgical birth (cesarean section) which is more likely to occur when she chooses a hospital.13

11. Easier Bonding with Baby and More Time to do so. The period after birth is a time for mother and baby to bond and for attachments to form between mother and baby. Having an unmedicated birth will help the bonding process, and that is more likely to happen out-of-hospital. With an unmedicated birth, the mother’s brain releases a cocktail of hormones designed to promote attachment. These hormones make mom fall in love with her new baby and this is a process designed by nature so that the mother will protect her new baby.

Sometimes the importance of bonding isn’t emphasized as much as it should be. Animals whose young are separated from them immediately after birth often reject them when they are reintroduced. Imagine that you and your partner are just about to share your first kiss when someone steps in to measure the circumference of your partner’s head. You will probably still fall in love but that special moment was interrupted and you will never get it back.

In an out-of-hospital birth, the midwife cares for mother and baby as a unit and recognizes their need for one another. An out-of-hospital midwife is more likely to give the mother and baby time to bond. Also, out-of-hospital, moms are encouraged to care for their own babies, where in the hospital, a nurse might do some of the baby care duties such as giving a first bath, the first diaper, etc. Often in a hospital, the baby is “cleaned up” before mom holds the baby. In nature, other mammals clean their own babies. For other mammals, cleaning their babies and smelling the scents of the birth is part of the bonding process and it may be important for humans too.

It is also easier to bond with a baby in a homelike environment because mother feels more relaxed and in her own element. Birth centers also have a more home-like feel than hospitals. Hospitals usually have policies in place which can interfere with bonding, such as a baby going to a nursery for a test or procedure, or a mother not being able to carry her own baby in the hallway of the hospital (mothers may need to wheel their babies around in their portable bassinet instead,) or just the constant interruption of someone coming in to take the mother’s vital signs. A hospital is also more likely to frown upon a mother sharing her bed with her baby.

12. Newborn Care Your Way. Parents have many choices concerning their babies once he or she is born. These things are not always presented as an option, but parents have the right to consent to or refuse any procedure done to their newborn. Parents may have many preferences including if the baby is routinely aspirated; if and when the umbilical cord is clamped and cut; how much uninterrupted skin-to-skin contact occurs between mother and baby before the newborn exam is done; use of a warmer; whether they administer eye ointment or a vitamin K injection; whether the baby receives a hepatitis B vaccine; and when, how and by whom the first bath is given.

After the birth, if a baby and mother have skin-to-skin contact, not only can the mother and baby bond, but the baby is better able to regulate his temperature and glucose levels than if he’s placed in a warmer.14 It is standard in many hospitals for a baby to be removed from his mother’s arms a few minutes after birth for newborn tests. A hospital has a set of standard procedures for what happens to the baby after he or she is born, it often feels like an assembly line. Some hospitals and staff are fine with deviating from the normal protocol. Others have a very difficult time deviating. At the hospital and with an OB, the doctor will be caring for the mother and (usually) a pediatric nurse will be taking care of the baby. With two separate people caring for the mother-baby, it’s easier for them to become separated and it’s easier for parents to forget to assert their wishes, especially in the excitement of seeing their child for the first time. A midwife out-of-hospital treats the mother-baby as a unit and will be more flexible and understanding if parents want to delay or refuse certain tests or procedures. Newborn tests and procedures are done when mom and baby are ready, usually at least an hour after the birth, and many of tests can be done while the baby is in the mother’s arms.

13. Reduced Likelihood of Postpartum Depression. Anytime a new mother experiences depression, it can be harmful to the mother, the baby and/or the family. Studies have shown that women who feel informed and in control of their care usually feel satisfied with the care they received and are less likely to experience postpartum depression. One study showed that the incidence and severity of postpartum depression was highest in women who had c-sections. It was higher in women who birthed vaginally in a hospital than in women who birthed at home.15 Another study showed that women who were cared for by midwives during their prenatal period were more likely to report satisfaction with their care and were less likely to experience postpartum depression than women under an OB’s care.16

Because mothers are less likely to receive medical intervention and are more likely to feel informed and in control of their care in an out-of-hospital birth setting, they are less likely to experience postpartum depression.

14. Breastfeeding support. A midwife at an out-of-hospital birth assumes a mother is going to breastfeed. The midwife has confidence in the new mother’s ability to feed her baby and this, in turn, gives the new mother confidence in her ability. If the mother does encounter difficulty in breastfeeding, the midwife can point the mother in the right direction to get the help she needs.

Hospital policy is not always breastfeeding-friendly. Locally, some mothers have encountered staff who were not supportive, or even undermined breastfeeding. I’ve heard from mothers who were told that they were starving their babies and that their babies were too big and that their colostrum was not enough (not true!) A new mother is very impressionable and even if she doesn’t believe this criticism, it is likely to affect her confidence. No new mother wants to hear that her baby is starving. Also, a hospital is more likely to routinely test the baby’s blood sugar (affecting mother’s confidence) and suggest glucose water or formula be given if levels are low, a practice that is counterproductive in babies who are not showing symptoms of hypoglycemia.17

When my twins were born at 32 weeks they spent 4 weeks in the NICU where they were fed only my milk, at first by tube, then by bottle and occasionally at my breast. The discharge instructions when they finally came home were, “Logan was fed at 2:00, so feed her again at 5:00, Lily was fed at 3:00, so feed her at 6:00.” Fortunately I had previous experience nursing my son and I knew that breastfed babies nursed more frequently than every 3 hours. I took them home and put them on the breast and there they stayed for the next 2 years. If I had not had this experience and confidence, I would have been set up for failure at breastfeeding because of the bad advice at discharge.

Studies have shown that if a baby can self-attach to the breast after birth, breastfeeding is more likely to be successful. Two things are very important for self-attachment: an unmedicated birth and uninterrupted skin-to-skin contact between mother and baby until the first breastfeeding session. If the baby is taken away for newborn tests such as height and weight, this process is interrupted.18 A hospital may interrupt this time for skin-to-skin contact and mother-infant bonding immediately after birth, and thus, can interfere with breastfeeding.

Medical interventions such as epidurals, pitocin and a cesarean section can also interfere with the natural release of hormones in the mother and can cause problems with breastfeeding. Any drugs that the mother receives also reach the baby and can cause the baby to be sleepy and have a dry mouth, both of which make initial latch-on difficult. A mother will more commonly experience such medical interventions if she started off at a hospital.

Note: Some women must deliver in a hospital because they have a risk factor that makes an out-of-hospital birth unsafe. If this is the case, it’s best to look for a hospital that is Baby-Friendly. This means the hospital has practices and policies in place that are supportive of breastfeeding. For more information go to www.babyfriendlyusa.org.

15. Empowerment. The more in control a mother feels during her birth, the more empowering it can be. If the mother feels that she birthed on her own, that body and mind knew what to do and did the job well, she is going to feel empowered.

If a mother feels that the doctor managed the labor and delivered the baby, or possibly even saved the mother and the baby, then the mother is less likely to feel this sense of empowerment. If the mother felt that she could not have given birth on her own because her body didn’t work right, or if she had to be told how to do things, or if she felt like things were done to her and she was treated as an object instead of a person, she may even feel disappointed or depressed after her labor, which is not an ideal way to enter motherhood.

Most women find labor difficult (which is why it’s called labor!) A natural birth in today’s environment is even more difficult because of the medical system and the fear that exists in our society. But labor is also something that every woman can do, it’s something women’s bodies were made for, and it is something that women for generations have been doing since the beginning of mankind.

Many women reach a point in their labor where they feel like they can’t go on. We call this “self-doubt” and the woman is likely to say or think, “I can’t do this anymore.” But then, with determination and/or encouragement, SHE DOES IT! As Elan McAllister, president of Choices in Childbirth, states in the movie The Business of Being Born, “it’s amazing to be with a woman after she gives birth when she says, ‘I knew I couldn’t do it, I knew I couldn’t do it and then I DID IT. I hit a wall that was higher than anything I had ever seen and I scaled it!’”19 This sense of accomplishment combined with the natural flow of hormones from birthing naturally gives the mother the feeling that she can do anything and that she is AWESOME (and she is!!!) Feeling awesome and able to do anything is a GREAT way to enter motherhood. A mother is more in control of her experience and empowered by choosing a midwife and an out-of-hospital birth environment.

Notes:
1. Johnson, K.C. & Daviss, B.A. ‘Outcomes of planned home births with certified professional midwives: large prospective study in North America’. June 18 2005 British Medical Journal 330 (7505):1416.

2. Tracy, S., Dahlen, H., Tracy, M., Laws, P., & Sullivan, E. ‘Birth Centres in Australia. A national population-based study of perinatal mortality associated with giving birth in a birth centre’. 2008. Birth 35(1), 86.

3. ‘Appropriate Technology for Birth.’ 1985. Lancet 2(8452): 436-37.

4. Center for Disease Control, National Vital Statistics Report: 57:12, March 2009, <http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf>.

5. See Note 1.

6. FloridaHealthFinder.gov: <http://www.floridahealthfinder.gov/Researchers/QuickStat/documents/Cesarean%20Rates%202000_2008%20for%20FHF.xls>.

7. Wagner, Marsden. Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth. New York: Penguin Group; 2006: 51.

8. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. ‘Continuous support for women during childbirth.’ Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub2

9. Goer, Henci. The Thinking Woman’s Guide to a Better Birth. New York: Penguin Group;1999: 65.

10. Mittendorf, Robert, et al. ‘The Length of Uncomplicated Human Gestation’. June 1990. Obstetrics & Gynecology, 75:6.

11. Wagner, Marsden. Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth. New York: Penguin Group; 2006: 91.

12. Alfirevic Z, Devane D, Gyte GML. ‘Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews’. 2006. Issue 3. Art. No.: CD006066. DOI: 10.1002/14651858.CD006066

13. Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Berkley, CA: Celestial Arts; 2009: 205.

14. Christensson, K., et al. ‘Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot’. June/July 1992. Acta Paediatrica 81(6-7): 488-493.

15. Edwards, D.R., et al. ‘A pilot study of postnatal depression following caesarean section using two retrospective self-rating instruments’. 1994. Journal of Psychosomatic Research 38(2): 111-17.

16. Bland, Michelle. ‘The Effect of Birth Experience on Postpartum Depression.’ 1 December 2008. National Science Foundation and Missouri Western State University National Undergraduate Research Clearinghouse. <http://clearinghouse.missouriwestern.edu/manuscripts/59.php>

17. Eidelman, AI. ‘Hypoglycemia and the breastfed neonate’. April 2001. Pediatric Clinics of North America 48(2):377-87. < http://www.ncbi.nlm.nih.gov/pubmed/11339158>

18. Righard, L., Alade M. ‘Effect of delivery room routines on success of first breast-feed’. 1990. Lancet 336: 1105-07

19. The Business of Being Born. Dir Abby Epstein. Prod. Ricki Lake. DVD, 2007.

Download a pdf of this article