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Vegan Pregnancy
Homebirth: Is It Right For You?
by Cecily Arenas
After 24 hours of laboring -- moving with each contraction up to the next
levels of labor -- Luna was about to arrive. I got into our hot tub. I could
feel her water bag moving down my birth canal. With one strong push the bag
burst. I gently pushed with each contraction and felt my baby move down with
my finger. With her father supporting my perineum, she crowned. I let out a
moan as I felt myself open completely to this birth. The next contraction
came. I knew this was it. With a primal yell, out came her head. The burning
and pressure lessened. Her father exclaims, "The head's out! A full head of
hair!" I have never heard such elation in his voice in the 6 years we have
been together. The next contraction came. I go into my body and out our
daughter slithers into her father's hands. I hold her. We all cry. We did
it! She breathes immediately. No suctioning was needed. No IV's. No fetal
monitors. No crowds. No one giving me orders. Just the power of birth. Just
us.
As late as 1900, 95% of all births took place at home in the United States.
As the medical profession became more organized, doctors were able to
successfully campaign for the eradication of the midwife. Doctors convinced
the public that birth was safer with them even though their mortality rates
were higher than those of the midwives. Midwifery training ceased as
midwifery was becoming illegal in some states. Some midwives continued to
practice but in poor rural areas or very discreetly. By 1960, 96% of all
births took place in hospitals.
Safety of Homebirth
Midwives deliver 80% of the world's babies yet in the U.S. they deliver only
about 4% of babies. The medical model tells us that birth is inherently
dangerous and homebirth is unsafe. Studies have shown otherwise. In the
Netherlands, a country with a low infant mortality rate (3rd in 1973),
homebirth is the norm. In 1973 two-thirds of all births occurred at home and the
cesarean rate was 2.3%. Obstetricians are rarely used and only in high risk
situations. In contrast, in the United States, who rates approximately 24th
in the world in infant mortality, hospital birth is the norm.
The Farm, an intentional community in Tennessee, compared homebirth outcomes
to those of the hospital. 1917 births occurred at the Farm between
1970-1994. Four percent of these births were transferred to the hospital. The cesarean
rate was 1.8%. The cesarean rate in U.S. hospitals averages 25%. 1 out of
every 4 women undergo major surgery in birth! Some hospitals have a 50%
cesarean rate while others have a 10% rate. There was no difference in
perinatal death, respiratory distress or birth injuries when comparing home
and hospital births.
A study by Lewis Mehl in 1977 shows that homebirth is safer than hospital
birth. Of 1146 homebirths in San Francisco the perinatal mortality is 9.5
per 1000 at home and 20.3 per 1000 in the hospital.
There are no studies that show otherwise.
Of course we think about all of the women and babies dying at the turn of
the century. This is true. Women and babies were dying because of poor
health, disease, and starvation. The medical model says that birth is safer
because of their technology and style. However birth has become safer
because of better nutrition, better work conditions, prevention, eradication
of diseases and overall better health. Women and babies are healthier than
ever yet normal birth occurs in the hospital.
Options
Even though birthing at home is not the norm in the U.S. we still have a
variety of birthing options. We can birth at home with or without a midwife,
at a freestanding birth center or in the hospital.
Birthing at Home
When making the decision to birth at home there are a few things to
consider:
- Do I feel comfortable birthing at home?
- Why am I birthing at home? (Your choice should not be based on pressure
from others but should be based on what you feel is best)
- Am I healthy?
- Do I eat well?
- Am I willing to take responsibility for my birth and take on an active
role?
- Am I able to birth without pain medication? (There are no epidurals at
home, however there are plenty of comfort measures that can help you cope
with labor)
- Who do I want at my birth?
Some women prefer a professional midwife at their birth. Midwives offer
comprehensive prenatal care which emphasizes nutrition, exercise, parental
responsibility, education, emotional balance and preventative care. Midwives
can serve as a counselor helping moms work through issues so that their
birth can be more complete. Because women use less medication with midwives,
there are less complications. Drugs interfere with the normal process of
labor and harm the baby. Midwives believe that birth is a normal process
which is not in need of medical intervention. Midwives are trained to
recognize complications and intervene in rare cases. She can deal with
emergencies or transport to the hospital.
There are two types of midwives, Direct-Entry Midwives (DEM) or Certified
Nurse Midwives (CNM). DEMs or "lay midwives" are trained through
apprenticeships with experienced midwives, midwifery courses, and self
study. In some states, DEMs are legal and can be licensed by that state. In
other states, midwifery is illegal or alegal (midwifery is neither legal nor
illegal). DEMs can be certified professional midwives (CPM) through North
American Registry of Midwives (NARM) which is a certifying organization run
by other midwives. CNMs are midwives who are RNs and have passed the
certification exam by the American College of Nurse Midwives (ACNM). CNMs
have about 1 year of midwifery specialty training beyond their nursing
education. They practice in hospitals and birth centers. Some will attend
homebirths.
The cost of homebirth with a midwife varies regionally. Midwifery care is
significantly cheaper than obstetrical care in a hospital. The average birth
in a hospital costs $3000-$6000 depending on the hospital and interventions.
The average birth with a midwife is $2000 which covers all of the prenatal
visits, the birth and postpartum visits. Insurance does not always cover the
cost of a midwife. Check with your midwife to see if she takes insurance.
Some midwives also offer sliding scale, trades, reduced fees or payment
plans in cases of financial need.
Other women prefer to birth unassisted. This can be done solo, with a
partner, with family or close friends or some combination. Mothers assume a
whole new level of responsibility for the birth and often report a strong
sense of empowerment. There are numerous reasons women choose to birth
unassisted. Some prefer to be left alone without any interference and listen
to their intuition. Some feel that birth is an extremely intimate event that
should be left to the couple who created the baby. Others do it for
spiritual reasons. I birthed my daughter Luna with just her father present.
I did my own prenatal care and found that I took a lot more responsibility
for my health and my baby's health compared to when I birthed my son in the
hospital. It was a wonderful experience being totally responsible and
sharing such an intimate experience with my partner.
Though there are few, some obstetricians will attend a homebirth. Check in
the list of resources to see if there is one near you.
Freestanding Birth Centers and Hospitals
Even though studies show that birth is safe at home, we are inundated with
technology and all of its glory. Since it is such a big part of our lives,
it is difficult to trust nature over technology. As a result, some women
just don't feel comfortable with a homebirth. Some can not afford a midwife.
Some have high risk situations.
Freestanding birth centers are an excellent option that combines the freedom
of a midwife-assisted homebirth with the "safety" of a hospital. They are
independent centers run by midwives, often CNMs and a physician usually
supervises. They have all of the comforts of home and support birth as a
natural process. At the same time they have access to the technology that
can save lives. Most take insurance.
Hospitals have made significant changes over the last two decades. Because
of consumer demand, many have added birthing rooms with nice wallpaper,
rocking chairs and a place for partners to sleep making it more homelike.
More and more are supporting rooming-in and breastfeeding. Some have added
jacuzzis with a few adding waterbirth tubs. If you decide that a hospital is
best for you, shop around for a hospital and obstetrician who will you give
you the birth YOU want.
Birthing my daughter at home was the most amazing experience. When I reflect
upon my birth experience I feel such satisfaction. I reminisce the
contractions, feeling the pain of labor. Wanting to give up but knowing that
she will be here soon. Feeling the ecstasy of her birth. I follow my
instincts which help with the pain. Looking around, certain doorways hold a
place in my heart for that is where I rocked back and forth during
transition. That shower soothed the agonizing hip pain. The birth tub
forever reminds me where Luna's life outside the womb began. I look at her,
feeling that intense mother baby bond and feel complete. I am here with my
family, my home and the love that surrounds us.
References:
Armstrong Penny and Sheryl Feldman. "Midwives: Tapping every Woman's
Strength." American Health. January/February 1989.
Ashford, Janet Isaacs. "Midwives."
Baldwin Dancy, Rahima. Special Delivery: A Guide to Creating the Birth You
Want.
Davis, Elizabeth. Heart and Hands: A Midwife's Guide to Pregnancy and Birth.
Berkeley, CA; Celestial Arts.1987.
Davis-Floyd, Robbie E. Birth As An American Rite of Passage. Berkeley, CA;
University of California Press. 1992.
England, Pam. "There's No Place Like Home: The Advantages and Joys of Giving
Birth Where You Live." Mothering. No. 94 (May/June 1999). pp.56-59.
Gaskin, Ina May. "Statistics for 1917 Births Managed By The Farm Midwives."
Spiritual Midwifery. Summertown, TN; The Book Publishing Company. 1990,
p.473.
Mehl, Lewis, et al., "Outcomes of Elective Homebirths: A Series of 1146
Cases." Journal of Reproductive Medicine. no. 19(5): 281-290.
Sears, William and Martha. The Pregnancy Book. Toronto; Little, Brown &
Company.
Resources:
Locating a birth center:
National Association of Childbearing Centers (NACC)
http://www.BirthCenters.org
Locating a homebirth obstetrician:
Homefirst Health Services
http://www.homefirst.com
American College of Home Obstetrics
PO Box 508
Oak Park, Il 60303
708-383-1461
Locating a midwife:
American College of Nurse-Midwives (ACNM)
info@acnm.org
818 Connecticut Ave NW, Suite 900
Washington DC 20006
202-726-9860
Midwives Alliance of North America (MANA)
http://www.mana.org
PO Box 175
Newton, KS 67114
888-923-6262
North American Regisry of Midwives (NARM)
cpminfo@aol.com
5257 Rosestone Dr
Lilburn, GA 30047
888-842-4784
Unassisted Birth:
Joyous Birth League International
http://jbli.meetup.com/
Bornfree
http://unassistedchildbirth.com/
Other:
National Association of Parents and Professionals for Safe Alternatives in
Childbirth (NAPSAC)
Route 1, PO Box 646
Marble Hill, MO 63764
573-238-2010
Books:
Obsteric Myths vs. Research Realities by Henci Goer
The Thinking Woman's Guide to Pregnancy and Birth by Henci Goer
A Good Birth, A Safe Birth by Diana Korte and Roberta Scaer
Homebirth by Sheila Kitzinger
Heart and Hands: A Midwife's Guide to Pregnancy and Birth by Elizabeth Davis
Birth As An American Rite of Passage by Robbie Davis-Floyd
Immaculate Deception by Suzanne Arms
The Pregnancy Book by William Sears, MD and Martha Sears, RN
Spiritual Midwifery by Ina May Gaskin
Unassisted Childbirth by Laura Kaplan Shanley
Unassisted Homebirth: An Act of Love by Lynn and Bob Griesemer
Cecily Arenas is a labor and postpartum doula, childbirth educator and
apprenticing midwife living in Willits, CA with her partner James and two
children Byron (8) and Luna (6mos). She is in the process of writing about
vegan parenting and unassisted homebirth. She can be contacted at
cecily4@hotmail.com.
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