Why Home Birth May Not Be For You-MainPhoto

Why Home Birth May Not Be For You-MainPhoto
I live with my partner and our toddler son in a Brooklyn neighborhood called Park Slope which is famous—some might say infamous—for being family-friendly almost to the point of tyranny. Just look at the bossy parental behavior featured in the popular video Sh*t Park Slope Parents Say. There are some things that seem quintessential to being the perfect Park Slope parent, including a Bugaboo stroller, a membership at the food co-op, and that perfect birth story. And lately, it seems like that perfect birth story is about having a homebirth.

Of course, there are many, many members of the community who are compassionate and non-judgemental when it comes to the subject of their fellow moms’ birthing experience. And then there are some who seem to hold the homebirth as somehow superior to the birth that takes place in a medical setting. For this story, I posted up a request for opinions and experiences from the mothers in my community, asking if anyone wasn’t in favor of home birth, making sure to state that I didn’t want to write an article bashing the practice of homebirthing; I just wanted to present another set of ideas and opinions on the topic. After all, I don’t want to judge anyone else’s birthing experience, just as I don’t want anyone judging mine (for the record, I had a C-section after almost 24 hours of labor—all in the hospital).

I received exactly two responses. (Usually, when I make such a request, my inbox is flooded with thoughtful and candid insights, sometimes too many to use.) The first response I received was a vaguely threatening email from a mom warning me to utilize “real journalism” when writing about the topic of homebirth. “If you’re going to quote someone saying something like ‘homebirths are more dangerous,’” she wrote, “please make a point to either find supporting evidence (which you won’t) or be VERY clear that it’s an opinion and that the piece is an op-ed style entry rather than a journalistic piece.” (The italics are mine; the caps are hers.) Her email closed with her assurance that she was “looking forward” to reading my “well researched, thoughtful, piece of journalism when it comes out.” I wasn’t sure if that was a threat or a promise.

Why Home Birth May Not Be For YouIT’S NOT ABOUT TRENDS…
… Or at least, it shouldn’t be. But my sense in recent years that homebirthing has become something of a trend seems to be valid. In 2008, the New York Times published an article rather tellingly titled “Midwives Say Home Births Are Up, Despite Warnings.” In the article, midwives in the New York area were finding themselves inundated with calls; a childbirth educator said that “20 percent of the 160 couples who take her classes each month are planning homebirths, twice as many as six months ago.” Even a birthing pool retailer claimed to have doubled their sales since the previous year. (Interestingly, two of the mothers interviewed for the piece who chose to have homebirths were located in the Park Slope area.)

But just because your friends are doing it doesn’t mean that a homebirth is right for you. And according to the American College of Obstetricians and Gynecologists, as well as the American Medical Association, a homebirth really isn’t right for anyone. Both organizations have condemned homebirths—the ACOG since 1975 and the AMA since 2008. The ACOG’s official statement warns that “although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.” Of course, some would say that this condemnation is self-serving, as both bodies would appear to have a vested interest in seeing women have their babies in hospitals. But if you want to participate in the perspective that everyone has an agenda, one could say the same thing about midwives—that they have a vested interest in perpetuating the homebirth trend and therefore are more likely to recommend a homebirth experience.

One of the influences upon the rise in homebirths is the 2007 documentary The Business of Being Born, which was produced by Ricki Lake and directed by Abby Epstein. I watched it with my husband when I was pregnant with our son CC, expecting an affirming, powerful commentary on women and childbirth. Instead, I was horrified at the way hospitals and doctors were portrayed. In contrast, the film showed women—including Ricki Lake—having sublime birthing experiences in their homes. “You couldn’t ask for a better home-birth sales pitch than [The Business of Being Born],” noted New York Magazine in a 2009 article called “Is Midwife Cara Muhlhahn Too Fearless in Her Home-Birth Advocacy?”

Muhlhahn is a midwife prominently featured in The Business of Being Born, as well as being one of the midwives interviewed for the New York Times article mentioned above. In the Times, Muhlhahn is quoted as saying, “People who wouldn’t naturally self-select for home birth are coming in and getting very open-minded.”

But in the New York article just a year later, a mother who worked with Muhlhahn recounts how she was in labor for over 72 hours during what began as a homebirth. “How long is too long for a woman to be in labor?” asked the woman’s husband, who was told “Never,” by Muhlhahn. (Generally, it is thought that 24 hours after one’s water breaks, there is a risk of infection.) But when this particular mother was finally taken to the hospital, it turned out she had signs of an infection, as well as something called “back labor” (pain during labor that can be caused by the baby’s position, when the baby faces the abdomen); she was given a C-section and her newborn son was in the Neonatal Intensive Care Unit (NICU) for five days.

That first email I received in response to my request for this story warned me that I wouldn’t find any “supporting evidence” if I were to write that homebirths are more dangerous. What I did find is that the statistics about homebirths versus hospital (or birthing center) births are very confusing. And I certainly didn’t come away convinced that homebirths are the safer option.

New York reported that “Muhlhahn’s website touts studies showing home births to be just as safe as hospital births, but when these kinds of high-risk births are included in statistics, the home-birth perinatal mortality rate jumps to fourteen per thousand versus five per thousand in the hospital, according to a University of Arizona study.”

A website called Science-Based Medicine, published an article called “A Critique of the Leading Study of American Homebirth” in 2009.  In it, author Amy Tuteur, MD, examines what she calls “the premier paper on the safety of American homebirth.” In this paper, called “Outcomes of planned home births with certified professional midwives: large prospective study in North America,” homebirths are touted as being just as safe as hospital births. But, Tuteur points out, the paper “actually shows that homebirth has nearly triple the neonatal death rate of hospital birth for comparable risk women.” Tuteur reveals, shockingly, that the authors of the paper were using statistics from the year 2000 for their information about home births… and comparing them to statistics about hospital births dating back to 1969—at best, not an accurate comparison, and at worst a purposeful deceit, meant to make homebirths look safer, regardless of whether or not this is actually true. In addition, the paper was (openly) funded by The Foundation for the Advancement of Midwifery.

Although The Business of Being Born is chock-full of happy home-birthing experiences, an interesting side story in the film showed director Abby Epstein, who had planned to have a homebirth, being rushed to the hospital in agonizing pain (urging the cab driver to do whatever he could to get her there as quickly as possible) for an emergency C-section. This made more of an impression on me than the criticism the film showered upon the medical system, or the pointedly smooth homebirths depicted. What I took from the film was that a homebirth could go smoothly… but that one needs the medical system as a backup plan in case it doesn’t. Later in The Business of Being Born, Epstein talks about her disappointment at having to have had her baby in the hospital. In an interview with writer Danny Peary, Epstein laments about her birthing experience, “I didn’t feel that going-to-the-moon experience. I felt that having an emergency C-section was more or less like having been in a car accident.” The interviewer then asks, “Do you worry how people will react to having the hospital rescue you, since this is a film that advocates home birth?” Epstein replies, “No, that’s what the hospital is for. The hospital is there to rescue you.”

I think it’s safe to say that no expectant mother wants to see a “rescue” factor into her birthing story. But having the medical system on your side from the get-go can circumvent that need.

I said earlier that I received two emails in response to my request for this article. The first one was the somewhat hostile one warning me to utilize “real journalism.” The second was a truly heartbreaking email from a woman I will call Mary. Mary began her extremely candid email by explaining that she is a “strong supporter of women being able to choose a birth experience that is right for them, including home birth.” But, she went on, “after my personal experience I wouldn’t choose it and I warn others to be sure to have a back-up plan and a doctor. I had a miscarriage while under the care of a home birth midwife and found myself completely outside of the medical system and unable to get the care I needed. The midwife did not consider me her responsibility once I was no longer pregnant.”

Mary had her first appointment with a midwife when she was 12 weeks pregnant. The following week, she had a nuchal fold scan [an ultrasound that screens for risks such as Down syndrome] at a hospital, where she found out her baby had died. The midwife, who happened to be at the hospital that day, advised Mary that she could allow her body to have the miscarriage naturally, have a D&C [a dilation and curettage is a surgical procedure that empties the uterus], or induce a miscarriage via medication. When Mary chose to have the D&C, the midwife referred her to a clinic—which turned out to be a genital cosmetic surgery clinic. While waiting to have the D&C, Mary sat in a waiting room with television sets that advertised “Brazilian butt lifts and labia rejuvenation,” only to be told that the clinic did not accept her insurance. The midwife then referred her to an abortion clinic—which wouldn’t see her because, by now, she was past the thirteen week mark which dictated the type of procedure used by this particular clinic. Mary then had to find an abortion clinic that performed second trimester abortions. “Although I’m very pro-choice, an abortion clinic is the last place I wanted to be after losing a very wanted baby,” says Mary. “I had to endure all the protocol services, even the meeting with the counselor who asked me if I was absolutely sure I wanted to terminate my pregnancy.”

Finally, at that abortion clinic, Mary found out that her baby had died at ten weeks—a fact either not known or not disclosed by the midwife, who had seen Mary when she was twelve weeks pregnant. “This was very important information for my care,” says Mary. “It meant that the waiting for the miscarriage to happen naturally was not an option because of the risk of sepsis. It also meant that I could have been seen at the first abortion clinic because I wasn’t thirteen weeks pregnant.”

Having a miscarriage is a terrible, terrible experience—and Mary suffered additional, needless trauma and duress. She closes her email to me with these words: “I am now wary of home births and have cautioned others against it because I don’t think women realize that they are opting out of the healthcare system if their pregnancy doesn’t have a happy ending, and they’ll likely be dealing with a provider they don’t know and may not feel comfortable with, in the midst of a difficult situation when they need emotional support, as well as physical care. I’m sure there are home birth midwives who have better back-up systems of care in place, but no woman is thinking to ask, ‘what will you do if I have a miscarriage?’ when making that choice.”

It’s true; no woman wants to think that. Any woman deciding between birthing options wants a healthy outcome for all. But her decision has to be about what’s best for her and baby. It cannot be about the blissful birthing story her neighbor tells her, making her feel inferior about potentially choosing a hospital birth. It cannot be about feeling modern and open-minded versus being called old-fashioned or stodgy. It cannot be about what an association of midwives wants, or an association of doctors, or a birthing pool retailer. And it cannot be about feeling that in a worst-case scenario, a last-minute visit to the hospital will be the answer. As Mary’s story so painfully illustrates, it benefits every expectant mother to have every possible resource at her disposal to insure the outcome that she so very much wants: a healthy, happy baby and a healthy, happy mother.