Why Homebirth/ HBAC?
I don’t think homebirth is for everyone, so I wanted to share my story of how I went from “homebirth is for wackos” to “wow, I feel safer at home,” because I think the transition in thought is fascinating. And before I decided to homebirth, I never understood how someone could make that decision. It is a gigantic mental leap.
I’ve found that when someone says, “I chose homebirth,” one of the first responses she gets from others is, “It’s not for everybody.” And I always wonder, “Who said it was?” Or they say, “I had a great hospital birth” as if you choosing to homebirth somehow implies that it’s impossible to have a positive hospital birth. It is possible to have a good hospital birth, BUT it is harder to achieve, especially if you are seeking a VBAC. I think the ultimate proof of this is our high cesarean section rates as well as poor newborn, infant, and maternal mortality rates. We can all pull out bad homebirth and good hospital birth stories, and compare individual stories, but it’s important to take a step back and look at the big picture. (More on this later.) I want to focus solely on birthing when the time comes, not have my attention divided between contractions and declining routine interventions and their associated risks.
I think the most important thing is for every woman to birth where she, after much research and thought, feels safe and comfortable. Where she feels her wishes will be respected and not just viewed as requests. Where she feels she, and her baby, will receive the best care and experience the best outcome. And I know for many women, this is the hospital. And for a very small minority of us, it’s at home.
- How I Decided to Have a Homebirth/HBAC (Homebirth After Cesarean)
- Comparing Homebirth/HBAC to Hospital Birth
- Point by Point Comparison of Homebirth & Hospital Birth
- Homebirth vs hospital birth for the number cruncher
- Rebutting Anti-Homebirth Half-Truths
How I Decided to Have a Homebirth/HBAC (Homebirth After Cesarean)
My road to homebirth was a long one. This is not a decision I take lightly nor is it one I made quickly. In fact, it took me several years of research, reading, soul searching, and analysis. With my first pregnancy, I contacted a homebirth midwife, but wasn’t ready to take the plunge. That pregnancy ended with a cesarean section for breech. Within a few months of my daughter’s birth, I started researching VBAC and while trying to conceive our next child, I started to entertain the home VBAC (HBAC). I looked at maternal, newborn, and infant outcomes around the world. I read about cultures and how they perceived birth. I learned about how different countries manage birth. I compared outcomes between countries that routinely use midwives and those that routinely use OBs. I also realized how you can’t just rely on studies to make this decision because there are many factors that have not been researched.
I reached a point where I was afraid to birth at home and I was afraid to birth in a hospital. I did not feel completely safe in either location. What if something went horribly wrong at home? So, I should be in the hospital. But there, I have no control, no privacy, and I would likely have to battle my way through my labor. . . and I just didn’t want to fight while in labor. I looked at everything I had to give up, everything I had to compromise, and everything I had to fight for to birth in a hospital . . . just to hedge my bets.
I emailed around and found a wonderful OB who was truly supportive of VBAC. I interviewed him and he took the time to answer my questions and everything he said made me feel confident that I would VBAC. The stage was set. But I still felt that nagging feeling. The more I thought about it, the more I realized that a supportive OB is only part of the equation.
As much as I really liked this OB, I would still have to deal with the nurses and hospital policy and since my OB wouldn’t be there for my entire labor, I could just see myself saying to the nurses, “Well, my OB said that XYZ was OK,” and them telling me “That’s not what we do.” And then being stuck. And then being in the hospital, in labor, and wishing I could go back in time and plan a homebirth. Who knows? Maybe the nurses would have been fantastic… and I have read birth stories where they are, but knowing what a huge impact nurses can make on your labor, I didn’t want to leave it to chance.
Since most women go in planning for their epidural, your average L&D nurse does not know how to support a unmedicated birth. I recently spoke to an L&D nurse who admitted that many of her nurse co-workers did not know how to support a woman seeking an unmedicated birth. Since fewer and fewer women seek an unmedicated birth, the skill set of how to support a woman without an epidural or narcotics is being lost. Whereas at home, your midwife does not have the capability to give you an epidural or narcotics, so her entire skill set, the way that she supports women during labor, is based on the fact that you are unmedicated. Additionally, it is harder for a L&D nurse to provide the same type of emotional support and encouragement because she is caring for multiple patients whereas at home, your midwife is entirely focused on you.
I contacted and interviewed that same homebirth midwife, who I ultimately hired, and learned that she had a less than 1% emergency transfer rate. This gave me another bite to chew on. See, midwives focus on keeping you low-risk through superior prenatal care because they don’t want to have complications at home. Whereas OBs know they have all the equipment in the hospital, so if the crap hits the fan, they can deal… so why worry about your nutrition, exercise, stress, or sleep? In addition, with seeing 6-8 women per hour, OBs do not have the time, even if they wanted, to provide women with the same level of prenatal care that midwives do. With a midwife, if you follow her advice, you are going to enter labor more healthy, and more ready, than you would under the care of the typical OB.
So, was I ready to give up all the advantages of being at home for a less than 1% risk of emergency transfer? Ultimately, no. I found the advantages of comfort, control, privacy, and safety of being at home to be so important, that I decided to make that mental leap and plan a homebirth. And in that decision, I ultimately took responsibility for my pregnancy and my labor. That is a pretty scary decision, because you can’t just blame someone else – it’s you.
When you have a midwife, you educate yourself on the pros and cons of everything, discuss your thoughts with your midwife and utilize her knowledge and experience, and only then make an informed decision. This is called informed consent. You can only give your informed consent if you understand the benefits and the risks of a given procedure, test, or intervention. If your OB simply suggests something and you say, “Ok,” this is not informed consent… and since it is ultimately your body and your decision, don’t you want to be aware of the pros and cons?
Comparing Homebirth/HBAC to Hospital Birth
As a member of a ton of email groups, I have come across women who are at the beginning of this decision making process. I want to help you during this time. I have compiled a pretty comprehensive comparison of homebirth/HBAC vs. hospital birth.
As the medical provider in a homebirth situation is typically a midwife, that is the terminology I will use below. There are OBs in the US who attend homebirths, but they are few and far between. Most births in the hospital environment are managed by L&D (labor and delivery) nurses, with your OB arriving just in time to catch the baby. So while you may have grilled your OB during your interview, you are going to spend far more time with the L&D nurses who you did not have the opportunity to screen. You just get whoever is working that shift. You might get a superb nurse who listens to your desires, reads your birth plan, and respects your wishes. Or you might experience what most of us do. They ignore your birth plan that you spent hours researching and putting together because it conflicts with their job. Their job is to enforce hospital policies and procedures and where your birth plan counter those policies, guess what will prevail? Their job is also caring for multiple patients. They simply do not have the time to provide the same level of attention that you would receive at home with a midwife whose focus is entirely on you. This is there the external/internal fetal monitor, the most common obstetrical procedure in the US, comes into play – it enables nurses to track multiple patients at one time.
Additionally, epidurals have become the standard of care at so many hospitals yet women are unaware of the side effects. Women don’t know that their blood pressure can drop (happens 30-35% of the time) and/or they get a fever (happens 15% of the time) and they need that “emergency” cesarean section. They don’t make the connection that their epidural was the cause of their cesarean.
So many things that once were considered normal, such as twins, breech presentation, and “big babies,” are now considered abnormal. This is so unfortunate and has contributed to our rising cesarean section rate. Many midwives consider these situations to be a variation of normal, whereas obstetricians, which is a surgical specialty, see them as abnormal and requiring a surgical delivery. If you want to avoid unnecessary surgery, hire a midwife.
Dr. Bruce Flamm in Birth After Cesarean states “Fifty years ago about three babies out of one hundred died prior to reaching one month of age. Today, this number has been reduced to about one in one hundred. But to attribute all of this improvement to the elimination of home birth would be ludicrous. Many of the life-saving methods we take for granted today such as antibiotics and blood transfusions didn’t exist fifty years ago. Today, in well-supervised home births, the risk to mother and baby is probably not extremely high.” He also speaks to VBACs in birth centers, “The decision about whether birth centers are suitable places for VBACs comes down to the risk of VBAC compared to the risk of any other labor. It has been shown that the risk of requiring an emergency cesarean section is no greater during a VBAC than during any other labor.”
The primary difference between being home and being in the hospital is control as well as how you are perceived. In your home, you are in control. In the hospital, their policies and procedures are in control. Your wishes, desires, requests, and birth plan are subject to the policies and procedures of the hospital which will almost ALWAYS prevail. What you want is not important in a hospital. What rules is their rules which were all created and enforced for THEIR convenience, not your safety. Birth After Cesarean also points out “Natural childbirth also has to do with the way the laboring woman is treated by those around her. Is she perceived as a healthy woman about to have a baby or as a hospitalized patient in need of intensive care?” At home, you and your labor are viewed as normal and healthy, whereas in the hospital, you are treated as if you are a problem waiting to happen.
Point by Point Comparison of Homebirth & Hospital Birth
I looked for a home vs hospital VBAC comparison on-line and couldn’t find one that examined each variable individually, so I made one myself.
The list below assumes that you have interviewed midwives, know your midwife well, have discussed what you want with your midwife and you two are on the same page. By the time the birth comes, there should not be any surprises with your midwife. With the midwife model of care providing hour long prenatal appointments, you have adequate time to get to know your midwife. Take advantage of this time.
The list below also ONLY refers to low-risk women. So when I say, “Homebirth is safe,” this is assuming that you don’t have pre-eclampsia or some other condition that makes your pregnancy high-risk.
This list also reflects the prevailing “standard of care” which is the care that most OBs and hospitals provide. There are exceptions, of course, but, they are very few and far between. What I have listed below is not true for all OBs or all hospitals, but it is true for most OBs and hospitals.
Please take the time to read. Read Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First
Every medical intervention from IVs to cesarean sections has risks. Just because an intervention is part of the hospital’s routine, does not somehow ensure that it’s risk-free. They use these interventions routinely because they view you as a problem waiting to happen. Whereas when you are at home, your birth is viewed as normal and healthy unless there is evidence to the contrary. In the hospital, a “normal labor” is a retro-active diagnosis.
If you want to birth, in a hospital or at home, you need to educate yourself so you can make decisions rather than have decisions made for you. You can not abdicate all responsibility and decision making to the medical professionals and then whine when things don’t turn out how you like. Take control. Educate yourself. Don’t just show up, be there. Be an active participant in your baby’s birth.
| Homebirth | Hospital Birth | Benefits of Home | ||
| Your Provider | Midwives specialize in normal, vaginal birth. | Obstetrics is a surgical specialty. | Birth is normal. Avoid unnecessary surgery. | |
| Your Wishes | … are discussed with your midwife beforehand and are honored. | … will be verbally expressed by you and/or documented in your birth plan. You will likely have to debate and defend your decisions to multiple nurses and doctors and be labeled a “difficult” patient in the process. | You will not have to fight during your labor. You have peace. | |
| Birth Plan | Since you have discussed the pros and cons of various interventions with your midwife throughout your pregnancy, and within the midwifery model of care less interventions are typically used, there is no need to create an official birth plan. | You will need to create a birth plan because the L&D nurses don’t know you, don’t know what you want, and unless you want a typical hospital birth, you will need to list every single wish and then ensure that they comply. | You will not have to fight during your labor. You have peace. | |
| Support | When you say your contractions hurt, your midwife says “You can do this.” When you say you can’t do it, she says, “You are.” When you don’t know what do to next, she supports you, encourages you, and gives you strength when you feel like you have none left. | When you say your contractions hurt, your L&D nurse says, “Just wait, it gets worse.” When you say you can’t do this, she says, “Do you want your epidural now?” When you don’t know what to do next, she offers you pain medication. | Your midwife is your non-obnoxious cheerleader who wants to be with you, supports your decision for a non-medicated birth, and is knowledgeable on non-drug pain relief methods. | |
| Unmedicated Birth | This decision is respected and supported by your midwife. | Your nurses watch you waiting for you to “crack.” They offer you pain medication repeatedly even though you requested they not offer it since you know that it is available if you change your mind. Nurses seem to have the attitude of “what makes you think you are different than everyone else.” | You will not have to fight during your labor. Your decisions are respected. You have peace. | |
| Comfort of Home | You are in your surroundings with your favorite food, in the clothes of your choosing, using the restroom with complete privacy, with complete control over who is with you. | You are not permitted to eat or drink, you wear a hospital gown, you have little to no privacy, and you have no control on who enters your room or when. | You are comfortable. You have your privacy. | |
| Continuity of Care | Your midwife provides your prenatal care, which average about 60 minutes per appointment, supports you during your labor, provides your post-partum care, as well as your annual well-woman care. | Your prenatal appointments, averaging less than 5 minutes, are provided by your OB as well as the other OBs in their practice, so you can get to know them in case your OB isn’t on call when you go into labor. During your labor, you are attended by L&D nurses. Your OB shows up for the last few minutes. | You are comfortable. You know your midwife. | |
| Safety – Ratio | One midwife whose eyes, ears, and hands are focused entirely on you | Multiple nurses who are caring for multiple patients most of whom are monitored via continuous external or internal fetal monitoring. Your nurse changes when the shift changes, typically every 12 hours. | Your midwife’s attention is not divided amongst many patients and she doesn’t leave you because her shift is over. | |
| Safety – Provider | Your midwife knows you and couples her knowledge with your instinct in making medical decisions. | To the nurses, you are just another patient who they assume is ignorant and if you are educated, you are viewed as difficult because you don’t easily comply. They carefully watch your fetal monitoring tape and ignore your instinct. | Complications are diagnosed sooner. | |
| Safety – Maternal & Infant Mortality | In the Netherlands, 30% of babies are born at home and they have one of the lowest infant and maternal mortality rates. In fact, the countries that use midwives for low-risk pregnancies and OBs for high-risk pregnancies, have the best outcomes. | In the US, 1% of babies are born at home and only 8% of births are attended by midwives. The US has the second highest newborn mortality rate in the developed world. We rank 41st in the world in maternal mortality rates (meaning 40 countries have fewer moms dying) and 29th in infant mortality rates (meaning 28 countries have fewer babies dying.) | Homebirth is safe. Midwives are safe. The routine use of technology on all women, regardless of medical indication, is risky. | |
| Safety – Cesarean Section | If you NEED a cesarean section, you will be taken to the hospital. Midwives have very low cesarean section rates because they focus on keeping you low-risk and diagnosing problems quickly. | 1 in 3 women in the US have cesarean sections. The World Health Organization says that 1/2 to 2/3 of these surgeries are unnecessary and contribute to our high infant and maternal mortality rates. | Avoid unnecessary surgery. | |
| Safety – Overall Outcomes | “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.” (Johnson 2005) | “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.” (Johnson 2005) | Homebirth is safe. | |
| Safety – Emergencies | Of 5,418 women in the Johnson 2005 planned homebirth study, 185 (3.4%) women needed urgent transfer to the hospital | 30 minutes is the guideline, but not requirement, for operating room readiness.¹ Only 17% of emergency cesarean sections occur within 10 minutes of the decision to cut and one third occur after 30 minutes. (Bloom 2006) | You are less likely to have unnecessary emergency surgery and if you do need it, by the time you get to the hospital, the OR should be ready provided you live within 30 minutes of a hospital. | |
| Complications | “Naturally occurring” unavoidable complications rarely occur such as uterine rupture, placental abruption, umbilical cord prolapse, and placenta previa with hemorrhage. | In addition to naturally occurring unavoidable complications you are also at risk for otherwise preventable complications resulting from routine interventions. | Lower complication rate at home. Avoid unnecessary interventions and surgery. | |
| Interventions – Overall | Occurred when intended homebirths transferred to hospital: “Epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), caesarean section (3.7%), [labor induction (9.6%), IV (8.4%), and continuous fetal monitoring 9.6%] ; these rates were substantially lower than for low risk US women having hospital births.” (Johnson 2005) | Hospital birthing women of all risk categories during 2002: Epidural (63%), episiotomy (35%), forceps (3%), vacuum extraction (7%), cesarean section (24%), labor induction (44%), IV (85%), and electronic fetal monitoring (93%). (Johnson 2005) | Upon transfer to the hospital, your rate of intervention is lower. | |
| Inducing Labor | If your midwife feels that you need to be induced, she will most likely refer you to an OB. It is very rare for a low-risk woman to need her labor induced. The risks are weighed against the advantages. | It is the standard of care to induce without medical indication, such as “being overdue” or when a “big baby” is suspected. 40% of women in the US are induced, most unnecessarily. (”Born in the USA” by Dr. Wagner) | Avoid unnecessary interventions and their risks. You are involved in the decision making process and your decision is respected. | |
| Augmenting Labor | Very rarely needed. Will only be performed if medically indicated. The risks are weighed against the advantages. | It is the standard of care to augment your labor (typically this is done by giving you Pitocin) if it is not progressing “fast enough” as defined by your L&D nurse and/or your OB. | You are able to labor as long as you and the baby are healthy. You are involved in the decision making process and your decision is respected. | |
| Artificial Rupture of Membranes | Your water is broken only if there is a medical indication. The risks are weighed against the advantages. | Your water is broken because they started your induction a couple hours ago and ‘nothing has happened,’ your labor stalled, slowed down, or isn’t proceeding fast enough. The risks are not discussed. You are not told that this can contribute to cord prolapse, a malpositioned baby, that your risk of infection now increases with every vaginal exam or that you are now “on the clock” meaning that they expect your baby to be born within 12 or 24 hours. | Avoid unnecessary interventions and their risks. You are involved in the decision making process and your decision is respected. | |
| Vaginal Exams | Can be declined you if wish. | If you wish to decline, you will have to tell every person who enters the room and then possibly debate it with them. You are not told that risk of infection rises with each exam especially if your water has already broken. | Your wishes are respected. You are involved in the decision making process and your decision is respected. | |
| “Stalled” Labor | Is fine as long as you and baby are ok. This is your body giving you a chance to take a nap and relax. | Is considered abnormal. You will be pressured to receive drugs to speed up/augment your labor or have a cesarean section. You are “on the clock” especially if your water has already broken. | Your baby will be born when they are ready. | |
| Eating and Drinking | You can eat and drink as you want from your fully stocked pantry and fridge. | It is the standard of care to provide ice chips or nothing by mouth. When you become dehydrated, they give you fluids via your IV. | You will not become dehydrated. You will maintain your energy from nutritious snacks. | |
| IVs | Very rarely needed. Will only be used if medically indicated. The risks are weighed against the advantages. | It is the standard of care to have an IV or heplock. | Your movement will not be restricted. You will feel like a woman in labor, not a hospital patient. You are involved in the decision making process and your decision is respected. | |
| Episiotomies | Very rarely needed. Will only be performed if medically indicated. | Many OBs still routinely perform episiotomies, especially on first time moms, despite evidence that it does not improve outcomes or shorten second stage (pushing) while increasing the chances of a 3rd or 4th degree tear into the rectum. You are not informed of the risk, so when you tear into your rectum, you think it’s just “one of those things” and you are so thankful that your skilled surgeon is there to sew you up. Meanwhile, you don’t realize that your episiotomy was the reason why you tore so severely. | Avoid unnecessary interventions. You are involved in the decision making process. Easier recovery. | |
| Fetal Monitoring | Periodic monitoring is utilized. Some midwives have underwater dopplers, so they can still monitor the baby’s heartbeat while you are in the water. | It is the standard of care to have continuous fetal monitoring, restricting you to bed and increasing the chance that you will have an unnecessary cesarean section. | Avoid unnecessary interventions and their risks. Your movement is not restricted and your risk of unnecessary cesarean section is lower. | |
| Going “Overdue” | 42 weeks, one day is considered overdue. | 40 weeks, one day is considered overdue. You will be pressured to schedule an induction or cesarean section possibly even before you hit the 40 week mark. | Your baby will be born when they are ready. | |
| “Big Babies” | Is considered normal. Your midwife also understands how unreliable ultrasounds are at estimating size. You have the option to deliver on your hands and knees or on the birthing stool which are great positions for birthing big babies. | Is considered abnormal. You will be pressured to schedule an induction or cesarean section despite the fact that is contradicts ACOG’s Practice Bulletin No. 22. If you are “allowed” a trail of labor, you will will not be given the option to deliver on your hands and knees since this inhibits viewing for the OB/nurses. Your hospital does not have a birthing stool. | Your baby will be born when they are ready. You have control. | |
| Weight Gain | Your midwife teaches you about nutrition and you keep a food diary so you can fine tune your eating habits. The focus is on what you eat, not on the weight you gain. | Rather than teach you about proper nutrition, you are badgered about your weight gain. Your OB essentially sets you up for failure by not giving you the tools you need to succeed. | Have a healthier pregnancy and thus a healthier baby. | |
| Twins | Are viewed as a variation of normal. Some midwives attend twin births. | Are viewed as abnormal and high risk. You are scheduled for a cesarean section. | Avoid unnecessary surgery. | |
| Breech | Is viewed as a variation of normal. Some midwives attend breech births. | Is viewed as abnormal and high risk. You are scheduled for a cesarean section. | Avoid unnecessary surgery. | |
| Time Limits on Labor | No limits as long as you and your baby are ok. | It is the standard of care to perform a cesarean section 24 hours after your water breaks, if not sooner, regardless if an infection as developed. | Your baby will be born when they are ready. Avoid unnecessary surgery. | |
| Movement | You can move as you like. | Your movement will be limited as most hospitals require you to have continuous external/internal fetal monitoring which requires you to be in bed. In addition, they will probably have a blood pressure cuff on your arm, a pulse oximeter on your finger, an IV in your arm so they can give you Pitocin, narcotics, sleep aids, antibiotics, blood anticoagulants, and/or acid-reflux drugs and, if you opt for an epidural in your back, you will also have a urethral catheter. | Baby is able to move and turn into the best possible birthing position and labor is able to progress normally with the assistance of gravity. You are in control. You are a healthy, normal laboring woman, not a sick patient. | |
| Noise | If you want it quiet, your midwife and support people will be quiet. If you want to yell and scream, you can. | Nurses walk in and out of your room and ask questions mid-contraction. You may be self-conscious to make noise since you are sharing a room or you fear other people hearing you. | You have peace. You are in control. You have privacy. | |
| Private Room | You are in your house. Only people YOU ALLOW are there. | You might have to share your room with other laboring women, their husbands, their family. | You have privacy. | |
| Being Naked | Not a big deal. You are in your home surrounded by people of your choosing. | People you don’t know walking in and out of your room. | You have privacy. | |
| Clothes | You wear whatever you want. | You wear a hospital gown that opens in the back. | At home, you are yourself. You have control. You have privacy. At the hospital, you are a patient. | |
| Travel | Your midwife comes to you. | You drive to the hospital… either to soon (before contractions are 5 min apart, lasting 60-90 seconds, for an hour) making your hospital stay longer than necessary and opening yourself up to “standard hospital policy/procedures” OR you labor at home “as long as possible” and then endure contractions on the road. | Your labor progresses naturally without the added stress of driving, changing locations, and enduring the hospital’s “standard of care.” | |
| Shower | You can labor in the shower. | You don’t have a shower in your room. You can’t shower anyways, because they have you hooked up to continuous fetal monitoring or they don’t “allow” you to labor in the shower. | You have control. | |
| Labor in the Water | You can labor in your bathtub, your midwife’s birthing tub, or you can rent one. | The very rare hospital permits you to labor in the water provided your membranes are still intact. | You have control. | |
| Water Birth | You can deliver in the water. | It is very rare for a hospital in the US to permit water birth. | You have control. | |
| Pushing | You push with the urge in the quiet of your home surrounded by people you love and who support you. | You push with a crowd of strangers yelling, counting to 10, and telling you to hold your breath. | You have peace. You have control. You follow your instinct. | |
| Delivery | You deliver in the position that feels right to you. | You deliver in the position that feels right to the nurses and/or OB. | You have control. You follow your instinct. | |
| Pitocin to Deliver Placenta | Very rarely needed. Will only be performed if medically indicated. | It is the standard of care to give the laboring mom Pitocin after the baby is delivered to quickly deliver the placenta. Your OB doesn’t have time to wait. | Your midwife is not in a rush. She will wait until your placenta delivers without employing unnecessary interventions. | |
| Your Baby | Nothing happens without your consent. | Hospital assumes control over your baby and a whole new set of policies and procedures are enforced. | You have control. | |
| Routine testing and medications for your baby | You and your midwife discuss the pros and cons of all procedures beforehand and you make an educated decision. | You voice your requests to the L&D nurses and they engage you in debate saying that this is “hospital policy.” You state loudly, “I do not consent to XYZ” and ask to sign a form stating you are going “Against Medical Advice.” | You don’t have to fight. You are involved in the decision making process and your decision is respected. | |
| Nursery | There is no nursery. Only your comfy bed. | Per hospital policy, baby will be taken to the nursery where policies and procedures will be enforced. Baby is taken to the nursery at night so “you can sleep.” | You have control. | |
| Skin to Skin | Once your baby is born, they are immediately put on your chest. | Once your baby is born, they are taken to a warming table, cleaned, suctioned, wrapped up like a burrito and returned to you. | You have control. | |
| Breastfeeding – Getting started | You breastfeed immediately afterbirth and your midwife assists if necessary. | Despite your requests, your baby is given pacifiers, sugar water, and/or formula while under the care of the nurses. | You have control. | |
| Breastfeeding – Scheduling | You breastfeed on demand. Your baby wakes when they are hungry. | Nurses wake you and your baby, every two hours, day and night, to nurse. Your baby is tired and cries, you are tired and cry. | You follow your instinct. | |
| Baby – Health – Gut Colonization | “Term infants born at home and breastfed exclusively had the highest numbers of bifidobacteria [good bacteria] and the lowest numbers of C. difficile and E. coli [pathogenic/ bad bacteria] compared with any other group of infants.” (Penders 2006) | “Each day of hospitalization after birth was associated with a 13% increase in the rate of colonization with C. difficile.” (Penders 2006) | Your baby is not exposed to high levels of pathogenic bacteria. | |
| After Delivery | You eat your own your food, you sleep in your own bed, and use your own bathroom. | You are in the hospital. | You are in your comfort zone. |
1. “The 30-minute guideline was published in the fifth Edition of Guidelines for Perinatal Care, which was published jointly by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in 2002″ per Medpage Today. A major medical study looking at 11,000 women defined “Emergency procedures . . . as those performed for umbilical cord prolapse, placental abruption, placenta previa with hemorrhage, non-reassuring fetal heart rate pattern, or uterine rupture. . . Approximately one third of primary cesarean deliveries performed for emergency indications are commenced more than 30 minutes after the decision to operate” with no adverse effects on maternal or infant outcomes. Only 17% of emergency cesarean sections occurred within 10 minutes of decision to cut and 27% within 20 minutes. It’s also interesting to note that of the 994 “emergency” cesarean sections that occurred after 30 minutes, 991 of those were for “non-reassuring fetal heart tones.” Clearly, since it’s taking them more than 30 minutes, the doctors can’t be that concerned, the condition of the baby can’t be that dire, and thus we can’t possibly consider the situation an emergency. This also illustrates the connection between continuous fetal monitoring and the rise of “emergency” cesarean sections. (Bloom 2006)
Please note that I am not a medical professional and this site does not offer medical advice, just information for you to discuss with your healthcare providers.
Thank you for making this list!! It is awesome. I have had 3 hospital births, 1 birthing center birth and 2 homebirths. Everything you have summarized here is exactly what I have experienced. I’ve bookmarked your page and will share it with others who are trying to decide what to do or for those who question my homebirth decision. Homebirth rocks!!!
This is a wonderful, easy-to-read compilation of all the points to consider when choosing where to give birth. Bravo!
Two things I thought of which could be added to your list:
1) Who is in charge? In the hospital, you have to do as the nurses say because the nurses have to follow what the doctors say. If you want something, you have to get permission. At home, you are Queen for the day. Everyone present is there to serve you. They ask your permission for things.
2)Changing your mind: If you decided while in labor you’d rather be in the hospital, you can go any time you want! If you’re already in hospital being monitored it’s almost impossible to leave.
I thought of one more:
3)Baby can sleep in your bed if you wish and breastfeed at will: more rest for both of you.
OH, and furthermore:
4)The baby joins the family at birth, rather than separating you from the family for the birth and hospital stay.
(I’m on a roll!)
5)Less disruptive to the family as there are no babysitting arrangements to make for any other children
How far apart was your VBAC to your C section? The reason I am asking is that I have had 4 Home births, 1 emergency c section due to problems with the baby. Baby passed shortly after birth. And I am now pregnant, the due date is just 15 months after my section. I am really wanting another homebirth but I am trying to find more info since it is so close to the section. Thank you for any information.
Hi Leticia! Congratulations on your pregnancy!My HBAC was about 3 1/2 years after my CS. I recommend joining the ICAN email support group as there are many women on their who have VBACed at different intervals. You might also get a definitive answer on if studies exist showing the ’safest’ interval. You can join by going here: http://health.groups.yahoo.com/group/ICAN-online/
Best of luck with your pregnancy and VBAC!
I think this is a great list, though it is clearly biased. I am also biased towards homebirth, but my husband is NOT. He still thinks that VBAC is much safer in the hospital and is pretty set against HBAC. I probably need a more neutral comparison…but you have definitely provided a lot that I can pull (especially the stats and figures…that will probably go a long way in helping to convince him). THANKS!!!
Hillary, If you find a neutral comparison of home vs hospital birth, I would love to see it. I don’t know if it exists. Your comment actually prompted me to finish a post I started months ago. Maybe your hubby would read it. I would be interested to know what he thought. Best, Jen
How about management of third stage? At home, you have the option of natural delivery of the placenta, cord clamping after it has stopped pulsing, immediate breastfeeding to help clamp down the uterus, etc … instead of managed “care” to include immediate cord clamping, cord traction, fundal massage, etc.
I have been interested in having a homebirth for my 3rd baby. While there are many good points about it and it looks a lot more peaceful and relaxing, I don’t think its fair to give only the cons of having your baby in the hospital. I had my first 2 babies in 2 different hospitals, and while there were things that I was unhappy with, the nurses in both hospitals were courteous, and listened to my wishes, even without a birth plan. I was not put on meds because my labor was taking a long time, and was offered the tub. It wasn’t a nuisance to them. I was not repeatedly offered meds even when I was having very strong contractions.
This is not a fair comparison.
Juliana, Thank you for leaving a comment. The descriptions above ring true for some people and not for others. I believe they are accurate descriptions of most hospitals, but I know there are women who have had very respectful and even wonderful hospitals births. However, I do believe that they are the rare exception. It is possible to have a good hospital birth, BUT it is harder to achieve, especially if you are seeking a VBAC. Just to take one example from your experience: I wonder how many hospitals, like the ones you went to, have birthing tubs? And of those, how many actually encourage women to use them? And of those, how many encourage VBACing women to use them? I suspect that number to be very low. So much of a laboring woman’s experience depends on the hospital amenities (birthing tubs, squat bars, showers in rooms, etc), hospital policy (the actual availability of those amenities), OB policy (do they permit you to use them?), L&D nurse attitudes (do they permit/encourage/discourage you use them?), the laboring woman’s expectations (does she want a “standard epidural birth” in which case, she may not care about using the birthing tub, or does she want to go drug free?), and the presence or absence of complications (in which case birth plans, rightfully so, go out the window.) I hope you share your birth experience with your friends, family, and on-line and give out your hospital and OB’s name when requested. I really believe that we need to “reward” OBs and hospitals that support non-interventionist, vaginal birth by going to those hospitals and giving them our money. For me, the one OB who I thought I had a fighting chance to hospital VBAC with had privileges at two hospitals. One “didn’t do VBAC” and the second had a 96% repeat cesarean rate. I didn’t think I stood a chance, so I had a homebirth. I wish you the best Juliana! Jen
Thank you for this. It’s exactly what I needed right now, while I’m facing the decision of a homebirth or a hospital fight for my upcoming VBA2C. You took the time to write out my own thoughts for me – everything I knew but needed to see side-by-side. This is the very best site I’ve found for making the HBAC choice!
HI — i just was laughing and nodding at your post because even though this is baby #1 for me, everything you are saying about your research is ringing true for me.. my hubby is NOT for homebirth, but I really think that I will have to print your chart out for him to see. Thanks sooo much for reading my thoughts and putting them here. I appreciate the hospital I am assigned to for my L&D, but I just feel so possessive about releasing my control over the birth when it is recommended to labor at home as long as possible to avoid C- section.. I might as well stay there and have the baby then!
This is a great resoure. Thanks for starting your site. My first delivery was normal and with midwives in a birthing center; my second ended in c-section because my son would not tuck his chin. I still have regrets over that one even though it would seem I didn’t have much choice. I need to work through that before any other pregnancies. I didn’t realize at the time that this c-section would doom me to hospital births for the rest of my reproductive life. My next and future deliveries will be HBAC because I would be required to labor & deliver in the hospital for any future pregnancies if I go with the Birthing Center I used for my son. The hospital was great by the way, AAMC, I just don’t want to be in a hospital unless I am gravely ill. I’d recommend it to anyone considering hospital birth. The midwifery practice I used uses it when their patients prefer a hospital setting (Special Beginnings Birth Center). But you do not get ANY rest as people are constatnly coming in to check BP and do tests. I was there for 5-long days. For me there is nothing like being at home. So I am trying to prepare mentally for my HBAC. Your site and the recommended reading will do this for me. Thanks for this resource.
i had a midwife in a hospital for my first birth, which ended in c-section as a result of my son not tucking his chin.. i had never heard of this as being an issue, and haven’t since ( my little guy is 7 months old) until you.. thanks for sharing..i have regrets as well that i am also working through, and also always wonder about the reasoning for the c-section.. like you, i’m definitely desiring a vbac or hbac for future births.. thanks again..
I had an HBAC in 2007, and it was the best decision I ever made. I sincerely believe that my chances of being able to birth my 10 lb son naturally in a hospital, with the threat of Pitocin and everthing else hanging over me, was about like the proverbial snowball’s.
There is a reason why, once you HBAC, you never go back.
Since I live in a state that is fourth worst in the USA for hospital support of VBAC, it turns out that my instinct about homebirth VBAC being the most likely to succeed was right.
And to my midwife, VBAC is “just another birth” so long as all other things are equal such as a healthy pregnancy, and no inductions or interference with nature taking its course.
For me, it was not only “just another birth” but it was the first time I had experienced natural labor and birth, and in this I discovered that my hunch was right the first time, when I felt that the unbearable pain of the induction couldn’t possibly be how bad childbirth would be naturally. Just getting to 4 cm with that awful induction ending in section, hurt more than the entire labor and birth at home of a 10 lb baby, unmedicated.
If more women knew that the hospitalized, induced version of labor makes it 10 times more painful than natural childbirth, they would think twice before allowing it to be done to them, especially for a reason as ridiculous as convenience. There’s nothing convenient about recovering from major surgery while caring for a newborn, and epidurals and inductions are not nearly as “safe” as people are led to believe.
You saved me hours of painful and stressful research. Thank you, thank you. I will be going over the list with my husband. Because of our miscarriage, he is doubly concerned and protective, but I think some of the facts will help calm his (and my) concerns.
It is amazing how many scenarios that you described I saw my sister go through. She was scheduled to deliver with her midwife in the hospital, but her midwife was injured so she was dumped onto OB’s and nurses who didn’t know/care about her. Induced labor, petocin, broke her water, epidural (done wrong) then after her “time was up”, c-section (b/c of mistake w/ epidural, she had to be totally put under and her husband wasn’t able to be with her). We kept saying that everything went wrong except that the baby was so healthy. It was so scary to watch.
All of that to say, I will be passing along your information. My sister wants to do a VBAC with her next baby, and I’m sure this info will help her as well. Thanks again!!!
I belive that the doctors are wrong about my due date! I’ve had two ultrasounds but I feel I’m further along then what they tell me. My due date is july 19th. From what I remember my LMP was sept 21 but i got it again oct 4th 5th 6th and 7th.???? dec 1st they told me I was 7 weeks. WHAT DO YOU THINK?
[...] doesn’t take much. For others, they have to fight tooth and nail or even hire a midwife and HBAC (homebirth after cesarean), which by the way, is not risky contrary to popular American [...]
The chart very accurately describes my birth experience #1- it was very traumatic for me. I now understand that the trauma was due hospital policies, and not being allowed to labor naturally. I was certainly treated like the “pain in the butt” patient b/c I wanted to birth naturally. I am now considering a HBAC…it sounds so appealing…husband is skeptical. Thanks for the reading!
Thank you so much for this easy to read and valuable information. I definitely want a HBAC for my next, but how in the world will I be able to do that if all the midwives I’ve called refuse to do VBACs at all? Does anyone know of a Midwife in the LA/Venutra/Santa Barbara area that will do a HBAC?
Hi, I am expecting #2, 18 mo after my c-section. Colorado has a law that a HBAC must be 18mo post c-sect. Luckily we got pg on our first round. I am now considering HBAC. I am scared but really tempted. My first baby was found to be breech at 41 weeks!! We tried to get her to turn naturally, but no luck. Spontanious labor- Hospital wouldn’t deliver except for c-sect. What I’m looking for is to face the risks of HBAC head on. I want to know all the risks of HBAC- yes- all the negatives- and I feel facing them will help me make a final decision. I want to know the worst of the worst stories & situations and at least have that in my educated mind. I know focusing on the negative is not the best plan , but I think I will feel more empowered if I can say I know this side.
Hi,
I want to thank you very much for your insight and detailed information. I plan to use this site and some others to justify my reasoning for a HBA2C. I’ve always thought it was crazy to attempt a birth at home, but seeing as how CNM’s are truly focused on one patient and have intimate knowledge of the mother, I think this is a logical and reasonable way to birth.
I have had two CS’s, while my first attempt at a “natural birth” in the hospital was thwarted, and ended in a CS, and many of the things in your article and chart happened, I don’t think that’s always true. I think some of the things you puport in your differences between a home birth and a hospital birth are not exactly as you say. While I hesitate to say my second scheduled CS was a much better experience, it was, in comparison to the first time around. Baby stayed with me the entire night and I even co-slept with him, though nurses informed me the hospital’s policy was against it–they did little to sway me otherwise but state the policy. The other thing that happened was that one of the neo-natal nurses told me the baby would wake to nurse–well baby was too doped up I’m sure and didn’t wake, as a result my breasts engorged and I developed mastitis. At the time, I remember feeling I should wake him to nurse, but didn’t follow my instincts….argggh!!! Anyway, I am engaged in my first 10 weeks of my third pregnancy and want to avoid going under the knife for a third time. Unfortunately, I live in a remote area of Northern California and none of the hospitals offer VBAC let alon VBA2C…from what I’ve read so far it sounds like it would be impossible to VBAC in a hospital anyway. Nor do I believe there are any birthing centers within 45 miles of our house. What a tragedy for all of us who know that women give birth naturally all over the world, each and every day!!!
Again, thank you for all of your time and dedication to the issues regardin home births and hospital births.
Exquisite, good post. I just bumbled upon your blog and wanted to say that I have truly enjoyed reading your blog posts. Any way, I will be subscribing to your feed and I hope you post again soon.
I wanted to say thanks for your post. It is apparent that you took much energy and work into it. I was wondering if you could point me in the direction to finding a midwife. I would like to try a HBAC when I become pregnant again. I had my first child April 16th, 2009. I had an emergency c-section pushed on me after pushing five hours on my back. My son was coming down my birth canal until the doctors made me go onto my back and he never budged after that. The doctors said the OB (who I never met) would not let me labor on my hands and knees which felt more natural and instictual for me. I was told I had HELLP Syndrome and given general anestisia and cut open. I awoke to the nurses pushing formula down my son’s throat. I had to fight the next four days to keep formula away from my son while recovering from the c-section and mourning my natural birth. I am afraid to have a homebirth but I am aslo afraid to go to the hospital. My doctors told me to wait a minimum of 2 years before I try for another baby because of my dificult labor and delivery. I am also worried about developing HELLP again, which would put me into high risk. My son was born a week late also and he weighed 8lbs 14 oz and was 21 inches long. I am a little worried that the next will be bigger or just as big. Thanks for the information.
Hi Valerie,
I’m so sorry about your son’s birth and hope that your next birth is different. I suggest getting a copy of your medical records and surgical report so that you may review it with your next care provider.
Please read I’m pregnant and want a VBAC, what do I do and Finding a Supportive OB or Midwife.
Warmly,
Jen
Valerie, Your post made me sad b/c it reminded me of the loss of my first chance at birthing vaginally. I have a similar c/s story. However, I had a VBAC last May and I can’t tell you how wonderful it was. My second son was bigger (9 lbs. 3 ounces & 21 inches) than my first. There was only 16 1/2 months between births. The birth went very, very well! Keep the faith! I’m hoping for an HBAC next time around.