My grandfather was a family physician for 40 years, and though I have no memory of him – he died of cancer when I was a baby – I know he was a strong proponent of the medical establishment. To him and his peers, who came of age during the Depression and began practicing medicine during the post-World War boom, it seemed entirely nonsensical that women would choose to give birth at home when they had the advances of modern medicine available. To my mother’s relief, I didn’t end up having a home birth – though I seriously considered one.
Being pregnant in a post-Covid world is a nightmare for moms and has been so for several years now. Not only do most physicians’ offices still require masks or even push vaccines and boosters on pregnant women (and eventually their children), but many moms are still required to wear masks throughout labor and delivery, a practice that borders on inhumane. It’s for these and other reasons that more women are choosing home births.
Why Is There a Stigma Around Birthing at Home?
The average woman who chooses to give birth at home is usually seen as “trad” or woo-woo. Some would say she’s even misinformed or putting herself and her baby in danger. That’s been the long-standing attitude around home births since most of us can remember. But back in the day, when hospitals weren’t widely available, didn’t everyone give birth at home? Isn’t that how our ancestors came into the world?
As with so many other topics, we often tend to fear what we don’t understand or what we’re led to believe by other parties who control the dominant narratives – in this case, the medical institutions which once governed how my grandfather ran his practice and treated patients and have now become mouthpieces for divisive political policies.
One home birth advocate writes, “Public discourse about childbirth inevitably reduces to polarized rhetoric. Caricatures are drawn of 'too posh to push' or 'whale-music hippies.' Private tragedies are tossed in as evidence. Women seeking natural birth, or women who admit birth trauma, are particularly singled-out for criticism, accused of not prioritizing their baby's welfare, cited as selfish, ungrateful, of whining about 'first world problems' or even labeled reckless.”
My mother urged me not to have a home birth, especially with five hospitals within a 10-mile radius of my home. Long before I was ever pregnant, I went on an ill-fated date with a coworker who asserted that he would never let his wife give birth at home. Only the granola “hippie moms” in his daughter’s music class birthed their babies at home.
Midwives have to be licensed to practice and are subject to much of the same ethical and legal standards as nurses.
It’s not just the moms who choose this option who are villainized, it’s the care providers too. Many states are still hostile to midwives, who have to be licensed to practice and are subject to much of the same ethical and legal standards as nurses or are nurses themselves. When we think of home birth, our minds most often go to the unfortunate but avoidable results for mother and baby, though there are still risks when delivering in a hospital, even if it’s touted as the most ideal option. Dr. Nicholas Rubashkin, an OB/GYN, writes, “When such a tragedy happens under the care of an OB/GYN, it’s often treated as a risk of the profession. When a midwife is in charge, especially in a home birth, people are quick to cast blame and assume they made a grave error. In the hospital, I had access to legally protected and confidential peer review where the entire clinical team could debrief the event and implement process improvements. If I were a midwife, I may well have instead faced criminal charges.”
The Benefits of Home Birth
The main opposition to giving birth at home is the perceived risk, though as Dr. Rubashkin admits, “things can go wrong in any setting.” Home birth is generally acknowledged as a good option for women with low-risk pregnancies and much of our preconceived notions on their risks are addressed by a five-year study from the Midwives Alliance of North America, which surveyed the home births and outcomes of almost 17,000 pregnant moms.
Of the participants, vaginal birth was almost 94%. Transfer to a hospital was usually for reasons like failure to progress and not due to fetal distress or danger to the mother. Neonatal death accounted for 2.06 per 1,000 births. The C-section rate was 5.2%, and interventions like epidural or use of pitocin, an artificial form of oxytocin used to induce contractions, was less than 5%.
Mothers who choose to give birth at home know the risks, or are well educated by traditional maternal care providers, and choose to do so anyway. Why?
In a hospital environment, it can be difficult, or for some impossible, to feel like you’re in control. Every pregnant woman is guaranteed to have a definitive list of what she wants and what she doesn’t want, whether it’s delayed cord clamping or little to no interventions. Hospitals may be advertised as the “safest” option possible, but a mom’s wishes for her birth experience can often get lost in the shuffle. This is not to say that there aren’t moms out there who feel the hospital is the most comfortable option for them. But for many, it’s the opposite.
I spoke with a close friend who has successfully had all three of her children at home and asked her to articulate what it was about a home birth that attracted her. “It was just nice to be in my own bed,” she answered after a long pause. “I was more comfortable breastfeeding at home, and I wasn’t constantly, unnecessarily, being swarmed by other people. Yes, it was painful, but I had my husband by my side and an experienced midwife that I trusted. That’s all I needed.”
Childbirth in a Post-Covid World
Covid has changed everything we thought we knew about the pharmaceutical industry and the medical establishment. For some, it was nothing new; for others, it was a wake-up call.
Despite the distrust that still surrounds home births, there was a sharp uptick in women choosing to give birth at home due to the onslaught of the pandemic. The CDC found that there was a 20% increase overall – from 38,000 in 2019 to over 45,000 in 2020. In 2020, home births accounted for 1.26% of all births. The American College of Obstetricians and Gynecologists still assert that a hospital or birthing center is the safest place to deliver. We have yet to see concrete data on what these statistics will look like this year and the previous year, but we know now that things will likely never return to the way they were pre-pandemic, which will motivate more women to choose to give birth at home.
In 2020, home births accounted for 1.26% of all births.
We can talk at length about the customary reasons women give birth at home: less expensive, fewer interventions, a more comfortable environment. But for many, arbitrary hospital regulations and state policies implemented in the name of Covid changed those motives. It should come as no surprise to anyone, least of all doctors who supposedly work for patients, that women don’t want to be subjected to daily tests for Covid or wear masks while delivering their child.
Giving birth at home has given women back what was taken from many of us as a result of this largely politicized global event: control. In making the choice to deliver at home, it opened women up to the wider realization of female capability and empowerment, of conquering a fear and executing the most important task a female body can undergo.
There is no right or wrong way for a child to come into the world. But the rise in home births, which is sure to continue, speaks to the larger choice women are making for themselves and their children. The medical establishment doesn’t always have our best interests in mind, and many women eventually come to the conclusion that their needs were not met, their desires weren’t heard, and what should have been a joyful experience suffered because of that.
I was extremely fortunate that I was able to deliver in a hospital and have an overall positive experience. Many were not able to have the same within the last two years. If the pandemic has done anything positive for us at all, it’s given women the confidence to make their own choices on how to have their ideal birth experience. Regardless of where a baby is born, every woman deserves that.
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