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  • Pregnancy and you blog

  • July 26, 2008

    Home birth: A woman's right to choose?

    By Mary M. Murry, R.N., C.N.M.

39 comments posted

Hello, ladies. I am sorry to have been absent for so long. Life goes by at 100 mph sometimes.

Today I wanted to say a little something about home birth which has been in the news lately. It evidently began because of a film that Ricki Lake produced about birth that included her own home birthing experience.

The American College of Obstetricians and Gynecologists introduced a measure to the American Medical Association's annual meeting. In the original "Resolution on Home Deliveries" Lake was named. The eventual resolution removed her named. The resolution states the safest place to labor and deliver and recover is a hospital or accredited birth center.

Do I truly believe that? Not in every case. In my rather long career I have done 2 planned home births, 1 unplanned roadside birth and a couple of car births. I don't think that qualifies me as an expert. I am a woman though and I will claim to be an expert at that.

I believe that a woman should have a right to choose where she delivers her baby. I don't think any legislative body should dictate that to her. I believe it is a woman's responsibility to educate herself about birth, home, hospital or birth center.

I believe she should have a qualified person to be with her and care for her and the baby. I believe it isn't so much about the place where we have our babies, but more about the comfort, care and support we receive when we are so experiencing such a life changing event.

Please, let me know what you all are thinking about this. I look forward to some discussion.

39 comments posted

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  • April 26, 2012 2:59 a.m.

    MY OB REFERRED US TO A MIDWIFE. He said we should feel free to leave him for a midwife for a homebirth as it would be safer for us than a hospital birth! However, my insurance just changed its policies today and they are removing ALL midwives from being covered. That means, my homebirth has jumped from $4,448(midwife) to almost $6,000 (hospital). The midwife, uncovered will be $5,560. Even if money wasn't a problem, what little research has been done shows that in 99% of homebirths, it's much safer. Thousands of women die in hospitals due to "complications". Women here risk a 44% chance of a C-Section. So, we've decided to do an unassisted home birth and then go to the hospital OR just wait till the next business day to see the pediatrician. I should NOT have to jump through any hoops to have an intervention-free, needle-free birth. Episiotomies are useless, pelvic/cervical "checks" are useless (they can't tell you WHEN the baby will be here) and antibiotics have been proven to be of little use. If you let moms eat/drink during labor, we wouldn't need IV fluids! So much is wrong with women's and pregnancy care. My own doctor told me obstetrics/gynecology is the LEAST evidence-based medicine. I WILL have my home birth, even if it's unassisted. (Besides, what the hell am I paying insurance for if they won't allow an in-network midwife to deliver my baby??)

    - Emmaleigh

  • May 24, 2010 4:09 p.m.

    @Mckennah- Not to be rude or anything, but you should really do a little research before you accuse women who choose homebirths of being irresponsible. For an average, low risk pregnancy, having the baby at home without the aid of inducers or pain medication is NOT risky to mother or baby, especially if the woman has the help of expert midwives or doulas, although this part is not necessary (research “unassisted childbirth”). I agree 100% that the primary focus of a birth should be the baby, but the mother must be comfortable as well, or else there are increased risks of complications and unpleasant side effects of childbirth (vaginal tearing, for example). Some women do not feel comfortable being starved, drugged, and forced to lie in a position that is considered to be the most uncomfortable for labor- on the back! It is very difficult to have a natural childbirth in a hospital setting, although you may already know this, hence putting quotes around “natural”. Medical personnel in hospitals will often try to convince women that a natural birth is somehow more risky, although for the majority of pregnancies, it is not at all. There are many women, such as Florence on this site, who can tell stories of being denied the birthing experience they desired in the hospital setting. Birth is a miracle of nature, something that does not need to be treated as a medical emergency. A “traditional” hospital birth may be right for you, McKennah, but not all women are the same, and

    - Anne-Marie

  • August 25, 2009 12:19 p.m.

    I think homebirths are irrespondsible and risky. It's not about having a pleasurable birthing experience, it's about having a healthy baby. WHY WOULD YOU TAKE A RISK? Go to a hospital and have a "natural" birth there.

    - Mckennah

  • October 16, 2008 3:24 a.m.

    I am a mother and an OB RN practicing in a hospital. I am posting in response to some of the comments here. I think that the AMA Resolution on Home Deliveries is out of line. It is more about keeping OB doctors well paid then about the safety of mothers and babies. For a normal, healthy pregnancy, a planned home birth with a qualified attendant is safer than hospital birth. This is particularlly true in respect to the baby. For the 80% of births that require no medical intervention, a doctor and hospital increase the risk to both mother and baby due to unnessesary interventions. For pregnancies at risk it is safer to be at the hospital. At the hospital, if an emergency c-section is needed, it takes about 30 minutes. If you are at home and can get to the hospital in less than 30 minutes then your c-section would not be delayed by the attempt at a home birth. Any home birth should be attended by an midwife with neonatal resusitation training and equipment. The option to birth at home is the right of every woman. Women should educate themselves and weigh the pros and cons of all their birthing options to make the best choice for themselves and their babies.

    - Kalah

  • September 28, 2008 9:05 a.m.

    Women have an inalienable right to birth in the environment of their chosing. The exception would be gross negligence or outright danger such as in a trash bin. That's a very different situation than a low-risk mother chosing a home birth. I birthed my first child 2 years ago (She was 10# 2 oz.) at home with a certified professional midwife, who of course monitors closely the well-being of mom and baby, holds neonatal resuscitation credentials, and carries emergency medications, IV equipment, and oxygen. I also see my family physician for consultation, and my back up plan is the hospital where I work (I'm a registered nurse). I often monitor the post-anesthesia recovery for women right after C-section (only unplanned ones on nights and weekends) and know the cascade of interventions which occurs in hospitals, under physician care, leading to poor outcomes and/or surgery (C-section). In my opinion, I am safer at home with an unmedicated, calm, empowering birth. I'll never choose a hospital as my place of birth without a medical necessity, no matter that I know the nurses at my hospital and trust them to be competent and that I know my physician and can communicate my preferences very strongly. I am right now in active labor, at home, with my second child, timing contractions on the internet and distracting myself until my midwife arrives.

    - Laura

  • September 8, 2008 9:12 p.m.

    I certainly think women should have the right to choose where to have her baby, but I also think she has the right, and perhaps the obligation to her unborn child, to make an informed choice, taking into account the risks of each choice - hospital, home or birth center. If she does choose to have her baby outside of the hospital, she should have a plan in place in case something goes wrong that is beyond the midwife or home specialist's expertise. Regardless of your choice, I'd recommend having a birth plan that details the key decisions and information you'll need when the time comes.

    - Chris C

  • September 3, 2008 11:21 a.m.

    I definitely think the government should stay out of a woman's right to have her baby where she wants to. The more legislature you introduce into it the more you'll have women afraid to seek out trained professionals. I had my daughter in a hospital with only a cervical block after 10 hours of her being stuck on my tailbone. I'm glad we were in a hospital because she spent the first 24 hours of her life in the NICU with depressed respirations. I also hemorraghed right after she was born. (When the doctor muttered "Where the heck is all this blood coming from?" I got a little concerned.) However, this doesn't mean home births aren't a great thing for those people who are educated and have the support of their families. (Personally, my husband would've called the men in the white coats if I suggested a home birth.)

    - Elizabeth

  • August 24, 2008 11:46 a.m.

    We have these same issues in Australia. We have also been showing Ricki Lakes documentary on her birth experience - I could not agree with you more when you say that women should have the right to choose where they give birth and that they should be fully informed. Pauline WA Australia

    - infomidwife

  • August 23, 2008 11:33 p.m.

    I personally would not consider a home birth for myself because the most important thing to me is the safety of the baby. I've spent a lot of time in hospitals and have seen how quickly problems can develop. Also, I thought it was very relaxing to have a whole team of people to take care of you, bring you food, change the sheets,etc. Reading the comments below about hospital birth 30 years ago, I can see why some people have negative feelings, but most hospitals and doctors now practice with a more modern philosophy.

    - Noelle

  • August 19, 2008 10:35 p.m.

    I had my son 36 years ago in a hospital, back when they were still baring husbands in the delivery room. They even made him leave my room when they examined me...what did they think that he hadn't already seen? I spent 3 days wandering around the hospital trying to figure out why I had to stay there, and they were feeding him sugar water in the nursery between breastfeedings. Three years later when I was pregnant with my daughter, there was no discussion about if I would go back to the hospital. No, I didn't tell my OB, but I faithfully went to all my exams & the first delivery was picture perfect. My husband had been a medic in Vietnam & delivered a few babies for the locals while there. I also had discovered the joys of laying in a warm tub to relieve the labor. The delivery went fine, we went to the doctor for a checkup the next day & register the birth with the state. The hospital called me about 3 months later and asked me why I had opted out of hospital and taken the "risk" of home delivery. I told them that my grandma had delivered all of her kids at home 50 years before, it's not like it was a new idea. I very clearly told him about my first experience & everything that was ridiculous & wrong from my point of view. We were a whole different generation & not willing to let the white coats dictate what was "best" for us. He said that they were thinking of letting husbands in the delivery room---thinking. I never r

    - gloria

  • August 19, 2008 10:08 p.m.

    Fifty-nine years ago my first was born in a hospital and they denied me a drug free delivery. Two years later had a drug free delivery at home, two years my third at home. A woman should educate herself about home birthing and have the right to choose.

    - Florence

  • August 19, 2008 7:37 p.m.

    I sincerely hope home birth is not a fad, and that state legislatures will permit it in all states. The statistics show that the infant mortality rates for countries that practice home birth or home-like births with a midwife are lower than countries we would consider modern. In fact, the US is 24th on the list--lower than many European nations. I had my first child at home and plan to home birth again. It was an empowering experience.

    - Julie

  • August 19, 2008 5:01 p.m.

    A home birth only takes into consideration one person - the mother. How does one truly know if there baby will need special care until they are born? Babies have been born for hundreds of years without hospitals, true - but what was the maternal and fetal death rate? Certainly it was much higher than it is now. Also, when looking at hospital statistics, keep in mind that many women giving birth these days are much older and have more health problems (obesity for example) as they did back then.

    - Amy

  • August 19, 2008 4:14 p.m.

    I could not agree with you more. In fact, I think home births are safer than hospitals.

    - Joan Jaffe

  • August 19, 2008 1:49 p.m.

    I am the mother of 2. I had my first natural childbirth in a hospital with a very fast delivery. All was well. My second was in another town at a birth center with a CNM. She was really wonderful and I was home resting several hours later. I feel that a woman should be educated on all choices and make the best one for her situation with the consultation of her Dr/CNM. I had very good pregnancies with no problems, and the birth center was across the street from the hospital so I felt very assured that I and the baby would be well taken care of if there were any complications. I enjoyed the privacy of the birth center and it made the experience very comfortable and generally stressless. I think if a mother wants a home birth and it is well planned with a qualified health practioner, go for it. I disagree that home births are some kind of fad- women have been giving birth in their homes for centuries, hospitals for the masses are a relatively modern development. Thank you for the great discussion.

    - Jill

  • August 17, 2008 1:09 a.m.

    As a Labor and Delivery nurse and mother of 3 I would hope that the options we have as women never change. I had one baby in the hospital, premature and the next 2 at home with a CNM. While I love homebirth and would never want anything else for myself, I know it isn't for everyone. I think having the option to choose is the most important thing. I do want people to understand that the midwife who attended my 2 homebirths had everything she needed in case of an emergency with the baby or myself. From a hemmorhage to a full resuscitation. Medicine, oxygen, iv's etc. I think a misconception is that people think of homebirth as a bunch of hippies sitting around with incense and candles discussing the beauty and magic of birth while the woman is in labor, when in actuality we were very prepared. Good prenatal care and preparation for the birth made everything smooth. As a nurse I know that isn't always the case, hospital or home, but preparation makes things easier. Being at home for my births with my last 2 kids was SO great and reassuring. I feel that the births went smoother because I was at home and comfortable with my surroundings, people could visit me when I wanted them to and I had the conforts of home. I love homebirth but I know that isn't everyones preference. Thanks for the good discussion and for those who don't agree with homebirth, please keep an open mind about it. It may not be something you would consider, but it is a wonderful option for many.

    - Robyn

  • August 15, 2008 10:25 p.m.

    I agree that it should be a woman's (educated)decision. I successfully birthed all three of my children at home, with a team of lay midwives/R.N.'s, and within minutes of a hospital. I had recognized ahead of time the psychological benefits of being in an environment familiar to me and under my control. I believe that there are potentially many other women for whom birthing would go smoothly and without the need for interventions if carried out in such an environment. I think a good alternative is a birthing center where the practices are much the same as at a home birth.

    - Elizabeth Rivera

  • August 13, 2008 7:53 a.m.

    I really enjoyed Catherine's post.. all of you should read it. I wish she had enough room to say more, as it was very succinct. I can tell she has put a lot of thought and research into this issue, as all mothers-to-be should do. Phyllis, thank you for the story of your births, and the food for thought there, as well. But to say that homebirth is "a fad" does not seem to me a reasonable conclusion to draw, regardless of ones feelings or thoughts (two very different things, by the way; the difference needs to be sorted out in one's own heart!). Hospital birth is really a much more recent development, and it remains to be seen whether "this, too, shall pass". We're not here to discuss world history, but let's try to keep things in perspective and remember that things have not always been as they are now, and will not always be as they are now. Let's not stop learning and making improvements.

    - Kelly

  • August 12, 2008 9:47 p.m.

    A WOMAN WHO WILL BE BIRTH FOR FIRST TIME SHE MUST SELECT FOR HOSPITAL,BUT AN EXPERIENCE MOTHER SHE CAN CHOOSE AT HOME FOR BIRTH A BABY IF BOTH ARE NO SEVERE PROBLEMS WILL BORN BEFORE BIRTH.

    - DR NEKIB UA YAMANEH

  • August 11, 2008 8:36 a.m.

    I must respectfully disagree with those who want home births. I think it is a bit self-indulgent. I say have the baby at the hospital, and then go home an hour later. The risks to your child are too great to gamble, and your child has no vote in this. My Dutch pediatrician told me that in Holland mothers have home births, but as the birth approaches an ambulance comes and sits outside the home just in case. The ambulance has all life saving equipment available, an EMT and of course can get to a hospital pronto if necessary. (I had two babies, one with a doc and one with a midwife. Good experiences, both, at a hospital.)

    - Wendy

  • August 7, 2008 9:19 a.m.

    I agree that the mother should chose her place of birth. The point that I disagree with is when it is stated that home births are safer. Lets not forget that the figures for home vs. hospital birth include all births. What I am saying is that a woman that knows that she is at risk is not going to deliver at home. Us mothers that know that our babies have holes in their hearts or severe defects chose to give birth in the hospital. These births are also included in the stats. Now if they only take stats from "normal" pregnancies for home births vs hospital I think the stats would be very different.

    - Jennifer

  • August 6, 2008 2:01 p.m.

    I would really like to see better care at the hospital. For those who think that hospital births are completely safe, it just isnt' so. I am grateful for the services available, but I think real safety would lie in giving home birth care in the hospital. We have way to many c-sections for one thing as a nurse, I have seen some pretty dangerous outcomes from that. Rachel

    - Rachel

  • August 6, 2008 7:27 a.m.

    I have 2 sons. The first born in South America in a hospital, everything went smoothly with no problems and it was a wonderful experience with wonderfully trained staff. The second born in Oklahoma, again in a hospital, wonderful experience until the baby was born. I hemorraged so badly that if I had not been in the hospital I don't think I would have made it as we lived 20 minutes from the hospital. There was no way for anyone to know if I would hemorrage so my experience and opinion is to opt for a hospital birth. It is sanitary, professionl and they have the drugs and equipment if it is needed. Also in case of problems with baby or mother time is truly critical. I know of cases where "throughly trained mid-wives" refused to call a doctor or ems when problems arised in home births that caused the loss of mother or baby or both. To me it is not worth taking a chance and I don't see how a home birth could be more comfortable. But of course, everyone is entitled to make their own choice. I personally feel that home birth is a new fad and will wane eventually.

    - Phyllis

  • August 5, 2008 7:32 p.m.

    I have had 4 children, the first was in the "conventional, safe" hospital.I spent a week there bacause of the infection I got because of "standard preactice". The next two I had at home with an acredited Medical Doctor, both pregnancies were monitered completely to make sure that I was in the "low risk" category. The fourth I had in the hospital because the insurance company refused to pay the fee for my doctor, even though the total cost was less than half what they had to pay for the hospital setting and doctor combined. I feel that if the mother and baby are monitored for health problems before the birth then there should be no reason for them to be forced to give birth in a hospital if the mother does not want that setting. Women have been giving birth for a lot of years without hospitals, and with the infections that are very much alive in hospitals that does not seem to me to be the best setting for a newborn. Although mothers and babies that have risk factors should be in the hospital, the same as any other person who needs extreme medical care. It is unfortunate,but babies do not always survive even with the best medical care. This country has been brainwashed into thinking that hospitals are best for everything when the fact is that is not always the case.

    - Kathleen

  • August 5, 2008 9:47 a.m.

    The statistical evidence seems to be slightly in favor of home births attended by a qualified midwife. The sad fact is, we will always lose a few babies no matter what. For every baby that is lost perhaps because they were not in a hospital, I wonder how many more or lost as the result of unnecessary medical interventions. It is so hard to quantify either. Overall, home births appear to be safe for healthy mothers and their babies. Thank you for a balanced opinion.

    - Alanna

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