When people hear about first-time moms (primiparas, or primips) planning a homebirth, those mothers are doubly inundated with opinions that they really should plan a hospital birth–at least the first time. While homebirth is hardly mainstream, it is an especially concerning idea for family members when it is the first baby.
Despite concerns, a recent article in Birth affirmed that primips who planned homebirths (using the same midwives as the hospital group) were not only more likely to have intervention-free births, but they were more likely to receive evidence-based care. While it is true that more first-time moms transfer to the hospital in labor (at least in my practice, and those of many of my colleagues), the rate is still relatively low. Weighing that against the chances of having a major intervention in labor at the hospital, it is often a chance families choose to take.
I recently asked my Facebook friends (not all were my clients) why they chose to plan to have their first baby at home. Here are some of their replies:
“I don’t really understand the reason why first time moms worry more about homebirth. I guess it could be fear of the unknown, but I would much rather experience birth with loving, amazing home birth midwives that understand normal birth the first time than take the chance of handing my birth experience over to the medical system in the hospital.” -AH
“I was 19 when I had my first, and after watching my mom have my sisters in all different environments I knew homebirth was for me. It was hard but an experience I’ll never regret.” -JE
“I felt much more comfortable with the idea of home birth than delivering in a hospital where it would be more challenging to have a natural birth experience. I have confidence in my body to do what it’s designed to do, and I trust the experience of the midwives to guide me through. Women have been having babies naturally for thousands of years, but modern medicine would have you think most women need interventions.
“My labor went fast and since I live in the mountains about 40 minutes from the nearest hospital, it was actually a good thing that I wasn’t planning to leave my house to deliver or I might have had a baby on the side of the road! At least the midwives got there a few minutes before the birth. It was also awesome to be home alone with our new baby just a few hours after birth, and to have the follow up visits at home. I will definitely plan a homebirth again.” -JM
“I wish that this didn’t sound so cliche but I have just always known that I was going to have my children at home. My mother never had a homebirth and either did my mother-in-law. I also didn’t have any friends that had had a homebirth. In fact, I caught a lot of flack from them when I told them of my plans. Everything about my prenatals, birth, and postnatal care was so peaceful. We are planning a homebirth for our hypothetical baby B.” -MW
“I trusted that my body could deliver a baby without intervention and didn’t want to be pressured or tempted into interventions that weren’t necessary. I know that women have safe births around the world with midwives and that part of the success of using midwives is that they understand when to get medical care (and transfer before it’s an emergency). My birth did happen at home and it seems completely normal now. I will definitely birth at home again and I’m glad I did with my first.” -CV
“I stumbled onto home birth through YouTube. After watching amazing births where the women were free to do what they wanted and beautifully empowered, I was fascinated. This led me research all birth options. I came to the conclusion that birthing in a hospital was not for me. Being pushed around by hospital staff scared me.” -SH
“I stared with a group of OBs, left them after they misdiagnosed my pregnancy as a blighted ovum and told me I’d soon miscarry. Went to a second group of OBs, left when they told me at about 10 weeks that pitocin was pretty much their birth plan from the get-go. Went to a group of hospital midwives and left them after they told me that I they would prefer me to lay on my back for labor, no matter what I may be desiring. My doula told me a story about one of her clients giving birth in the driveway trying to get in the car to go to the hospital. I was like “I hope that happens to me!” That is when I realized I needed to go ahead and plan for a homebirth. I was 6 months preggo when I finally decided. I loved the actual homebirth experience. My labor was about 22 hours long altogether, and I had a big-headed 8lb 4oz baby boy. The hour long prenatal visits with my midwife were great, as was all the at home after care.” -AY
“I think I knew long before I was pregnant that I wasn’t going to have a hospital birth. Funny enough when I was like a week pregnant and blissfully unaware my sister in law had a baby at [hospital x]. As my husband and I left the hospital, I looked at him and told him I didn’t want to have my babies in a hospital. Two weeks later we found out I was pregnant. I originally went to the nurse practitioner that I had seen for years. After a few appointments I met the OB/GYN. The next time I saw him I asked about the birth and he went on to explain this medical condition I had, and how drugs and surgery were not only accessible in a hospital but more than likely needed (my summary of his words). I was so angry with this guy by the time we left. I was not dying, I was not sick, I hadn’t even suffered morning sickness. How was this a major medical condition? So I did my research, made some phone calls and moved quickly (being 22 weeks pregnant) to find another option. I found my midwife and after talking to her just once I just knew that was the right thing for my family. I am so glad to have had a homebirth I can’t fully express it. My homebirth has really empowered me and shaped my beliefs in what normal birth should be. Everyone should have a chance to have a birth like that. I think it’s helped me thrive as a mom. I’m still fascinated by birth and am entering the world of birth assistants so I can help other mamas have empowered births too.” -MC
“As a first time mom I was so glad to take the journey with a homebirth midwife. I thought I needed the midwife mostly to make sure the birth was safe (and that is a HUGE reason) but what I got most out of my relationship with her was that she really helped me prepare to “have” a baby. Not just birth a baby, but to prepare to welcome this tiny little soul into my life. We talked about pregnancy, labor, birth, parenting, relationships with family, nutrition, music, good books, hiking and biking trails, and so much more. A midwife knows that pregnancy and birth are part of you and your life. They don’t separate it out. They treat you as a whole person. From what I see of family and friends there is not enough time for OB’s or even hospital-based midwives to cover all these things. The postpartum care is also exceptional. I feel sad for my family and friends that have to lug their healing body and tiny infant into a nasty, germy doctor’s office. I remember with my first especially walking out of each appointment with my midwife and thinking, ‘This was the right decision.’ My insurance did not cover any of the costs of homebirth but would have covered hospital birth 100%. I can tell you that I think homebirth was worth every penny I spent. I would do just about anything I had to to cover the costs of a homebirth.” -JV
Lest it look like I’m painting too rosy a picture, I want to be clear that it doesn’t always work out the way we want. But most families who transfer are still glad they planned a homebirth:
“I was a hospital transfer and I ended up with a c-section. Even with that outcome, I would plan a homebirth again if I could go back in time. If I had been in the hospital to begin with, I’m not sure I ever would have believed I did everything I could to prevent my surgery. On most days, I feel like because I labored so long at home, because I was under the care of a midwife I trusted, and because I was informed, I at least did my absolute best. I would have delivered my baby via cesarean no matter what. Sometimes that happens. It’s why we have cesareans and hospitals and OBs. I’m grateful for that. But I’m also grateful for the knowledge that nothing that happened to me was unnecessary or uninformed. For our second baby, we will plan a VBAC. Most likely in a birth center, but I am not ruling out an HBAC. My faith in my body is slowly returning and I know if I work at it I can have it back to 100% before next time.” -MJ
Homebirth is, of course, about having your baby at home. But that is not all there is to it–it’s also about midwifery care. Part of midwifery care is determining when it is safe to stay home, and when medical intervention is warranted. That is part of what makes homebirth safe–appropriate transfer. But no matter where you end up delivering, you will still have received personalized care from a midwife–and that really does set us apart from the medical model of care.
Once again I say that homebirth isn’t for everyone, but being a first-time mom may not be enough reason to dismiss it as an option. Experience and evidence shows it is certainly a good choice for many families.