Stop Saying That: Home Birth Experience Edition

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Stop Saying That: Home Birth Experience Edition

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There’s nothing like mentioning the words “home birth” on the Internet to invite all sorts of vitriolic nonsense and myopic arguments from those who don’t support home birth (and even from those who do).

Really–it gets downright nasty sometimes.

Nastiness aside, there’s nothing like people saying something like this to inspire a good old-fashioned eye roll from me:

“Why would you put your baby’s life at risk just for the experience of a home birth?”

STOP SAYING THAT

In the name of promoting rational argumentation and civil discourse and charitable interpretations of other people’s words, JUST STOP IT.

Now, time for some full disclosure: I’ve had a home birth.  And I loved my home birth.  And believe you me, I thought long and hard about the decision to have a home birth.

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me (and three midwives and a doula and tim and my sisters and my mom and a friend) having a (safe) home birth experience.

Yet at no time in my decision-making process did I think that my choice was between risking my baby’s life for “the blissful home birth experience” and guaranteeing a safe outcome for my baby with an okay experience in the hospital.  (This, folks, is what we call a false dichotomy.)

Here’s the thing: the “putting your baby’s life at risk for the experience” comment–which many home-birthing women and families encounter, either directly or indirectly– fails to grasp the multiplicity of reasons that people might appeal to when choosing home birth.

For instance, a person could appeal to one, two, five, or even all ten of these reasons when choosing to plan a home birth:

  1. I have examined the research on home birth and hospital birth and am convinced of the potential benefits of home birth.  I do think that it is a safe option for my baby and me.
  2. I have access to skilled home birth providers whom I trust to care for my baby and me prenatally, during labor, and in the postpartum period.
  3. I had a horrendous experience giving birth in the hospital and do not want to repeat that experience.  I think that planning a home birth gives me a better chance of not repeating it.
  4. If my baby or I need to transfer to the hospital, I trust in the collaborative care I will receive from my midwives and their back-up medical team.
  5. I have a deep-seated fear of the hospital and am nearly paralyzed with terror at the thought of giving birth in the hospital.  A home birth is a better choice for me.
  6. I am having a low-risk, healthy pregnancy, and I know that this makes me a good candidate for home birth.  I don’t think that it puts me or my baby at a significantly greater risk than hospital birth at all.
  7. After weighing the pros and cons of hospital and home birth, our family has decided that home birth fits our values, preferences, and beliefs better than hospital birth does.
  8. I want to avoid both the maternal and neonatal complications associated with the high intervention rates at my local hospitals.
  9. My midwives have many births and many years of experience between the two of them, and they have provided me with accurate and transparent information regarding their skills, their educational backgrounds, their practices and protocols, and their past rates of complications and transfers.  Given this information, I trust them to care for my baby and I throughout pregnancy, birth, and the postpartum period.
  10. There is no hospital within a 100 mile radius that will support my desire to have a VBAC.  I want a large family, and I’m planning a home birth so that I can avoid the possibility (and the potential complications) of three or four repeat cesareans.

The reasons are unique.  They are radically unique, just as unique as each individual person themselves.  This is why two people can have the exact same situation and still arrive at different choices based on the uniqueness of their values and preferences.

And this is why, I think, the reasons that people use when making their birth choices–and the choices themselves–deserve at least a modicum of respect.  From all of us.

And sure, sometimes an additional reason might involve some hope or wish or dream for what the “home birth experience” might be.  But give women a little credit: most people aren’t choosing home birth simply for some candle-lit, orgasmic birth experience, just as most people aren’t choosing hospital birth simply because they like the pretty pictures on the wall in their local labor and delivery unit.

With that all being said, I can understand how some people–many people, even–might have reservations about home birth.  I get that.  I even think that there are many well-placed critiques about the disjointed nature of home birth care and the lack of consistency across home birth standards in the United States.

But this doesn’t mean that expressing these criticisms should involve slinging false dichotomies or asinine comments toward those who do choose home birth.

So if you’re someone who is keen on asking people why they’d choose to risk their baby’s life just for the experience of home birth, try saying something like this instead:

1I bet you have lots of reasons for choosing a home birth.  Are you comfortable sharing them with me?

2I would not choose home birth for myself, but I respect your right to make that choice.  I also understand that the reasons for choosing home birth are multifaceted and vary from woman to woman, from family to family.  My main concerns are about safety.  Can you tell me how you and your midwife (or midwives) are working together to ensure that you and your baby can have a healthy birth at home?

3Women are going to keep choosing home birth no matter what my personal evaluation of that choice is.  Thus, I think it is wise to support promote programs, issues, and strategies (be they midwifery licensure, better educational requirements, a more integrated maternity system, better informed consent regarding home birth, etc.) that help to improve the safety of home birth.

And then for those of you who need it, here’s a bonus alternative for you to say: I need to learn how to disagree with home birth without being an asshole.

 

(And just to give you a sneak preview, tomorrow I’m gonna tell people to stop saying, “Just have a home birth!” so don’t get all in a tizzy thinking that I have pie-in-the-sky ideas about home birth.  SO HOLD YOUR HORSES.)



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20 Comments

  1. Lisa
    Lisa01-02-2013

    Thank you for this! We are planning a homebirth in May with our first, and I/we match up with 8 out of the 10 items on your list. we weren’t expecting all-out support for our decision, but we certainly weren’t expecting the near-hostility about it either from family/friends! I may have to direct the current naysayers to this post. :)

  2. Kate @ Modern Alternative Mama
    Kate @ Modern Alternative Mama01-03-2013

    Nothing drives me crazier, really. I get “But what if something happened?” (especially if honest — I can then talk about my midwives’ skills and how they handle complications) or even “You just never know” (because then I can talk about how hospital birth isn’t a guarantee of safety either, and my previous experiences suggest I am actually MORE at risk there; plus, there are no guarantees in anything. I could die in a car crash tomorrow, but the benefits of using a car, just like, for me, having a home birth, outweigh the risks).

    I cannot stand “Why would you risk it just for the experience?” Let me tell you, if your baby isn’t doing well, you don’t say, “Well, I’m not going to the hospital, I don’t care, because this is about MY experience.” Umm…no. You say, “If something’s wrong, let’s transfer, I want my baby to be safe.” There is no happy, beautiful birth experience if complications arise and something happens to the baby. There is not.

    Not to mention you should never, ever, ever make a mom’s birthing choice — whether she is at home or in the hospital, whether she is choosing pain meds or not, no matter WHAT — about mom vs. baby. All moms have their baby’s best interests at heart and their own comfort and needs come in second. Their needs are important too but I don’t know any mom who is told “There’s a serious problem and you need a c-section NOW” who would say no! (Given that was actually the situation, and not a scare tactic, anyway.) I have heard L&D nurses say things like “Sometimes I can’t follow your plan because I have to consider your baby’s needs.” No. Do not ever pit mom vs. baby. It will not go well for anyone. Mom and baby and their well-being are inseparable in mom’s mind, especially someone who is thoughtful enough to research and make a very conscious, careful decisions about birthing (wherever she ends up).

    So, enough! We can have a respectful conversation about home birth and its merits and why some people choose it and some people don’t without pulling the ‘experience’ card.
    Kate @ Modern Alternative Mama´s last blog post ..Improving Your Family Relationships

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas01-03-2013

      There are parts of me that are sympathetic to the “life is full of risk” sentiment. To be fair, I think that there are very salient differences between riding in a car and choosing a birth location, so the analogy can break down (especially when considering that many people MUST ride in cars to get from point A to point B, but not many people MUST choose one setting or mode of birth over another). But at the same time, I think that recognizing that no choice is without risk is an exceedingly important part of making decisions regarding childbirth. To present it otherwise–either in favor of hospital birth OR home birth–does nothing but a disservice to women.

      Just like everything else, every woman is going to have a slightly different and nuanced risk tolerance. Every woman is going to have her own perspective on how she weighs her needs and her baby’s needs among the variety of circumstances that she faces when making decisions about birth. And my HOPE is that all care providers, all across the board, become more skilled and competent in presenting information to women so that they are as well-equipped as possible to make the decisions that are right for them. (And as you point out, scare tactics do nothing of the sort!)

  3. Mariah Lemieux-Lupien
    Mariah Lemieux-Lupien01-03-2013

    Good article.

  4. Michelle S
    Michelle S01-03-2013

    Well said!! and I love seeing a picture of one of my favorite midwives, Nina!! :)

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas01-03-2013

      I love Nina (and Amy and Rachel) too! Nina, in fact, is the midwife who caught Eric. :)

  5. Jeanette
    Jeanette01-03-2013

    Thanks for putting together this great explanation of this false dichotomy. I don’t think any mother ever chose *anything* over the safety of their baby.
    Jeanette´s last blog post ..Tips For Conference Organizers: Making the Most of Social Media At Your Next Birth and Breastfeeding Conference

  6. Jen
    Jen01-03-2013

    I love love LOVED when people would ask me why I would choose home birth. It gave me the opportunity to point out some highlights of my (rather extensive) research. My favorite was when one of my husband’s buddies asked, “Why not just go to the hospital?” and my husband responded with a succinct list of reasons why he personally supports home birth. (Love him!)

    Thankfully, I was never asked about choosing the experience over safety. I likely would have responded with something like, “So…you want me to increase the risk of cesarean so you can feel better about my baby’s safety?” If someone disagreed with our choices, they at least had the courtesy to keep their mouths shut.

    (BTW, your home birth pics are awesome. Yay HBAC!)

    • Tracy
      Tracy01-06-2013

      If I had to choose between an unnecessary cesarean or an emergency that required a transfer to a hospital (and all the time/unknowns that go with that), I would choose the unnecessary cesarean. It all comes down to how much risk/gambling each person can tolerate. Let’s be honest: in a homebirth, you are gambling that nothing very serious will go wrong.

      • BirthingBeautifulIdeas
        BirthingBeautifulIdeas01-06-2013

        I do agree that there is an acceptance of risk with a home birth (just as there would be an acceptance of risk if I were choosing an unindicated cesarean section and planning to have two or three more children via cesarean; an increased risk of placenta accreta is no laughing matter, yet I also support a woman’s right to make a fully informed decision to choose a cesarean section). But I don’t think that it is fair to cast the choice to have a home birth as a gamble that NOTHING serious will occur. Properly skilled, trained, and equipped midwives (and I KNOW that this is a matter of contention, so please don’t assume that I think that all home birth midwives are equal in this matter) CAN treat some serious complications (such as postpartum hemorrhage) at home even without transferring to the hospital, and DO transfer to the hospital even when some complications (such as heavy meconium staining) don’t always mean that an emergency is imminent, and ALSO can transport in a timely fashion when an emergency (such as fetal distress) does occur–and they aren’t going to abandon their clients at the hospital or try to obscure an impending emergency out of fear of prosecution either.

        And I do think that the most robust form of “informed consent” for home birth involves accepting the risk–and let’s not exaggerate it OR minimize it–that the small percentage of serious complications that such midwives could not or cannot treat might very well happen at home. To me, this does not warrant casting home birth simpliciter as patently unsafe or risky or a huge, careless gamble. To many others, even that risk is too much to take on–and this itself is a more than justifiable position.

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  8. Naima
    Naima01-03-2013

    Well, often time advocates of home birth will mention a negative hospital experience as a reason for choosing to birth at home. You kind of cant have it both ways.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas01-04-2013

      I’m not sure I understand what you mean. I think that one can have a negative experience at the hospital or at home, and one can have a positive experience at the hospital or at home. What sort of issue can one not have both ways?

      • Naima
        Naima01-04-2013

        I’m saying many mothers begin to look into homebirth for the experience. Their hospital experience was not satisifing or they didnt feel empowered. Clearly a hospital is the safetest place to engage in just about any activity where a life could be at risk. And you’re saying that they don’t put experience above safety. I’m saying they do and will often admit that experience is what brought them to homebirth.

        • BirthingBeautifulIdeas
          BirthingBeautifulIdeas01-04-2013

          Okay, that makes sense–fair enough!

          Part of the problem here relates to the connotation of “experience.” When people criticize the “experience of a home birth,” it tends to connote the “candle lit, orgasmic, hippy dippy” type of experience of home birth. (And trust me, I know that this what some–NOT ALL OR EVEN MOST–home birth advocates seem to prize above all else.) But to seek an experience that is different from a traumatic or even injurious hospital birth experience seems to connote a different sort of experience, and in a significant way too.

          What’s more, I don’t think that the home birth choice in and of itself is patently unsafe. With some specific home birth care providers? Yes. With some specific health circumstances? Yes. In some regions that are far removed from integrated or proximate medical care? Yes. But the choice itself is more often than not so much more complex and nuanced than what advocates on either side sometimes (NOT ALL THE TIME) paint it out to be.

          So…a person could seek a different experience and find that the *relative risk* of home birth is a risk that they can tolerate. It doesn’t mean that they are prioritizing experience over safety.

  9. Erin
    Erin01-04-2013

    Boy, isn’t this a widely-applicable principle. “I need to learn to disagree with _______ without being a [fill in the adjective of your choice].”

    On the topic of home birth, both sides need to be kind and respectful. I am working towards becoming a home birth midwife after having 4 hospital births (good and bad) and an amazing home birth. I am not doing it because home birth is the ONLY way, or best for EVERYONE, but because women need to have choices available for them to have the birth experience that is comfortable and precious to them.
    I attend a religious congregation where a higher-than-usual percentage of the women opt for home birth. A friend of mine (who chooses hospital births) said to me in the nursing room “I feel like I have to defend my choice to have hospital births here.” Not because anyone had said anything directly negative to her, but we were so excited about and passionate about our choice and the rightness of it for us, that she felt outside – like so many of us who prefer home birth feel when we are in most other settings.
    It’s about respect.

  10. Tracy
    Tracy01-06-2013

    I agree that women should have the choice of where to give birth. However, I do think the choice should be based on accurate information about the risks of hospital vs. homebirth. Right now, that information is not available, since the Midwife Alliance of North America refuses to release their data on homebirth deaths.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas01-06-2013

      I’m not sure that their refusal to release these numbers obscures the risks of hospital birth vs. home birth entirely or to the point where NO informed decision is possible. This is not to say that I find it problematic that they haven’t released their data. At the same time, I’m always skeptical about crying “CONSPIRACY THEORY!” too loudly and/or passing off speculation as fact. My guess (which seems to be just as likely a candidate as any other theory out there) is that the data will reveal that there are some particular midwives who have patterns of unsafe practice and poor outcomes. And yes, I think that women SHOULD be able to access this information, just as I think they should have more accurate and transparent information regarding their OB/GYNs or hospital-based CNMs.

  11. Katt Mikaboshi
    Katt Mikaboshi01-09-2013

    love this!

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