Wednesday, February 9, 2011

Why a Midwife and a Homebirth Make Sense for Me

When Matt and I were planning our wedding, I would go through phases of insecurity related to blogging about the experience and sharing it with others. I would write a post about how we were doing x, y, and z, and then I would stop and wonder, "But what if it totally fails? What if the event feels completely 'budget' and 'tacky' because we did x, y, and z? Maybe I shouldn't be putting any of these ideas out into the universe until I know they actually work?"

I think I've been feeling something similar about our home birth experience. I haven't talked much about it because if something goes terribly wrong and I wish I would have given birth in a hospital, I might feel terrible that I promoted home birth for the previous nine months.

However, Matt and I are having such a wonderful experience with our midwife, and with each passing day, we are more and more convinced that we chose the right path for our family. At this point--even if we do have some rare complication/emergency that can't be solved by our midwife or by a hospital transport and could only have been successfully dealt with if we had already been in the hospital--I still think I would be an advocate for home birth. That's why I feel like it's important to write this post (while the outcomes are still uncertain).

But let me back up and say that I am not proselytizing about home birth. I don't believe in a "one-size-fits-all" approach to birth. I think each of us needs to find the path that is right for us. I would never recommend a home birth to someone who isn't completely comfortable with the idea and who couldn't bring themselves to feel safe in that environment. It's important for all of us to feel safe and confident as we head into birth. Also, the kinds of care that are available to each of us varies so much from city to city and town to town.

The only thing I am dogmatic about related to this issue is that we should each find caregivers who respect us, listen to us, and make us feel comfortable. There are a lot of recommendations and decisions that go into the entire prenatal and birth process. The more we trust our care providers, the more stress-free and smooth our pregnancies and birth experiences are likely to be.

My first exposure to home birth was back in 2005. One of my best friends had a home birth, which I didn't even realize was an option. Seeing her go through the experience helped normalize it for me. Then, years later, Matt and I watched The Business of Being Born, and I started to open my eyes to some of the shocking realities of our mainstream, modern maternity system.

When I started preparing for conception and doing research about birth options in Houston, I quickly realized that my options weren't all that great. Most of the birthing centers aren't near hospitals (and they look like ugly hotel rooms), which kind of defeats the benefits of a birthing center. We do have a wonderful group of midwives that works within a hospital setting, but the hospital doctors are ultimately in charge, and the midwives are still bound by hospital protocols. Further, I wanted to see the same person for prenatal care and delivery. I didn't want to take my chances about who would be on call when it was time to deliver. Also, I wanted to be able to labor in a giant birthing pool, not just a bathtub.

Fortunately, there is a very prominent and experienced midwife in Houston who has delivered over 1,700 babies (and she happens to be the same midwife who delivered my friend's baby). She used to run a birth center, but she prefers to do home births (since she can bring all of the same equipment to your home that she used to have in the birthing center). When Matt and I met with her before we conceived, we immediately felt completely comfortable and knew that we wanted to ask her to be our midwife, once we conceived.

Most people who choose home birth for their families find their way to it after a less than satisfactory first birth experience at a hospital. As first-time parents, Matt and I didn't really know what we were getting ourselves into. However, the more we read, watch documentaries, attend child birth classes, attend prenatal appointments with our midwife, and talk to others about their prenatal and birth experiences, the more confident and excited we feel about our initial decision. Here are some of the benefits we've encountered:
  • Amazing Appointments with Our Midwife: Prenatal appointments are a prominent part of pregnancy. Initially, they are once a month, but by the end, they are every week. Because our midwife works very flexible hours, we've been able to schedule every single one of our appointments after work or on the weekends. Starting in the third trimester, our midwife started coming to our house for visits, which makes the whole experience even more comfortable and convenient. Further, each appointment lasts an hour to 1.5 hours because we talk about a range of issues, including nutrition, the emotional aspects of pregnancy, preparation for parenthood, etc. In my experience with doctors, I usually wait 45 minutes for a 15-minute appointment.
  • Proactive Rather than Reactive Care: Our midwife emphasizes a very proactive approach to health and wellness. She is a huge advocate for strong nutrition during pregnancy, and she recommends all sorts of natural supplements (like red raspberry and nettle tea to promote a healthy uterus and alfalfa to prevent hemorrhage). She examines my diet logs and helps keep me on the right nutritional path.
  • An Environment that Makes Natural Birth Easier: Regardless of whether I were giving birth at home or in a hospital, I would still be aiming for a natural child birth. I'm wary of using drugs that could potentially have unintended consequences, and I believe that a woman's body is built to give birth. However, I believe that it is much easier to have a natural birth at home or in a birthing center than it is in most hospitals. At home, I will be in a completely private environment that I can control. I can decide what kind of lighting and music make me comfortable. I can labor in any room of the house and in any position. I can get into the giant tub that will be set up in our dining room, or I can shower. I can labor in the comfort of my own bed or couch. I believe that I am much more likely to be able to bear the pain of labor in those conditions.
  • A Caregiver Who Believes that Gentler Births Make for Healthier Babies: Oftentimes, people think I'm simply choosing a home birth for my own benefit. Although the reasons I listed above are about my comfort, I believe in the synergistic connection between mother and baby. The more comfortable I am, the more relaxed I will be. The more relaxed I am, the more efficiently and effectively my uterus can work. The better my uterus works, the smoother the birth will be for our baby. Further, midwifery emphasizes more baby-centric practices. For example, once our baby emerges, Matt will be the one who wipes him clean with blankets. Then I will be encouraged to breastfeed on and off for three hours. Next, the baby and I will take an herbal bath together to promote healing. Throughout the whole process, Matt and I will not be separated from the baby. After several hours, our midwife and doula will tuck us into bed and say goodbye.
  • Decisions Based on My Situation, Not Protocol: There are certain unnecessary things that hospitals are required to do by law or by hospital protocol that many midwives are willing to ignore, based on individual families and their needs. They have more freedom to make decisions on a case-by-case basis rather than being obligated to apply blanket policies to everyone. Sorry for being so vague; I just don't think it's wise to publicly broadcast specific examples of law-breaking activity!
  • A Culture of Confidence: My midwife completely believes that birth is a natural, empowering experience that women are built for. For this reason, she tries to use as few interventions as possible. Every conversation with her is soothing and empowering.

I'll definitely report back after the birth. Maybe I'll crave an epidural so badly that I'll be cursing my decision to birth at home. But I wanted to share an update with you now, after nine months of working with my midwife.

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Anne said...

I am so, genuinely excited for you and I'm sure you'll be as strong as ever!
My partner and I are just coming to a place where we feel right about concieving, and we've followed more or less the same thought-process as you and Matt about homebirthing.

However, I feel tremendous pressure in favor of a hospital birth from my 2 sisters and my sister-in-law who all went the hospital route. They all tell me going natural is virtually impossible because of the pain and that without the medical team, such and such problem could have been very dangerous.

I am very secure in what I believe (and know for a fact that some of the problems they encountered were DUE to invasive medical procedures) but I just hope I can tell them firmly and lovingly to support my choice.

Did you receive any negative comments about your decision?

Sending you very positive vibes for the greatest adventure of all!

Carissa said...

I am excited for you as well and love that home birthing is a viable option for women. One question I have, is do health insurance companies that cover child birth recognize and cover the costs of home births? I would hope so, but somehow I am fearing the worst.

demandablog said...

I'm sure that everything will go well. Birth is a crazy experience, and you'll be able to handle it. I applaud you for not being preachy and entitled about your decision, too. It's really graceful to approach things the way you are. :)

Rosalie said...

I am so glad I chose a home birth. I didn't really worry much about difficulties there are only a small number of those (so rare) that would only be better in a hospital and I felt that risk was outweighed by benefits. Most issues as you say can be dealt with by transferring to hospital during labour if needed, particularly first labours where everything tends to happen slower.

It's still pretty rare here to have one and most people when I tell them say oo I couldn't do that. The UK website was a great resource for me to look at the worries and for if I came up against resistance in my choice. The healthcare is provided for free which is wonderful - not complaining! - but it is potluck as to whether you get pro-homebirth midwives or not.

It was just perfect being in your own bath and bed after as a family. It was wonderful in labour being in my birth pool in our living room with candles and music and people I love (while the midwives sat in the kitchen doing very little mostly!).
I hope you get a wonderful homebirth too :)

Rochelle said...

Good for you and Matt for seeking out as much information as possible then making the decision that feels right for your family.

And thank you, thank you for consistently being willing to share the thought process that goes into these types of decisions. It's appreciated.

Sarah said...

Thank you for sharing your thoughts and decision-making process on this often controversial issue.
It saddens me that there are not more baby and mother friendly hospital and maternity teams available. I feel very lucky that I am working with a wonderful group of trained midwives who will deliver our baby at our local hospital with the goal of a natural childbirth without intervention. That seems to be the norm around here, but I understand it's unusual in most places.

AZ said...

I've just starred this post (underlined it! highlighted it! marked it with a big smiley face!), because I definitely think it's one I'll come back to often whenever it is in the next couple of years that we come to the point of making decisions about birthing options. Having the benefits laid out so neatly makes me feel more confident about considering home birth as an option, and I know I'll share your post with my family and friends when explaining our considerations. Thanks for your clarity and insight, as always, Sara!

Julia said...

Thanks for sharing your thoughts. I'm also pregnant and trying to figure out my options, but I'm really confused about insurance, since our insurance won't cover a homebirth. Can you say anything about how you've handled insurance (meaning, if you do need a hospital transport will that be covered? If not, how are you planning to pay for it?) It would be so helpful!!

redfrizzz said...

Not sure about Texas coverage, but I know that my insurance in Indiana covers some costs of homebirth (even though it's illegal here). And because you are at home you aren't incurring the costs of hospital care and the costs of unnecessary interventions.

It frustrates me how opinion-laden and controversial women's choices are when it comes to their bodies. I applaud you for your choices, informed decision-making, and positive outlook on your pregnancy and birth.
Having attended many births at hospitals and homes, I believe that home is the best place for a woman who wants to labor actively and who believes she can trust in her body and mind's ability to birth. That said, I strongly agree that it isn't for everybody. I'm glad it's for you, and I hope everything goes smoothly. You'll be stronger than you've ever imagined!

will you be posting about your prenatal experience with your doula?

V. Wetlaufer said...

Yes! What a wonderful post, Sara! I absolutely agree that we can't say one way of giving birth is right for everyone, and though I am a huge advocate for natural delivery and homebirths, all my clients have delivered in the hospital, some with (completely unnecessary) interventions. I really think that so many people are afraid of natural childbirth and/or homebirth because they've been socialized to be afraid of their own bodies and to think of birth as unnatural. You are so right when you say your body is made to have a baby.

After having attended numerous births as a doula, there is no way I would ever feel comfortable giving birth outside of my home. I hope I get to have my own home birth someday!

I am so excited for you and Matt! I am sure everything will be just fine.

Latrice said...

I'm so excited for you & Matt. Reading your posts almost makes me want to have another baby! Lol. I believe home births are better than hospitals anyday. I wasn't fortunate enough to experience one in any of my 3 pregnancies. I did labor at home with my last child and moved to the hospital when it was time to deliver. That was the best thing I could've done! All my delivery experiences were smooth and pretty to the point. I had wonderful support from hospital staff and my family was allowed to move in and out of the room as they pleased. I was encouraged and uplifted in each aspect of the birthing process and I know that made all the difference. I was a natural labor and I honestly believe that doing it completely natural was the main reason my laboring time was so short. I have 3 children and none of my laboring times lasted over 3 hours. I also walked alot and exercised. You will do great because you are comfortable, confident and surrounding yourself with love & support. I can't wait for you to hold that little one in your arms and you get that ultimate rush of gratitude, accomplishment and love. It really is a phenomenal moment and experience when you have put into place the things that make you most yourself in every moment.

Lacey said...

hey sara,
i just wanted to say good luck on your labor and birth, i'm rooting for you (and matt and the babe!) i've been reading your blog for a few months, and have appreciated the interesting information you've presented (not just about pregnancy and birth, also crafts/books/chickens too :), just haven't commented on anything yet.

i do have a question actually when you have a minute to respond (this goes for anyone else reading this): do you have suggestions for resources about good pre-conception nutrition? the hubby and i aren't at the active conception stage yet, but i've been taking good vitamins, and want to start shifting my body towards better health/nutrition, so it's not a shock when that time actually comes.

i want to stress not only good resources, but EASY resources as well. meaning, i'm a grad student right now with no time to read a ton of volumes about nutrition (or even one really, sigh), so anything that's a concise, to-the-point resource would be wonderful.

Linsey said...

I am also wondering if you can provide more info on the costs of home births. It seems like it would be incredibly expensive. I'd appreciate your insight.
Happy pushing!

Randa said...


It's too late now considering you're about to give birth but I thought this might be a good resource for your other readers! My favorite, favorite, FAVORITE book to go for in terms of good, solid nutrition is "Nutrition Through the Life Cycle" by Judith E. Brown. Now, be forewarned, it is set as a text book but it has such great information about nutrition for every single stage of life - from preconception, pregnancy and infancy to adolescents to the elder years! And it caters to many different diets - vegetarian, vegan, etc. Plus, instead of saying "do this because I said so," it explains about why so-and-so is a good option and encourages you to look at alternative views!

Just reading about your experience makes me so happy - you've definitely found a community that is willing to help and learn with you but some parents just don't have this type of community around them. I just wanted to share so that they may be just as informed as you are.

Good luck with birthing your baby boy!

[] < link to the edition I have.

Sara E. Cotner said...

@ Anne: Yes! I received lots and lots of negative feedback about our decision! Many readers of this blog were critical when I started talking about it a long time ago, the woman I go to for waxing gives me a hard time about it, one of our relatives asked us a lot of "what if" questions, etc. But, more and more, I talk to people who are excited about it. I meet a lot of people who say they wish they would have had home births.

We tried to get our families ready for our decision even before we conceived. We wanted the stressful conversations to happen before we got pregnant, not during the pregnancy. That helped a lot.

Also, my experience with my midwife just keeps getting better and better, which helps build my confidence about our decision and helps me face adverse reactions from others.

@ Carissa: We have an HMO insurance plan, which does not cover home birth. Another woman in our child birth class has a PPO, and she was able to petition her insurance to cover her home birth (with the same midwife I have). She simply got our midwife added as a preferred care provider (since they had a category for midwives but had no one listed in it).

Our midwife charges $5,600, which includes all pre-natal visits (many of which are at our home), access to a lending library with books and videos, lots of free books that she wants us to own, the birthing tub rental, and post-partum care. We have had to pay a couple extra hundred dollars for blood work and another $150 for an ultrasound. Our midwife is pretty expensive compared to other quotes I've heard, but it's probably because she is so, so experienced.

Further, we paid $800 for a doula, which is also expensive (probably for the same reason that our midwife is expensive).

As part of our pre-conception process, Matt and I set up a separate account (called "Lima Bean") and automatically deposited money into it each month. Also, whenever we had extra money left over in another account, we transferred it over. Fortunately, so much of the "stuff" we need for our baby was purchased for us by friends and family off our registry. We have really only paid for the midwife, doula, and nursery furniture.

@ Julia: Even though our insurance doesn't cover our home birth, it will cover an emergency transport to the hospital. We double-checked on that one because emergency care is so expensive.

@ Lacey: You should sign up for my next e-course on Purposeful Conception! I condensed everything I learned/did during the conception process into a 5-week course (with one lesson a day). It covers things like nutrition, exercise, finances, fear, preparing your partnership, etc. If you're interested, you can go to this link and sign up to receive an update about when registration begins for the next class:

You could also check out my favorite pre-conception books in the left side bar of my blog! I definitely think it's never too early to start creating a healthy foundation (especially since the things that make your body/life healthy for a baby are the same things that make your body/life healthy in general!).

@ All: Thank you for your words of support and encouragement! And to the other readers who are skeptical of my decision but didn't comment, thank you for not expressing it a few days before my due date! I'll be more than happy to hear it after our home birth...

Heather said...

Just wanted to give you a little encouragement on the natural birth. I have had three natural births, and not one time during any of them did I want an epidural. And once labor really gets going, I don't even remember that drugs exist. The experience just carries you away.

When I was pregnant with my first, and I would tell people I was going to do a natural birth, I got a lot of "you think that now, but wait until you see how much it hurts. You will want the drugs."

Well, I was in labor for 18 hours with my first and the thought of drugs never crossed my mind. If you are committed to a natural birth, then absent an unexpected complication, you can totally do it. Good luck!

cileag said...


I followed you as a bride and have loved following your pregnancy. I too, chose a home birth for my first and it was fantastic! I'm a labor and delivery RN so I know how it is to get hassled about the choice to home birth. I also felt tremendous pressure at various times during pregnancy as the "poster child" for home birth. I finally had to come to the place it sounds like you are at---being comfortable with transfer without the sense of failure. In fact, I was so sure I would labor at home, but deliver in the hospital, I was absolutely SHOCKED when my daughter was born gently and safely at home.

I hope the rest of your pregnancy continues along smoothly and your birth unfolds exactly the way it needs to.

Leah said...

Thinking of you and your family! I love how you find a perfect balance between being true to yourself and thoughtful of others. Best wishes for an amazing, empowering birth!

cecile said...

Wish you the best for your delivery !

Anonymous said...

This is so random, but for some reason I can't send you a personal e-mail so I'm posting this here. After the birth you will probably be sore "down below" and I *highly* recommend getting an innertube (such as for going to a pool) or something similar (any inflatable round thing with a hole in the middle) for sitting on. Keeps pressure off all the "down below" areas. Looks ridiculous... saves you a LOT of pain. Okay, just had to say this & feel free to delete the comment from here after you read it... I know it doesn't exactly "go" with the topic. :s

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