Are you weighing home birth vs hospital birth? Follow one woman’s journey through both childbirth options, and learn what questions to ask a midwife.
Deciding where your baby will be born can have a lasting impact that reaches far beyond the experience of a single day. For Ginny Yurich’s family, a home birth changed the trajectory of their lives. Recently, they moved to a 14-acre farm, where they tend ducks and chickens, and have plans to add more livestock and a garden. Ginny also maintains a blog, 1000 Hours Outside, where she encourages parents to provide the ample outdoor time necessary for kids’ optimal emotional and physical health. These new ventures directly resulted from her decision to give birth to her third child in the peace and comfort of her own home.
Ginny is part of a small but growing trend toward home birth. The numbers of planned out-of-hospital births dwindled to almost nothing in the middle of the 20th century, and then rose slightly in the 1970s during the natural childbirth movement. The rate of home births has risen again in the 21st century, to 1.5 percent nationwide.
Moms choose to birth on their own turf for a variety of reasons. Among the benefits: the security and comfort of familiar surroundings; a relaxed atmosphere; freedom from unnecessary medical interventions; independence to move about and make decisions regarding care; a chosen crew of family and helpers; and a post-birth bonding time with no separation from the baby, facilitating a smooth start to breastfeeding.
Ginny had also wanted natural births for her first two babies. During her first pregnancy, Ginny happened to meet a doula, a professional labor assistant devoted to providing physical and emotional support to mothers during labor and birth. Ginny learned from the doula that, while a healthy baby is the most important goal in any birth, it also matters how mothers experience the process. Ginny hoped to give birth in a tub of warm water with no interventions, but she developed preeclampsia, which disqualified her from childbirth at the birth center she’d chosen. Instead, she went to a hospital, where intravenous drugs induced her labor. After 24 hours, Ginny was diagnosed with “failure to progress” and wheeled to the operating room.
The hospital allowed her to attempt a vaginal birth with her second child, but, once again, Ginny’s labor didn’t progress quickly enough, and she underwent a second cesarean section. Ginny and her husband now had two healthy children, but she sums up their births this way: “I don’t remember much. I was alone a lot, and there was a randomness about it. The staff involved were people I didn’t know and would never see again.”
Natural Life, Natural Birth
Ginny admits it was a huge leap for her and her husband, Josh, to explore home birth with a midwife for their third child, but doing so offered them more personalized care. Prenatal appointments lasted an hour or more. The midwife got to know Ginny’s kids, learned of her hopes and fears for the upcoming birth, and familiarized herself with Ginny’s blood pressure readings and medical history.
When Ginny’s labor began the third time, two midwives and a doula attended to her in her home. Although the process lasted for 24 hours, as with her first birth, Ginny wasn’t stressed or rushed. When she felt she couldn’t labor any longer, the midwife encouraged her to walk around the neighborhood. When they returned home, the midwife suggested she put one leg up on a chair. That’s when the birth happened. “Here came the baby!” Ginny says. “It was grueling, but it was life-changing. My previous births I endured, but this time I gained a significant piece of knowledge: My body wasn’t broken.”
Ginny paid more attention to nutrition during her fourth pregnancy, hoping for an easier experience and shorter labor. “My whole family was healthier, and I only labored for six hours before my fourth baby was born,” she says.
Home Birth vs Hospital Birth
Ginny’s perspective isn’t unusual for women who’ve birthed in both a hospital and at home. They find care to be more fragmented and impersonal in an institutional setting, where pregnancy and birth are viewed as potential emergencies. In contrast, the midwifery model helps the woman care for herself. Rest, exercise, nutrition, and emotional issues are well-covered throughout the pregnancy, and the midwife forms a relationship with the expectant mother. “With the midwife, there was more time to grow and to learn,” Ginny says.
The Worth of Home Birth
Though midwives typically charge several thousand dollars for their services, that’s a fraction of the average hospital bill for even uncomplicated deliveries. Still, parents often pay their midwives out-of-pocket, because many health insurance plans don’t cover home births. Hospitals offer little wiggle room for a mother to bring personal touches to her room or to her experience. But home-birthing families make a range of choices based on their personal styles and preferences. Every home birth is different. Some women invite so many family members and friends that it becomes a social event. Mothers who prefer privacy and solitude might arrange a birth that feels more like a retreat, with a midwife in the background ready to come forward and assist as needed.
Home-birthing families have the privilege of setting the scene. The laboring mother decides who’ll be invited, and where she’s most comfortable. She’s free to move around and change positions as desired. She can eat and drink as she feels the need. Although pharmaceutical pain relief isn’t available at a home birth, the expectant mother can experiment with any other comfort measures she finds appealing. For instance, a warm water bath can help mothers cope with labor pains. Many women rent large tubs to use for water births at home, but any ordinary bathtub or shower will also work. If the parents have other children, those children can experience the gift of meeting their new sibling in a familiar setting. When events are allowed to unfold naturally, some children will drift away or become absorbed in another activity, while others will be drawn to help their mom with a massage or a cool cloth for her forehead.
Safety can be a major concern for families considering home birth vs hospital birth. In 2014, the Midwives Alliance of North America released data collected between 2004 and 2009 on over 16,000 planned home births. The mothers, on average, experienced fewer interventions and complications, and had babies with fewer physical challenges, than women who planned hospital births. About one in 10 of the planned home births transferred to a hospital, the majority for failure to progress. In the United Kingdom, where around 2 percent of births occur at home, the Royal College of Obstetricians and Gynaecologists has recognized the favorable statistics in similar studies, and officially stated that home birth is safe for low-risk mothers. Although the analogous body in the United States, the American College of Obstetricians and Gynecologists, remains opposed to home births, each pregnant woman has the privilege and responsibility to make her own decisions about safety and risk, and where she’ll be most comfortable.
Ginny’s fifth and most recent birth took just a few hours from start to finish. She spent much of her early labor in an apple orchard, and then carried on with her family’s evening routine and put the older kids to bed. “My water broke around 7:30 in the evening, and we had a baby by 10 that night. The midwives barely made it,” Ginny says. Birth now fits seamlessly into the fabric of her family’s life, and that’s a powerful concept for her: “The way you look at birth is the way you look at life, and birth helped me discover another way to live.”
Questions to Ask a Midwife
Most home births in the United States are attended by midwives, occasionally by Certified Nurse-Midwives (CNM), but more often by direct-entry midwives who didn’t begin their careers in nursing school. Often, they’ve obtained a Certified Professional Midwife (CPM) license, meaning they’ve met a set of educational benchmarks, and they keep a record of statistics for each birth they attend. But it’s the responsibility of each home-birth family to interview a potential midwife (and more than one, if necessary) and ask about their training and experience to ensure they’ll be a good fit. You should be comfortable in the relationship, because you’ll have to discuss some personal issues.
At minimum, expectant parents should ask the following questions of a midwife before labor begins:
- What supplies do you expect us to have on hand?
- What equipment do you carry?
- Who do you use for backup if you’re busy when we call you?
- What circumstances might necessitate transfer to a hospital?
- What kinds of working relationships do you have with area hospitals?
Mary Ann Lieser is a freelance writer and doula, and she sells used books in Wooster, Ohio. She’s given birth at home to eight children.
