The Delightful Doula
Today's Top Three: let's talk home birth!
Humans have been giving birth for a veeeery long time. But, birthing in a medical setting really only started gaining traction in the early 1900's, shifting the norm from home births to hospital births. Today, it is estimated that around 4000 babies are born at home (or in a birthing center for those lucky ducks with access) in Canada each year!
Let's take a look at some of the pieces you might want to consider when choosing, planning for, and giving birth at home!
*please note: since I'm most familiar with the resources in my own province of BC, I won't be addressing birth centers in this post!
Number One: home birth versus hospital birth.
For some, the decision between having a home birth and having a hospital birth is a no-brainer. However, the decision isn't always easy, and for some birthers, the choice is made for them whether they like it or not. Below are some of the factors that might influence your decision to choose to have one type of birth over the other, as well as some factors that will, in most cases, cause you to be ineligible for a home birth.
Factors to consider:
A) Your comfort level when it comes to hospitals/medical personnel/unfamiliar environments. Unusual sights and smells, bright lights, lots of strangers walking around - for someone who is afraid of or unfamiliar with a medical setting, these factors can stall (and in some cases even completely stop) labor altogether. This can be frustrating and uncomfortable for some birthers, and depending on the provider responsible for your care, can lead to a "cascade of interventions" in order to deliver your baby. It's important to note that things can shift quickly in the hospital setting, and sometimes a lack of comfort or an unease can lead to birthers not feeling empowered to speak up for themselves, and having procedures or interventions done "to them" when they would have rather not, simply because it is all just too overwhelming. If this is the case for you, a home birth might be a really cool option. That being said, some people are WAY more comfortable in the hospital, knowing that if anything were to go sideways, all of the facilities and support would be available at the push of a call-button. Some people are health care professionals themselves and feel right at home in the hospital. In those cases, it makes a lot of sense to choose a hospital birth.
B) Your home-situation. Are you living in a 10-story apartment with a broken elevator? Do you have an empty room in the basement with perfect access to the spare bathroom with a double-wide jacuzzi tub? Do you have a roommate who likes to bake bread every morning and hangs out in the kitchen, where you were planning to have your birthing pool, until noon? If a home birth is very important to you, you can make *almost* anything work. But as a general rule of thumb, you will need;
access to water (lots of it - check into this if you are a renter in a large building with many tenants using the same tank)
a stove-top or hotplate, some means for boiling water
enough space for your midwife to move around your birthing pool (if choosing a water birth) or bed from any side
easy access to the home in the event of an emergency (ie. needing to be transferred to hospital, having paramedics arrive, etc)
ideally, a bathroom on the same floor of the house that you are laboring on (I obviously can't tell you that this is a make or break item, but from what I've heard and what I've seen in my doula practice, you will NOT be happy about walking up and down 12 steps to get to the bathroom every hour...)
a reasonable travel distance from your home to the hospital in the event of needing to be transferred - in BC, there doesn't appear to be a specific, standard radius around the hospital that dictates whether you can have a home birth or not, however this is a really important consideration for you and your midwife to discuss
If you're reading this list and feeling discouraged that your own home might not fit the birthing bill, try problem-solving by asking a family member or close friend if they would let you birth in their home, or find a hotel to stay in for your birth (yes, that IS a thing).
C) Whether you would like to use pain medication during your labor. It's a common misconception that working with a midwife and having a home birth means you're completely out of luck when it comes to pain relieving medications. Midwives can provide you with various pain medications throughout your labor, as well as suggest non-medical pain relief options, like accupressure or herbal remedies, which are less likely to be offered or available in a hospital setting. However, in the event that you want/need an epidural, you will have to be transferred to the hospital.
D) Who you want to attend your birth. Usually, the maternity unit at your local hospital is pretty chill when it comes to birth attendees and visitors (within reason). But, due to the current health crisis worldwide, it's likely that newer hospital policies limiting individuals on the ward will remain in place for the foreseeable future. Now, birth is generally regarded as an intimate, personal experience. It is busy and messy and you may not want any extra spectators anyway, but if you have a large support system, or even older children that you would like to be a part of the experience, a home birth could give you the opportunity to include everyone! Your house, your rules, no L&D nurse kicking your mom out when she gets to the maternity floor (although, you should definitely have a conversation about guests with your midwife if you're planning to have a party-worth of people, just so they know what they're in for when they show up to catch your baby!).
Factors that may mean hospital birth option only:
A) You're having a high-risk pregnancy. This is by no means an exhaustive or definitive list, but as per the Provincial guidelines, you may be considered a high-risk pregnancy if you have a genetic or chronic disease, if you have chronic infections, a brain disorder, heart problems or high blood pressure. Also, if you are categorized as under/overweight, if you are under 17 or over 35 years old, or if you've had complications in previous pregnancies. If there are fetal abnormalities indicated in your current pregnancy, you are also considered high-risk. Also worth noting, if there are instances of substance use throughout the pregnancy, or if the baby is in a breech position prior to delivery, you may be encouraged to birth in the hospital setting (although these factors are influenced more by your care provider's level of comfort - some midwives live for a little breach babe!).
B) You're having multiples. Generally, carrying two or more babies will increase your risk for anything from preterm labor to needing a delivery via c-section, and in the majority of cases limits you to a hospital birth.
C) Your primary care provider is a GP or OB. Bottom line is - only midwives perform home births. If your primary care provider is your family doctor or an obstetrician, you will not be eligible for a home birth. Doctors know a lot of things about a lot of things when it comes to bodies and medical procedures and stuff, but midwives know a LOT of things specifically about having babies. That's what they do. And specifically in North America, home birth is what they are trained for.
Number Two: how to prepare for a home birth.
Continuing where we left off above, step number one in preparing for a home birth - find a midwife to take on your perinatal care! Midwives are perinatal-magicians, y'all. If you are even entertaining the idea of having a home birth, you MUST be working with a midwife. Doctors and OB's do not perform births out of hospital.
Step number two is gathering your home birth supplies. These supplies will be different depending on the birther's needs and wants, and will also be dictated a little by your care provider. For the sake of not reinventing the wheel, I'm going to link a couple great, BC-based home birth supply lists here and here for you to look at (shout-out to Pomegranate Midwives in Vancouver and Plum Midwifery in Comox for these comprehensive lists).
Step number three is "tying up all the loose ends" - this includes looking at the bigger picture of your home birth as well as all the little pieces. For example, do you need to make sure that someone is on snow-clearing duty to ensure your midwife can get inside when you're in labor in November? Have you prearranged for your neighbour to come pick up your pup when things get going? Does your doula know your midwife's phone number, is it listed somewhere obvious so she can make the call without interrupting your labor focus? Are there a few meals prepared in your freezer for your immediate postpartum? All of these little things are important to factor into your home birth and can make a HUGE difference in how the experience goes for everyone involved! A good goal to strive for when planning and preparing to tie up your home birth loose ends is somewhere around the 37 week mark - this will give you a week or two of peace of mind, knowing that everything is in order for baby to come at any time.
Step number four is pretty obvious - wait for labor to start and have a beautiful home-born babe!
Number Three: pros and cons of choosing a home birth.
As with literally everything pregnancy + birth related, everyone is going to have a different opinion, preference, experience and bias. Even individuals who have never birthed before - like myself! The pros and cons listed are based on information from various sources, including the Ministry of Health, the Midwives Association of BC, my own personal doula education and training program, and from care providers and birthers I've had the privilege of learning from.
comfort of being in your own familiar space/home environment
full control over lights/sounds/smells/location of birth
no need to travel to the hospital while laboring
no concern of forgetting important items at home in the rush of getting to the hospital (camera, glasses, etc)
extra support people and visitors allowed if wanted
ability to move freely, eat and drink as desired
water birth option (as this cannot always be accommodated in the hospital)
in low-risk pregnancies, home birth has been proven to be just as safe as a hospital birth
no exposure to hospital germs
supported delayed cord clamping, immediate skin-to-skin, slower pace after delivery
lowered risk of unnecessary interventions
more work for new parents; both prenatally in gathering supplies and in the postpartum in clean-up from the home birth (doulas are excellent post-home birth helpers, by the way *winkwink*)
complications or emergencies are more urgent due to the need to be transferred to hospital mid-delivery
some birthers with lived experience have commented that it was challenging to settle into the postpartum period as the energy within the home hadn't changed from the intensity of labor and birth - whereas coming home from the hospital helps with compartmentalizing and feeling comfortable and at ease in the home.
a few less options for pain relief than in a hospital birth
Ultimately, it's YOUR decision. And whatever decision you make will be the right one. For more information on home birthing, talk to your registered midwife, or send me a message!