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Questions
about Home Birth
Do
you think home births are better than hospital births?
If
a woman is low risk (and most are), and if she wants a home
birth, then I believe that having her baby at home is best
for her.
But I would never try to talk a woman into having a home birth.
It has to come from her heart, be part of her belief system.
Are
home births safe?
Statistical
studies, such as the Klaus and Kennel study that appeared
in JAMA (Kennell J, Klaus M, McGrath S, et al. Continuous Emotional
Support during Labor in a US Hospital: A Randomized Controlled
Trial. JAMA 1991; 265:2197-201), prove that the single factor
that increases the chances for a healthy outcome for both mother
and baby is uninterrupted 1:1 care during labor by a skilled
caregiver. That situation is guaranteed in a home birth. These
days, it’s virtually impossible to achieve that level of
care in hospitals.
At the hospital
where I had my practice, about 80% of the delivery room
nurses who became pregnant during the years I was practicing
there (1980-1990) chose to have home births. A doctor asked
one of them, "After all the complications that you see
here, how can you choose to have your baby at home?"
She said, "It’s BECAUSE of what I see here that I’m
having a home birth!"
Have
you ever lost a mother or baby at a home birth?
One
baby was born dead within about 15 minutes of my assistant’s
arrival to check her in what we all thought was early labor.
No reason for the death was ever found.
Was
pain medication available to your home birth patients?
No.
When women moved to the hospital for complications of labor,
drugs were sometimes used for pain. But never in 15 years did
I move someone to the hospital solely for pain relief.
What
did you use to help women at home manage their pain?
We
used lots of tricks, the most useful, I think, being Verbal
Anesthesia: talking them through the contractions. Touch, eye-contact,
making noise along with them, encouraging mobility and frequent
changes of position, laughing and keeping the atmosphere upbeat,
massage, rhythmic and repetitive movements – all those
things were very helpful.
The freedom a woman has in her own home to do whatever works
for her (whether it’s reciting multiplication tables or
screaming), makes it easier for her to deal with the pain of
childbirth. In hospitals, women too often feel they must conform
to some unwritten code of acceptable behavior.
How
do you feel about children
attending births?
The
only two times I saw a problem was when the children clearly
were uncomfortable and the adult responsible for them was trying
to force them to stay.
If the parents are comfortable having other children present,
if the children know they can change their mind, and if there
is a relaxed and upbeat adult who stays with the children, regardless
of their decision, then I think it’s nothing but a plus
for everyone.
Interestingly, it’s teenagers and grandmothers who usually
have the hardest time.
What
do people who have home births do about the mess?
Home
births are usually very tidy, much neater than a hospital birth,
because we’re so careful. We had the couple make the bed
with clean linens and then cover it with a fitted plastic sheet.
On top of the plastic went an old sheet for the woman to deliver
on. After the birth, we piled all the washable things onto the
bed while the new mother was showering, popped the corners of
the plastic sheet, and carried everything to the washing machine.
And her clean bed was ready for her when she came returned.
What
did couples do with the afterbirth?
I’m
sure you don’t want to hear about the small minority who
tried to consume it. That was popular during the hippie years,
but it had mostly passed from the scene by the 80s, even in
Berkeley. However, I found a current online source for Roasted
Placenta, so there is apparently still some interest in
this practice. We put the placenta in a double plastic bag and
left it up to the couple to deal with. Most threw it away. Some
buried it and planted a tree above it. That’s about as
exotic as they got, although one couple from Indonesia enclosed
it inside a hollow coconut shell, and depending on the sex of
the baby, they buried it to the left or right of their front
door. Each time they moved, they took a scoop of the soil with
them to deposit beside the door at their new home.
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