Let your wild bloom!

Wildflower Midwifery

Jean A. Hartley, LM, CPM

Is home birth safe?

My 13 year old daughter told me that anytime she tells her classmates or teachers about what I do for a living, they respond with amazement and question the safety of having a baby at home. (or they exclaim that they could never do it without pain meds)  I expect this is also the reaction you might get if you tell your parents or in-laws that you are considering a home birth. First, let's look at the common fears about the actual birth.
 
What if labor stalls or goes on (seemingly) forever?  Common things that slow or stall a labor are fear, exhaustion or medications.  During a home birth the woman is in her own home, not a foreign environment where she is not in charge.  She is surrounded by people she trusts and has invited to her birth.  The midwife is a collaborator in her care and she has developed a close relationship during lengthy prenatal visits.  The woman has had the opportunity to learn about pregnancy and birth and what is happening and given the opportunity to ask questions, make her own decisions and express her concerns in an environment where her opinions and knowledge are accepted and valued.  This setting eliminates a lot of the fear related to child birth.  During a home birth, a woman is encouraged to eat and drink.  Labor is hard work and requires calories and fluids.  This helps her to avoid exhaustion.  During home labor there are no pain medications that commonly can cause a slow down in contractions.  Labor discomfort during a home birth is managed by moving around, changing positions and many other techniques that often do not happen in a hospital when a woman is required to stay in bed because of continual fetal monitoring or an IV.  Moving around and changing positions can actually reduce the length of labor.

What if the baby isn't coping well with contractions? Fetal heart rate change is often the first indicator of a problem during labor, while it alone does not always mean there is a problem.  During a home birth the midwife monitors the the baby intermittently with a fetal doppler or fetascope.  Early in labor it may be every 30-60 minutes and later every 15 minutes.  During the pushing stage the baby is monitored more often as necessary.  Midwives are trained in normal birth.  If anything appears to be varying from normal, steps will be taken to find out why, remedy the situation or get additional care. 

What if the baby is too big?  True CPD (cephalopelvic disproportion-common reason given for C-sections) rarely occurs and is often a failure of the caregiver to be patient.  If labor begins or moves along without the baby becoming engaged in the pelvis then dilation will not occur. In these situations the mother would be transported to a hospital for birth.  If a shoulder dystocia occurs there are several maneuvers to get the shoulder unstuck.  The mother can be an active participant because she is not drugged or unable to use her legs because of an epidural.  The best way to move the baby through the pelvis is to change positions.  However, there have been many large babies successfully born at home, the woman's body is an amazing vessel and passage for baby!

What about hemorrhage?  Minnesota Midwifery laws allow me to carry anti-hemorrhagic drugs to stop bleeding after the birth of baby.  These are some of the same drugs they use at the hospital. I also use herbal tinctures to stop bleeding.  Blood loss is monitored closely and additional care will be sought if needed.

What if the baby isn't breathing?  The umbilical cord is not cut until it stops pulsing and often not even until the placenta has been delivered. This keeps the infant's life line attached and he still receives oxygen from mother. I am certified in CPR and Neonatal Resuscitation.  I carry resuscitation equipment for just such an emergency and will contact EMS if needed.  The mother and baby's vital signs are monitored frequently during labor and every 15 minutes after the birth for the first hour to ensure that each is stable.  Additionally, baby stays with you, to hear your voice and feel your touch welcoming her to the world.  The most common reason I have had to transport any client to the hospital is actually for baby not breathing well after the birth.  The average has been about 4% of births that have required transport for further observation of baby.

What if the cord is around the baby's neck?  This is commonly given as a reason that there was an emergency situation in the hospital.  However, the cord frequently gets wrapped around all parts of the baby and it rarely a true emergency.  The vessels in the cord are protected by a gel called Wharton's Jelly which helps keep the blood flowing even if the cords gets squished, squeezed or even in a knot.  If the cord is around baby's neck it may slow descent into the birth canal and may make labor last longer.  Once the head is born the cord can be looped over baby's head or pushed down over his shoulders as he is born through it.  If the cord is too tight for this, the baby can be somersaulted out.  A midwife's tendency to trust the woman's body and trust birth can actually prevent injury to the baby that would occur if labor were augmented with drugs to make contractions harder and stronger, thereby stressing and stretching an umbilical cord beyond the mother's natural body influence.

Second, lets look at the safety of prenatal care.  During a prenatal visit (which are scheduled at the same intervals as you would have with an obstetrician) vital signs are checked as well as urine, weight and general well being.  The baby is measured and heart tones are evaluated, just as at a doctor visit.  Tests can be done including the initial blood tests (OB panel and HIV test), glucose testing, group Beta Strep testing and tests for anemia.  I can also refer you to a suitable location for a sonogram if you wish.  Nutrition and exercise are discussed at every visit.  Before every test you are encouraged to read, research and make your own decisions about testing and treatment with guidance from the midwife.  Each visit lasts approximately an hour.  That's an hour of face to face time with a caregiver, not waiting in waiting room or exam room for endless minutes.  Throughout the prenatal period, if you or baby develop a problem that makes home birth unsafe, you will be referred to another provider. Additionally, a risk assessment is completed before care even begins to see if you truly are a good candidate for a home birth based upon medical history.

Third, let's look at the safety of postpartum care.  The midwife (and assistant) remains with mom and baby until both have been stable for at least two hours, have been thoroughly examined, baby has nursed and mom has shown that she is ambulatory and can use the restroom.  The midwife can administer erythromycin eye ointment and vitamin k injection to the baby if you wish. (just as in the hospital)  After instructions are given for care and how to monitor baby and mother in the next 24 hours, parents are encouraged to rest and enjoy their baby.  Additional home visits occur at 24-48 hours after the birth, one week, two weeks and six weeks.  This is much more frequent visits than with an doctor.  Additionally, mother and baby are safe at home and not in a waiting room or hospital with sick people.  These visits include a full examination of the infant and mother as well as discussions of breastfeeding and adjusting to life with a newborn.  Many women report this support as the reason they were able to continue breastfeeding and helped prevent depression.
Please examine the links to the left side of the page to read articles, studies and first hand accounts of the safety of home birth.  I also encourage you to talk to other families who have had a homebirth.  Facebook has a MN Homebirth Families page and multiple other groups with like minded people who love to talk about their midwifery care.

(Please keep in mind that the above are general protocols for Wildflower Midwifery, Inc. and not all Minnesota midwives will operate in the same fashion)