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A Transition from Medical Model Maternity Care to Women--Led Maternity Care


by | April 22, 2020

On an epidemic scale, women in childbirth today are being “cared for” by maternity health care personnel who take control and make decisions for them. I have often observed coercion camouflaged as “informed consent.” I think it’s high time we make a fundamental shift to supporting birthing women in ways that allow them to hold on to the reins of control. Respecting women’s innate abilities to birth their babies and supporting them to do so is a paradigm shift that I believe is of paramount importance, if we are to shift the current trajectory of humanity. Women’s inherent ability of how to birth their babies is as ancient as anything human gets, despite the emerging idea that it is “new.”

Women need to know that they are born “programmed” to gently and safely birth their babies. A woman’s birthing knowledge has been deeply programmed within her and was fine--tuned over thousands of generations. Like many other body systems that involuntarily operate--like our respiratory system, our circulatory system and our digestive system--our reproductive system knows how to cycle, ovulate, carry and grow a child, as well as give birth. We, as birth care workers, need to do everything possible to respect and support that innately programmed physiological system first and should only intervene when something is truly “wrong” or pathological. If we are to do this, do we not first need to know what normal is, in its almost infinitely possible variations? (And by the way, going to a hospital during or, even worse, before labor is often the first in a cascade of not only unnecessary, but often harmful, interventions.)

Here is my story of not only my own birthing history, but also the last 20 years of my experiences as a busy midwife.

I had lived in Tonga, a small group of islands in the South Pacific, in the early 70s as a child, from the ages of 7 to 10. My consciousness about birth and breastfeeding was formed there--where babies were usually born at home and mothers breastfed their babies whenever they were hungry, wherever they were. My perspectives were also influenced by my mother’s birth stories of me and my two brothers. She always told me that the days she gave birth to us were the best three days of her life. She had taken a Lamaze class and done “natural” childbirth in a hospital, with an obstetrician about whom she spoke fondly. Apparently, after she gave birth to one of us, he turned to one of the labor-and-delivery nurses and said, “Now that’s the way it’s supposed to be done.”

When I became pregnant with my first baby, I was 28 years old and already running two care--providing businesses in rural Georgia--an outpatient rehabilitation clinic and a personal care home for the elderly. Before becoming a midwife, I was a physical therapist. I thought I was on top of my game, so to speak.

My pregnancy was planned and I was over the moon. I had always known I wanted to be a mother, and it was finally going to happen. I blindly made an appointment to see the Ob/Gyn I had seen a few times for annual Gyn checkups and contraceptive needs.

My husband, Dave, who had two significantly older children, went with me and we waited in the big University Hospital Ob/Gyn group’s waiting room. It was on something like the seventh floor of a huge University hospital office building and occupied the whole of that floor, if I remember correctly. The waiting room had seats for at least 40 patients to wait for their appointments and that’s what we did--for over three hours. We were told that Dr. Williams was doing a cesarean, his second for the day, but we were promised that he would eventually see us if we just waited.

When the time finally came for us to go into his examining room, Dr. Williams did a quick ultrasound scan to confirm my dates and showed us a small gestational sac on the screen, with no visible fetus yet, as I was only four weeks pregnant. He proceeded to put his arm around me and say, “Don’t worry, I take care of all my girls. I don’t let them suffer.”

I left his office completely gobsmacked. I had never considered the possibility of having a cesarean before, and I certainly wasn’t comfortable with him “taking care of me.” I wasn’t a “girl” and I wasn’t afraid of “suffering” in childbirth, because I knew women had been birthing babies for thousands of years. If suffering was a natural part of it, I was prepared to suffer. I also felt patronized by him putting his arm around me like that, especially in front of my almost 50-year-old husband, who was a university professor. It didn’t take long for me to realize that I needed to make other birthing arrangements. I didn’t even know where or how to start a conversation with Dr. Williams. We spoke completely different languages.

In the next few months, I did some research into available alternatives. A friend was planning a VBAC homebirth with some midwives and I met them, but homebirth was illegal in Georgia at the time and I wasn’t comfortable with that. I thought there was a possibility, albeit slight, that I might need medical assistance and I wouldn’t want to have to be dropped off at a hospital emergency room without my midwives being able to accompany me because they could be arrested. And besides, how would I get treated if the hospital staff knew I had been planning to have a homebirth?

Then I found out about a woman a friend of mine knew, who had just had her first baby in Bamberg, South Carolina, with a midwife at a birthing room attached to a rural family doctor’s clinic. His office was across the street from the small county hospital where there was also a birthing wing. There was no obstetrician there and epidurals were not available without a transfer to a bigger hospital in Orangeburg, South Carolina. I was told that if there was a real need for an emergency c--section, their general surgeon could do it. They assured me that a cesarean was a fairly straightforward procedure and a general surgeon could do it. To me it seemed like a perfect fit, except for the fact that it was a two-and-a-half-hour drive from where we lived. But for me, the drive seemed well worth it.

For the remainder of my pregnancy, Dave and I drove five hours back and forth to each antenatal appointment. I ended up having several days of early labor and, when we thought it was time to head to Bamburg, I still wasn’t in established labor. We rented a motel room and stayed there until I was finally “cooking with gas,” as I now like to refer to active labor.

I had a long and difficult labor and ended up needing some Pitocin to help make my contractions more regular and effective. Leigh, the midwife I ended up with for my labor and birth, was covering for the midwife I had booked with because my midwife was away for the Christmas and New Year’s holidays. Leigh only worked at the rural hospital birthing unit, so my planned place of birth had to change. As it turned out, that was probably a good thing, because if I’d had to transfer to the hospital in strong labor from the birthing room across the street, I might have felt anxious.

Leigh was wonderful! Each step of the way, she talked us through options that she thought were safe, and Dave and I felt very supported to make the decisions that felt right for us. After several days of early labor, I went through another 41 hours of very difficult prodromal labor. Looking back on it with years of reflection as a midwife myself, I realize that it was almost like being in transition for those 41 hours. And, I had only dilated to about 3 cm.

Dave had a lot of anxiety about the use of Pitocin. His first wife had had a very bad experience with it while birthing their second child in Malawi, Africa, when they were Peace Corps volunteers there. She had been given too much synthetic oxytocin (Pitocin) and he’d watched her whole body go into tetany with each contraction. That means instead of just her uterus contracting, her whole body was contracting uncontrollably until they gave her some strong medication to counteract the effects of the Pitocin overdose. With my labor, we finally agreed to what was promised to be just a “very tiny trickle” of Pitocin.

As it turned out, my contractions changed from a very painful, discordant pattern to a more tolerable, coordinated pattern that led me to progress and birth my baby “naturally” about six hours later. They did intermittent monitoring of my baby’s heart rate because they did not have an electronic fetal monitor. They did not have or use one because they were well aware that the research does not show any improved outcomes with continuous fetal monitoring--only increased interventions.

Shortly before giving birth, my waters broke on their own and there was lots of meconium. My baby was suctioned on the perineum as that was thought to be “best practice” at the time. He was born perfectly healthy and, as he was being born, Leigh told me to reach down and get my baby. We had not discussed having me do this ahead of time, so it was a surprise and the most exhilarating feeling ever. Leigh helped me bring my baby straight up to my chest. Birthing him was the hardest and most empowering experience I’d ever had in my life. I am so grateful for Leigh’s care; it still brings tears to my eyes. I believe she helped support me to have the best birth possible at the time, under the circumstances. I am certain I would have ended up with a cesarean if I’d stayed with Dr. Williams and probably would have had one with any other obstetrician or many other midwives.

Years later I came to understand that I’d been sexually abused by my father, who was a doctor. Although I was not able to identify as abuse what had happened to me growing up until years later, I believe the difficulty during my first labor and birth was likely a result of that incestuous abuse. I also may possibly have inhibited my labor progress subconsciously due to the fact that I knew my father was fearful and unsupportive of my choice to birth with a midwife.

Two-and-a-half years later, I had my second child with Leigh and her then--partner, Ruth. I stayed in a local Bamburg motel again, this time knowing that I was just in early labor. Everything stopped at about 9 pm, and I slept soundly at the motel until about 4:30 am when I woke up in very strong, active labor. My second baby was born within three hours. A very different experience, indeed. I think once my body had experienced birth, it knew exactly what to do and just did it. Again, I was totally empowered and became obsessed with what felt like a calling to become a midwife myself.

I did not want to subject myself to nursing school as I didn’t want to be conditioned to be subservient to doctors. My attitude was probably at least partially left over from my experiences with my father, who definitely suffered from the “Doctor God” syndrome. But I also was used to “evaluate and treat” referrals as a physical therapist, and I knew I could think for myself. I had confidence that I would recognize if and when the help of a doctor was needed, and I knew I wouldn’t hesitate to get it. I was passionate about supporting women to birth under their own power, physiologically, and in ways that were empowering.

I decided to attend SUNY Downstate’s direct entry midwifery program. They were accredited by the American College of Nurse Midwives to educate non nurse-- as well as nurse-midwives. I received an excellent education and was awarded one of two clinical excellence awards for my class. Out of about 20 students, four or five of us were not nurses. While the program was comprehensive, I left feeling a bit like I’d been trained to be a physician’s assistant. The spirit that had led me to feel compelled to become a midwife had not felt nurtured and, except for the award and a few other times, almost not even recognized.

During the few weeks between finishing midwifery school and taking the national certification exam, I went to The Farm in Summertown, Tennessee. I attended a workshop that was designed to prepare women to be midwives’ assistants for homebirths. I had just completed a Master’s of Science degree in midwifery, but felt I needed some recognition and nurturing of my midwifery spirit, which I hoped I could get at The Farm, and I did.

After I took the national midwifery certification exam, my husband and I took our two children to Cambodia, where we volunteered as consultants to a community-based rehabilitation program that was helping to address the many needs of disempowered, often ostracized, disabled Cambodians. The program was run by The American Friends Service Committee (AFSC)--Quakers.

While in Cambodia, I made arrangements to work with a local Khmer midwife. She had a “birthing center” of sorts under her house and she also worked as a midwifery supervisor at the local government hospital. She normally charged $100 US per birth at her house and the women stayed there for one or two nights after having their babies. My arrangement with her was that I could bring women to birth with her and I would pay her $80 US per birth. I believed that the $80 per birth was well worth my money for the continued learning and valuable experiences. The women we cared for together were very poor Cambodians whom I mostly met through my work with AFSC. They were either disabled themselves, or their husbands or other children had disabilities. I figured it was a win/win/win situation. The women had care they otherwise would not have had; I gained valuable experience in a very different environment than what I’d experienced as a student in two big city hospitals in the Bronx; and the Cambodian midwife received some extra income.

It was a wonderful arrangement. The midwife, Siu Pah, spoke only Khmer and French and when I started with her, I spoke only English. So, we drew a lot of pictures. The reality is that birth doesn’t depend on culture and languages, it just happens. It is something that happens across cultures, across languages, across traditions, and across time. I was very fortunate to have been able to make that arrangement with Siu Pah, as I gained immensely from those experiences with her. I have been back to visit her a couple of times, and she keeps our picture under the glass on her desk in the waiting area of her new clinic.

After Cambodia, we decided to go to New Zealand, where direct entry midwifery had recently become the standard. I figured the two best places in the world to be a midwife were New Zealand and The Netherlands. Because I didn’t speak Dutch and I liked what I’d heard about New Zealand being more rural and in the South Pacific, where I’d lived as a child, we settled on New Zealand. That is where I’ve practiced as a lead maternity carer (LMC) for the last 17 years. My experiences here sometimes have been challenging and midwifery here is not “perfect,” but I am convinced that the system here is what the rest of the world should be striving for. Women do not have to pay for their maternity care because it is covered by the national health care system. Women can choose their midwife and that midwife provides continuity of care from conception until four to six weeks after the birth, for both mother and baby.

The vast majority of babies in New Zealand are born with midwives, and almost all women want a midwife rather than an obstetrician. Obstetricans provide input when there are complications, but midwives are the primary providers of maternity and newborn care. Midwives also refer to or work collaboratively with pediatricians, social workers, family practice docs, occupational and physical therapists, alternative health care providers...with whomever and whenever it is needed. The government pays for it all, and there isn’t even a copayment. I submit my claims electronically and the money is in my bank account for what I’ve done within nine working days. Incredible!

New Zealand touts its “partnership model” of midwifery care. The partnership is between the midwife and the woman. There is also a Health and Disability commissioner, with a Code of Rights--and these rights are taken very seriously. They include:

  1. The right to be treated with respect.
  2. The right to freedom from discrimination, coercion, harassment, and exploitation.
  3. The right to dignity and independence.
  4. The right to services of an appropriate standard.
  5. The right to effective communication.
  6. The right to be fully informed.
  7. The right to make an informed choice and give informed consent.
  8. The right to support.
  9. Rights in respect of teaching or research.
  10. The right to complain.

Any complaint is investigated and where concerns about health care practitioners arise, they may be investigated, and restrictions, supervision, or even suspension of the health care provider’s practice may follow, if deemed appropriate.

My practice as a midwife has, almost without exception, focused on providing women--led care. This orientation came from my personal experiences birthing my own babies, as well as from what I observed worked best for good outcomes. Women who feel like interventions are done for them and their babies end up feeling empowered. Women who feel like things were done to them and their babies often end up feeling disempowered or even traumatized.

Over the years, my practice has become more and more aligned with the belief that women know what they need, even when it sometimes does not match what is being recommended or what the guidelines and/or protocols direct and expect. If the situation or circumstances change and the woman or her baby ends up requiring intervention, more often than not the mother will be the first one to ask for it.

I believe it is important to provide women with information, recommendations, and the rationale for those recommendations. I also believe that women know themselves better than anyone else. They are in the best position to make the best decisions for themselves. And, almost always, women want what is best for themselves and their babies. They may, however, have a different set of priorities than the midwife or doctor who is caring for them and making the recommendations. If, for example, they say that they want a homebirth--even if they have had a previous caesarean--and are informed of the risks and recommendations, they have the right to not go to the hospital. Or, for example, they may want to go to the hospital and have a waterbirth, with intermittent rather than continuous fetal monitoring if a continuous waterproof fetal monitor is not available, or if they just don’t want continuous monitoring. After all, has anyone explained the risks of continuous fetal monitoring or, for that matter, the risks of going to the hospital?

I am convinced that women’s birth trauma and women’s growing preference to birth outside of the system stems from not having and following a Codes of Rights similar to New Zealand’s. Women feel violated, abused, lied to, coerced, and disrespected in the medical systems that are currently in place. A silent revolution opposing this system is happening now. One symptom of the revolution is the rise in freebirthing. Women do not trust the current system and, I am sad to have to say, I understand why. Even midwives can be coercive when they are afraid, more often than not, for themselves. There have been many times when I have felt like I was on the front lines of a war zone when providing maternity care, especially when I was supporting women who did not want to do as they were being told by the doctors and/or other midwives. Unfortunately, many women do not even understand that they have rights.

Many providers think they know best and that women should just be made to do as they are told. I believe that it is absolutely necessary to transition from this medical model of authoritarian maternity care to women--led maternity care--to move away from the care provider being “in charge.” We need to start treating women as if they know what they need, because they do; treating women as if they have a right to choose, because they do. We need to stop treating women like we need to protect their babies from them. Almost without exception, mothers want what they believe is best for their babies. If women are to be able to love, respect, and protect their children, they need to feel loved, respected, and protected.

These words by Suzanne Arms underpin my calling to become a midwife:

“If we hope to create a non--violent world where respect and kindness replace fear and hatred, we must begin with how we treat each other at the beginning of life. For that is where our deepest patterns are set. From these roots grow fear and alienation, or love and trust.”




Continuing to Nurse Your Baby Through Coronavirus (2019-nCoV; COVID-19) and Other Respiratory Infections


19 February 20
News From LLLI


Contact Information: zion@llli.org
Raleigh, North Carolina, USA
The novel Coronavirus (COVID--19) currently in the news is a rapidly evolving global medical situation with limited information available at this time. La Leche League International (LLLI) respects the efforts of international health and medical organizations and associations to maintain up-to-date information and recommendations as understanding of the virus is developed. LLLI will continue to track the development of the current global health crisis.

With over 60 years of breastfeeding experience, La Leche League International stands firm in encouraging all families to recognize the importance of breastfeeding in providing immunological protections to the breastfed child. Most often, babies who are being nursed remain healthy even when their parents or other family members fall ill with an infectious illness. There is a growing body of research showing babies benefit from multiple and diverse immunologic proteins, including antibodies, provided in human milk, particularly through direct breastfeeding.

Those who become infected shortly before giving birth and then begin breastfeeding, and those who become infected while breastfeeding, will produce specific secretory IgA antibodies and many other critical immune factors in their milk to protect their nursing infants and enhance their infants’ own immune responses. At this time, these immunologic factors will aid their infants’ bodies to respond more effectively to exposure and infection. Following good hygiene practices will also help reduce transfer of the virus.

If someone who is breastfeeding becomes ill, it is important not to interrupt direct breastfeeding. The baby has already been exposed to the virus by the mother and/or family and will benefit most from continued direct breastfeeding.

Disruption of breastfeeding may lead to several issues:

  • significant emotional trauma for the nursing baby or toddler,
  • a drop in milk supply due to the need to express milk,
  • later breast refusal by the infant due to the introduction of bottles,
  • a decrease in protective immune factors due to lack of direct breastfeeding and expressed milk not matching the infant’s needs at a particular time, and
  • an increased risk of the infant becoming ill due to lack of immune support from direct breastfeeding.

The last point is of critical importance: when any member of the family has been exposed, the infant has been exposed. Hence, any interruption of breastfeeding may actually increase the infant’s risk of becoming ill and even of becoming severely ill.

Anyone who believes they may have COVID-19 (also known as novel coronavirus; 2019-nCoV; SARS-CoV-2) is encouraged to follow good hygiene practices, such as thoroughly washing their hands and wearing a protective mask to prevent spread of the virus. If someone becomes ill enough to require hospitalization, the baby should be allowed to continue breastfeeding if at all possible, keeping in mind the above list of possible results from any separation or disruption of breastfeeding. In an extreme circumstance, if an interruption of breastfeeding is deemed medically necessary, hand expressing or pumping the milk is encouraged. In such cases, the expressed milk, which contains multiple immune factors, may be fed to the baby to help prevent the baby from getting the infection or to help reduce the severity and duration of an infection if the baby does get sick.

The World Health Organization (WHO) offers guidance and other information on coronavirus in multiple languages on the WHO website. UNICEF also provides information for breastfeeding through COVID-19 infection. Links are included in the references below.
All of the information above also applies to families at risk of or experiencing influenza and other respiratory viruses.

REFERENCES

Centers for Disease Control and Prevention (CDC; 28 January 2020). About 2019 Novel Coronavirus (2019 - nCoV). Accessed 29 January 2020 and 12 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

Centers for Disease Control and Prevention (CDC; 17 February 2020). Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy. Accessed 18 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html

Centers for Disease Control and Prevention (CDC; 15 February 2020). Coronavirus Disease 2019 (COVID-19): Frequently Asked Questions and Answers. Accessed 19 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; published online Feb 12 2020 at https://doi.org/10.1016/S0140-6736(20)30360-3

China National Health Commission. Transcript of Press Conference on Feb 7, 2020 in Chinese. Available at http://www.nhc.gov.cn/xcs/s3574/202002/5bc099fc9144445297e8776838e57ddc.shtml

Lam, C.M., Wong, S.F., Leung, T.N., Chow, K.M., Yu, W.C., Wong, T.Y., Lai, S.T. and Ho, L.C. (2004), A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome. BJOG: An International Journal of Obstetrics & Gynaecology, 111: 771-774.

Scientific American (12 February 2020). Disease Caused by the Novel Coronavirus Officially Has a Name: COVID-19. Accessed 12 February 2020 from https://www.scientificamerican.com/article/disease-caused-by-the-novel-coronavirus-officially-has-a-name-covid-19/

Shek CC, Ng PC, Fung GP, et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics 2003; 112: e254.

UNICEF (February 2020). Coronavirus disease (COVID--19): What parents should know. Accessed 18 February 2020 from https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know

Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191: 292-97.

World Health Organization (WHO; 20 January 2020). Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts: Interim guidance 20 January 2020. Accessed 29 January 2020 from https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

World Health Organization (WHO, 2020). Novel coronavirus (2019--nCoV). Accessed 12 February 2020 from https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; published online Feb 10 2020. DOI:10.21037/tp.2020.02.06.



Midwives Explain What a Home Birth Really Means


BY LAUREN VALENTI
April 16, 2020

The COVID-19 pandemic has presented a unique set of emotionally distressing challenges for pregnant women. From concerns about their health and that of their baby, to the prospect of having to go into labor and birth alone in hospitals, mothers-to-be are facing extreme fear and uncertainty in an already vulnerable time.

With many hospitals operating near or at capacity with limited resources as they take on the flood of Coronavirus patients, many expectant mothers are rethinking their birthing plans--and considering the option of a home birth which, typically, only about one percent of mothers do each year. Midwives are being inundated with home-birth requests. Here, the birthing experts speak on commonly asked questions about home birth, the benefits and potential risks of doing so, and why the decision to have one should be made with careful consideration.

What Is a Home Birth?


"A home birth is exactly what it sounds like--when someone decides to birth their baby in their own home!" explain licensed midwives Robina Khalid and Tanya Wills of New York City's Small Things Grow Midwifery in a shared interview. "People who have a planned home birth, in the absence of complications, will never need to go to the hospital." While someone can birth at home without a midwife, the vast majority of people who choose home birth will work with one. As for who else is present, it varies from family to family; oftentimes it’s just the birthing person, their support person, and a midwife. "In general, home birth is a quiet, intimate experience," explains Sara Howard, a Los Angeles-based midwife and educator at healthcare center LOOM. "Lights can remain dim, music can play in the background, and partners and doulas can provide support no matter where the birthing person wants to be physically, whether that's in a bed, tub, or somewhere else."

What Role Does a Midwife Play in a Home Birth?


The midwife is there to safeguard the health and safety of the birthing person and the baby. While many midwives vary in credentials in the U.S.--there are licensed midwives, certified professional midwives, certified nurse midwives, and traditional midwives, for example--practices are similar. "I’m licensed by the same medical board that licenses doctors," explains Howard. "I carry a doppler to listen to the baby’s heartbeat in labor, medications to stop bleeding after birth, oxygen, suturing equipment, IVs and antibiotics, and more. I’m certified in neonatal resuscitation and infant CPR, as well as trained in advanced fetal monitoring." A midwife may involve herself during birth by "catching the baby" or, during the immediate postpartum, ensuring the placenta is birthed safely, keeping a watchful eye on bleeding, giving stitches when needed, performing a head-to-toe newborn exam (including weight and measurement), and assisting with breastfeeding. "In the best case scenario a midwife is just there to remind the birthing person of their own strength and to help ensure the birthing person feels safe enough to do what only they can do--birth their baby."

What Are Some Benefits of a Home Birth?


"Home birth may be the best chance the average American person has at having a physiologic birth--a birth that occurs without intervention," explain Khalid and Wills. This method has been shown to carry benefits to parent and baby, including a better transition to breathing for the baby, less genital trauma for the birthing person, quicker recovery from birth, increased rates of breastfeeding, improved parent-infant attachment, and decreased incidence of postpartum depression. Planned home births attended by a registered midwife have been associated with reduced rates of obstetric interventions, such as C-sections, and other adverse perinatal outcomes. Plus, there is an inherent bond that's been formed between mother and midwife. "By the time we arrive at the birth, there is a deep understanding of the person, baby, and family we are caring for--there is trust," say Khalid and Wills. "People can birth anywhere they like on their own turf while listening to their bodies and allowing their own innate wisdom to guide them."

How Is Labor Pain Managed During a Home Birth?


"Epidurals are an amazing technology that many people choose to use in the U.S., but there are many other people who place value on the experience of labor and birth as it is," explain Khalid and Wills. "We have a belief in our culture that pain is always bad or wrong. And is labor painful? Yes. But pain is different than suffering, and pain is sometimes instructive." For example, the pair believe that having full sensation when pushing helps people know how to push--and when to back off--which helps people tear less than they would during guided pushing. Moreover, birthing at home gives the birthing person the opportunity to move more freely, as well as take advantage of multiple spaces, such as a bed and a pool of water. "Laboring in a big pool of water at body temperature is probably the most soothing tool we have at all to relieve pain at home," explains Howard. "Virtually all people who labor at home will utilize a birth pool for that very reason." Another way to relieve pain naturally is deep, focused breathing. "When you relax and breathe, your muscles get more oxygen, which reduces pain," she explains. "Whereas when people are scared and tense, their muscles constrict and they feel more pain."

What Are the Safety Concerns Around Home Birth?


In order to be a good candidate for home birth, a person and a pregnancy need to be “low-risk,” which generally means that there are no major medical problems present either before or during the pregnancy, says Howard. Generally, high-risk factors may include high maternal age or previous C-section delivery. The best way for an expectant mother to know for sure is to talk to their doctor, as well as consult a midwife about their specific history and situation. As for unexpected medical emergencies that could arise during an at-home birth, Howard says the most significant risk is the delay in getting from your home to a hospital, which is why many medical experts recommend that an at-home birth should take place within 15 minutes of a hospital. "The majority of problems that occur during labor and birth present warning signs, and midwives are extensively trained in recognizing these warning signs," explain Khalid and Wills. "Our intimate knowledge of our clients, as well as years of observing people's labor while sitting with them for hours on end, gives us the ability to interpret what’s going on, and decide whether staying at home is still appropriate." The pair also stresses that most transfers are not emergencies, and that the most common reason for going to the hospital during labor is exhaustion or a very long labor that might need some augmentation or pain relief.

How Can I Decide Between a Home Birth and a Hospital Birth?


In additional to consulting medical professionals, it's important to gauge your personal comfort level with the idea of a home birth. "Home birth can be an incredibly warm, sweet way to bring your baby into the world--but it isn’t for everybody," says Howard. "There are times when epidurals and surgical births are terrific, life-saving things that we can all be grateful for. Deciding where to birth is personal. Take the time to gather the information and resources you need to ensure that you’ve made the best choice for you and your family. You know best." As far as the timing of a mother-to-be's decision, the earlier the better, especially in the instance of home birthing. "Things get tricky when it’s very late in the pregnancy and folks want to have a home birth, especially because most midwives have small practices that fill up early," explain Khalid and Wills, who released an open letter to address increased interest in home birth during the COVID-19 pandemic. "Moreover, creating trust and familiarity between the midwife and the family over time is key to a safe and healthy experience." Ultimately, the decision to have a home birth is not one to be made out of fear and panic, even in unprecedented times--fundamentally trusting the location of one's birthing is the best way to ensure safety for the mother and child, they stress. "If after diligent and thoughtful research, the autonomy and safety of home birth remains appealing, pregnant people are always welcome to contact individual practices, with the understanding that most practices book up far in advance," Khalid and Wills note in their address.