Should I plan a home birth?

Whilst home birth was the norm in centuries past, the twentieth century saw more women delivering in hospitals. As education about pregnancy and birth becomes far more accessible, many women are once again opting to give birth in their own home.

Kay Johnson, a Certified Nurse-Midwife, speaks with Dreaming of Baby on home births, assisting moms-to-be in making an informed choice on finding the optimal place to birth.

Daniela: Good morning, Kay, and a warm welcome to Dreaming of Baby. Our focus today is childbirth where we will be looking into the specifics of a home birth. Before we start with our discussion, grateful if you could introduce yourself as well as your experience in this field.

Kay Johnson, Certified Nurse-Midwife: I was trained as a nurse and then went to graduate school at Emory in Atlanta to study nurse-midwifery. I worked for 8 years in Houston, first in a large midwifery practice at the public hospital and then in two small private practices, one in the Baylor School of Medicine and one at UT-Houston. I was also an instructor for medical students and residents in both of their OB-GYN departments. I moved to Atlanta and was in private hospital-based practice since 1993. I left hospital-based practices and been doing home births in the Atlanta area for 6 years now.

What is a home birth?

Daniela: That’s impressive, thank you, Kay. Starting from the basics, and with the aim of presenting a full picture to our readers: what is a home birth?

Kay Johnson, Certified Nurse-Midwife: A home birth, that is, an intended home birth (as the birth certificate describes it) is a birth in one’s own home (although we have had birth in the grandparents homes a few times this year), attended by the mother’s birth team.

The people at a home birth

Daniela: When you refer to a birth team – who are the people at a home birth?

Kay Johnson, Certified Nurse-Midwife: The birthing mom, her partner (usually a husband), the midwife, her assistant, (often a student-midwife), maybe 50% have a doula, as well as a good friend, sister, mother and sometimes the siblings. About 25% have a photographer. Rarely, the mother and partner are alone with the midwife and assistant.

Daniela: In other words then, a home birth allows for more people to be present, as I believe in a hospital setting this would be more limited?

Kay Johnson, Certified Nurse-Midwife: Hospitals have different tolerances for people in labor and delivery. I’ve seen the whole range, from no one to whoever you want.

Who can plan a home birth?

Daniela: Moving on to the ins and outs of a home birth, can everyone plan a home birth or there are specific criteria which have to be met?

Kay Johnson, Certified Nurse-Midwife: A midwife would not take on a woman who had existing problems that would interfere with growing a healthy baby, such as diabetes, high blood pressure, or any other chronic issues. She would not keep a patient who developed problems during the pregnancy, such as high blood pressure. My practice is very conservative and will not keep women who have twins or has a baby that is not head down. We also do not do vaginal births after a caesarean section. These are controversial issues among the midwives.

Daniela: So a VBAC (Vaginal Birth After C-Section) at home would not be possible across the board or this would depend on the midwife?

Kay Johnson, Certified Nurse-Midwife: Depends on the midwife. In some states, the regulations governing midwives will speak against this. Others, like Georgia do not.

Daniela: Thank you for clarifying. What are the procedures for planning a home birth? What does the mom-to-be need to do during her pregnancy?

Kay Johnson, Certified Nurse-Midwife: We have regularly scheduled appointments which are the standard in Obstetrics, monthly visits until 7 months, every 2 weeks until the last month and weekly after that. We offer the same standard prenatal tests, a set of blood tests early that includes blood type and blood count among others, we offer genetic testing with a perinatologist, an anatomy scan at 20 weeks, diabetes screen at 7 months, GBS testing at 36 weeks. We include a home visit at 37 weeks to insure we know how to get to the house, offer our suggestions about laboring at home, and check their supplies. We have a list of supplies for them to buy and collect for the birth room. We do suggest a birthing class, especially for first time moms. We like for them to have a doula, but the cost is so high we don’t require one. And sometimes, the partner or the mother or sister make great doulas.

Kay Johnson: “There is more personal attention and care; the kind of attention and care that keeps labor and delivery normal.”

Supplies needed for a home birth

Daniela: You mention supplies – what would be the items needed for a home birth and which the parents-to be must prepare?

Kay Johnson, Certified Nurse-Midwife: The box of supplies should include: gloves for us, pads for the bed, 2 Depends for the first post-partum day, a few very large pads the next few days, a bulb syringe, cord clamps, a baby hat, gauze packs, a couple of bendy straws, etc. Then we ask them to buy large garbage bags, kitchen-size garbage bags, hydrogen peroxide, witch hazel, paper towels, and a thermometer. All this should cost about $70-80. Then if they want a water birth, there is a list for that.

Daniela: And what would the list for a water birth at home look like?

Kay Johnson, Certified Nurse-Midwife: We add a tub and hoses and extra towels. There are professional birth tubs that start around $200 and go up. Most of our families buy a kiddie tub that costs about $50. They also need a couple of new yard hoses and an adapter for the faucet, and a pump to blow up the tub and a pump to drain the water. So about $100. They would also need about 6 to 8 clean towels.

Benefits of a home birth

Daniela: Based on your experience, what are the benefits of a home birth?

Kay Johnson, Certified Nurse-Midwife: Mostly, less unnecessary interventions: less risk of interventions that lead to complications. And this is not only for the mother, but also for the baby. Added to this, there is much more attention paid to the woman in labor. There is more personal attention and care; the kind of attention and care that keeps labor and delivery normal. A lot of women say that they really like not having to go to the hospital in labor. Some like to have their kids with them in labor, some like the comfort of their homes instead of a hospital room to labor and deliver in.

Kay Johnson, Certified Nurse-Midwife: I do believe that it is possible to have a natural birth supported in the hospital. I did that for 30 years, but sometimes it takes a little arguing on the part of the woman to avoid the usual treatments, the IV, the epidural, staying in bed, food and water withheld, active pushing cheerleading, etc.

Disadvantages of a home birth

Daniela: Thanks for this insight you’re sharing. Looking at the other side of the coin: What are the disadvantages of a home birth?

Kay Johnson, Certified Nurse-Midwife: Pregnancy and labor and delivery in this country is generally discussed with a fear-based attitude. It’s rare to find a pregnant woman who is not exposed to this fear from all around her. If she isn’t supported in her decisions about labor and choice of delivery site, it is very hard for her to go through the hard work of labor without the fear defeating her intentions. Epidurals and narcotics play an essential role in managing fear in labor and delivery. Some women don’t anticipate this while planning their home birth and therefore are not able to continue laboring at home. This is often seen by them as a failure, but I believe that we sometimes don’t know what is going to be overwhelmingly frightening for us during stressful experiences.

Kay Johnson, Certified Nurse-Midwife: There are a few rare emergencies that would be handled easier at hospital, which is why we are diligent in our constant assessment of the pregnancy and labor. Our transfer rate is less than 10%. Most of them are “failure to progress”, and most of them deliver vaginally with the help of an epidural.

The women who birth at home

Daniela: If I understand well then, much of it boils down to how much the mom is mentally prepared for a positive labor. It’s great to note that the majority of women who choose a home birth do manage to birth at home.

Kay Johnson, Certified Nurse-Midwife: My practice is full of very strong women: usually well educated, often foreign or who have lived abroad. Mostly with money, but lots lately without insurance. We have a lot of non-vaxers, home schoolers, feisty women!
Daniela: So the majority of women who choose to birth at home fit these characteristics – or that’s public perception?

Kay Johnson, Certified Nurse-Midwife: In my practice, that’s true. There are lots of midwives around the country with other populations, Amish and Mormans, other religious groups. Some just like all the personal attention you get, sort of concierge midwifery. Home birth is attractive to women who for a variety of reasons distrust the American medical treatment of normal pregnancy.

Daniela: Thanks for clarifying. On a final note, for the mom to be reading this article, who is experiencing a straightforward pregnancy, and asking ‘Is home birth for me?’, what would your reply be?

Kay Johnson, Certified Nurse-Midwife: If you are interested in a supported natural pregnancy, labor and delivery, then you should consider a home birth or a birth center. The birth attendants there are interested in and invested in keeping you healthy and your labor normal.

Daniela: Thank you for your time today Kay, it was a pleasure speaking with you on this subject!
Kay Johnson, Certified Nurse-Midwife:I love talking about midwifery, home birth and pregnant women! Thank you for your excellent questions!

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