"Of course I'm going to have a hospital birth"

I can’t count the number of times I’ve worked with clients who have a clear vision for their birth that would 100% be better supported by birthing at home (and conversely, has a high chance of being derailed by birthing in hospital) and yet they’re dead set on birthing in hospital anyway.

On the surface, this doesn’t make a lot of sense, but if we dig a little deeper, it becomes clearer. Culturally, most of us learn from a very young age that birth happens in hospitals. It’s the narrative we’re taught and unless we have reason to question it, most of us simply don’t.

Here’s the thing: unless you’re shining a big ol’ spotlight on those hidden narratives you’ve inherited, your decisions will never be truly your own. They belong to the people you inherited your narratives from.

Interested in changing your narrative? Here are five thoughts to consider that may help:

1. Home birth is as safe (and sometimes safer) than hospital birth for both birthing people and babies (Hutton et al., 2016).

   I often hear folks say “I’d love to have a homebirth, but I’m too scared. What if something goes wrong?” That’s a valid question – you should know what happens at a homebirth if complications arise. However, when folks voice this objection, and I try to drill down with them to what they’re concerned about, it’s usually just a vague sort of “something”.

   The truth is that we know what the most common complications of birth are (for example: bleeding more than expected after birth aka postpartum hemorrhage) and I can guarantee you, your midwives have a policy and procedure in place to manage that at home (just like doctors and nurses do in hospital).

   But here’s the kicker – you have a decreased chance of having a postpartum hemorrhage in the first place, just by deciding to birth at home (Scarf et al., 2018).

   So get clear about what you’re actually worried about and then ask your care provider how they would manage that complication if it happened. You’ll likely feel deeply reassured.

2. Conversely, hospital birth isn’t de facto the safest place for most birthing people to birth in.

   Culturally, we’ve broken the birthplace narrative down to two options:

   Hospital birth = Safe
   Community birth (home or birth centre birth) = Dangerous

   The truth is that there’s no such thing as a “safe” choice and a “dangerous” choice. There are pros and cons to both options – your job is to decide which set of pros are most desirable to you and which set of cons are most acceptable.

   Just as there are benefits and risks that are unique to home birth there are also benefits and risks that are unique to hospital birth. There are potential complications that arise in hospital births that simply can’t happen in community birth, that are a direct a result of being at the hospital (this is referred to as iatrogenic risk).

   But what if I or my baby need urgent medical care? Good question!

   It’s important to understand that comparing hospital birth to home birth is NOT comparing apples to apples. A home birth provider does not practice the same way as a hospital birth provider (and having a midwife doesn’t automatically mean you have a home birth provider. Some midwives don’t have a ton of experience or confidence in supporting home birth - make sure to ask them directly).

   When you’re birthing at home, as my good friend and registered midwife Lisa Cowdery (Mockingjay Midwifery) says “you can’t practice like you have an operating room down the hallway. Because you don’t have an operating room down the hallway”.

   What does that mean? It means that IF you do any sort of intervention in a community birth, it’s an intervention intended to support and augment the physiological process of birth NOT interrupt it. You don’t induce or augment birth at home. You don’t do unnecessary vaginal exams (which is pretty much all of them). You don’t poke and prod the labouring person because “it’s standard of care”.

   And when birth is supported in this way, the likelihood that an unforeseen and completely unanticipated complication would arise that required an operating room five minutes ago almost never happens.

   The vast majority of transfers into hospital from community birth are non-urgent. Your midwife has seen something that may be a sign that more medical help might be needed, has discussed their observations and recommendation with you, and you’ve all decided that it would be best to transfer in.

   Most folks go on to have a lovely, unmedicated, uncomplicated vaginal birth in hospital. And occasionally, it turns out that you maybe did need extra medical support and then voila! You’re where you need to be.

   In the extremely rare circumstance where an urgent cesarean section is warranted, the hospital staff use the time it takes you to transfer into the hospital to prep the staff and the OR for your arrival. It’s not uncommon for you to be birthing your baby by cesarean as quickly after a transfer in from your home as it would have taken to set things up if you’d already been in the hospital.

   This isn’t to say that it’s a guarantee that everything will be fine when you give birth at home. But there’s also no guarantee that everything will be fine if you birth in hospital. That’s just not how birth works. There is risk to it, no matter what you decide, who you decide to birth with, or where you decide to birth.

   Since that rare risk of the worst happening is existent no matter what, why not choose your birth location based on what you WANT rather than what you don’t want?

3. What if I need pain meds?

   Then you need pain meds, no problem. You transfer into the hospital with your team and get what you need. As I mentioned, most transfers into hospital aren’t emergent – you and your partner just drive there in your own car.

   That being said, in the same way that birthing at home reduces your chance of having a postpartum hemorrhage in the first place, birthing at home also reduces the chance you’ll need pain medications.

   When folks are planning a homebirth they’re much more motivated to search out non-pharmacological pain coping strategies and practices for their birth because they know that pain meds, while still an option, are going to be more of a PITA to access. That process of preparation alone can often create a self-fulfilling prophecy when it comes to having an unmedicated birth.

   Not to mention that most people feel safer and more comfortable birthing in their own space = reduced stress hormones and increased oxytocin production = decreased perception of suffering. Win/win/win.

   My final thought on this is that transferring in for pain meds can also help to clarify whether or not you really need them – being willing to get in your car, transfer to the hospital, and get an epidural is a lot to ask of a person in labour. If you’re willing to do that, it’s probably because you really need to.

4. What about the mess?

   There’s a lot that can be done to mitigate the mess of birth (READ: 15+ tips for a great home birth). Not to mention, your midwives and your doula will take care to clean up after the birth so that you and your partner can focus on getting to know your baby.

   The other option, if you really and truly don’t want to birth in your own home but do want the benefits of a homebirth-like environment, is to book the Arbor Birth Centre.

5. Your home, your turf

   When you choose to birth at home, you’re inviting people into your space, onto your turf. YOU know where everything is. You feel free to move around in any way that you want because it’s YOUR house. You feel 100% comfortable to go and grab a glass of water or a snack because it’s YOUR kitchen. Need to go to the bathroom? You just go. No need to check with your nurse first.

   On the other hand, birthing in hospital can feel like you have to ask permission for everything you do. It’s not your space, you’re not sure what those buttons do, and if you get up and go to the bathroom without asking first, is the fetal monitor alarm going to blare off?

   The sense of comfort and power that comes from birthing in your own space cannot be downplayed in how it improves the birth process. Feeling safe and comfortable in your birth space is the number one thing you can do to support physiological labour and to decrease the need for medical intervention.

   Look, at the end of the day, as your doula, I don’t care where you choose to birth (in the sense that I’ll support the eff out of you wherever you birth). If hospital’s the best choice for you, I support that 100%. I trust you to know what’s best for you.

   What I AM saying is that the decision of where to birth is one that’s worth a deeper look than most of us ever give it. Here’s your chance to take that deeper look.

   If you’d like doula support for your upcoming birth (home, birth centre, or hospital), FILL IN AN INQUIRY FORM TODAY and we’ll get the ball rolling.

REFERENCES

Hutton, E. K., Cappelletti, A., Reitsma, A. H., Simioni, J., Horne, J., McGregor, C., & Ahmed, R. J. (2016). Outcomes Associated With Planned Place of Birth Among Women With Low-Risk Pregnancies. Obstetrical & Gynecological Survey, 71(4), 205–206. https://doi.org/10.1097/01.ogx.0000481815.84386.6d

Scarf, V. L., Rossiter, C., Vedam, S., Dahlen, H. G., Ellwood, D., Forster, D., Foureur, M. J., McLachlan, H., Oats, J., Sibbritt, D., Thornton, C., & Homer, C. S. E. (2018). Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis. Midwifery, 62, 240–255. https://doi.org/10.1016/j.midw.2018.03.024