Doula Blog
All about Pregnancy, Birth, & Postpartum
Many women find that bringing their babies into the world in a calm, home-like atmosphere has powerful benefits for both them and their babies. Birth can be one of the most transformative moments of your life. It is crucial to birth in a setting that you feel the safest to allow your body to relax, release tension, and surrender to the process. Depending on the city in which you live, there may be a birthing center staffed by Certified Nurse Midwives. You are encouraged to move freely, use the bathtub or shower for comfort and progress of labor, eat and drink as you wish to keep your energy up and stay hydrated. You are able to have whoever you’d like at your birth, labor in a comfortable, quiet environment with minimal interruptions. It is such an intimate experience to bring your baby into the world and feeling comfortable with privacy is important for reducing fear and increasing relaxation. The Shift from Home to Hospital In the early twentieth century in the United States, the majority of births shifted from home to hospital (nearly all births were at home with a midwife in 1900, 50% by 1938 and less than 1% by 1955). One of the motivations for doing so was to take away pain in childbirth by introducing general anesthesia and to decrease infant and maternal mortality rates by having a more sterile environment. However the decreased mortality rate for both mom and baby has largely been attributed to the medical advancements to helping high risk women birth safely and the availability of antibiotics when needed during pregnancy, labor or early in the infant's life. The use of general anesthesia is very rare now and women since the 1970s have been trying to regain control in their birthing process. Although most births in the US occur in the hospital, there is a shift happening again back to more home and birthing center births (increasing since 2004, and increasing massively in 40 states since 2020). The safety of homebirth has been studied and is not widely known. The factors that make home birth as safe as hospital births in numerous studies include home births with; a trained midwife attending, adequate prenatal care, healthy mom and baby, and having a hospital close by. Some studies showing that home births are less safe include free births with no medical provider, births that happen ‘outside the hospital’ by accident. ie. In the car on the way, high risk births etc. Home births and birthing center births are more common in other developed countries and are shown to be a safe option with less medical interventions for low risk women. Benefits of Planned Home or Birth Center birth:
For an inside look into birthing suites and to learn more about the birthing center experience check out some of my favorite pages!: Welcome to Birth Center of Chicago (Chicago) Birth Option (midwifecenter.org) (Pittsburgh) Hygge Birth and Baby | Denver Birth Center (Denver) Transferring to the Hospital Most planned home and birth center births transition to the hospital setting in a non-emergent way due to the mother requesting pain medication and labor dystocia (long labor). According to a systematic review of the literature in 2014, "Fifteen studies were eligible for inclusion, containing data from 215,257 women. The total proportion of transfer from home to hospital varied from 9.9% to 31.9% across the studies. The most common indication for transfer was labor dystocia, occurring in 5.1% to 9.8% of all women planning for home births. Transfer for indication for fetal distress varied from 1.0% to 3.6%, postpartum hemorrhage from 0% to 0.2% and respiratory problems in the infant from 0.3% to 1.4%. The proportion of emergency transfers varied from 0% to 5.4%." (1) What do health organizations say about this? The AAOG's (American Academy of Obstetrics and Gynecology) current stance is that a hospital or birth center is the safest option but that women should be educated on the risks and benefits of all birth options and should be able to make a medically informed personal decision on place of birth. This stance changed in 2014 from stating that birth should always be done in the hospital setting to recognizing home and birth center births as a valid choice for place of birth. (2) The ACNM (American College of Nurse Midwives) states that women should be educated on all birth place options and have the right to access safe home-birth options. Its position is based on numerous studies from other developed countries who have a highly integrated maternity care system to include planned home births (3). Home and Birth Center birth is shown to be just as safe as hospital birth for low risk mothers- but with less medical interventions, continuous fetal monitors that limit movement, interruptions, machines beeping, and paperwork! The worldwide statistics from the WHO regarding out of hospital births show it is safer to give birth in a hospital setting where access to a clean, safe environment for women with inadequate prenatal care, nutrition and education is beneficial. Home and birth center births are shown to be equally as safe with less interventions when there is a medical professional present, in a clean home or center with birth and emergency medicines and supplies available and when a timely transfer to the hospital is possible. This is not possible in areas that lack transportation and resources to provide this type of care. The WHO is working to increase access to maternal health care worldwide and currently the hospital in many countries is the safest option. However, in the US and many European countries where midwifery care is more integrated, home births have been shown to be a good option for low risk pregnant women. Birth doesn’t need to be seen as a high risk medical event, but a natural process that can be monitored and only intervened in when necessary. “Only rarely do doctors in training have the opportunity to sit continuously with laboring women for hours. Most are taught to intervene in the normal process so often and so early that they have never witnessed a normal labor and birth.” - Ina May Gaskin, midwife and author of Ina May’s Guide to Childbirth. Many people are not aware that they have a choice in where to birth their baby. I am an advocate for out of hospital births for low risk women because I have seen the benefit of birthing in a comfortable, dimly lit, peaceful environment where interruptions are minimal. That setting allows the mother to relax and trust her body's ability to birth. I hope this has been helpful to those searching for another way to approach women’s health care and birth- one that is personal, intimate and empowering! References & Resources: (1) Transfer to hospital in planned home births: a systematic review | BMC Pregnancy and Childbirth | Full Text (biomedcentral.com) (2) Planned Home Birth | ACOG (3) ACNM Statement on Practice Settings – 2005 (midwife.org) National Birth Center Study II - American Association of Birth Centers Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician - PMC (nih.gov) Home Births Gain Popularity in ‘Baby Bust’ Decade | Healthiest Communities Health News | US News What is Home Birth? - Evidence Based Birth®
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