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The Case for Home Births

Most babies born in the U.S. draw their first breath inside a hospital room. Only a tiny minority are born at home.

The few women who do choose home birth do so because they believe childbirth is a relatively safe, natural process best experienced without a lot of medical intervention, in the safety and privacy of one’s own home. Until the past few generations, home birth was the norm everywhere in the world. In much of the developed world, home birth remains vastly more common than it is in the U.S.

Given how few babies are born at home, one wonders if “the case for hospital births” really needs to be made. But The Atlantic makes it in an essay published last week arguing that home birth is unsafe every time, basically in response to a single data point: the writer’s experience with a last-minute emergency transport from home to hospital. The author, an obstetrician, writes movingly about caring for a mom going through her first labor in the care of a midwife, and the unpleasantness of their transport into a hospital setting. It’s a bad experience for everyone involved, though one that results in a healthy baby and healthy mom.

The OB is fairly shocked that the family still plans to attempt a home birth for their next child.

I’m not.

I’ve been that mom. The mom laboring at home for far too long, until her body is exhausted. The mom being rushed to the hospital in the care of a midwife with no professional standing once we walk in the door. The mom whose partner and labor support people mistrust everything the hospital wants to do. The mom who planned a home birth and finds herself very suddenly in the confines of a hospital bed.

It was, as The Atlantic writer reports, no fun for anyone. But it did, as in the case The Atlantic profiled, result in a healthy baby girl being delivered into my arms. I’ve always seen my first child’s birth story as a case for home birth, not the other way around. It was, in my eyes, a shining success story, evidence that the model of midwifery care at home with a hospital backup works.

Would I want to risk a home birth with no safety net? No. Would I have another home birth with the knowledge that medical intervention was a 911 call away? Absolutely. I think it’s preferable to the alternative of starting out in a hospital, where the whole environment is designed to create a cascade of medical interventions.

Sometimes medical care is necessary. I’m immensely grateful for the care I got at the hospital when I transported there. I believe they saved my daughter’s life. But I also believe that most births don’t require medical intervention. When it came time to have my second child, I chose a freestanding birth center. The midwives who cared for me were under the same constraints as a home birth midwife: they could provide support and care, but no medical intervention. After a five hour labor, I was holding a healthy baby girl. An hour later, I was up and showering to go home.

That’s how the system should work, in my opinion: let healthy moms and babies do their thing with a minimum of interventions, but have the big medical guns available should something go wrong. In that sense, the Atlantic story, and my story, make the case for home birth.

They demonstrate that even when a medical emergency arises, a woman in the care of a midwife can get the medical attention she needs, and good outcomes still ensue for mother and baby. If I had another child, I would absolutely do it under a midwife’s care, outside a hospital setting.

What do you think? Is the Atlantic story a case for hospital birth, or does it reinforce that home birth can be a smart choice even when something goes awry? Photo: iStock

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