The point of this long post is to encourage all mothers and coaches that
you can have a child without modern medical intrusions. No petosin no
epidural no doctor telling you that you need an epiesiotomy or internal
fetal monitor. If you have ever thought about doing it naturally YOU
CAN. You will be forever thankfull that you did!!!
Good Luck All,
> The point of this long post is to encourage all mothers and coaches that
> you can have a child without modern medical intrusions. No petosin no
> epidural no doctor telling you that you need an epiesiotomy or internal
> fetal monitor. If you have ever thought about doing it naturally YOU
> CAN. You will be forever thankfull that you did!!!
Dan - you're story moved me to tears. I would like to hear Laurie's version too. No
disprespect, I'm sure if you were this involved she probably had a wonderful
experience too, but your being a man does taint the ?validity? (couldn't think of
another word) of how "great" the experience was.
I wanted very much to go into spontaneous labor and experience it as much as
possible. Being 42 weeks and watching the babies weight increase each day encouraged
me to accept the induction. It's not what I would have preferred, but it's what I
agreed to. What matters is that our baby arrived healthy and with no complications
(intervention does not equal omplication in my book.) Next baby, I will also wait the
limit for spontaneous labor to occur, but if it doesn't happen, I will follow the
same procedure I did with our first.
Thank you for sharing your birth story. And I'm sure that a lot of women who choose
epidural know they CAN do it naturally, (of course, the baby will still be born one
way or another) the question is do they want to?
This is not intended to be a flame, just my point of view as a woamn who
Dear Dan and Lauri
Congratulations and thank you so much for a wonderful birthing story.
I think the name you chose was ace too (I'm an Anna Marie too) :-)
It's also nice to hear from a Dad and his experience of the birth.
I hope our birth in February had as much love as yours did.
Please pass on my congrats to Lauri, and give Anna Marie a big
kiss from me.
Annie & Nyall
(or Anna Marie)
(& Bubo due 12 Feb 97)
* ------ Anna James *
** / / o\__ Admin, Computer Centre **
* /___/ \O Brunel University *
** __/ _\__/ mail: Anna....@brunel.ac.uk **
* / Tel : +44 18 95 20 30 87 *
After 100 years or so of watching these guys apply the ether and yank
babies from comatose moms it is really time to wake up and realize that
we have gone nowhere at all. Oh sure, the drugs have gotten a little
sexier---you've got your "walking epidurals" and your demerol and a bunch
of really other cool "spinal speedball" cocktails and stuff, but I would
suggest that we have remained essentially in the same ethereal haze
that medicine started us out in over 100 years ago.
In the absence of overwhelming known medical preconditons or problems
with mom or baby I would suggest to you that medicine does not belong in
the practice of birthing babies at all. Just say no. Heck, no one wants
to insure and Obstetrician anyhow---so get out now! If you like kids
become a pediatician. If you're into reproductive medicine---get into
infertility medicine. Or just remain a Gynecologist---it's an honest
trade. If you must remain an Obstetrician then come out to my house and
deliver the kid in a safe environment and not one of those darn
disease-ridden hospitals. Sick people go there to get well. I don't
want my baby or my wife there unless one of them is sick.
I know that babies and moms sometimes get sick or that complications
sometimes arise which require mandatory intervention. Neo-natal ICU's
and Perinatology are practices that can and must continue to be tools
that medicine uses to deal with these unexpected emergencies. We just
need to use these tools when they are necessary and not for each birth
experience that comes down the road.
Kat mom to Corwyn (3-24-96) & Jennifer (8-10-93)
Matt Fellows wrote:
<sniped to get my message to post>
I agree, "natural childbirth" is the exception. Totally natural
childbirth, as women did it 100 years ago, led to lots of deaths for moms
and babies. Childbirth was *the* most common cause of death for women
under 30 until well into this century.
I personally used Lamaze for low-intervention births. This is not
"natural"; the breathing techniques take training and practice and are
sometimes counter-intuitive (but worked for me).
: We here in the USA
: seem to treat pregnancy as a disease that must be "cured" or at least
: somewhat mitigated by some heroic and generally completely unnecessary
: bizarre medical intervention of some sort.
I have to admit that I was shaved for my births in the 1970s. But does
anyone actually do that now? I think not--not in the USA.
Let's face it--most interventions are done at mom's request. Some women
do not want to deal with the pain of childbirth, and why should they have
to, if there are safe alternatives? (But then, I think we should have
been developing the technology for uterine replicators, devices that could
grow a fetus so that mom doesn't have to personally do the pregnancy.)
: Our medical personnel [...] set about to either
: speed up or slow down the labor process through the use of known
: hormones and/or dangerous narcotics.
Then your personnel are wrong, and you should find a new provider. I
never had hospital personnel give me drugs I did not request, not even
pitocin after birth (I was breastfeeding right after delivery, so it was a
: After 100 years or so of watching these guys apply the ether and yank
: babies from comatose moms it is really time to wake up and realize that
: we have gone nowhere at all.
Wow, you've been "watching these guys" for 100 years? I thought I had a
long perspective, having given birth over 18 years, but you do have me
: [...] but I would
: suggest that we have remained essentially in the same ethereal haze
: that medicine started us out in over 100 years ago.
And I would disagree, having seen dad welcomed at birth, the development
of LDRPs, birthing beds and chairs, and an assumption that mom is in
Now, I agree with you that there were medical excesses in the past. In
the 1970s, my doctors had a 33% c-section rate. But the doctors that
helped me deliver my last children had an 11% c-section rate, and they do
a fair amount of high risk cases.
If you like having home birth, fine. I could never feel comfortable with
that, partly because I watched a woman next to me have a postpartum
hemorrhage and partly because I had one baby get an arm wrapped around
her neck and partly because I want the maximum number of choices. I never
had an epidural for childbirth, but I took great comfort in knowing it was
there if I decided I wanted it. I have yet to hear one thing that a home
birth offers that birth in a good birthing center does not, and
considering the many advantages of the birthing center, that was my
I really don't see what you're trying to prove with this
diatribe...especially when it just ain't true.
Colleen Kay Porter
mom to Lorissa (3), Elaine (5), Becky (15), Julia (16) and
Elder Phillip Porter (20)
- - - - - - - - - - - -
"Keep 'em confused; leave 'em laughing."
--motto of Guppy Photo Adventure Tours
> I have yet to hear one thing that a home
>birth offers that birth in a good birthing center does not, and
>considering the many advantages of the birthing center, that was my
Very high on my list of advantages of home birth was not having to move from my
home, a familiar and comfortable place, to a strange environment, no matter how
Visit The Breastfeeding Advocacy Page at
I still can't fathom why people think that they are safer in hospitals
when giving birth than at a variety of other venues (including, but not
limited to home). I can't think of any place I would rather not have an
infant human being exposed to than a hospital.
I think somehow they all want to collect the $5000.00 or so they get for
"delivering" our kids and they feel guilty if they don't offer some sort
of "product" for that kind of dough. Just sitting there and catching the
little one doesn't seem worth $5K and it may very well not be. They
don't want their practices or fees scrutinized very carefully, so they
adopt intervention policies which necessitate further interventions and
help to justify some of these costs.
Most of us would be perfectly happy handing over the money if the doctor
would just sit there and do absolutely nothing, except in the face of
dire emergency, but I guess this might irk some folks in the insurance
industry. I really have yet to figure out why women allow all of this
power to be held over them instead of exerting it themselves. Let's hand
over the entire resposibility of human reporduction to some unknown third
party--because they really know what's best. I'm having a really hard
time with this.
: > I have yet to hear one thing that a home
: >birth offers that birth in a good birthing center does not, and
: >considering the many advantages of the birthing center, that was my
: Very high on my list of advantages of home birth was not having to move from my
: home, a familiar and comfortable place, to a strange environment, no matter how
Well, just goes to show you how people are different. I considered
being in familiar surroundings a *negative* thing about birthing at
I feel that by birthing at the hospital, I kept the unpleasant birth
memories AT THE HOSPITAL. So when I woke up, days and weeks later,
with nightmares that I was in labor, all I had to do was look around
and be comforted that all that was over, and I was home. To me, this
was the greatest comfort my home could offer.
Now if you know in advance that you are not going to have anything
unpleasant about your delivery, this is not a problem. But the human
brain does this thing called "association". We associate a certain
song with a certain sweetheart from our past, associate a smell with
grandmother's kitchen, and so on. I certainly don't want any bad
memories associated with my bed. I think of my bed as a place of
refuge and comfort, of pleasure and NOT of pain, and I'd like to
keep it that way. It's bad enough that my bathroom is associated with
all those hours of puking--that color of green will probably remind
me of barfing for the rest of my life.
Like many women, I suffered from mild post-traumatic stress after some
of my deliveries. I'd have nighmares about the delivery, or just
flashbacks during the day. I think this was exacerbated by the post-
delivery uterine contractions that can be so painful in nursing
multigravidas. Two of my deliveries were standard 6-to-11-hour
labors, and they were not a problem afterward. But with Becky, her
arm got caught around her neck. I had already delivered the head
without an episiotomy, thought I was home free, and ended up with a
huge cut and lots of difficult pusing in between. And while I
remained calm at the birth, later I had a terrible time worrying
about what could have happened. With Elaine, I had back labor so that
it was as bad at 3 cm as the others had been at 7, and the long,
grueling labor was draining. And with Lorissa, she went from 5 cm to
delivery so fast that there was no time for the natural "pressure
anesthesia" and it burned terribly. Very little tearing, and over
quickly, but intensely painful while it lasted.
So I'm glad that I did those things at a strange place. For me,
leaving the birthing place was a way of symbolically and
psychologically leaving those bad experiences behind, which
was very healing and helpful to my recovery.
>cpo...@afn.org (Colleen Porter) wrote:
>> I have yet to hear one thing that a home
>>birth offers that birth in a good birthing center does not, and
>>considering the many advantages of the birthing center, that was my
acti...@clark.net (J. Rachael Hamlet) wrote:
>Very high on my list of advantages of home birth was not having to move
>from myhome, a familiar and comfortable place, to a strange
>environment, no matter how well-decorated.
WARNING: This post is full of generalizations. While I am aware that
there is always an exception to the rule, this is the way *I* see it,
due to *my* past experiences. I discuss herein things that are
important to *me*. You might have different priorities; that is
Besides that intervention rates are lower at home than even in a birth-
ing center. My midwive NEVER gives episiotomies, and I really mean
never. She points to research that shows natural tearing is better
than a little cut that is likely to cause more major tearing then if
it had happend on its own. And well, the only c-section she had in
recent history was b/c the baby was 3/4 transverse and the version
and exercises didn't work, so after several hours of trying, the
parents and midwife decided a transport was in order. Her practice
is almost as busy as some ob's, so that's a pretty darn low c-sec.
rate (less than 1%).
Homebirths also have lower injury and morbitity and mortality rates
that other births, even when controlling for risk-factors. Anecdotally
the people I know who chose birthing centers so that insurance would
cover it were more dissatisfied than those of us who paid out of
pocket for DEM attended homebirths, and they had a much higher
intervention rate -- usually in the form of an episiotomy.
I use lay-midwives (DEMs) who are better (IMO) at easing a woman through
the natural progression of labor, even better than many CNM's who,
being nurses, must inherently adhere to some medical protocol. DEM's
tend to be more respectful of the beauty and sexuality and spirituality
of birthing. My midwife does a blessing-way in which she rubs sacred
blue cornmeal on my feet as a sign of supplication to the mother-to-be.
She's there to serve me and support me and give me gentle guidance, not
manage my labor. Yes, I am aware that som doctors do this (so I hear)
and that CNM's are generally better than doctors, but they can't compare
to the lay-midwives that attend my births. I assure you they just
can't, at least not for me.
I use a lot of herbs, so having a lay-midwife who is very knowledgable
about herbs and homeopathy is another possible advantage to a home-
birth. Herbs have been used for thousands of years by people, and
have been shown, empirically, to be safe when used with proper
education and respect. I am a firm believer that the Goddess has
placed everything here that I need to survive, and I don't need to
rely on man-made chemicals to live.
There are "foreign" germs in a birthing center from the other mothers
babies and their visitors, although admittedly ther are much fewer than
in a regular hospital. They also use all sorts of chemicals, none of
which even shadow the door of my house, and those chemicals "out-gas"
for quite some time. I don't want my baby exposed to them.
And in the end the baby still has to be poked and prodded (unecessarily
in most cases) and eventually given eye drops/ointment. I want
my baby's body left whole. I don't want the continuum disrupted by
having the baby whisked away "just for a few minutes" -- even that's
too long for me.
It is mentioned in many childbirth preparation books that changing
locations during birth can slow some women's labor down at least
for a little while. So no matter how cozy the birthing center is,
it's quite possible some women would tense up a little bit by being
in a new environment.
The control you have over your birth in your own home is incomparable
to any other environment, period.
Colette (mom to Amy, a beautiful homebirthed 19 m/o)
(and ?????? due to make an appearance sometime in late December!)
"Man did not weave the web of life. He is merely a strand in it.
Whatever he does to the web he does to himself."
- Ted Perry (inspired by the words of Chief Sealth [Seattle])
>I agree, "natural childbirth" is the exception. Totally natural
>childbirth, as women did it 100 years ago, led to lots of deaths for moms
>and babies. Childbirth was *the* most common cause of death for women
>under 30 until well into this century.
In fact, until car accidents overtook it. I don't have the figures in
front of me, but I believe that the notion that vastly more women died
per childbirth is not correct. More, certainly, but the general
improvement in women's health and education has been a big help with
this. And of course, women had more children, and there was a greater
risk associated with older women who had had a lot of previous
pregnancies and were in poor health anyway. Anyway, I don't think
anyone is suggesting that intervention is a bad idea in the rare cases
where the *mother's* life is at risk.
Alison Scott ali...@fuggles.demon.co.uk
This .sig supports Attitude for Best Fanzine Hugo.
Well, you haven't met every doctor, have you? I'd grant many may be as
you describe, but not all.
: I still can't fathom why people think that they are safer in hospitals
: when giving birth than at a variety of other venues (including, but not
: limited to home). I can't think of any place I would rather not have an
: infant human being exposed to than a hospital.
Well, I'm not sure how much "variety" we've got. I commonly hear of
people giving birth in two types of places other than hospitals--home and
birth centers. I personally would have preferred a birth center, but the
nearest one is over an hour away and I wasn't comfortable with going that
far. Does it really matter *why* people feel safer in hospitals, or
whether you understand it? If that's where the woman feels safest,
that's where she should be. If not, she should go elsewhere.
: I think somehow they all want to collect the $5000.00 or so they get for
: "delivering" our kids and they feel guilty if they don't offer some sort
: of "product" for that kind of dough. Just sitting there and catching the
: little one doesn't seem worth $5K and it may very well not be. They
: don't want their practices or fees scrutinized very carefully, so they
: adopt intervention policies which necessitate further interventions and
: help to justify some of these costs.
: Most of us would be perfectly happy handing over the money if the doctor
: would just sit there and do absolutely nothing, except in the face of
: dire emergency, but I guess this might irk some folks in the insurance
I doubt the insurance industry would mind. Just about any intervention
costs *something*, and I'm sure insurance companies wouldn't object if
more doctors stopped using them. It's cheaper for them to pay the $5000
alone than that amount plus cost for an IV, pain meds, anistheiologist,
catheterization, surgical fees, suturing supplies.... Maybe you know
something about the insurance industry I don't, but it seems to me they'd
want to shell out as little money as possible. That's how you keep
profits up, right?
I really have yet to figure out why women allow all of this
: power to be held over them instead of exerting it themselves. Let's hand
: over the entire resposibility of human reporduction to some unknown third
: party--because they really know what's best. I'm having a really hard
: time with this.
I'm having a hard time with you trying to suggest that all women should
do it *your* way. I went to an OB. He did not hold "all of this power"
over me. He did not bear the "entire responsibility" for my reproductive
ability. He was also not an "unknown third party". Over the course of
my pregancy, I got to know him. And yes, I did value him for his
knowledge, but I don't think he necessarily knew best all the time.
I don't think he even thought so, but you probably won't believe me. Are
you suggesting women give birth without *any* outside assistance?
Midwives, doulas, nurses, all are third parties, and can be just as
"unknown" as a doctor. Very few women I know would really want to go
through pregnancy and birth with no professional assistance. And most
women are not so weak that the mere presence of such a person means they
can no longer exert any power.
>Sharing your experience helps others to come around to the notion that
>"Natural Childbirth" is the norm, not the exception. We here in the USA
>seem to treat pregnancy as a disease that must be "cured" or at least
>somewhat mitigated by some heroic and generally completely unnecessary
>bizarre medical intervention of some sort. Our medical personnel are
>trained to save lives, so during even the most routine of labors they
>want to make sure that no one gets killed. So they set about to either
>speed up or slow down the labor process through the use of known
>hormones and/or dangerous narcotics. By doing this thay have convinced
>themselves that they are a fundamental and required part of the birth
>After 100 years or so of watching these guys apply the ether and yank
>babies from comatose moms it is really time to wake up and realize that
>we have gone nowhere at all. Oh sure, the drugs have gotten a little
>sexier---you've got your "walking epidurals" and your demerol and a bunch
>of really other cool "spinal speedball" cocktails and stuff, but I would
>suggest that we have remained essentially in the same ethereal haze
>that medicine started us out in over 100 years ago.
>In the absence of overwhelming known medical preconditons or problems
>with mom or baby I would suggest to you that medicine does not belong in
>the practice of birthing babies at all. Just say no. Heck, no one wants
>to insure and Obstetrician anyhow---so get out now! If you like kids
>become a pediatician. If you're into reproductive medicine---get into
>infertility medicine. Or just remain a Gynecologist---it's an honest
>trade. If you must remain an Obstetrician then come out to my house and
>deliver the kid in a safe environment and not one of those darn
>disease-ridden hospitals. Sick people go there to get well. I don't
>want my baby or my wife there unless one of them is sick.
>I know that babies and moms sometimes get sick or that complications
>sometimes arise which require mandatory intervention. Neo-natal ICU's
>and Perinatology are practices that can and must continue to be tools
>that medicine uses to deal with these unexpected emergencies. We just
>need to use these tools when they are necessary and not for each birth
>experience that comes down the road.
I have to agree with you on most of your points regarding medical
However, you have to take into consideration that some women WANT to
have those analgesics-- even well before the onset of labour.
The accessibility of these medical provisions are our fundamental
RIGHT to have if we so choose.
Epidurals and analgesics DO have their place in the birthing process,
but like any science, it needs to be applied in moderation and to be
applied with more selectiveness.
In reading how the birthing process took place in the past, I feel
that we ARE progressing more towards the goal of natural childbirth.
It seems that expectant mothers were not educated as thouroughly as
they are today.
This increased knowledge now gives up more control over what WE want .
Of course, this is not 100 percent the norm yet, but we're getting
Unfortunately, I didn't discover how much control I could have until I
had my third child.
It was a natural childbirth (as natural as could be in a hospital,
anyway) and I wouldn't change a thing.
But if a problem had arisen, or it just got to be too much, I would be
extremely thankful to have the medicine available there, right on the
other side of the room just in case!!
I didn't even know that I could have control over the birth of my
third child until I had already gone through it twice before.
Let me introduce you to my OB. He monitored me. He told me how I was
doing. He mostly sat and waited for things to progress normally. (And
helped other mothers in other birthing rooms between visits to my room)
(After 90 minutes or so of pushing, he commented that, while he COULD use
forceps at that point, he knew I'd rather do it myself.)
Do not generalize about doctors. There are good ones and bad ones.
> I think somehow they all want to collect the $5000.00 or so they get for
> "delivering" our kids and they feel guilty if they don't offer some sort
> of "product" for that kind of dough. Just sitting there and catching the
> little one doesn't seem worth $5K and it may very well not be. They
I didn't pay anywhere near 5 grand. About 2 thousand, and that included
all the prenatal visits and post birth check-up. (That was 4 years ago,
but I don't think inflation has more than doubled the cost.)
I do know that different communities have different prices.
Not here in Austin, at least with my OB. I can't imagine that it would be
much different with other local doctors. For a standard vaginal delivery, it's
less than $2,000. (It's $1,600 to be exact.) For a c-section, it's just a few
hundred dollars more.
Earlier today I was watching a public information film made
shortly after WW2 - between 1946 and 1955 at a guess. It said
2000 women still die in childbirth. Thirty years ago, my mother
was told "they no longer lose the mothers". At the start of this
pregnancy I was told (in the UK) that 1 in 100 000 pregnancies
result in the death of the mother.
Dave & Colette <lnrp...@ripco.com>
> >cpo...@afn.org (Colleen Porter) wrote:
> >> I have yet to hear one thing that a home
> >>birth offers that birth in a good birthing center does not, and
> >>considering the many advantages of the birthing center, that was my
> WARNING: This post is full of generalizations. While I am aware that
> there is always an exception to the rule, this is the way *I* see it,
> due to *my* past experiences. I discuss herein things that are
> important to *me*. You might have different priorities; that is
> your perogative
Yup, that's what it comes down to, from my POV.
> [...] My midwive NEVER gives episiotomies, and I really mean
Never, huh? And what do they do when a baby is stuck in the birth
canal, with an arm wrapped around the neck and the vital signs
starting to deteriorate? This seemed like a pretty warranted
intervention to me. (And the fact that I had already delivered the
head without one was ample proof that the doctor was not scissors-
> And well, the only c-section she had in
> recent history was b/c the baby was 3/4 transverse and the version
> and exercises didn't work, so after several hours of trying, the
> parents and midwife decided a transport was in order. Her practice
> is almost as busy as some ob's, so that's a pretty darn low c-sec.
> rate (less than 1%).
Which means there is a lot of pre-selection going on in who uses
that health care practitioner, since a lot of parents make their own
decision to deliver by c-section for a variety of reasons. (I
thought my friend was being overly cautious when her doctor gave her
the option to deliver a breech baby vaginally, but she chose the c-
section instead. But it's her call, totally.)
> My midwife does a blessing-way in which she rubs sacred
> blue cornmeal on my feet as a sign of supplication to the mother-to-be.
I would refuse the offer when she asked to do this (she does ask
first, right?) because it is *my* birth, and I don't want her
injecting her religious beliefs into my birth experience.
> She's there to serve me and support me and give me gentle guidance, not
> manage my labor.
And how is this different from a CNM or doctor? Oh, yes, I know
there are some doctors who think they deliver babies--but they are
fortunately becoming less common. I said, "a good birthing center."
Of course a good homebirth is preferable to a birth at a bad
You can paint a picture of evil, poking, controlling doctors and
brinwashed CNMs, but it doesn't make it true. You seem to be trying
to draw a stark dichotomy between homebirth and birth anywhere else,
but in reality there is not really that much difference.
> I use a lot of herbs, so having a lay-midwife who is very knowledgable
> about herbs and homeopathy is another possible advantage to a home-
> birth. Herbs have been used for thousands of years by people, and
> have been shown, empirically, to be safe when used with proper
> education and respect. I am a firm believer that the Goddess has
> placed everything here that I need to survive, and I don't need to
> rely on man-made chemicals to live.
That's amazing--I didn't realize there were herbs to help with
appendicitis. Sure would have like to skip that surgery.
> There are "foreign" germs in a birthing center from the other mothers
> babies and their visitors,
If you intend to stay home after birth, this may be a legitimate
concern. I had my last two babies in May, which meant that they got
taken around to end-of-year concerts, graduations, awards
assemblies, etc. As well as dentist appointments, church etc. So
this is not a big deal to me.
> And in the end the baby still has to be poked and prodded (unecessarily
> in most cases)
Poked and prodded? My pediatrician cuddles the babies.
> and eventually given eye drops/ointment.
Unless you sign a waiver that you don't want it done.
> It is mentioned in many childbirth preparation books that changing
> locations during birth can slow some women's labor down at least
> for a little while. So no matter how cozy the birthing center is,
> it's quite possible some women would tense up a little bit by being
> in a new environment.
The studies I've read on that subject all talk about moving a woman
from a labor room to a delivery room in advanced labor. Since all
the hospitals and birth centers around here have LDRPs, where you
stay in one room the entire hospital stay, this is not an issue. I
like walking around during labor. For most labors, our pattern was
to stop by the hospital or doctor's office to check progress, go
shopping or erranding for a few hours, and then go to the hospital
to deliver. If I birthed at home, I'd probably follow the same
pattern, so this was not a concern for me.
> The control you have over your birth in your own home is incomparable
> to any other environment, period.
First, I figure that the really important things, like the position
of the baby and how tired I am when labor hits, are totally out of
my control, anyway.
Second, the kind of control one gets at home is being a big fish in
a little pond--my choices would be much fewer than at the birthing
center. At home, I would not have the option of a jacuzzi during
back labor, or an epidural if I decide I am just to tired to labor
without. If trouble arose during delivery, my pediatrician would
have been there in two minutes; that would not have happened at
home. And the equipment they have--pushing bars designed to be used
in a squatting position, and the birthing chairs that are open
between the legs--seem like they'd be really helpful for a difficult
seond stage. Those are some of the choices I had by birthing at a center.
At a hospital-based birth center, I was supported in giving
unmedicated birth, nursing the babies right after birth, kept the
baby at my side, and slept with my husband in a double bed. If I
hadn't been able to do those things, I would consider a home birth.
Thirty years ago, women had to make that choice as a home birth
was the only way to keep eating in labor, have dad there, etc. Now
there is not such a big differene.
Obviously, if other things are important to you, then you'll make a
different decision. But just be real about what the choices are.
---lots of controversial stuff cut---
I have a logistics question about at-home birth. Isn't is really messy? How
do you keep body fluids from soiling the sheets, carpet, floor, etc? Do you
give birth on a big shower-curtain?
I'm sorry to sound so stupid, I am 18 weeks along and have been wondering this
for the full 18 weeks!
Well, all I have to say is that women did not die from childbirth as it has been so generalized here. It was more from infections, etc. that increased when
birth moved to the hospital.
There are good care providers and bad in every variety.
MY PERSONAL PHILOSOPHY:
Women need to give birth WHEREVERE they feel the most comfortable, and
the safest, wherever that may be.
Women need to be attend by the ones that they feel comfortable with.
Good birthing to all,
Robin and STaple (expect March 97)
Robin Elise Weiss, ICCE, CD(DONA), NACA
Pregnancy, Reproduction, and Health Education Homepage
> I have a logistics question about at-home birth. Isn't is really messy? How
> do you keep body fluids from soiling the sheets, carpet, floor, etc? Do you
> give birth on a big shower-curtain?
Hi, I haven't done it yet, but plans are full steam ahead. My midwife says
she will bring incontinence pads etc. (big ones that go on the bed), a bedpan
and various other bits and pieces. I have been recommended to get a plastic
sheet from a DIY store or builder's suppliers - as big as possible and to
wash my oldest sheets and towels for use at the birth. The bedding will be kept
in another room until everything has been tidied up, to keep it clean. I have
been told to turn the heating up, so the house should be very warm anyway.
I have been told to make sure the washing machine is on standby, so we can just
chuck dirty sheets, towels and cloths in it as soon as the birth is over with
(that's my hubby's job). I will make sure it has soap powder ready in it and
it on the hot wash setting.
The bathroom will also need a major clean to make sure it is spotless for use
during the labour and for cleaning up afterwards, and I will have several
buckets for putting soiled things in. The midwife will bring plastic "soiled
dressings" bags anyway, for disposable nasties.
I need to have a hot water bottle in a crib for the new baby and new baby
I have given birth before, and it is major messy. However, nothing got on the
floor in hospital, so I cannot imagine it will do so in the house. The
disposable pads collect most of the uky stuff and they can be rolled up and
binned immediately in a soiled dressings bag. OK, it is more work than a
hospital birth, but I still think I'll prefer it.
Anna (mummy to Emma, born 17th Jan 1995 and No.2 due September 16th 1996)
You were hungry and I was sorry.
You were thirsty, and I blamed the world.
You were a stranger, and I pointed you out.
You were naked, and I turned you in.
You were sick, and I said a prayer.
You were in prison, and I wrote a poem. STEVE TURNER
>cpo...@afn.org (Colleen Porter) wrote:
>> I have yet to hear one thing that a home
>>birth offers that birth in a good birthing center does not, and
>>considering the many advantages of the birthing center, that was my
>---lots of controversial stuff cut---
>I have a logistics question about at-home birth. Isn't is really messy? How
>do you keep body fluids from soiling the sheets, carpet, floor, etc? Do you
>give birth on a big shower-curtain?
>I'm sorry to sound so stupid, I am 18 weeks along and have been wondering this
>for the full 18 weeks!
Here is my experience: we put a plastic sheet down on the bed and put our
oldest sheets on top of that. I actually birthed standing at the foot of the
bed and I don't remember what I was standing on, but the carpet only got a few
spots on it, so I must have been standing on something. Afterwards, we put all
the soiled sheets in a bucket full of hydrogen peroxide. The next day, the
doula did all the laundry for us. I also used "chucks" (incontinance pads)
that covered part of the bed. Nothing was permanently stained.
>I have a logistics question about at-home birth. Isn't is really >messy? How do you keep body fluids from soiling the sheets, carpet,
>floor, etc? Do you give birth on a big shower-curtain?
Actually it is sometimes suggested that you cover your mattress with
a shower curtain or some sort of plastic and then cover that with
old sheets. (A lot of women give birth near their bed or on the edge
of a bed and then move quickly into bed with the baby.)
Also, part of the birthing supplies that I had to have ready for the
birth were "chux pads." Those are those big disposable pads (like
3 ft x 3 ft) with a blue backing that are often used in hospitals.
And we had to have 3 or 4 large garbage bags, gloves, sterile packs
containing I don't remember what (for emergency use only)
I had to have 3 or 4 dozen available, and we only used about one
dozen, so I had lots left over. They came in handy for under me
for a while and to let Amy air out without a diaper.
It is also suggested that you have a lot of peroxide on hand for any
possible blood stains that get on sheets, carpeting, etc., but we
had just one little spot. The midwives really do a lot of cleaning
up before they leave, so it wasn't a problem at all.
Also, a lot of women who do homebirths try for water births. A water
birth has even less mess, except you have to empty a big tub, but
the mess in contained inside the tub.
And ... barring unforeseen problems such as hemorrhaging it really isn't
all THAT messy in many cases. I'm sure YMMV on this one, though.
> I have been told to make sure the washing machine is on standby, so we
> chuck dirty sheets, towels and cloths in it as soon as the birth is over with
> (that's my hubby's job). I will make sure it has soap powder ready in it and
> it on the hot wash setting.
Hi Anna! This is fairly trivial, but wouldn't it be better to have the
washing machine on a cold- or at most warm-water setting? My understanding
is that stains from blood and other bodily fluids are "set" by hot water &
come out better with cold water & lots of nonchlorine bleach, i.e. Clorox
II or other hydrogen-peroxide-based "bleach."
SF Bay Area, USDA Zone 9
Yes, but in Britain we have a wonderful product called "Biotex" which is a
biological prewash. You can use it on baby stuff because all the enzymes are
washed out later. I also use a germicide product with my normal powder called
"Napisan" which is non-bleaching. I understand that neither of these products
is available outside Britain which is a shame.
>Also, part of the birthing supplies that I had to have ready for the
>birth were "chux pads." Those are those big disposable pads (like
>3 ft x 3 ft) with a blue backing that are often used in hospitals.
I used those, too. They were great! If your midwife doesn't offer
them, you should be able to order them through any pharmacy.
>dozen, so I had lots left over. They came in handy for under me
>for a while and to let Amy air out without a diaper.
Yup. I'm usually very big on using cloth (old diapers, in fact)
for napkins and clean-ups, rarely buy paper towels, cloth diapers,
etc., but for right after birth, when the last thing I wanted to
be thinking about was extra laundry, I sure appreciated those dis-
We also warmed a few towels in the oven to wrap the baby in right
after birth. They must have got messy -- I don't remember :) --
but the only mark that lasted was one that touched the edge of the
oven and got singed.
>Also, a lot of women who do homebirths try for water births. A water
>birth has even less mess, except you have to empty a big tub, but
>the mess in contained inside the tub.
I don't know whether I'd call it "less mess." It's more contained,
but... you're also *sitting* in it! Not that some assorted goop
in the water is likely to be anybody's biggest concern at the time,
but it is something to think about.
>> I can barely remeber anything else other that her little blue eyes
at us from Laurie's chest as I was crying tears of joy and thanking God
for his miracle. We named her Anna Marie<<
Gosh, what a thread! I would just like to congratulate you on the birth
of your daughter!
Katt........... due December 9, 1996
Ironically, my wife, who has a very fair complexion and red hair--lost a
mere 60cc of blood during the birth process. The chux underneath her
caught every bit. In fact, her and I and the baby slept on the birth
sheets for the two days subsequent to the birth.
Have a few (2 to 3) lined waste baskets around. You will find stuff to
stuff in them.
But *THE* most important thing you need at a home birth is a comfortable
and relaxed location for your labor. If you're feeling edgy, your labor
will be a miserable experience regardless of the venue! Have a
supportive crew around. Preferrably your mate will be among those in
attendance. Those who you choose to have in attendance should be folks
who are prepared to see you at your absolute best AND your absolute
worst. You should feel free to be able to dismiss ANY member of your
birth team from attending your birth at ANY time and for ANY
reason--especially during labor. Folks who might become offended about
being "kicked out" of the birth shouldn't even bother showing up. This
is YOUR experience--it is not for the benefit of anyone except you and
your baby! If everyone agrees to the rules beforehand your birth will
be a relaxed experience and will proceed quickly. If you are tense or
anxious about something---anything---try to resolve these issues before
you are having *HUGE* contractions one minute apart. Tensions and
anxieties can make labor last forever--perhaps even cease altogether.
father to Nathan William...incidentally...born at home...I'm tellin'
it's the wave of the future...:)
>I still can't fathom why people think that they are safer in hospitals
>when giving birth than at a variety of other venues (including, but not
>limited to home). I can't think of any place I would rather not have an
>infant human being exposed to than a hospital.
Had I not given birth in a hospital, I do not know if my baby and I would have
survived. I am greatful to the hospital staff and the OB who used medical
technology to assure the safe birth of my child and to keep me alive to care
for my child.
I do hope I don't detect a slight flame there. I uphold the right of any woman
to give birth where she personally feels safest - whether that be in a hospital
or at home. The research doesn't actually prove that either place is "safest"
although it might surprise you to learn that there is a slight statistical
advantage in birthing at home. The fact is that there are few medical
emergencies that could not adequately handled at home - usually this involves
first-aid and transfer to a hospital, but often it can be handled entirely
at home. With properly trained birthing attendants and a good backup service,
there should be no more danger than at a hospital.
Ofcourse, there are conditions where a homebirth would not be safe and probably
wouldn't even be countenanced by a sane person - for instance, if you were
pre-eclamptic, or needed to be induced, or the baby was severely distressed.
If you actually look at the fatalities (which are too few to be a good
statistical sample, in many cases) you will see that a large majority were
unpreventable, regardless of the location (undiagnosed heart or kidney problems
in the newborn, for instance). Another huge proportion were women who didn't
have adequate antenatal care (including teenage concealed pregnancies) and
a frighteningly large proportion were as a result of inadequate staff training,
staff shortages *in hospital* or sheer incompetance. The "preventable" deaths
usually occurred in hospital, regardless of where the birth was originally
This fact was underlined for me last week, when I heard of a local woman who
lost her baby. She was being transfered from one hospital to another "specialist
unit", after the baby got into difficulties. No doubt, if she'd been at home
and this had happened, she would have been blamed for having a homebirth. The
fact is, the specialist unit is nearer to her home than the hospital she
attended and who knows, maybe the baby could have made it.
>I do hope I don't detect a slight flame there. I uphold the right of any woman
>to give birth where she personally feels safest - whether that be in a hospital
>or at home. The research doesn't actually prove that either place is "safest"
>although it might surprise you to learn that there is a slight statistical
>advantage in birthing at home. The fact is that there are few medical
>emergencies that could not adequately handled at home - usually this involves
>first-aid and transfer to a hospital, but often it can be handled entirely
>at home. With properly trained birthing attendants and a good backup service,
>there should be no more danger than at a hospital.
Could someone please post the relevant studies for this again? I was talking
it ovewr with a medical student and wanted to have all my ducks in a row for
our next, er, row. :-)
Yes! And I don't think that hospital births are necessarily miserable
experiences. You have to do a lot of soul-searching and ask why you
really want to give birth in a hospital. Some mothers have written that
it's because drugs are available if they *want* them. I think with that
attitude going in, you're almost assured that you will accept any offers
of drugs during labor.
Some mothers, however, have resolved to have a completely natural
childbirth within a hospital--up to the point of requesting that drugs
not be offered/proferred to them during labor. They simply feel safer
in a hospital environment.
I hope that we all hope that more folks choose natural childbirth. Who
really cares about the venue? The bottom-line is that we shouldn't
needlessly drug mom & baby and prolong labors or necessitate some rather
My wife feels more comfortable at home. You may not feel that way.
What you should recognize is that home birth is an option. If I were to
say to you "we should all give birth in hospitals..." it would be very
much akin to saying "the sky should be blue..." because the fact of the
matter is that for whatever reason most of us either choose to give
birth in that environment or we allow that choice to be made for us.
What I want is for *you* to make your *own* informed decision. What you
decide will be right for *you*. You shouldn't have a home birth because
I say so. Neither should you have a hospital birth because "the
experts" all agree that this is the way to go. Ultimately you are
responsible for your birth experience, sometimes even moreso if you
choose to turn that responsibility over to a 3rd party.
It is my sincere hope that home birth will be considered "normal" once
again in my lifetime. ...And that no one will be chastised or belittled
for *whatever* birth choice(s) they make.
Dad to the now-a-bit-cranky Nathan, born June 7, 1996--in the safety and
relative comfort of his own home.
Home Birth Safety studies (I lost the web page, sorry)
I also lost my abstract for The Mehl Study, but you should look
that one up; it's excellent.
Also, besides just citing study names, emphasise that there is such
a large number of studies that all corroborate each other -- not just
one isolated study or two. In addition the methodology of these
studies is very good. There is one UK study called Cespi, I believe,
that a lot of detractors use, but it's stats are extremely skewed
(lots of stillbirths) b/c it includes a huge proportion of emergency
UNPLANNED homebirths without proper attendants and a few instances
where the midwife/doctor strongly urged transport during the birth
and the mothers refused outright.
In these studies there is a qualified attendent (DEM, CNM or MD)
present, and in the comparative studies the women in both the home and
hospital groups are usually matched for risk factors, etc., when
applicable. Finally, Mardsen Wagner, Director of Maternal-Child Health
for the World Health Organization, recently wrote a book that is quite
interesting, though not specifically about homebirth, called _Pursuing
the Birth Machine_ that discusses the overuse of medical procedures and
the iatrogenic problems that it often causes in birthing.
Hafner-Eaton C. Pearce LK.
Oregon State University
Birth choices, the law, and medicine: balancing individual freedoms and
protection of the public's health.
Journal of Health Politics, Policy & Law. 19(4):813-35, 1994 Winter.
To many Americans, the idea of home birth, the use of a "direct-entry
midwife," or both seem archaic. Although much of the professional
medical community disapproves of either, state laws regarding birth
choices vary dramatically and are not necessarily based on empirical
findings of childbirth outcomes. Public health practitioners,
policymakers, and consumers view childbirth from the perspectives of
safety, cost, freedom of choice, quality of the care experience, and
legality, yet the professional, policy, and lay literatures have not
offered an unemotional, balanced presentation of evidence. Reviewing
the full spectrum of literature from the United States and abroad, we
present a Constitutional medical-legal analysis of whether home birth
with direct-entry midwives is in fact a safe alternative to
physician-attended hospital births, and whether there is a legal basis
for allowing alternative health policy choices is such an important yet
personal family matter as childbirth. The literature shows that low- to
moderate-risk home births attended by direct-entry midwives are at
least as safe as hospital births attended by either physicians or
midwives. The policy ramifications include important changes in state
regulation of medical and alternative health personnel, the allowance
of the home as a medically acceptable and legal birth setting, and
reimbursement of this lower-cost option through private and public
health insurers. [References: 64]
Janssen PA. Holt VL. Myers SJ
Licensed midwife-attended, out-of-hospital births in Washington state:
are they safe?
Birth. 21(3):141-8, 1994 Sep.
The safety of out-of-hospital births attended by midwives who are
licensed according to international standards has not been established
in the United States. To address this issue, outcomes of births attended
out of hospital by licensed midwives in Washington state were compared
with those attended by physicians and certified nurse-midwives in
hospital and certified nurse-midwives out of hospital between 1981 and
1990. Outcomes measured included low birthweight, low five-minute Apgar
scores, and neonatal and postneonatal mortality. Associations between
attendant and outcomes were measured using odds ratios to estimate
relative risks. Multivariate analysis using logistic regression
controlled for confounding variables. Overall, births attended by
licensed midwives out of hospital had a significantly lower risk for
low birthweight than those attended in hospital by certified
nurse-midwives, but no significant differences were found between
licensed midwives and any of the comparison groups on any other
outcomes measured. When the analysis was limited to low-risk women,
certified nurse-midwives were no more likely to deliver low-birthweight
infants than were licensed midwives, but births attended by physicians
had a higher risk of low birthweight. The results of this study
indicate that in Washington state the practice of licensed
nonnurse-midwives, whose training meets standards set by international
professional organizations, may be as safe as that of physicians in
hospital and certified nurse-midwives in and out of hospital.
Afdeling for Social Medicin, Kobenhavns Universitet
[Home delivery and scientific reasoning]. [Norwegian]
Source Tidsskrift for Den Norske Laegeforening. 114(30):3655-7,
1994 Dec 10.
Doctors commonly assume that it is safer for all women to give birth in
hospital rather than at home. Nevertheless, all statistical comparisons
relevant to Nordic women today show that for healthy pregnant women it
is at least as safe to give birth at home--and perhaps even safer.
Furthermore, many randomised clinical trials consistently show that
several of the elements which characterize home births make the births
proceed much easier. The question is raised, in what ways it is possible
to convince obstetricians that they should base their judgements and
advice regarding place of birth on empirical evidence rather than on
"well established" but pre-scientific dog-mas.
Woodcock HC. Read AW. Bower C. Stanley FJ. Moore DJ
A matched cohort study of planned home and hospital births in Western
Midwifery. 10(3):125-35, 1994 Sep.
OBJECTIVE: to evaluate practice comparing planned home birth with
planned hospital birth
DESIGN: a retrospective analysis of a cohort who had planned
to have a home birth compared with a matched hospital birth group
SETTING: Western Australia (WA) PARTICIPANTS: all women (N = 976) who
'booked' to have a home birth 1981-1987 and 2928 matched women who had
a plannedhospital birth (singleton births only).
MEASUREMENTS AND FINDINGS: women in the home birth group had a longer
labour, were less likely to have had labour induced or to have had any
sort of operative delivery. They were less likely overall to have had
complications of labour, but more likely to have had a postpartum
haemorrhage and more likely to have had a retained placenta. Babies in
the home birth group were heavier and more likely to be post-term. They
were less likely to have had an Apgar score below 8 at 5 minutes, to
have taken more than 1 minute to establish respiration or to have
received resuscitation. The crude odds ratio for planned home births for
perinatal mortality was 1.25 (95% CI 0.44-3.55). Postneonatal mortality
was more common in the hospital group. Planned home births were
generally associated with less intervention than hospital births and
with less maternal and neonatal morbidity, with the exception of third
stage complications. Although not significant, the increase in perinatal
mortality has been observed in other Australian studies of home births
and requires continuing evaluation.
KEY CONCLUSIONS: Planned home births in WA appear to be associated with
less overall maternal and neonatal morbidity and less intervention than
IMPLICATIONS FOR PRACTICE: whether these
observed differences in intervention and morbidity have any relationship
to the small, non-significant increase in perinatal mortality could not
be determined in this study. Continuing evaluation of home birth
practice and outcome is essential.
Bortin S. Alzugaray M. Dowd J. Kalman J.
Santa Cruz Women's Health Center, California
A feminist perspective on the study of home birth. Application of a
midwifery care framework
Journal of Nurse-Midwifery. 39(3):142-9, 1994 May-Jun.
Studies of home birth have compared it with hospital birth, with a focus
on perinatal outcomes. Although such studies have established the safety
of midwife-attended home births, this narrow view does not include all
of the concepts represented in a proposed midwifery care framework
derived from the philosophy of the American College of Nurse-Midwives.
In this essay, the authors recommend the employment of qualitative
research with a feminist perspective as a method to elucidate other
concepts in the midwifery care framework, and suggest that future home
birth research should explore the recognition and validation of the
woman and her experiences, appropriate use of technology, and the
influences of the birth environment. [References: 51]
Department of Anthropology, University of Texas at Austin 78712
The technocratic body: American childbirth as cultural expression.
Social Science & Medicine. 38(8): 1125-40, 1994 Apr.
The dominant mythology of a culture is often displayed in the rituals
with which it surrounds birth. In contemporary Western society, that
mythology--the mythology of the technocracy--is enacted through
obstetrical procedures, the rituals of hospital birth. This article
explores the links between our culture's mythological technocratic model
of birth and the body images, individual belief and value systems, and
birth choices of forty middle-class women--32 professional women who
accept the technocratic paradigm, and eight homebirthers who reject it.
The conceptual separation of mother and child is fundamental to
technocratic notions of parenthood, and constitutes a logical corollary
of the Cartesian mind-body separation that has been fundamental to the
development of both industrial society and post-industrial technocracy.
The professionals' body images and lifestyles express these principles
of separation, while the holistic ideology of the homebirthers stresses
mind-body and parent-child integration. The conclusion considers the
ideological hegemony of the technocratic paradigm as potential
future-shaper. [References: 45]
Health Policy Institute, Boston University, MA 02215
Midwifery care and out-of-hospital birth settings:
how do they reduce unnecessary cesarean section births?
Social Science & Medicine. 37(10):1233-50, 1993 Nov.
In studies using matched or adjusted cohorts, U.S. women
beginning labor with midwives and/or in out-of-hospital
settings have attained cesarean section rates that are
considerably lower than similar women using prevailing
forms of care--physicians in hospitals. This cesarean reduction
involved no compromise in mortality and morbidity outcome
measures. Moreover, groups of women at elevated risk for adverse
perinatal outcomes have attained excellent outcomes and cesarean
rates well below the general population rate with these care
arrangements. How do midwives and out-of-hospital birth settings
so effectively help women to avoid unnecessary cesareans? This
paper explores this question by presenting data from interviews
with midwives who work in home settings. The midwives'
understanding of and approaches to major medical indications for
cesarean birth contrast strikingly with prevailing medical
knowledge and practice. From the midwives' perspective, many
women receive cesareans due to pseudo-problems, to problems
that might easily be prevented, or to problems that might be
addressed through less drastic measures. Policy reports
addressing the problem of unnecessary cesarean births in the U.S.
have failed to highlight the substantial reduction in such births
that may be expected to accompany greatly expanded use of midwives
and out-of-hospital birth settings. The present study--together
with cohort studies documenting such a reduction, studies showing
other benefits of such forms of care, and the increasing reluctance
of physicians to provide obstetrical services--suggests that
childbearing families would realize many benefits from greatly
xpanded use of midwives and out-of-hospital birth settings.
Kenny P. King MT. Cameron S. Shiell A
Satisfaction with postnatal care--the choice of home or hospital
Midwifery. 9(3):146-53, 1993 Sep.
This paper reports the findings of a study of client satisfaction with
postnatal midwifery care. Women could choose one of two forms of care;
either domiciliary care following early discharge, or hospital care
until discharge. Consumers' perceptions of their postnatal care were
examined at the end of the period of care. Women assessed the midwives'
interest and caring, education and information provided, their own
progress with feeding and baby care, and their own physical and
emotional health. They were also asked about their expectations of and
gains from postnatal care. The findings indicated that women choosing
domiciliary care and women choosing hospital care had different
expectations of their postnatal care, but were largely satisfied with
the quality of the care they chose. The women who chose domiciliary care
rated their postnatal care more highly than the women who stayed in
hospital. The findings reinforce the importance of providing women with
choices for the maternity care which best suits their needs.
Merrimack College, North Andover, Massachusetts
Where babies are born and who attends their births: findings from the
revised 1989 United States Standard Certificate of Live Birth
Obstetrics & Gynecology. 81(6):997-1004, 1993 Jun.
OBJECTIVE: To examine the results of changes in the birth certificate
with regard to characteristics of the mothers and the birth weights of
their infants. The United States Standard Certificate of Live Birth was
revised in 1989 to include specific designations for the place of births
out of hospital and the presence of a nurse-midwife or other midwife at
METHODS: All results are based on data from the Natality, Marriage and
Divorce Statistics Branch of the National Center for Health Statistics,
Centers for Disease Control. In all cases reported here, the data
at least 91% of all United States births in 1989.
RESULTS: Different patterns of birth attendance emerged in different
settings. In residential births, other midwives and "others" attended
66% of all births, whereas in freestanding birth centers, physicians and
certified nurse-midwives attended 75.1% of all births. The
of the mothers differed substantially according to who attended their
births in these settings. Substantial interstate variations in place and
attendant were also documented.
CONCLUSION: The positive outcomes achieved in certain settings
indicate a need for further research into the factors that influence
MacVicar J. Dobbie G. Owen-Johnstone L. Jagger C. Hopkins M. Kennedy J.
Department of Obstetrics & Gynaecology, Leicester Royal Infirmary, UK
Simulated home delivery in hospital: a randomised controlled trial
British Journal of Obstetrics & Gynaecology. 100(4):316-23, 1993 Apr.
OBJECTIVES: To compare the outcome of two methods of maternity care
during the antenatal period and at delivery. One was to be midwife-led
for both antenatal care and delivery, the latter taking place in rooms
similar to those in one's own home to simulate home confinement. The
other would be consultant-led with the mothers labouring in the delivery
suite rooms with resuscitation equipment for both mother and baby in
evidence, monitors present and a delivery bed on which both anaesthetic
and obstetric procedures could be easily and safely carried out.
DESIGN: Randomised controlled trial.
SETTING: Leicester Royal Infirmary Maternity Hospital.
SUBJECTS: Of 3510 women who were randomised, 2304 were assigned to
the midwife-led scheme and 1206 were assigned to the consultant-led
MAIN OUTCOME MEASURES: Complications in the antenatal, intrapartum
and postpartum periods were compared as was maternal morbidity and
fetal mortality and morbidity. Satisfaction of the women with care over
different periods of the pregnancy and birth were assessed.
RESULTS: There were few significant differences in antepartum,
and postpartum events between the two groups. There was no difference in
the percentage of mothers and babies discharged home alive and well.
Generally higher levels of satisfaction with care antenatally and during
labour and delivery were shown in those women allocated to midwife care.
School of Behavioural Sciences, Macquarie University, Sydney, NSW,
Experiences of Australian mothers who gave birth either at home, at a
birth ventre, or in hospital labour wards
Social Science & Medicine. 36(4):475-83, 1993 Feb.
In order to compare their antenatal education levels, reasons for
choosing the birthplace, experiences during labor and childbirth,
analgesia, satisfaction with birth attendants and others present, and
related attitudes 395 Sydney-area mothers were recruited within one
year of giving birth. Five sources were used to obtain mail-
questionnaire responses from 239 who gave birth in a hospital labor
ward, 35 at a birth centre, and 121 who chose to give birth at home.
Homebirth mothers were older, more educated, more feminist, more
willing to accept responsibility for maintaining their own health,
better read on childbirth, more likely to be multiparous, and gave
higher rating of their midwives than labour-ward mothers, with
birth-centre mothers generally scoring between the other two groups.
As well, homebirth and birth-centre mothers were more likely to feel
the birthplace affected the bonding process and were less likely to
regard birth as a medical condition than labour-ward mothers. In
regression analysis birth venue (among other variables) significantly
predicted satisfaction with doctor, if present during labour and
delivery, and five variables correlated with birth venue significantly
predicted satisfaction with midwife, husband/partner, and other support
person. Findings are discussed in the light of the current struggle
between medical and 'natural' models of childbirth.
Department of Obstetrics and Gynaecology, University Hospital Nijmegen,
Home deliveries in The Netherlands--perinatal mortality and morbidity
International Journal of Gynaecology & Obstetrics. 38(3):161-9, 1992
The obstetrical organizational system in the Netherlands is based on
the selection for risk factors. We conclude that: (i) The reporting of
perinatal death is not complete. (ii) Perinatal mortality can be
reduced. (iii) More iatrogenic interventions are present in low-risk
deliveries in hospitals. (iv) Neurological behavior of low-risk babies
born at home is equal to those born at the hospital, despite the worse
maternal profile of the latter and the level of acidemia at birth in
the first. Good data especially in referred cases are necessary before
adopting a similar system.
van Steensel-Moll HA. van Duijn CM. Valkenburg HA. van Zanen GE.
Department of Epidemiology and Biostatistics, Erasmus University Medical
School, Rotterdam, The Netherlands
Predominance of hospital deliveries among children with acute
lymphocytic leukemia: speculations about neonatal exposure to
fluorescent light Cancer Causes & Control. 3(4):389-90, 1992 Jul.
Department of Health, Commonwealth of the Northern Marianas Islands,
The safety of home birth: the farm study
American Journal of Public Health. 82(3):450-3, 1992 Mar.
Pregnancy outcomes of 1707 women, who enrolled for care between 1971 and
1989 with a home birth service run by lay midwives in rural Tennessee,
were compared with outcomes from 14,033 physician-attended hospital
deliveries derived from the 1980 US National Natality/National Fetal
Mortality Survey. Based on rates of perinatal death, of low 5-minute
Apgar scores, of a composite index of labor complications, and of use
of assisted delivery, the results suggest that, under certain
circumstances, home births attended by lay midwives can be accomplished
as safely as, and with less intervention than, physician-attended
Ford C. Iliffe S. Franklin O.
Department of Primary Health Care, Whittington Hospital, London
Outcome of planned home births in an inner city practice
BMJ. 303(6816):1517-9, 1991 Dec 14.
OBJECTIVE--To assess the outcome of pregnancy for women booking for home
births in an inner London practice between 1977 and 1989.
DESIGN--Retrospective review of practice obstetric records.
SETTING--A general practice in London.
SUBJECTS--285 women registered with the practice or referred by
general practitioners or local community midwives.
MAIN OUTCOME MEASURES--Place of birth and number of cases transferred to
specialist care before, during, and after labour.
RESULTS--Of 285 women who booked for home births, eight left the
practice area before
the onset of labour, giving a study population of 277 women. Six had
spontaneous abortions, 26 were transferred to specialist care during
pregnancy, another 26 were transferred during labour, and four were
transferred in the postpartum period. 215 women (77.6%, 95% confidence
interval 72.7 to 82.5) had normal births at home without needing
specialist help. Transfer to specialist care during pregnancy was not
significantly related to parity, but nulliparous women were
significantly more likely to require transfer during labour (p =
0.00002). Postnatal complications requiring specialist attention were
uncommon among mothers delivered at home (four cases) and rare among
their babies (three cases).
CONCLUSIONS--Birth at home is practical and safe for a self selected
population of multiparous women, but nulliparous women are more likely
to require transfer to hospital during labour because of delay in
labour. Close cooperation between the general practitioner and both
community midwives and hospital obstetricians is important in minimising
the risks of trial of labour at home.
Abel S. Kearns RA.
Department of Anthropology, University of Auckland, New Zealand
Birth places: a geographical perspective on planned home birth in New
Social Science & Medicine. 33(7):825-34, 1991.
In New Zealand until the 1920s, most births occurred at home or in small
maternity hospitals under the care of a midwife. Births subsequently
came under the control of the medical profession and the prevalent
medical ideology continues to support hospitalised birth in the
interests of safety for mother and child. Despite resistance from the
medical profession, recent (1990) legislation has reinstated the
autonomy of midwives and this has come at a time when the demand for
home births is increasing. This paper locates these changes within the
geographical context of home as a primary place within human experience.
It is argued that the medical profession has been an agent of an
essentially patriarchal society in engendering particulat experiences
of time and place for women in labour. Narrative data indicate that
the choice of home as a birth place is related to three dimensions of
experience unavailable in a hospital context: control, continuity and
the familiarity of home.
Albers LL. Katz VL.
University of Medicine and Dentistry of New Jersey
Birth setting for low-risk pregnancies. An analysis of the current
Journal of Nurse-Midwifery. 36(4):215-20, 1991 Jul-Aug.
This article reviews the literature on birth settings for women with
low-risk pregnancies. Methodological issues of the existing research
include nonrandom designs, small samples, selection differences, data
limitation, and confounding bias. Studies for four birth sites are
summarized: the home, freestanding birth centers, in-hospital birthing
centers or birthing rooms, and traditional hospital settings. Despite
the methodological limitations, nontraditional birth settings present
advantages for low-risk women as compared with traditional hospital
settings: lower costs for maternity care, and lower use of childbirth
procedures, without significant differences in perinatal mortality.
Chamberlain M. Soderstrom B. Kaitell C. Stewart P
Consumer interest in alternatives to physician-centred hospital birth in
Midwifery. 7(2):74-81, 1991 Jun.
A survey of 1109 women who delivered in a hospital or at home in a major
city in Canada was conducted. The women were asked to respond to
questions concerning the type of health professional they would like to
provide reproductive care. The choices they were offered were: midwife,
obstetrician, general practitioner or nurse, or a combination.
Respondents were also asked to identify if they had an interest in an
alternative such as a birthing room, birthing centre or home birth, to
hospital labour ward care. Almost 60% of women were interested in some
form of midwifery care with the major emphasis placed on counselling
and support. Of the women who expressed an interest in midwifery
services a large number elected for that service to be shared with an
obstetrician. Women who were older and had achieved a high level of
education were more interested in midwifery services than other women.
If given choices of a hospital labour, birthing room, birthing centre
or home birth 53% of women would choose to give birth in a hospital
labour ward. A major reason for this choice was the accessibility of
epidural analgesia. The majority of women who had experienced a home
birth would make the same choice again. There was a strong positive
association between interest in using midwifery services and interest
in a birthing centre and home birth.
Mathews JJ. Zadak K.
Loyola University Medical Center, Maywood, IL 60163
The alternative birth movement in the United States: history and current
Women & Health. 17(1):39-56, 1991.
The alternative birth movement is a consumer reaction to paternalistic
and mechanistic medical obstetrical practices which developed in the
United States early in this century. Alternative birth settings
developed as single labor-delivery-recovery rooms in the hospital or
as free-standing birth centers. Both alternatives offer family-centered,
home-like, low technological maternity care. In order to overcome
physician resistance to non-traditional maternity care, alternative
birth center policies eliminate all women who are expected to have a
complicated pregnancy or delivery. Physician resistance to alternative
birthing is publicly based on the issue of maternal and infant safety.
Additional issues, however, are that physicians fear economic
competition and resist loss of control over obstetric practice. This
paper (1) traces the historical antecedents and social factors leading
to the alternative birth movement, (2) describes the types of
alternative birthing methods, and (3) describes ways in which the
obstetrical community has maintained and rationalized dominance over the
Anderson R. Greener D
A descriptive analysis of home births attended by CNMs in two
Journal of Nurse-Midwifery. 36(2):95-103, 1991 Mar-Apr.
This study examined outcome data from two nurse-midwifery operated home
birth services in Texas. All clients who planned a home birth within the
two services during 1987 comprised the population. Analyses revealed
that women choosing home birth with these nurse-midwives were more
frequently married, usually white, and more educated when compared with
the overall U.S. childbearing population. Analgesia, episiotomy, and
cesarean delivery were all found at lower rates than is reported when
birth occurs in a hospital setting; complications occurred less
frequently or at similar rates to those reported in the home birth
literature and national statistics. Research, educational, and clinical
implications of the study are discussed.
Outcomes of 1001 midwife-attended home births in Toronto, 1983-1988
Birth. 18(1):14-9, 1991 Mar.
A retrospective descriptive study of 1001 midwife-attended home births
in Toronto, Ontario, was carried out between January 1983 and July 1988.
Interviews with 26 midwives and reviews of client records provided data
on maternal age, socio-economic status, gestation, ruptured membranes,
length of labor, episiotomies and perineal lacerations, transfer to
hospital of mother or baby or both, infant resuscitation, and
breastfeeding. Of 1001 planned home births, 361 involved primiparous
women, of whom 245 (68%) remained at home and 116 (32%) required
transfer of mother or baby to hospital during labor or the first four
postpartum days. Of the 640 multiparous births, 591 (92%) women remained
at home and 49 (8%) required transfer to hospital. Among women
transferred, 91 had spontaneous vaginal births, 34 had forceps
deliveries, and 35 had cesarean sections. Variables significantly
associated with maternal transfer for both primiparas and multiparas
were length of latent and active phases of the first stage of labor,
length of the second stage of labor, and duration of ruptured membranes.
Five neonates were transferred and two died, one each after birth at
home and in hospital. There were no maternal deaths. The proportion of
mothers breastfeeding without supplement at 28 days postpartum was 98.6
> Ofcourse, there are conditions where a homebirth would not be safe and probably
> wouldn't even be countenanced by a sane person - for instance, if you were
> pre-eclamptic, or needed to be induced, or the baby was severely distressed.
One thing to remember in the comparison of homebirth and hospital birth statistics
is that home births tend to have the "high-risk" cases removed (and sent to hospital),
and therefore it may not be surprising that they show fewer problems -- anyone with
a forseable problem is told they should use the hospital.
A more useful comparison would be homebirths vs. hospital births of women
who would have been "eligible" for homebirths had they wanted that.
CESDI stands for "Confidential Enquiry into Stillbirth and Deaths in Infancy"
and is an annual enquiry, interviewing parents and staff surrounding a large
number of infant deaths. The 1995 report only included 21 deaths from
homebirths, of which most had been transported to hospital before the death
took place. Of that, only 9 deaths arose from planned homebirths. It is not
a study looking at the comparative safety of homebirths v. hospitals etc. but
is intended to look at ways of avoiding infant deaths by finding out why they
The most common reasons for the "homebirth" deaths were exactly the same as
the hospital deaths - unavoidable problems with the baby (fatal heart defects
etc), mismanagement of the labour, lack of proper monitoring of the baby,
failure to act promptly in an emergency, lack of experience with malpresentation
and incorrect resuscitation technique etc. This was statistically more likely
if a doctor was doing the delivery than a midwife (sorry, all you good doctors
Incidently, the no.1 most dangerous birth (apart from an unplanned, unattended
homebirth) was to have an induced labour, in hospital, VBAC, on a weekend or
national holiday, attended by a junior doctor who then tried to deliver the
baby with forceps. The combination of VBAC with oxytocin (Pitocin) and
prostaglandin seemed to be particularly bad, leading to a rupture of a uterine
scar which was not correctly handled.
It was interesting to me that as many deaths occured due to incorrect use of
induction as occurred due to not inducing when they should have done.
My impression of CESDI is that most babies die due to Act of God and most of
the rest die due to medical negligence. It's depressing, but true.
Ofcourse, this has nothing to do with homebirth.
Anna (mummy to Emma, Born 17th January 1995 and No.2 due 16th September 1996)
> It is my sincere hope that home birth will be considered "normal" once
> again in my lifetime. ...And that no one will be chastised or belittled
> for *whatever* birth choice(s) they make.
> Dad to the now-a-bit-cranky Nathan, born June 7, 1996--in the safety and
> relative comfort of his own home.I couldn't agree more !
It seems so much natural and comfortable to give birth at home !
Me and Michal are now in this dilema as to that issue. We keep circling around that
point: what if something *does* go wrong ? Can you really be ready for that ?
What is the staff and equipement needed for that "mission" ? How can they be ready on
>A more useful comparison would be homebirths vs. hospital births of women
>who would have been "eligible" for homebirths had they wanted that.
I believe there have been quite a few studies where women were classified
according to whether they originally planned on homebirth or hospital
birth, and all other things were kept equal. Planned homebirth still came
Matt -- This is true. I had a hospital birth with a CNM attending, and
the experience was completely positive. I can't remember any points of
disagreement / displeasure. It was a progressive hospital, probably,
newly remodeled and very conscious of its PR. All my attendants were
women (although the night nurse was male!) and my mother was allowed to
be there too. I wore my own T-shirt, received no enema, no episiotomy,
etc. Monitoring was non-intrusive. I had complete freedom of movement.
The staff were very supportive.
I had selected my OB practice specifically because they had midwives, so
that probably had something to do with the liberal hospital culture.
I had been wary of hospitals for many years, and briefly contemplated a
home birth, but my husband wanted to take no chances. The downside, of
course, was cost. We were uninsured, and the hospital bill was $3000, for
a uncomplicated 6-hour labor!
For our second child I would like to have some options. A real birth
center, if I can find one, would be ideal. I am fairly confident of my
ability to birth -- but I can see why a first-time mother would not be.
She really has no idea what it will be like. And the pain is a real
issue. Who wants to be in agony with no relief in sight? A person doing
home birth is potentially putting herself in that position.
There is another philosophy to which I subscribe: If it works the first
time, don't mess with success.
Why soul searching. If the idea of a home birth does not appeal, and
there are no birth centers available, a hospital is the only other
option. That was my experience. (And in any case, lay midwifery being
illegal in Indiana, I wouldn't have known how to go about locating an
attendent if I HAD even given serious consideration to the option.)
> Matt -- This is true. I had a hospital birth with a CNM attending, and
> the experience was completely positive. I can't remember any points of
> disagreement / displeasure. It was a progressive hospital, probably,
> newly remodeled and very conscious of its PR. All my attendants were
> women (although the night nurse was male!) and my mother was allowed to
> be there too. I wore my own T-shirt, received no enema, no episiotomy,
> etc. Monitoring was non-intrusive. I had complete freedom of movement.
> The staff were very supportive.
And my hospital experience was also positive. There were a few minor
problems, but most were related to my labor, NOT to anything the hospital
or its staff did. And yes, I was attended by (gasp!) an OB! (One of my
few complaints with the staff was a particular nurse who thought that
Shaina wshould REALLY have a pacifier, even though I said I didn't want
it. (Shaina didn't want it either, so the issue never became very important.)