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Open Door Midwifery

Where Should I Have My Baby?

Numerous studies have shown that birth is easiest and safest when the mother is in an environment that provides her with a feeling of safety and privacy, so she can relax and let her own powerful hormones of birth do their job. For some women the environment which provides the best option for this is her own home. For some women it is Open Door Birth Center, and for some it is the closest hospital. Only you can decide where you will feel most secure and comfortable having your baby.
My Master’s research was done on the safety of home birth. There are many well conducted, published articles that demonstrate the safety of home birth and birth center birth for healthy pregnant women, with a trained attendant present. The links on this site can supply you with references. The general consensus among those who carefully analyze the research and report on it without bias is that there is no research that proves either hospital birth or home birth is safer. There is intrinsic risk in the birth process. There is no way to completely remove this risk other than not having a baby! There is risk involved wherever you have your baby. There are also benefits to each option. Below is a partial list of risks and benefits of birth options. These lists are based on research.

OUT-0F-HOSPITAL BIRTH (home or birth center)

BENEFITS

  1. The mother is not subjected to routine procedures such as IV’s and electronic fetal monitoring.
  2. The mother has freedom to follow her desires to eat, drink and move about freely.
  3. The mother is free to find her own best position in which to give birth.
  4. The midwife who provided prenatal care, whom the mother has gotten to know well, is the same person who attends the birth. This continuity of care is an important aspect of out-of-hospital birth that protects the mother from the stress of having new and strange people attending her birth.
  5. The mother is in charge of who is present at her birth. She can insure that only people she is comfortable with are present. The control over the environment of birth is a very important aspect of care, which reduces the level of stress hormones that can cause complications.
  6. There are more options for comfort measures, such as massage, aromatherapy, herbal remedies, homeopathic remedies, water, music, vocalizing (as loud as you want!), changing the scene by getting outside for a walk, getting some private time in your own bedroom, and spiritual practices such as prayer, ritual, or whatever is specific to your religious beliefs. Women are much less inhibited in their own homes, and in the birth center, which allows the powerful hormones of birth to work optimally.
  7. Because of the mother’s greater control over her environment, she is much more likely to deliver without drugs, vacuum extraction, or cesarean section. This makes birth safer for her and her baby.
  8. There is less risk of infection for the mother and baby.
  9. Birth at home, and in the birth center is a family event and becomes a continuum of the family life. This can reduce sibling rivalry and increase sibling bonding.
  10. There is no mother-baby separation. This reduces the chance of postpartum depression, increase the success of breastfeeding, enhances bonding, and is an essential part of attachment parenting.
  11. The environment can also be made more comfortable for the baby with dim lights and natural warmth from mother’s body instead of an artificial warmer.

Disadvantages

  1. Home and birth center birth requires a high level of effort and responsibility by the parents. More time is needed for preparation and education.
  2. Even though research has shown that out-of-hospital birth is safe for carefully screened women with a trained attendant, there is still a cultural bias against it. Out-of-hospital birth is going against the status quo, and people who are not aware of the research may not hesitate to inform you that in their opinion you are making an unwise choice.
  3. Home and birth center birth is not appropriate for certain women. Careful screening and monitoring must be done before, during and after birth, by the midwife.

HOSPITAL BIRTH

BENEFITS

  1. If the midwife or physician is comfortable with and adheres to the non-interventive midwifery model of care, a hospital birth can proceed naturally and benefit the woman who is risked out of home birth for some reason, or who simply feels more
    comfortable in a hospital.
  2. The mother does not have the added stress of going against the status quo with her choice of place of birth.
  3. In most hospitals there is quicker access to anesthesia and surgery if a cesarean section is needed. However, if the birth attendant has set up a good consulting agreement, surgery access may be just as quick from home or birth center.

Disadvantages

The mother is more likely to have her labor induced and/or augmented with pitocin or prostaglandins, to have electronic fetal monitoring which inhibits movement and leads to a greater chance of having a cesarean section, to have an episiotomy, to have a more severe laceration, to have drugs which interfere with the natural process of labor, to have an instrument delivery (forceps, vacuum extraction), and to have a cesarean.
  1. She is much more likely to be subjected to at least some interventions.
  2. She is not in control of who attends the birth, except for choosing her doctor or midwife.
  3. She will not be in control of which nurses, or other hospital personnel attend.
  4. She is much more likely to be separated from her baby.
  5. She and her baby are more likely to pick up an infection.
  6. She is less likely to be able to follow her own rhythms for eating, drinking, and movement. This in itself can increase pain level.

    Some of these disadvantages of hospital birth can be overcome by careful choice of birth attendant and hospital. This requires a high level of commitment on the part of the parents to find the right care provider and hospital that will be able to satisfy their requests for how they want the birth conducted, who will be there, and what the mother is allowed to do, or not do.
In summary, choosing where you are going to have your baby and who is going to be there is a very important decision, and not to be taken lightly. The environment of birth; the people present and the place of birth, has a dramatic impact on how the birth proceeds. I suggest you have consultations with several midwives and/or physicians before you make this decision, and choose who and where fits best for you.

Selection Criteria for Home Birth

Women who choose to birth at home or in the birth center are accepting a high level of responsibility for themselves and their baby. Clients need to be self-motivated to take on that responsibility, and to make necessary changes in their lives to ensure the best possible outcome. These changes may involve nutrition, exercise, stress reduction, devoting time for prenatal care and education, and avoiding substances that could be harmful to the developing baby.

 

Time must be spent to gather birth supplies and prepare your home and family for the birth. Clients must meet several medical and non-medical criteria to be accepted. These include but are not limited to:

  • Attend childbirth classes or private instruction (unless she has already done so)
  • Agree to make required preparations at home, including the selection of a support person for any siblings that will be attending the birth
  • Breast feed
  • Work to achieve optimal nutrition
  • Be a non-smoker
  • Agree to transfer of care to a physician for herself or her baby if the midwife feels it is necessary
  • Assume financial responsibility for services rendered

 

The physical exam and lab tests of clients must be within normal
limits which is defined as no evidence of the following:

  • Chronic hypertension
  • Epilepsy or seizure disorder
  • HIV positive
  • Severe psychiatric disease
  • Persistant anemia 
  • Diabetes
  • Heart disease
  • Kidney disease
  • Endocrine disease
  • Multiple gestation
  • Substance abuse

 

The physical and emotional environment of the client’s home or chosen place of birth should be conducive to having a natural delivery as well. Client and partner must both be comfortable with the birth plan.