Vol. 13 No 4 | Summer 2011
Seeking simplicity

This article is 13 years old and may no longer reflect current clinical practice.

To homebirth or not to homebirth is not an existential question – the factors involved are complex and the decision-making process is lengthy.

To homebirth was a big decision in our house for quite some time. There were a lot of considerations and the final choice did not come easily. Like most families who consider homebirth, we did a lot of research and subsequent planning. As a midwife and childbirth educator working within the public-health system, I had a good head start. We had also had a baby before, which unlike some women’s births was not a traumatic hospital birth. It was a great hospital birth among colleagues and, therefore, among friends – a wonderful experience for my husband and me.

Physically the birth was perfect, but there was one complex intervention that was extremely difficult for me: the transfer to hospital. Transfer is not viewed as an intervention in most obstetric circles, but when labour hormones are disrupted to this degree, it interferes with the flow of labour. My first labour began at home at 40+3 days after a very healthy pregnancy. We stayed at home for ten of the 12 hours of labour, I moved in and out of a shower as I needed to through the night. I was also reassured by the sounds I was making as they were very familiar to me: I sounded just like the many women I had cared for over the years. Everything was fine, until it was time to go to hospital – a 50 minute drive. Prior to labour, I thought the transition would be quite smooth as we had our bags packed and someone to drive. I had not considered the effect transfer would have on me. I had read about it, but thought as I was going to a very familiar environment and would be cared for by good friends I would be unaffected. I was naive to expect myself to be immune to this hormonal imbalance. I cannot begin to imagine how transfer feels for women who are not familiar with their birth attendant or environment.

Towards the end of natural labour, and particularly in transition, many women lose their inhibitions and have an overwhelming urge to be naked. I needed to put my clothes on for transfer, which also interfered with the progress of labour. The turbulence of transition and transfer to hospital both coincided with the sunrise of a hot December morning. My neo-cortex was in full swing and my catecholamines were overflowing. I had lost all focus, with my mind and body in panic mode. I felt out of control and my body had now completely overtaken my mind instead of vice versa. Obviously, this huge disruption was a pivotal moment in my life. This seemed to be a massive insult to my natural birth and the intervention that would form the basis of a decision to homebirth in the future. Luckily for us, the birth did proceed after some time quite smoothly once at the hospital. After two hours of pushing, our beautiful daughter was born into her father’s hands with no drugs, no needles and no stitches. It was the birth we wanted and we could not have been happier, but I knew I could make the next birth much simpler.

I am well aware that not all births are as straightforward and I have been there when the unexpected has occurred; even low-risk women do sometimes have trouble birthing. Working as a midwife and watching these unfortunate outcomes unfold makes me realise how much we need a good medical model in place. Homebirth is definitely not for everyone and neither is hospital birth. I have never been an advocate for ‘high-risk’ homebirth and I am saddened by some women choosing homebirth at all costs.

After the birth of our first baby, I gained complete confidence in being able to do it again someday. For the second birth, three years later, I hoped to simplify things further and have more family input, particularly from our daughter. We wanted to normalise the birth process for her by staying together. I had never been apart from my daughter, so it seemed logical to stay at home with her if possible. As a family, this birth would be the biggest and most exciting experience we would ever share so if the pregnancy remained low risk I certainly didn’t see the sense in separating my family at this important time in our lives. Older siblings do miss many opportunities when families are separated in hospital and we did not want to miss a thing.

We repeatedly went over the ‘what if’s while planning our second birth, as every homebirth couple does. For us, it seemed a safer option for me to stay home rather than travel in a car in labour, given our past experience. In the rural hospital where I am employed, we have an on-call roster system and we certainly don’t have theatre staff in the hospital at all times. We need to call staff in who are asleep in their own beds, in their own homes and who sometimes also live out of town. I knew that if I was in need of urgent obstetric assistance, there would be a delay anyway. I had also booked into my closest hospital only ten minutes away. I am a realist and am well aware that if something was going to go terribly wrong, for example stillbirth, then it would happen no matter where we were.

After much consideration, we employed the services of an independent midwife with 30 years of home and hospital birth experience. We had very clear guidelines of what we needed and wanted from this birth. Open communication is obviously extremely important when embarking on a homebirth. We were reassured by her knowledge and use of national midwifery guidelines for consultation and referral. She was also very clear about particular issues, for example, thorough antenatal screening including pathology, ultrasound, regular visits and very strict gestation cut-off criteria for care (36–42 weeks). We were also impressed with the equipment that our midwife carried with her: with a one-hour supply of oxygen, neonatal resuscitation equipment, postpartum haemorrhage medication and a complete IV kit. When all this is in place and all the boxes ticked, it feels extra reassuring that everything is normal and will be safe. The further the pregnancy progressed and the more antenatal visits we had (also conveniently at home) the more evident it became that we had made the right choice.

The time came, at 39 weeks, for the birth of our baby. After three hours of labour I gave birth to our daughter into her father’s hands in our bedroom. I felt so relaxed and relieved that we didn’t need to travel. Our eldest daughter was asleep in her own bed during the birth, but we did wake her to come and meet her new baby sister and to help cut her cord. What a wonderful memory for all of us. To then recover in my own bed and be surrounded by the people I love the most was priceless. We were able to remove the complexities that we felt with our first birth. The experience was so wonderfully simple, just as we had intricately planned. If a third baby was to come along in the future and the pregnancy was low risk then we keep it as simple as possible and have another homebirth.

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