Homebirth at the Hospital

By Doula Giuditta Tornetta
Web Exclusive

Mother and newborn sleepingYour question:

I’d love to have a natural homebirth, but I feel safer in the hospital. What do you suggest I do to create a homebirth environment at the hospital? Will a doula help me at the hospital?

Answers:

Many people believe that doulas work with homebirths more than hospital births. Truth is 95 percent of the births I attend are at the hospital. In fact I’d say the majority of doulas work in hospitals, helping women have natural, home-like childbirth experiences.

There are five steps to help you realize your desire for a home-like, natural and painless childbirth at the hospital. I speak about a painless childbirth, because I have experienced it firsthand, and so have many of my clients, friends and fellow doulas. Here are the five steps.

1. Become willing to have a natural experience, no matter what. Willing to change what you believe and what you have being taught. For us to change our intention and the outcome of any of our endeavors, we need to start by becoming clear as to what we want.

Get a clear intention of the kind of birthing experience you want, regardless of what you have heard, what kind of birth your mother, sisters, etc. have had, and regardless of your age, size, heritage and so forth.

Before the Golden Gate Bridge was built there was an idea, a desire to build it and a willingness to do whatever needed to be done to make it happen. Reading books on natural childbirth and talking to women who have experienced natural childbirth is a good way to begin.

2. Trust that you can do it. Believing that not only you can do it, but that you deserve to have such an experience is a very important step toward success. If Columbus did not believe that he could circumnavigate the earth, he would not have begun his journey east to get west. Fake it till you make it if you have to. Tell yourself every day that you will have the birthing experience you desire.

Write it down, meditate on it, pray for it. Do whatever it takes to grow the self-confidence that you have all that it takes to have such an experience. Make sure you surround yourself with supportive people. Do not waste time listening to those who are quick to tell you that it is impossible, those who like you to have the same medicated experience they have had.

3. Make a decision that a natural childbirth, a homebirth-like experience is what you want and will have. So far the first two steps had to do with an inner dialogue. This step suggests that you actually no longer vacillate about your intention. Yes, you have chosen to have your child at the hospital because you feel more comfortable. You have made a good decision, now decide that you will have a home-like birth at the hospital you will choose. Make sure you choose a hospital that will allow you to have such an experience. Go and visit the hospitals that are covered by your insurance company, ask about each facility to other women, doulas, childcare educators and if you have any midwives in your town, ask them too.

4. Take action. Choose a care provider that will support your desire. Interview a few, make sure they have supported other women with the same experience you want. Ask the doctors for references, be polite, ask them if they are willing to give you the names of patients who have had a natural childbirth, so that you may talk to them and get some advice. We never ask our doctors for references, yet our references are always checked when we are to get a new job. Go to independent childbirth education classes, hire a doula (visit DONA.org to find a certified doula in your area), find alternative ways to cope with labor. Look into hypnosis for a painless childbirth.

5. The fifth and final step comes much later. Because you have been successful obtaining a natural, home-like birth at the hospital, share your experience with other women and helped them fulfill their desires, and dreams. If you can do it, we can all do it. Share the joy. What you focus on expands!

Many of my clients will tell you they have experienced a natural and painless childbirth. When I say painless, please understand, I don’t mean you will not feel anything.

What you will feel is a lot of pressure; you will feel the might of creation come through you. But pain is associated with something gone wrong. You break a leg, you feel pain. Something is not “right.” Childbirth is a lot of hard work, and the sensations that accompany it are very strong, but there is nothing “wrong” with labor.

Labor is what happens when a baby comes into this world. Remember, until something goes wrong you are not a patient, you are a healthy birthing mother using the hospital facility to bring your child into this world. Labor comes one minute at the time, and if you focus on managing that one minute you will be able to conquer it.

Birth is sacred and if for some reason you have to be medicated, or even if you have to have a Cesarean birth, know that it does not make you less of a woman and you have done nothing wrong. We are blessed with modern technology, great medicine and amazing doctors who are standing by ready to help us in the moment of need. We embrace all births, and we take charge of our own, as we stay open to whatever happens.

 

Giuditta Tornetta is a birth and post-partum doula, a lactation educator, and hypnotherapist. Her CD Joyful Birth has helped hundreds of women experience a natural and stress free birth. She has a private practice in Marina del Rey, California. She is the author of the upcoming books “Joy In Birthing: Homebirth at the Hospital” a daily guide to a natural and painless childbirth. She can be reached through her website www.JoyInBirthing.com or by calling 310-435-6054


Below is a letter we received regarding Giuditta Tornetta’s article, followed by a response from Ms. Tornetta.

I received an email this morning (1/25/06) from Mothering which included a link to the online article “Homebirth at the Hospital.”

While I understand that the author is helping families get the best possible experience that any low risk birthing family can get in the hospital, and that her intentions are good, this article detracts from real homebirth and gives people the impression that a homebirth experience in a hospital can really happen. Having a “homebirth at the hospital,” even with a doula, would never be the norm*&8212;it would be the very rare exception. What goes on at a hospital is not what goes on at home with a homebirth midwife. You can’t even compare the two: homebirth with Midwives Model of Care versus hospital birth with Medical Model of Care.

To make families think that they can get a homebirth at the hospital is confusing and readers deserve better than that “g they deserve the truth of what it is really like to birth in a hospital today “g in those same hospitals where the CDC reports that the Cesarean rate for 2004 is 29.1%. “A cesarean rate of no more than 15 percent is recommended by the World Health Organization, and a goal of the US National Health Service is a cesarean rate of 15 percent for first-time mothers by the year 2010*.” (*Thank you to Nicette Jukelevics for this information from her Mothering article: Issue 123, March/April 2004 Once a Cesarean, Always a Cesarean: The Sorry State of Birth Choices in America). How many homebirths at the hospital do you think are really happening with the cesarean rate at that level, and continuing to increase?

About 8 years ago, I became a doula, attending hospital births. Since then, my journey has taken me to homebirth midwifery. I have completed the rigorous clinical requirements involved in working towards the Certified Professional Midwife (CPM) credential. I gave birth to my son 5 years ago, at home with a CPM “g I could never have gotten that birth experience at the hospital “g even with a doula (my daughter was born in a hospital 9 years ago). What goes on at a typical hospital birth with a typical low risk mom is something I would never do to my families at home “g it’s not evidence-based care.

I asked a doula, local to me, what her thoughts were. Kelly Valceanu, CD (DONA) and AAHCC, from Alexandria, VA, was taken aside one day by a hospital CNM, who demanded that she go back and tell the other local Bradley Method instructors and their students that if they want a homebirth experience, please do not go to the hospital, since they cannot provide that experience. The CNM had her babies at home.

I am asking that Mothering not confuse its readers about the care and experience they receive in a hospital with the care and experience they receive at home with a trained midwife.

Don’t take my word for it “g look at the research: “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416 (18 June). Medical intervention rates of planned home births were dramatically lower than [compared with the relatively low risk hospital group] of planned hospital births, including: episiotomy rate of 2.1% (33.0% in hospital), cesarean section rate of 3.7% (19.0% in hospital), forceps rate of 1.0% (2.2% in hospital), induction rate of 9.6% (21% in hospital), and electronic fetal monitoring rate of 9.6% (84.3% in hospital). 97% of over 500 participants who were randomly contacted to validate birth outcomes reported that they were extremely or very satisfied with the care they received.

Sincerely,

Tammi L. McKinley
Arlington VA

Dear Tammi,
Let me begin by thanking you for the feedback. I absolutely agree with you that giving birth at home is the best and most natural place. As a matter of fact, I have given birth to both my children at home and I would not have done it differently. Perhaps I should have prefaced my article by stating that homebirths are best; I had assumed that the title would imply just that. I do agree that “What goes on at a hospital is not what goes on at home with a homebirth midwife. You can’t even compare the two: homebirth with Midwives Model of Care versus hospital birth with Medical Model of Care.”

Nevertheless, we cannot discount the following facts:

  • Nearly 99% of all births in the US are hospital births.
  • Lack of insurance coverage for homebirth makes it and out-of-pocket expense which is simply prohibitive for many women (despite the fact that midwives charge very little compared to what hospitals and doctors charge the insurance companies.)
  • Midwifery assisted homebirths are not available is all communities in the US. My job as a doula is to offer hope and encouragement in each client’s specific situation.

My article “Homebirth at the Hospital”concerns the vast majority of women: those who either choose to go to the hospital, or have been told they must. My mission is to help them have a drug-free birth, with the least amount of medical interventions. As a doula I am there to support them. My job is to inform them of the pros and cons of each decision, to help them physically and emotionally, and to hold a space so that the sacredness of the birthing ritual is not forgotten.

“I am asking that Mothering not confuse its readers about the care and experience they receive in a hospital with the care and experience they receive at home with a trained midwife.”

I trust that Mothering readers know the difference between the hospital environment and the home environment.I also trust that the readers, who have chosen or must go to the hospital, canobtain a different experience once there. I propose that they set a clearintention for a natural childbirth regardless of the setting, in order to obtain such experience.

Any doula must respecteach woman’s decision, and preserve the sacredness of the newborn’s entrance into this world. I am confident that myarticle provided those women who do not have home care available, or whochoose to go to the hospital, with the confidenceto set their intention and take specific steps to insure their birthing experience is as natural as possible.

I do appreciate the opportunity to clarify my intention and respond to your feedback.

“While I understand that the author is helping families get the best possible experience that any low risk birthing family can get in the hospital, and that her intentions are good, this article detracts from real homebirth and gives people the impression that a homebirth experience in a hospital can really happen..”

I appreciate your understanding of my intentions are good. I know that any doula or midwife supports and cares for her clients, providing them with encouragement and the hope for a natural, and above all sacred, birth, even should a hospital transfer occur. In the upcoming Midwifery Today Conferences, schedule for this March, I noticed there will be a workshop taught by midwife Harriette Hartigan, teaching “how to create a nurturing environment for women who are giving birth in the hospital” Areas covered include Changing Hospital Culture, Techniques to Bring Miracles to Hospital Practice, Inspired Hospital Births and Holistic Labor Care in Hospital Births.

Tammi, we are on the same path, striving together: doulas, midwives and enlightened doctors, to bring a little homebirth to the hospital. As I write this I am reminded of the adage: “home is where the heart is.”