How do I know what to believe?

[puddle]

I just found out I'm pregnant with #2, and really wanted a homebirth.
DH is adamantly opposed, as he believes that giving birth anywhere but a hospital is endangering our child.
Since this baby is his too, I've been doing a lot of research the last few days trying to see both sides and find out the truth about whether or not homebirth really is as safe.

Now I'm thoroughly confused.
Both sides make really strong arguments.
Neither side is unbiased.
It appears that all the studies are flawed and all the data can be interpreted both ways and I just don't know what I believe anymore.
I don't have access to more than the abstracts for most of the studies, and the abstracts reflect the bias of the author.

The experience of a homebirth sounds amazing, but of course I want to do what's best for the baby.

DH also keeps pointing out that our hospitals here are better than average and are fairly supportive of natural birth as far as hospitals go, so I can't justly compare them to aggregate results from less accommodating hospitals in these studies. If they are less likely to push interventions, is birth actually safer there? We do have one practice at one hospital that employs midwives, so I also have that option.

I really want to believe that homebirth is as safe, but I'm no longer thoroughly convinced. I can't convince DH unless I'm convinced myself.

Help me sift through this?

[CI Mama]

I have a somewhat philosophical response to your question. It has to do with the nature of "belief" and how we choose our path, which is the thing that you're trying to work through right now.

I think that decisions around something as important as how & where to give birth come from a deep place in each person. We bring together our intellect, culture, history, emotions, and some kind of gut instinct that all figure into the decision. Scientific research, statistics, and studies are important tools for our brains, but as you've found, it can be challenging to sort through all the information, filter out the bias, and come to a firm conclusion. And frankly, sometimes there is no firm conclusion. There are pros & cons to every choice, there are risks and benefits of every choice.

That's why I think other parts of ourselves (not just our brains/intellect) participate in the decision. What feels right to you? Where will you be comfortable? What does "safety" mean to you? What are the most important things that you want from a birthing experience (besides a healthy baby, of course)? Are there things from your 1st birth that you definitely do/don't want to repeat? Are there things that you will be disappointed about if they do/don't happen as a result of your choice about where to give birth? What scenarios do you want to consider as you make your choice?

These are personal questions that only you can answer. It will probably be helpful to hear from other women, find out where their beliefs come from, and see other information or studies could help point you in a clearer direction.

What sounds great in your situation is that the only obstacle to choosing a home birth is your husband's attitude. In other words, there aren't financial or legal or logistical barriers that are making the decision for you. And it sounds like you believe your husband is open to persuasion if you yourself can be clear about what you need. That's great!

Good luck. I don't know if my thoughts on this subject are helpful. I'll be very interested to see what others have to say. Please let us know how the process is going for you!

[kJad29]

Well, I can't tell you what to believe. I can only give you a hug and make suggestions. You can continue to do your research on homebirth and present the information to your DH and you can also research other options such as hospital with a midwife or in a free-standing birth center. I think that perhaps your husband is turning into the protective person he should be. He has a fear of losing you and your baby together so he is going to be a bit irrational about these things. I don't know if logic is going to help. If he is completely adamant about not having a homebirth,you may want to go to a free standing birth center as a happy medium. You get a homebirth-like experience and he gets to fulfill his need to go somewhere to give birth. I will add that homebirth is perfectly safe for low risk birthing women. Selecting a very skilled midwife is essential to a successful birth and many midwives who attend births in a birth center also do homebirths so you can go with them and make the final decision later on whether you want to birth at home or at the center. Just let him know what your preferences are. You are in fact that one who is giving birth. If you don't feel comfortable at the hospital, going there is not going to help matters. Also, if anything happens, you can always transfer to the hospital. People don't understand that you aren't locked into the decision to homebirth or have an out of hospital birth. It's not like the midwife is going to let things get to a point that it's a disaster by the time you get there either. If your midwife is competent, then she'll make sure that a transfer happens before it gets to disaster levels.

BTW I had my first baby at home and plan on birthing my second at home too. Nothing crazy happened. The birth was smooth and I was completely satisfied with everything. I got to snuggle in with my husband and new baby and take a much needed nap after the baby came out. There is nothing like it. Best of luck to you.

[Youngfrankenstein]

I found the Dutch homebirth and Canadian studies very well done. DH and I read through all the data and found it pretty solid.

I will say that for some reason, "we" take our responsibility as potential homebirthers wayyyyy more than if we use a hospital. Never once in my hospital births did I feel the burden of responsibility for the outcome. But aren't we just as accountable?

I don't think there's a right answer for who should and shouldn't homebirth. I can see both sides and I think a person must be comfortable with their choice.

I will say that even after we decided to homebirth, we still needed time to let the idea and realities sink in and then it felt very natural.

[elus0814]

I guess you have to draw your own conclusions from your research, just as those writing the studies did.

My bigger question is why you must convince your husband. Mine still thinks that planning a homebirth is nuts, the kind of thing hippies on a commune do. I know that he will be very annoyed with me if it doesn't go just right but that is something I have to deal with. He's tried to convince me I need to find an ob and go to a hospital but I've just told him over and over again that he is not the one giving birth but when he does I will be fully supportive if he wants to do so in a hospital. It's not his choice and I'm ok with him not being totally comfortable with it.

Another big issue we did have was with the money. With military insurance an ob and hospital would have been free to us but the midwife and homebirth is running over $1000. I think part of his issue with it has been spending money he doesn't think needs to be spent. We got around it because I used my personal spending money, as well as some I gleaned off the grocery budget by using coupons and cooking from scratch, to pay the midwife fee.

If homebirth is what you feel is best for you then go for it!

[ktgrok]

This study is from the British Jounal of Medicine, and was done by the equivalent of the CDC. I hardly think that they are biased towards homebirth, yet they find it as safe as hospital birth. This includes all homebirths attended by CPMs in North America.http://www.bmj.com/cgi/content/full/330/7505/1416%20

[homemademom]

I'm guessing that your dh wouldn't be interested in doing the research and reading you are doing, but would he watch a video? The Business of Being Born makes great arguments and shows that there is a place for both home and hospital birth, but that the hospital is way overused.

Also, if he never agrees, I think there are still things you can do to make your birth more natural. Find a care provider that is supportive of natural childbirth, get a doula, take childbirth classes (that focus on preparing for natural childbirth), birth in a birth center, etc. Any or all of these will give you a better chance of having a birth that is more in your control and comfortable.

Personally, if I were to birth in a hospital (and I have, once, while the other three were homebirths), I would not step foot in there without a doula.

Best of luck! And just keep working on your dh. He just sounds like concerned husband who believes what he's been taught to believe about hospitals and birth. My dh was the same way about circumcision until he did the reading and research and realized that it was medically unnecessary.

[Gena 22]

Too tired to break down and link to actual studies, so forgive me for a general post. As the PP mentioned, I think it's beyond question that HB is known to be at least as safe as a hospital birth. The studies are there, and are large and reliable.

But, in a way your husband is right. A theoretical hospital birth, where a mother is well supported and interventions are only used when there's a medical necessity are safer and more pleasant than a HB with a poorly trained and badly matched midwife and mother. Safety is somewhat relative. HB maybe more so than hospitals. Many hospitals generally offer the same level of service. MWs vary a lot in manner, philosophy and experience.

Your DH says the hospitals near you are good. OK. Do you have a good MW around? You have two choices - of theoretically equal safety. Only you can decide which is your preference and which is better in your circumstances.

I choose a HB because the large, fancy, well staffed and well funded hospitals near me are very unfriendly to natural birth. DH and I went on 2 hospital tours. My favorite quote was from one, where I asked about walking around during labor. I was told I would have to "qualify to be ambulatory" and even then, only for 40 minutes out of every hour. Qualify to be ambulatory!!!

I stayed home because for me, I KNEW HB was safer. No one was going to induce me, pit me, guilt and pressure me into an epidural, break my water, c/s me for FTP. Yes, I could have gone to the hospital and fought tooth and nail every moment of my birth, and get for some of what I wanted. Get some of the healthy choices I demanded. But even then, I also knew my OB was not as experienced as my MW in natural births. How many natural births does your OB really see? And the L&D nurses too. How many of the hospital births are really med-free? Which is not to say you have to go natural. But you do want to know what your chance of being respected and well cared for if you do.

From my research, it's pretty clear that in an ideal birth, both mother and baby do better with as few interventions as possible. Going without pain medication and labor augmentation are easy defend-able choices. And what's gaining attention are the consequences of induction. I stayed home to avoid these. I had to, and in my area, I wouldn't consider a hospital birth unless there was a serious medical need.

Your situation may be different.

If you can truly choose between and positive hospital birth and a positive HB, then it does come down to experience and preferences. I'd still prefer not to drive during labor or after birth. And I'd prefer to keep my newborn away from a germy hospital. For any number of reasons, you might choose differently.

PS - One last comment. The biases of the ACOG are pretty clear. But really, what biases do HB'ers have? HB'ers are not telling everyone to stay home. They are just asking for evidence based medicine and fair birth choices. If we had those, I might have considered a hospital birth. But I'm really glad I stayed home.

[ShwarmaQueen]

It's a hard question only you can answer.

I gave birth to DS at home, but had complications afterwards so ended up spending a few hours at the nearby hospital (DS stayed home and was perfect). I feel great that I got the homebirth (a VBAC actually) but that hospital was there when we needed it (which we did).

If/when we have another baby it will be at home again, because I still believe that homebirth is the safest place for most moms.

[bicyclingbethany]

As other people have said, only you can decide.

One thing to consider: If you and your husband have lingering doubts about the safety of birthing in your home, those doubts will probably play out in a very negative way during labor, if you so chose to home birth.

My experience:
I had a home birth, and I do not think I would do so again. We were only a 7 minute drive from the hospital, but that is too long in some cases. I hemorrhaged after the birth, and it was kept under control- but it was really, really scary and made me realize how quickly things can become life-threatening.
Also, the variability of the skills of a midwife are huge- some know how to recognize and handle emergencies, others don't. They just aren't factoring this in to the studies. Also, many studies have recently been showing that home birth here in the US is NOT safer (UT just did one on home birth from 2000-2005). The BMJ study includes a random splattering of birth info, from the 70s and 80s. I really do not know why everyone cites this study- it's more flawed than any of the others I have seen.

Until midwives have tougher educational requirements, better regulation, and improved access to hospitals and physicians, I'll be sticking with CNMs and birth centers/hospitals as being safer. We do NOT live in the Netherlands, Germany, or the UK. We cannot apply those studies to our situation.

[homemademom]

Originally Posted by bicyclingbethany

My experience:
I had a home birth, and I do not think I would do so again. We were only a 7 minute drive from the hospital, but that is too long in some cases. I hemorrhaged after the birth, and it was kept under control- but it was really, really scary and made me realize how quickly things can become life-threatening.
Also, the variability of the skills of a midwife are huge- some know how to recognize and handle emergencies, others don't. They just aren't factoring this in to the studies. Also, many studies have recently been showing that home birth here in the US is NOT safer (UT just did one on home birth from 2000-2005). The BMJ study includes a random splattering of birth info, from the 70s and 80s. I really do not know why everyone cites this study- it's more flawed than any of the others I have seen.

Until midwives have tougher educational requirements, better regulation, and improved access to hospitals and physicians, I'll be sticking with CNMs and birth centers/hospitals as being safer. We do NOT live in the Netherlands, Germany, or the UK. We cannot apply those studies to our situation.

It's true that mw standards vary widely in the US, but I think a person can research and figure out what credentials they want, what experience, what skill level and then, find that mw (not always easy, I know, depending on location). My current mw is all of that to me, and she has a good relationship with the doctors and hospitals here, too.

I understand where you're coming from, but I would gently suggest not to throw the baby out with the bathwater. Just because we're not Germany or the UK doesn't mean we can't be diligent consumers and try our best to find a mw that meets our standards.

[Gena 22]

Yeah to homemademom. One of the studies that ultimately sold me on HB are the statistics from the Farm. They are amazing:

http://www.thefarm.org/charities/mid.html

This study, as well as other ones, shows that HB with a skilled MW is every bit as safe as a hospital birth, and in many ways more so. But there's the catch. Finding a skilled MW. We have a real shortage in this country. God bless the MWs we have, it's not an easy job. But finding a really good one is tough. I'm humble about the fact that I totally lucked into my MW. It's a very important decision.

But, looking back, I now know that my MW was WAY more experienced in the kind of natural birth I wanted than any OB I would have gotten. Do I want to be some on-call doc's first drug-free birth? Do I want to deliver on my back? NOOOO!!!!!

Sorry to be so vehement, this is still a sore point for me.

[ktgrok]

Originally Posted by bicyclingbethany

The BMJ study includes a random splattering of birth info, from the 70s and 80s. I really do not know why everyone cites this study- it's more flawed than any of the others I have seen.

Um, no. The study I'm referring to was a prospective study, published in the BMJ, that included ALL homebirths attended by CPMs in a single year..I think it was 2002, but not sure about that. It is definitely NOT a badly done study, it's very comprehensive, the most comprehensive ever done.

[HappyMommy2]

I think many of us homebirthers had to convince our hubbies. Once you decide, by investigating all of your options, it will be easier to convince him.

what helped my DH was asking the mw all of the "what if" questions, any and all "worst case scenario questions, and exactly what she and I would do.

Also, it helped to learn that almost all scenarios have warning signs early enough to transfer, as long as you have a knowledgeable midwife.

[smeep]

I just skimmed through the answers and didn't see this point. Your DH says the hospitals in your area are good? What makes him believe that? What does he consider to be good? As in, they have lower mortality rates? More positive NICU outcomes? I think what's most important is to look at their intervention rates. So what if their NICU outcomes are great? It's completely irrelevant if induction and cesarean rates are through the rate; those are things that put babies in the NICU in the first place. It is recommended that cesarean rates be no higher than 15%. The national average is over 30% now and I've seen as much as a 90% cesarean rate in some hospitals. My midwife's cesarean rate is 2-8% annually and, while she does work with low-risk clients, it's still a fraction of the rates for any local hospital's low-risk patients. You also have to look at induction rates. They roughly double the likelihood of a cesarean (which has a whole set of risks of its own), yet many hospitals/OBs have no problem inducing for non-medical reasons (convenience, dates, etc.), and augmenting (speeding up) labour with pitocin is also extremely common in hospital births. Other common interventions that, when used routinely without caution, often cause more harm than good are EFM, epidurals, lithotomy position/immobility in labour, "clock watching," etc., etc. A hospital that truly is a good hospital (i.e., supports and encourages natural labour and uses interventions only when medically necessary) is extremely rare in the US.

My opinion? Hospitals are GREAT if you're at high risk, but if you're low risk and all is going well then you're safer with a well trained midwife out of hospital. Less intervention, more personal, and most importantly, they are more likely to recognise a need to transfer before an OB in a hospital would because you're not just another chart and a room to peek in every few hours, they're with you the whole time and notice the signs earlier. Also I believe the average OR prep time for a cesarean is around 17 minutes - if you're at least that close to a hospital, in a true emergency they can call on the way and it'll be prepped while you are on your way.

Good luck either way, and follow your intuition. Point is, there is PLENTY of information supporting homebirth safety - what matters most is that YOU feel comfortable with it. I did it with my first and will do it with this one. My mother did it with all of us, and my sister did it with my niece. I actually saved myself from an unnecessary induction and possible cesarean because I birthed out of hospital and instead had a quick, spontaneous 5 hour labour and birth. Happy researching!

[sarahkristy]

I just wanted to say, I'm right there with you.. also have the natural minded hospital with CNM's as an option.. that's where I birthed for my first birth and it wasn't exactly how I would have liked it.

If I end up at the hospital this time, it will be with a great doula or because I transferred from home.

[Juvysen]

I'd call whatever homebirth midwife is available in your area and ask for their stats. Then call whatever OB or midwife you'd see in a hospital. Compare the stats. As you said, your local hospital is pretty good, so the generalized stats don't work for you... likewise, you could have a terrible midwife in that area or not. Can't hurt to look, right?

[Youngfrankenstein]

Right on, smeep!

[cileag]

One of the more unique ways of thinking about it that I heard was to ask the question:
"Are you more comfortable with risks that occur from someone doing something or from someone NOT doing something?"

Is it the random complications such as cord prolapse, abruption or hemorrhage that scare you? Or does knowing you're more likely to experience fetal distress or maternal discomfort or anxiety due to AROM, Pitocin, continuous fetal montitoring etc. bother you more?

I had to think long and hard about the very real but very rare risk of complication that could happen in a home birth that could maybe not be as easily "fixed" and I was ok with that relative risk more than I was ok with current standard of practice in most hospitals. Also, does your hospital have in house obstetricians and anesthesia? If they don't, your ability to get a stat c/s is about the same depending on your distance from a hospital with those amenities.

[billikengirl]

http://www.nashvillemidwife.com/safety.html

I wonder if your husband would read through The Thinking Woman's Guide to a Better Birth. I find it really interesting how some husbands (mine included) think hospital birth is so much safer, yet I'm more likely to die after a c-section, and I'm more likely (even as a low-risk, health woman) to have a c-section if I choose hospital birth. These beliefs don't jive with reality.