There's No Place Like Home

By Pam England
Web Exclusive

"I know that I'm healthy and everything's going well with my baby and I know everything's going to be fine."

Those words, uttered by an extremely pregnant Dawn Louro on CBS's Morning Show in February, sound more innocuous than momentous. But in some ways, they are revolutionary. Because Ms. Louro's calm assessment of her pregnancy came only weeks before she gave birth on television, before an audience of millions. At home.

In some circles, laboring or birthing at home is considered quite radical. Most first-time mothers probably doubt that they know enough to give birth anywhere, much less at home. They are surprisingly out of touch with the innate, miraculous processes involved in giving birth. Even though those mothers do not know birth technology either, they know it is out there. Daughters of our technological age, users of cellular phones and computers, understandably have faith in technology.

In addition, women who plan to labor and give birth at home typically get little support and a lot of anxious skepticism from those around them. Under such circumstances, it is not surprising that so few women today give birth at home.

But that may at last be changing and more than 20 years after Mothering first began writing about the possibility and the pleasures of delivering your child in his or her own home. Oprah Winfrey has done shows about alternatives to hospital birth. Chris Bohjalian's book Midwives has been a national bestseller. And then there was Ms. Louro's labor. "I just want it to be in my own home environment," Mr. Louro told the CBS correspondent. "I want to be able to get up, walk around, and have my whole family around me after the baby is born."

As a childbirth teacher, one of my greatest challenges is to inform people objectively about their choices and give them respectful support in their decision-making, so they are not left feeling coerced or guilty about whatever informed choice they eventually make. That is what I wish to do here. Homebirth may not be right for you, for reasons of physical health or personal philosophy. It also may be the perfect choice for you, but one you hadn't considered until now. In a childbirth class I taught recently, the topic arose spontaneously. A couple, one of whom was a physician, said they were thinking of a homebirth. The class erupted into animated discussion, provocative questions, and a sense of hopeful excitement.

At the end, one mother turned to me and sighed happily, "I feel more relaxed just knowing that a homebirth is a possibility," she said, "whether or not I choose it."

Is Homebirth Safe?

The Farm is a 1,700 acre commune in Summertown, Tennessee, founded in 1971 by Stephen and Ina May Gaskin. The trained and skilled midwives there have professional consulting relationships with physicians and refer mothers with complications or risk factors to the hospital.

In 1992, a major study compared 1,700 homebirths attended by The Farm midwives to a sample of 14,033 physician-attended hospital births. The findings were dramatic and heartening: The cesarean rate among mothers who received prenatal care at The Farm was only 1.5 percent compared to 16.5 percent in the doctor-attended group. The transfer-to-hospital rate was 13.5 percent. There was no significant difference between the two groups for perinatal death, bleeding, birth injury, or respiratory distress syndrome.

This excellent outcome for those choosing homebirths has been found in other studies as well. In a famous 1977 project, Dr. Lewis Mehl studied birth outcomes from the medical records of 1,146 elective homebirths in the San Francisco area. The results: the perinatal mortality rate among women who elected homebirth was 9.5 per 1,000 births and compared to a rate of 20.3 per 1,000 among California women who gave birth in the hospital. In other words, as Dr. Mehl concluded, "the [homebirth] outcomes were better than average and the complications rates lower than expected."

And then there are the subjective, anecdotal reports from women who have chosen a homebirth. According to a wide-ranging 1992 survey, "91 percent of . . . women who had had their last baby at home said that they would prefer to have their next baby at home, compared with 15 percent of those who had had their baby in a hospital. Among the few women who had experienced both a homebirth and a hospital birth, 76 percent preferred giving birth in their homes."