By Tamra Klaty
Years ago, when I was contemplating my own birth options, I had heard about birthing at home, but as much as I tried, I could not picture it. Where would I have the baby? What position would I be in? How would we handle the mess? What if I needed an episiotomy? All I had experienced were hospital births, and within that paradigm, all of those aspects are already put in place and a laboring woman simply follows the script. I was trying to fit the constructs of a hospital birth into a birth taking place in my home, and without the bed that turned into a birthing chair complete with foot rests, it was impossible to imagine.
As it turned out, all of those questions took care of themselves. I moved and rocked wherever I wanted. I sipped tea, walked through the neighborhood, stood in the shower. I napped, hugged my toddler, moaned loudly on my birthing ball and enjoyed a snack. And when the final moments came, I breathed the baby out wherever I found myself, with the gentle guidance of my midwife.
Over the years while attending births as a doula (a trained assistant providing emotional and physical birth support), I have seen women birth in beds, on floors, and in tubs. Sometimes it’s in the bedroom, but often it’s in the living room or the kitchen. The after birth moments are unhurried, as caregivers peacefully attend to mother and baby, often with a meal simmering on the stove while the washer and dryer hum. When we leave, the last picture I have of the mother is a content woman tucked comfortably in her own bed.
It’s not about trying to squeeze institutional birth as we know it into a home setting. It is an entirely different world altogether. My oldest children have witnessed what the majority of obstetricians, and labor and delivery nurses never see in their lifetime—a completely undisturbed physiological birth. They have the privilege of viewing birth as a normal part of family life.
The significance of this rarity is not lost on me, knowing the preparation for birth choices takes place long before we even have any thought of making those decisions for ourselves. As unconscious as we may be of it, the images we have imprinted on our brains and the messages we are given about birth are what influence our own experience. Many women choose to birth at home because they first observed a friend or family member do so, and their own choice isn’t even remembered as a conscious decision at all, but rather an automatic extension of those positive and peaceful feelings. If the birth symbols we carry with us are surrounded by images of home and familiarity, our choices will reflect that.
This reality also works the other way. While many woman choose to birth at home due to an intuitive leaning towards the comfortable, haven-like images they hold, the vast majority of women do so as a direct move against a previous negative birth experience at a hospital. We’ve come to equate safe with technological, and therefore we assume that the more technology that is utilized, the better the odds are for a safe birth outcome.
And yet, as Alice Dreger, professor of clinical medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine has said, the most scientific birth is often the least technological birth. She wrote in one article published in The Atlantic, “Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it.”
It is strange to come to the realization that choosing an autonomous birth can be an act of defiance. Two issues our society values highly are scientific evidence and women’s rights, specifically consent and choice, and yet these ideals have yet to truly make inroads in birth culture. The home birth world is full of women who describe a previous hospital birth using words like shame, harassed, dismissed and lonely. Women who were told their wishes were irrelevant and their disappointment ridiculous, then given a huge bill that includes several additional charges for all the interventions they didn’t want.
The idea that where and how we birth our babies can be an act of rebellion is unsettling. Our culture implies that everything, including birth, can be controlled and so we are sold an illusion of safety. True medical intervention is rarely necessary, which is a stark contrast to the high rates of inductions, episiotomies and cesareans among hospital births, and yet often the first thought surrounding home birth is ‘What if something happens?’
Bringing a tiny human into the world is never without risks. Taking on the freedom of choice means welcoming the burden of responsibility. When faced with the reality that it’s her birth plan against the hospital’s birth plan, her choices against the policies that protect the institution from liability, and her needs against their time limits and habits, women quickly learn that undisturbed birth is a radical goal. And so they go where their choices are not only accepted, but celebrated. They go home.
When asked what words they would use to describe their births at home, the most frequent answers were empowering, relaxed, safe and comfortable.