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Jill Ayers English 110 Project 4, Draft 2 Ashley Rowan Why Home Birth is a Better Option than Hospital Birth Hospital birth in the United States has become little more than a medical procedure and a manipulation of one of the most amazing, innate functions of the human body. From the moment a laboring woman enters the hospital, she is put on a twenty-four hour time table to progress, given multiple injections, attached to monitors, introduced to assorted staff members, and told what the hospital will and will not allow. There is a medication to induce labor, a medication to stall labor, a medication to numb labor, all resulting in an artificial, often disappointing, experience. Because it has become so mundane and expected, most people dont question the policies of the majority of hospitals concerning labor and delivery. Those who do question it often have little success in having a natural childbirth in a hospital setting. It is possible, but the woman and her birth partner often spend a significant amount of time and energy arguing for their rights. There is a better way. Home birth under the care of a midwife allows childbirth to occur in a familiar setting, labor is allowed to progress at whatever pace feels natural, and the unnecessary interventions are often avoided. The mother can labor in whatever position feels comfortable, instead of being told to give birth flat on her back. In her article, Best Labor and Birth Positions, Catherine Beier explains that lying on ones back to give birth is possibly the worst way to deliver, but is

convenient for the doctors attending the birth. Beier states a non-supine position allows for fewer tears and pain, but that 97% of women in hospitals giving birth vaginally deliver either flat on their backs or in a semi-upright sitting position. Both can lead to undue pressure on the pelvis and groin. As opposed to a nurse or doctor handling the baby directly after birth to get measurements and perform an examination, with a home birth, the mother can immediately hold her baby, which facilitates bonding and easy breastfeeding (La Leche League). Delayed cord clamping is also easily achieved with a home birth, which increases the blood volume of infants, and prevents the need for a synthetic Vitamin K shot given to the baby directly after birth to thicken the blood (Mercer). Medical emergencies are easily handled by the midwife, but rarely occur. Of course, there are exceptions, and giving birth in a hospital can sometimes be necessary. Reasons to transfer care to a hospital would include preterm labor (going into labor three weeks before the expected due date), when pregnant with multiples, or when diabetes or preeclampsia is present (Mayo Clinic). Debatable reasons to choose a hospital birth would include a breech position of the baby (which many find normal and quite safe), being past fortyone weeks overdue, and if there is a history of previous cesarean sections. Many home birth advocates would argue that breech is another variation of normal, HBAC deliveries (home birth after cesarean) are quite safe, and that every baby will be ready to be born at some point or another, whenever he or she is ready. Each woman must evaluate her situation, consult with medical professionals, and research what is best for her.

There are many other secondary benefits of comfort with home birth that are often overlooked, such as being able to eat and drink freely in labor, move without constraint, and having dimmed lighting, all of which are usually prohibited in a hospital setting. Family and friends may be present, the laboring woman is in a familiar environment, and there is no need for transfer after the birth. All of these things promote a positive birthing experience, and offer advantages a hospital may not be able to provide. Of course, the well-being of mother and baby are about what people are most concerned. Research shows that women having planned home births experienced fewer lacerations, hemorrhage, and infections, than those who had planned hospital births and that the babies born were less likely to be premature, have a low birth weight, or need ventilation to assist with breathing (Hall). This may be because of the many interventions practiced in hospitals, including induction of labor and epidurals, both of which are believed to cause a cascade of more unnecessary steps. More than 50% of women giving birth in a hospital are given an epidural (Staehler), which can often stall labor, cause a womans blood pressure to drop significantly, or make pushing quite difficult. Because pushing is made more challenging with an epidural, this often leads to the use of forceps, vacuum extraction, or cesarean section (American Pregnancy Association). Cesarean section rates in the United States are astronomical. According to the Centers for Disease Control and Prevention (CDC), 33% of hospital births led to cesareans in 2009. In their article, Cesarean Rates in US, the CDC, it is the most commonly performed operation in this country. They also showed that the increase from 21% in 1996 to 33% in 2009 was unexpected, since it rose in low risk patients, who were not pre-term, presenting breech, and did not have a history of cesarean sections. The World Health Organization links cesarean rates

above 15% to do more harm than good, and recommends 5-10% cesarean rates for optimal outcomes, (Gibbons, Belizan, Lauer, Betran, Merialdi, Atthabe). Cesarean sections have grave consequences, including infection, injury to major organs, scar tissue, and even higher maternal mortality rates. They can also lead to other surgeries, including hysterectomy and bladder repair. In a hospital setting, many women are forced to give birth within a certain amount of time, or face interventions. A substantial number of cesarean sections are due to failure to progress, which is a term given to women experiencing less than one centimeter of cervical change for two consecutive hours (Rackliffe). According to the Joint Commission, starting in January 2014, hospitals with more than 1,100 births will be required to report on their cesarean rates, and will be pressured to drastically reduce the national rates of C-sections for first time mothers. One of the reasons most listed for cesareans is failure to progress. The Joint Commission, who is responsible for accrediting and certifying more than 20,000 health care organizations in the United States, states that many times failure to progress should be more accurately called failure to wait, (Dekker). Ina May Gaskin, who has been described as the mother of authentic midwifery, is a Tennessee midwife who has been helping women with maternity care since the 1970s. She manages The Farm Midwifery Center, where thousands of women have given birth in the past forty years. Gaskin has developed a theory on what most physicians consider failure to progress, called Sphincter Law. According to Gaskin, the bodys natural sphincters include the vagina, cervix, anus, urethra, and vocal folds (commonly known as vocal cords), and play an important role in labor and delivery. She explains that when a woman feels comfortable, secure, and uninhibited, her sphincters will open naturally. This is one reason women groan and become vocal when laboring. As is the case with conception, opening the vocal folds can help open

other sphincters. Gaskin points out that these sphincters do not open on demand, and require privacy and intimacy. It takes time and patience to wait for the cervix to open, and this cannot be rushed. In her book, Ina Mays Guide to Childbirth, she gives a somewhat crude example of why so many women in labor are being labeled with failure to progress. If someone asked a group of men to defecate in a brightly-lit room in front of several medical staff members, it is probable that several of them would be labeled with failure to progress. Such is the case with women in labor in a hospital under pressure. While the national average of cesarean rates is at 33%, a wide-spread North American study in 2000 involving 5,418 women giving birth at home under the care of a midwife revealed that number was drastically lower, at only 3.7%. No mothers died in the study, and the mortality rate for the infants was 1.7%, which is much lower than the US national rate of 6.7% (Johnson). Compared to other wealthy, developed countries, including Australia, Canada, France, Germany, Japan, and the United Kingdom, the United States has a staggeringly high infant mortality rate. This number is based on hospital births, as home birth accounts for less than 1% of the total number of births in this country. Although home birth has been proven to be just as safe as giving birth in a hospital, many women do have one fear that is difficult to overcome when looking at giving birth naturally at home, and that is the pain of childbirth. Pain management is one reason women believe hospital birth to be a better option, but this may stem from the misconception that labor and delivery without medical intervention is much more agonizing. However, a womans body is designed for childbirth, and there are ways to lessen the discomfort. As mentioned above, changing positions during labor is an effective way to feel more comfortable. Many women also choose to give birth in warm water, relieving some of the pressure. While Lamaze, yoga, and the Bradley

Method help with controlled breathing during labor, a somewhat new technique to manage the mind has been developed called Hypnobirthing. Hypnobirthing focuses on freeing the mind of anxiety, and removing the stigma of fear attached to birthing. The concept is not to be pain-free, but to manage it in a calm, relaxed manner, and to view each contraction as a surge, (Park). One imperative concept to grasp when evaluating pain is to understand exactly what happens to a womans body when giving birth naturally. Judith Lothian explains the flood of hormones during and after labor in her article for the Journal of Perinatal Education, Why Natural Childbirth? When a woman goes into labor, each contraction sends a signal to the brain, and in return, oxytocin is discharged. As a result, endorphins are released to decrease the sensation of pain and cause labor to progress. Eventually, the endorphins cause the woman to experience a dream-like state as she enters transition. Once the baby is born, the rush of oxytocin released causes immediate bonding. Some even call the rush of hormones natures love potion. But when the feedback system is disrupted by Pitocin (a drug used to mimic oxytocin), and other interventions are performed, labor becomes less efficient. Knowing what naturally occurs is beneficial when weighing the benefits of natural childbirth. Natural childbirth can be inspiring, and the most rewarding occurrence in a womans life. One blogger, Vicki, describes the deliveries of both of her children, and the drastic difference between a hospital birth that resulted in a C-section, and a home birth that helped her feel redeemed. In her entry, From Disappointment to Triumph, Vicki tells about her first birth in a hospital. After failing to progress within thirty hours of labor, her daughter, Lyra, was born via cesarean. Obviously, I was elated to meet my baby, but I had envisioned this awesome, empowering birth, and instead I feel like I was railroaded into making choices I didnt want to make, she explains. After her disheartening labor, she made the choice to have her second child

at home under the care of a midwife. As with her first child, Vickis labor stalled at approximately thirty hours once again. However, this time, with the help of her support system, she was encouraged to give it time. This successful approach caused Vicki, giving birth at fortytwo weeks to daughter, Olive, to write, It was the single most empowering moment of my life. I cant even think about it without beaming and tearing up. Vicki is just one woman in thousands who have experienced a disappointing hospital birth. Although the awe of meeting ones child often supersedes the disappointment, many women are frustrated, and desire a change. Home birth offers a powerful experience to women who do not wish to be pressured into unnecessary medications and interventions. The peace and calm that accompanies home birth is unmatched, and has been proven safe given the right circumstances. There are many reasons to consider home birth under the care of a midwife. Women may prefer to give birth in their own beds or bathtubs, surrounded by loved ones, music playing softly, lights dimmed, allowing nature to take its course, instead of in a cold, sterile hospital being bombarded by strangers, interventions, and procedures. To believe that she is wonderfully made, and to give birth peacefully, is a brave act, and may be a womans ultimate gesture of trust in herself and her body.

References American Pregnancy Association. Epidural Anesthesia. August 2007. Retrieved from http://americanpregnancy.org/labornbirth/epidural.html. April 2013. Beier, Catharine. Best Labor and Birth Positions. April 2013. Retrieved from http://www.givingbirthnaturally.com/birth-positions.html. April 2013. Dekker, Rebecca. US Hospitals Held Accountable for C-Section Rates. January 2013. Retrieved from http://www.improvingbirth.org/2013/01/u-s-hospitals-held-accountable-for-csection-rates/. April 2013. Friedman, Howard. US Infant Mortality Rate Higher Than Other Wealthy Countries. Huff Post World. June 2012. Retrieved from http://www.huffingtonpost.com/howard-stevenfriedman/infant-mortality-rate-united-states_b_1620664.html. April 2013. Gaskin, Ina May. Ina Mays Guide to Childbirth. New York, New York. Random House, Inc. 2003. Gibbons, L., Belizan, J., Lauer, J., Betran, A., Merialdi, M., Atthabe, F. The Global Numbers and Costs of Additionally Needed and Unnecessary Cesarean Sections Performed Per Year. 2010. Retrieved from http://www.who.int/healthsystems/topics/financing/ healthreport/30C-sectioncosts.pdf. April 2013. Hall, Harriet. Maternal and Newborn Outcomes in Planned Home Births vs. Planned Hospital Births: A Meta-Analysis. American Journal of Obstetrics and Gynecology. August 2010. Retrieved from http://www.sciencebasedmedicine.org/index.php/home-birthsafety/. April 2013.

Johnson, Kenneth. Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America. April 2005. Retrieved from http://www.bmj.com/content/330/7505/1416. April 2013. La Leche League. Childbirth and Breastfeeding. April 2009. Retrieved from http://www.llli.org/docs/lad/ChildbirthandBreastfeeding.pdf. April 2013. Mayo Clinic. Labor and Delivery: Postpartum Care. June 2011. Retrieved from http://www.mayoclinic.com/health/home-birth/MY01713. April 2013. Mercer, Judith. Current Best Evidence: A Review of the Literature on Umbilical Cord Clamping. Journal of Midwifery and Womens Health. December 2010. Retrieved from http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(01)001969/abstract;jsessionid=4DCFE48EAD73A26AB85F0A68D640E138.d03t04?deniedAccess CustomisedMessage=&userIsAuthenticated=false. April 2013. Park, Madison. Hypnobirthing: Relax While Giving Birth. CNN Health. August 2011. Retrieved from http://www.cnn.com/2011/HEALTH/08/12/hypnobirth. pregnancy/index.html. April 2013. Rackliffe, Julie. Failure to Progress. NYU Medical Center. 2013. Retrieved from http://www.med.nyu.edu/content?ChunkIID=101291. April 2013. She Knows. From Disappointment to Triumph. April 2013. Retrieved from http://www.sheknows.com/parenting/articles/988341/home-birth-after-cesarean-successstory. April 2013.

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Staehler, Richard, MD. Epidural Steroid Injections: Risks and Side Effects. July 2007. Retrieved from http://www.spine-health.com/treatment/injections/epidural-steroidinjections-risks-and-side-effects. April 2013.