First of all, I just want to thank everyone who has been following me on Facebook and has contributed a story to the Birth Trauma Project. I want to assure you all that I will get back to work on reaching out and getting these stories written and posted, but with the nature of these stories being so HEAVY I felt it necessary to take a break during this time of high stress and uncertainty.
There is another matter that I wish to address, especially as I see more and more heartbreaking posts from mothers who are fearful of how the current hospital protocols and limitations are going to affect their births. It is clear that the Covid-19 virus has now made Social Distancing more crucial than ever and I wish to point out for those of you who are healthy, low risk, and currently pregnant might want to think of alternatives to birthing in a hospital.
Currently the rate of births with midwives that were planned at home in BC overall, according to Perinatal Services BC 2015/16 data, is 19%. Fraser Health has the lowest percentage of planned homebirths in BC at 12.3%.
It is entirely possible that this number has risen as more families choose midwives and consider home birth, however based on the cultural consensus that I see often in the mainstream comments threads, it’s not very encouraging that these numbers have risen significantly above the stats that we currently have available to us. From what I have heard in the birth communities, the reality is that the hospitals are not equipped to handle caring for so many sick people AND tend to so many birthing people at the same time. Beds and care providers are not infinite. The resources of the medical system need to be rationed; given out only to those in the most dire of need for them. On a GOOD day, not during a pandemic, birthing people choosing a hospital birth play a game of Russian roulette. They can’t guarantee that the maternity ward will have enough beds or enough staff. Nurses are overworked. The operating rooms are booked for other surgeries. The stories I have posted already shows that there is abuse and disrespect happening in the birth room. Now, with the possibility of birthing without support from those outside the system, it is understandably terrifying.
The high risk births and pregnancies are often suggested to be in a hospital, however “high risk” is also a relative term. When I talk about “high risk” I am referring to life-threatening complications or medical conditions. I am not including twin birth, breech birth, or VBAC in this category. These kinds of births have been done at home; in fact, I have seen multiple sites and groups dedicated to home birth of multiples, breech babies, and VBAC. It’s not a new thing. Often these groups are pushed into homebirth due to a “ban” on vaginal birth, where no hospital will “allow” them to birth vaginally. The more headstrong of these parents have decided the hospitals cannot force them into an unnecessary and unwanted surgical birth, and they find an underground midwife or even birth unassisted.
So it follows that breech, multiple gestation, and VBAC might be classified as “high risk” but may not lead to any adverse outcomes at all, should the mother/birthing person choose to birth at home anyway.
The World Health Organization determined that between 10-15% of births truly need medical intervention to prevent neonatal or maternal mortality and morbidity. That leaves between 85-90% of the population where birth without medical intervention would be safe and appropriate.
We KNOW that intervention rates are MUCH higher than 10-15% in BC. It’s all over the Perinatal Health Reports. It’s something that drives me mental every time I sit down and crunch the numbers.
So, in this time of extreme caution, we not only have the very real likelihood of unnecessary intervention in birth leading to preventable complications and birth trauma, but also we are putting ourselves and our babies into the hands of a medical system that is already at capacity on a NORMAL day and is pretty much panicking now that there’s a pandemic.
IS HOME BIRTH RIGHT FOR YOU?
So where does that leave us? Well, there’s some difficult choices that need to be made. Is the hospital truly “safer” in this time for birth, or could we lessen the burden on the system? While everyone needs to do their own research and examine what is right for them, here are a few circumstances where birth might be better planned at home.
You are “Low Risk”
If you have no major complications that would make birth feel unsafe for you at home, then you could probably be stranded in the middle of nowhere and still be able to birth on your own if you absolutely had no other option. This isn’t to say you should plan an unassisted birth, but having had a rather quick labor with my second child with no discernible pattern to the contractions and no warning before my membranes ruptured and my daughter crowned, I can say with certainty that having the IDEA of an unassisted birth already set as a Plan C made the whole experience a lot easier to deal with. Babies arrive, sometimes without warning, and often if we let birth just happen it goes smoothly. Our bodies know how to birth.
You already have a midwife
This makes things so much easier, because you already have your care provider lined up. Your midwife can attend to you at home and if you change your mind and choose to transfer to the hospital, there’s no rule saying you can’t. Most of the transfers from a home birth are due to the birthing person wanting access to pain medications. They are rarely true emergency situations.
You are “High Risk” but not really
The label “high risk” is given to anyone who deviates from the “normal birth” textbook. If you have hired a very skilled midwife, however, they might be able to assist you anyway. I personally know of a few who would respect a client’s decision even if it ruffled the feathers of the health authority. If you’re in doubt, there are also online resources that your midwife might be able to access in the weeks leading up to your birth, so they can feel more confident assisting you. You won’t know until you try.
HOW MIGHT HOME BIRTH APPEAL TO YOU?
There are many advantages to birthing at home, but especially during this uncertain time of social isolation. Obviously one of the main ones is to avoid catching the virus and either getting sick, becoming a carrier, or both. The others are what I personally found to be the best things about a home birth:
Midwife visits YOU
With the threat of this virus, you might be able to get away with more than the one home visit before birth. You would have to ask. But for at least ONE visit, with a planned home birth, the midwife comes to you. I found this to be a wonderfully relaxing visit even with my toddler plus my niece and nephew bouncing around the house. During labor, the midwife comes to assess you rather than you having to go to the hospital, risk exposure to the virus, and then find out you are NOT actually in active labor yet. Finally, after the birth you don’t have to worry about taking your newborn out of the house for at least a week, possibly even longer.
You don’t have to go anywhere
I’m an introvert, so when I was in my final month of pregnancy 4 years ago and experiencing a lot of prodromal labor it was very reassuring to me that even with all those contractions that weren’t doing anything PRODUCTIVE, I didn’t have to count them or time them. I was in complete control of when I decided to call the midwife, and until that time I just focused on getting on with my day and rested as I needed to. Knowing I didn’t have to go anywhere made it so simple to just ignore contractions and prepare the “nest” without wondering if today was the day. Even when I eventually did go into labor, I could just focus on the sensations, rest in the pool, and just labor as my body directed me to. I know that my doula did time a few contractions for a while, but they never really established a pattern and they never got intense like in my first birth until right near the end. When my water broke and I felt a head crowning already, I wasn’t panicking. I knew that the midwife would arrive soon. And after the birth, having something to eat, and having a bath, I climbed into my own bed. I think the only thing that would be different between that time and now, if I were to do it all over again, is that instead of going shopping 12 hours after birth I would be staying home.
You control your birth space
You decide who is there and who isn’t. There won’t be any random hospital staff coming into your room whom you don’t know. As an introvert, I found that to be a detestable part of hospital birth and a huge bonus of home birth to not have random strangers in my room. With this pandemic, the fewer people coming into your birth space, the better. You’re far more likely to be able to decide WHICH people get to be there if you’re at home.
You decide who to have as your support people
There has been talk in other hospitals in the US already about limiting birth support people, or excluding them altogether. I cannot say for sure that Canada would do something so drastic, but I CAN see them limiting the support that is allowed to JUST be the partner or the doula. Some hospitals are already taking such measures. Depending on how bad this whole situation gets though, it’s entirely possible that the health administrators might decide on having NO visitors or support people at all. If you’re having a home birth, you get to have whoever you want there for support.
You don’t have to figure out where to send other children
Daycares are closing. Childcare is limited in some areas or not available at all. We are being advised not to have playdates and not visit relatives. Grandma probably shouldn’t be babysitting. It’s difficult under NORMAL circumstances for some families to figure out childcare when they go into labour, but this is a whole other level of difficult. I can say this: I considered sending my son to my sister’s, and later my mother in law’s. His baby sister was having none of that and refused to come out while her brother was away. Labor just stopped and didn’t start up until weeks later. When labour started up again my husband was at work and I was caring for my almost 3 year old son. I had my doula over for support and help with my boy and when labour stopped AGAIN until the next evening I spent the day snuggled with my boy in bed. He was able to go to his swimming lessons and then go to bed. In the morning he had a baby sister to welcome and it was all very relaxed with no rush to do anything or go anywhere. With our kids now stuck at home with us and no childcare options, or very limited options that may not be ideal, a home birth might solve THAT conundrum at the very least. Kids are also surprisingly awesome helpers in labour; even the little ones.
Midwifery care and especially home birth has all been linked to a lower rate of intervention. Trying to care for a baby in isolation is difficult enough without also trying to recover from surgery or heal stitches from an assisted vaginal delivery. This is one of those advantages to home birth and midwifery care that cannot be understated. As I said earlier, I was out SHOPPING 12 hours after my birth. Should I have been out? Probably not. I didn’t suffer for it, I felt fine, and honestly I had been suffering pelvic and hip pain for months and just wanted to be able to leave the house and walk around. Obviously there won’t be any shopping after birth, but if the weather is nice, you can always go for a nice family walk in the sunshine close to home.
Home Birth isn’t the answer for everyone, but it definitely has its advantages at this time where going out into public is a major risk. We are actively trying to do our part to stop the spread and severity of a virus that the experts know very little about. Our healthcare system is already struggling to provide adequate care for everyone. For those of us who are healthy and don’t actually NEED to use these facilities and could safely birth at home, it might do well to consider it as an option. There is no law saying that once you choose home birth that you can’t go to the hospital, but there is a 75% chance that you will birth at home with no issue, perhaps even with less fear and less pain. Water birth is AWESOME! Not having repeated cervical checks is AWESOME. Being able to just do your own thing and not watch a clock is AWESOME. If you have other children, there is something reassuring about knowing that they are okay and close by if it turns out to be a false alarm and baby isn’t ready yet. Not having to make multiple trips to the hospital is also AWESOME. And who knows, maybe in just keeping home birth as a backup option for you it will give you more confidence in your birth even if you DO choose to go to the hospital in the end. You might be able to labor at home much longer, thus freeing up the resources for others who need them for hours before you, yourself, need assistance. You could free up beds faster by choosing a midwife because you can go home as early as 4 hours after birth. In a time where every bed is needed for sick people and every care provider is already overworked, wouldn’t it help to lessen some of the strain on the system and choose to stay home to have your baby?
What do you think? Would you consider a home birth if the risks of infection at the hospital or lack of support from a partner or doula became an issue?