Following on from my last post about the safety of all the different options of where to give birth, I realised that it’s probably not enough just to point out that home birth is as safe as birth in other environments. In order for women to make a truly informed decision about where to birth their baby we really need to consider the benefits of a home birth, and there are many. However, first things first, I want to address the top three (terrible) reasons I hear for not wanting a home birth.
1. ‘I don’t really want to have to deal with the mess’. My heart sinks and I steel myself not to say ‘Mess is nothing when compared to the life affirming joy and empowerment that a home birth brings!’ and usually manage something more along the lines of ‘Well there is usually very little mess and the midwives will clear it all up anyway’ (which is true).
2. ‘I’d quite like a home birth, but my partner’s not that keen’. Tempting as it is to just say ‘well it’s 2019 and high time you stopped letting someone else make decisions about your body’, I recognise that partners are often every bit as scared about birth as pregnant women are. They have such a positive contribution to make as ‘gatekeeper’ of you and your baby’s safety during birth, but often aren’t terribly well prepared for it. Hopefully, if this is you, encouraging your partner to read this post (and the previous one about choice) will help them to see the light. If your partner is male, it might be worth also taking a look at www.birthing4blokes.com (a great resource designed by Mark Harris, a male midwife of 20 years).
3. I’m worried that I will have to transfer to hospital as the transfer rates are quite high’. Yes, the transfer rates are high for first time mums, at 45% (just 12% for subsequent babies). But if you choose a hospital birth the transfer rate is 100%—as you will have to transfer to hospital at some point during the course of your labour in order to give birth in the hospital. This will involve an often fraught and painful car journey that usually causes at least a temporary halt in the progress of labour. If it is your first baby it is likely that the hospital will send you back home until labour is more advanced. Personally and professionally, I would take the ‘risk’ of transfer for a home birth over the certainty of transfer for a hospital or birth centre birth any day.
So back to those benefits. Your own bed, your own bathroom, freedom to roam around your house, familiar environments, comforting distractions, everything you need where it always is, freedom to have food and drink of your choice, whenever you choose to, not having to travel to hospital, not having to decide ‘when’ to travel to hospital, I could go on for hours. While all of these home comforts may be viewed as ‘nice to haves’ during labour and birth, they actually play a far more important role in the birthing process than you might think.
To understand these factors, let’s go back to a brief (I promise!) science lesson. The hormones involved during the birthing process include oxytocin, (the love hormone), endorphins, (nature’s own opiate/mega pain relief and general happy hormone), cathecholamines (adrenaline and noradrenaline controlling the fight or flight or rest and digest status) and prolactin (the ‘mothering’ hormone). This ‘cocktail of love hormones’, as described by birth aficionado Dr Michel Odent, is critical to birth. Fascinatingly, these are all controlled in the part of the brain that we have in common with mammals, the ‘mid brain’. All the processes required for labour to happen are controlled in the part of the brain that doesn’t require use of our advanced human functions (e.g speech, social awareness etc). Really, for birth to happen, our ‘human’ brain, the neocortex, needs to switch off and this is where we so often get birth wrong. Our neocortex, normally such a fundamental part of our brain, actually causes us to be the only mammals who fear birth, which is totally counterproductive to the process of labour.
Oxytocin, the love hormone, is essential during labour as it facilitates contraction of uterine muscle. It is usually present at intimate moments during our life—ranging from general human connection and compassion to sex, orgasm, birth and breastfeeding. And it’s often considered the ‘shy hormone’ as it does not like being observed! Anyone who’s ever had a pet give birth will know that no matter how hard you try and control the circumstances by providing a nice clean environment and hoping to be present, the cat/dog/horse will almost invariably choose a tiny little dark space under a bed, at the back of a cupboard or a secluded corner of a barn. Any midwife who has much experience of home birth will have lost count of the women who, irrespective of their original intention, have ultimately birthed their babies in the smallest room in the house – usually the toilet. I’ll always remember the mum who part way through her labour in hospital, went to use the bathroom and accidentally wedged the door shut with the heart rate monitor leads. To her (and my) surprise, once in this more private location she progressed rapidly and proceeded to push her baby out whilst myself and her husband desperately tried to un wedge the door!
Stimulation of the neocortex through the unfamiliar sounds, sights, smells, conversations and general anxiety that are ever-present in a hospital setting keeps cathecholamine levels, adrenaline in particular, elevated. This inhibits production of oxytocin by blocking the oxytocin receptors. To your impeccably designed, primitive birthing brain the effect is akin to trying to fall asleep in a busy shopping centre or even conceiving a baby in a hospital (as demonstrated in this video by Freedom for Birth Rome Action Group).
Despite our widespread cultural notion that birth is difficult, fraught with complication and unbearably painful, this doesn’t have to be the case and the circumstances of birth are key. Birth is hard-wired to happen. Given the right conditions, it will take place irrespective of a woman’s pain threshold, body shape or other measure we may use to undermine ourselves. I’m not suggesting it’s easy—giving birth is hard work, but the benefit of home birth is that it creates the perfect environment for hormones to flourish and birth to flow: one where anxiety is reduced, comfort is elevated and oxytocin abounds. Is that really less important than a little bit of mess (that the midwives clear up)?