Ash Dasuqi gave birth to her first child last July. It was at home under the care of a midwife. The soon-to-be grandparents feared her decision would result in pain and complications. But Dasuqi was convinced she made the right choice. She had a smooth, drug-free labor, and a satisfying experience.
Dasuqi said much of her confidence came from her own research and education. She is currently working as an emergency room nurse in Ohio, but she has also been observing births over the last couple years in training to become a midwife. She looks forward to sharing her positive experience with other women.
“I feel passionate about providing families with the opportunity to have their children in the familiarity of their home instead of feeling like their only option was to go into a medicalized institution for their birth experience,” she said.
For most of human history, women helped their fellow women through the birthing process. That all changed at the end of the 19th century with the advent of modern obstetrics. Over the last 100 years, doctors have taken the reigns from midwives, and birth has moved from the home into the hospital.
Today, U.S. women overwhelming choose an obstetrician to deliver their baby. In 2012, midwives delivered eight percent of babies born in the Unites States, according to the National Center for Health Statistics. Less than two percent were born in the home.
But not everyone is sold on the American model. In Sweden, Germany, Japan, and other industrialized nations, new mothers are more likely to choose a midwife to guide their birth. In the Netherlands, most mothers prefer to give birth at home.
Over the past few years there has been a growing interest among U.S. mothers to explore birthing alternatives, and a backlash from doctors who consider this a worrying trend.
In 2008 the American Medical Association pushed for legislation to steer mothers away from home birth, citing that the “safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex.”
But restricting freedom of choice is always a hard sell, especially when some studies suggest that home birth is a safe option with fewer complications for healthy women.
“Birth is a normal process,” said Dasuqi. “It’s not a disease process. It’s not a pathology. For the default to be that it needs to be in a hospital, that’s a paradigm that we’re hoping to shift.”
Choosing by Fear
A home birth has risks, but so does a hospital, and a small but growing number of women would rather take their chances at home.
Studies show that birth outcomes are better when midwives rather than doctors lead the event. Most studies also report more maternal satisfaction in the midwifery-led model. But Dasuqi says fear is a big reason why mothers-to-be often reject alternative birthing methods.
“There is a common fear based mythology that floats around out there. It’s a feeling of better safe than sorry, and/or you’re making a selfish decision because this is not in the best interest of the baby if you’re not in the hospital if something goes wrong,” she said.
“That thought can be more than some women can handle. And yet for other people, there’s a realization that I am making a decision that is ultimately best for me and my baby based on the knowledge and the information that I have, and based on my intuition.”
Much of the problem stems from basic birthing ignorance. The vast majority of American women never witness an actual birth until they experience one on their own, and the picture they hold can be skewed. According to birthing educator Jo Anne Lindberg, most of us get our knowledge from overly dramatic portrayals from movies and television.
“They show that pain is unmanageable and that it’s always a crisis. It’s always this doctor who has to rush in and save the baby and the mother,” Lindberg said. “That isn’t what happens in most births if they’re allowed to progress on their own. It’s very quiet and very boring, clearly unsexy, and doesn’t sell a lot of stories.”
Lindberg is the president and founder of Birthlink, a Chicago-based service that teaches parents about birthing options. Lindberg’s consultations consider everything from where to have the birth to who will lead it based on the mother’s individual needs. She says more new mothers would be interested in alternatives if they understood the drawbacks of the conventional model.
Modern Interventions
Until about 20 years ago, nearly all babies were delivered vaginally, and surgery was reserved only for serious emergencies. In 1965, only about five percent of U.S. births resulted in a C-section. Since the mid-1990s, C-sections account for more than one third of all deliveries.
While a few C-sections are medically necessary, such high numbers suggest that many done in the U.S. are not. Some women request one to avoid the pain and bother of a vaginal birth (about one percent according to Childbirth Connection). However, with no clear reason to account for so many, medical organizations put out new guidelines for doctors last year in an effort to lower the C-section rate.
Some say the system itself is the problem. Lindberg describes a domino effect of birthing interventions that she says leads to otherwise healthy mothers now enduring major abdominal surgery to birth their children.
“The medical model is pretty much: you get induced, and you get an epidural because the induction makes the pain management practically impossible. Then your body can’t function because you’ve got all these medications in your body messing up with the hormonal system,” she said. “Doctors also don’t like to wait. They don’t have the patience, and they have very strict protocols. The more lawsuits they get, the more strict the protocols become, and the worse it becomes.”
Compare the conventional birthing model to Dasuqi’s experience. She had a relatively swift nine hour labor, no drugs necessary. She credits her experience with her midwife’s support, and the relaxed atmosphere of her own home, which allowed her to focus all her energy on the task at hand.
“Through every contraction I ended up just finding myself meditating a lot on opening up and trying to surrender to those contractions as opposed to tensing up against them and fighting them,” Dasuqi said. “In the hospital you really aren’t afforded the same capacity to go into a meditative state like that.”
Lindberg observes that mammals typically seek a birthing environment that is dark, quiet, and calm. “Does that sound like a hospital? We joke a lot about how our pets and farm animals get better treatment than humans, because vets and zookeepers understand these things,” she said. “They say, ‘leave the mother alone, don’t aggravate the mother.’ I wish we would apply these things to us.”
Birthing Choices
Most everyone agrees that home birth is an option for low risk pregnancies only, and anyone with any sort of risk is better off at the hospital.
However, there may also be reasons why an otherwise healthy mother would not feel comfortable about a home birth. Lindberg gave birth to her two children at home, but she says it isn’t for everyone. “The mother has to believe in it,” she said. “No matter what she thinks in her brain, she has to truly believe it in every cell in her body or she’s probably not going to be able to pull it off. “
Most parents choose to work with a midwife in a hospital or at a birthing center rather than at home. Lindberg’s goal is to guide the mother toward environment where she feels safe and relaxed because it makes the process a whole lot easier.
“A lot of people come to me wanting me to explore the possibility of having a home birth. They’re not sure. They heard about it. How does it work? They have a lot of concerns. So I help them work through that,” Lindberg said. “Often the dad is not trusting that a less intervention-oriented choice, even with a midwife in the hospital, is going to be the best thing for their mother and baby because they don’t know about it. They don’t trust it. And I often have couples work through that too.”
Training among midwives varies widely, but there are a few credentials to consider. A Certified Midwife (CM) and Certified Nurse-Midwife (CNM) both possess graduate level training that meets the requirements of the American College of Nurse-Midwives. A Certified Professional Midwife (CPM) meets certification standards of the North American Registry of Midwives, which specifically includes training for facilitating a home birth.
Direct Entry Midwives (DEM) do not have to complete traditional nursing training like the certifications mentioned above, although some may have some Master’s and doctoral programs as part of their education. DEMs can obtain a state license through an apprenticeship program.
Styles among midwives can vary too. While midwifery is often associated with home birth, many midwives work exclusively in hospitals. Others prefer birthing centers (facilities that provide a comfortable birthing environment with access to emergency treatment if a problem arises). Some midwives tend toward more conventional interventions, while others support a less invasive approach.
Certified midwives can do everything an OB-GYN can do except surgery, but they may also possess skills that you won’t find in a conventional birth. Dasuqi says a good midwife develops an intimate relationship with the mother and family so she can address emotional and psychological issues that might emerge during labor, such as past sexual trauma, fear of complications related to a previous birth, or other problems.
“[The midwife] might ask, ‘what’s the one thing you’re most afraid of right now?’ And the mother may say something like, ‘I’m really scared that my partner isn’t ready to parent and I’m just going to be a parent all by myself.’ So the midwife might seriously deal with that situation right then and there, and talk to the partner because the fear is really stalling her labor,” said Dasuqi. “I think that’s a pretty profoundly underrated skill that many midwives develop that saves women a lot of different interventions and issues.”
Cost
Another factor that guides birthing decisions is cost. The price of a conventional hospital birth can vary tremendously. According to a 2014 study looking at hospital birthing prices in California, charges for an uncomplicated vaginal delivery ranged from $3,300 to over $37,000 depending on the hospital. For a C-section, women were billed between $8,300 and nearly $71,000.
A home-based, midwife-led birth is typically much less expensive than an OB-GYN, but it’s the price tag that parents see that has the biggest impact.
“If they have a home birth and have to pay $4,500 out of pocket, that may be a show stopper,” Lindberg said. “But people who’ve done their homework and the research, and really know what they’re talking about and can afford that, that’s not a really big deal to them. They plan ahead and make it a priority.”
