Is Homebirth A Green Idea? A Thoughtful Review (Part 1)

4 out of 5 leaves

4 out of 5 leaves (homebirthing is nice, but NOT for everyone!)

For almost all of human history babies have been born at home.  Over the last 100 or so years however, birth has begun to move into the hospital in industrial countries that practice Western-style medicine.  In America, hospital birth has become so ubiquitous, that homebirth is not well understood by our generation, or our mother’s generation.  However, since the 1970’s there has been a small, but growing movement to promote homebirth as a valid and safe choice for healthy, low risk mamas.  While this movement has drawn criticism from some American medical groups, today I want to explore the sustainable side of homebirthing.  Is homebirth a Green Idea?  And is it worth it?

Note: this review is intended to explore the GREEN side of homebirth.  I do not want to begin a debate on the safety of homebirth.  Numerous studies have show equivalent safety rates when comparing home and hospital births (source).  Of course, it is YOUR responsibility to do your own research and decide if homebirth is right for you.  I will delete any comments debating the safety of homebirth, only because this is not the right forum for that discussion.

The Good

  • Better for you – women who birth at home have lower rates of vaginal tearing, episiotomy, pharmaceutical drug use, and surgical intervention
  • Better for baby – babies born at home (to healthy, low risk mothers with a certified midwife in attendance) have similar outcomes as babies born in a hospital, but also get more skin to skin time with their mother, allowing them to initiate breastfeeding much more easily.
  • Better for the Earth – homebirth is a very environmentally low impact process, focusing on the body’s natural processes.  Use of electronics, disposables and pharmaceutics (which enter the waste stream) is minimized, and the clean up is limited to a small bag of trash plus one or two loads of laundry.
  • Saves time – no need to wait for child care, or pack-up and ride to the hospital while in labor.  Everyone you need comes directly to you.
  • Saves money – homebirth can offer out of pocket savings of up to 60% or more depending on the area of the country you live in and your health insurance situation.
  • Comforts of home – homebirth allows you to labor in a comfortable and familiar environment, to sleep in your own bed after delivery, and have 100% control over who is coming in and out (medical professionals and potentially unwanted well-wishers).
  • Great customer service – at the hospital you are another vagina with a baby coming out of it.  At home you are a real person who has a name other than “mom”.  More on this later….

The Bad

  • No pharmaceutical pain relief available – you need to be prepared to manage the pain of an unmedicated labor.  If you can’t handle it, you must transfer to the hospital.
  • Not all births can happen at home – even in healthy, low risk mamas, the homebirth to hospital transfer rate is around 10%.  Hospital transfer (even for good reason) can be super disappointing if you were planning a homebirth.
  • No break from home and family life – some mamas really enjoy the alone time they get at the hospital, where meals are brought to them and they don’t have to get up for anyone other than themselves.  It is hard to get this kind of atmosphere at home where everyone is used to you being the mom, regardless of the soreness of your lady bits.
  • Insurance coverage is hit or miss – depending on your type of health insurance, the type of midwife you use, and how the birth is billed, you could be stuck paying for the whole thing out of pocket.
  • Your family and friends will not understand – and their range of reactions will include questions about your sanity, hilariously ill-informed comments, concerned requests for more information, or even harassment and fear mongering in order to get you into a hospital with a “real” doctor.

My Experience

One of my homebirth deliveries.

I was born in a typical mid-western hospital.  So was every one in my family for the last three generations, as far as I am aware.  Homebirth was not something I was “raised” with or knew anything about.  Except there was this one lady at church…

She was (is) one of those fun, super chill, always creative mamas with six or seven kids.  One summer when I was a teen, she delivered a baby at home and I went with a bunch of youth group kids to visit her and wish her well.  She was tucked into her own bed at home, cuddling her sweet newborn, and with her husband attending to everything.  She told us about a very calm labor where she read portions of the Psalms out loud during contractions.  It was all serene and natural and beautiful. That short visit made a huge impression on me.

After that, I tucked away homebirth as an option in my mind.  During those early married but no kids years, I mentioned it to my husband once or twice as something I was interested in.  I don’t remember him ever questioning, or pushing back.  He just always responded with something like “as long as insurance covers it”.

My first pregnancy was a big surprise.  We had experienced fertility issues, and instead of addressing medically, had set the dream of a family aside and moved cross country so my husband could chase a dream career instead.  Needless to say, having a baby was NOT part of our first year in L.A. plans, and I panicked at the sight of a positive pregnancy test.

I was also so naive.  After seeing that no homebirth midwives were listed in the Blue Cross Blue Shield directory (haha, as if), I made an appointment with a random OB.  Our first meeting (that one where you’re supposed to interview your provider to see if they are a good fit for you), I asked questions like “so do you like delivering babies”, and “I was thinking homebirth could be cool”.  So naive.  I was totally unprepared for the OB and type of care she provided, mostly because I was totally unprepared to be pregnant.  It didn’t take too long, however, for me to get up to speed with what was going on versus what I really wanted to be happening…

Most OB visits were a series of urine tests and blood draws for reasons that were never explained to me.  I would get 5, maybe 10 minutes with the actual doctor, who always offered more testing to check on all the things that could potentially be going wrong.  She told us we should get all the testing done so we could “terminate the pregnancy” if test results were unfavorable.  This conversation did not sit well with me, especially after we had it multiple times.  When I told her I wanted a natural birth, she shrugged her shoulders and said, “sure, whatever you want”.  We never talked about things I should be doing for optimal health, or to increase chances of natural birth (good nutrition, special exercises, etc).  We never talked about what to expect, or what options for treatment were available during birth.  As the weeks went by I was feeling more and more uneasy about the OB and what may be waiting for me at the hospital.

The “Cascade of Interventions”. (source)

We decided to hire a doula to increase our chance of natural delivery in the hospital.  Frankly, I was afraid of delivering at the hospital.  Afraid that things would be done to me without asking that I didn’t feel comfortable with.  (The hospital standard of care is anything but “natural”).  Afraid that I would not be in a place to make truly informed decisions while laboring.  Afraid of the cascade of interventions.  Afraid that I would be just another vagina with a baby coming out that no one really cares for personally.  As I interviewed a very wise doula she pointed out that it sounded like I would be much more comfortable at home than in the hospital.  Then she encouraged me to MAKE IT HAPPEN!

We are very fortunate that in California, and especially in Los Angeles, there is a large network of independent home birth midwives that practice legally and have good relationships with back-up OBs.  I was able to find a Certified Nurse Midwife who lived only about 20 minutes away.  She had space for me, and at 20 weeks we made the switch.  Yay!  (Would you believe the OB’s office never contacted me after I stopped making appointments?  You would think they would at least check in to make sure everything was okay if I abruptly stopped coming.  I guess I was not very important to them at all!)

My Sweet Midwife, Mary Lou O’Brien of Beach Cities Birth Service

My midwife appointments were much different than with my OB.  Appointments lasted about 45 minutes – all of the time with the midwife.  I did my own urine dip tests and weight checks.  We spent lots of time getting to know each other, taking about nutrition, exercise,  what was happening with baby this month.  As the birth grew closer, we talked about test and care options available (i.e. GBS swab, vitamin K drops, eye ointment after birth, etc).  The choice to do any of these was mine with no pressure, and she was very good in spending time talking about the pros and cons of each choice.  We talked about what was happening in life, and how I was doing emotionally.  By the time the birth came, we were good friends, and I KNEW she cared about me personally.

I have now had three home births with the same midwife, and I couldn’t be happier! The midwife and her assistant arrive at my home within about 30 min of when we let her know we need her.   She has left me to labor alone with my husband’s support, only checking in with intermittent electric fetal monitoring as necessary.  She has done minimal, but necessary interventions when required (pitocin injection for a  post delivery hemorrhage, artificial membrane rupture followed by immediate delivery for fetal distress).  These interventions were only done, however, after true informed consent was given.

After the baby arrives and is stable, the midwife leaves my husband and I alone with the new babe for at least 30 minutes just to cuddle and bond.  This is before the cord is cut, and even before baby is measured or cleaned!  Then the baby gets a full physical exam while laying on the bed right at my feet.  Afterwards, the midwife and her team clean up any mess, make the bed up fresh, and start a load of laundry.  Meanwhile, the midwife’s assistant helps me to the bathroom and bathes me (literally cleaning blood from between my toes if necessary), dresses me and tucks me back into bed.  I feel so special and pampered!

In summary, Homebirth has been a great choice for my family!  Now, I know I promised to discuss more about the environmental impact of homebirth.  However, as I approach 2000 words on this post, it seems I have a lot more to say than I realized.  Stay tuned for Part 2, when I will go further into the case for homebirth, the green factor, and answer some frequently asked questions about homebirth.  I am by no means an expert on homebirth, but it is something that is important to me, and I want to spread the word about this GREAT option for women with low risk, healthy pregnancies!

Have you had or considered a homebirth?  Why do you think it is something that the “crunchy granola” crowd seems drawn to?

Victoria

 

Reminder: I do not want to begin a debate on the safety of homebirth.  Numerous studies have show equivalent safety rates when comparing home and hospital births (source).  Of course, it is YOUR responsibility to do your own research and decide if homebirth is right for you.  I will delete any comments debating the safety of homebirth, only because this is not the right forum for that discussion.

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34 Responses to Is Homebirth A Green Idea? A Thoughtful Review (Part 1)

  1. Lovely post. I’m having my first baby in August and really wanted a homebirth. Unfortunately my insurance doesn’t cover homebirth. They will, however, pay 100% for a nurse-midwife attended birth in the hospital, so we are going that route instead. I’m still a little nervous about the hospital, but I feel good about the midwives so hope that it turns out well. Thank you for sharing your story. 🙂

    • Victoria says:

      Oh Meghan, Congratulations! I hope you’re feeling well.

      Officially, I don’t think any of the big insurance companies cover a home birth. I know ours is explicit in letting their customers know they DO NOT cover home birth. However, you can get around this pretty easy as long as your midwife knows how to bill. My midwife submits a claim for only office visits, with the total charges reflecting her total cost for everything. So the insurance company does not see any delivery charges, and really has no way of knowing that you delivered at home. With our PPO insurance, we have been reimbursed the standard 70% for an out of network provider. For this last birth, with the new insurance company that ABSOLUTELY DOES NOT cover home birth, we just got a check for $3700, which covered most of the $4200 the midwife billed us. Note that the midwife bill covers all prenatal visits, the birth, all postpartum follow up visits, and a six month well woman visit (with pap). Just something to think about… It can take a little work to figure out the financial logistics, but it’s totally worth it IMO.

      • Thanks for your reply, Victoria. I didn’t know about insurance companies’ “official” policy vs. what they will actually pay for. It prompted me to do a little more research. I actually have Medicaid, which is possibly more strict than other insurances. In any case, certified professional midwives in Colorado will absolutely not take Medicaid. Medicaid does pay for certified nurse midwives, so theoretically I think they would cover a homebirth attended by a nurse midwife–but apparently nurse midwives who attend homebirths are incredibly rare in Colorado! I can’t find any in my area. So I guess geography matters. Makes me wish I was still living in California…:)

        Anyway, thanks again. I will keep all of this in mind for the next time around…

        • Sheena says:

          I have had to go with a midwife-assisted delivery at my local hospital for my first, and will for my second, because I wanted the midwife that brought me through my term to be with me at the hospital in case a “worst case scenario” happened. And the local hospital doesn’t have any midwives that are licensed to practice there that do home births. But I love my midwife (same for both) and the hospital is great with moms who want to do delivery without interventions. It can still be a great, wholesome experience for you. Best of luck!!

        • eema.gray says:

          I live in CO. 🙂

          In our state, a CNM must be backed up by an OB, whether she works out of a hospital or attends home births. The tricky bit for her is finding an OB who will back her up if she is attending home births. If you happen to live back in the mountains, this is probably going to be easier than if you’re on the front range or out on the plains. There is a group of CPM’s in the Denver area and you might enquire as to out of pocket costs with them. It’s possible you may be able to swing paying out of pocket for them as their costs are MUCH lower than the traditional OB’s office and hospital route.

    • Meghan, we had the same problem with our insurance. And the midwives in our area don’t do homebirths, because they can’t afford the malpractice insurance (this is the reason they gave us). Our midwife practice has 3 midwives, and each appointment you rotate through who you see, so you get to know each one. While we did end up having a hospital birth (and I SO wanted a homebirth) I couldn’t have been happier with the care received from the midwives (we are currently using them for the upcoming birth of our 3rd baby). The midwife who was there when my daughter was born was literally with us through the entire process, despite the fact that it was 27+ hours of labor- she only left for potty breaks and food breaks. She made sure that we were trying different positions, provided me with whatever food and drink I wanted, and basically just made the experience as good as possible. After baby was born, another of the midwives came to check on us the following day, make sure breastfeeding was going well, etc. If a homebirth is possible for you, that’s awesome, but if it isn’t, know that a midwife will advocate for you to continue naturally as long as possible, and that you will receive wonderful care!

  2. Tillie says:

    I have off and on considered a home birth. Here is my consideration now though – after 5 non-troubled births, and one miscarriage, I am no longer considered “low risk” (apparently.) I have never used any kind of pain medication for any of my labors, so that is not a problem – but just about the time that I’m ready to move in that direction, I may not be able to! If I get pregnant again, I guess we’ll see!

  3. Dea says:

    Congratulations on your wonderful birthing experiences. I considered home birth for my second child, as I was not assisted by a Dr. until the last 3 minutes of my first pregnancy. I figured I could do it myself just as well as I had the first time. About 6 weeks into my second pregnancy I was thrown from a horse, and had continual spotting and intermittent bleeding (heavy) throughout the remaining term. As I am Rh negative and both Husband and daughter (first child) were positive, the choice was made to take no chances. I don’t regret the decision, however I did miss the chance to have a home birth.

  4. Sheena says:

    What a great, very different approach to the home birth discussion. Many people talk about home birthing from a variety of perspectives, but I’ve never really heard the discussion from the “green” view. Nicely stated, and very politely directed/focused, discussion.

  5. Hannah says:

    loved my homebirth!! bliss (yes it hurt like heck.. a sideways poterior baby) but BLISS! (my 1st was in the hospital… not so bliss for me) I’d love if you’d come share your post with us at Eco-Kids Tuesday!!

  6. Carol says:

    One other benefit of a home birth is that mom and baby avoid being exposed to germs in the hospital. At one time I attended home births with a physician practice. If a woman’s bag of waters broke in early labor or even before labor started, and she stayed at home, the risk of infection was less.

  7. I’ve birthed four kids. First one in hospital with “finest OB-GYN in the region.” After that experience, informed husband that I would never have a baby in a hospital again.

    Second baby, at home with mid-wife. Third — in hospital (yech!) because only midwife in area could not yet deliver at home. She kept everyone away and made the experience survivable. Fourth baby, at home.

    Definitely worth it.

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  9. Dana says:

    Amazing approach to home birth. I love it. Many of us make the shift to midwife, but we don’t all make the shift to home birth. My first was born in hospital with MW. Second baby born at home with MW. Both great experiences but home Birth was perfect in every way. You described it well. It was my birth experiences that inspired me to change careers and become a birth doula. Can’t wait to read your part 2…

  10. Amy says:

    I love this ♥ I also had two homebirths — and the same two midwives for both births! — and wouldn’t have it any other way — I felt so loved and cared for and SAFE! So glad I found this!! Here are my stories 🙂 http://wildflowerramblings.wordpress.com/home-birth/my-son/
    http://wildflowerramblings.wordpress.com/home-birth/the-water-birth-of-my-daughter/

  11. raisingcropsandbabies says:

    (comment deleted by admin)

    • Victoria says:

      Hi Betsy, I am so sorry that you had a traumatic homebirth and that the recovery was so difficult. It is always impossible to tell if things would have been different at the hospital (unless you had a planned c-section prior to the beginning of labor). There is plenty of data available that shows homebirthing can be safe for mother and baby with the right support team. (I’ve linked to this information twice in my article).
      All of life is a gamble, and we never know ahead of time how things will turn out. It is each family’s responsibility to determine if homebirthing is something that is right for them, and if they feel comfortable with it. If they don’t, then by all means they should use every bit of hospital technology available to help them feel more comfortable.
      As I stated twice in my post, I am not interested in debating the safety of homebirth here. There will always be horror stories on both sides of the debate, and this blog is not the appropriate forum for that. I am truly sorry to have to delete your comment, as I stated I would. I believe this is an important conversation, but this blog is not where I want to have it.

  12. great post and beautiful pictures!

    I’m thankful that I live in B.C Canada where midwives are covered. I haven’t hired a doula and I really wish I had for both my births. Both were attempted homebirths, the first time was a hospital transfer due to meconium and being 2 weeks ‘late’; the second transfer was my choice as after 5 hours of pushing and the last hour having 3 seconds of a break between contractions- I felt too exhausted to carry on and wanted pain relief (thank God she finally dropped RIGHT as the doctor was giving me an epidural so I still ended up having a natural birth!)
    My second born is almost 6 months, and even though both homebirth attempts ended up being a transfer I would still try to have a home birth if we choose to have more babies! I’m glad to see this topic discussed as most women are highly uneducated on their options and unsure of their own ability to give birth.

    • Victoria says:

      So glad you had a great midwife team supporting you, and helping make the decision for when it was the right time to go to the hospital!

  13. My partner and I are expecting our first child together in October (she is carrying) and we are planning a home birth with a mid-wife and a doula. We have gotten mixed looks and comments from family and friends and have done lots of internal work around our own ideas about home vs. hospital birth. Our insurance will partially cover a home birth (~70%) and we are considering ourselves lucky in that aspect. It floors me that the costs of hospital births are higher than home births but insurance companies will cover less…such a racket!

    Anyhow, thank you for these two posts! The perspective and information are greatly appreciated!

  14. Cara says:

    I actually loved this post although I’m in the “hospital is for me” camp. I personally feel much safer and more “in control” (I know, that doesn’t make sense, and lots of times feelings don’t make sense!) in the hospital. Some of my favorite birth stories have been home births!!! And I know they can be VERY safe! 🙂

    I have had 4 babies in the hospital-all induced and all but 1 with an epidural. All of my labors were under 5 hours with VERY minimal pushing (funny, I’m apparently made for giving birth but getting pregnant has only happened naturally once!) and all of my babies were EXCLUSIVELY breast fed for over a year! Yay!

    I’m off to read installment 2 now! 🙂

  15. Rachel R. says:

    I am always fascinated by the differences in perspective, and how comfort levels/preferences vary. We have had three, so far, all home waterbirths (#4 is due any time now!) and (assuming all is otherwise normal), I wouldn’t do it any other way. People have told me I’m “brave” for having my babies at home but, frankly, the hospital is the scary option for me!

    I got to thinking about that again after reading on your “bad” list about the lack of time away during recovery afterward. I would hate to recover being fed nasty hospital “food” (which is never nutritious, rarely tastes good, and where they struggle to bring me something I can actually eat, now that I can’t have gluten) and being interrupted every hour or two from sleep to take vitals, etc. I would *much* rather recover at home where I can get real sleep and be fed real food!

    • Victoria says:

      Hi Rachel, I think the hospital stay can be good or bad depending on your perspective. For me, I love being at home, but I also know that when you’re home you will very likely find yourself spending less time in bed in those first days than you would if in hospital. When my second was born, I was up during the very FIRST night tending to my toddler. That was not so good. Also, I have friends who RAVE about their hospital stay, and try to stay as long as possible. So, you’re right in that it’s all in perspective.
      Congrats on (almost) number 4, and best wishes for a safe and speedy delivery!

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  17. Lovely post, we did a natural birth at the hospital for our first one, but I am definitely planning a home birth for the second 🙂

    Thanks for linking up with the Tuesday Baby Link-Up! 🙂

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  19. Liz says:

    Thank you so much for this post. I have one child and hope to have another in the near future. My first child’s “birth” was the worst experience of my life. Talk about a cascade of interventions that’s all it was from the word go. Anywho all that made me realize there must be something better but I don’t know much about such options. My first ended in an emergency cesarean with a blue limp child that was nearly dead. (Once again worst experience EVER). After reading this I would hope that this could be an option for me. However with the afore said cesarean I have been told I might not get a midwife to take me. :,-( just wandering if you know anything about this?

    • Victoria says:

      Hi Liz, My understanding is that the science says that VBACs are generally safe for most women. It really depends on the comfort level of the midwife, however. Don’t give up until you hear it directly form the midwife! Best wishes to you!

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  21. Carol says:

    Hi Victoria, I’m so happy to hear you had a hone birth with Mary Lou and enjoyed the experience! I’m pregnant with my first baby and we’re considering a home birth. Yesterday I met with Mary Lou and really liked her, but since I don’t know anybody who had a home birth is hard to have an idea of how things really are. Do you mind telling me more about your experience and if you had any regrets? That would really help us make our decision! Thanks 🙂

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