When it comes to discussions of home vs hospital birth, safety is usually the top concern. I suspect that cleanup is probably the second concern, but that topic isn’t going to get a whole post: as our prenatal class teacher says, “Birth washes out!”
The biggest factor in my decision for home birth is trusting that my body was built to make babies, that the biology and physiology of birth have not changed at all since long before all the technology of modern medicine, and the belief that normal birth is not a medical emergency but a natural event. I know that things can go wrong and that for all the stories of women giving birth in fields then going straight back to work plowing them there are also stories where moms and babies lose their lives (for the record, at 29 weeks, I do not feel like plowing any fields! Obviously these women are superheroes). With that said, a hospital birth doesn’t guarantee any particular outcome, and I don’t want to make decisions based on either fear or a false sense of security. For the record, Matt and I will pre-register at the hospital (which is less than two blocks north of us) and pack a bag in case we need to transfer there, and we will be attended by midwives – birth experts with a ton of experience to facilitate normal birth and recognize when things are getting not normal. I’m not choosing home birth because I don’t want to go to the hospital period, I just don’t want to go unless there’s a need for it.
Why not go to the hospital just in case? Well, statistically speaking home is neither safer nor more dangerous for a healthy woman giving birth. Midwives bring all of the same emergency equipment that would be available in a hospital room for fetal monitoring, resuscitation, postpartum hemorrhage, and they are trained to perform and repair episiotomies if necessary as well as any tearing that requires stitching (shudder). The main difference between having a midwife for a home birth and being in the hospital is that the equipment is all portable (in the hospital it’s built into the wall at the head of the bed), and there is no operating room down the hall. However, being in the hospital to start (versus transferring there from home) is no guarantee that you will actually make it into the operating room any faster because the OR needs to be available and prepped, surgical team assembled etc. This process can be started by a midwife calling the hospital to let them know we’re coming just as easily as an OB-GYN making the decision from within the hospital.
The other important thing to recognize about emergencies in birth is that they RARELY come out of nowhere. Midwives are trained and experienced in dealing with many common complications and challenges in birth, but if an issue arises that they are not comfortable dealing with in the apartment, then we will transfer to the hospital. If we transfer to the hospital during my labour it will not be because we waited until the last possible second until there was no alternative; it will be either because we are no longer comfortable letting the birth play out at home or because the midwife says we should go. Going to the hospital doesn’t necessarily mean that I will require any medical interventions either – it is possible that my transfer could result in an epidural or C-section, a forceps or vacuum delivery, but depending on the circumstances I could also still have the same kind of birth I’d have at home, just… at the hospital to be on the safe side.
For example, one reason to transfer to the hospital would be if there is meconium when my water breaks or at any time in the labour (this means the Truck has pooped. Delightful). Meconium can be a sign that the baby is in distress (or has been in distress), although it can also just mean that the baby is mature and ready to be born, hence it has moved its bowels (little keener!). The thing is, it’s hard to know what the reason is and as a potential sign of fetal distress we would err on the side of caution. However, if the Truck’s heart rate remained strong, and there were no other signs for concern, I would just labour at the hospital as normal – they wouldn’t cut the baby out of me just because it pooped! Granted, if there were further signs that the Truck was in distress, steps would be taken to expedite the delivery and that would likely involve interventions, which is what hospitals are great for, helping in emergencies.
Total side note: I just learned that expediate is not actually a word, it’s a dictionary typo from 1605 that refuses to die. Amazing!