First off, let me say that I definitely don’t believe that homebirth is for every woman.  Even though studies have shown homebirth to be generally as safe as hospital birth for babies and safer for mothers in low-risk pregnancies (that is, 70-90% of women), some mothers simply feel safer in the hospital and that’s OK.  Others might choose a hospital because of cost/insurance or fear of pain, two topics which will require their own posts.  What I’d like to do here is go over a few other reasons I’ve heard for choosing hospital birth over homebirth and why they might or might not be legitimate.

“It’s too messy.”

I have to admit, this was one reason I didn’t pursue a homebirth with baby #2.  After having been through one birth, I couldn’t imagine dealing with all that mess at home. Then I attended a homebirth and saw just how mess-free it could be.  Here’s a typical scenario:

• Before labor, the mother puts protective plastic of some kind on her mattress (something all women should do anyway since your water could break while you’re sleeping, even if you’re having a hospital birth).  Some women also put on old and/or dark-colored sheets.  She also gathers old towels, washcloths, and flannel receiving blankets.
• Once labor begins, the midwife puts down chux pads (the same large, disposable pads they use in the hospital) on the bed and anywhere else the mother is sitting/standing.  She covers any carpeting with tarp or flannel-backed tablecloths.
• If the mother is planning a water birth, they put tarp under/around the tub and make a tarp pathway between the tub and the bathroom.
• As chux get dirty, they are thrown into one trash bag.  If it’s a waterbirth and the mother is in and out of the tub, the wet/dirty towels get thrown into another bag.
• Once the baby is born, baby is dried off with a warmed baby blanket or a towel (if born in water).  Chux pads may continue to be replaced during and just after birth.
• After mom and dad have spent some time getting to know their new baby, mom typically gets up to shower, at which point the midwife or her assistants change the sheets (if necessary) and put down clean chux pads.  All of the dirty laundry gets thrown in the washing machine to soak, and any trash is collected and thrown out.
• The biggest hassle is the birth tub.  However, if you want a water birth in Fargo, home is the only place you’re going to get one.  Most often, the midwife’s assistant can have it emptied (with the help of a submersible pump), deflated and wrestled back into its Rubbermaid container by the time mama is out of the shower.
• Like in the hospital, you get to wear some of those fabulous adult diapers and may want to sleep on a chux pad for a few days.  You may also want one down on the bathroom floor for before and after you shower.

Most often, the house after a homebirth is cleaner and tidier than the house of a couple who labored at home but went to the hospital for the birth.  (Full disclosure: at the last homebirth I attended, even with all the precautions listed above, the baby still managed to poop on the carpet.  There’s a metaphor for life in there somewhere…)

“I like someone to take care of me.”

During pregnancy and labor, homebirth midwives tend to beat other types of practitioners hands-down.  Each prenatal appointment is about an hour long, compared to a few minutes with the average OB (appointments with CNMs may last a bit longer).  Once you go into labor, your midwife will arrive at your home as soon as you want her there and will stay with you until several hours after the birth.  She and her assistant(s) will bring you food and drink, suggest positions to ease pain and help labor progress, monitor baby’s heart rate at regular intervals, and just be present to see that you and baby are healthy and well cared-for.  Contrast that with the typical hospital birth wherein the nurses (whom you have likely never met before) are certainly present but spend a great deal of their time focusing on hospital protocol, not you.  They ask their standard battery of questions, mess with machinery, set up for the delivery, put in an IV, and, if there’s time, might offer the occasional “good job!”.  The OB (whom you also probably have never met) does not enter the room at least until you have started pushing, and may only be there for the last few pushes.  He or she will stitch you up (because you have a greater risk of tearing or getting an episiotomy in the hospital) and be out of the room before you’ve counted baby’s fingers and toes.  CNMs tend to spend more time in labor rooms, but that often depends on the time of day.  Some family practitioners get a bonus because they attend the births of their own patients; again, however, they’re typically flying in just as your baby is on her way out.

“I want it to feel special.”

This reason may have a lot to do with what we think birth should look like in this country.  You may have envisioned beginning labor, a nudge to your husband and the words, “Honey, I think it’s time!”.  You’ve thought about the drive to the hospital, being tended to by nurses and doctors day and night, your new baby lying in his bassinet in a room filled with flowers and balloons from well-wishers.  Then comes the momentous drive home from the hospital, entering your house for the first time as a family.  A homebirth, by contrast, seems a bit ordinary to some people, even anti-climactic.  It reminds me of what I thought babycare was going to be like before I had any babies: I spent my first pregnancy designing and decorating a cowboy-themed nursery for our son, painting multi-colored stripes on one wall to match the rug, hanging suede drapes, buying a crib, dresser, changing table, artwork, lamps, and, of course, a cowboy light switch plate cover.  I envisioned him sleeping peacefully in his crib, or lying on the rug appreciating the cohesion of my design.  Then baby arrived, and I realized all of my work had gone into creating a space that was used solely to change his diapers and store his clothes.  He didn’t want anything to do with all that stuff!  He needed diapers, a couple of blankets, and his mama.  That’s it.

So it is with birth: the hospital SEEMS special – it’s filled with extra special birthing stuff, after all – but low-risk mothers and their babies don’t need all that stuff.  Many women find that stuff is actually a bother during and just after birth.  Home is indeed ordinary, but that’s what’s so great about it.  Only people you’ve approved are allowed in.  They focus on you and only you, not other patients, machines, charts, or hospital protocols.  The midwife doesn’t spend the first hour asking you silly questions that you’ve already answered in the clinic (“Have you had any surgeries?  Do you have any allergies?  Do you take drugs?”).  Rather than ordinary, I would describe it as low-key, quiet, private, and intimate.

“I’m afraid I’d be cleaning the house during labor.”

I am hardly the poster child for housekeeping, but even I have some nesting instincts that kick in around 40 weeks.  (Of course, they don’t always result in a cleaner house: with baby #1, I decided our front hedges were ugly and took a hacksaw to them about 5 days before he was born.)  Frankly, housecleaning is not a terrible way to spend early labor: you’re in an upright position, bent forward, or on hands and knees, which allows gravity to help keep things moving and helps ensure that baby is in a good position for labor.  Of course, housecleaning is NOT a good idea if you are exhausted and need a nap more than you need a shiny floor.  In this case, consider it good practice for when baby is born and you are given the advice to “sleep when the baby sleeps”.  This can be difficult for some women who immediately grab a broom or empty the dishwasher once baby is napping.  Another piece of advice that people forget to give along with the sleep advice is “lower your standards”: you are entering a season where it is not possible to take care of yourself, your baby, your spouse, and your house, particularly if you live far from family (or your family isn’t all that helpful).  If you don’t think you can live with the mess, either during labor or after baby’s born, consider hiring a cleaning service once a week for a time.  Even better, hire a postpartum doula: they are specially trained to take care of new mothers and babies, including housecleaning, errand running, and meal making.

“I like the peace and quiet at the hospital – I have 2 other kids at home!”

This one is easily remedied for most people.  Presumably, the children would not be attending the birth at the hospital, and would require someone to watch them during both your labor and hospital stay.  Simply have the child minder you’ve lined up TAKE THEM OUT OF THE HOUSE.  If you want two or three days of peace and quiet with just the new baby, they can stay at grandma’s or a friend’s house or a hotel (my children look back fondly on the day their little brother was born because they got to spend the day at a hotel waterslide).  Another option would be to have someone watch them all day for a few days, then bring them back to your own house to sleep.  If there is no one but dad to care for the older children, consider a traditional lying-in period for the first week or so: mama and baby stay in bed, meals are brought to her, and she never ventures into the rest of the house lest she be tempted to tidy up or make someone a snack.  Also, remember that being in the hospital isn’t always restful: yes, someone brings you food, but it’s not that good; nurses are in and out at all hours checking on you and/or baby; plus, the beds are uncomfortable.

What other reasons have you heard for not having a homebirth?