Which is safer, Hospital or Home birth?

This morning, someone told me hospital birth was safer than birth at home.
I thought that was an interesting, yet scientifically unsupported, claim! As I am fully aware of the safety of home birth, I personally only had information on unassisted birth, so I began to look for credible studies with certified midwife assisted birth!

What I had found was incredible!
First, this article listed below shows that home birth is all around, a better option! The ones listed at the end follow in agreement.

Outcomes of Planned Home Birth with Registered Midwife versus Planned Hospital Birth with Midwife or Physician – NCBI

Planned home birth with a certified midwife vs. A planned hospital birth with a midwife vs. A planned hospital birth with a physician/OB

The most notable stats of babies born via planned home birth with a midwife in assistance:

  1. Lowest amount of perinatal deaths
  2. Lowest mortality rate over all
  3. Lowest chance of adverse maternal outcomes (postpartum hemorrhage and 3rd & 4th degree tears)
  4. Lowest rates of infection
  5. Lowest amount of intervention needed
  6. Lowest chance of pyrexia (fever)
  7. Lowest chance of birth trauma for both mom and baby
  8. Lowest cesarean rate
  9. Lowest need for resuscitation
  10. Lowest need for oxygen in their first 24 hours of life
  11. Highest maternal satisfaction

I mean, it speaks for itself! 🤷🏼‍♀️

Here are a few other articles/studies 👇

Planned Home Birth: Benefits, Risks, and Opportunities – NCBI
Planned Hospital Birth versus Planned Home Birth – NCBI
New Studies Confirm Safety of Home Birth with Midwives – Midwives Alliance
Dueling Statistics: Is Out-of-Hospital Birth Safe? – NCBI

👆 This last one concludes that a Hospital birth is not safe for low risk pregnancy/birth. No kidding!

Is your Midwife there to serve YOU? – Questions to ask a Potential Midwife

So you want to hire a homebirth midwife?

That’s a great choice! There are many great midwives that serve women all across the world. They usually serve in a more natural-minded manner, and know more about physiological birth than their obstetric counterparts.

When you go about hiring a midwife, it is important to be aware that they are not one size fits all. They are each very different, will practice differently, will have different views on what physiological birth is, and not all midwives are ideal for YOU.

When choosing a midwife, be aware that most are limited in how they can serve you, due to state laws. Most licensed midwives will not serve you completely autonomously without risking the loss of their license; which is sad – but important to be aware of, as many women are not. There are also midwives that are not bound by legalities and can serve you completely autonomously. These women are often considered Traditional or ‘underground’ midwives.
I’ve also heard of licensed midwives who are willing to bend rules and fudge numbers to ensure a safe, out of facility delivery – making you the number one priority.
Be sure you know who you have along for your journey before hiring!

Questions for Your Midwife

1. What does a physiological home birth look like to you?

Some may have a more medical version of home birth in mind with monitoring vitals, checking the cervix, and so on. Some will have a more natural flowing version where medical monitoring/assisting only occurs when needed.

2. How often do you need to monitor baby?

In some states, licensed Midwives are required to monitor baby every few minutes. This can be an unnecessary bother during labor. If this is something you’d like to avoid, be sure your midwife is able to support your choice of limited monitoring.

3. Are cervical checks ever required, if so, how many?

Most women do not enjoy cervical checks during labor. They can be hindering during labor and are 100% unnecessary. If your birth plan is to avoid cervical checks, be sure to discuss this, as some may require them.

4. What  could cause me to ‘risk-out’ of your care?

Closer to the end of pregnancy, many women are shocked when their provider tells them they’ve “risked out” of care. This means you are no longer a client and they will no longer serve you. Some midwives will risk you out for silly reasons, such as baby being breech, solely to protect their license. Be sure you are aware of every situation that could risk you out of their care before signing a contract.

5. What would necessitate a transfer during labor?

During labor, your midwife can choose to transfer you. Transfer is necessary in some situations! Unfortunately, some will choose to do so for unnecessary reasons and without warning. Of course, you can refuse transfer, but they may be required to call 911 before they leave – this then becomes your issue to deal with while you are vulnerable. Some will transfer for silly reasons such as two slightly elevated blood pressure readings, baby being breech, or “failure to progress”. Be sure you are aware of all scenarios your provider will transfer for, before labor. It is important to also discuss what you will do in the case of a suggested unnecessary transfer. Will you stay home and continue with delivery or will you do as she suggests? This should all be discussed prior to laboring day.

It’s comforting to believe that all home birth midwives have your best interest at heart, but this unfortunately is not always the case. Those are a few questions that might be able to help you decipher if she is more concerned about you or licensure.

A few things you could do to protect yourself if your midwife drops you or suggests unnecessary transfer would be:

  1. Do not pay in full until the deadline of payment.
  2. Be informed on your state’s midwifery laws and the legalities surrounding.
  3. Have a plan of what you will do in the case she drops you out of care.
  4. Discuss each unnecessary transfer scenario and what you and your partner would do if she made the suggestion to transfer.
  5. Discuss with your midwife prior to labor what you will do if she feels she needs to leave your birth to protect her license. Discuss each situation and scenario.
  6. Make sure there is a refund policy in your contract, be sure you agree with it.
  7. Be sure your partner and/or Doula are in the loop with all of the above because they will be the ones you look to for support if your midwife drops you or suggests transfer. Everyone involved should know what would cause you to “risk out” of care, as well as what might necessitate a transfer. No need for surprises on laboring day!

Final Thoughts

I’ve heard too many stories where a home birth midwife left a woman hanging, mostly for unnecessary reasons. Most times, the woman was unaware that their midwife could abandon them like they did. Most did not get any amount of refund, and many were left with traumatic births. This is what drove me to create this article. Women in their childbearing years need to be aware that this can happen. They need to know what questions to ask and how to decipher if the potential midwife is a good fit, prior to signing a contract and paying in full. She can be a sweetheart and say she supports, you but there is more to it than that.

Again, not all midwives are the same. It’s important to acknowledge that there are a few snakes in the grass. Many midwives will have your best interest at heart, will bend silly rules for you, and put you before themselves – be sure the woman you hire is one! There are amazing midwives out there, you just have to look! Keep in mind, if your midwife is driven by the law, that is exactly what she will deliver.

I am not BRAVE for Having an Unassisted Birth (Eye Roll)

If you’ve birthed unassisted, you’ve likely heard it.
“You are brave”, “You are daring”, or ” You are bold!”
Quite flattering, sure, but brave isn’t exactly the word I would use.

The women who waltz into a facility – mid labor, putting their birth into the hands of a medical provider, expecting them to successfully allow a physiological birth to take place; they are brave.

Medical birthing providers are the cause of our incredibly high maternal and infant mortality rates – higher than any other 1st world country. (Mortality rate means the amount of women and infants who die during pregnancy/child birth- we have the highest rate.) Medical providers in general are the third leading cause of death in the US due to their iatrogenic care. What a huge risk to take!

Putting your birth outcome in their hands is incredibly brave if you ask me.

Better words to describe an unassisted birther are empowered, educated, unhindered, fearless, self sufficient, capable, or confident.

What is it about staying home and allowing a physiological function to take place is brave? Bare with me here for a second.
Am I brave for taking a poop? Quite a few things could go wrong when making bowl movements. Am I brave for staying home and avoiding doctors to monitor my bowl movement process? Of course not! How silly! They are both physiological bodily processes though! Different, sure, but very similar in the same token!

People are so conditioned to believe we need medical assistance to bring our offspring earth side. This is a scary understanding to have when the ‘assistance’ has proven to be failing women and infants and is an actual leading cause of death. Allowing birth to happen with out unnecessary interventions, in a peaceful environment, with full autonomy, unhindered connection to baby, ability to get in get in your birth zone to bring baby earth side, the way biology intends, is not brave. It is the biological norm – something society has zero grasp of.

Before you tell a woman that she is “brave” for birthing the way nature intends, think about how silly it sounds. Replace it with one of the words shared above! Have you ever been told you were “brave” for having a home birth or unassisted birth? Tell us, how hard did you eye roll them in reply?!

How To Have A Gentle C-Section

When you picture a cesarean, what words come to mind first?

Cold. Quiet. Bright. Scary. Scrubs. Scalpel. Shaky. Drugged Up. Curtain. No Skin to Skin. Sore. Inactive. 

But wait! Ending up with a C-Section, whether by emergency or by choice, does not mean that you have to miss out on being an active participant in your birth!

What is a Gentle C-Section?

While a gentle cesarean is not going to do much to change the postpartum recovery, it is still a major surgery, it can reduce the trauma or disappointment you may experience, if a c-section was not in your expected birth plan. And even if it was, how neat is it to have a more active and informed surgery, right?!

A gentle cesarean is something that should absolutely be discussed with your provider prior to you going into labor, whether you are planning to deliver at home or planning a scheduled c-section, everyone needs to be on board and knowledgable about your intentions in the event of a cesarean happening! OB/GYNs that do not routinely do cesareans need to be informed on their role during the cesarean and what things will be different, which will not be much on their part honestly – just a little extra time and flexibility. If you have a doula, she can aide you in advocating for your gentle cesarean, as you will be numb, but if not make sure your partner or support person is fully informed on what exactly it is that you are aiming for.

What Makes a Gentle C-Section Different?

First things first, you will still be prepped like every cesarean mama would be; you will need to sanitize your body to prevent your opening from becoming infected, and everyone coming into the room will be scrubbed up from head to toe to keep germs to a minimum. You will be given a form of pain medication in your spine to numb you; your best bet is to ask for a spinal block instead of the epidural or general anesthesia. This will be a shorter lived pain medication (about two hours) that will get you well through the surgery, but not linger as long as the epidural and generally does not have as many side effects.

Insist on a small, low transverse scar that is to be double sutured. If this is a repeat c-section, make sure they remove built up scar tissue before suturing, so you are less likely to experience placenta accreta on your scar tissue in future pregnancies. This will increase your likelihood of a successful VBAC, if that is potentially a future desire of yours. Babies can squeeze out of a hole the size of a bagel, trust me, they do not need to cut you from hip to hip.

Leave the shawl down or ask for a transparent sheet to go in between you and the OB/GYN operating, so that you can see everything happening! Ask the OB/GYN or a nurse to talk you through the procedure and everything that is going on to help keep you fully engaged in your baby’s entrance.

Music may play during the birth to encourage a loving and soft environment. If possible, you can request that the temperature be warmed and the lights reduced just for a few minutes as baby emerges. Of course, when the OB/GYN is opening and stitching you back up, you will want them to have full visual. Have monitors turned silent and away from your face so you can be relaxed and at peace.

Allow baby’s head to be pulled to the top of the opening and turned towards you, to emerge slowly and gently. If possible, you or your partner can do this part, and still deliver your own baby! They can still do the breast crawl this way or just be pulled up to your chest for skin to skin. Delayed cord clamping should absolutely still be an option and you can almost always keep your placenta. They should allow the placenta a few moments to attempt to detach naturally, before pulling or manually removing, and it should be removed gently as to not cause any damage to your uterus.

Simply have them place the placenta in a bowl or container next to your bed for delayed cord clamping and keeping the placenta. It should not be allowed to go to pathology, except for a small sliver, if they absolutely must test.

Baby should remain skin to skin with you or your partner while you are stitched back up. After they stitch you, be sure to ask for them to swab your vagina for vaginal seeding, this provides baby with probiotics and healthy culture from your vagina that they would normally get passing through the birth canal. Baby should not be washed, especially with soap! Rub their vernix and any other fluids into their skin.

If baby must be separated from you for any reason, have someone else provide skin to skin, or at minimum stay with them, especially if you are declining vaccinations, or eye ointment.

Check out this video as an example of a gentle cesarean:

 

 

Racism in Maternal Care

You’d think we are in a time where everyone would be treated equally. Those in a professional position would not complete their duties based on the ethnicity of a person – so we would think.

If you look at the birth outcomes of each ethnicity, you will find that things are not equal. It is almost as if the providers are trained to take advantage of and disservice women of color.

If we look back in history at the “Father of gynecology”, James Marion Sims and the things he did, it isn’t hard to see where it began. Dr. Sims practiced under the racist assumption that black people did not feel pain. He would complete surgical experiments on black women without anesthesia or any type of numbing agent. When he would operate on white women though, he would use anesthesia.

sims

Sims wrote a book about his life and shared in it that he would “take ownership of the women”, and went on to share the advantages he found in working on people that were basically his property. “There was never a time that I could not, at any day, have had a subject for operation.” he stated.

sims

He would take slaves, “patch them up”, and send them back to their owners so the black woman could continue to reproduce for the owner. These women would endure hours long surgeries, screaming and crying out in pain, as he documented in his literature.

When his patients would die, it was never his fault. (You know…kind of like how OB/GYNs are today) He would blame it on, “the sloth and ignorance of their mothers and the black midwives who attended them.” – it was not anything to do with him or his experiments. Unwilling to recognize his own iatrogenic care.

The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Slaves – History
The Medical Ethics of the ‘Father of Gynaecology’, Dr J Marion Sims – Journal of Medical Ethics

Today we find that women of color are treated unfairly with blatant racial discrimination, almost as if licensed providers are trained to treat these women differently; it happens that often. Performing similar acts to what Sims did back in the day – treating them as less than.

In one study, women shared their experiences. One black woman shared that during an appointment she expressed to her Midwife that she did not feel comfortable going to her appointments anymore. The midwife replied with a racial slur, “Do you do crack?”. Blatant racial slurs were reported by multiple women in this study. How is this acceptable or professional? With so many providers doing this, it makes you wonder if they are trained to act this way towards the minorities.

black 3

Black women are 4X more likely than white women to die during pregnancy or childbirth in the US. Between 2013 and 2015, 54 black women died for every 100,000 births compared to 15 white women. These numbers are rising each year.

black

We could say “Maybe the black race just has poor health.” or “The black women’s body is biologically doomed”, but those would be comments lacking knowledge. It is not hard to see that racism is the invisible risk factor. OB/GYN, Dr. Joia Crear-Perry, wrote the article below explaining and in agreement with this unspoken truth.

Race isn’t a Risk Factor in Maternal Health. Racism Is. – Rewire.News

black 4

In the link below you can read a few first-hand testimonies from black women who experienced racism in their maternal experience:

Black Mothers Share the Devastating Impact of Racism in Maternal Health Care – Vice

Such sad stories, and the saddest part is that these stories are so incredibly common. So many women of color are disserviced by medical professionals, on a daily basis, during their childbearing years, especially in big cities or low income locations. Same as it has been since 1845 when Sims, The Father of Gynecology, began practicing with a racial bias towards black women.

It makes sense why more black women are choosing unhindered, unassisted birth after experiencing a facility birth. It has to be hard to walk into a facility knowing the disservice that is likely to occur, according to statistics.

We’d like to hear from you! What are a few possible ways that might correct this issue that is apparent and rising in the US?

When your Doctor chooses for you, They aren’t choosing FOR you.

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The practice of paternalism in the medical field is becoming more common. Where the patient is tricked into blindly trusting the doctor, because the doctor is believed to be the “educated professional”.

What many do not realize is the conflict of interest that comes with their medical suggestions. Convenience and revenue are two factors that play into a providers suggestions. For example, if a woman is 39 weeks pregnant, many prenatal medical doctors will suggest that she induces labor – at least offers it to her as an option to pick an induction date. Often times, for no medical need! Even more often, for silly reasons such as “baby is too big”, “fluid seems low”, or a slightly elevated blood pressure. Scenarios where the risk of induction outweighs the possibly benefits.

Why though?

If they induce, they won’t be called in at random hours, in the early morning, on their day off, when mom would go into labor naturally. They could schedule labor to happen when they are scheduled to be at work! How convenient! But why aren’t the risks shared?

Providers are taught medicine and how to best benefit the pharmaceutical industry. Keep in mind, the pharmaceutical industry is where their schooling/learning materials come from! If people are truly healthy and well, the pharmaceutical industry isn’t making money.

Can you say “Conflict of Interest”?

They are taught how to use medicine in all situations to medicalize the birth process. They are taught that the use of Pitocin is equal to the naturally occurring Oxytocin hormone (it is NOT), and that there isn’t significant risk in replacing the natural hormone with synthetic (there IS significant risk). Using these methods brings in revenue for the pharmaceutical companies (be it from insurance or government funding, money is still made). They are taught to use these means even though it is proven healthiest to leave the natural birth process alone to unfold naturally. Often times when a woman is induced, her body isn’t ready for labor. NO KIDDING! She then might run into complications such as poor fetal heart rate or poor blood pressure, then is rushed off for an emergency cesarean. Again, NO KIDDING. This, in turn, bringing in more revenue. All while the doctor ! This is pretty textbook here in the US as well as many other countries.

It is important to make your own informed decisions regarding your birth and baby. You do not need a degree to research or make an educated decision. Never let a doctor sway you into doing something that make your instincts scream “NO!”. After all, when your doctor is choosing for you, they aren’t choosing FOR you. To believe your best interest is always at heart, is ignorant. Take this time to look up what the 3rd leading cause of death in the US is, then reconsider taking their advice!