The CDC has released a new report on home birth statistics in the US that shows a 36 percent increase in home births among (non-Hispanic white) women in the US between 2004 and 2009. Though the numbers are still very small-- that jump brought home births to just 1.09% of all US deliveries (whereas home births by far dominate the scene in countries like Japan and the Netherlands)-- 36% is a pretty big step up. Other information included in the report, too, sheds light on some of the reasons behind the increase. Reading between the lines, I’m willing to bet-- if our healthcare and hospital systems continue operating according to the profit- over- patient status quo-- this recent upward trend will continue to climb.
You don't have to dig too deep to derive from the report what’s behind the home-birth boom. “Women may prefer a home birth over a hospital birth for a variety of reasons,” it reads, “including a desire for a low-intervention birth in a familiar environment surrounded by family and friends.” One CDC statistician told USA Today , in decidedly less vague terms, “a lot of women are worried about higher C-section rates and other types of intervention that happen once you go to the hospital.”
Birth is, after all, a natural process. And medicine in America operates on the basic premise that the body doesn’t know what it’s doing. (Case in point: the CDC also recently released a paper suggesting women abstain from breastfeeding so as to maximize vaccination efficacy... I'm not even gonna get started on that noise!). That modern medicine should, as a matter of course, serve as a kind of chaperone (at best) during pregnancy and birth is an assumption that is fairly recent, if also pervasive, in our culture; most births before the 1940s did not take place in hospitals (anyone seen the baby-birthing episode of MadMen? Things got crazy, fast, when hospitals entered the baby business...). But it’s an assumption that women are beginning to question. Particularly white women, according to the report, who account for the significant increase in home births, with a three to five times higher home birthing percentage than any other racial or ethnic group. One out of every 90 of their babies is now born at home. While these demographic statistics may not tell us exactly why these women are picking up the home birthing ball and running with it, they do clearly indicate that-- having gained a foothold with this group-- home birthing has hit the mainstream. A cultural shift is under way, as the popularity of documentaries like The Business Of Being Born, as well as alternative birthing services and-- yes!-- blogs circulate through mom-circles. They’re changing minds, beliefs, and behavior. The numbers don’t lie.
So who are these mommies, anyway? According to the report, they’re mostly married, over the age of 35, and have multiple children. Their home births are almost always planned, and are usually assisted by midwives.
There are a few interesting nuggets in there, no? Let’s start with age. The 35-and-up preggo set is, in medical birthing circles, usually treated as higher-risk, often based on age, and age alone (a 34-year-old friend of mine who recently gave birth to her daughter was classified as ‘high risk’ for this reason. She was induced at term as a result). Copious ultrasounds, possible amnios and, eventually, epidurals are just a few of the technologies utilized in bringing this population’s babies to their birth days. Yet a bunch of these moms are now going low-tech (like, birthing in a bathtub-style). And for many of them, this is not their first rodeo, even if it is their first home-birthing bash. Statistically speaking, it’s reasonable to guess that most of them have delivered at least one other baby in the hospital. So why the shift toward home birthing? These women know from experience that having babies hurts like hell... Why don’t they want the doctors? Or the drugs? Perhaps they had unsatisfactory hospital-birth experiences, or perhaps they simply realized that growing and birthing a baby, in most situations, doesn’t require DNA testing, constant monitoring or, finally, a panoply of interventions to see the process through.
The report goes on to note, “Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births.” The CDC’s deduction? “The lower risk profile of home births suggests that home birth attendants are selecting low-risk women as candidates for home birth.” But why not interpret this the other way around? As in, more low-risk pregnant women are selecting home birth attendants, in place of doctors, to oversee their deliveries. This locates the mama in the decision-making role (which-- listen up, CDC!-- she is; Midwives aren’t running around jumping healthy pregnant ladies. The pregnant women are finding the practitioners! Duh). Which makes a lot of sense, and starts to reflect the approach to birthing that countries like Japan and the Netherlands take as a matter of course. Sometimes hospital births are, of course, necessary. And thank goodness for capable, caring doctors who are ready and willing to deliver those babies! But in many places around the world-- places that also happen to have some of the lowest infant mortality rates worldwide-- midwives and home births are standard practice. Obstetricians are the backup plan.
I was 25 when Kaspar was born, but I was classified as high-risk because I’d had a blood clot in college (caused by birth control pills, which had been handed to me like candy back when I was 16). During my pregnancy, I underwent all of the (highly profitable, sometimes alarmist and usually unnecessary) tests that are available, because I was told to-- though I did not have an amnio, nor was this recommended for me. I was a nervous first-timer, and wanted all of the reassurances I could get, especially in the beginning. Frankly, an experienced doula or midwife telling me to chill out and let the magic happen would have been far more reassuring than the medical conveyor belt I rode down instead, but I took “high risk” seriously and followed doctor’s orders. (My doc did tell me, before I delivered, that I was his healthiest “high risk” patient ever... and he’s delivered a LOT of babies).
Kaspar’s delivery was induced, and while that experience itself was wonderful-- because holy cow, I had a baby! -- the post-delivery experience, in the hospital (a world-famous, high-tech NYC hospital, no less. *Cough* Mount Sinai *Cough*), felt like a brief, somewhat traumatizing imprisonment. What you won’t see in our birth story photos is the roommate I was assigned to share my small post-delivery space with (I could have had a single room for 5 grand out of pocket); she had newborn twins and smoker's cough, and she watched TV day and night at full volume. 24/7. She had to pee in a cup twice a day, too, and that cup sat on our shared bathroom floor for hours... and hours... on end. Nurses rarely stopped by to retrieve it, let alone confirm we were alive. I hobbled, barefoot, up and down the hall one afternoon in search of a glass of water. And the nurses that did occasionally appear were straight-up mean. As for Kaspar, he was healthy, but was kept in the nursery for much of our stay. I’d put a “breast ONLY” sign on his little cart, so he was occasionally whisked in for me to feed him, seemingly at random. But something was up with his eating... He couldn’t seem to get a good latch (he was brand new, after all), and once he finally did, and ate, he’d end up crying not long after. I later realized he was suffering from reflux, and-- an epiphany-- that I, as his mom, know when something isn’t right. But back then, I wanted guidance, instruction... something! My whole pregnancy and delivery had been managed by the world of medicine... I was never, in that process, reminded that I am, in fact, the expert on my body and my baby. I pleaded for a full forty-eight hours to talk to the lactation consultant that was rumored to be available on staff. She didn’t appear until about ten minutes before I was discharged, during which time I was changing Kaspar into the tiny clothes I’d brought with me, having daydreamed about this moment for months. She suggested I get a breast pump. I nodded, signed the papers confirming I’d been told a newborn should pee six times a day, and finally escaped.
Escorted home by my husband and some of our closest friends, I felt exhausted, and terrified. It was only once we’d arrived, home at last-- our fridge filled with food from friends and our apartment warm and nesty-- that I soaked for hours in Kaspar’s smell and sounds. Snuggling with him, staring at him, I felt content and calm. I felt like a mother.
Three months later, I wrote a letter to the hospital about my experience. I received a reply, an apology and a promise that changes would be made based on my concerns. I threw that letter away, and moved on, not wanting to remember Kaspar’s beginning as anything but beautiful. I’ve never written about this before. But I will say that if I could do it all again, there’s no way I’d go for the induction; my little man was baking along just fine. (I've often wondered if his initial reflux, and the food allergies that followed, would have occurred if he'd been able to bake to his self-determined lebel of doneness). I’d birth my baby right in our little nest, and indulge the bare minimum of medical monitoring required to get us there. I'd trust the process. I know other moms who had less-than-stellar hospital births, and who had a hard time getting over it. I deliberately didn’t wallow and rarely think about do-overs, because life doesn’t work that way. But if I do it again, I’m gonna try for a home birth. This shift in my perspective is based on hindsight, though, and in this way I am like the majority of women choosing to forego hospitals these days.
What about you? Have you had an experience with home birth? How about hospital experiences-- how’d those go? I know some are totally fine! Would you try a home birth next time, if you haven’t already?
As a final note, alternative health care is currently mostly paid for out-of-pocket in this country. Many women who are a part of minority groups may have only mainstream medicine as an option; although the CDC report notes that home births cost about one-third as much as hospital births (!), if a woman has Medicaid or another form of state-subsidized health coverage, the medical establishment (and pharmaceutical companies) still stand to make a small fortune off of her hospital delivery. I wonder if this is part of the reason that minority groups, as a whole, aren’t keeping pace on the home birth front? While the new data from the CDC reflects a really cool climb in women taking charge of their birthing experiences, I hope we’ll feel appropriately challenged by the demographic disparity and do what we can to get the information, and options, to all women in this country. Let’s make the next report show a continuing upward trend in home births-- and birthing options-- among women of all backgrounds!
I'm looking forward to hearing about your experiences and thoughts on home and hospital births!
PS. Extra special thanks to dfwbirthphotographer.com for the beautiful pic for this post! Mamas, check out all of the amazing birth stories and photos on the site. Wowza!
PPS. Bonus round! Here's a six-year-old sibling's adorable account of what home birth is like; Enjoy!