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Choosing How to Give Birth: Is there a right way and a wrong way?

Health_0611_MomMore women in the U.S. are opting for giving birth at home. After years of decline, a study published in Birth: Issues in Perinatal Care reveals that home births increased by 20 percent between 2004 and 2008. Still, less than one percent of U.S. babies are born at home.

During that same time period, there was a drop in the percentage of babies born at home who were premature or had low birth weight.

"A significantly larger number of women in 2008 have chosen to opt for a home birth experience, a development that will be of interest to practitioners and policymakers," wrote the study's lead author, Marian MacDorman.

Choosing How to Give Birth: Is there a right way and a wrong way?

That's the question we asked Denise Spatafora, author of Better Birth, The Ultimate Guide to Childbirth from Home Births to Hospitals, who believes wholeheartedly in personal choice.

"Choosing how to birth, where and with who is such a subjective choice ... there is no right or wrong ... it is a powerful opportunity to understand yourself at a very deep level, and everything around the birthing experience is a reflection of that," she said.

"Also, we all should get educated on how to use our 'internal medicine chest,' meaning all the natural chemicals that run through us and how to access them. When you relax you release endorphins, which are more powerful than morphine; when you are upset, interrupted, or anxious in any way, you release catecholamines, 'fight-or-flight' hormones, which cancel out the endorphins. The idea is to not only relax during birth so you can access the hormones that will work for you, but prepare yourself mentally and emotionally beforehand to release tense thoughts and concerns, as well as having all the conversations that will leave you trusting yourself and your 'birth team.'

"There is emotional and physical pre-work to birthing and many of us do not know what that work is or how to go about it. I teach this in great detail in my book. (http://www.betterbirthbook.com/)

"I have two children, both who were born at home, and that was the right choice for me. I felt most relaxed at home, carefully chose my midwife, worked through all the back-up plans and much more. I am forever grateful I trusted myself and my choice."

Other Experts Weigh In: Pros and Cons of Home Birth

The American College of Nurse Midwives (ACNM) believes "every family has the right to experience childbirth within a context that respects cultural variations, human dignity, and self-determination."

According to ACNM, "high quality controlled trials and descriptive studies have established that planned home births achieve excellent perinatal outcomes. Home birth is also credited with the reduced use of medical interventions that are associated with perinatal morbidity. Unfortunately, studies which have not differentiated between planned and unplanned home birth and attendance by qualified versus unqualified attendants, and/or that do not clearly define appropriate inclusion criteria, have been used to discredit all home birth."

Earlier this year, The American College of Obstetricians and Gynecologists issued a statement saying it does not support planned home births. "Although the absolute risk of planned home births is low, published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births. A review of the data also found that planned home births among low risk women are associated with fewer medical interventions than planned hospital births."

Health_0611_babyAn article published in American Journal of Obstetrics & Gynecology (AJOG) last year reported that "less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation.

"Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group," according to Joseph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center.

AJOG Editors-in- Chief Thomas J. Garite, MD, and Moon H. Kim, MD, commented that "The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels."

A recent item in Consumer Reports concluded, "Home birth might be a safe alternative for low-risk women, according to some but not all professional organizations. If you're considering one, it's important to get care from a skilled and experienced practitioner. That could be an M.D., but is more likely to be a certified midwife. Make sure, too, that you have easy access to more advanced care if needed. That means knowing in advance when you would go to a hospital, where you would go, and how you would get there."

Last year, an editorial in Lancet, said, "While women have the right to choose how and where to give birth, they do not have the right to put their baby at risk. [...] "Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care."

Home Births Around the World

Around the world, a third of all births take place in the home without the assistance of a skilled attendant, according to The World Health Organization (WHO). WHO advocates for "skilled care at every birth" to reduce the 536,000 maternal deaths, 3 million stillbirths, and 3.7 million newborn deaths every year.

In the U.K., three percent of total births take place at home, and in the Netherlands, one third of women give birth at home.

In a WHO press release for May's International Day of the Midwife, the organization acknowledged that, "Midwives are essential to the delivery of quality services before, during, and after childbirth for women and newborns. A key approach of the midwifery profession is to create the conditions for women and their newborn to go through a safe, humanized and respectful childbirth experience."

In some parts of the world, women and their families have few options. In others, it all boils down to the freedom of individual choice. In order to make the healthiest choices possible, women the world over need access to information and the resources to give birth in the healthiest possible way. Skilled care at every birth - that sounds like a good place for practitioners and policymakers to begin.

Ann Pietrangelo is a freelance writer covering a wide range of issues, most notably multiple sclerosis patient advocacy, health care policy, and healthy living.

Sources: Birth: Issues in Perinatal Care; Denise Spatafora, Business Coach, Consultant, Speaker, and Author of Better Birth, The Ultimate Guide to Childbirth from Home Births to Hospitals; The American College of Nurse Midwives; The American College of Obstetricians and Gynecologists; American Journal of Obstetrics & Gynecology; Consumer Reports, World Health Organization; journal Lancet

Image copyright: photoxpress.com

Find out more about related services in the Washington area:

Fertility / Infertility Treatment; Midwifery; Pregnancy Services; Women' Health, Pediatric Medecine

Additional resources: Birthing Naturally - Is It For Me?