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I got an email recently from Ruth who says she wants a home birth with this second pregnancy she's carrying. Her first labor was "perfect" and lasted only 6 hours. She wants to use a midwife (didn't say if it was a certified nurse midwife or a "lay" midwife) but says the "one and only midwife" will be out of the country. She's booked a room at a hospital she's not crazy about as a back up plan and has a general practitioner who's supportive. I'm confused now. If the midwife's not going to be there, who's delivering the baby? She says her husband was very supportive with her first, easy birth. Is he delivering the baby? Yikes. That's not such a great plan.
First of all, a word about home births. I'm neither for them nor against them. Lots of babies are born with excellent home-care and everything goes smoothly for mom and baby. I know lots of women who've had wonderful home births attended by good midwives. They're totally healthy and have no medical issues that should keep them from doing it again. I'm partial to certified nurse midwives because they have excellent, comprehensive training that covers the whole gamut from normal to catastrophe in the labor and delivery world. Those that do home deliveries have established relationships with back-up obstetricians to take care of their patients at the hospital—just in case.
There are plenty of lay or direct entry midwives out there doing lovely home births too; many with enough wisdom and experience to do top-notch work. Their training is primarily hands-on at the feet of experienced midwives, hopefully with a generous smattering of book-learning too. The problem is that anyone can call herself a midwife. That doesn't guarantee they know what they're doing (certification doesn't guarantee that either but at least it's something).
As a hospital nurse, I see the patients who've labored at home for far too long and come in with serious problems— the homebirths gone bad. We see women whose water has been broken for days. They have a raging fever and their baby's heartbeat is dangerously fast. Their deliveries result in a mom and baby with infection, a trip to the NICU and a whole lot of antibiotics, probably after an emergency cesarean section. We see women who've been pushing for 12 hours with no success. They too get a cesarean and then deliver an exhausted, bruised baby who will visit the NICU. Or worse, the baby has died and mom is in lousy shape, because the midwife didn't know enough to bring them in sooner. As for Ruth, just because baby number one was a breeze, doesn't mean baby number two will be. If she's planning on her husband being the midwife, she's a set up for trouble. Maybe she'll get lucky and the baby will fall out with no problems. Maybe not. Maybe the placenta will sheer off the uterine wall and she and the baby will hemorrhage. Maybe the cord will be so tight around the baby's neck that it will strangle itself. Maybe she'll have a vaginal tear that won't ever heal properly without expert needlework. Maybe the baby won't be able to tolerate the stresses of labor and her parents won't know because they don't know how to tell. An experienced midwife knows how to deal with problems like this. Inexperienced husbands don't.
Birth is unpredictable. True, most are normal. We do too many cesareans. Hospitals aren't the only place to have a safe birth. A home birth without skilled medical care is not a good plan though. My advice for Ruth? If you don't have a midwife, don't have a home birth. Maybe you're not crazy about your hospital but they're a better option for quality care than your husband. Go to your general practitioner (usually a family practice doctor who delivers babies) or find an obstetrician who is aligned with your birth wishes and get good care. Then work out the details of your hospital labor together.
The usual advice is to labor at home (barring any problems) until you're in active labor then head to the hospital. If baby number one was born in only 6 hours, baby number two might come quicker. Be prepared. But don't take any unnecessary risks. If anything goes wrong because you stayed home and didn't have skilled care, you'll regret it the rest of your life.
Got a question for Jeanne? E-mail it to firstname.lastname@example.org and it may be answered in a future blog post.
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