THE HOME BIRTH OPTION: An alternative to hospitals
Getting informed is a great place to start.
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Due to current public health concerns regarding the spread of COVID-19, I am accepting late-to-care clients on a case-by-case basis. Please review the information below before moving forward with a consultation.
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The letter below was written in response to the overwhelming increase in calls for home birth care in New York by the NY Midwives. The sentiment rings true for home birth midwives across the country as we struggle to be available for women who are scared and feel incredibly helpless during the international pandemic. At our core, midwives are altruistic in nature and so often over-extend ourselves to the detriment of our own bodies, minds and our family. This past week I have received more than 3 dozen calls and emails. This rate of increase in Homebirth interest is more than I see in a single year. I have worked late into the night answering each and every inquiry in hopes that I may offer some calm in the center of this storm.
I am in daily contact with the Co-Midwifery Director at South Shore Hospital. As of today she has assured me that they are doing everything they can to keep families together and are also allowing doulas to support women. She has offered to personally speak to any woman due to give birth at South Shore Hospital to help reduce fear and have an honest conversation about hospital birth during a pandemic . This is an incredible action, given that many of the Boston area hospital have banned doulas and cannot ensure women that their partner will be allowed into the hospital during delivery. Our system is stressed to the point of breaking and the fear women feel is real. But I encourage anyone seeking to switch to Home birth to continue reading this letter. Home birth is not a choice to come from fear. It is a choice that comes from empowerment, trust in yourself, trust in your midwife and a deep belief in the Midwifery Model of Care.
An Open Letter to the Birth Community Regarding COVID-19 and the Increased Interest in Homebirth
From The New York Homebirth Collective
The care homebirth midwives provide is rooted in a genuine conviction that, for low risk individuals, birth at home is the safest option. This is not simply a philosophical attachment to the idea of "natural" birth. The evidence associated with planned homebirth with a licensed provider demonstrates a reduction in medical or procedural intervention while maintaining excellent outcomes for infants and birthing parents. (Cheney, 2014; Scarf 201). Physiologic birth has been repeatedly shown to carry benefits including but not limited reduced morbidity for both parent and infant; an effective respiratory transition for the baby; less genital tract trauma; reduction in likelihood of chronic disease related to cesarean birth/delayed breastfeeding; and decreased incidence of postpartum depression (Buckley, 2015).
During this time of unpredictability surrounding the global COVID-19 pandemic, many pregnant people are feeling understandable anxiety about what it will look like to give birth in, and bring life into, such a world. Many are grieving that what they hoped would be a time of joyful and loving anticipation has become one of fear and uncertainty. There is also rightful anxiety about giving birth in a hospital housing COVID-19 patients, as well as anxiety about hospital policies to contain the virus, such as limits on the number of support people, the wearing of masks during labor, and potential for separation from their babies. Some may be wondering if avoiding the hospital altogether is a solution to these worries and concerns. We empathize with the weight of these concerns.
We homebirth midwives are first responders committed to caring for clients in all situations including disasters and crises of all kinds. We believe homebirth remains a safe and viable option during these times. We as a community have been working closely together to develop protocols and support systems that allow us to continue to provide a high caliber of care without interruption as much as possible.
Part of what keeps our care safe now, in the time of COVID-19, is to prioritize our resources. Most of the homebirth midwives have full practices and do not have the ability to take on a meaningful amount of new clients at this time. We are not an institution that can absorb a large influx of birthing people. We also do not have access to the protective equipment that institutions provide to their providers. We are reliant on the market to order supplies – a supply chain that is rapidly dwindling.
In order to keep providing high quality, safe care, our own health and ability to serve one another in times of need are also resources we need to prioritize. Midwives, like any health care provider, put their own health and the health of their families in jeopardy every day to take care of clients no matter the circumstance. The nature of our jobs is that we cannot socially distance. The reality is that some of us will become ill during this time. Without an institution behind us to take care of our clients if we are ill, we need to rely on each other. Therefore, we have a responsibility to maintain a manageable client load so that we may support each other and keep homebirth accessible to those who have been planning for it.
That planning is in fact a significant factor in the safety of homebirth. The careful screening of clients before and during their care, as well as the developing of a relationship of trust over time, helps ensure the best outcomes for parent and baby. This not only involves medical screening in order to make sure the birthing person remains low risk throughout their pregnancy. It not only involves partnering with the birthing person to promote well being through nutrition and lifestyle. It also, importantly, involves facilitating emotional preparedness. Throughout pregnancy, we process fears and anxieties about giving birth. We develop strategies for coping with the intensity of labor and birth without analgesic medication. Clients are advised to take childbirth education classes to fully understand the physiology of normal birth. Many secure a doula. All of this work and emotional preparation make homebirth safe.
People choose to have a homebirth because they seek autonomy in their pregnancy and birth, because they believe home is the safest place to give birth, or because they desire to experience all that homebirth offers, from the intense and challenging to the joyful and transcendent. Fear and panic do not lend themselves to an empowering homebirth. This is true generally and it is true now during what is unequivocally a scary time for so many of us. If a pregnant person originally chose a hospital because they believed it to be the safest location in which to give birth, that belief continues to make the hospital the safest place for that person to give birth. Birth is a physiologic process that is greatly impacted by one’s environment and one’s emotional state. For most people, the two are inextricably linked. Homebirth with a client who does not fundamentally trust their location of birth place is unsafe for both client and midwife.
While homebirth midwives support every birthing person’s ultimate autonomy in choosing the birth space and attendant that feels safest to them, we also have reservations about the practice of “birthing in place,” or choosing late in pregnancy or even in labor, to stay home without a skilled attendant and without any planning, education, or preparation. While birth is a physiologic event, it does carry the potential for emergencies. Midwives are extensively trained and skilled in responding to emergencies (and have the appropriate medications and equipment to respond to them), but we are also highly trained and skilled in interpreting the warning signs that often precede them. The one on one expertise we provide in continually assessing and resolving elements of a labor that might otherwise result in an emergency is another important component of what keeps homebirth safe.
In sum, we believe that the anxieties and fears birthing people hold surrounding birthing in hospitals during a pandemic need to be addressed by the systems those people originally entrusted with their care: the hospitals themselves. It does not serve birthing people to birth in a place they do not trust is safe. Pressure needs to be placed on the hospital system to provide creative and humane solutions to these understandable anxieties. Given the evidence that having a doula improves outcomes for both parents and infants, guaranteeing entry to doulas as an essential and irreplaceable member of the birth team is one measure to allay these anxieties. Reducing the length of postpartum hospital stays and allowing early (6-12 hour) discharge with appropriate medical postpartum care may be another.
If pregnant people still feel compelled to investigate their options for out-of-hospital birth, they may contact me or explore the myriad resources provided by local midwives. If after diligent and thoughtful research, the autonomy and safety of homebirth remains appealing, pregnant people are always are welcome to contact individual practices, with the understanding that most practices book up far in advance.
For more information about local midwives and resources, please visit
http://massmidwives.org
I am in daily contact with the Co-Midwifery Director at South Shore Hospital. As of today she has assured me that they are doing everything they can to keep families together and are also allowing doulas to support women. She has offered to personally speak to any woman due to give birth at South Shore Hospital to help reduce fear and have an honest conversation about hospital birth during a pandemic . This is an incredible action, given that many of the Boston area hospital have banned doulas and cannot ensure women that their partner will be allowed into the hospital during delivery. Our system is stressed to the point of breaking and the fear women feel is real. But I encourage anyone seeking to switch to Home birth to continue reading this letter. Home birth is not a choice to come from fear. It is a choice that comes from empowerment, trust in yourself, trust in your midwife and a deep belief in the Midwifery Model of Care.
An Open Letter to the Birth Community Regarding COVID-19 and the Increased Interest in Homebirth
From The New York Homebirth Collective
The care homebirth midwives provide is rooted in a genuine conviction that, for low risk individuals, birth at home is the safest option. This is not simply a philosophical attachment to the idea of "natural" birth. The evidence associated with planned homebirth with a licensed provider demonstrates a reduction in medical or procedural intervention while maintaining excellent outcomes for infants and birthing parents. (Cheney, 2014; Scarf 201). Physiologic birth has been repeatedly shown to carry benefits including but not limited reduced morbidity for both parent and infant; an effective respiratory transition for the baby; less genital tract trauma; reduction in likelihood of chronic disease related to cesarean birth/delayed breastfeeding; and decreased incidence of postpartum depression (Buckley, 2015).
During this time of unpredictability surrounding the global COVID-19 pandemic, many pregnant people are feeling understandable anxiety about what it will look like to give birth in, and bring life into, such a world. Many are grieving that what they hoped would be a time of joyful and loving anticipation has become one of fear and uncertainty. There is also rightful anxiety about giving birth in a hospital housing COVID-19 patients, as well as anxiety about hospital policies to contain the virus, such as limits on the number of support people, the wearing of masks during labor, and potential for separation from their babies. Some may be wondering if avoiding the hospital altogether is a solution to these worries and concerns. We empathize with the weight of these concerns.
We homebirth midwives are first responders committed to caring for clients in all situations including disasters and crises of all kinds. We believe homebirth remains a safe and viable option during these times. We as a community have been working closely together to develop protocols and support systems that allow us to continue to provide a high caliber of care without interruption as much as possible.
Part of what keeps our care safe now, in the time of COVID-19, is to prioritize our resources. Most of the homebirth midwives have full practices and do not have the ability to take on a meaningful amount of new clients at this time. We are not an institution that can absorb a large influx of birthing people. We also do not have access to the protective equipment that institutions provide to their providers. We are reliant on the market to order supplies – a supply chain that is rapidly dwindling.
In order to keep providing high quality, safe care, our own health and ability to serve one another in times of need are also resources we need to prioritize. Midwives, like any health care provider, put their own health and the health of their families in jeopardy every day to take care of clients no matter the circumstance. The nature of our jobs is that we cannot socially distance. The reality is that some of us will become ill during this time. Without an institution behind us to take care of our clients if we are ill, we need to rely on each other. Therefore, we have a responsibility to maintain a manageable client load so that we may support each other and keep homebirth accessible to those who have been planning for it.
That planning is in fact a significant factor in the safety of homebirth. The careful screening of clients before and during their care, as well as the developing of a relationship of trust over time, helps ensure the best outcomes for parent and baby. This not only involves medical screening in order to make sure the birthing person remains low risk throughout their pregnancy. It not only involves partnering with the birthing person to promote well being through nutrition and lifestyle. It also, importantly, involves facilitating emotional preparedness. Throughout pregnancy, we process fears and anxieties about giving birth. We develop strategies for coping with the intensity of labor and birth without analgesic medication. Clients are advised to take childbirth education classes to fully understand the physiology of normal birth. Many secure a doula. All of this work and emotional preparation make homebirth safe.
People choose to have a homebirth because they seek autonomy in their pregnancy and birth, because they believe home is the safest place to give birth, or because they desire to experience all that homebirth offers, from the intense and challenging to the joyful and transcendent. Fear and panic do not lend themselves to an empowering homebirth. This is true generally and it is true now during what is unequivocally a scary time for so many of us. If a pregnant person originally chose a hospital because they believed it to be the safest location in which to give birth, that belief continues to make the hospital the safest place for that person to give birth. Birth is a physiologic process that is greatly impacted by one’s environment and one’s emotional state. For most people, the two are inextricably linked. Homebirth with a client who does not fundamentally trust their location of birth place is unsafe for both client and midwife.
While homebirth midwives support every birthing person’s ultimate autonomy in choosing the birth space and attendant that feels safest to them, we also have reservations about the practice of “birthing in place,” or choosing late in pregnancy or even in labor, to stay home without a skilled attendant and without any planning, education, or preparation. While birth is a physiologic event, it does carry the potential for emergencies. Midwives are extensively trained and skilled in responding to emergencies (and have the appropriate medications and equipment to respond to them), but we are also highly trained and skilled in interpreting the warning signs that often precede them. The one on one expertise we provide in continually assessing and resolving elements of a labor that might otherwise result in an emergency is another important component of what keeps homebirth safe.
In sum, we believe that the anxieties and fears birthing people hold surrounding birthing in hospitals during a pandemic need to be addressed by the systems those people originally entrusted with their care: the hospitals themselves. It does not serve birthing people to birth in a place they do not trust is safe. Pressure needs to be placed on the hospital system to provide creative and humane solutions to these understandable anxieties. Given the evidence that having a doula improves outcomes for both parents and infants, guaranteeing entry to doulas as an essential and irreplaceable member of the birth team is one measure to allay these anxieties. Reducing the length of postpartum hospital stays and allowing early (6-12 hour) discharge with appropriate medical postpartum care may be another.
If pregnant people still feel compelled to investigate their options for out-of-hospital birth, they may contact me or explore the myriad resources provided by local midwives. If after diligent and thoughtful research, the autonomy and safety of homebirth remains appealing, pregnant people are always are welcome to contact individual practices, with the understanding that most practices book up far in advance.
For more information about local midwives and resources, please visit
http://massmidwives.org
Get informed for you, your baby and your family. Where you give birth and who you choose for maternity care are parenting decisions.
Current Client Communications
With several current clients in various stages of pregnancy and post-partum care, I maintain frequent and open communication with each individually. But in unprecedented times like this, I feel it is important to share collectively the precautions that I will take and that they should take to care for themselves and their families. Please read this letter that I shared with my clients on March 13.
In Consideration of Home Birth
If you're reading this page, then you may have considered a home birth before, or suddenly find yourself looking for alternatives to hospital births. Here, I share a few resources to aid your consideration...
Let's Talk
Reading is one thing, but talking will help you get a much better sense of whether home birth is right for you in this time of great uncertainty, concern and confusion. Please email me or call 781.812.9445 to arrange a consultation.
Current Client Communications
With several current clients in various stages of pregnancy and post-partum care, I maintain frequent and open communication with each individually. But in unprecedented times like this, I feel it is important to share collectively the precautions that I will take and that they should take to care for themselves and their families. Please read this letter that I shared with my clients on March 13.
In Consideration of Home Birth
If you're reading this page, then you may have considered a home birth before, or suddenly find yourself looking for alternatives to hospital births. Here, I share a few resources to aid your consideration...
- 47 questions that I recommend every expecting mother should ask a prospective midwife.
- You can also hear me discuss these questions in a Pathways to Family Wellness podcast that I recorded with Dr. Brendan Riordan of Seaside Chiropractic in Norwell.
- "Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009" from the Journal of Midwifery & Women's Health
- "I’m an Obstetrician. Giving Birth at Home Isn’t Irresponsible" in the New York Times.
- "Safe, Healthy Birth: What Every Pregnant Woman Needs to Know" in the Journal of Perinatal Education
- "There’s No Place Like Home: Why Having a Home Birth is a Good Option" at jennifermargulis.net
- "Severe maternal complications less common during home births, study suggests" from the British Medical Journal
- "Birth is no reason to go to hospital, review suggests" from the University of Copenhagen
Let's Talk
Reading is one thing, but talking will help you get a much better sense of whether home birth is right for you in this time of great uncertainty, concern and confusion. Please email me or call 781.812.9445 to arrange a consultation.