Dear Honest Midwife,
My first birth was in a hospital and it was horrible. I had a long, painful labor, and they wouldn’t let me in the tub because they broke my water. I had pitocin, which hurt so bad I had to get an epidural. Then I couldn’t push hard enough with the epidural, so my son was pulled out with a vacuum. It was the typical cascade of interventions! I was so exhausted by the time he was born I barely could hold him. My second baby was born at home and it was like night and day. My labor was easy because my water wasn’t broken, I didn’t need any pitocin and my labor was so much shorter. I barely had to push at all and when my daughter was born I was calm and happy and elated and she never left my arms. I understand that statistics say that home birth isn’t as safe, but it sure seems much better to me. I guess this isn’t really a question, just wanted to see what you thought of this.
Dear Callie,

pregnant woman on a sofa with childYour story is the classic, most common tale of home birth. Most women have their first baby in the hospital. First babies are also, by nature, the most likely to be longer, more difficult births. Some women who have long, difficult births in the hospital then go on to have their second babies at home. It seems as if the birth was better because they were at home, when in fact a second birth is very likely to be much easier just by virtue of it being second. 

Yes, there are exceptions, but as home birth midwives we generally assume that primips (first time birthing moms) are going to take longer and be tougher on everyone, mom and midwives alike. Second-time moms we usually hope to be “butter births,” easy births where the baby just kind of slips out after a relatively short labor. Third and higher births are usually comparatively straightforward as well. 

First-time moms are also more likely to experience complications compared to mothers who have had a successful vaginal birth before. Sometimes what seems like a “cascade of interventions” in the hospital is really just a series of treatments for what would have been a dysfunctional labor at home as well. We don’t have parallel universes to experiment with to know for sure with any individual birth, but I have attended enough dysfunctional first-time labors to know that sometimes an epidural and a little pitocin is absolutely needed in order to have a vaginal birth at all. 

Now that you’ve had a successful home birth, you likely feel that you would be home-free with any future home births. You likely do fall into a particularly low risk category: no previous c-sections, no serious pre-existing health risks, proven pelvis, no history of severe complications. You and your baby would have a very high chance of everything being fine, should you plan another home birth. 

Unfortunately, no home birth is guaranteed safe no matter how low-risk you are. There are mothers out there who have experienced shoulder dystocia, hemorrhage, Group B strep infection, and other harmful or deadly complications with their third or fourth babies, totally unexpectedly. Oftentimes, these complications are ones that could be prevented with professional prenatal care; sometimes they occur suddenly and must be treated very quickly for the best possible outcome. 

The great news is, you are a terrific candidate for a natural birth in a hospital! You are at very low-risk for needing interventions, and women have natural births in hospitals every day. I have attended many beautiful hospital births, and the best part is, I never have to worry: either everything will go right, or we’re already in the safest place if it doesn’t.

Honest Midwife

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