Home birth is back in the news. In early December, the British health service released new statistics on the use of midwives at home and in birthing centers. Based on these findings, they concluded healthy women were safer delivering with a midwife at home or in a birthing center than in a hospital. These findings prompted the New York Times Editorial Board to officially recommend a more welcoming approach to midwifery and home births here in the United States.
On one of her recent shows highlighting these findings, Diane Rehm noted that there seemed to be a consensus among her guests and the medical community - midwives offer a better standard of care and real lessons on how to improve the patient experience.
Unfortunately, despite the growing evidence that midwives and home births can be a safe option for mothers, my most recent discussions involving home birth have centered around a viral post on PopSugar entitled "What A Home Birth Is Like: My True Feelings Regarding My Home Birth Experience" by Ashley Martin.
In the post, Ashley shares her traumatic home birth experience that led to both her and her son being transferred to the hospital. Ashley is obviously still feeling the effects of this traumatic experience and I am so, so sorry for that.
“I have nightmares about my birth. I think about it constantly. It consumes me. It has changed who I am as a person.”
However, I am honestly troubled by the way in which she describes her journey to home birth and I think - as valid as her story is - using it to represent the dangers of home birth is incredibly problematic.
Ashley spends a lot of time describing the home birth experience she was expecting.
“I went into my home birth wanting that picture perfect birth — just like all the other home birth photos showed... I wanted a fairy tale — picture perfect birth. ”
In fact, Ashley admits to investing hundreds of dollars in birth photography. The post itself is in response to the release of these photos on the internet. PopSugar even describes the previous post as a "beautiful photographed" home birth.
I full admit to being swept up into this newest trend. When Griffin was born, having your home birth photographed was not a thing. Not to mention, due to the legal implications of our birth, photographs didn't seem like such a great idea. Amos's birth was documented but not by a professional. However, as I saw more photos and videos of home births, it seemed like such a wonderful idea.
No one loves to document more than me! Plus, these images seemed to undo all the negative stereotypes surrounding home birth and paint a VERY different visual than the imagery surrounding hospital births. Surely, that was a good thing?
Of course, after reading Ashley's story, I see the downside of "beautifully photographed" home births, especially if they perpetuate the myth of a "picture perfect birth."
Y'all, let me be VERY clear, there is no such thing as a perfect birth. The word perfect should not ever be used to describe an event during which one can poop oneself. Period.
My births were really wonderful. I gave birth to BIG babies without a ton of hard labor and with minimal pushing. I had zero intervention and great recoveries. However, there was nothing "pretty" or "glamorous" about it. I threw up. I screamed. I cried. I was unkind to my family members. I even had a few moments of panic.
Birth is WORK. In my opinion, it's the best kind of work - work where your mental and physical and spiritual selves align. I realized recently when reading about Mihaly Csikszentmihalyi and the concept of flow (what he considers to be the secret to happiness) that that is what I experience during birth - full immersion in the process and a feeling of total focus and enjoyment.
And that's where else I take issue with Ashley's description of birth.
“We shouldn’t trust birth, we should respect it.... Birth is just about luck — making sure all the stars align perfectly.”
I couldn't disagree more.
Birth is not about luck and implying that it is involves a passive acceptance of the process that too often leads to victimization and trauma. It is also not about blind trust in either your body or your caregiver - be they a doctor or a midwife.
There are million factors - many we understand and many we don't - that contribute to birth. Not to mention, every mother, every baby, every birth is special and unique and no approach - be it a midwife's or a doctor's - holds the answer to every single scenario.
There IS some trust involved and from Ashley's description it seems like her's was misplaced.
“I was misled, lied too, and manipulated. Informed consent? Hah. I wish.
I left my birth feeling broken, beaten down, cheated. I felt like no one there really cared about the most important thing: my child’s safety and well-being.”
Unfortunately, I've heard people describe hospital births in exactly the same way - people who left a health care experience feeling surprised and traumatized that what they considered to be their best interests were not being met. I've recently had this discussion with many of my close friends regarding not just birth but birth control options, infertility, and general hormonal issues.
You cannot simply hand over the decision making for your health to a provider - be it a doctor or a midwife. No one has the same values and priorities as you do. No one knows your body the way you do. No one is invested in the outcome as much as you are.
None of this is to say what happened to Ashley Martin is her fault. If she was lied to or her concerns were brushed off, then there are some real problems with her midwife and care providers that need to be addressed. Not to mention, she states that "No one was monitoring my vitals or his. No one was trained for this type of emergency." which obviously is a massive danger.
However, there are no perfect home births and we don't need perfect outcomes to decide on the safety of home birth either. Anecdotal evidence - like what happened to Ashley Martin - is not how we should assess the future of home birth in this country.
As I often say, the presence of ANY risk does not define a behavior as unsafe.
There are risks involved with ALL birth and they are not erased once one crosses the threshold of a hospital. My favorite question I get when I tell people I am planning a home birth is, "What if something goes wrong?"
The implication being nothing goes wrong at a hospital.
There are risks unique to a hospital birth. There are risks unique to a home birth. Believe me, as I plan my third home birth after a pregnancy loss due to cord injury, I have thought A LOT about these risks.
However, I cannot let the emotional and fearful voices in my head run my life. If I did, I would never have gotten pregnant again in the first place. I can't even rely solely on my previous home birth experiences - which are no less anecdotal than Ashley Martin's.
I have to look at the mounting evidence that states home birth is safe and complications rare. I have to look at the incredible experience of my midwife who has delivered over 700 babies and has encountered almost every complication imaginable. I have to look at my amazing obstetrician who supports my decision and is there in an emergency should I need her. And, yes, I have to look to my own body and build back a trust that was lost after the death of our baby.
The one thing I'm not looking for is perfection.
