Book Review: The Essential Homebirth Guide

The Essential Homebirth Guide is my new favorite book. It is wondrous, wise, and woman-centered. It is really the only book like it on the market for families planning or considering birthing at home. It’s also a great resource for homebirth midwives and childbirth educators looking to provide a valuable educational resource to expectant parents.

The information in the book is well-structured. After a foreword by Dr. Christiane Northrup, a welcome note, and a note from the authors, the book features twelve chapters, five appendices (on questions to ask during an interview, further reading for the homebirth family, resources for childbirth education and support, resources for higher risk mamas with homebirth hearts, and the photo credits), acknowledgements, notes, and an index. Each chapter begins with a brief overview of the contents (bullet-pointed) followed by a quotation from a mom that conveys her perspective. Every chapter is full of questions that families might ask (or might need to ask but not know that they should), followed by answers and explanations. Interspersed throughout each chapter are stories from mothers, black and white photographs, and occasionally an offset box that begins “the midwife says … “ or contains some useful, related information. The question-and-answer format really makes the chapters easy to understand. The cheerful, down-to-earth tone makes it easy to enjoy.

Chapter 1 tells the story of homebirth, giving a brief history that mentions early American midwives like Bridget Lee Fuller who caught babies on the Mayflower and Martha Ballard who practiced during the Revolutionary War era. It discusses the rebirth of natural childbirth and homebirth midwifery in the 1970s, referring to Ina May Gaskin, as well as some of the reasons that motivate families to seek homebirth today: many women are seeking it because they feel that birth is not a medical event nor should it be treated as one (p. 8); for others, it is more affordable care (p. 9); and some choose it because of deep religious convictions (p. 10). A growing number of women who have experienced birth trauma in the hospital are seeking a different kind of birth experience at home.

Chapter 2 focuses on early pregnancy, finding a care provider, and the importance of prenatal nutrition. The authors outline the distinctions amongst midwives: direct-entry midwife, certified professional midwife, licensed midwife, certified nurse-midwife, and physicians, including reference to the MDs, DOs and obstetricians who attend homebirths in some communities.

Chapter 3 focuses on what prenatal care with a homebirth midwife is like. Since midwives focus on holistic care, prenatal visits are 30-60 minutes long (compared to the average obstetrician visit, which is only 7-15 minutes long), giving the opportunity for conversations that build trust and develop relationship. Visits naturally include good, standard care: checking maternal blood pressure, pulse, weight, and urine as well as fetal heart tones and position. But mothers are involved in this process, reporting their own weight and learning how to read their own urine analysis strips. This is all part of encouraging home birthing families to take responsibility for their own self-care.

Chapter 4 discusses relationships in the mother’s life to her partner, her parents, coworkers and even strangers, and how these relationships might be affected by her desire or decision to birth at home. It gives wise advice for coping with diverse reactions to this choice. Chapter 5 is likewise about communication, specifically the importance of informed consent, crafting a birth plan for homebirth and the possibility of hospital transport, and involving family members in the plan with the understanding that it’s important not only to be informed, but flexible (since things really go exactly as we plan them!).

The authors give BRAINS as a great acronym for:

These six evaluative measures can be helpful when applied to any decision being made during the childbearing year.

Chapter 6 focuses on the birth team and different types of childbirth education. The authors note the great benefits of having a birth doula for physical and emotional support. They mention four doula training organizations: ALACE, Birth Arts International, CAPPA, and DONA. In the next edition of the book, I hope they will also mention TOLABOR: The Organization of Labor and Birth Options and Resources (https://www.tolabor.com) and BirthWorks doulas. With childbirth education, they give a brief survey of Lamaze, the Bradley Method, HypnoBabies and HypnoBirthing, Birthing from Within, and The Pink Kit. Again, I hope they’ll also mention BirthWorks childbirth education classes in the next edition, as these classes are excellent preparation for VBAC, HBAC, and homebirth in general.

This chapter also mentions a variety of other professionals and services that pregnant and birthing moms can benefit from, including postpartum doulas, massage therapists, and chiropractors as well as Mayan abdominal massage, yoga, and acupuncture.

Chapter 7 is all about special circumstances that might impact a family’s decision to have a homebirth. The authors begin by addressing risk and fear. They go on to discuss twins and breech babies. They acknowledge that some, but not all, homebirth midwives attend twin or breech births. They explain state regulations that may restrict a midwife’s ability to attend as well as the risks that make hospital-based resources useful in some of these cases.

They also take time to acknowledge the emotional impact a personal history of abuse can have on a childbearing woman. I hope the authors will expand this section in the next edition because this is such a critical issue facing a third of childbearing women today. On a related note, they discuss the pressures facing teen moms and what a great option homebirth can be for them. The story they include from the perspective of Nikki, a teen mom, is one of the most encouraging, inspiring, and witty in the whole book.

Chapter 8 focuses on HBAC: homebirth after cesarean. It’s a splendid chapter exactly in line with the BirthWorks philosophy and the principles of ICAN: International Cesarean Awareness Network (https://www.ican-online.org). It reassures mothers that home birth is certainly possible after cesarean and informs them of their options and resources.

Chapter 9 considers the “big ten” pregnancy-related issues: the emotional experience, anemia, vitamin D deficiency, Rh-negative blood, GBS, gestational diabetes, thyroid problems, common cold, hypertensive disorders, and miscarriage. The information provided is concise and comprehensible with an emphasis on prevention. As the authors say, “What is the take-home message? … 1) Make sure that the calories you ingest are nutrient dense and 2) exercise regularly” (p. 209). This is an excellent message! Good nutrition does prevent many (though, of course, not all) pregnancy-related complications.

Chapter 10 focuses on labor and birth at home. The authors discuss the importance of cleaning the house before the birth, in some detail, and what to do with pets and siblings as well as the necessity for a homebirth kit. In this chapter, they also discuss what to pack in a bag in case of hospital transport and options for what to do when a pregnancy is postdates, including out-of-hospital methods of induction. They discuss the experience of early labor, some pain relief measures for active labor (with an emphasis on water birth), and pushing out and catching the baby.

They mention some of the top reasons for transport to the hospital: fatigue, pain management, maternal fever or high blood pressure, significant blood loss prior to the birth, baby’s heart rate too low or too high, meconium in the amniotic fluid, uncontrolled postpartum hemorrhage, retained placenta, newborns who cannot maintain their temperature, and other newborn anomalies that require pediatric care (p. 266). This provides a good overview for parents and helps to foster realistic expectations.

Chapter 11 focuses on the postpartum period, including immediate postpartum care, skin-to-skin mother-baby contact, breast-feeding, and newborn medications (eye ointment and Vitamin K) and screenings (initial heel-stick and others). The authors discuss postpartum depression and how to get help for it. Happily, they note the postpartum depression is rare in homebirthing mothers, but it does occur, so it’s important to be on the look out for it. They are careful to distinguish between normal “baby blues” and PPD. In this chapter, they mention placental medicine, including encapsulation, as one option that families may use to combat PPD.

The final chapter includes, in the tradition of Ina May Gaskin’s Spiritual Midwifery and Guide to Childbirth, eight birth stories from mothers with different homebirth experiences. There is a note of realism and a diversity of experience represented in the stories. The mothers express themselves honestly, often with a great sense of joy and triumph, but they don’t over-idealize their experience. Only one says she had a pain-free birth, and none mention an experience of orgasmic birth. Perhaps these are the sorts of stories that connect to most American women’s experiences of childbirth, even at home, today.

I recommend this book wholeheartedly to expectant parents, childbirth educators, and midwives. Doulas looking to add to their resources for families should pick this book up immediately. In my opinion, it is the best book for American families on midwifery care and preparing to birth at home available today.