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We Must Do More to Honor Birth as a Peak Life Experience

by Molly Wales, CCE(BWI)

Excerpts from a talk given on Labor Day Weekend, 2012, at the Unitarian Universalist Fellowship of Athens, Ohio.

Molly with her newborn daughter
 My name is Molly Wales.  I am the director of The Birth Circle (a consumer birth group) in Athens, Ohio, and am a BirthWorks childbirth educator.  I’m here today to talk to you about why I believe that we aren’t doing enough in our country to honor birth as a peak life experience.  Perfect for Labor Day!
A short review of where I stand:  I believe that all people are deserving of equal treatment and opportunity.  I believe that a woman is born with the knowledge of how to give birth, and that if Mom can give birth with people who make her feel safe and secure, she’ll be able to follow her instincts and her body and her baby will know just how to work together.  I believe that a woman should have the right to give birth wherever she pleases, with whomever she pleases.  And I believe that birth is a hugely pivotal moment in life, and that the birth experience has a life-long impact on the mother, the child, and on their relationship.
These views do not represent the norm in our society.  Americans, in general, are taught not to trust birth.  Many, if not most, fear it.  And so we keep developing new ways to manipulate and change what already works. And as we force our control like this, the effects are disastrous.
According to a recent Amnesty International report, “The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 49 other countries, including Kuwait, Bulgaria, and South Korea.”  What?!  WHAT?!  Why is this happening?  What has gone wrong with maternity care in our country?
Imagine a mom has her first visit with her care provider, be it an OB or midwife.  She’s told, “You are capable of having this baby without drugs.  And if that’s what you choose, we will support you in that.  If you or baby needs medical attention, we’ll be here.  But otherwise our job is to let your body do what it was created to do.”  If that were that norm, we wouldn’t be in such a crisis.  Rates of intervention would drop substantially, and our moms and babies would be healthier.
But that isn’t the kind of support that moms in our country generally receive, unless they choose a home birth assisted by a midwife.  Because OBs and hospital-based midwives work under protocol and deadlines that rush the process and place little to no value on the emotional importance of the experience.  Now I don’t mean to say that the OBs and midwives themselves don’t value the experience, necessarily, but rather that they are put under restraints that severely limit what they can do to honor birth as normal and natural, and to work with a mother on her body’s own timeline.
For example:  One of my students recalled going in for her very first visit with her OB, to talk about her exciting new pregnancy.  The doctor told her, “You’ll go into labor, you’ll come to the hospital, and we’ll get you an epidural.”  Notice the commands.  Notice the lack of choice.  Notice the complete failure to acknowledge this mom’s innate ability to give birth to her baby on her own.  In one short sentence, her power was robbed from her.
Or another student, who, while having a perfectly normal labor at the hospital, noticed that everyone in the room kept their eyes fixed on the monitor, telling her when a contraction was coming, telling her how hard it was…when all she wanted, needed, was some eye contact, someone to acknowledge that SHE was doing the work here, and that she was a healthy human mother, not just another illness hooked up to a machine.
And so most moms, at least in our country, never get that chance to realize their own power, that chance to feel accomplished as a mother, right from the very start, those sensations of labor that combine intense vulnerability with unimaginable atomic power.  When a woman gives birth naturally, she has to open up, physically and emotionally, to greet her baby.  It is an incredible start to the mother-child relationship, one of deep bonding, as mom and baby work together through one of life’s greatest challenges.  If we in the U.S., this world power, honored birth as the baby’s start to life-long mental health, and as the mother’s chance to untap her human potential, just think of how we could empower whole generations of women and children.  I remember saying to my little Lola, six short months ago, as I held her there on my living room floor in the darkness of the morning, “We did it, honey, we did it!”  So she was born into that joy, that total soul bearing, that pride.  What an advantage for us both. And I am no extraordinary woman.  Most healthy women are capable of having their babies without medical intervention.  Now certainly homebirth isn’t the right choice for every woman, but imagine what a difference that would make, in our country and in the overall state of our planet, if the majority of mother-baby pairs were trusted, unrushed, and just given a chance to let their bodies work in their own way.
But they aren’t.  Instead most pregnant women in the U.S. are highly uninformed.  They are treated as if their pregnancies are an illness. In labor, they are offered drugs when they should be offered emotional encouragement.  And yes, of course, a healthy baby and healthy mom are the most important things.  But they aren’t the ONLY important things.  There is a chance there for a peak life experience, for both mom and baby, a chance for that relationship to begin with a surge of strength, hormonally and emotionally, that fortifies them for years to come, if not for their whole lives.
In the end, it’s all about creating a peaceful world, isn’t it?  And where better to start, than our barest beginning.
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How caregiver inquiry can shape prenatal care and birth experiences

By Anna Holder, CCE(BWI)

“What’s your cesarean section rate?”
“What is your episiotomy rate?”
“May I eat and drink during labor?”
“May I have a doula/ lots of family/ a photographer at my birth?”

Women and their partners are often encouraged to ask these and similar questions when selecting a care provider for their pregnancy and birth, the theory being that the provider who provides the answers the woman and her partner are looking for will provide safe and effective care. What about compassion, satisfaction in the birth process and empowerment of the woman and her partner? 

The answers are in the questions — the questions that the provider asks, that is.

When a doctor or midwife goes beyond impersonal lifestyle surveys and “intake” questions, they are able to establish a relationship of trust with their client. They are also gaining a unique and in-depth look into the lives of their clients. Conversely, women and their families are given a strong voice and are invited to become true partners in their care and birth process rather than obedient “patients”. If a provider can not be bothered to ask in-depth questions or encourage the birthing family to research both scientific evidence and their own personal realities, why would that provider value the laboring woman or her support team in the throes of labor? Moreover, if the woman and her care provider have not explored these issues in the relative calm of the prenatal period, how will the relationship between them play out in the excitement of birth?
Some questions prospective caregivers should be asking women are:
  1. Tell me about your previous births or experiences with birth. What did you like or not like about them?
 This question encourages reflection on the part of the woman and her partner and identifies possible fears, expectations and goals. When started early, this dialogue can build a foundation of trust between provider and client as well as between the woman and her partner. It also helps to create a framework of what client and provider are working towards in regards to maternal and fetal health and birth process.
 I once had a client who wanted a vaginal birth after cesarean (VBAC). Her primary cesarean was for a breech baby where no option for External Cephalic Version (ECV) was offered. She was separated from her child for 3 hours and suffered Postpartum Depression. Upon learning of her second pregnancy, she chose a different provider and place of birth. When it was found that her second child was also breech, she was encouraged to try herbs, acupuncture and positional techniques before being offered an ECV. When the version was unsuccessful, she chose to go into labor on her own before a repeat cesarean was performed. She was never separated from her child and reported a great deal of healing from her first experience. As she had explained her hopes and fears to her doctor, she had her wishes honored and had a respectful birth. 
  1. Why do you want to have or avoid particular tests or procedures? Have you read about the risks and benefits?
Asking this question sets the stage for informed consent or refusal and promotes research and accountability for the birthing family. When families are encouraged to participate in their care and hold some level of responsibility for it, they are more likely to make well thought out choices in addition to feeling more satisfaction with their experience.
The safety of VBAC is well documented. However, many obstetricians dissuade women from pursuing this option in spite of the most current recommendation by the American College of Obstetrics and Gynecology (ACOG) endorsing trial of labor after cesarean(s) (TOLAC). Even a cursory exploration of the current research would provide those wishing to have a VBAC with ample support of their goal.
  1. What are you eating? How can I help you incorporate healthy changes?
Simply telling a woman not to smoke, drink alcohol and avoid sushi is not the same as ensuring proper protein intake and identifying any potential deficits in diet. By dedicating ample attention to nutrition, mother and baby can achieve optimal health while avoiding complications from morning sickness to pre-eclampsia.
I know of a woman who was planning a home birth with a midwife. At her home visit it was found that her blood pressure had elevated after she had been following a strict diet and herbal regime. After asking more questions and a tour of her cupboards, it was found that a powdered tea beverage the woman was drinking daily was delivering a whopping 27g of sugar.  The midwife counseled her that this was not helping her pressures and could make her already presumably large baby bigger. After removing the beverage, the woman went on to have a healthy 8lb 15oz baby at home 3 weeks later. (Okay, okay, the woman was me, but I still haven’t had any more chai).
Just as a provider’s cesarean rate doesn’t always belie their philosophy about birth, the number of births a woman has had doesn’t illustrate the unique circumstances present in her current pregnancy. The earlier providers establish a deep dialogue, the more compassion and satisfaction are united with safety and efficacy to provide better outcomes for moms, babies and providers.
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Supporting Women Without Epidurals

Presentation at the Virtua Voorhees Hospital
by Cathy Daub,  PT
Photobucket
I recently gave two presentations on “Supporting Women Without Epidurals” at Virtua Voorhees, the local hospital in Marlton, NJ. The hospital has approximately 5,500 births per year and  a 43% cesarean rate.  New Jerseyand Floridahave the highest cesarean rates in the country.  My audience consisted of doctors, midwives, doulas, labor and delivery nurses, and the nursing supervisor.  One doctor stayed for both presentations.  At the end she stood up and said to everyone, “I think it is time for Virtua and BirthWorks to have a relationship with each other.” 
They were very interested in hearing what it means to have an emotional preparation for birth as well as an academic preparation.  Human values, pelvic bodywork, grieving and healing, and primal health are not part of their current childbirth preparation curriculum. They do not see underwater births because they have no birthing pools.  So many women give birth with epidurals there, that they are not as familiar with the fetal ejection reflex and behaviors of hormones. 
The need to present such a topic as this indicates that with such a high epidural rate, many nurses and caregivers are not witnessing women giving birth normally and naturally anymore.  They only see birth as a medical event that is treated with medical procedures and obstetrical drugs.  They do not see women moving around, working with their bodies, and having euphoric endorphin expressions that come with feeling the experience of birth.   
I presented three surveys on the topic.  The first was an informal BirthWorks survey with 55 responses that addressed the following questions:
  1. Where do you feel safe giving birth?
  2. I want to be engaged in my birth and am choosing not to have an epidural.  Some tools and strategies for my birth are?
  3. If you have previously given birth without an epidural, what kind of things made your pain better (less)?
  4. What can birth professionals and hospital staff do for women who choose not to have an epidural?
  5. Do birth professionals and hospital staff need training not currently being provided?  If yes, what type?
The second was a small Facebook survey with 16 responses, and the third was the Listening to Mothers II survey1 with over 1500 responses.  The surveys presented all pointed to the same conclusions as the Listening to Mothers II survey
         Our maternity care system is profoundly failing to provide care that many mothers told us they want and that is in the best interest of themselves and their babies.
         Safe and effective maternity practices are available but not being used by enough pregnant women. The goal is to increase childbirth preparation for all childbearing women and their families so more can achieve safe vaginal birth. 
         Health professionals need to become educated in normal birth and improve their care and skills to help more women achieve safe vaginal birth.
         Research must seek ways to translate current knowledge about safe and effective maternity care practices, so they are easily understandable, and can be put into practice by not only childbearing women and their families, but also health professionals. 
Few women used highly rated nonmedical methods of pain relief such as:
  1. Fetal monitoring with handheld devices rather than electronic fetal monitoring,
  2. Drinking or eating during labor,
  3. Freedom of movement during labor,
  4. Pushing and giving birth in non-supine positions, and
  5. Supportive rather than directive bearing down. 
The Listening to Mother’s II survey concluded:
  • Nurses should be very concerned that care practices known to support normal birth are apparently unavailable to the majority of healthy childbearing women in the United States.
  • The challenge is to take seriously and respond to the disregard for care practices that support normal birth apparent in the experiences of women reported in Listening to Mothers II.
These conclusions point to three concerns:
    1. We need more childbirth educators.
    2. We are not reaching enough pregnant women and their families with good quality consumer oriented childbirth education.
    3. Birthing women need to learn about non-pharmacological ways of coping with labor that are proven to be effective and safe.
    4. Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant.
    5. Essential topics such as pelvic bodywork and human values are missing  from most traditional childbirth education classes.
Consider becoming a childbirth educator today.  Contact BirthWorks International to begin a career helping women and their families to have more positive birthing experiences.
Reference:
1.  Declercq, E.R., C. Sakala, M.P. Corry, and S. Applebaum.  2006.  Listening to Mothers II: Report of the Second National survey of Women’s childbearing Experiences.  New York: childbirth Connection. Available at http://www.childbirthconnection.org/listeningtomothers
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Birth Panel

by Anna Holder CCE(BWI)
Truth, like surgery, may hurt, but it cures.
– Han Suyin
The fourth annual Hudson Valley Birth Options panel took an especially hard look at the truth this year. As in previous years a number of childbirth educators, doulas, midwives and mothers form a panel for local families to explore their birth options. Families from a wide range of backgrounds and birth experiences attend in hopes of connecting with providers and to better understand the choices in pregnancy and birth.
It is interesting to note that the hospital with the highest cesarean section rate (58%) once again failed to send a representatives and that two Ob/gyns who were slated to appear did not. This year’s panel experience was different in that many of the women in the audience were moved to tears. A brunette raised her hand and began to speak
. “ This question is for any of you, I am just wondering if I have any options; I am 8 weeks pregnant and I have had multiple c-sections and it was so horrible that I didn’t want to have any more children and now i find myself pregnant and I just….”
She began to sob and was unable to continue. Luckily she was in a room full of support and love and thus was quickly surrounded by hugs and tissues. The most interesting development was from one of the older homebirth midwives in the area.
“ You have to leave the state. I can’t tell you what your birth will be like but if you want an honest chance at a vaginal birth, then you have to leave the state.”
            Even sadder is that the entire room full of women knew she was right. What kind of society are we living in where it is easier to schedule a major surgery with its inherent risks, than it is to have a natural, physiological birth?  What kind of society are we living in where mothers fear having more children because of trauma from previous births? What kind of society are we living in where a woman is told that her only option for a VBAC is to leave her home, children and familiar surroundings to go to another state? Someone brought up the familiar OB saying,” I don’t get sued for doing the C-section”
If the upper limit of the World Health Organization (WHO)  recommended rate is 15% then we can conclude that the other 23% in New York State and 17% nationally are more likely than not unnecessary.  Doctors are failing to practice by their governing bodies (ACOG) guidelines, which state that women should be given a trial of labor even after multiple cesarean sections.
The evening further explored:
  • Suing for non urgent or emergent primary cesareans
  • The limited availability of skilled providers to attend breech vaginal births and the failure to recognize breech as another variation of normal
  • The fact that even positive birth stories can be detrimental by “setting the bar too high “ and influencing a mothers idea of a “good birth”
 It is clear that the climate of birth is changing, at least in New York State.
In a time when we are facing an ever-increasing C-section rate, there is a small but not discountable group of women rallying against it saying “We are taking back birth,” but  we need to remember is that we never gave it away in the first place!


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Silence In Labor

by MaliSchwartz  

Why is it so important to create a quiet, peaceful atmosphere during labor?   And how can women take charge of creating a peaceful environment no matter where they choose to give birth? 
The Leboyer Method, established by Dr. Frederic Leboyer in the 1970s was proven to minimize the trauma and stress experienced by a baby at birth.  This method of delivery advocated giving birth in a quiet room that had low or dim lighting.   Not pulling on the baby’s head; placing the baby on the mother’s stomach; not cutting the baby’s umbilical cord until it has stopped pulsating, and placing your baby in a warm bath shortly after birth were other ways to ensure a less stressful birth. 

This method has had some influence in delivery rooms where noise levels are minimized to make the atmosphere more peaceful for mothers.  According to an article found on the website (pregnancy-info.net), “many midwives and doctors are willing to incorporate some, if not all, of the facets of the Leboyer method into the birth experience.”

Dr. Michel Odent, another birth pioneer who has conducted extensive research on how womb ecology can impact human development, has proven how important the quieting of the neocortex is during birth.  BirthWorks International provides a link on their website where anyone can access Odent’s primal health research.

According to Odent, the neo-cortex is the center for what we commonly consider our intellect.  It is the part that allows us to be logical and also creates our sense of inhibition, giving us our civility and our modesty.  When we are being stimulated intellectually or feel we are being watched, the neocortex is active.  This is not conducive to laboring women, who like mammals need no distractions while in labor.  They naturally focus inward and shut out the outside world.  Dark, warm, quiet surroundings are critical for her to maintain this space of consciousness safely and have the best possible labor and birth experience/outcome.

Engaging the birthing woman in discussion is not a good idea.  Other triggers that should be avoided are watching television, bright lights, feeling cold, and feeling observed.  Even music with certain beats, tempos and lyrics may cause– without the woman’s total awareness– a stimulation of the neocortex.   Although a woman might not even be aware when her neocortex is being stimulated, it’s vital that this part of the brain be at rest so that primitive brain structures can more easily release the necessary hormones such as endorphins, serotonin, acetylcholine, and vasopressin which help relieve stress and pain.

Have you ever heard someone say “I feel like I was on another planet,” while she was giving birth?  This means that the activity of her neocortex was reduced.  This reduction of the activity of the neocortex is an essential aspect of birth physiology.   Even the slightest attention can keep her from the true meditative nothingness of the primal consciousness her birthing body seeks.

What can we do to reach this state of meditative nothingness?   A book “Frequency: The Power of Personal Vibration,” helps us to understand how to intentionally work with energy to transform our lives.   Author Penny Peirce makes a leap that science has not yet made – namely that the energy frequencies of matter have matching consciousness frequencies.  In describing the four categories of brain waves from fastest to slowest –  beta, alpha, theta and delta, it is interesting to note that the fastest brain waves correspond with lower frequency waves, while the slowest brain waves correlate with higher frequency – expanded awareness. 

According to Peirce we can influence our personal vibrations, although our personal vibrations are also affected by vibrations in the world, other people’s vibrations, and our environment.   Peirce believes that we all have the power to determine how we want to feel and when we choose to attune to the frequency of our soul, a new perception based on our souls expansive, loving wisdom opens to us.

The Leboyer method, Dr. Michel Odent’s neo-cortex research and author Penny Peirce understanding of personal vibrations can empower us with the knowledge of how important silence is during labor.  With knowledge comes wisdom – the wisdom to create a peaceful, loving atmosphere in which to welcome a new life into this world.


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Exploring The Home Birth Option

“I really want a home birth but…” How doulas and childbirth educators can help expectant parents explore the home birth option. By Monica Basile, CPM

 How many times as a doula or childbirth educator have you heard someone say, “I really want a home birth, but…?” Usually this is followed by a list of perceived barriers to home birth or misconceptions about home birth, rather than personal convictions, structural barriers, or health concerns that might make hospital birth preferable or necessary. When a woman says to me, “I really want a home birth but…” what she is usually communicating is that she has an active desire for home birth but does not know how to realize that desire, or has not explored it fully enough to feel confident in her decision about her birth place.

  As a home birth parent myself, and as someone who has been teaching childbirth classes and attending births for 16 years, it’s taken me a while to discern how to best respond to clients when they say this. Years ago, I would simply let it go. I’d be thinking to myself, “this person needs better information,” but because I didn’t want to be perceived as trying to sway anyone’s birth decisions, I’d respond by saying things like, “it sounds like you’ve thought about your choices and that the hospital is the right place for you.” What I now realize is that this expression can be an important invitation to us to share information and engage parents in a process of self-discovery to help them clarify their desires and options.

 It’s no wonder that many people don’t know how to pursue home birth. We live in the midst of a culture of birth fear, which spreads mostly misinformation and misrepresentations of birth, especially home birth. Depending on where you live, home birth midwives may not be able to practice legally, and may therefore be extremely hard to locate or financially inaccessible. Friends and family members may be skeptical or unsupportive, and your client might not know anyone who has had a home birth. Although many women feel intuitively drawn to home birth, it can be hard to imagine the practicalities of making such a countercultural decision.

 Helping a woman to conceive of ways to manifest her deepest wishes for birth is an important task – one that can inspire a lifetime of empowered decision-making. I encourage all doulas and childbirth educators to not shy away from these conversations, but to undertake them in a compassionate, thoughtful, and nonjudgmental way, without attachment to the ultimate decision. I believe strongly that each person has the right and the ability to decide what kind of birth is most appropriate for them, and that everyone deserves access to information with which to evaluate the choices available. In this spirit, I offer some strategies for sharing information and drawing out clarity with those considering home birth

  Address Common Concerns.First of all, it can be useful to explore the “but” in the statement “I would like to have a homebirth but…” Often, these “buts” are simply misapprehensions about home birth that come from either the imagination or the media. (For example, “I want to have a home birth but I don’t want to have to clean up all that mess.”) Here are some of the concerns I hear most often:

  Mess: Birth is actually not as messy as one might think, and midwives tend to have a very efficient system down for mess prevention and cleanup. Typically, when the midwives leave the home after the birth, it’s cleaner than before they got there.

  Cost: Depending on what state you’re in, and your midwife’s credentials, home birth midwives may be able to accept Medicaid and/or private insurance. If not, it never hurts to ask a midwife about payment plans, bartering, and sliding scales for students or those with low incomes. Often, the cost for a midwife’s services is less than or equivalent to insurance deductibles.

  Small space: Although different midwives have different preferences, I have attended many home births in small apartments; even in boarding rooms. Even in large homes, midwives often find themselves in close quarters when women decide to give birth in the corner of a bedroom, between the bed and the wall, for instance.

  Other children: Depending on the age(s) of the child(ren), and the mother’s preference, it may or may not be desirable for siblings to be present at a home birth. I recommend having someone who can be on call to take care of older siblings, either at home or away, depending on the preferences of all involved. I have never encountered a sibling who was voluntarily present at a home birth who felt traumatized by the experience. This can be an extraordinarily special way for children to bond with the new baby.

  Switching care providers: If your client has an established relationship with a care provider in a hospital-based practice, it can seem difficult to end that relationship. However, this is usually a very straightforward process. There’s no point at which someone is obligated to stay with a care provider they don’t like, or who doesn’t suit their birth plans. Sometimes, people choose to continue concurrent care with the original provider after making plans to switch to a home birth midwife.

  Encourage parents-to-be to interview a midwife — or several. Know your local midwives, and if an expectant parent is considering home birth, encourage her to contact a midwife for a consultation. This is the number one most important resource you can offer. Most people considering home birth have a long list of questions that only a prospective midwife can answer. Usually people want to know what happens in case of complications, and what reasons a hospital transport would be necessary. Rather than speculating on these answers, it’s much better to talk to a midwife about reasons and protocols for transport. (When I was pregnant, I asked my midwife about complications, to which she replied, “which complications are you most worried about?” I realized then that I didn’t really know – I was just duplicating the fears that others had voiced to me. My midwife empowered me with specific information, and I felt both comforted and capable of educating my concerned family and friends.)

 Your client has nothing to lose by interviewing a midwife; a consultation does not obligate her to enter into a midwife’s care. If she decides to pursue home birth, this will put her on her path. If not, she can rest easy knowing she has investigated every option available and made a truly informed decision.

  Share evidence-based information on home birth safety. In 2005, The British Medical Journal published the largest, most well-designed study to date of out-of-hospital birth in North America. The study found that planned home births attended by Certified Professional Midwives are just as safe for low-risk women and babies as hospital birth, with many significant benefits over hospital birth in terms of lower cesarean rates and lower rates of common interventions, such as induction of labor. This study is just one in a large body of literature documenting the excellent outcomes associated with midwife-attended home births. The World Health Organization, the American Public Health Association, and the American College of Nurse Midwives all support increased access to home birth as a safe, responsible choice. A link to this study, as well as plenty of other good information, is available here: www.mothersnaturally.com

  Be clear about legal status in your state. Some people erroneously believe that home birth is illegal. This is not the case – a parent may choose to give birth wherever she wishes. There are no laws against having a home birth. Laws pertaining to home birth apply to birth attendants. In 27 states, direct-entry midwives (non-nurse midwives trained specifically in home birth, and credentialed as CPMs, or Certified Professional Midwives) are licensed, easily accessible, and accepted as part of the health care system. In the remainder of US states, licensure is not available for direct-entry midwives, and in several of these states, practicing as a midwife is illegal. This does not, however, mean that there are no midwives in states without licensure – it just means finding one to work with will be more difficult. Educate yourself and your clients about the legal status of midwifery in your state. You can find a state-by-state chart of midwifery laws here: http://mana.org/statechart.html and find a link to your state friends of midwives organization here: www.thebigpushformidwives.org

  Encourage honesty and harmony with spouses/significant others. It’s common for a pregnant woman’s partner to feel protective, and sometimes this manifests in disagreements about birthplace. Help pregnant women to remember that they have the same ultimate desire as their partners: a healthy birth with a healthy mom and baby. I always encourage expectant couples to go together to a consultation with a midwife, so they both get a chance to voice their concerns and ask questions. This provides a good foundation for further discussion.

  Encourage autonomy in relationships with parents and siblings. Many people express extreme apprehension about a lack of support from family members. There are several potential ways of dealing with this. Protecting one’s inner peace about the choice to birth at home may mean not sharing this information with family until after the birth. For some, on the other hand, it can be very empowering to discuss their decision and share information with family members. Sometimes, inviting a family member to be present at a home birth can be an effective and mutually satisfying way of garnering support. In any case, and regardless of birthplace, becoming a parent ushers in a growth transition in which new parents differentiate from their own parents, and it can be helpful to put this in perspective.

  Encourage positive community.If a woman or couple has never met other home birth parents, it can be very isolating to choose home birth. Share information about birth circle groups, La Leche League or other breastfeeding support groups, home birth meetups, Holistic Moms Networks, childbirth classes, Babywearing groups, or other potential resources for positive community building.

  First births are important.It’s not uncommon to hear someone say, “Maybe I’ll plan a home birth next time.” This is a good opportunity to ask questions like, “How is it that you envision a future pregnancy and birth as being different from this one?” Many people have the idea that they will “know better what they’re doing” and be more self-possessed with second or subsequent births. This might a good moment to remind your client that her body already knows what to do, and that the capacity to give birth already exists within her. You may also want to help her keep the importance of the first birth in perspective: avoiding a primary cesarean has been identified as a key factor in avoiding maternal and infant morbidity associated with repeat cesareans and birth complications resulting from previous surgery. The cesarean rate for planned home births in the U.S. is roughly 4%, which stands in sharp contrast to the national cesarean rate of 32%.

  Pay attention. Sometimes, a woman will say “I really want a home birth but…” and may not actually feel at all comfortable with home birth. Instead, saying this may be a way for her to communicate her orientation toward a more holistic mindset in general. If this is the case, she will likely not engage actively with attempts to open up an in-depth discussion of home birth. Listen attentively, follow her lead, and remember, it’s up to that mother-to-be to know what’s right for her birth.

  Home birth may not be the right choice. There are several reasons that home birth may not be the right choice for your client. One woman’s perceived barrier may be a very real barrier to another woman. If home birth is ruled out for any reason, you can still provide, or refer her to, doula services to help her maintain continuity of care and preserve other birth preferences. If you don’t have access to home birth midwives in your area, as is unfortunately the case in some parts of the country, further options to explore include traveling to give birth, unassisted birth, birth centers, or hospital birth.

 By sharing this information and giving our clients the opportunity to explore their thoughts, desires, hopes, and fears, we fill an important role: that of taking women’s desires for birth seriously. This is an invaluable service, regardless of the decisions our clients ultimately make about where to give birth.

 —

 Monica Basile is a BirthWorks Certified Childbirth Educator, DONA Certified Doula, and Certified Professional Midwife. She is the mother of a 15-year-old son born at home, and is a co-founder and member of Friends of Iowa Midwives. She holds a PhD in Gender, Women’s, and Sexuality Studies from the University of Iowa.