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Home Birth: Megan's story
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I have taken moms into the hospital, where I was extremely grateful for having medical technology. That's what it's there for. But for pain relief, not everybody needs an epidural. There are studies that clearly show that the use of an epidural increases the time of pushing and the frequency of cesarean sections, vacuum extractions and forceps. I feel that moms do not have the opportunity to labor with appropriate support where they might not need an epidural.
-Heike Doyle, licensed midwife
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Story summary:
Megan is pregnant with her second child. During her first pregnancy, she developed toxemia (pregnancy-induced hypertension), so she gave birth under the care of a physician in the hospital. With her second child she felt confident about birthing at home, knowing she has medical back-up close at hand if needed. Attended by a midwife and her assistant, she delivers a healthy baby girl without complications.
Obstetrical View:
In 1999, the American College of Obstetrics and Gynecology affirmed its longstanding position on home birth: that labor and delivery, while a physiological process, clearly presents potential hazards to both mother and fetus before and after birth. These hazards require standards of safety which are provided in the hospital setting and cannot be matched in the home situation.
Obstetricians point to the lack of data supporting the safety of home birth. They feel that the existing research has only looked at a "self-selected" population - women who are low risk, well educated and do not represent a random sampling of the population. Most obstetricians believe that home birth may have good outcomes for certain individual women, but to offer it as a safe choice for all low-risk women would be dangerous.
Midwifery View:
Midwives demonstrate through births such as Megan's that the midwifery model of care is a choice that should be available to all low-risk women. Midwives approach labor with a variety of low-tech, high-touch techniques, such as labor sitting (continuous, one-to-one physical and emotional support), allowing women to eat and drink if they desire, and changing positions - upright, hands and knees, walking and using the bathtub or shower. Midwives working outside the hospital use a hand-held doppler device to monitor the baby's heartbeat, which allows a woman to have full freedom of movement. They believe that creating a calm birthing environment where a woman feels in control leads to faster labors with fewer complications and less pain. They feel that many procedures have become standard in the hospital without adequate research into their long-term effects on women and their babies.
Midwives require that women remain low risk throughout pregnancy and labor, that they actively participate in their births and that they have appropriate medical back up in the unlikely event that it is needed. Midwives maintain that the growing body of data, published in medical journals and the Cochrane Database - a worldwide storehouse of scientific studies - supports midwifery as a viable model.
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