What if Home Birth is Actually Safer than a Hospital?

A May, 2016 article by Jennifer Margulis, PH.D. on the web site www.reset.me includes an interview with Awakening Birth’s Certified professional Midwife Deborah Flowers , addressing the question, “What if Home Birth is Actually Safer than Hospital Birth?”

Click here to read the full article. Below, an excerpt:

Jennifer Lang, M.D., a highly skilled surgeon and obstetrician, chose to deliver 2 of her 3 children at her home in Southern California. Lang says home is where she felt safest and most relaxed. Photo via: clinicalnotebook.com.

Heidi Rinehart, M.D., is another obstetrician who chose out-of-hospital birth. Based in Keene, New Hampshire, Rinehart estimates she has attended over 2,000 births. Twenty-three years ago, Rinehart and her husband — who’s also an obstetrician — decided to birth their first child at The Farm, an intentional community located 95 miles southwest of Nashville, Tennessee. Rinehart explains they were living in Tennessee at the time, she wanted to have an unmedicated childbirth, and she was impressed by the statistics The Farm midwives had previously published.

“I evaluated the safety of that choice based on real data,” Rinehart says. “And I could see from my work in the hospital that it was very hard to have a physiologic birth without interventions that interfere with the unfolding of the process. I wanted to have a natural birth, and I knew the constraints of the hospital, both physical and physiological, would have made it harder.”

Midwife Deborah Flowers has been delivering babies at The Farm in Tennessee for 30 years. Photo via: Deborah Flowers.

Midwife Deborah Flowers has been delivering babies at The Farm in Tennessee for 30 years. Photo via: Deborah Flowers.

Excellent Birth Outcomes At The Farm

“We have a 1.7 percent C-section rate,” says midwife Deborah Flowers, 61, who has been delivering babies on The Farm for thirty years and was one of the midwives who cared for Rinehart during labor. Flowers herself birthed both her children at The Farm. All four of her grandchildren were born there too.

“Ninety-five percent of the time when a woman starts her labor here she delivers here on The Farm,” Flowers tells me. “Of the five percent who transfer to the hospital for one reason or another, less than two percent have C-sections.”

The United States has a 32.2 percent C-section rate, a maternal mortality rate of approximately 16 per 100,000 (which means more than 600 women die from childbirth-related causes in America each year), and an infant mortality rate of six deaths for every 1000 live births, a rate so high compared to other developed countries that the Washington Post has called it a “national embarrassment.” We also have the highest maternal mortality rate of any country in the industrialized world. Though Flowers tells me they are still compiling the most recent statistics, out of over 2,800 births, The Farm has never lost a mother and have had a single-digit number of infant mortalities.

Flowers points out that the low C-section rates and excellent birth outcomes are partly because The Farm midwives attend mostly low-risk, healthy women. But midwives at The Farm also deliver breech babies and twins and care for women in their late 30s and 40s, all of which is considered “high-risk” by the mainstream medical establishment. Rinehart and Flowers both explain that The Farm midwives are highly skilled and experienced, they provide psychological as well as physical support for laboring women, they have an excellent relationship with the area doctors who practice a model of collaborative care (the midwives say they learn from the doctors and vice versa), and they are not afraid to transfer a laboring woman to the hospital when necessary.

Jen Childs, 37, had her baby, Jeralyn, at The Farm just three weeks before I talked to her via Skype. Childs and her husband had been living in Shanghai, China, where she was working as an interior designer and he as an architect. After downloading Ina May Gaskin’s Guide to Childbirth (Ina May Gaskin, arguably the most famous midwife in America, was one of the original founders of The Farm, along with her husband Stephen), Childs was so inspired that they decided to move back to the United States to have her baby there.

First-time mom Jen Childs was not technically “low-risk,” but she gave birth at The Farm in Tennessee, where midwives also attend breech and twin births. Photo via: Nicholas Kothari.

First-time mom Jen Childs was not technically “low-risk,” but she gave birth at The Farm in Tennessee, where midwives also attend breech and twin births. Photo via: Nicholas Kothari.

Childs was not technically low-risk. At 37 she was considered of “advanced maternal age.” She had a painful uterine fibroid that was growing along with the baby and was told by a doctor in China that because of the fibroid she would be monitored closely and she may need a C-section. That turned out to be a false alarm: With the help of weekly Chinese medicine, the fibroid stopped growing and did not interfere with the pregnancy. But hospital midwives in Ann Arbor, Michigan, who provided prenatal care to Childs before her family went to The Farm, told her there was a problem. A 37-week ultrasound revealed that the placenta had calcified to “Grade 3,” the midwives said. Her daughter might need to be induced early and was at risk of being stillborn. They advised a hospital birth.

Instead of accepting their assessment of her placenta, Childs — who was determined to have a natural childbirth if she could do so safely — called her midwife at The Farm. Deborah Flowers consulted with two obstetricians and two ultrasound technicians to find out if the placenta calcification was a real risk. The obstetricians recommended non-stress tests to monitor the last weeks of the pregnancy, which Childs was happy to do. A non-stress test (NST) records the baby’s movements, heart rate, and reactivity of the heart rate to movement (a healthy baby will respond with an accelerated heart rate when he or she moves, and the heart rate will decrease when resting). “We used to think that a Grade 3 placenta reflected pending placental insufficiency,” one obstetrician wrote to Flowers, “but that has kind of fallen by the wayside. If the twice weekly NSTs and weekly amniotic fluid index (AFI) continue to look good, I would be reassured.”

Jen Childs laboring in the birthing tub in the cabin where she and her husband stayed at The Farm . Photo via: Nicholas Kothari.

Jen Childs laboring in the birthing tub in the cabin where she and her husband stayed at The Farm . Photo via: Nicholas Kothari.

So three weeks before the due date, Childs and her husband packed their bags and drove to Summerton, Tennessee, where they rented one of the cabins the midwives provide for women to give birth. Her husband’s parents came too, staying at a bed and breakfast on The Farm. She went into labor when she was 39+ weeks pregnant on a rainy April morning. Childs remembers looking out the window at the forest outside while she was in early labor and then going inside herself, slipping into a meditative state that felt euphoric. She was surprised at the deep, primal, guttural sounds she made during the 17-hour labor. “Oh, man, this is really intense,” she remembers thinking at one point as she waited for a contraction to end.

“It was even more transformative than I expected,” Childs says, her eyes shining. “It’s a rite of passage in a woman’s life. You’re going through this transition from the single you to the mother you. If you can be present for that whole transition and remember every single part of it — and feel like you’re in control of your birth — it’s a lot more meaningful than having someone else in charge of you.”

Deborah Flowers with Jen Childs and baby Jeralyn at The Farm, where midwives visit new moms frequently postpartum to provide breastfeeding and other support. Photo via: Nicholas Kothari.

Deborah Flowers with Jen Childs and baby Jeralyn at The Farm, where midwives visit new moms frequently postpartum to provide breastfeeding and other support. Photo via: Nicholas Kothari.

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