Why a Midwife

Homebirth: What Are the Issues?

by Sara Wickham, RM, BA (Hons)
© 1999 Midwifery Today, Inc. All rights reserved

There is no shortage of evidence to support the fact that homebirth is safe, satisfying and empowering for women and their families. It is also a much-neglected option for childbearing women in Western society today. This article seeks to discuss modern-day attitudes about birth and present the arguments for midwifery care and homebirth in an accessible format.

It must be stressed that different caregivers have different philosophies in relation to birth. These philosophies are generally referred to as the “midwifery” and “medical” models, although it is not accurate to say that all doctors believe in the medical model and all midwives in the midwifery model. The medical model sees childbirth as inherently dangerous and suggests that all women should undergo routine interventions to ensure safety and give birth in hospital, and the midwifery model uses a more holistic approach and assesses women on an individual basis—a process which often enables women to give birth in their own homes. Although the medical model has been the dominant model of birth in our society for a number of years, researchers in all fields are now showing the midwifery model to be more accurate in the way it sees birth.

Many women approach a “medical model” practitioner for care during their pregnancy, although this is not necessarily the best option. While obstetricians and hospitals have a part to play in the care of women with serious medical conditions or who develop a problem during pregnancy or labour, research shows that the vast majority of women would be better served by choosing a midwife for their care. Equally, this majority of women would also be well advised to consider homebirth as an option because of its many advantages over hospital care. Some of the advantages of homebirth with a midwife are cited below.

Women Experience Less Pain at Home

It is well understood that sensations of pain in labour are regulated by hormones released by the woman’s body. During labour, oxytocin—the hormone which causes contractions and helps the baby be born—works in harmony with endorphins—the body’s own pain relieving hormone. During a homebirth, the woman’s body will release these hormones according to her needs and she will usually cope well with the sensations of labour.

When a woman attempts to give birth in another environment such as a hospital, however, this process may not work as well. Even if a woman feels rationally that hospitals are “safer” places in which to give birth, her subconscious mind knows that this is not the case, and she feels insecure. This causes her body to secrete the hormone adrenaline, which causes the levels of both oxytocin and endorphins to drop. She experiences far more pain than she would in her own home, and this has several other effects on her labour which are described below.

Women Experience Lower Levels of Intervention at Home

There are two main reasons that women experience lower levels of intervention at home. The first concerns the hormones described above. In a hospital environment, women often produce the hormone adrenaline in response to subconscious or conscious fear. This inhibits the release of the hormone oxytocin, and labour may well slow down. Although this slowing of labour is a natural safety mechanism designed to let the woman know she needs to find another environment, it is interpreted by many medical professionals as “failure (of her body) to progress.” Rather than suggesting that the woman talk about her fears or find a different environment, they will turn instead to drugs to “speed up” the labour. This drug (usually Pitocin or Syntocinon) can cause distress in the baby, among other effects, and often itself leads to a “cascade of intervention” which may result in an instrumental delivery or a cesarean.

The second reason is that hospitals are systems which need to run efficiently. They need to have procedures in place for workers to follow so that chaos does not ensue! Unfortunately, this often means that hospitals have policies where a certain number of interventions are carried out on all women who choose to give birth there. Often there is no evidence to support these interventions, and many of them (e.g. electronic fetal monitoring) are known to be harmful when used on a routine basis. Every intervention is useful to a small number of women when used appropriately, but when applied to all women, they often cause far more harm than good. Women’s choices are not sought and it is often difficult for staff to offer individualized care, because they feel restricted by the “hospital policy.”

Women Have More Autonomy at Home

Another major difference between giving birth in your own environment or in someone else’s is this: in your own home you are “in charge.” You would not feel you needed to ask permission to make a drink in your own home or visit the bathroom, yet that is exactly the way many women feel in hospital. And the effects of feeling as if they need to ask permission to do everyday things can lead to women feeling they are not in control. This may then have an impact on a woman’s labour, because labour is a time when women need to feel very strong and powerful within their own bodies, not as if they were small children who needed to ask mommy to take them to pee!

Eating and drinking is another important aspect of this. In your own home, you are free to eat and drink whatever you feel like. Although women often do not feel like eating in strong labour, the choice is there. Many hospitals still refuse women food and drink in labour, even though all the research evidence shows that this restriction is harmful rather than beneficial. Consequently, women become dehydrated and have low energy levels at a time when they need lots of energy. Hospital staff may provide an IV drip to replace fluids but this is not ideal—it limits a woman’s movement and adds to the feeling that she is “sick” rather than experiencing a perfectly normal event.