No place like home!
The 2 year UK Place of Birth study showed that for healthy women a planned home birth was most likely to result in a natural birth, compared to labouring in an obstetric or midwifery led (primary) unit. Whereas healthy women labouring in an obstetric maternity unit more often had their labours sped–up (called ‘augmentation of labour’) and needed an epidural for pain relief, both of which contribute to labours ending with either an instrumental or surgical delivery. These findings are the same for birth outcomes in New Zealand  where most women have continuity of care through-out each pregnancy, labour and the first 6 weeks after birth by the same midwife, which is rare in the UK. When NZ women labour in a secondary or tertiary hospital, up to one-third of healthy women may have their babies delivered by either forceps, vacuum or surgery. Where-as those who labour at home in either country, are the women most likely to have a natural vaginal birth compared to those who labour in a midwifery led (primary) birth unit or a hospital.
Also contrary to popular myth or mis-information, it is neither accidental nor lucky, that women who plan a home birth are more likely to have a natural birth primarily because the hormones stop the labour when a woman is disturbed, anxious (eg about getting to the hospital on time) or watched in labour. The decrease in hormonal stimulation of labour when fearful or anxious is one of many evolutionary means to ensure that a woman labours and births when she is safest and most able. Thus many women who leave home to give birth often find that their labour subsequently either stalls or stops. Yet an understanding of this physiological fact about human labour is not generally understood by most people today, including maternity carers who have limited or no experience of natural birth at home. Though many acknowledge that home is the place where labour can best progress, most fail to appreciate that to maintain effective, natural labour midwifery care should primarily promote, protect and support birth at home or in a “woman centred” environment for healthy women. Meanwhile, many women whose labours do stall on admission to hospital experience contradictory messages which precede or occur around a cascade of intervention to re-start, maintain or speed–up labour in an unfamiliar environment and an anxiety provoking situation (“but I was in a lot of pain”; “surely I am close to having baby?” etc). Often hospital environments are poorly staffed, ill-equipped or not set-up to support many alternative, ‘natural’ means to deal with stalled labours , so speeding-up labours with an oxytocin drip is common despite evidence and UK calls to restrict the use of this treatment because of life-long adverse outcomes for some babies.
In contrast, women who confidently and calmly stay labouring at home often have shorter labours and easier births than is ‘expected’ even for first babies. In my experience it all depends on whether a woman’s head, heart and body are in peaceful harmony so she can surrender or allow her body and baby to give birth. Like most other species women need to feel settled according to their own needs, to be able and ready to nest and birth. For example, I remember a woman in stop-start labour of her fifth child who needed to cry over some life changes and put the other children to bed before she went into consistent labour which was faster than my late night effort to return to her home!
Also contrary to the medical idea of stages and set time frames for labour and birth of first, or subsequent babies, some ‘early’ or ‘pre’ labour activities of women who believe/trust that ‘their bodies work’, can occur over days or weeks preceding their birth day. Similarly, home birthing women have taught me to gauge progress in labour by their behaviours and, or noises which come as a response to the movements of their emerging babies; rather than according to how many hours or minutes have passed from the start of, or in-between contractions. Such home birth experiences, when you know the woman from pregnancy teach midwives to be able to; “distinguish between a woman who is expressing her wild birthing instincts, from a woman who genuinely needs reassurance and calming.”
Michel Odent refers to labour as a time when everything should be done not to interfere with the cascade of birth hormones which results in the easiest birth possible for both mother and baby (see previous blog). He says “The passage towards the fetus ejection reflex is inhibited by any interference with the state of privacy. It does not occur if there is a birth attendant who behaves like a “coach”, or an observer, or a helper, or a guide, or a “support person”. It can be inhibited by vaginal exams, by an eye-to-eye contact, or by the imposition of a change of environment. It does not occur if the intellect of the laboring woman is stimulated by a rational language (“Now you are at complete dilation; you must push”). It does not occur if the room is not warm enough or if there are bright lights.”
Thus the cascade of hormones flowing through an accepting, responsive woman in a supportive environment is intended by nature to “eject” or assist the exiting baby to leave its womb in a cocktail of ecstatic hormones which ensures that mother and baby are ready to ‘fall’ in love and begin a life-long bond of child and parent. The US Childbirth Connection web site says “You and your fetus/newborn have innate abilities to start labor, labor and give birth, breastfeed, and become deeply attached to one another. The ebbing and flowing of hormones drives these well organized, finely tuned processes. It is important that you and your caregivers understand how to work with — and avoid disrupting — this inborn knowledge and drive for birth, connection, and optimal nutrition. While you don’t need to be taught how to give birth, it is fascinating to learn about the amazing capabilities of women and newborns. For example, a newborn who was not exposed to pain medications and is placed skin-to-skin on his or her mother right after birth can crawl to her breast, self-attach, and begin nursing.”
For those who wish to be more informed about the safety, benefits and practicalities of planning a home birth I recommend reading the web pages of Dr Sarah Buckley and the Canterbury Home Birth Support group.
For whose who have had the profound experience of birthing one or morer babies in your ‘nest’ I ask you to consider sharing this good news by wearing a Home Birth Aotearoa T-shirt during Home Birth Awareness Week 2012.
 Dixon,L. et al (2012) “What evidence supports the use of free-standing midwifery led units (primary units) in New Zealand/Aotearoa?” New Zealand College of Midwives Journal 46; June 2012 p13.