A new CDC report looks at the trends of home birth from 1990-2009. While home birth was relatively stable from 1990-2004, after that there was a 29% rise in the number of home births, though still a very low number.  You’re more likely to have a home birth if:

• Non-hispanic white woman
• Over 35
• Married

Interestingly enough 33% are listed as being attended by “other.”  This is dad, mom, EMT, etc.  I wonder if this is in part by midwives not wanting to be listed on the birth certificates.

While many like to cite the rise in the home birth rate as being from Ricki Lake and Abby Epstein’s Business of Being Born, it wasn’t released until May 2008. (See trailer below.) So what’s your take? Why do you think the rates of home birth are increasing?

_{MacDorman MF, Mathews TJ, Declercq E. Home births in the United States, 1990– 2009. NCHS data brief, no 84. Hyattsville, MD: National Center for Health Statistics. 2012.}

An MSNBC article describes this trend as a growing “natural birth subculture” led by white women. Just calling it a subculture lends a derogatory connotation, as if all home birthing families are… what? Hippies? Cultists? Anarchists? A “lunatic fringe”? Maybe some home birthers are any or all of the above, but many of them are no different from anyone else, except that they reject the hospital/medical model of childbirth.

The fact that white women have the highest rate of home births is a reflection of the way health care works in this country. With private insurance offering only spotty coverage for midwifery care and home birth, it is often affluent white women who can afford to seek midwife care outside the scope of their insurance. Minority women are unfortunately more likely to be under- or uninsured, or covered by Medicaid.  Their options for home birth are severely limited as a result, and they are often unable to afford to pay cash to a midwife for a home delivery.

Rather than scoff at home birth as some sort of fad among affluent white women, perhaps we should take the data provided by the research to make midwifery care available to women of all races and socioeconomic strata. I have heard it suggested many times that in the poorest regions of the country, midwives could make all the difference in terms of access to prenatal care, reducing preterm births, and improving maternal and infant mortality. Yet Big Obstetrics seems desperate to hold on to every single patient it can, even as OBs complain that they are overworked, underpaid, and burdened with high patient loads and mounds of insurance paperwork.

The tide is just beginning to turn. Home birth advocates recognize that home birth isn’t for everyone, but what we do realize is that midwife care has the potential to change the lives and the outcomes for women and babies across the country and around the globe. That’s not a trend, that’s common sense and compassion.

Is home birth becoming more main stream? Is Pampers trying to reach out to moms who might otherwise be more likely to cloth diaper? What’s up with this? Share your thoughts in the comments.

“You call her [the midwife] right now.  I’ve done a lot of crazy [insert expletive] in my life but I am NOT delivering a baby.”

Guest Post by Alyssa Chirco

This was my husband’s response when I realized that the irregular contractions that I had been experiencing all day were getting stronger and coming routinely every four minutes.  He had agreed to the home birth of our second child, but he was adamant that he would not be the one doing any sort of catching or delivering.  It was obvious that the whole thing still sort of freaked him out.

What is it about husbands and home birth?  Most of the women I know have had to either talk their husbands into home birth, or have compromised their own desires and been talked out of home birth by their skeptical partners.  Why are men so afraid of home birth?  And how do we convince them that, for many families, it can be a safe and viable alternative to birth in a hospital?

My own husband’s journey began with my first pregnancy, when I was planning a hospital birth with an obstetrician, but was also intending to have an unmedicated birth.  I hired a doula, and signed us up for Bradley childbirth education classes.  Most of the information in the classes was not new to me, as my sisters had been born at home and I had already read a lot, but the classes were incredibly eye-opening for my husband.  He learned about how birth really works, and realized why so many hospital policies and procedures are often unnecessary and even detrimental to the birth process.

My first birth experience was not ideal, but as a young, first-time mom giving birth in a hospital, I fared pretty well.  I refused an IV, was allowed to walk and use the shower, and received electronic fetal monitoring only twice during the few hours I labored at the hospital.  Thanks to my doula, I was never offered an epidural, and didn’t have any episiotomy.  And because my entire labor lasted less than eight hours, the obstetrician only made in time to catch a healthy baby girl.

This easy delivery (and lack of hospital interventions) made it a lot easier when it came time to casually mention to my husband that I wanted to have baby #2 at home.  As supportive as he was of my desire for natural childbirth, and as much as he understood the difficulties that come with trying to have a natural birth in a hospital, he wasn’t really comfortable with the idea of having a baby at home.  But I was able to point out to him that the doctors and the nurses at the hospital never really did anything at my first birth.  I never utilized any of the interventions that you need to be in the hospital to get; my body did it all on its own.

My husband agreed to a home birth the second time around because had witnessed a safe, natural birth first-hand and because, ultimately, he trusted that I had done my research and knew what was best for our baby (and, yes, I consider myself extraordinarily lucky that he has this much faith in me).  He also felt more comfortable after meeting with our midwife and hearing first-hand about her experience and how she handles emergency situations.  And when I finally got my hands in a copy of The Business of Being Born and he was able to see the safe and peaceful home births of so many babies for himself, he was more fully convinced that we were doing the right thing.

He still didn’t want to be the one who had to deliver the baby though, and he still had his doubts.  He worried that it would be messy, he worried that something would go wrong, and he worried about what the neighbors would think . . .

My second birth experience was far better than my first.  I labored at home.  I was allowed to eat and drink.  I didn’t have to fight to avoid interventions because my midwife didn’t believe in them in the first place.  When my son’s head emerged but his body didn’t follow, my midwife knew exactly what to do, and within a few minutes she had dislodged what she termed “sticky shoulders” and he slid easily into the world.  From my perspective, it was a great birth.

Overall, my husband found the home birth experience to be a positive one as well.  He particularly enjoyed the fact that he got to sleep in his own bed and not on a hospital couch.  But I also learned afterward that, at one point, he had been afraid that my son and I were going die right there in our bathtub (which was never even close to happening).  If we have another baby, I know that he will support my desire for another home birth.  But I also know that, on some level, he would still feel more comfortable if I chose to go back to the hospital.

As birth activists, it can be hard to see women who have given up on their hopes for a home birth because they can’t convince their husbands.  It’s easy to judge men who are hesitant about home birth, and criticize them for being unsupportive.  But, in fact, I think we are the ones who need to be more supportive and understanding.  Most men aren’t being trying to be difficult, or actively deny their wives and babies a safe and positive birth experience.

They just don’t know any better because no one has told them any better.

We talk a lot about how women in our culture know so little about birth and are rarely exposed to it before they have a baby themselves.  If American women know so little, doesn’t it stand to reason that American men know even less?

The notion of medical superiority is deeply rooted in American culture.  We tend to believe that doctors, hospitals, and procedures can make everything better, and this thinking is applied to birth as well.  Most Americans assume that interventions always help the birth process, and aren’t familiar with the idea that interventions can actually be harmful.  In many cases, pregnant women don’t even know that they have options and choices when it comes to birth.

Women come to home birth in a variety of ways – disappointment with a prior birth experience, reading books, participating in online forms, talking with other women at mom’s groups or playgroups, just to name a few.  But husbands don’t often share these experiences.  Men don’t have to heal from cesarean scars.  Men rarely participate in chat groups or attend support groups about pregnancy and birth.  Men don’t share intimate details of their birth stories with other women, and don’t hear about the experiences of others.

Instead, men mostly hear the messages from the mainstream media that home birth is dangerous.  Chances are they have never met or even heard of anyone who has had one.  So when husbands hear their wives start to mention the idea of having a baby at home, it’s no wonder that they’re skeptical.  Given what they know, concern and opposition actually seem like perfectly logical responses.

I don’t believe that husbands oppose home birth because they want to be difficult.  In most cases, it’s because they love their wives and they’re unborn children.  It’s because they have only been exposed to the mainstream media message that home birth is dangerous and hospital birth is always a safer alternative.  It’s because they haven’t read the studies and met the women and heard the empowering stories of birth at home.

As birth activists and home birth advocates, we need to change this.

My question to you is how.

If you had a home birth, did you have to convince your husband?  If so, how did you do it?  Or, did you want a home birth but agree to give birth in a hospital or birth center because you couldn’t convince your husband/partner?  How do we help men to be more comfortable with the idea of home birth?

Alyssa Chirco is a stay-at-home mom and freelance writer who lives in St. Louis, Missouri with her husband and two children.  She is active in both birth and breastfeeding education and advocacy, and combines her love of writing with her love of everything parenting-related in her blog St. Louis Smart Mama (www.stlouissmartmama.blogspot.com).

If only that is how it really worked.  You march in to a hospital, have an amazing natural first birth and prove the whole staff wrong. Whoa, what a powerful and usually unobtainable image. With fear implanted into their heads these first time parents are under the illusion that 1) They are safer in a hospital (but apparently only for the first baby). 2) That they are the exception to the rule and will get EXACTLY what they want in a hospital setting.  I am under no illusion that we will see a great change in my lifetime where 98% of women will birth at home and 2% in the hospital.  While that would be just dreamy to this home birth midwife, I am speaking to those moms who want a home birth…next time.

What will next time look like?  Why is it different?

The reality is it will most likely be different but not in the way these mamas think or would like.  In the USA there is a 30% plus chance you will be a post cesarean mom.  In my hometown of Miami make that 51%. You will have to find a provider to agree to “allow” you to attempt a vaginal birth after cesarean.  Your family will say things like “You can’t do that at home, you had a c-section, it’s dangerous” and “Thank G-d you had an operating room waiting for you there, you needed it last time, you’re going to need it again” You will be considered high risk.  (Don’t get me started on the fact that THAT is bull)  You will be put on time tables, subjected to extra ultrasounds, and at the mercy of an OB to tell you what you can do and where.

My advice: Avoid the high section rates.  Stay home this time.  Home birth is just as safe on a first birth as a second.  Trust your body, it was built to birth.  Trust your instinct and research and find a midwife that has experience and the knowledge to  recognize signs and symptoms early that intervention is needed.  Don’t fear birth, fear the practice of obstetrics.

You are 3 times more likely to have a c-section if you choose a hospital birth than a home birth.  And with all this surgery and technology we have 42 countries that have better outcomes than we do.

I’ll stay home….just in case!

As I moved into my own practice I adopted the same policy. No boobs, No Birth. I watched women walk out my door and couldn’t help but wonder what became of those mothers and babies. Suddenly one day it dawned on me that I was playing birth god, judge and jury, and all around know it all midwife. Who was I to say who deserved a good birth? These families had sought out midwifery care, only to be told they didn’t deserve it.

More recently I have noticed such practices run rampant in midwifery. Not limited to breastfeeding however, families are judged on their decision about vaccinations, western medicine, carnivorous diets, and so many other personal life decisions. It seems that midwives are at a loss when a Meat eating YUPPIE chooses a homebirth.

Was good birth intended only for certain people? Who made the criteria?

While it is the obligation of the midwife to inform her clients as to the risks and benefits each choice they make holds, is it really their place to impose their system of belief on her clients? Is that not the very reason we home birthers avoid hospital birth? Perhaps we can make them understand our point of view, and us theirs.

It is time we all re-examine our image of who is an out of hospital birther. I can’t tell you how many times I have been told I don’t “look” like one.

I’ve known J for a long time.  She was not my first midwife, but my longest midwife.  Her first birth as an apprentice was with my third baby and oddly enough, her last birth as apprentice was with my fourth baby.  She then went on to also attend my births for babies number five, six, seven and eight.  So, you could say we have some history.

J listens to me complain about how my hips hurt.  She comes over and patiently waits for multiple sets of little hands to feel my belly and listen to their siblings heartbeat in utero, each with a mini-lesson on how its done.  She laughs and cries with me.  She doesn’t freak out when I scream, “Come now!”  She doesn’t complain when we’re going on hour forty of labor, either.

She knows my quirks when it comes to pregnancy, but she trusts that I know my body and my “stuff” when it comes to statistics.  J leaves her own child at home to come be by my side.  She’s probably missed some fun events, dinners or heck, just quiet nights at home because I needed her.  I also know that she has cold hands that warm up after awhile, that she prefers hot soup and bread for an after birth meal and that she thinks my husband is a great cook.

She is also an amazing carpet cleaner, laundress and even makes a mean bed.  She’s a great photo grapher of newborns.  J even teachs a sweet little lesson to the older siblings on placentas after the birth – every time.

Whether you know my J or not, you know a midwife like her, be sure to take a minute to say thank you for everything that they give up so that women can have safe, satisfying births.

Molly from Citizens for Midwifery starts us off with a great look at the history of childbirth in popular literature. She really covered a it of territory in terms of books that have changed the landscape of birth in popular culture. Remember – the book was once what Baby Story is now to childbirth. I’d also like to add to her list of book: A Good Birth, A Safe Birth by Diana Korte and Roberta Scaer. This book was one that really changed my life in so many ways.

Simone from the International Childbirth Education Association (ICEA) blog reminds us that Peggy O’Mara of Mothering also had a lot todo with the popular press in more recent years, including making an amazing switch from the book to more electronic mass medias. That’s what Authentic Parenting talks about – the women in the electronic trenches. She’s a big fan of the bloggers, tweeters, and the like. It’s pretty amazing the wide net one can cast with the simple press of the finger.

Speaking of home birth, Mary Breckinridge and the Frontier Nursing Service were the nominations of Delia of Birth Story. I really don’t think Mary had any idea of what she was starting, simply by riding that infamous horse over the mountains in Appalachia to deliver good maternity care to women. Now Frontier is a leader in distance education programs for nurses, particularly nurse midwives. This allows women who are dedicated to helping other women and families have healthy, safe births can stay within their communities as they learn the skills that they need.

In a shift of focus, look at Dr. Beatrice Tucker submitted by Carol Van Der Woude. Dr. Tucker was an amazing practitioner, working in another place where home birth was underrepresented – this time in Chicago.  At one point the Chicago Maternity Center was doing 360 births per month!

Kelli from Birth True listed some of her heroines in birth. It was a list that, as I read, I found myself nodding to all the amazing women on the list who are well known. She also started naming names of women who are well known to me, but maybe not as well known (yet) to the rest of the world, like Angela Garvin, a childbirth educator. I have to admit I was so touched that Kelli gave me a shout out too. What you may not know about Kelli is that she’s working hard in rural Kentucky, where you’d think birth wasn’t touched by technology, but unfortunately suffers mightily from the same problem as the bigger cities. Now we just need to get Kelli a horse, a saddle bag and a pelvis and she’ll really be like Mary Breckinridge!

I was particularly touched by Boheime’s (Living Peacefully with Children) post about her grandmother and how she influenced her decisions about birth, particularly unassisted birth and home birth. I had to laugh as I read this sweet tribute, as I shared a similar memory with my own grandmother after my first birth and leading to my second baby but first home birth. Perhaps we should stop being afraid to talk to that older generation, maybe they aren’t as frightened of birth as we are…

Inside the released data, it showed an increasing trend in out of hospital births.  Home births rose about 5% from 1990 to 2005 and were steady in 2006.  About two thirds of these births were at homes and about another third were in birth centers. Which I believe has come from more education on the safety of home birth, as well as the increased interest in women who do not wish to be put through the hospital birthing system, or are looking to VBAC in an area with no hospitals currently permitting the hot button procedure.

What this study also showed was an increase in Midwife attended home birth, showing that women are planning these births and not just accidentally birthing at home, or not making it to the hospital in time. The number of midwife attended home births increased from 43% in 1990 to 61%.

What Robin pointed out on Pregnancy.about.com is that people will try and blame or say these trends are due to the popularity of the film The Business of Being Born, or the Big Push for Midwives campaign but these were unavailable during this time. The Business of Being Born was not released until 2007.

I find these statistics encouraging because women are becoming more educated on their options, and truly are being informed consumers.

_{MacDorman M, Menacker F, Declercq E. Trends and characteristics of home and other out-of-hospital births in the United States, 1990-2006. National vital statistics reports; vol 58 no 11. Hyattsville, MD: National Center for Health Statistics. 2010.}