From: drew@cs.anu.edu.au (Drew Corrigan)
Newsgroups: misc.kids
Subject: Re: Homebirth vs. Hospital birth
Date: 21 Dec 1992 14:00:25 +1100
Organization: Computer Science Department, ANU, Australia
NNTP-Posting-Host: pollux.anu.edu.au

Hi Ginger! I'm sending from Canberra, Australia. Below is a copy of a 
posting I submitted to misc.kids about two years ago. Our daughter, born
at home, is now 3.5yrs old. Any children that follow will definitely be
born at home too.

Hope you find something of worth in it.

Cheers,

Drew.  (drew@cs.anu.edu.au)

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My wife and I had our daughter born at home about 15 months ago, and we can
heartily recommend homebirth if *you* both feel comfortable with it and
certain provisions apply. 

We began looking into homebirth over a year before our daughter was
born.  We conducted as much unbiased research as we could.  In the end
we decided to go with homebirth.  We joined a homebirth association
which handles about 100 homebirths per year in a city with a population
of about 260,000.  We chose a doctor (1 of 2 in the city) who handles
homebirths and hospital births.  We also "interviewed" each of the 4 or
5 homebirth midwives who work with the association, and chose one we
felt most comfortable with.  We also nominated a backup midwife.  All
the homebirth midwives in Canberra are registered midwives, though there
are lay-midwives working with homebirth associations in other Australian
cities. 

The homebirth association has a reasonably good relationship with the
hospital system here and even gets some of the necessary birth equipment
(eg. "sterile bundle") from the hospitals.  Other items of equipment such
as an oxygen tank, drop sheets, syntocin (a synthetic hormone that causes
the uterus to shrink in the case of haemoraging) are hired from the
association for $50.  

The midwife and doctor provide certain items of their own - eg.
stethoscope, blood pressure measuring device, equipment to stitch up a
mother in case of a perineal tear, forceps etc.  Finally, we had to
provide various things ourselves: hot towels, ice packs, drinks, dry
warm clothing for baby, garbage bins, general purpose rubber gloves (for
cleaning - not delivery!), and the like.  We also chose two helpers, one
a close friend, who had both had several babies at home. 

The typical arrangement in Canberra is for the couple to meet
alternately with the doctor and the midwife during the pregancy.  The
midwife comes to your home which is very nice, and spends as much time
as you like answering questions, talking about pregnancy and birth, and
just getting to know you.  We also attended ante-natal classes dealing
with labour and birth and natural methods of coping with pain.  We chose
classes especially oriented towards homebirth, though not all attending
were planning on homebirths. 

With our midwife we drew up a "birth-plan" - basically a plan of how we
would approach different stages of the birth, what we did and did not
want done, and so forth.  A birth-plan is useful because in the emotion
of the moment it can be easy to forget that you really wanted to choose
option A before option B.  For example, what if contractions slowed down
(as in fact happened)? One option would be a drip (yes it *can* be given
at home!).  Another would be to try nipple stimulation - this causes a
release of hormones that can spur on contractions.  We chose nipple
stimulation as our first choice, drip as second (or was it third?!)
choice. 

We also spoke to as many people who had experienced homebirths as we
could.  We attended several video nights of homebirths.  We read dozens
of accounts of others.  We visited the nearby hospital (10 minutes drive
away) and had a tour through the labour ward, so that we might know
where to go and what to expect should it become necessary to transfer to
hospital.  We even booked into the hospital as a safety precaution and
to obviate any paper work.  Actually, the homebirth association will not
hire out any equipment, nor will midwives agree to attend, unless you
sign an agreement to transfer to the hospital should in the opinion of
the midwife or doctor the need arise during labour. 

The usual arrangement for first births is midwife in attendance
througout labour, birth, and afterwards; midwife notifying the doctor at
the onset of labour and keeping him/her informed throughout labour; and
the doctor attending for the actual birth and immediate post-partum
period.  For subsequent births, the doctor usually only comes for the
post-partum period, unless complications arise.  After the baby is born,
the midwife visits every day for 10 days afterwards, and on the 10th day
the doctor gets to take another look at the baby again.  The midwife is
also responsible for the usual blood cord samples and heel pricks etc. 

Why did we choose homebirth over hosptial birth?

1. Safety. Surprising as it may seem, modern homebirth in Australia, and 
   most Western nations has a lower infant and maternal mortality rate than
   the hospital system. In Australia a major study was just released last
   month showing the homebirth mortality rate over the last decade or so
   to be *half* of the hospital rate.

   Why is this? Well a large part is due to the fact that women are carefully
   screened before everyone involved agrees that homebirth is viable. But,
   this is not the only reason. Some hospital practises add undue elements
   of risk to the procedure - epidurals are a good example. Other factors
   are involved too, but I don't have a copy of the report with me to refer
   to.

   Some cite the high mortality high of homebirths prior to hospitals. Every
   serious study I have read traces these problems to lack of hygene and
   knowledge. The vast majority of women (> 94%) can birth normally, and
   safely without major complications if given half a chance.

   NOTE: this does not mean that one should have a casual attitude towards
   homebirth. It is only good sense to make sure that one has ready access
   to a nearby hospital should the unforseen occur - I believe 20-30 minutes
   drive is usually considered the upper limit of safety.

2. Control. In a homebirth one is more likely to have control over the
   situation and have your needs and wishes met, than in a hospital. You can
   eat and drink when you like, dress as you like, move about as you like, 
   choose the most appropriate labour and birthing positions, agree to or veto
   certain procedures (within reason). You can have the midwife you know,
   the helpers you know, and even your children if you wish, all in attendance
   at the birth.

   Hospitals may or may not be so flexible - something you should find out.
   For example, one of the anesthetists in operation at the hospital nearby
   us, refuses husbands to be present while he administers an epidural. If
   he happened to be on duty and we happened to need one - tough luck! I'd
   would have been out in the waiting room!

   Hospitals can impose unnecessary procedures which you might feel obligated
   to accept. A friend was urged to have an *unnecessary* episiotomy in order
   for a midwife in training to get some experience! I was horrified that
   medical staff would urge the cutting of *muscle* tissue for someone else's
   convenience. She (my friend) acquiesced to the request.

   Some things you should query closely are routine shavings of pubic hair,
   routine enemas, routine episiotomies, supine birthing position, *all*
   drugs, when and why forceps, routine monitoring of baby, whether baby
   can be left near mum or whisked off to a nursery, whether feeding is when
   mum and baby want it or at hospital approved intervals - just to name a
   few!

3. Avoiding the "cascade of intervention". It has been well documented that
   certain medical interventions (which are often routine) often have side-
   effects that require further intervention, and so on. I wish I could
   publish the chart which has been drawn up to illustrate this effect, but
   will have to content myself with an example or two.

   A common practise is fetal monitoring - applying electrodes to the baby
   to monitor its heart beat. If the heart beat dips significantly, everyone
   flys into actions to speed the birth. The cavet is that baby's heart beat
   will *normally* rise and fall as it moves down the birth canal. Fetal
   monitoring, while useful in some cases, can lead to undue alarm and un-
   necessary further intervention if used routinely.

   Another example would be epidurals. These too can lower the baby's heart
   beat leading to caesarens or breathing difficulties for the baby at birth.
   (The drug enters the baby's bloodstream.) They will almost certainly lead
   to episiotomies.

4. Environment. The nearby hospital has tried to make it nicer for birthing
   women - pastal colours, equipment hidden away, etc. But its just not home!
   We enjoyed lasagna, apple cake and champagne after our daughter was born.
   It was so delightful to bed down for the first night with our new little
   girl between us. Nothing a hospital can provide can ever match home!

   Issues like privacy, learning about your brand new baby together, dads
   and siblings not feeling left out - all these things *do* make a 
   difference. The emotional side of birth is one that I feel hospitals
   cannot do justice to. I recall the day of our daughter's birth and the
   next few weeks as having an almost dream-like happiness and "lightness"
   and euphoric quality about them.

   A birthing centre might be a good compromise if you feel uncertain about
   homebirth. Assuming you have one nearby. Canberra has one but only after
   years of lobbying by numerous groups (including homebirth assoc. because
   we recognize it as a valid choice for women and their families). The 
   opposition stemmed from the medical fraternity who regarded it as 
   "unsafe"! Their *real* fear was loss of control and power over birth due 
   to the natural preference of mothers for midwives.

Well that about sums it up. I can recommend homebirth, BUT only you know
your situation and only you can decide. I firmly believe anyone wanting a
homebirth *must* be convicted about the choice. It will probably involve 
more effort and expense on your part to organize things than a hospital
birth, but that's a consequence of the choice. You will no doubt receive 
much sincere and well meaning advice. (We sure did!) Be sure of your facts
and your plans. 

Read as much as you can. Two excellent books on birth are
  "Birth at Home" by Sheila Kissenger (sp?)
  "The Active Birth Book" by Janet Balaskas.
Actually, any books on pregnancy and birth by either of these two authors 
are worth reading. "Birth at Home" has recently updated very useful. Janet 
Balaskas' strength is in the area of "active birthing" - birth where the 
mother is free to move about and take up the most appropriate positions 
throughout labour and birth, as opposed to the foolish, extra painful, and 
even risky position of lying on one's back.

Also, contact the "National Association of Parents and Professionals for
Safe Alternatives in Childbirth". This is a US organization which has plenty
of useful advice to share about homebirth.

Well I'll get of my soapbox now. Above all things, remember "You're having 
a baby, not a birth" - and have fun!

Drew.

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The Birth of Amy Elise, March 28, 1989.

My wife (Vanessa) and I are both members of the Canberra Homebirth Association
(a marvellous organisation :-).  Canberra has a population of about 250,000
and an excellent road system whereby one can travel from anywhere in Canberra
to virtually anywhere (in Canberra), in about 30 minutes maximum.  Where we
were living at the time our daughter was born, it was a 10 minute or less trip
to the hospital. 

From early on in our marriage we had both been intrigued with the idea of
having a homebirth.  Both of us associate hospitals with sickness and we felt
that if there was a better way for us as a couple, we would find it and take
that path.  Fortunately, we were friends with another family who had had three
children at home, and with their support and encouragement we were able to
contact the CHA, and start getting some information on what was involved. 

We spent about 6-7 months prior to conceiving reading, talking with others,
attending meetings and viewing videos, before being settled that homebirth was
the choice for us.  We knew that approximately 10% of all intending homebirths
end up being hospital deliveries for one reason or another, so we recognised
the need for flexibility.

The association works with two doctors and a rotating pool of fully qualified
midwives.  Once the pregnancy was confirmed, we went about the task of
"interviewing" the midwives to find out their feelings on issues of concern to
us, and how well we felt we could get along with each.  Eventually, we picked
Victoria (I'm giving names so that you can follow the story as it develops). 
We couldn't have been happier with her - she became a true friend, helper and
"birth confident". 

As the pregnancy progressed, we took turns seeing the doctor we had chosen (Dr
Peter Black), and Victoria.  Actually, Victoria came to see us, rather than us
go to see her.  She would spend up to an hour at a time with us, explaining
various things: the position of the baby, exercise, nutrition, birth plans,
choosing birth classes, and so on. Closer to the birth, she assisted us in
getting things in order for the birth.

The mother of the family who introduced us to the CHA (Leonie) offered her
services as a birth helper which we gratefully received. We felt we ought to
have a second helper, and the Association put us in contact with another
homebirth mother (Allison) who offers her services to homebirthing families.
(Actually, the association is something of a little "community" all its own,
even though the members are scattered all over Canberra, and has a strong
history of helping and supporting its members. Many members freely give their
time and energies to assisting other birthing families.)

About two months before our baby was due (January 1989), we began attending
birth classes held by a registered physiotherapist who had also had her
children at home.  The classes were oriented towards homebirth, though not all
the couples attending were choosing homebirths - some just liked her general
approach to birthing.  We went through breathing techniques, methods of
dealing with pain, relaxation, birth positions and the like.  We also saw a
video of a particularly hard labour (36 hours!), and spoke with a couple who
had given birth only a matter of weeks beforehand. 

As the weeks slipped away we went to the hospital to register (in the event of
a transfer being necessary) and had a tour of the facilities.  Somehow,
there's no place like home!

We also picked up our birthing equipment from the Association.  Some of their
equipment is available for hire and the rest is supplied to them through an
arrangement with the hospital.  Both doctors who handle homebirths in Canberra
also deliver at the hospital, so your "doctor of choice" is still available if
a transfer is required.  (Incidentally, one of the conditions of hire of
birthing equipment is that you agree in writing to transfer to hospital should
either the doctor or midwife in attendance consider it necessary.)

The Thursday before Vanessa went into labour (Monday evening, March 27), she
came into town to see me and spent quite some time walking around the shops
for the "last time" (at least for several months).  That weekend happened to
be Easter weekend, meaning that both the Friday and Monday were public
holidays.  On the Sunday afternoon, we both went into the University again to
meet a friend for afternoon tea.  We like to think that it was these two days
of walking around that helped move things along - but who knows :-)!

Sunday evening the earlier Braxton-Hicks contractions became increasingly
stronger and sharper and Vanessa had a very restless night.  Monday morning we
asked Victoria to come over to examine Vanessa, and Leonie dropped by too to
get to know Victoria a little better.  Victoria said that the contractions
were really too far apart and irregular to be thought of as labour, but told
us to keep a check of the interval between them.  Leonie jokingly told us
before she left that she "felt" she might be back that night. 

Possibly in expectation of the events shortly to follow, Vanessa prepared an
apple cake and some meat sauce for lasangia. (We had planned a celebratory
meal of lasangia, apple cake, and champagne!)

Around 5pm the contractions were coming far more regularly and we decided to
time them: 5 minutes apart.  We rang Victoria who dropped over (luckily she
lived only 3-4 minutes away).  She assessed Vanessa as being in the early
stages of labour and offered to spend the night with us in our spare bedroom. 
Since she was so close we decided to let her go and rest at home. 

We went to bed early but the contractions kept Vanessa awake (and I didn't
get much sleep either). Around 1.30am Vanessa felt she would like Victoria to
come over, so we moved downstairs to the living room (our birthing room) and
gave Victoria a ring. Vanessa found that by kneeling and leaning forwards
into a beanbag, and me rubbing her lower back, the contractions went easier.
We had already set aside some "birthing music" and put on the soothing strains
of Handel's "Water Music".

Victoria arrived shortly and took Vanessa's vital statistics, listened to the
baby's heartbeat, and started to draw up her log of events.  At 2.30am we rang
Leonie and she arrived around 3.00am.  The next few hours seemed to pass
slowly - I remember Vaness and I spent some of the time experimenting with
different relaxation positions and trying the various breathing techniques we
had learned.  Vanessa put Leonie to good use and had her clean the upstairs
bathroom (!), and make the cheese sauce for the lasangia. 

When dawn finally came, Victoria suggested we help Vanessa into some clothes
and take a walk in the back garden.  We were delighted to see that the days of
cloud and drizzle had cleared into beautiful sunny skies.  What a perfect day
for the birth of our baby! We walked slowly around the garden, pausing every
time Vanessa had a contraction.  Being Tuesday morning and the long weekend
over, most people were preparing to go to work.  We amused ourselves by
wondering what our neighbours would think if they only knew the drama
unfolding in our modest home and yard!

Returning inside, Vanessa decided to lie down on the lounge and I slipped away
for a shower and breakfast.  After she had dozed off and on for a time,
Victoria suggested she take a shower, and it was then we discovered a
*wonderful* :-) way of moving events along.  Our house was a 3 level, 2 story
home.  There was one bathroom (shower and toilet) on the second level.  A
second bathroom on the top (third) level.  The lounge room was on the bottom
level.  To move Vaneesa to the second level bathroom for a shower involved
climbing about 8 steps.  Climbimg those steps really helped: as soon as I
helped Vanessa into the shower, the mucus plug (at the mouth of the cervix)
started to come out!

We were excited and Vanessa seemed to draw strength from the hot shower.  We
returned downstairs to the lounge and around this time (10am ?) Allison
arrived with fresh muffins.  Leonie brushed Vanessa's hair while she sat on a
birth stool to rest.  As the morning wore on, Vanessa became increasingly
tired and (probably) because of this, the contractions slowed.  Victoria
suggested we try nipple stimulation to help re-establish a rythm.  This worked
quite effectively.  Victoria (who had been keeping in contact with Peter Black
via phone) offered to do an internal examination.  Vanessa agreed and after 19
hours of nominal labour wanted to know how things were progressing. 

She was 5 or 6cms dilated (I forget the details at present) which was an
encouraging sign.  Victoria suggested taking a warm bath, and so Leonie and I
helped Vanessa up the stairs (16 this time) to the bathroom.  Again Vanessa
found the water soothing.  Sometime later we resturned downstairs.  I think
Vanessa requested an examination.  At any rate, she had one: 10cm dilated! It
was now early afternoon.  Peter Black dropped around and mentioned that
sometimes it is necessary to help the waters to burst.  That was not on our
plan, and it must have given Vanessa some extra determination, for after he
left, she managed to break them by bearing down during a contraction. 

The baby was now progessing down the birth canal, and we settled into a
routine of Vanessa sitting on the birthing stool for rest between
contractions, and then moving into a supported squat during them.  Allison,
Victoria and Leonie kept up a supply of hot wet nappies which were applied to
Vanessa's lower back and abdomen.  She began to doze between contractions, at
times perking up to have a drink or chew on some crushed frozen fruit juice. 

Around 3pm I went to bring in some washing from the line and dumped it on the
bed in our bedroom.  For a moment I lay down, and the next thing I knew I was
struggling out of sleep to the sounds of a baby crying! What had happened?! I
stumbled downstairs to find it was only Allison's 6 month old daughter whom
she had brought along, making a small fuss.  I tell you what - when you're
tired, *all* sorts of weird ideas can pass through your mind :-)!

The baby's head could now just be seen at each contraction.  We used a mirror
to help us see what was happening though Vanessa couldn't make much out (the
mirror was too small).  Prior to this time, Victoria had unpacked the sterile
bundle and other equipment and covered the floor with a protective rubber
sheet.  She regularly monitored the baby's heartbeat and assured us everything
was okay.  Vanessa began to bear down really hard.  I was completely amazed at
her determination (despite incredible tiredness).  She apparently had *no*
urge to push at any time and decided in her mind that it was up to her to get
this baby out.  It was then I developed a new and profound respect (in a way I
had never understood before) for birthing women, and my wife especially. 

Peter Black turned up again as the baby began to crown.  Leonie and I were
supporting Vanessa in a squat.  Allison took photos and Victoria massaged
Vanessa's perenium.  Watching a child being born is always astonishing.  But
when it's your own child, it is miraculous.  Right up until the head came out,
the fact that *we* were going to be parents seemed "like a dream".  But here
we were and it was real and happening before our eyes! Our baby's head was
suddenly out, and with another push the shoulders and body! Vanessa elatedly
cried, "A baby girl!" Amy Elise had entered the world!

After Victoria sucked some mucus from Amy's nose and mouth she quickly wrapped
her in a warm towel and handed her to Vanessa whom we helped back on to the
birth stool while waiting for placenta to come out.  Amy seemed more
interested at looking at Mummy's face than taking the breast.  Daddy cut the
cord when offered the scissors.  Once the placenta was delivered, Peter Black
put a couple of stitches into a small tear Vanessa incurred.  Then we settled
down to enjoy our celebratory meal and champagne. 

Vanessa was extremely weak (primarily due to tiredness and the huge amount of
effort she had put into the birth), so we propped her up on the divan while I
held Amy and generally marvelled over her and said silly things (why do babies
do that to fathers? :-) Victoria, Leonie and Allison did a tremendous of job
of clearing up the mess and equipment, before Leonie and Allison left. 
Victoria assisted me in giving Amy her first bath and teaching me how to dress
her.  Some friends dropped around with a couple of casseroles for meals the
next two days and we all wondered at the uniqueness of the little girl we were
observing. 

When everyone had left apart from Victoria, she helped me turn the divan in
the lounge down into a double bed.  Vanessa was too weak to climb the two
flights of stairs to our bedroom, and so we decided to settle down together in
the lounge.  Victoria mothered around us until about 9pm when she departed
home.  After that we collapsed into bed together, our brand new daughter
between us.  What a day it had been!

Postscript:

Victoria continued to visit us each day the next 10 days, teaching, helping,
bringing an odd meal, and even flowers. We keep in contact with her from 
time to time. Leonie is going to have a forth child this July and Vanessa will
be a birth helper to her. Allison? She's still helping other families and is
waiting on us to a second child :-). And Amy? Well, last night she slept in
her own bed (no longer a cot) for the first time. Our baby's no longer a baby.
Time passes too quickly.