Birthing – At Home or In a Hospital?

The miracle of life, truly a fascinating time for a woman and her partner. It’s also a vulnerable, stressful time, with life altering decisions to make.  What factors should a prepper take into consideration when planning for the event?

I mentioned in a post last week that we considered birthing at home for Podling #2, but are currently planning on a hospital delivery. I want to share some of the thought processes behind the decision and touch on some of the risks inherent in both choices.  (I will mention, briefly, if you live in  or near a large enough metropolitan area, you may have a third choice, a birthing center. Those don’t exist in my neck of the woods, so I’m not as familiar with them.)

If you are unfamiliar with the legalities of birth, here’s a quick primer: Every state has different laws.  In Texas it’s legal to have a professional midwife attend your birth at home, even for multiples and breech presentations.  In Iowa homebirthing with professional midwives is not legal for any birth, but you can birth at home “unassisted” or you can go to a hospital and be seen by a Certified Nurse Midwife (CNM) or Obstetrician.  (There are midwives who attend homebirths in Iowa spite of the lack of licensing.)  Then there are states with everything in-between.

At home – Depending on your state laws and the outcome of your home birth, this choice could bring increased scrutiny by authorities.  That can range from EMT’s if something goes wrong, your OB dropping you as a patient or possibly even a visit from DHS. You may have to deal with the uneducated opinions of loved ones if you tell them of your homebirth choice. Birthing has become such a highly medicated event, that generations of women in the US no longer remember any other way. All of that should be weighed against the positives of homebirths.  Namely, complete freedom to labor and deliver exactly as the mother wants.  No Cover Your Ass procedures or restrictions. No limits to labor time. No limits to food/drink intake. No restrictions on labor or delivery positions.  No pressure for interventions like Pitocin, narcotics or surgery.

Cost is usually reduced for a homebirth.  My health insurance lists average birth costs at above $8,000.  (They don’t cover homebirths.) Most homebirth midwives charge in the $2-3,000 range, some even less, and going unassisted gets things down below $1k.  There are expenses even at home; you’ll need clean supplies for catching the various fluids, laboring devices like a birthing ball, birthing pool, etc. and general first aid/delivery supplies to deal with any tearing or pain as well as cutting the cord and suctioning the gook out of baby’s breathing passages.

You’ll need to make arrangements or plans for transfer options should an emergency or complication arise.  There are reasons women and children die in birth, things CAN go wrong.  If you are birthing at home, make sure the attendants know where/who and when to call for an EMT.

In a SHTF event, a homebirth may be your only option.  If the hospitals are full of pandemic victims or trauma patients from a large deadly event, you’ll be better off at home, so never rule it out as a possibility. Make sure you’ve done your research so you know what to expect.  I love Ina May Gaskin’s books for practical advice on natural at home birthing.  There are others out there though, find one that matches your situation. And of course have the preps on hand to handle such an event.

At a hospital – Going to a hospital increases your risk of interventions, surgery, and higher costs.  In large part due to the CYA procedures mentioned above, a short lis tof them includes:

Internal exams – Dr’s have to “track your progress” and will often insist on vaginal exams to do that. These can be painful, they can introduce foreign bacteria into the birth canal and generally throw a woman off her laboring  groove.

Limits to food and drink – Their thinking is if the woman needs a general anesthetic, (for surgery) the danger of inhaling undigested stomach contents if she vomits while anesthetized is greatly reduced.  Yea, I’ll let you figure out how often that actually happens.  But, they have to CTA so they deny ALL women anything other than ice chips.  This plays into the time limits they impose on laboring women, if you’re starving someone who’s working hard, of course their stamina will give out.

Labor “augmenting” drugs  – Dr’s (and nurses) prefer to follow timelines and schedules, no matter what is natural.  So, they have terms like “failure to progress” and “stalled labor” to justify pumping the laboring woman full of drugs.  Pitocin is the most commonly used augmenter. More and more often it seems to be used to keep women “on schedule” so the Dr can make a golf Tee-time.  There are dangers, please be informed before acquiescing to such augmentation.  I’m sure the fact that they get more money for every drug they prescribe doesn’t factor in at all.  Pitocin is also used to start labor in women who have gone over the guess-date.  Again, it’s back to the issue of wanting to schedule something that isn’t interested in the Dr’s vacation plans.  Most chemical induction methods have some pretty serious risks, risks I am not comfortable with, and would refuse. But, again, do your own homework.

Limits to labor and birthing positions – Women aren’t the only ones who have forgotten what natural birth looks like. Dr’s no longer like to crease their suits by getting down to floor level, so they prefer the woman push on her back in a bed so that the baby is nice and easy to catch. Nevermind that it works counter to gravity and often isn’t the most comfortable position to push in.

I could go on, but this post is getting long enough already.  Going to a hospital can be done though, know your preferences, and know your rights. Be prepared to say over and over again, “I refuse X procedure, write it in my chart and bring me the waiver.” Know how the cascade of interventions works and how to counter them so you lessen your risks of ending up in painful, expensive surgery.

In our case, the costs of a home birth vs the costs of a vaginal hospital birth were within a few hundred dollars of each other. ($2,800 vs $3,200) There are only a couple of homebirth midwives that moonlight in my rural area, and I didn’t click with any of them during interviews, so there was no pull to stay home to be with one of them. Our rental place is small, we have wall to wall carpeting covering every square inch, and we don’t have a couch or a tub.  So, comfort and ease of cleaning tipped me over the edge to the hospital decision.  It helped that the hospital we’re going to has an awesome CNM who we clicked with immediately and is dedicated to natural births and has a great relationship with said hospital.   I won’t have to fight every inch of the way for natural methods and respect.  I’m due late enough in the spring that I’m not worried about blizzards, and I’m strong willed enough to be close to narcotic pain relief without giving in to the temptation. So, it’s the right decision for us. It is good to know that we could birth at home if we needed to, hubby and I are both comfortable enough with the process to handle it, and we have all of the first aid supplies necessary for such an eventuality.

Would you ever consider birthing at home? Are you prepared for such an event?

– Calamity Jane

Personal political plug: If you are interested in seeing more freedoms for birthing mothers in your state, do consider joining up with your state’s midwifery association. I’ve done lots of work with our Iowa Midwives group, lobbying state legislators for state licensing of professional midwifes and increased support for homebirths as a valid and safe choice.