by Greg Kotkowski

Two weeks ago I was honoured to become a father for the second time. My wife happily gave birth to our first son. I was deeply moved by this emotional moment. For a long time to come I’ll have memories of my wife relaxing with a newborn in a swimming pool in the middle of our living room.

Wait! What? In the living room at home? Has she delivered at home in the 21st century?

Yes, at home. For those who are interested, let me explain our conscious and deliberate decision to give birth at home.

In the 50s and 60s of the 20th century, governments in almost every European country prohibited home births as a way of decreasing maternal and infant mortality during childbirth. Definitely, this was a good step, as many lives have been saved this way. Consequently, public awareness stopped considering childbirth as being natural and risky and started to consider it as a medical event that must be done, a baby must be dragged out of its belly-box.

However, home birth has always been tempting for some parents who expect a baby. For them, it feels much more natural, comfortable and less stressful to deliver at home. The other reasons are avoidance of unnecessary medical interventions common in hospital births or a negative hospital experience. Finally, there could be economic or technical reasons for such a decision, as for example far distance to a hospital. For our own personal reasons, we became part of this group and wanted to have a home birth.

Telling people about the home birth brings a wide range of reactions, from “I would also love to do so” to “Are you stupid and irresponsible?”. The first group is the one that agrees subconsciously with the listed arguments, while the other is worried about the safety issues. However, usually, despite the strong opinion on the subject in both groups, society has no arguments to support their beliefs for the subject.

Nowadays, home birth is practiced more and more often in developed countries and is strongly region-dependent. This “fashion” requires us to have an opinion about the subject, but opinion supported by facts, not by beliefs and superstitions.

For a start, let us have a look at the data from the United States Department of Health and Human Services to check the frequency of births in Residences and Freestanding Birth Centers in the USA in the years 2007-2015, illustrated in the graph below. These non-hospital birthplaces definitely gained interest (almost doubled in the listed 9 years), however they still count for a minority of all births (together about 1% of the total).

Rplot01
Births at home and in freestanding birth centres as a proportion of all the births in the USA.

Safety is the most often emphasised disadvantage of  home birth. There are publications about it, but they differ in their conclusions. Some point out that at home neonatal mortality rates are tripled with respect to the hospital, hence a wise mother-to-be should not neglect that fact and just go to a hospital.

However, all the home births cannot be thrown into one bag. There are accidental births at home or in a car of mothers who didn’t reach a hospital in time, there are births assisted by professional midwives and there are unassisted births in a shelter deep in a forest to feel “close to nature”.

Definitely, the potential for midwifery/medical interventions in these cases differs and is an important factor for safety. According to the data for the USA cited above, about 29% of residential birth is not assisted by any midwife or doctor. This is shocking, but the poorest class in the USA, that is not covered by health insurance, cannot afford a stay in a hospital or midwife assistance for a delivery.

I realise that the subject is very complex and controversial, even among the gynaecologists, and in this short article I need to simplify the whole picture, but let me give you a taste and reasons for home birth. My wife and I would not risk the life of our child only for comfort reasons.

There are guidelines that classify women for a residential birth in order to avoid the riskiest situations. For example, women who have twins, known heart disease, prior cesarean deliveries etc. should not be allowed for such a delivery. The others are considered to be low-risk.

In the case of Poland, where our child was born, low-risk women who want to deliver at home contact a midwife (or as in our case a team of midwives) to plan the delivery and get acquainted and informed about the details.

However, during the gestation period, there are conditions that could prevent women from home birth. These are for example induced diabetes, issues with the placenta, genital herpes, post-term or pre-term delivery. In the case of the team that assisted during the delivery of my son, about 1/3 of the preselected low-risk women who had wanted to have a home birth were condemned to deliver in hospital due to the unwanted risky conditions that appeared during pregnancy.

The other 2/3 of the preselected women try to deliver at home. The psychological condition of a mother-to-be is an important factor for a natural delivery. The presence of a husband or other family members, home atmosphere and professional care of an experienced midwife greatly help to have a happy ending.

However, in about 10% of the cases, the delivery stretches to be too long or the pulse of the child drops below the given limits and a transfer to the nearest hospital has to be done. This brave decision has to be taken well in advance, to minimize any health or life risk of the infant.

Another study confirms that residential births by low-risk women with proper assistance are as safe as hospital births by low-risk women. However, nobody should be forced to give birth at home. If for someone hospital feels the right place, I would never persuade them to do otherwise.

Here is a short summary of our case. We were happy that my wife had been classified as low-risk. When the first regular contractions began, I set up a swimming pool in the middle of the living room and filled it with warm water, which is known to ease the pain. Through the first part of the delivery my wife was enjoying the water and was calmly talking with us. A joyful time of expectancy. From time to time the midwife was silently controlling the progress and pulse of the baby.

After a few hours of more or less painful contractions, my wife finally took the baby out of the water by herself and hugged him. This was a wonderful moment that can be understood only if experienced. And home was the best place for us to feel close to each other, safe and in good hands, free to let out our emotions and much more.