Homebirth for people who want hospital birth

Through my apprenticeship, I've seen a fair number of families both here and in Utah who have come to homebirth not out of any real desire for a homebirth. Their idea for themselves was always to have a hospital birth, with an epidural, and some of these women have had children before, and done exactly that with those births. And now they've come to us not seeking an improvement in care, as some moms do after hospital birth, but because of money. They don't have insurance, and the cost of homebirth is about 1/5 of the cost of a completely straightforward hospital birth.

Often these relationships start with lots of questions about safety, and one question about pain - generally a variation of "can I really do it without drugs?". These questions, which are nearly universal no matter what a family's idea of birth is, usually get answered during the interview and over the first visit or two. Then through our usual prenatal care, these families come to trust us in a way they never imagined trusting a health care provider. They trust us not in the Western medicine way that I so often hear on the internet: "I trust my doctor because she's the expert and what she says I should do must be the right thing to do."

Instead they learn over time to trust us to provide them with all the information that they need to know so that they can make the most appropriate decisions for their families: risks, benefits, alternatives of all tests, procedures, and treatments available, and information about their own babies and bodies gleaned through long discussions with them and through any tests they have opted to take. Through this trust-building they also slowly trust deep down what their brain had believed when they hired us: we really will be able to recognize situations that would make a hospital birth a safer option, and we will tell them, and we will go. They trust us to guide them through a process that is theirs. "I trust my midwife to let me stay in control of this process and to tell me if this process gets outside the range of normal so we can alter our course if needed."

Sometime, usually in the third trimester, we return to pain, because now that trust is really built, mom admits she's worried that she won't be able to handle it. We talk about how the sensations of labor are not the same as an injury but more similar to physical work. We talk about how it's easier at home to make all the hormones of labor which help ease the sensation. We talk about all the ways the sensations can feel, and the ways that our support can help. Often, this is the one part that mom never quite fully trusts us on... but she trusts us enough to move into her birth calmly, and with the knowledge that she has our full confidence.

Then comes the birth. Sometimes it's huge for her, she thought it would be easier, she has a hard time moving into it and letting her body take over. Sometimes she soars right through it easier than a mom who had always wanted a natural birth or a homebirth. Usually, it's the same doable challenge we see time and again. Regardless, during the immediate postpartum, we always hear, "I'm so glad I'm home," and from the multips, "I feel so much better than I did right after my other(s) were born!"

With all our clients, we ask how the birth was for the mama (and even her partner) at postpartum visits, and allow her to process it. Sometimes we first hear, "That was so incredibly hard," and sometimes, "That was a lot better than I thought it would be." We hear the whole range of experience from these moms, the same as any other moms. But the one thing we always hear, sometimes 5 minutes after the birth, sometimes the next day, or a week later, or a month later: "I would not want to have a baby in the hospital. I don't care if we have insurance next time. If we have any more babies we'll have a homebirth again."

Those are some of my favorite words, and these clients have a special place carved out in my heart. It shows a special kind of courage to move into an uncomfortable place and embrace it, as mothers who would have preferred hospital birth have to do in order to have a homebirth. And it shows that, while I wouldn't push anyone to have a homebirth, it truly can be the gold standard of maternity care not only for "natural birth types" but for anyone.