Home birth: safely protecting and supporting normal birth

In this column, the author examines the safety and advantages of home birth. She urges childbirth educators to promote normal birth by encouraging pregnant women to consider the option of home birth.     

Home birth: the wave of the future?

A childbirth educator expresses frustration with a medical system that does not work for women or for many maternity care providers. She suggests out-of-hospital birth as an alternative. This column explores the safety of home birth, women's experiences of home birth, and the issues related to home birth once again being the standard. Childbirth educators are encouraged to present home birth as a viable choice.     

Preparing for the First Birth: Mothers' Experiences at Home and in Hospital in Australia

The aim of this research was to explore the experiences of a group of first-time mothers who had given birth at home or in hospital in Australia. Data were generated from in-depth interviews with 19 women and analyzed using a grounded theory approach. One of the categories to emerge from the analysis, “Preparing for Birth,” is discussed in this article. Preparing for Birth consisted of two subcategories, “Finding a Childbirth Setting” and “Setting Up Birth Expectations,” which were mediated by beliefs, convenience, finances, reputation, imagination, education and knowledge, birth stories, and previous life experiences. Overall, the women who had planned home births felt more prepared for birth and were better supported by their midwives compared with women who had planned hospital births.     

How Do Women Who Plan Home Birth Prepare for Childbirth?

In this column, the findings of a secondary analysis of data from a larger qualitative study of the experience of home birth are discussed. The aim was to describe the ways in which women who plan home birth prepare for their births. The findings provide support for the idea of birth preparation and education occurring throughout pregnancy and describe the ways in which women planning to give birth at home develop confidence, plan for support, and make decisions related to the particulars of the labor and birth. Implications of these findings for childbirth education are explored.     

Transitions: The Birth of Flora Arden

In this column, a young mother shares the story of her second home birth. Like the birth of her first baby, her daughter Flora’s birth was supported by the presence of a midwife and doula, the peace and quiet of her own home, and the love of her husband and family. Birth is described as transforming and a powerful transition for women. She describes the births of both her children as being “forever emblazoned on my heart as the sweetest and strongest days of my small life.” Paralleling this story of birth is the story of her mother-in-law as she faces brain cancer and seizes the power of that life transition.     

Home birth matters-for all women

Although it remains rare in the United States, planned home birth has drawn increasing attention and criticism in the mainstream media and has come under attack from organized medicine. Yet, recent peer-reviewed studies contribute to the evidence base supporting home birth as a safe option for low-risk women attended by skilled midwives. The author of this editorial argues that home birth is an important cultural touchstone in the landscape of American maternity care.     

Teaching in a patient-centered medical home

Teaching Lamaze International classes in a patient-centered medical home allows the childbirth educator the best environment for giving evidence-based information and empowering parents to give birth their way. Patient-centered medical home facilities and providers practice evidence-based care and adhere to the principles of family-centered maternity care. In patient-centered medical homes, women can expect to give birth using the Lamaze Healthy Birth Practices and to fully participate in their care with appropriate interventions and the right to informed consent and informed refusal.     

Lamaze Childbirth among the Amish People

This paper is an account of the author's observation of three Amish births in 1972, one in a home and two in a hospital. This 30-year-old story illustrates normal birth among a group dedicated to "low-tech" living. Although some aspects of Amish life and birth may have changed in the past 30 years, the basic philosophy of life and birth has not. This philosophy serves as a living reminder to us that generations of women from many cultures have given birth in a similar manner.     

Research summaries for normal birth

In this column, the author presents summaries of four research studies that further illuminate the physiology and benefits of normal birth. The topics of the studies are home birth, upright positions during the second stage of labor, delayed pushing in women using epidural analgesia, and the effect of exposure to familiar odors on newborns.     

Childbirth education for multiple pregnancy: part 1: prenatal considerations

Women with a multiple pregnancy have unique learning needs in preparing for birth. This paper explores the issues relevant to women with a multiple pregnancy to support a positive birth experience. One of the foundations of childbirth education and nursing care is to provide the individual woman and her family with knowledge regarding the birth process, what to expect, and how to cope with labor and birth. Education also focuses on caring for the newborns after birth and how to manage in the early days at home. However, traditional childbirth education classes, which meet in a series of evenings or Saturdays, may not meet the needs of women with a multiple pregnancy. In addition, because of the differences in care that exist for women with a multiple pregnancy, new paradigms for childbirth education are needed to meet the learning needs of these families. The purpose of this paper is to provide information to the childbirth educator on the differences in care women with a multiple pregnancy can expect and to suggest strategies to meet the childbirth education needs of these families.     

More Than Clinical Waste? Placenta Rituals Among Australian Home-Birthing Women

The discursive construction of the human placenta varies greatly between hospital and home-birthing contexts. The former, driven by medicolegal discourse, defines the placenta as clinical waste. Within this framework, the placenta is as much of an afterthought as it is considered the “afterbirth.” In home-birth practices, the placenta is constructed as a “special” and meaningful element of the childbirth experience. I demonstrate this using 51 in-depth interviews with women who were pregnant and planning home births in Australia or had recently had home births in Australia. Analysis of these interviews indicates that the discursive shift taking place in home-birth practices from the medicalized model translates into a richer understanding and appreciation of the placenta as a spiritual component of the childbirth experience. The practices discussed in this article include the burial of the placenta beneath a specifically chosen plant, consuming the placenta, and having a lotus birth, which refers to not cutting the umbilical cord after the birth of the child but allowing it to dry naturally and break of its own accord. By shifting focus away from the medicalized frames of reference in relation to the third stage of labor, the home-birthing women in this study have used the placenta in various rituals and ceremonies to spiritualize an aspect of birth that is usually overlooked.     

Step 5: has clearly defined policies, procedures for collaboration, consultation, links to community resources: the coalition for improving maternity services:

Step 5 of the Ten Steps of Mother-Friendly Care ensures that the hospital, birth center, or home birth service has clearly defined policies and procedures for collaborating and consulting with other maternity services and for linking the mother and baby to appropriate community services during both the prenatal and the postpartum periods. The rationales and evidence in support of this step are presented.     

Helping hospitals change: part 2: childbirth education techniques to empower women

As the director of patient-care services for maternal-child health and clinical practice at two large, metropolitan hospitals, the author of this article outlines ways in which childbirth educators can empower women to receive the birth experience they want. Techniques include offering a special prepregnancy class, helping expectant women to formulate questions for their care providers, and encouraging women to express their perceptions of their birth experience by responding to their hospital's patient-satisfaction survey, writing letters, or nominating mother- and baby-friendly nurses for special recognition.     

Home and Career Development: A Life History of Elia Hill Swann, 1878–1961, with Implications for Counseling

This study is based on a life history of a woman born in 1878 who, at the age of eighteen, left her farm home in an isolated rural area to make a life in an urban career. Her life history parallels and extends our understanding of the experience of modern day women who leave home for careers in distant areas. It is also an example of the experience of women of a rural diaspora. The results identify ways that home and memories of home can support women's career development over the lifespan. The qualitative data analyzed in this study leads to recognition of how home can support the launching as well as reinventing of a career by providing a source of strength for women who are far from home. In addition, a woman's home and reminiscence of home can provide a source of comfort and support during times of emotional or financial hardship. Women who are from outside the mainstream American urban/suburban culture, such as women whose homes are in rural or non-European American areas, need to be prepared for difficulties that can arise while becoming acculturated in a commercial, consumer culture. Finally, implications for counseling are discussed.     

Water Birth at Home: Two Perspectives

In this column, a grandmother, with a long history as an author and activist for normal birth, and her daughter, a new mother, offer their unique experiences of a water birth at home, attended by family members and midwives. Their unique perspectives demonstrate the trust in the normal birth process that is possible for every birth.     

Normal birth: two stories

THE AUTHOR SHARES TWO STORIES: one of a normal birth that took place in a hospital with a nurse-midwife in attendance and another of a home birth unexpectedly shared by many colleagues. Both are told with the goal to inform, inspire, and educate.     

Continuing Education Module: Persuasion: The Key to Changing Women's Ideas About Birth

Although standard maternity care is not evidence-based and, in many cases, increases risks for mothers and babies, few women make birth decisions that reflect this knowledge. This column discusses persuasion as a way to change women''s ideas about safe, healthy birth. The relationship between persuasion and choice is discussed, and the differences between presenting information and persuading women that natural birth is the safest and healthiest way to give birth are explored.     

In Search of a Common Agenda for Planned Home Birth in America

Leading maternity provider organizations in North America have been in conflict about birth at home and birth centers, debating issues related to safety, access, the value of obstetric intervention, and patient autonomy. In today’s environment, childbirth educators and doulas are often required to explain to parents why physiological birth and evidence-based, low-technology methods of labor and birth care are not available in every setting, and why maternity providers disagree about birth place. There are very few regions in the United States where home birth providers are integrated into interprofessional provider networks that allow for seamless care across birth settings. In October 2011, multidisciplinary leaders met at a Home Birth Consensus Summit in Warrenton, Virginia, to discuss the status of home birth within the greater context of maternity care in the United States. This article describes the intent and outcomes of the summit. Four of the nine consensus statements developed at the summit are of particular interest and importance to mothers and families and, hence, to childbirth educators and advocates. Consumers, educators, and birth advocates are encouraged to widen the circle, identify communications experts, lead individual projects, or serve as advisors.     

Alternative strategy to decrease cesarean section: support by doulas during labor

This research was conducted in a public general hospital in Mexico City, Mexico. The objective was to evaluate efficacy of the support given by a doula during labor to reduce cesarean rate. From March 1997 to February 1998, a group of 100 pregnant women were studied. These women were at term, engaged in an active phase of labor, exhibited 3 cm. or more cervical dilatation, were nuliparous, had no previous uterine incision, and possessed adequate pelvises. The group was randomly divided into two subgroups comprising 50 women, each: The first subgroup had the support of a childbirth educator trained as a doula, while the second subgroup did not have doula support. Measurements were recorded on the duration of labor, the use of pitocin, and whether or not the birth was a vaginal birth or cesarean section. Characteristics and gestational age were similar in both groups. Results confirmed that support by doulas during labor was associated with a significant reduction in cesarean birth and pitocin administration. There was a trend toward shorter labors and less use of epidurals. The results of this study showed, as in other trials measuring the impact of a doula's presence during labor and birth, that doula support during labor is associated with positive outcomes that have physical, emotional, and economic implications.