FAQ Safety and Outcomes

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The safety of homebirth is the most commonly asked question that we address as midwives.

And for good reason.  We clearly discuss what low-risk pregnancy and birth is and compare it to a higher-risk situation at all consultations.  We also follow pregnancy and birth closely in order to avoid problems, identify problems early and start necessary treatment, and then make joint decisions about each person’s care.  Most parents appreciate having the problem with all its risks clearly outlined and being part of the decision-making process.
Let’s discuss some of the issues and find some more resources.

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MAWS’ guidelines for medical consultation or transfer of care are reviewed every two years to include new evidence and data.

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MANA Statistics project with almost 100,000 planned home births recorded.
Washington has the best outcomes of all.

Science & Sensibility

A research blog about healthy pregnancy, birth & beyond

The author has interviewed Melissa Cheyney, both a researcher and homebirth midwife, about recently published articles on homebirth outcomes.  Their discussion is very interesting and enlightening.

Henci Goer’s recent blog posts are also accessible here.

Is homebirth safe, really?

YES or else we wouldn’t be homebirth midwives or have our own babies at home.  Women are designed to birth naturally.  And we have many independent, peer-reviewed studies to show this.  You can start your search at the Midwives Alliance of North America. From the first day of practice, Sunrise Midwifery has participated in the largest data collection research project on homebirth that now has almost 100,000 planned homebirth outcomes.  And Washington midwives have the best outcomes of all.

…BUT certain safety guidelines also need to be followed to have the best outcomes possible.  First, midwives care for healthy women experiencing normal pregnancies.  This already decreases the likelihood of birth problems.  We also have evidence-based guidelines for identifying women at risk and who may need further medical care during pregnancy, birth, and postpartum.  Another criteria for homebirthing is that the home is clean and functional and is in proximity to a hospital.  Finally, we work very hard to make good relationships with the EMS, OBs, and hospital staff so that transports go smoothly.

Maternal and infant mortality and morbidity rates are constantly rising in the United States.  Home birth with midwives, however, continues to have a very high level of proven safety when in settings that have access to medical care, qualified providers, and emergency transportation. Countries which use the most midwives have the best outcomes. Midwifery care consistently results in statistically safer births, less use of traumatic interventions, and higher maternal satisfaction.  This is largely due to the fact that we are well-trained, recognize normal pregnancy and birth, recognize abnormal situations, and can prevent and treat a variety of complications.  It also helps that during birth the midwife is in constant attendance, listening for small changes that might become larger problems.

What happens if I develop a complication during pregnancy?

Sunrise Midwifery will work with you and the consulting provider to find the best care options for you.  There are some women who have either a pre-existing condition that makes her ineligible for homebirth from the beginning or who have a significant complication arise during pregnancy that requires medical care.  Of course, this small proportion of women do absolutely belong in the hospital for birth as her risks will be minimized there.

What happens if there is a complication during birth?

Complications do sometimes occur in birth, that’s why you are hiring a midwife.  Part of what makes midwifery so special is our ability to recognize and treat most complications at home.  Those we can’t treat we recognize early and initiate a timely transport to the nearest hospital.  This most likely takes place in your own car, with the doctor and hospital notified of your arrival, and me accompanying you to relate important details of your health and birth and give documentation.

There are many misconceptions that surround birth, one of which is that most births have some kind of really BIG and BAD thing happen and it takes a skilled surgeon to see it and fix it.  The truth is, most healthy women experiencing a normal pregnancy have only minor complications at home.  Or even none at all.  However, these same healthy women subjected to the routine interventions and drugs at the hospital and end up with higher rates of minor and major complications.

Midwives are not opposed to needed medical intervention.  Rather, we recognize that necessary medical intervention saves lives and reduces illness and unnecessary medical intervention carries with it significant risks.  We reduce the need for medical intervention by good nutrition, personalized care, natural remedies, and low intervention of drugs and procedures during birth.

What happens if I bleed too much after birth?

Postpartum hemorrhage (PPH) is a very common complication for any birthing woman.  In WA, midwives carry multiple medications that treat PPH quickly and effectively.

What happens if the baby’s cord is around its neck?

I especially love answering this question because the answer shows just how effective midwifery care can be.  The cord is wrapped around the baby’s neck in every 3-4 births, so it’s very common.  Most of the time the cord can be loosened by moving it over the baby’s head.  Rarely, a tightly wound cord can prevent the baby from descending and coming out.  If this happens, the problem shows up in labor via poor fetal heart tones and we go in to the hospital.  But the more complete answer to why a cord around the neck is very rarely a problem lies in delayed cord clamping.

What happens if I tear?

The short answer is that I can repair 1st and 2nd degree tears.  A 1st degree means that a skin layer is involved, whether on the perineum or the labia and often does not need to be sutured.  A 2nd degree means that the tear has extended through the skin and into or through the first layer of muscles.  This is usually sutured to help make your postpartum easier.  About 50% of my births have no tearing, 35% a 1st degree, and 15% a 2nd degree.

Tearing does occur during birth, but it happens so much less at homebirth.   This is due to several factors.  One is that most moms spend a good amount of time in the warm tub water, which helps those muscles relax and stretch.  Even if a mom does not choose waterbirth, tearing is minimized by not forcing a mom to push before she is ready.  We’ll get into this at prenatals and childbirth ed, but it comes down to giving the pelvic muscles enough time to relax and move out of the way once the baby’s head moves down the vagina.  There’s no need to push just because you are 10 cm!

How many people should be at my birth?

It is definitely best to keep this to a minimum!  Plan on having your husband or partner, your kids (if you have them and want them there), and one other adult to watch the kids.  Having a doula is always a great choice too.  I welcome doulas and your kids at births.  Of course, I and my student(s) will be there too.

Don’t invite a bunch of people, even if it is your mother or mother-in-law or best friend wanting to come over!  I tend to find that the family and friends of my clients have not experienced homebirth themselves and so are curious and/or worried about it.  So they want to come to just see how it goes.  If that is their intent, that energy comes across and hampers your birth because they are not there with the specific intent to support you.  Other people at homebirths tend to be there for the entertainment value and to just see the new baby.  News flash: your birth is not theirs, it’s yours; they already had or will have their chance.  It’s not up to you to educate them on homebirth by letting them be there and it’s not up to you to make sure their expectations of your birth are up to scratch.

I have lots more questions that aren’t covered here. How do I get them answered?

We’d love to see you for a free consultation to go over those questions.  You are welcome to browse the website and the links provided.  And use your favorite search engine to dig things up.  Your midwives do have an answer for you!