On Trusting Relationships in Home Birth

When I began writing posts to share here, I started by reflecting on birth-y things. Perhaps because I'd just given birth (at home), but also because it's a topic I'm pretty passionate about -- as evidenced by my being a birth photographer and doula. This post started as a home birth check list (which I'll share here soon). But after my first bullet point turned into a few paragraphs, I decided I needed to take a step back and speak to one particular facet of home birth, at least at first -- established, unwavering, trusting relationships.

Perhaps your womb is full and you're already on your way to your first home birth, or perhaps you've already had two, or maybe you're not quite to that stage in life but already know you're drawn to the idea of giving birth in your home. Whatever your situation may be, if you're anywhere between being curious and sold on giving birth at home, I'd like to encourage you to ruminate on this question for the next few minutes:

What about your partner (assuming there is one to consider, for this particular point); where is he or she most comfortable, at this point, with your giving birth? 

As I was considering images to include, my thoughts immediately went to this birth as it was a most beautiful example of both of the points I'm making here in this post.

As I was considering images to include, my thoughts immediately went to this birth as it was a most beautiful example of both of the points I'm making here in this post.

It is SO important that you include your partner in the process of deciding where you deliver -- that is, if you intend for your partner to have an active role in supporting you before and during the birth process. In my own experience, it's much smoother to go from point A (curious but unsure about home birth) to point B (MUST. HOME. BIRTH.) with your partner than it is to arrive at point B solo and then try to talk him or her over to your side.

As you go about choosing where to give birth, there's pressure on both partners in a relationship -- and that means there can be tension between you. Because the last thing you want as you approach your due date is unwarranted tension, here's some hard-won advice: allow your partner to take that journey with you. In so doing, you allow your relationship the opportunity to grow more unified, more whole, and thus stronger as a result of the process (and we haven't even gotten to the transformative power of birthing as a team!).

So nearly just as important as your feeling most safe, most comfortable, and most empowered by your chosen birth space, is your partner feeling most safe, most comfortable, and most empowered by your chosen birth space. Essentially, you want to both have an unwavering, trusting "relationship" with the place you'll give birth (whether it be home, hospital, birth center, or forest). Allow him or her the opportunity to own that with you.

Perhaps equally as important is your relationship with your midwives. CENTRAL, paramount, of principal importance to home birth is having an unwaveringly strong relationship of trust and mutual respect* with your chosen birth support providers.

I think I have a unique perspective on this after my two experiences giving birth, one being a really excellent hospital birth and one being a really excellent home birth, both with the same midwives (Louise Aucott, Pamela Rosser, and Heather Daniel of Midwifery Care Associates in Pennington, New Jersey).

Five years ago I would have been the woman reading this blog before my first pregnancy, interested and curious about home birth, with an uninterested partner, but none the less... willing to entertain the discussion. It just so happened that we needed to move from New Haven, CT, to Princeton, NJ, towards the end of my first pregnancy, thus... new midwives, new birth space, new everything. I really adored my midwives in New Haven and I was quite nervous about finding new midwives that could fill their shoes so late in the game. I did an overwhelming amount of research from multiple unique angles (a blog on that will come later down the road) to make sure I landed in the hands of the right midwives for me/us.

The midwives I chose, and were open to taking me on as a client so late into my pregnancy, were predominantly home birth midwives. I mentioned I was interested in giving birth at our new (would-still-be-in-boxes-most-likely) home, despite not having had that option available to me in New Haven. Still, I was curious to see if home birth could be an option for me with my new midwives. I was a bit disappointed they didn't feel that home birth was the best idea for me, what with being so far into the pregnancy already after the move. I was thrilled with them regardless, though, and moved forward with a plan for hospital birth in their care. It was a beautiful, as home-birth-like as you can get in the hospital, birth. I remember as soon as all was said and done my midwife exclaimed how smooth of a home birth that would have/could have been. Next time (and so it was)!

Between my two birthing experiences I became a birth photographer and doula and thus began attending births in one role or another (or both). Many of those births were home births, all of them were midwife attended (or unassisted), and a couple were with my own midwives. I can't begin to tell describe how my knowledge of birth and respect for midwives grew exponentially during this time. And so, of course, a lot of my thoughts on birth have been informed by my experience at the births into which I've been invited.

The palpable strength between them was a gift to all in attendance. 

The palpable strength between them was a gift to all in attendance. 

Fast forward a couple years to my pregnancy with Walden and we knew from the start we wanted our new baby's birth to take place at home. In the time between my pregnancies, however, I'd learned why my midwives didn't think it wise for me to leap into a home birth with them so late in my pregnancy -- despite my being a perfect candidate for it, and wanting to do so.

As much as I thought I trusted them, as much as I loved everything they were all about, my relationship with them was young. We hadn't had the usual allotted time to really grow in relationship together. Most women establish care with their provider of choice by the time they are about 12 weeks pregnant and then the typical pregnancy lasts about 40 weeks (give or take a few). That means that, on average, a woman and her provider have about 28 weeks to get to know each other, if they don't already. The mother has the opportunity to have all the relevant conversations with her providers necessary for her to have a really good feel for what she could expect from them through her labor and birth. 

It pains me when I hear women who don't have a great relationship with their providers for one reason or another (conflict of approach, preferences, personality, etc.) and yet still expect to have the birth experience they want. Let me first say, I believe every woman should be enabled and empowered to have the best chance at the birth experience she wants for her self and her baby. Yet I also think expecting a provider to usher the birth experience a particular mother wants when the provider has shown the mother throughout the pregnancy that the birth experience she most wants is unlikely to be the way her labor and delivery unfolds is just... foolish, and unfair to both parties (mom and the provider).

A separate scenario--but one that I also struggle with--is when I see moms desperately seeking midwives in the final days or weeks of their pregnancy to take them on as a home birth patient just because that's what they want so. badly. And I get it. I get wanting what you want and yes, you should be able to have that. I'm with you -- you should get it, in theory.

But here's why I think that's ultimately far from ideal. While yes, everything will most likely play out smoothly in your labor and delivery, if not excellently... it also may not.

I do not fear birth. I do not fear home birth. However, I would be remiss to not acknowledge the risks of any decision I make for myself and my baby (whether that be to home birth, or to get an epidural, or to get the flu shot while pregnant or breastfeeding (or ever), or to, or to, or to...). With every choice comes risk. Being well-informed of those risks is ultimately where I find the most comfort.

And so, let us acknowledge that there is risk in home birth (much like how there is risk in hospital birth, because there is risk in birth). BUT, the difference is, when something goes wrong at a home birth it is usually blamed on the fact that it occurred at home -- i.e., not at a hospital. "If she'd been in a hospital they could have, blah blah blah." And worse, "If I'd been in a hospital they could have, blah blah blah." Yes, in some rare instances medical intervention is necessary, intervention that one must be in a hospital to receive. And yes, in some even more rare instances mom or baby don't receive those interventions as speedily as is necessary and harm or death may occur. Yet harm or death may, and do, occur in hospitals as well. 

(Oh geeze, the blogs and blogs and blogs I could write as offshoots of each sentence... it's killing me.) 

This isn't about what others think of your choices and your outcomes, though. It's about your heart, how you feel at the end of the day.

This is actually me at Walden's home birth and here's what I wrote about this image soon after he arrived: "I don't think I'll soon forget this moment. It was THE ONLY moment through my short but intense labor that I enjoyed and found comfort in being touched. But it wasn't Pam that touched me; I touched her. She was near and I leaned into her. Subconsciously leaning into your midwife when you're moments from birthing your child is a pretty incredible indicator that, in her, you find safety and love. Thank you for being that, Pam."

This is actually me at Walden's home birth and here's what I wrote about this image soon after he arrived: "I don't think I'll soon forget this moment. It was THE ONLY moment through my short but intense labor that I enjoyed and found comfort in being touched. But it wasn't Pam that touched me; I touched her. She was near and I leaned into her. Subconsciously leaning into your midwife when you're moments from birthing your child is a pretty incredible indicator that, in her, you find safety and love. Thank you for being that, Pam."

I entered labor believing with full confidence that if Walden--sweet, precious baby Walden--had been harmed or died during my labor or birth, that my midwives would have done EVERYTHING within their extremely capable hands to have prevented it, and that I was in the best hands for me, regardless of what may come. Also, that I had chosen to give birth in the best location for me and that birth, at that time. 

I can remember (because it wasn't that long ago) lying in bed as my belly protruded far above me, hand resting on his bum nestled in my womb, and asking Russ, "Are you nervous about the birth at all? Do you feel at all unsure about having a home birth?" And he unwaveringly answered, simply, "No." I agreed. I felt unwaveringly confident in our choice. Not unwaveringly confident that all would go perfectly smoothly, but unwaveringly confident that we were in good hands and that we were making the right decision for our family.

I can truly say, I began labor not at all afraid of what may come, and I don't think that's in the least because I was ignorant about the possibilities.

Midwife, Dina Aurichio of New Birth Experiences, and mama in a passionate exchange post-birth. They were a beautiful example of deep, established, unwavering, mutual trust.

Midwife, Dina Aurichio of New Birth Experiences, and mama in a passionate exchange post-birth. They were a beautiful example of deep, established, unwavering, mutual trust.

So, if you're considering home birth, make sure you have a supportive, informed, engaged partner, and that you both have unwavering confidence in your chosen birth space, as well as midwives with which you have an established, unwavering, trusting relationship.

Because you can't share that many photos from one birth and not show baby (in the midwife's arms)!

Because you can't share that many photos from one birth and not show baby (in the midwife's arms)!

*Not long after writing this one of my midwives happened to share this article that discusses research that found that the bond between mother and midwife is the key to a happy birth.