Lauren Bialystok is Assistant Professor in the Department of Social Justice Education at the University of Toronto
I used to think of home birth as something vaguely counter-cultural. That’s not me. When I was pregnant with my first child, I thought that giving birth in a hospital under the care of midwives would strike the perfect balance between medical security and holistic support.
Like most women who are accustomed to a certain measure of autonomy, I had a birth plan. I wanted to labour at home as long as possible and go to the hospital once active labour was underway. I wanted to move around freely during labour. I wanted my midwife to deliver my baby. I wanted an epidural to be available, but hoped to use natural pain reduction methods instead.
The birth did not go as planned. My water broke on a Thursday afternoon in the absence of any other signs of labour. I showed up at the hospital 24 hours later, 1 cm. dilated and without any contractions to speak of. I was charged with “failure to progress.”
Thus began the interventions: the IV, delivering the dreaded Pitocin; the fetal heart monitor; the contraction monitor; and the permanent blood pressure cuff that automatically tightened every 15 minutes. My midwife’s care was overtaken by an obstetrician. Very quickly I couldn’t walk, stand, or change position because it disrupted the monitors all over my body, alerting someone at the nurses’ station to rush in and adjust them. The Pitocin made it feel like a bomb was exploding in my abdomen every minute, and I was shaking uncontrollably, even between contractions, to the point that I could barely speak. All the pain relief techniques my husband and I had practiced were laughably useless.
I laboured like that for five hours, until the obstetrician said it would be three to six more hours until birth and the anaesthetist was about to go home for the night. I signalled for the epidural.
When it came time to push, I had no sense of what was going on in my body. Assuming the lithotomy position, I pushed on the obstetrician’s orders. My baby only weighed 5”11’ but tore me open as I expelled her in my detached fog. Still shaking, I was afraid to hold her. A male resident I’d never met before appeared to stitch me up, discussing suturing technique with the obstetrician as he practised on my vagina. I heard my baby wail as they shone a sharp light on her for her first check-up. I felt injured and inadequate.
What happened after was supposed make all these indignities irrelevant, and, for a while, it did. My baby was healthy. Our parents burst into the room to welcome their new grandchild. A few hours later we were discharged.
It was easy to rationalize my first birth experience as an unfortunate anomaly with a happy ending, if not a potential tragedy averted by modern medicine. My husband and I felt that the induction was a necessary evil and everything after that was inevitable. At least I didn’t end up having a C-section. I did not feel permitted to complain about what had transpired, or even to grieve the gentler birth I had envisioned.
Fast-forward three years. Around halfway through my second pregnancy I started to obsess about the impending birth. My mother had been induced with both her children; so had my sister; and my first labour was no different. Was there really any possibility that I could avoid another medicalized labour?
I had assumed that labour has some kind of inexorable trajectory – that my body would behave the same way irrespective of where I was, and that any interventions would improve on what my body was doing alone. But it’s far from that simple. When I started to dig, I realized that the mind and the body interact in labour, just as they do in the rest of our lives, and that stress and fear can make labour slower and harder than it would otherwise be. Furthermore, the kinds of constraints I had experienced the first time actually work against labour, preventing the use of motion and gravity to encourage the baby’s descent.
Over time, I began to hear war stories from more and more friends, and wondered how it was possible that so many healthy, educated women with excellent health care could need so many surgeries and drugs to have their babies. I also had a growing number of friends who had given birth at home, with no complications, and despite the small sample size, the contrast between the two groups didn’t seem to be a coincidence. I realized that I was likely to have a medicalized labour just by going to the hospital – regardless of any other circumstances.
Childbirth is the only situation in which a sane person would voluntarily admit herself to the hospital without being very sick. Hospitals are frightening, impersonal, and uncomfortable – but they save lives. Before my first child was born, I thought the hospital was safer than anywhere else, by definition, even if it wasn’t exactly “homey.” Things can go wrong so quickly, people say. But statistics do not seem to bear this out. The divided attention of doctors in obstetrics wards can make it seem that labour has taken a sudden turn, prompting aggressive medical responses, when in fact some fluctuations are part of the normal course of labour. In fact, when I dug further, I found that many of the unfortunate outcomes that require hospital interventions are themselves the product of prior intervention. Pitocin can cause the fetal heart rate to drop or cause the mother to become febrile; epidurals and the lithotomy position can make it hard for women to dilate and push; constant fetal heart monitoring results in more caesareans but no improvement in outcomes. Why get on this train in the first place?
All this helped explain to me the initially counterintuitive research showing that home birth is actually as safe as hospital birth, for healthy women attended by licensed midwives, despite being so low-tech. And living in midtown Toronto, I knew I could always get to a hospital quickly if I needed to.
Suddenly, home birth, which had initially struck me as kind of reckless, seemed like what I had been looking for all along. It was safety, comfort, and control all rolled together.
My second daughter was born at home. My water broke right away and I met her 18 hours later. During that time I didn’t once wish for anaesthesia. Rather than feeling like I was catapulting toward a crisis, I felt that I was doing extraordinary work. I walked around naked, leaning against furniture and moaning through the contractions. Two midwives monitored me constantly, yet unobtrusively, timing my contractions, taking my vitals, and using a Doppler to listen to the baby’s heart. I felt completely calm and focused. My husband was relaxed and able to help. When it came time to push, I got on all fours and my baby emerged gently, without tearing. She was born into the smells and sounds of our home, without harsh lights or cold instruments or foreign bacteria. She latched immediately. I felt like a million bucks.
Having had the experience of both hospital birth and home birth, it is undoubtedly the former that now strikes me as alternative or risky. With my first labour, I had no sense that what was happening was healthy, safe, or even exciting; it was more like torture that had to be endured. I put myself in the hands of the doctors and ended up feeling like a failure.
Home birth felt exactly right – not flakey or rebellious, but the perfect way to let my body do what it in fact knew how to do. It’s not for everyone, but it’s time to get over the stigma and misinformation. Our hospitals’ resources and doctors’ expertise are better used on actual medical emergencies. And healthy women have amazing resources for giving birth which, like me, they may just need an opportunity to discover.
Editor's note: a version of Lauren's story was published earlier this year in This Magazine