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Homebirth or Hospital Birth:
Making the Decision

QUESTION: I want to have a homebirth. I am afraid of pain in labor, but I believe it will be less painful at home in my own environment. My husband, however, is terrified of the idea and wants me to be in the hospital, where he feels safety is guaranteed. I know this is his baby, too, but it is my body. What should I do?

ANSWER: Homebirth can be a safe alternative to hospital birth, but be cautious about expectations that labor at home will be less painful because it is your own environment: Women can be overwhelmed by the reality of childbirth due to false expectations that may negatively impact the course of labor.

Whether you give birth at home or in a hospital setting, prepare yourself realistically to deal with pain in labor. Active coping styles discussed in my book, "An Easier Childbirth" and Janet Balaskas' "Active Birth" prove effective for meeting contractions and releasing tension in between. There is time to rest and relax between contractions in active labor; however, the capacity for releasing into a deep relaxation between contractions happens more easily when there is little discrepancy between a woman's expectation for pain and the reality of labor.

The hippocampus of the brain mediates between what is expected and what is experienced. When there is a significant difference between what a woman expects and what she perceives at the time of labor, the hippocampus of the brain may communicate to other parts of the brain's limbic system to shut down the flow of oxytocin that fuels contractions. This is a natural protection: Our bodies are designed with a fight-or-flight reaction to allow for escape from danger when there is perceived threat. Labor at home will not be less painful than labor in the hospital. However, you may feel more relaxed in your home environment, if indeed you do not react with fear to the natural intensity of childbirth.

That brings us to your husband. If your partner remains in great conflict about your choice for delivery, your home atmosphere can become charged with tension instead of harmony. Do your homework together: Watch videos of childbirth. Talk to couples who have given birth at home and in the hospital. Know what your hospital backup would be if you did choose homebirth and pick an experienced and competent midwife team. Be willing to discuss your husband's fears. Address any concerns with your midwife together. Ask for your husband's involvement in this process beyond his initial reactions. There are many things you will have to discuss and decide upon together as your child grows. This is your first opportunity to make a decision together about what is in your own and your child's best interests.

The bad news is that the medical system in the United States is not set up to support homebirth, as it is in some European countries, such as Holland. The good news is that the responsibility for considering homebirth requires a deeper involvement in understanding and meeting labor that is beneficial no matter where you give birth.

Early research on safe alternatives in childbirth -- by myself and others -- found that the process of taking responsibility inherent in the unconventional decision to give birth at home served as a framework for development. (See my book, "Birthing Normally" for greater detail.) In other words, preparation for the reality and risks of childbirth resulted in safe home deliveries -- not because of the environment itself or even the popular belief that hospital intervention caused problems (which sometimes was true). But likely, because men and women who prepared realistically were active participants, involved in a soul-searching endeavor that informed their final decision. The tendency to leave things to others is diminished when we realize there are no guarantees in life. Consider adopting this attitude, no matter where you give birth.

If, after educating yourselves and assessing realistic risk and benefit, you and your spouse choose to give birth at home, it may indeed provide the best atmosphere for you and your baby. But if tensions remain high, either due to your husband's fears or your own considerations about coping with the natural pain of labor, you may want to explore other options. Is there any setting that optimizes privacy and respect and quells your husband's anxieties about nature's unpredictability?

A birth center, or a hospital that encourages family members' participation, could provide an acceptable compromise. But if you do the soul-searching together -- whatever place you decide to give birth has potential for a positive experience of empowerment and family bonding.


Gayle Peterson, MSSW, LCSW, PhD is a family therapist specializing in prenatal and family development. She trains professionals in her prenatal counseling model and is the author of An Easier Childbirth, Birthing Normally and her latest book, Making Healthy Families. Her articles on family relationships appear in professional journals and she is an oft-quoted expert in popular magazines such as Woman's Day, Mothering and Parenting. . She also serves on the advisory board for Fit Pregnancy Magazine.

Dr. Gayle Peterson has written family columns for ParentsPlace.com, igrandparents.com, the Bay Area's Parents Press newspaper and the Sierra Foothill's Family Post. She has also hosted a live radio show, "Ask Dr. Gayle" on www.ivillage.com, answering questions on family relationships and parenting. Dr. Peterson has appeared on numerous radio and television interviews including Canadian broadcast as a family and communications expert in the twelve part documentary "Baby's Best Chance". She is former clinical director of the Holistic Health Program at John F. Kennedy University in Northern California and adjunct faculty at the California Institute for Integral Studies in San Francisco. A national public speaker on women's issues and family development, Gayle Peterson practices psychotherapy in Oakland, California and Nevada City, California. She also offers an online certification training program in Prenatal Counseling and Birth Hypnosis. Gayle and is a wife, mother of two adult children and a proud grandmother of three lively boys and one sparkling granddaughter..

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