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.
