As a childbirth educator I frequently speak to pregnant couples around town – whether they are my clients or not. One of the first things I ask is, “Where are you giving birth?” and the answer I’ve been hearing more and more often is: “At home.”
Though home birth has seen a slight rise in popularity in the wake of “The Business of Being Born” (2008 documentary by Abby Epstein & Ricki Lake) it is still, for some, an unusual choice – one that harkens back to a different era. In Jersey City we have access to the finest hospitals in Manhattan plus several good options here in NJ – yet more couples are choosing the intimacy of their own home, rather than a more typical labor & delivery environment, to usher their newborn child into the world. This story is an exploration of three Jersey City couples who chose home over hospital birth and why.
Althea Bernheim had previously given birth in a hospital setting, which she described as “stressful and painful.” Getting epidural medication relieved her discomfort but left her feeling “disconnected.” Though husband Sebastian was by her side for the entire labor, she felt frustrated that he couldn’t do anything for her, conceding however that there was nothing much for him to do.
“The worst part for me,” she recalls, “was having my baby taken away [for observation] and put into a room next to mine where he squalled for an hour. I felt like I wanted to just die.” Though an attending physician eventually brought the baby back so he could start nursing, Althea remembers that first hour as feeling devastated that her baby was separated from her for what she felt was “no good reason.”
Most hospitals attempt to keep mother and child together, particularly right after birth, but ten years ago “separation for medical observation” was more commonplace. In Althea’s case it traumatized her enough to beg her husband not to have any more children (though she says that half-kidding.) She adds, “I really found the whole environment very stressful plus I found traveling in order to GIVE birth very painful.”
The second time around the couple talked about the concept of home birth. Husband and father Sebastian says, “Originally I voiced opposition to the idea. I am from a medical family and wasn’t sure about having a baby without a doctor present.”
Eventually his wife won him over with safety statistics and the assurance that a capable midwife could handle just about anything. Their nearest hospital was six minutes away and had an excellent NICU (Neonatal Intensive Care Unit.) Althea interjects, “I threatened to have the baby under the porch like a dog rather than enter a hospital again, so he really had little choice but to acquiesce.”
Baby two and three were born in the Bernheim’s home in a birthing pool surrounded by family and friends who were invited for the occasion. Althea maintains that the pain from contractions were far more manageable in her own environment and overall labor was shorter. “In a moment of absolute love, I pressed my forehead into Sebastian’s and he covered my ears with his hands. It was pure necessity; I needed him and he was there. The whole rest of the world melted away — we gave birth together.”
Since then, Sebastian describes himself as passionate about the subject often broaching the topic with pregnant couples they encounter. He says, “The births of my two youngest sons convinced me that home birth is really the best childbirth experience.”
Elizabeth and Donovan Cain, owners of specialty pet store Hound About Town and Hazel Baby (eco-friendly baby boutique), are also in the home birth club. “Our priority was welcoming our baby into a peaceful and loving environment – and convenience!” In the first trimester of pregnancy when the couple did visit with an OB-GYN they found the experience to be surprisingly disappointing. “We were all excited about this pregnancy, of course,” Donovan explains. “But the doctor’s visit took all the optimism out of our excitement by filling our heads with fearful statistics and risks.” They are referring to the genetic counseling, blood tests, and other issues that come up in a typical prenatal visit. “While some of this may be warranted,” Donovan concedes, “it was NOT how I wanted to begin our joyous experience of bringing life into this world.”
Soon after, the couple looked into hiring a midwife as their practitioner and that swiftly led to a discussion about birthing at home. Exploring all the possible scenarios the Cains realized that their risk factor was actually quite low. “Hiring an experienced midwife, knowing that there are local hospitals we could easily get to, and having a back-up doctor in place really made us feel secure,” Donovan adds. With midwife Jessica Lawlor on board, prenatal visits began in the comfort of the Cains’ home. “I’m super busy, so having all my prenatal visits at home was an amazing convenience,” Elizabeth says.
When labor began for the Cains their midwife and doula were welcomed into the sanctity of their environment. Donovan reflects, “I got to sit on my own couch, in my slippers and PJs, right behind my wife and watch my son take his first breath of air. I could never put a price tag on that.” Elizabeth concludes, “Everything about delivering at home makes the entire pregnancy and birth a wonderful and stress-free experience. I would do it again a million times.”
In the case of Christine Goodman of Art House Productions and husband Michael Flinck, they too were seeking a more intimate and meditative setting for birth. Like many others, they started their process with an obstetrician but soon switched to a midwifery practice (Jessica Lawlor, again.) “Our friends and family were very loving and supportive,” Christine offers in response to my question about familial opposition. “There was definitely a learning curve as my parents had never heard the terms ‘midwife’ or ‘doula.’ We explained the process to them and it ended up being a wonderful dialogue.” Again, for most folks, knowing that there is a back-up plan in the event of an emergency generally puts fears to rest.
“I knew I wanted a safe and comfortable experience. But safety and comfort for me meant my home; I wanted options like a birthing pool, a shower, and the freedom to labor in whatever position I felt I needed to be in.” Christine alludes to the restrictions in many conservative hospitals where laboring women are expected to be closely monitored, which restricts movement. Not all hospitals allow women to get in the shower (which decreases the perception of pain) and almost none offer bathtubs or Jacuzzis for comfort. Inability to move about freely during labor, to hydrate, and to have access to the relief a shower or bath can make labor more challenging. This is why we tend to see high epidural usage in NYC hospitals.
Christine and Michael enjoyed a healthy and uneventful pregnancy, trying to stay calm as the due date approached around the holidays in late December. During their many prenatal visits their midwife talked them through various scenarios including the possibility of transfer to a hospital if the need for that occurred.
When people think about home birth not going according to plan, they tend to focus on an emergency. But the truth is many transfers to a hospital are not about an emergent situation but something more along the lines of what happened to Christine and Michael.
“I had a very, very long labor. At a certain point it became clear that we would need to deliver the baby surgically – but it was by no means an emergency c-section. With the flexibility of a homebirth and my support team of midwife, doula and husband, we were able to try every possible scenario for normal birth. When all possibilities were exhausted, and so was I, the idea of a cesarean was not a terrible disappointment.”
Michael observes that transition to the hospital went better than expected, “It really made a difference to have a home birth midwife with privileges at a good hospital. Not only did we transfer in smoothly, she also had an established rapport with the doctor there and stayed with us until the baby was born. It really helped to have that continuity of care.”
Studies and support groups indicate that women who felt they were “talked into” a surgical birth without being offered viable alternatives have a more difficult time accepting that turn of events. In Christine’s case she cites her intrepid support team for helping her accommodate this unexpected outcome with grace and acceptance. “I really appreciate that our team did everything we could to make that home birth possible. The choice was made with care and consideration and after all other options were exhausted. In the end I felt at peace with it.”
Culturally, Americans are not inclined to use midwives as their labor practitioners, just as they are not inclined to give birth on their kitchen tables. In fact, the American College of Obstetricians and Gynecologists has officially opposed home birth since 1975. However, many couples in the New York area are re-thinking the existing model, realizing that there are other choices and alternatives when it comes to childbirth.
As Althea reflects, “It was an experience that changed both of us. There was no one to tell you what to do; no insurance policies dictating anything – it was just family – slow and simple. There was no rush, no where to be. We were home.”
Bernheim photo by Gabby Creery, Cain photo by Mickey Mathis, Goodman and Flinck by Ingrid K. Studio.