So You Want to Have a Homebirth in a Hospital… (by Jen Dembo, CCE, CD(DONA) )

Pregnancy - pregnant woman and newborn

Homes and hospitals. They might not seem to have a whole lot in common, except for the fact that they both begin with the letter “H”.

But homebirth and hospital birth can and do co-exist, though that is sometimes hard to reconcile. We are so accustomed to categorization in our society – something has to be either/or; this or that. And often times those two choices are seemingly opposing ones. Why? Must there be conflict and judgment at every turn, especially when we are talking about teenie-weenie, precious babies and their awesome, warrior moms?

Personally, I don’t think so. I believe we should be framing birth in the context of generational wisdom, evidence-based practices, and ultimately, the sacredness of little ones coming into the world. All of these things can and should be applied to every kind of delivery setting, whether it’s a home, birth center or hospital.

Some women who would like to have a homebirth don’t have legal access to care in their states; some need to deliver in a hospital for medical reasons. Some choose to deliver in a hospital but desire – to the best of their abilities and to the extent by which the facility allows – a “homebirth-like” experience. (For Anne’s suggestions on how to do just that, click here).

Women interpret that phrase in different ways. For some, it means being surrounded by treasured items that remind them of the comforts of home. For others, it means being cared for by midwives. For one client of mine who I’ll call Jackie (not her real name), it meant birthing without unnecessary medical intervention.

She and her husband both came from long lines of doctors who felt very strongly that she have her baby in a hospital. Although she wanted to give birth at home, Jackie decided it wasn’t worth the familial turmoil and chose a doctor and birth place. But she didn’t take these tasks lightly. She selected a care provider with whom she felt would really honor her preferences and chart them so that they were on record. She took a comprehensive childbirth education course (which taught her to be prepared AND open-minded), and made it abundantly clear to the nurses upon admittance that though she was aware pain medication was available, she did NOT want it to be offered. Lastly, Jackie had faith in herself and in the process of birth.

Of course, labor is completely unpredictable, and women who are very firm about their birth vision have the right to change their minds at any given time. In addition, many hospitals are in fact set up to intervene, because they are based on a model that considers labor and birth for even low-risk mothers a medical condition, not a physiological process.  Of course, these potential challenges had crossed her mind. But she was determined.

As Jackie’s doula, I certainly had faith in her. And I knew her husband was going to be a terrific and loving support partner. But I was silently concerned about those who would be attending her during labor. Would Jackie’s nurses respect her preferences? Would another care provider in her practice (in case the doctor she really liked wasn’t on call at the time) do the same?

As luck would have it, Jackie’s nurse was fabulous and agreed to her requests. Every once in awhile, she would come in and marvel at how Jackie listened to her body and just allowed labor to happen. When Jackie went into transition, this nurse came in, gently approached her and whispered in a voice that was almost inaudible, “You are doing such a fabulous job! But I have to chart that I offered you pain meds, even just once.” Jackie nodded, confirming that she heard the nurse’s comment and said “No thanks”. Then the nurse gave me the thumbs up, and quietly left us.

Shortly thereafter, Jackie’s beautiful baby came into world without any medical management in the most highly interventive hospital in the county. Jackie was over the moon at the sight of her gorgeous baby boy and proud that she had done it her way. In no small part, she was able to accomplish this because she found people to care for her who really listened and supported her choices.

In the end, it’s not that any one comfort technique, any one protocol, any one approach is right or wrong. What counts is a healthy baby and a healthy mom who’s preferences and needs are recognized throughout pregnancy, labor and birth.

There are lots of things you can do to maximize your odds for having the kind of birth you envision. You can start by building your support team with people who believe in you. An aligned mom-provider philosophy is a great place to start. You may ultimately have to make some compromises, but the value of a mutually respectful relationship can be immeasurable.

‘Til next time,



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