It’s her choice.
By Sian Hannagan
Oct 2016
Choosing homebirth can be monumental, or it can be as ordinary as laundry and cups of tea. Each step to homebirth can be lifechanging, life affirming or simply life. That’s because the reasons to home birth are as varied and as multihued as our daily lives. Everyone comes to homebirth on their own terms and for their own reasons. Some of these reasons are universal, like a desire for fewer interventions or a need to be in a place of comfort and safety, and some are unique, special to that family. All of these reasons are valid. For many people, the value of this choice is less about the birth itself and more about ownership of choice, and the right to exercise it. Sometimes it’s not about homebirth at all, but about having the right to choose homebirth.
Whatever the reasons, the choice on how and where to birth belongs to the person doing it. Which seems like a controversial thing to say, but it’s true. And it really shouldn’t be all that controversial. So often we hear from women telling us they wanted a homebirth but didn’t because their family disagreed, or their partner didn’t feel happy about the decision. On the surface this seems reasonable, we want to include our families in big decisions. But I want to challenge this idea, we need to stop telling women how to birth. If they want to birth at home, we need to treat this as a core need rather than a ‘nice to have.’ When women are supported and comfortable, their birth outcomes are better. But mostly we need to start trusting that the person doing the birthing to know what is best for them and their baby.
How we birth and how we are supported in birth has far reaching outcomes, for both mother and baby. Many of these outcomes are measurable, and on a wider level led to healthier families and stronger communities. This may seem like a long bow to draw, but there is plenty of evidence, both qualitative and quantitative that highlights the importance of supportive families and agency for birthing women. Both for immediate birth outcomes, but also for long term outcomes in terms of maternal health, mental health, bonding, and thriving children.
However, the outcomes that are less measurable, are no less valuable. The stories of women who birth their babies in an empowering and supported way are often filled with a sense of wonder, of power, and becoming. They did it. They can do anything. This sense of ownership and achievement can often lead to empowered parenting, which has benefits down the line for everyone. Don’t ever doubt that birth matters, most especially to the women who do it. There is also something phenomenal in witnessing this, partners who have watched their babies born at home have spoken of this as a life changing experience. It can be transformative for the whole family.
For us all, the choice of where, and how to birth is valuable, it has worth. It may seem like a small part of that journey to parenthood. But having agency and ownership of birth is something that is hugely undervalued. Too often it is seen as secondary to all other considerations, as if the person doing the birthing cannot be trusted to own the process. As if their choices in birth are less important than the opinions and concerns of others. Too often women are treated as if birth is something that happens to us, not through us. This is incorrect. Having ownership of birth is intrinsic to birth outcomes, and there is plenty of science to back this up.
The importance of comfort and happiness during birth cannot be understated, the hormones that lead to effective labour and safe births are hormones that are optimal when someone feels safe and supported. It is no coincidence that mammals seek warm dark places when they birth their babies. There is a physiological reason for it. When there is anxiety, or stress, the hormones for a good birth are inhibited, which can lead to longer, more painful births, which need more intervention. Often the choice to birth at home is made because women want to avoid birthing in a setting that can actively hinder the natural processes of birth. Having to drive to hospital before birthing in a bright hospital room, with unfamiliar people and surroundings is not an ideal way to initiate an optimal labour. We also know that birthing in hospital can increase the risk of intervention, without any measurable gain in safety. Requiring someone to birth where they are least comfortable or burdening them with our own anxieties about the birth can negatively impact their birth in measurable ways.
I want to make something clear, it is not the birthing woman’s job to convince those around her that she is doing the right thing. Her role is not to defend her inalienable right to choose her birth. Her role is to prepare for her birth, in the way that best suits her. Ideally, this will be mean she births in a way that suits her needs, supported by her friends and family. Because support is essential, but telling her that you don’t trust her decision, is not supportive.
Which is not to say the people supporting a birthing woman cannot have doubts. It is fine to feel not okay with her choices, it is fine and normal to have fears and anxieties. It’s okay to be completely freaking out. What is not okay, is to burden her with these doubts. To burden her with the job of convincing us.
It can seem like I am suggesting that partners and family can’t be part of the decision-making process, that they can’t be included. Which is not the case I promise. Women value the input and the support of those close to them, they draw strength from it. For many women, having a supportive partner can be an essential part of empowered birth. Which is why it’s so vital that she feels supported in her choices. The problem lies when women place the comfort and needs of their partner above their own needs. This is putting the cart before the horse, the comfort and needs of the birthing woman need to be met first and foremost. We need to trust women to be wise enough, and intelligent enough to make decisions about their own birth and their own body.
What I am saying, is that we really need to acknowledge that the person who is doing the birthing, for whom the stakes are highest, needs to have the largest say in that process. That their needs are a core consideration. That what they want from their own birth shouldn’t be seen as selfish or treated as less important than safety. Because that’s a false paradigm. A comfortable birth is a safe birth.
It seems ridiculous that we need argue for agency over our own bodies, but the current culture in pregnancy and birth tells us many lies. The biggest one being that the needs of the baby and the needs of the mother are at odds and must be treated as separate concerns, which is not the case. The second biggest one is that a woman’s choices are petty wants only, and not essential requirements for birth. The third one, but possibly the most monumental one, is that women are incapable of making risk assessments about their births, that they simply don’t understand how to make wise decisions about their body.
These myths need to end. Women are capable, they know their bodies best and they are as able as anyone else to make reasonable risk assessments and informed decisions about their birth.
From the perspective of a support person or a partner, this can be a difficult concept to put into action. At core I think we understand it, but practically it can be difficult. We may trust our partners but thanks to strong social conditioning we do not trust birth. We genuinely want the best for our birthing women, we want our babies to be safe and we want to feel confident that nothing will go wrong. It can be challenging to bench our doubts and move into the role of a true support person rather than a grudging one. Ultimately though, we need to realise that it’s not the birthing woman’s job to convince us, it is our job to convince ourselves.
In the spirit of offering practical support as well as a moral and ethical argument. Here is a list of things a support person can do to step out of the role of challenger and into the role of supporter.
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- Seek out people who have had successful homebirths, talk to them about their experience. Read positive birth stories, talk to other support people and partners who have experienced homebirth. If you are a dad, speak to dads about their homebirth experiences.
- Look at some of the studies out there, including our own ministry of health data that confirms the safety of homebirth. As a general rule, hospital birth is no safer than homebirth, but comes with a higher chance of intervention.
- Look at doing antenatal preparation classes that are proactive about birth and that support physiological birth. Some great options are positive birth classes, active birth classes and hypnobirthing.
- Use the circle of support theory, imagine the person birthing is at the centre, you are a circle surrounding them and the people supporting you are yet another circle surrounding you. In this circle, the positive support goes inwards, and the negative support goes outwards. So, you would offer proactive support to the centre and seek support and affirmation from the circle outside of you. Add as many circles as you need to feel supported so you can support her.
- Listen. Rather than expressing your doubts or listening to simply to come back with an answer. Truly listen, listen to her reasons, listen to her needs. Let her share how she feels. Validate those feelings, treat them as important.
- Stop telling her about dead babies and mothers. Just stop. Using coercive tactics does not allow proper informed decision making. There are better more constructive ways to talk about risk. Also do not tell her gory birth stories for the same reason.
- Tell her how her feel. Let her know you have reservations, but that you’re going to take the time to come to terms with it and let her know that you still have her back, you are going to support her no matter what.
- Be prepared, if you are worried about unexpected outcomes, make contingency plans. Look at transport options. Be prepared for the unexpected. But don’t make it a focus. Do the heavy lifting of the contingency planning so that she doesn’t have to.
- Talk to your midwife. Make a time to do it without your partner if possible. Tell the midwife your deepest darkest fears, get her to discuss with you in practical terms how unexpected events are managed. Get her to tell you about her own contingency plans. Come up with some communication techniques you can use during the birth to keep you feeling at ease.
- Consider another support person for the birth. A doula or someone close to you both who has experienced a home birth, who will be there and can support you as well as your partner. If you truly feel you can’t be supportive and present during the birth, you may even decide that another support person altogether is a better choice.
- Learn about birth, there are some fabulous books out there that offer practical, well referenced information on the mechanics of birth. If it will help you to feel more in control and understanding of birth, to know in detail how it occurs and what can happen then this is a great proactive option for the science minded amongst us.
- Be her advocate when people question her decision, step in, and offer your support. Support her choices in group conversations. Speak positively about her choices to your mutual friends.
Where we birth and how we birth is important, homebirth may not be the right choice for everyone. But the people who do choose homebirth should be supported in this choice. Because where we birth matters. Relying on fear based decision making is not helpful if we want to make empowered and informed decisions. Too many compromises are made based on the misconception that birth is inherently dangerous and that women cannot be trusted to make their own risk assessments. So, I challenge us to change the narrative, instead of asking women to justify their choices, let’s focus on supporting those choices instead.
Sian Hannagan – Home Birth Matters Editor
Home Birth Matters
Volume 2 Issue 2
Published continuously since 2013
ISSN 2422-9946
Editor: Sian Hannagan
Advertising and Editorial enquiries:
editor@homebirth.org.nz
