Birth Plans

Homebirth

In some ways, planning for a homebirth will be easier than planning for a hospital birth. In other ways, it will be more difficult or involved. It depends on where you live, the resources available to you and your overall health. If you are preparing for the possibility of a homebirth as a back-up, your planning will be different than a family who is planning for homebirth as their primary plan.

As you begin to gather the information you need to plan for a home birth, remember there is no standard answer to any of the questions you need to ask. Your health, the place you live, the resources available to you in your town or city, and the events of your particular pregnancy and birth will all contribute to the overall desirability of a home birth for your family. Two families living near each other may make completely different decisions about the desirability of home birth.

On average, there are differences between a homebirth and a hospital birth. The type and amount of fetal monitoring is different. The options for pain managment may be different. The ability to try different positions and comfort measures may vary. Despite the differences, it is the same process whether you give birth at home or in the hospital. Your body must do the same work.

Safety

Overall, homebirth is safe. In some regards it is actually safer than a hospital birth. However, in asking if it is safe, there is a hidden assumption that non-homebirths are the safety standard. It is interesting to note that no study has ever shown hospital births to be safer than homebirth. Here are some studies you can look up for more information.

The Cochrane Collaboration is the ultimate in evidence based research. This review of the research found no strong evidence of either homebirth or hospital birth being safer than the other. You can see all their recommendations for pregnancy and childbirth here.

The Midwives Alliance of North America maintains an extensive list of research about homebirth. You may be able to access some of the journals listed through your local library, or by getting a library card at a nearby university library.

Citizens for Midwifery maintains a list of resources regarding midwifery issues. Scrolling through this list will reveal several homebirth safety studies and fact sheets for you to use while educating yourself or others.

The Homebirth Reference Site maintains an index of homebirth research you can review. You can view the references, or click on them to see the research.

These lists of research ought to give you all the evidence you need for determining the safety of homebirth in general. Your birth attendant can help you determine if there are any unique circumstances that might make homebirth unsafe for your family.

Attendant

Your should begin early to decide on a midwife or doctor who attends homebirths in your area. In some areas, it is as easy as opening the phone book. In other areas, any providers of homebirth services are practicing outside the law and so are hidden from the general public. Check the Natural Childbirth Directory for midwives in your area. If you cannot find anyone there, your next step should be to contact doulas and childbirth educators in your area to find out about the homebirth climate. If there is someone in your area assisting at homebirths, they should be able to point you in the right direction. If you are unable to find someone to attend you, you might consider contacting an organization that supports homebirth to get further advice. You might even want to volunteer some of your time to promoting the availability of homebirth in your community. If you cannot find an acceptable attendant, you will need to decide if you are more comfortable with another birth setting or with giving birth at home without an attendant.

Your midwife will help you assess your overall health. Most women will find their health is more than suitable to plan for a homebirth, but in some rare cases a midwife may recommend a woman not plan for a homebirth. Unless laws limit midwifery scope, most midwives will not judge based on past "failure", so you do not have to worry that having had a cesarean or having had an epidural means you are not a candidate. Instead, for a midwife to recommend against homebirth would mean something specific with your health concerns her. While this may not be the answer you want, remember homebirth midwives are there to keep you and the baby safe. If she has concerns about your health, ask her about things you can do to improve your particular risks. You may be able to re-evaluate the situation in a few months to see if your chances of being successful have improved.

Supplies

Once you have made your decision about attendants, you can begin to collect supplies for your labor. If you hired a midwife, she will have a list of supplies she requests you provide. She may have the materials packaged in a bundle you can order from a supply store, or you may be expected to purchase them on your own. Lists vary by midwife and region. Here is a list of some commonly used items.

Waterproof Cover

Some women have used shower curtain liners to provide a waterproof barrier. Some midwives recommend using several old towels instead of plastic because the towels are absorbent and the plastic would leave a puddle of bodily fluids there for you to sit in. Which ever method you choose to protect your mattress (or chair, or floor), consider making your bed in the following manner: Prepare the bed with a fitted sheet and a top sheet. Adjust your waterproof barrier over the top sheet. Now place another fitted sheet over the waterproof barrier and make your bed as usual. This allows you to simply remove the soiled sheets and waterproof barrier revealing an already made bed.

Absorbent Pads

Some women purchase puppy training pads, others purchase disposable pads from a medical or homebirth supplier. These pads are useful to catch fluids while pushing, and could be helpful if your water is broken and you want to keep furniture clean and dry. You may prefer to use folded towels which are just as easy to clean up.

Cord Clamps

These plastic clamps help prevent bleeding from the umbilical cord. They can be cut off after 24 hours, or left on until the cord falls off (although they could be cumbersome)

Sharp, Strong Scissors

Your midwife may ask you purcase a new pair or have a pair she uses. Alternately, you might use a new razor blade. Whatever you use, it is important the edge be sharp and the tool be sterile.

"Peri" Bottle

These soft water bottles allow you to squirt warm water on your perineum after you use the toilet. You do not want to use toilet paper on the tender skin after your baby is born, so you need some way to wash the area.

Oil and Gauze

The oil is for the perineum, to help lubricate it. The Gauze is used to give perineal support and to remove any waste that is expelled while pushing. You can use olive oil to lubricate, so do not feel you have to buy something special. Instead of gauze, you might find warm washcloth compresses to be more comfortable.

Pool or Tub

If you want to use warm water immersion during labor, be sure you have a tub or pool that allows you to have water over your belly. Also consider how you will fill a temporary tub or pool with warm water once labor begins. If you will be using a Jacuzzi or hot tub with a pumping system, give thought to how you will clean the jets if bodily fluids get into the water.

Suture material

Your miwife will want to have suture material available in case you have a tear which needs repair. It may be part of the birth kit you purchase, or she may bring it.

Gloves

Your miwife use bth sterile and non-sterile glvoes. Sterile gloves are for vaginal exams, catching the baby, and for doing any necessary perineal repair to help prevent introducing bacteria or other pathogens to you. Non-sterile gloves protect the midwife while she removes soiled linens or other materials.

Preparing the Space

You should consider what spaces in your home will be used for the labor. Some families use the entire home, while others set up a sacred space in a corner of the house. Some families wash or toss anything that gets soiled, others protect surfaces from any fluids they may come into contact with. Consider how the spaces can be used. A small room may not be a good place to give birth with a large group of family and friends planning to attend, but it might make the perfect place to store the supplies during labor.

Family

You have complete control over who is invited to your homebirth. Most midwives are as comfortable working with large families as they are first time parents who want to be alone. Consider your other children and their desire to be at the labor. Some children love the opportunity, others couldn't care less. Consider your feelings about having your children with you. Some mothers labor easier knowing their children are off having fun, others labor easier knowing they are safe at home.

If homebirth is your back-up plan, you might want to make sure you have a friend or neighbor you can call just in case. This will give you the confidence of knowing even if things do move fast and you can not get to help, help can get to you without your having to call an ambulance. Although you will probably be fine, it might be nice to have someone to help clean up the fluids and placenta so you can cuddle the new baby.

Back up Plan

If homebirth is your main birth plan, you will want to figure out a back-up plan. Most homebirths will be uneventful, and the back-up plan will not be used. On the rare chance you are one of the mothers who transfers to a hospital, you might want to research your options to make sure the transfer is as comfortable and stress-free as a mid-labor transfer can be. A basic back-up plan simply involves 1) where you will go, 2) how you will get there, and 3) who will go with you.

How far you go beyond the basics will depend on how much information you need to feel comfortable and confident. For example, if your plan involves using an ambulence, does your insurance limit you to a specific ambulence company? If your plan involves driving, do you know where to park and what part of the hospital houses the maternity? Some women like to meet the physician who provides back-up services in case of hospital transfer. Some women like to tour the hospital to ensure there are no surprises in the event of a transfer. Some women pack a "just in case" bag, then store it in the back of the closet. Other women feel prepared just knowing they have a place to go, a way to get there, and someone to take them. It all depends on how much you need to feel ready.