Choosing a homebirth was a gamble. This is not because homebirth is unsafe. It was a gamble because if anything went awry, our first major decision as parents would be questioned.
Research has recently shown that the chance of perinatal death (i.e., during labor and up to 28days after birth) is 0.18% for hospital births compared to 0.21% for homebirths. However, after adjusting for maternal risk factors, which are worse among planned hospital births, there is an estimated 0.16% increased risk associated with planned out-of-hospital birth.
We want share our positive experience to help demystify homebirth and explain why we found it best for our family.
Although Kai Vanderveer Hidaka was recently born in our living room on Wednesday (March 30th, 2016), having a homebirth was a process that began a long time ago.
Hannah was interested in a non-mainstream approach to childbirth after watching the documentary The Business of Being Born. After watching it myself, I wanted to learn more. There is a newer documentary called Why Not Home about doctors and nurses choosing homebirth for their families.
We were connected to a midwife practicing in the Kansas City area through a friend. She came over for tea and explained her philosophy and approach; her values were completely congruent with ours. She answered our questions, told us to think about a partnership, and left us her 5-page, single-spaced, informed consent paperwork.
MamaSara, our midwife, returned a week later and we officially agreed to embark on this adventure together. She took a complete medical history of Hannah and shared her cell phone number. She encouraged us to contact her at anytime with questions or concerns. Throughout, she responded quickly to text messages and always answered her phone.
Upon reflection, attending a potluck picnic was pivotal. It was an annual event for families whom she had served. There were dozens of kids running around and parents from all walks of life. The families were living proof that we were not alone. It solidified our decision.
The care was as evidence-based as what I saw during my obstetrics and gynecology rotation. MamaSara ordered a set of prenatal labs (CBC with diff, CMP, blood type, rubella titer, syphilis, hepatitis B, HIV), a urine culture, and a vitamin D level for Hannah to have drawn at a reference laboratory. We were offered options for birth defect screening. We had an obstetric sonogram at 20weeks gestational age, at which we requested no gender revelation. We checked for Group B Strep infection at 36weeks. We were given options (with thorough, balanced informed consent) of the following recommended interventions at birth: prophylactic antibiotic treatment of Group B Strep, vitamin K injection, erythromycin eye ointment, hepatitis B vaccination, metabolic screening, hearing screening, and heart defect screening.
Similar to standard prenatal care by an obstetrician/gynecologist, we met every four weeks, then every two, and then weekly toward the end. In our home, our midwife tested Hannah’s urine, measured blood pressure, listened for the fetus’ heartbeat, and measured fundal (top of the uterus) height. At each visit, she had questions for us and answers for ours. Most importantly, she always had time for us. My experiences as a medical student helped generate questions for her.
We cultivated a healthy pregnancy that began with a wholesome diet. We often had green smoothies for breakfast. We continued our dinners of sautéed vegetables (in organic virgin coconut oil, organic extra virgin olive oil and/or organic pastured butter) with a whole grain and a protein (meat, eggs, tofu, nuts, and/or cheese). We did not stop indulging, e.g., homemade waffles, Topp’d pizza, Glace ice cream, and Ibis croissants. Our supplements included a B-complex, magnesium, kelp (for iodine), vitamin C, fish oil, and vitamin D; we don’t take all of them everyday, but most on most days. Hannah was super-proud to have the highest vitamin D level MamaSara had ever seen: 67ng/ml. I believe that our balanced diet and supplementation regimen contributed to Hannah not experiencing stereotypical pregnancy cravings, e.g., pickles, clay, etc. To Hannah, basil and balsamic vinegar were repulsive, so I enjoyed her share on her behalf. Hannah occasionally enjoyed a half-glass of wine on a full stomach.
Our midwife gave Hannah an endless supply of an herbal pregnancy tea consisting of nettle leaves, alfalfa leaves, red raspberry leaves, and oatstraw; she drank a quart on most days. I was impressed, because the tea tasted bitter and bad to me. Following MamaSara’s advice (based on a randomized controlled trial), Hannah started eating 6 dates a day at 36weeks.
Hannah also continued to practice yoga and walk often. Toward the end, we were taking multiple walks together each day.
Throughout, MamaSara armed us with knowledge via DVDs, handouts, and books. I read The Expectant Father, which gave me helpful tips for being a more supportive partner to a pregnant person and inspired me to get life insurance. Hannah read Expecting Better, All Joy and No Fun, Birthing from Within, Happiest Baby on the Block, Easing Labor Pain, and Journey into Motherhood. The books empowered Hannah with real, factual experiences of labor; these stories replaced the only other childbirth images in our culture, Hollywood’s. Several DVD’s and handouts gave us helpful pain management strategies.
We recall one poignant conversation with MamaSara and her student, Catherine, who said that “pain” is not the right word for it, because pain is something to avoid and move away from; the intense sensations of labor are instead something to move toward and through. Hannah viewed the discomfort as a mountain to climb; she said her experience running a half-marathon (and training for it) last year is a great analogy.
We were very excited to reach 37weeks, because, no longer “preterm,” we could have a homebirth. We prepared the home by rearranging and gathering everything on MamaSara’s recommended supply list. She and Catherine brought us a birthing pool.
As our due date approached, happened, and then passed, our anxiety rose. MamaSara reassured us that the baby would come when it was ready. She was not concerned about us being “overdue,” because first-time mothers usually go longer than 41weeks and her experiences had not shown “late” newborns to look overcooked. If we got to 42weeks, she suggested that we get a biophysical profile to ensure everything was okay.
For two weeks, we woke up thinking the baby would be arriving that day. On the evening before day 41wk5d, Hannah felt her first contraction. Contractions occurred sporadically throughout the next day, gradually increasing in frequency. We spent the day cooking, making art, walking in Loose Park, playing a game of Bocce ball in the backyard, and relaxing at home with a movie. The waves became regular and with shorter intervals. Labor began in earnest around midnight.
At that point, we followed MamaSara’s advice to get some rest, because, although it was very exciting, it was important to be well-rested for a process that was probably going to last a long time. So we rested until 3am. I slept in bed while Hannah dozed between waves on the couch. This time was important for her to gain control of her breathing and embrace the ebbs and flow.
When the waves were happening every 2-4minutes, we asked MamaSara to come over. It was 5am and she said that if we are doing okay she would take a shower and be over in 45min. She said to call if we needed anything. Shortly thereafter, the waves changed in character; they went from just being super-intense menstrual cramps to having an additional intense urge to defecate. Fortunately, we had prepared for this moment.
Evidently, it is wise to resist the urge to push, because that gives the perineal tissue time to stretch, thereby making tears less likely. Hannah tried her best not push. Hannah wondered if we should start filling up the birthing pool, but I told her that we could wait until MamaSara got there. I would later be proved wrong.
I held Hannah close. The waves were raising their intensity. We transitioned from the bathroom to a chair, which she sat in backward on top of a folded towel. I massaged her lower back and squeezed the outside of her hips and encouraged her to breathe deeply through the contractions. I said things like, “Your body is amazing,” “You’re doing so well,” “Remember to breathe,” “Long, deep inhale. Slow, deep exhale.” My experience as a yoga instructor probably helped.
MamaSara arrived around 6am. She surveyed the scene and immediately began setting up all of her tools and equipment without saying much. She had told us at one of our appointments that she generally tries to keep out of the way, but she is willing to do anything (within reason) that we think might help. We asked her if she thought it would be okay to start filling the pool, which she initiated. After she got the water flowing, she brought a soft floor cover and multiple flat soaking pads out to the living room and laid them in front of the chair. I asked her what she was doing. She said that it usually takes about 30min to fill the pool and she just wanted to make sure that we had a plan in case we didn’t get there.
I suggested that Hannah try a different position, since that can help. She transitioned to the floor; she was on her hands and knees, with her head in my lap. She was in the zone. She rested between contractions, resisting the urge to push. I did what I could: I held her head, supported her shoulders, massaged her back, and held her hands, which she sometimes squeezed in unison with her uterus. In between contractions, the house was calm and quiet.
Catherine arrived, was quietly oriented by MamaSara, and kneeled behind Hannah with comforting words of support. After the next contraction, they motioned to me that the head was crowning. Catherine donned sterile gloves. Hannah reached with her right hand and felt the baby’s head and said, “Oh my god, that’s the head! What do I do?!” Catherine told her that she doesn’t need to do anything, that she should continue to try and relax and that she was doing great. “Okay,” replied Hannah. MamaSara offered to switch places with me so that I could catch the baby. It was 7:00am.
I sat down at Hannah’s side with my hand on her back and glanced at the top of my baby’s head. MamaSara encouraged me to take off my nice, new watch, which Hannah had gifted me 24hours prior. After two more contractions, the head popped out and there was a gush of clear liquid. It was the amniotic fluid; her water had finally broken. The baby began crying while the shoulders came through with another push. I was there to catch the baby. I brought him (I saw a penis and scrotum!) through Hannah’s legs and into her arms.
We held our slippery baby, laughing, awing at it, and kissed each other. Waves of joy crashed over us. Hannah noticed his genitals and said, “We have a baby Kai!” We sat against the couch and savored our first moments with our first-born son. Time then becomes a bit blurry. It seemed within seconds that someone offered Hannah a straw to sip from a mug of warm, sweet, herbal tea to help her uterus contract and shrink. She downed it immediately and had three more whole mugs before retiring to the bedroom. Within a couple of minutes, Kai had successfully latched onto Hannah’s right nipple and began to suckle. It was surreal.
Meanwhile, Catherine was checking Hannah’s uterus and for evidence of a bad bleed. There was no hurry to deliver the placenta or clamp the umbilical cord. The placenta arrived. They ensured that all parts had successfully detached and put the placenta in a Tupperware container next to us.
At one point, they helped Hannah to the bathroom. Catherine ushered Kai and me to our bedroom; she walked close carrying the placenta-filled Tupperware that was still tethered to Kai’s abdomen. When I reached our bedroom, I found that it had been prepared for us. Hannah joined me and they did a pelvic exam at the bedside. She was found to have a couple of small tears and one moderate labial tear. After discussing the pros and cons, Hannah elected to allow the moderate tear to heal without sutures. Hannah promised to heal by keeping her legs close together for two weeks, which includes no steps or stairs.
I cut the umbilical cord, which Catherine tied off. The rest of the cord and the placenta would be dehydrated and given back to us within 24hours. The placenta was pulverized and encapsulated, which Hannah is taking as a supplement to support lactation, energy, sleep, and mood during the postpartum period.
Catherine performed a newborn exam, weighing him (8lbs 1oz), and demonstrating the neat reflexes. We were then fed scrambled eggs and muffins in bed. We were oriented to temperature tracking (of baby and mom), goals for pooping and peeing (for baby and mom), and the tinctures to allay uterine cramping (extracts of Black Haw, Cramp Bark, and Motherwort). It was slightly overwhelming, but they left us handouts. During all this time, they were cleaning up the pool and everything else.
By 10am, they had left us with our new son in our bed in a clean house. Until the afternoon, we stayed in our bedroom, took a couple of naps, and stared at him. We had warned our family that we needed 24hours to just our ourselves, which they honored (not easy with my mom living right next door and Hannah’s mom a couple blocks away, visiting from Texas!). But we felt so good that we broke our own rule and invited them over for a little bit that evening to meet their grandson.
The next day, Catherine and MamaSara returned to check on Hannah and perform the newborn screenings to which we had agreed. They shared how happy and impressed they were by us! Labor normally lasts much longer for first-time mothers. MamaSara came again two days later. She will visit again in one week and will follow with us for as long as we need. We feel like her one-time, all-inclusive fee of $3,000 (which is the fee if paying out-of-pocket with cash) is a bargain for the quality, breadth, and depth of care we have received.
In summary, choosing to have a homebirth was right for us, because Hannah and I share a mindset of aiming for the best, working for it, and manifesting it by expecting it. We had sketched out a plan B, but we did not dwell on terrible things that might transpire.
Labor and delivery is inherently uncertain; nobody can predict what will happen. Childbirth in a hospital aims to make disasters least likely. For us, homebirth was an opportunity to make our best-case scenario most likely. We were blessed with exactly that.
We cannot imagine a better start to our family’s newest addition.