But is homebirth safe if it's your first ...
This is a question I hear a lot - concerns that homebirth might not be a very safe option if it is your first baby, untried pelvis etc etc. "I'd love a homebirth ... but not for my first ... maybe I'd think about it for my second or subsequent babies ..."
The problem with this reasoning is that after a hospital birth that often involves some degree of trauma and possibly some sort of surgery, many women find their confidence in their bodies and in birth is so shot, they face many obstacles to have a homebirth. For example, planning a VBAC homebirth is probably harder logistically and emotionally than planning a primip homebirth.
27% of mothers in Australia who had homebirths in 2006 were first time mothers. In my experience, homebirth for your first baby is a more than reasonable option because it sets you up with a positive "obstetric history" and is much less likely to end in surgery (4% c/s rate compared to 40% for primips in most hospitals - that's one tenth of the chance - just because of the different location).
But that was just my subjective impression - until I came across this research paper from New Zealand about first time mothers and homebirth.
First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes
First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes
First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes en_NZ
Author Miller, Suzanne Claire
Advisor Moss, Cheryl
Advisor Skinner, Joan
Unit Graduate School of Nursing, Midwifery and Health en_NZ
Copyright 2008
Abstract
A woman's first birth experience can be a powerfully transformative event in her life, or can be so traumatic it affects her sense of 'self' for years. It can influence her maternity future, her physical and emotional health, and her ability to mother her baby. It matters greatly how her first birth unfolds. Women in Aotearoa/New Zealand enjoy a range of options for provision of maternity care, including, for most, their choice of birth setting. Midwives who practice in a range of settings perceive that birth outcomes for first-time mothers appear to be 'better' at home. An exploration of this perception seems warranted in light of the mainstream view that hospital is the optimal birth setting. The research question was: "Do midwives offer the same intrapartum care at home and in hospital, and if differences exist, how might they be made manifest in the labour and birth events of first-time mothers?" This mixed-methods study compared labour and birth events for two groups of first-time mothers who were cared for by the same midwives in a continuity of care context. One group of mothers planned to give birth at home and the other group planned to give birth in a hospital where anaesthetic and surgical services were available. Labour and birth event data were collected by a survey which was generated following a focus group discussion with a small group of midwives. This discussion centred around whether these midwives believed their practice differed in each setting, and what influenced care provision in each place. Content analysis of the focus group data saw the emergence of four themes relating to differences in practice: midwives' use of space, their use of time, the 'being' and 'doing' of midwifery and aspects relating to safety. Survey data were analysed using SPSS. Despite being cared for by the same midwives, women in the hospital-birth group were more likely to use pharmacological methods of pain management, experienced more interventions (ARM, vaginal examinations, IV hydration, active third stage management and electronic foetal monitoring) and achieved spontaneous vaginal birth less often than the women in the homebirth group. These findings strengthen the evidence that for low risk first-time mothers a choice to give birth at home can result in a greater likelihood of achieving a normal birth. The study offers some insights into how the woman's choice of birth place affects the care provided by midwives, and how differences in care provision can relate to differences in labour and birth event outcomes.
I had my first baby at home (with a single midwife, in Ireland). 24 hours of labour, in and out of the birth pool, hands-off midwife, 7 pound 2 ounce baby girl born at 2 am, perfect apgars, intact perineum.
Of the 19 primip women I've been doula for over the last two years, 6 had homebirths. 5 had spontaneous vaginal births at home with no tears. 1 transfered to hospital and had a vaginal birth with the help of ventouse.
How about you? Did you have your first at home? How did it go? How did you handle the pain, effort or intensity with no pharmaceutical pain relief available? If there were any complications, how did you and/or your midwife handle it?
