Why Not Home?
By Jessicca Moore, MSN, FP
“You and your mom would have died.” I was breech, delivered by cesarean section. According to my dad, if my mom had been outside of a hospital for delivery, we both would have died. Whether or not this is true, we’ll never know, but it was true for him. At least in part because of this story, I always assumed I would give birth in a hospital (nearly 99% of women in the United States do, so it was a pretty safe bet). Then I got pregnant.
I had suffered from endometriosis since an early age and battled with infertility for several years before pursuing IVF. When the nurse called to tell me it worked, that my hormone levels were consistent with a normal pregnancy, I was beyond relieved.
When you’re pregnant, everybody wants to tell your their birth story. When my friend Denise, a labor and delivery nurse, told me she had delivered both of her children at home, I was caught off guard, “Isn’t that dangerous?” Then a physician who attends births at a hospital confided in me that she too had her children at home, but she didn’t want it getting out. She knew some people would question her judgement and knew another OB who lost a job because of it.
As a nurse, and then a nurse practitioner, I had cared for babies in neonatal intensive care units and supported mothers during their pregnancies and deliveries. I had witnessed devastating loss and knew there were no guarantees. Like all mothers, I wanted to deliver my baby safely into the world, but I started questioning my assumptions about where that was most likely to happen.
Media has largely portrayed women who have home births as fringe, anti-establishment, earth mamas who care more about having a birth experience that’s Instagram worthy than having a healthy baby. That depiction is a false image set-up to divide us and distract from the real and valid reasons families would choose to go against cultural norms and have a baby at home. The physicians and nurses I knew who were choosing home birth were keeping quiet for the most part. They didn’t need that kind of negative attention from colleagues.
You see, in the hospital setting, doctors and nurses often talk about the “train wrecks” that come in from “failed home births.” But this too is overly simplistic and says more about the paternalism that persists in obstetrics and the siloed systems of care we’ve created in the United States than the midwives and families opting for birth at home or birth center.
I did end up having both of my children at home. It was work. There were moments when I wasn’t sure if I could do it, but I had everything and everyone I needed to support me in that huge transition from woman to mother. I pulled my warm, wet baby onto my chest in the bed where we sleep. Healthy and peaceful. Undisturbed. I wouldn’t have wanted it any other way. Could it have happened at a hospital? Sure. Does it have to? No.
The right to choose where and with whom to deliver your baby is a reproductive right. In about 21 states in the United States, midwives cannot be licensed to attend home births, putting them at risk of prosecution. This type of restriction makes it hard for families to access this type of care and makes it less safe when they do. It contributes to a narrative that maintains home birth a risky and ill advised choice.
Like many issues in the United States right now, home vs. hospital birth is polarized and divisive. Too often the only voices we hear are the extremes. While we fight about whether or not women should be allowed to birth in the location of their choice, maternal mortality rates in the United States are rising. This at a time when they are falling in every other industrialized nation.
Black women are 3–4 times more likely to die during childbirth than white women. This is the real crisis. There is strong evidence that the midwifery model of care improves birth outcomes for all families. When women have have agency, are listened to and respected, both their outcomes and experience improves.
Too often in our current state, families make decisions based on fear, misinformation, or insurance coverage. What if instead everyone was supported to make decisions about their birth based on accurate information and an honest assessment of their own values and needs? If we are going to improve maternity care we need to listen, ask questions, and tell our stories. This is mine.
Jessicca Moore is a Family Nurse Practitioner and Filmmaker in Petaluma, CA. Her documentary, “Why Not Home?” tells the surprising birth stories of doctors and nurses facing professional and personal challenges in and out of the hospital.
