Childbirth: drug-free home birth
 Vanessa, Andrew and baby Oscar: the happy result of a drug-free water birth |
For some women, thoughts of endless hours of labour pains and an excruciating childbirth experience are enough to make them opt for an elective Caesarean section. For others, the experience of giving birth is almost spiritual. 36-year-old architect Vanessa Palfreeman tells myDr why she chose a drug-free home birth. |
Vanessa and her husband Andrew, who live in Sydney, have 2 boys, Oscar, now four-and-a-half, and Eddie, now 2.
Oscar was born in a birth suite in a Sydney hospital, with the aid of 2 independent midwives, while Eddie was born at home with the aid of the same midwives.
For Vanessa the idea of having a natural, drug-free labour and childbirth experience in a comfortable, relaxed environment was paramount, even with her first child.
She said: ‘My sister had a home birth for her first baby and I was invited to be one of her helpers, so my first experience of a home birth was very exciting and positive. It was an amazing experience.
‘When I became pregnant I had to think about my choices for having the baby. I decided to use the services of the 2 independent home birth midwives my sister had used. They run a private service that supports women who want to have their babies at home. They’re known as home birth specialists, and they are with you every step of the way.
‘With my first child, though, I wasn’t 100 per cent confident about having the baby at home. The whole experience of having a baby was completely unknown and uncharted so I wanted the reassurance of being in a hospital with facilities at hand if they were needed.
‘The midwives then offered me the option of having all my antenatal care done at home, rather than in a hospital, with the delivery in a comfortable birth centre in a hospital.’
Vanessa said that she saw an obstetrician only once, towards the end of her first pregnancy, because the bulk of the antenatal care was conducted by the midwives.
Drug-free labour
At antenatal classes, the midwives talked to Vanessa about what to expect from the birth and how to manage the pain of labour and childbirth.
Vanessa said: ‘With my first baby, the birth itself was very straightforward and I didn’t have any drugs for pain relief. However, towards the end of labour I finally asked for some pain relief and was told I was a bit late — the midwife could already see Oscar’s ears!’
In a hospital environment, women are usually offered drugs for pain relief. For example, pethidine may be given by injection early in labour to reduce pain. However, it can affect a baby’s breathing and make him or her feel drowsy and the mother may also feel a bit nauseous and drowsy afterwards.
Anaesthetic pain relief may be given as an epidural, which is delivered to the area of the spinal canal known as the epidural space. After cleaning the skin with antiseptic, the anaesthetist will inject some local anaesthetic into the back before inserting an epidural needle in to the space between the vertebrae (bones) of the spine to find the epidural space. A catheter is then inserted through the needle before the needle is taken out. The catheter, which is taped to the skin, then allows the anaesthetist to deliver the anaesthetic and top it up to keep you numb. The exact procedure for an epidural may vary from hospital to hospital. An epidural may take up to half an hour to be administered and take effect, depending on the strength of the anaesthetic delivered. You are still conscious but cannot feel any pain.
For Vanessa, pain relief was largely achieved through breathing, being in water and finding a comfortable position, as the midwives did not carry pain-relieving drugs.
Vanessa said: ‘The pain of a drug-free birth really does hurt, but it is bearable. I think people get blasé about drugs during labour. After all, an epidural is a major spinal procedure.
‘The midwives inspired a lot of confidence in me that my body could do it and that I could handle the pain. I never felt that it would be too difficult or painful for me and they made sure I felt confident I’d be able to cope. By the time of the birth I was very sure my body could handle it.’
The birth centre
Vanessa and the midwives made sure that the birth of her first baby was as close to the home birth experience as possible, with the added reassurance of hospital facilities at close hand.
Vanessa said: ‘Quite often, you hear of women who have laboured very well at home but as soon as they get into the frantic hospital environment everything stops, and I believe that’s because the usual hospital environment isn’t particularly relaxed.
‘With Oscar, I laboured at home for about 3 hours and then called the midwives and they came to my home, examined me and took me to the birth centre. We were in a very comfortable room which was very unlike a hospital so I went from the comfortable, relaxed environment of home to the very comfortable birth centre, with no frantic activity in between.’
Birth centre: benefits
Birth centres offer a useful option for women who prefer not to be ruled by the hospital system but who need the comfort of knowing that hospital facilities are nearby. Although they may be located in or close to a hospital, birth centres are designed to feel less medical than the usual hospital environment. You will probably be given your own room so that you can remain active and move about as much as you want to during labour.
For Vanessa, having her baby outside the government hospital system had considerable advantages, in terms of control.
She said: ‘Oscar was 8 days late but there was no pressure from the midwives to be induced. I believe that if I were in the hospital system there would be a higher chance I’d be encouraged to be induced, as it was my first baby. I did go and get acupuncture to try to stimulate labour and Oscar was born the next day!’
Water birth in the birth centre
Vanessa said: ‘Oscar was born in a water bath. I hadn’t planned this or even discussed it beforehand but the birth centre had a lovely big bath and I felt so good in the water during labour that I didn’t want to get out! I trusted the midwives completely and when they said they felt confident that I could safely have the baby in the bath, I felt reassured that nothing would go wrong.’
 Water birth in the birth centre |
For many women, being submerged in a warm bath offers great pain relief during childbirth. Because the body is buoyant and supported by the water, the pressure on the abdomen is relieved. Water also makes it easier for a woman to move around and find the best position for pain relief. This relief of pressure on the abdomen can help aid the power of the contractions to help move the baby’s head down the birth canal. Lying in warm water also helps the blood to flow to the heart more efficiently and helps increase the action of the heart. |
The baby born in water will not drown, as it starts to breathe only when it is lifted out of the water. In addition, the umbilical cord keeps pulsating for a few minutes after delivery, giving the baby vital oxygen. Some women also believe that, for the baby, being born into warm water rather than cold air provides a less shocking introduction to the world, as the baby has been floating in warm amniotic fluid for 9 months.
Vanessa said: ‘Having a baby in water isn’t particularly messy as there is no blood until the baby appears [although there may be some faeces]. When I had Oscar I did try lying on my back at one stage and I found it terribly painful: I don’t know how women can do that!’
Oscar was born in the birth centre at 5 pm, only a couple of hours after Vanessa, Andrew and the midwives arrived at the birth centre.
She said: ‘After Oscar was born, I waited in the birth centre for the paediatrician to do the first health checks on the baby (known as the Apgar score, see below). I also needed a few stitches as I’d torn a little during the birth. I could have stayed there for a few days but I wanted to go home. I was home by 8 pm so the visit to the birth centre was not very disruptive. The midwives came home with me, settled us in and then left us to ourselves.’
Home birth
It was this very positive experience that encouraged Vanessa to have a home birth for the couple’s second child, Eddie.
 The relaxed environment of a home birth means the whole family can be involved |
Today, only a small percentage of births take place in the home compared with the number of hospital births. |
The relatively unusual decision to have a home birth prompted some reservations in Vanessa. She said: ‘At first I didn’t tell people I was having a home birth because everyone seems to have an opinion about the best way to have a baby, and I wasn’t prepared to listen to people accuse me of not doing what’s best for me or my child by not being in the hospital system.’
However, she added: ‘What people need to remember is that I had total trust and confidence in the midwives. They monitored me and the baby closely all through my pregnancy and were definitely not into risk-taking. I knew they could predict possible problems and would be able to make the right decisions about transferring me to hospital if it was necessary. If there had been any signs that the pregnancy wasn’t standard, neither they nor we would have gone ahead with a home birth.’
Home birth: benefits
The main advantage of having a home birth is the familiar environment. Vanessa said: ‘It’s the relaxed environment that makes a home birth successful, as well as support from your partner and family.
‘With a home birth you feel very comfortable: you know no one’s going to walk in unannounced at any moment, there are no hospital instruments around, and you can be supported by your partner, your family and your helpers.’
The relaxed environment also means that the whole family can be involved.
Vanessa said: ‘In addition to your partner and the midwives, it’s a good idea to have at least one extra person to be a general helper. Two of my sisters, Annabel and Rachel, were my helpers for the birth of Eddie. Annabel had the job of looking after Oscar. He could choose whether he wanted to be there for Eddie’s birth or not, and it was Annabel’s job to monitor Oscar and make sure he was all right. Whatever he wanted to do, she would do, even if that meant leaving the house altogether to go for a walk or to play in the park. It’s very important to have someone to focus on the other child and how they’re coping.
‘As it turned out, Oscar was keen to be involved and he was there when his brother was born. He was fine, sitting on his dad’s lap; he wasn’t distressed at all. He was very excited and can still remember the event very vividly.’
Home birth: risks
There are some instances in which it is not recommended to have a home birth, for example, if the baby is in breech position (where the baby is born bottom first, rather than head first) or if the placenta is in the wrong position, the doctor or midwife would probably recommend a hospital delivery.
Because you are outside the hospital environment, emergency treatment isn’t always readily available, so you need to be prepared to transfer to hospital if anything starts to go wrong during delivery. You also probably won’t have access to pain relief such as an epidural or pethidine.
Preparing for a home birth
At the last couple of antenatal check-ups, the midwives visited Vanessa and Andrew’s home to discuss preparations for the birth.
Vanessa said: ‘They gave me a list of things I’d need, and there are some things you may not think of. As well as nappies, and clothes for the baby we had to make sure we had enough food and drink available for the helpers, and Oscar and Andrew. We also had to cover the bed with a plastic sheet as you do bleed a lot afterwards. If you’re in hospital, that is all taken care of for you so you don’t even need to consider it.’
Vanessa opted to have a water birth for Eddie. Fortunately, the couple had just designed a new bathroom with a large bath so they decided to use that.
For people who don’t have a bath or whose home bath isn’t big enough, home birth midwives can supply an inflatable pool, which can be set up in advance at home.
Labour at home
In the run up to the due date, the midwives were on call, ready to go to the house when labour began.
Vanessa said: ‘My contractions began at about 1pm so I rang the midwife and told her to be prepared as I’d probably need her by the morning.
‘I enjoyed labour with Eddie. The contractions went all night slowly every 10 to 15 minutes. Andrew stayed up with me until about 1 am or 2 am but then I sent him off to bed. I really wanted to be by myself just to enjoy the moment. I had a really lovely night. It’s very difficult to explain the feeling but I turned inwards to myself: I think you have to do that to be able to find the strength to go through the birth. It was very emotional, knowing that at the end of this birth process something amazing — our new baby — was on its way.’
By 5 am, Vanessa knew that the baby was well and truly on the way so she woke up her husband and rang the midwives, who arrived at about 6 am.
Vanessa said: ‘The midwives could have come sooner, but part of me didn’t want them there any earlier than necessary. Still, there came a point where I knew I needed the midwives right away!
‘When they arrived I wanted to get into the bath but they told me to wait. They monitored the level of contractions and then realised how close the birth was: only then did they let me get into the bath. It was a warm, not hot, bath, with a cushion behind me for support and I think I had something to brace my feet against. It was big enough that I could turn around and be on all fours for a bit of pain relief if I needed to. I moved around quite a lot, sometimes squatting with my arms hanging over the bath, sometimes on all fours.’
The feeling of introspection remained with Vanessa throughout the birth. She said: ‘During the birth, I did not have — and still don’t have — any real idea of what my partner or helpers were doing. I really turned inward and went completely into myself. During Eddie’s birth my husband, thinking he was helping, started saying all the right things, such as "you’re doing really well, you’re doing fine" but I told him to be quiet! I needed him to be there with me but I didn’t need him to talk or to try to encourage me in any other way.’
Eddie was born at 7 am, 2 days before his due date. The placenta was delivered a few minutes later, and was examined by the midwife to ensure that the entire placenta was delivered as any pieces remaining inside the body could cause infection and bleeding.
The Apgar score
The midwife then conducted some tests on Eddie, which happens to every baby. The Apgar score is a standardised way of checking the health of a newborn baby.
The score is based on 5 elements: heart rate, regularity of breathing, muscle tone, pinkness of skin colour and the baby’s reflexes, and each element is given a score of 0, 1 or 2 to provide a total score of 10.
The checks are conducted at one minute and 5 minutes after the birth, and a score of 7 or more is considered normal. However, if the baby has a low score at one minute and a normal score at 5 minutes, this, too, is considered normal, particularly if the birth took a long time.
Recovery after birth
The 6-week period of recovery after the birth of a baby is known as the puerperium.
Women experience bleeding for at least 2 weeks as the site of the placenta starts to heal. The discharge, known as the lochia, varies from red in the first 4 or 5 days, to brown, after about a week, and then to yellowish-white.
Because the entrance to the womb and the vagina have been stretched during delivery, its takes at least 7 to 10 days for them to start to regain elasticity. Some women will never again regain the elasticity they once had, although doing pelvic floor exercises should help them tighten up.
Vanessa said: ‘My recovery was fine. The midwife visited me every day for about 2 weeks. I had very heavy bleeding for about 3 or 4 days and by about a week to 10 days, the bleeding was like a normal period and then it stopped. I’d had some stitches but they were the type that dissolves so there was no need for them to be removed. And our sex life had resumed by the time of the baby’s 6-week check-up.’
All being well, Vanessa and Andrew are already planning a home birth for their third child, due later this year.
* Since this item was written, some home birth midwives have found it increasingly difficult to obtain medical indemnity insurance, so it can be very difficult for them to practise in hospitals. Since this article was written, the midwives mentioned no longer use the Sydney hospital's facilities and have largely stopped practising.
Last Reviewed: 30 April 2002
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