An Open Letter to Those Concerned about a Loved One Choosing a Home Birth

Larry G. Overton, with Beth Overton, LM, CPM, Copyright © January 24, 2006To whom it May Concern

Congratulations! Someone you love has just chosen to employ the services of a midwife and have her baby at home. It’s an exciting, wonderful time, and your loved one and her baby are going to get the best of professional and personalized care. With a midwife attending her at home, she has the best chance of having a birth experience that she will cherish for the rest of her life. So again, congratulations!

However, some of you reading this may be thinking, “Are you out of your mind? You actually think congratulations are in order because _______ [fill in the blank here with the name of your loved one] has decided to have her baby at home? That’s the scariest thing I’ve ever heard!”

If this is your reaction to the news of your loved one choosing a homebirth, I can understand and even relate on some level to what you are feeling. No, really. Believe it or not, I understand, to some extent at least, where you are coming from on this and what you’re feeling. I’ll explain that claim a little later on. Right now we should turn our attentions away from feelings and look at the facts.

Fact One. You are motivated out of your love and concern for your daughter or granddaughter or sister or your best friend. Whatever your relationship is to this prospective homebirther, it is a relationship of love and caring. You want what’s best for her, and you don’t at this time think that a homebirth is what’s best for her and her baby.

At this point, we don’t agree as to what constitutes the best prenatal and birth care for her, but I certainly respect your motives. You’re not voicing your objection to homebirth and/or midwifery care just for the sake of being contrary; you truly love this mother-to-be, and you are concerned. This is very admirable, and by the way, it is one of the reasons I could say earlier that I understand and relate.

Let this fact work for you. Be courageous and up front about this. When you discuss this decision with your loved one, let her know that you are concerned because you love her. You can honestly say that, so do. Just say something like, “You know I love you, and because I do, I have to be honest here. I must tell you that this homebirth idea really scares me. Can we talk about this?”

This approach is very important, for several reasons. First of all, it is important because it is honest. Secondly, it is important because your loved one needs your love and support right now. She is excited about this prospective birth, but likely as not she’s a little frightened, too. Okay, maybe a lot frightened. If she’s a first time mom, she may quite naturally be apprehensive about what is to come. And if she’s had a baby before, and she’s chosen a homebirth, then she probably has a good idea of the pain and work that is ahead of her on this (they don’t call it “labor” for nothing, you know). And as that new life develops in her womb, her body is changing, and her hormones are playing havoc with her emotions. Therefore, this is definitely not the time to confront her with an “Are you out of your mind?” approach. So even if you disagree with her decision, disagreeing agreeably is tremendously important to her morale.

Fact Two. Your negative reaction against the idea of midwifery care and homebirth is because you have preconceived ideas. Yes, that is a bold statement, but I don’t mean that in a condescending or insulting way. I am just thoroughly convinced that it is true. Here’s why:

1. Reaction based upon preconception is pretty much a universal condition. We have all had (or currently have) a set of ideas that we hold to, not because we have done a good deal of research on the subject and arrived at a conclusion based on facts, but because of some concept or tradition that has been ingrained in us by society or by our culture or our family.

2. The very fact of your reaction is evidence of bias due to preconceived ideas. In other words, your negative reaction against midwifery and/or homebirth is evidence of a preconceived bias toward a medically managed birth in a hospital setting. Think about it: if you had no preconceived notions about what is best for prenatal care and childbirth, you would have not reacted so to midwifery/homebirth. You would have instead been equally open to both the midwifery and medical models of care.

3. I confidently assert that your reaction is based upon preconception because I know it is not based on the facts. Of course, you don’t as yet agree with that statement, but I can honestly make such a statement. Once you know the facts about midwifery, it ceases to be a frightening option. And once you know the truth about the medical model of managing labor and childbirth, it is that approach that becomes a scary prospect, and not homebirth. So I say again that your negative reaction against midwifery and/or homebirth is evidence of a preconceived bias toward a medically managed birth in a hospital setting.

Are you still with me? I hope so. I know that what I am writing here is not altogether comfortable for you. Okay, maybe it’s downright uncomfortable. But the circumstances definitely call for facing these issues. Your loved one has made this decision, and like it or not, your differences of opinion are now an issue that must be faced. If you want to be helpful to and supportive of your loved one during her pregnancy, labor and childbirth, then you must come to terms with this choice of hers.

So, what should you do about Fact Two? Well, as I just said, you need to face it head on and make the necessary changes. Though an initial negative reaction based on preconceptions may be understandable, a steadfast refusal to examine the facts is inexcusable. It is one thing to initially resist change and fall back on what you know and are comfortable with when you are challenged with something new. It is quite another thing altogether to refuse to consider any information that does not conform to your preconceived notions.

And before I move on, let me just point out what should be quite obvious. This article is not designed to present all of the relevant facts about either the holistic, homebirth and midwifery model of care or the “quality” of the medical model of prenatal care and the medical management of labor and delivery. Quite a few books have been published on this subject. There are a number of good magazines and journals representing both perspectives. There is a lot of information readily available via the Internet: statistics from state departments of health; published results of studies;1 online articles; etc.

So, don’t look to this article of mine to answer all of your questions and/or objections. I am writing this merely to point out certain pertinent facts and to challenge those interested to research the situation. So if—make that, since—you care, do your homework. Ask your loved one’s midwife to suggest some reading and maybe (if you’re up to it) even some video viewing. Better yet, ask your loved one. After all, she made this decision because she was convinced. Find out what convinced her. And this leads me to my third point.

Fact Three. You will do well to remember that this is your loved one’s decision. You should be prepared to accept her decision and support her the best way you can, even if you don’t agree. Unless you think that her intellectual capacity or her emotional maturity disqualifies her from making her own decisions in this regard, you need to accept this.

And I do not bring up mental capacity and emotional maturity facetiously, or as a hypothetical scenario. I mention this as a real (albeit unusual) scenario.2 It is of course possible that a woman may be physically and chronologically a woman, and yet emotionally or mentally challenged. Such a woman might physically be capable of conceiving a child, but mentally or emotionally need some help in making the best decisions for her regarding prenatal care and childbirth.

However, if this circumstance does not apply to your loved one, then I would caution you against taking an approach with her that might come across as though you question her intelligence or maturity. Respect the fact that she has the ability to make a reasonable and informed choice in this matter. Remember that in the final analysis, the decision is hers to make, not yours. Even if you just refuse to change your mind, if you are unwilling to consider that midwifery care and homebirth is in most cases a preferable option, you still should treat your loved one as a responsible adult. You should respect her decision, even if you disagree.

Before I conclude this article, I must return to the claim I made earlier: I can understand and even relate on some level to what you are feeling. You may be saying to yourself, “How? How can you possibly understand, let alone relate, if you are so convinced about the benefits of midwifery care and homebirth? If you are such an advocate of this model of care, how can you possibly understand how I’m feeling right now?”

That is a valid question, and it deserves an answer. Quite simply, I have experienced what you are going through four times over, but in reverse. You see, I am not only the husband of a prominent midwife; I am also a grandfather. As I write this, I am eagerly anticipating grandbaby number eleven. That’s right; I have ten grandchildren, and number eleven is due in just about a month. And this is pertinent because four of our ten grandchildren have been born in hospitals.

We have three grown children: Kassy, Larry and Jessica. The two girls have had homebirths with all of their children (Jessica is the one that is due with her fourth child and our eleventh grandchild next month). Our son is married to Hannah. We love her; we are grateful for her loving commitment to our son and to our grandchildren. But Hannah has never been comfortable with the idea of homebirth. She has a medical background, and is more comfortable with that setting.

So when it came to prenatal care and how to labor and give birth, she went with that which was comfortable to her; she chose to birth her children in the hospital. She chose the routine procedures of a model of care that is downright scary to Beth and me (including interventions such as early inductions and epidurals). The lack of holistic care and dependence on drugs are not good choices in our view, either for her or her babies.

You may not agree with or understand our fears, but that is not my point. Remember, I don’t agree with or understand your fear of homebirth. The point is that I know first hand what it is like to object to the decisions made by a loved one concerning the birth of her child. I know what it is like to feel afraid because of those decisions. But I also know how to let go, to focus on the positive and show respect for my grown children, even when they make decisions that I personally am uncomfortable with.

But having said that, I must also say that feelings—whether yours or mine—are not what are important here. In the final analysis, it is important that you hold your emotions in check. Make your own feelings secondary to how your loved one feels. Respect her…do your homework…love her and support her.

And don’t worry; once you’ve done your homework, you will see that she is in good hands with a midwife. You will see that a homebirth, far from being a scary prospect, is not only an intimate, loving and nurturing environment in which to give birth; it is a very safe alternative to the hospital.

Sincerely,

Larry G. Overton

1 My wife Beth is a Licensed Midwife and a Certified Professional Midwife. Throughout her midwifery career, Beth has been a leader in a statewide association of midwives, serving one term as a board member and two terms as President. In the information packet she gives to prospective clients, she includes a handout on the latest study of this issue, a five-page abridgement of an article published in the British Medical Journal. Cf. Kenneth C. Johnson & Betty-Anne Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ, Volume 330, 18 June 2005.

2 Over the last decade, in the course of her studies and practice, Beth has encountered just one such case. A woman scheduled a consultation appointment for her younger sister who was pregnant, and came with her to the appointment. I can’t tell you the names here, even if I wanted to; I was never told their names, and I never met them. At any rate, this young pregnant woman (let’s call her “Jane”) was obviously physically capable of conceiving a child, but she was emotionally stunted. She needed help thinking through the issues involved and she had to be challenged to take some responsibility. Her sister took on the task of helping her. And for what it’s worth, Jane did not wind up choosing midwifery care. Obviously, such a scenario is an unusual—one could even say rare—occurrence.