Homebirth Cesarean

I’m particularly excited about the new (and only) Homebirth Cesarean book and workbook that just came out. I don’t have my copies yet, but I have many dear friends who have experienced homebirth cesareans and I’ve been listening to and learning from them for many years now. My own copies of the books will be arriving shortly, but I wanted to write based on my own experiences and what I’ve learned so far, before I read the books. For a review of the book, I recommend checking out this article: http://commonhealth.wbur.org/2015/03/what-to-expect-when-youre-birthing-at-home-a-c-section-possibly

If you aren’t familiar with the term “homebirth cesarean,” there’s a good, albeit unfortunate, reason for that: the term hasn’t been around for very long, oddly enough. The reality of homebirth cesareans has been around for quite some time, but until recently virtually nobody was talking about them and there certainly wasn’t a specific term for them.

A “homebirth cesarean” is, put quite simply, a homebirth that requires hospital transport and then a subsequent cesarean section. Nobody is actually having cesareans at home (as far as I know).

This special term is necessary because, in our (USA) society, it takes a specific type of commitment and belief in the benefits of out of hospital birth in order to even consider a home birth. Usually the women who plan homebirths are extremely involved in the natural/home birth community and, in the pushback against unnecessary birth interventions, this community has had a tendency to demonize interventive births and hasn’t always managed to differentiate between necessary interventions and routine interventions.

Many natural birth advocates have seemed to forget that — although it’s true that the vast majority of births don’t require much, if any, intervention and it’s also true that it’s better to let things progress naturally when everything is normal and going well — every modern birth intervention has a time and a place when they’re appropriate to use. These birth interventions can be extremely necessary and even life-saving depending on the situation. In the name of “positive thinking” women are often actively discouraged from considering the possibility that there could be complications during their births. Homebirth transports in general tend to be all but a completely taboo topic in many natural birth circles.

Coming from that community it’s easy to see how a very medical birth of any type, let alone the ultimate of interventive births — a cesarean — can be perceived as a failure. The questions about what the mom, midwife, and/or doula “could’ve done differently” to “avoid” or “prevent” a surgical birth are all too common from the natural birth community, as are the well-meaning but ultimately dismissive comments about “well at least you have a healthy baby” from those outside of the natural birth community.

Mothers who experience homebirth cesareans not only have to deal with the loss of their preferred birthplace and type, but often also the loss of the support of the community that had previously encouraged them in their homebirth plans. Instead of feeling supported and validated, they are often viewed as examples of home birth “failures” —  cautionary tales of what “not to do” or instead threats to the viewpoint that birth is overall a safe experience if not interfered with.

The reality, however, is that there are no guarantees in birth. You can do everything “right” and still have an unexpected or undesirable outcome. Planning a home birth doesn’t necessarily mean you will birth at home or avoid a cesarean. Safe hospital transport options and the availability of cesareans when needed are integral to helping home birth remain a safe option.

Unfortunately, the emotional fallout from a home birth transport can be devastating even when the mom and baby are healthy in the end and I believe that the natural and home birth movements are partly to blame for that fallout by not acknowledging and talking with expecting moms about the potential for this to happen.

On the hospital side, respectful reception of moms and babies who transport would go a long way as well. However, as doulas and (student) midwives and natural birth advocates, we have to begin and continue to listen to moms who have transported for cesareans, to talk about the reality of transports, and to talk about the reality that cesareans are life-saving operations when they become necessary.

Cesareans aren’t something to avoid at all costs and they don’t signify a failure of women or of home/natural birth. A cesarean is far from the worst birth outcome and sometimes it’s the best outcome.

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