So for some people, a midwife assisted homebirth can be a happy compromise of rights and responsibilities. Most women will make arrangements to engage a qualified independent midwife. Usually they make an agreement, sometimes written, sometimes only verbal, of where the line of responsibility is to be drawn. When this is clear, the pregnancy and the birth proceed along those lines. More than just a commercial agreement, over the course of the pregnancy, the mother and the midwife build a trusting relationship so that, along with any other birth assistants, they are all able to work together as a team. Such a relationship requires lots of commitment and energy but is ultimately more satisfying than the usual, more fragmented experience through a hospital.
In the event of any complications beyond the midwife’s experience or equipment, the midwife will make a professional assessment and all parties will usually agree on a transfer to a hospital. But, as the homebirth manager, that decision and any events that flow from it are, ultimately, the mother’s responsibility. The mother may also decide prior to the midwife’s assessment, that she wishes to “bail out” of the homebirth.
To find out about independent midwives in your area, contact your local homebirth support group, and the Internet has many great websites, some of which may list birthing support groups in your area. A homebirth support group is an informal gathering of women who share personal experiences and knowledge about the many elements of birthing and natural pregnancy, and this in itself can be a wonderful form of birth preparation.
In Australia, there was a time when one could have a GP assisted homebirth. At anytime of day or night, in the city or the country, a woman in labour (or her attending lay-midwife), could ring the local family doctor who would drop what he was doing (be it attending to another patient or sleeping in bed) and drive to your house to deliver your baby. Those days are long gone now due to changes in health services, insurance liabilities and doctors’ own lifestyle preferences.
However there is a small movement in some countries, to bring back the option of doctor-attended homebirths. Exactly how it could work in this society I haven’t explored, but I see no reason why it could not be introduced if there was demand for it, and political will to arrange it. Such a system would be a good back-up option, were expertise beyond midwife care
required in the home. It could also help to remove a lot of weight off the already overdriven hospital system and save the taxpayer enormous amounts of money.
Summary of Reasons For
• The most comfortable, familiar place
• No need to travel after starting labour
• Environment, mood, companions can be completely controlled
• Nowhere to go after the birth
• Less interruptions after the birth
• Completely your choice of birth assistants
• Philosophically satisfying
• No time pressures
• No restriction on labouring behaviours
• Familiarity of a known birth attendant
• Good access to community support pre and post-natally.
Summary of Reasons Against
• High cost. Independent midwives (quite rightly) charge for their time and expertise.
• Transfer to hospital if needed can be traumatic
• The “what if” anxiety factor in family members (or hidden in yourself)
• More to clean up and wash afterwards
• May end up being unassisted if midwife arrives later than birthing
• Requires great faith in oneself and nature.
A midwife-assisted homebirth can be a good way for those who are aspiring to have the most natural kind of birthing experience, but who want the security of some professional supervision present. It requires that the woman (or couple) take prime responsibility for the event and have a faith strong enough to handle all possible outcomes. It allows good freedom to birth just as you want to, and is the least disruptive option (no travel) for the mother and newborn. It is not necessarily a cheap or easy to arrange option and, in the event of a very short labour, you could find yourself birthing unassisted!
When we call it unassisted, that doesn’t mean you have to have it all on your own! Some do – but most don’t. It is most formally called Medically Unassisted Domiciliary Confinement! Janine Parvati Baker, a midwife who uses Native American ritual and herbal medicine in her role as a birth attendant, has coined the much simpler and poetic term “freebirth” .