Is Homebirth for You?

Adriana Lozada: Welcome to Birthful, Might Parent or Parent-to-Be. I’m Adriana Lozada.

Robina Khalid: There is, like, an almost like… a DIY element to home birth. And that’s not to say that you’re cleaning up your own blood after you give birth— no, that’s not happening at all! Like, the midwife and the birth assistant are taking care of it. People often ask me, like, “Is it messy?” You don’t have to worry about that. It is not, it is not messy. And we take care of any mess that happens. 

But what I mean by “DIY” is exactly that: it’s that emotional preparation and it’s that responsibility.  

Adriana: That is licensed midwife and owner of Small Things Grow Midwifery, Robina Khalid, giving us a glimpse of why a home birth needs to be approached differently than a hospital birth. 

No conversation on Models and Places of Birth would be complete without us talking about home birth, and I also wanted to give you a little bit more context on the motivation for this episode, which came about after I read the “Open Letter to the Birth Community” that Robina wrote during the height of the pandemic. At that time, we all saw a sudden increased interest in homebirth in our communities, but that interest was coming from the fear of giving birth at a hospital and not necessarily from a deep desire to give birth at home. Needless to say, that is not a great reason to have an out-of-hospital birth. 

So then, what do you need to consider to help you decide if having a homebirth is a good fit for you? That’s precisely what we’ll be talking about today.

You’re listening to Birthful. Here to inform your intuition. 

Adriana: Welcome, Robina! It is so lovely to have you here on the show. Finally, we made it.

Robina: I’m so excited to finally make it.

Adriana: Let’s tell the listeners: like, we’ve rescheduled this interview about… ooh, five times, maybe?

Robina: I think it’s been five times, yeah.

Adriana: It was a labor of love!

Robina: No pun intended.

Adriana: Can you tell us who you are a little bit about yourself and how you identify?

Robina: So my name is Robina Khalid. My pronouns are she and her. I am a community home birth midwife in New York City, which is unceded Lenape land. and I have been a home birth midwife for the last three and a half to four years. Before that, I was a hospital midwife and I’ve been attending births for the last seven years in one or the other settings.

Adriana: Fantastic! So what are some of those things that people need to consider when trying to decide if a home birth is right for them?

Robina: Home birth is not like a hospital birth in your home. It’s its own thing. And so in order to want a home birth, you have to want a home birth. You can’t just be afraid of something else, right? I think in most of the situations in life where we’re making choices with pure fear as the primal motivator or the primary motivator is not going to give you the best decision, right? You need to be able to consider things beyond that fear. And so I always say to people, you can’t only want a home birth because you’re afraid of the hospital. You have to want a home birth because you want a home birth. 

And before we get too deep into it, I do want to say just that, at the outset that… if that sounds discouraging, I do want to say that for the vast majority of birthing people in the United States right now (and I would imagine most of our listeners are in the United States) from a physical level, right, on a physical level most people are excellent candidates for home birth because most birthing people are low-risk. And so, y’know, if it was just a matter of like, if someone’s sitting there being like, “Am I a good candidate for home birth? Like, is it safe for me to give birth at home?” The answer is probably “yes,” but there’s some nuance to whether you want to— like, if you’re asking the question of “Should I?” or “Do I want to?” it’s different than “Am I a good candidate?” Does that make sense?

Adriana: Absolutely. And then we get into the whole aspect of physiology and how for regardless of where you give birth, you need to feel safe, secure, and loved so that your oxytocin can flow and hormones can work, that your body can work to birth this baby. And if you’re doing it from fear, it’s not a question of the place where you give birth.

It’s actually, “Let’s talk about that fear. What are you afraid of, and how we can we work around it and resolve it? How can we make you feel safe in the hospital?” if that was your first choice anyway. Or if you’re going, “We’ll never feel safe in the hospital,” then, okay, let’s look into homebirth and what you need to do.

Robina: Yeah. I mean, I think it’s exactly what you’re saying, is the reason why so many people who are laboring at home, right— this is like the classic example of how fear and those hormones (like cortisol) can shut down the hormones of labor (like oxytocin), right? The classic example of that is when people are laboring fine at home and they get into the hospital and they stall out, right?

Like, every birthworker has seen that. Many people have experienced that. And then from there, interventions start happening, right? Because labor essentially stopped. And that’s… it’s because of fear, right? People are moving from a space where they feel safe to a space where they don’t. The opposite is also true, right?

If you have always felt safest in a hospital, and then you’re deciding, “Oh, I should give birth at home,” well, the same thing could happen. If you’re not feeling safe, you might not go into labor or your labor might be complicated in some way. I mean, that’s a vast oversimplification, but you see what I’m saying?

Adriana: Oh, no. And I totally hear it. And I find that people’s labor, when it stalls during the hospital, it might… they might not inherently feel unsafe in the hospital. It’s even that they need to acclimate to this new environment, like the body needs to go, “Okay, this is all new. Let me figure it out. Oh, okay. We’re good. We’re good. We’re good.” And then labor might pick up again or usually, often picks up again— if there’s interventions, that’s a whole different process,

Robina: It depends on how long it takes to kick in again, right? Like it probably would kick in again no matter what, but how long is your provider going to allow it to naturally kick in again, before they want to, y’know, augment it.

Adriana: Yeah. So you mentioned people needing to be low-risk. What are other things that… so what… two-part question: what constitutes being low-risk, and what other things aside from being low-risk are things that are needed— I guess, “required,” that’s, like, a hard word to use, it sounds very definitive, but— to do a home birth?

Robina: Yeah. So that is a two-part question. I guess I’ll answer the, I guess, slightly less complicated question first— which is the “low-risk,” like what constitutes somebody being low-risk? So that, even that question has some nuance to it, right? Because we know that in the medical industrial complex people are being told if they’re 35 or over they’re “Advanced Maternal Age,” and that increases their risk and that’s like this blanket term that doesn’t actually confer really any risk that affects your choice of birth place, right?

And different home birth midwives and different home birth families will have certain gray areas of what’s too high-risk, right? So some home birth midwives might not do vaginal birth after cesarean, and they might decide that’s too high-risk, or they might not do breeches, or they might not do twins.

And some home birth midwives might feel confident that that’s low enough risk to be at home. So there are a few things that are not absolute risk factors. You would have to see how you feel about that and also how your midwife feels about that, but I think most midwives would agree that there are a few things that are absolute contraindications. And one of them would be placenta previa, right, which is where the placenta is essentially covering the cervix, and that could be an emergency if you go into labor with your placenta there. Y’know, very preterm birth, would be, like, a contraindication to home birth— you want to have a full-term baby at home, because you don’t have a peds team.

Adriana: Just to clarify, that would be counting from 37 weeks, at least? 

Robina: So again, there’s like a little gray area there because preterm, y’know, up until very recently was defined as pre-36 weeks. So that 36 to 37 weeks kind of depends on the midwife and the family’s comfort. But yes, the official definition is 37 weeks. But that’s something, again, that’s a risk factor later, right?

You wouldn’t know that necessarily when you’re signing on with a home birth midwife. Same with placenta previa, y’know, that would be something that would risk you out during the pregnancy. 

Adriana: I also want to say that placenta previa is going to risk you out even in a hospital birth as well. Like, if your placenta doesn’t move away from your cervix, you can’t have a vaginal birth— because the placenta is in the way. So that would be a cesarean anyway. 

Robina: Yes, no matter where, and it’s also worthwhile to point out because this is one of those things, like, a lot of people will pick up a low-lying placenta on their 20 week ultrasound and be like, “Oh my God, I’m going to have placenta previa and not be able to have a vaginal birth.” It’s pretty rare for a placenta to stay low, in the absence of a prior cesarean birth. Right? So if you’re somebody who’s considering home birth and you’re like, “Well, I have to see if my placenta is okay” almost certainly it is. So these are very… these are very rare risk outs.

Adriana: Yeah. I’ve seen cases where more often than not, there is that, and then the placenta moves out of the way by the time you are ready to deliver. Yeah.

Robina: Right? ‘Cause it implants where it implants when your uterus is small and then as your uterus grows up, it migrates up the uterus with the fundus, so! 

So, other risk factors that you might know about before you get pregnant are things like an active seizure disorder, right? Or hypertension or, y’know, I think most home birth midwives probably would not take on somebody with uncontrolled diabetes, whether it develops during the pregnancy or prior to the pregnancy. If you get gestational diabetes during a pregnancy and can control it, most home birth midwives do not consider that a risk outright because your blood sugars are under control.

But if you have preexisting diabetes, a lot of people will consider that a risk out. What else would there be…? Like a heart disease or, like, a cardiac anomaly, or some kind of anomaly seen on the anatomy scan of the baby, right? So if we know that there is a chance that the baby, y”know, might not breathe well or might need some kind of intervention shortly after birth, that baby probably should be born in a hospital. Again, all of these are very rare, right? Because most birthing people are young and healthy. 

Adriana: And in the same way, things that might develop during pregnancy— that then, if you started out with a home birth midwife would risk you out to a transfer to hospital care— you mentioned hypertension as a risk factor, so then if you develop preeclampsia, then that would lead to…?

Robina: Right. So there are some things that, y’know, aren’t necessarily things you would consider while you’re trying to choose a home birth, but that could develop during a pregnancy that would risk you out of a home birth. And one of those would be something like preeclampsia or potentially cholestasis, which is a liver disorder.

And so, y’know… but I will say, those things developing during— potentially developing during the pregnancy is not a reason to not get started with the home birth, if that makes sense. Right? So because you will have the benefit of the prenatal care of your home birth midwife leading up to that, and you will have the attention placed, so that if those things develop, they’re not ignored, which is often what happens in the medical industrial complex, particularly to Black birth people— Black birth givers, birthing people, I conflated those together. So, y’know, what I’m trying to say is that if you’re considering home birth and you’re like, “Well, but I might develop preeclampsia,” even though you have no risk factors, that’s not really a reason to not consider it because what will end up happening, you’ll have the same kind of outcome— which is that you’ll be screened for preeclampsia the whole pregnancy, if you develop it, you’ll be transferred to a hospital and the hospital will manage your induction, y’know, but you will have all the benefits of home birth care leading up to that point. 

Adriana: Yes, absolutely. So that ties into another question that I had, which is when is the ideal time for them to contact you? 

Robina: Yeah. So I always tell people the earlier the better, sometimes people have an idea like, “Oh, I should initiate care with an OB and then transfer to a midwife, y’know, just so the OB can verify that I’m pregnant or draw my initial labs.” Well, midwives do that too! We do all the standard care that an OB does. 

So, from my perspective, there’s nothing but benefit to looking into this as early as possible, primarily, partially because the first trimester is such a vulnerable time. It’s such a liminal state, right? You might feel sick. You might not feel sick. You might be exhausted. You might not be exhausted. Probably you’re one of those two things. You certainly are not feeling your baby move yet.

It’s kind of like you’re going on faith that you’re pregnant and for a lot of people that’s really hard to navigate. And also you may have spotting— like, so many people have spotting in the first trimester and it’s so nerve-racking. And then in the system that we have now, they don’t really have access or a close relationship with their provider during that time, because from a medical perspective, there’s not much to be done in the first trimester, right? But if you initiate care with a home birth midwife, you automatically have access to someone who can be reassuring or who can look into things if they’re worrisome, and who can, y’know… sort of, remind you that everything is normal and everything is okay, and that, y’know, can affirm your feelings of liminality in that first trimester. So I love when people get started early, and the other reason for that is because, you know, we live in a country that has not prioritized one of the most evidence-based interventions to improve maternal and infant mortality, which is training more midwives. And so there’s a lack of midwives and because the care is so individualized, we don’t take as many clients as a hospital-based practice would, right? Because we can’t, we’re not on a floor where we’re taking care of six people at the same time.

So the longer you leave it, the less likely you are to find somebody. So that’s why I think it’s a good idea to sort of think about this seriously as early in your pregnancy as you can. That being said, you can transfer at any time, y’know, if you can find a midwife who has room in their schedule, you can, you can transfer later if you need.

Adriana: And we know how research shows that having midwifery care— whether it’s at the hospital, in a birth center, or at home— improves your outcomes, lessens the risks, lessens the chance of bad outcomes. So we need more midwives all around!

Robina: We absolutely need more midwives and we absolutely need more midwives of color, because because we’re… it’s also shown that having a care provider who is culturally similar to you also improves outcomes, right? And we know that our maternal health crisis is worse for Black birthing people. So we definitely need to be focusing on midwifery care, but of course, instead we’re putting all our resources into more intervention and more technology.

Adriana: Well, and there goes our technocratic model of healthcare, that leads that way. But I think it’s really interesting also, for People of Color and birthing in hospitals, that one of the things that becomes really protective is also having more of your community advocating, witnessing, and basically really creating a safer space for you.

Have you seen this? People wanting to do home births because they can have all their community with them, surrounding them, that makes them feel safer?

Robina: Yes. Although it’s funny— I feel like a lot of people who ended up choosing home birth, have this idea that it’s going to be lots of people, in the beginning. And as they learn more about  physiologic birth, the cast of characters gets smaller and smaller and smaller, because they realize that actually it’s a super intimate experience— and that’s part of why people choose home birth, right, is because they want to not have space where somebody random is walking in every 10 minutes. And so yes, I do a lot of births where there are community members and family members and friends, but I also do a lot of births where it’s just the birthing person and their partner and a doula and me and the birth assistant, y’know?

And I— oh, I’ll add something to that, which is to say that, one of the benefits I think people really see about home birth is that they trust their provider. They trust that their provider is on the same team as them and wants the same things as them. 

Adriana: Well, and that definitely stems from the months of building a relationship and having these meetings with you that are not 10 minutes long, but are actually an hour long (or more!), whatever the person needs, which is a drastically different way of caring for somebody and centering their needs.

Robina: Right. I mean, I think like— okay, before I say anything else, I do want to say a big part of what makes home birth safe is that in the vast majority of cases, a birth itself is safe— so I don’t want to say that it’s all because you have this relationship with the midwife and the midwife keeps you safe.

No, most of the time it’s safe because it’s designed to work. Right? And actually the more we intervene with it, the more we increase risk that something might not quite go the way it’s supposed to go. Right? Because it’s designed to just go and be okay. So I want to just put that disclaimer out there before, “I have the relationship,” take all the credit, but I will say that in the situation in which most birthing people are giving birth in this culture, part of what makes home birth safe is that there’s a relationship of trust that’s built over a long period of time between the midwife and birthing family, because the midwife is getting a really strong sense of that person’s health on all the levels.

We’re talking to you about your emotional health. We’re talking to you about your familial health. We’re talking to you about your nutritional health— which is not just shaming you for how much weight you’ve gained, right? Which is talking about like, “Do you feel well-nourished? How do you feel in your body? Are you coping with the changes to your body?” Y’know, we live in this society where any kind of weight gain is stigmatized: “How are you coping with that?” That’s what I mean by nutritional health, I also mean movement health. “Do you feel good in your body or as good as you can?” And then we’re also talking about your physical health in addition to all of that other stuff. 

And so what ends up happening is that the client really understands that the midwife cares about their health holistically and begins to trust them. And the midwife starts to learn a lot about the client so that if anything is off, everybody feels comfortable communicating it and also has the ability to notice it. 

Adriana: Well, and that emotional component allows for those conversations where if somebody comes up to you and you haven’t had that relationship and they go like, “But how are you feeling right now?” Your answer is going to be different than if it’s coming from somebody who you’ve had deep conversations with already, and you’re going to be more open, more vulnerable and, frankly, disclose a more honest situation.

Robina: Well, there’s a really clear… how would I say this? Most of us have a relationship with healthcare where most of us have had an experience of, like— to use a kind of loaded word, but I’m gonna use it anyway— have been kind of gaslit, right? Where we’ll say like, “Ooh, we’re feeling…” and I’m not even talking about obstetric care, I’m just talking about in the medical system entirely, “I’m feeling X, Y, and Z,” it’s particularly if you identify as a woman. 

So all of us have that experience, even if it’s on a more minute level where you don’t want to bother somebody, but something that’s not wrong, you don’t want to, like, take up too much of their time, or you just don’t want to be gaslit, so you don’t bring things up. But if it’s somebody who has listened to you, actively listened to you, and gives you a space where you feel safe, then you’re not worried about it being seen as stupid or taking up too much time to say like, “Hey, is this normal? Like, is this thing that I’m feeling normal? Because I feel scared that it’s not normal?” 

Adriana: What are the responsibilities of an aspiring home birther? Because the preparation that is required for home birth at all levels— physically, mentally, how you prepare your house, how you prepare your emotions— is different than if you’re birthing at a hospital or even a birth center. So what are some of those responsibilities? How do you facilitate, I guess, “emotional preparedness”?

Robina: Right. We talked about, like, what makes a low-risk person and then never got to the more nuanced part of it. Okay, so you’re thinking about whether you want to have a home birth. In thinking that, you really have to question whether you are open to being that agential, autonomous person, that you want to be an active participant in your care instead of, like, a passive recipient of care. So, part of what that means is there is, like, an almost like… a DIY element to home birth. And that’s not to say that you’re cleaning up your own blood after you give birth— no, that’s not happening at all! Like, the midwife and the birth assistant are taking care of it. People often ask me, like, “Is it messy?” You don’t have to worry about that. It is not, it is not messy. And we take care of any mess that happens. 

But what I mean by “DIY” is exactly that: it’s that emotional preparation and it’s that responsibility. So I’ll give a couple of examples. In the medical industrial complex, typically what’s happening is there are certain standard tests that are done and half the time people are drawing your blood and you have no idea what it’s for.

And often when clients come into my home birth practice, having gone to an OB beforehand, I’ll say, “When they took your lab, did they talk them over with you?” And they’re like, “They just said they were fine,” but still don’t know even what the labs are… that is hopefully not happening to you in a home birth practice.

Right? So the first thing you need to know is that you are going to be asked to make decisions that you might not be asked to make in the medical industrial complex. I’m never even going to draw your iron levels without asking you if you want your iron levels drawn, explaining to you why it’s important, and explaining whether most people do or don’t get that test.

Right? So we’re going to have true informed consent. And y’know, most people want their iron levels drawn, but sometimes it’s a bigger conversation about, for example, do you want genetic testing? Y’know, people will just get blood work drawn without talking about, like, the ethical implications of genetic testing in terms of, like, what you do with that information? Do they want that information? What will that make them feel differently about their pregnancy and so forth? I think it’s important people understand the consequences of certain testing. That being said, most of my clients do get genetic testing. They do choose it, but they choose it, understanding what it means, y’know. 

Or sonograms, like how many sonograms you want— what’s the value of frequent third trimester sonograms? Like many people just get sonograms at every visit and in the medical industrial complex, and don’t know why, and don’t know that that’s often looking for things that might be benign, but then we’ll give a reason for an intervention.

So you’re not going to have that kind of relationship and home birth. You’re going to have to make those decisions yourself. So that’s one thing. Like, you do have to be comfortable with that because it usually means that you’re going to end up reading something or you’re going to end up having a long conversation about something and then having to decide it. 

Adriana: Well, and that goes right hand in hand with the level of involvement and education that you have to do. You really have to go neck-deep into learning what happens during birth at all levels because of the decision-making that you’re having to do, yeah.

Robina: Right? That’s my second example. So, first, there’s all this stuff that comes up in the prenatal care that you have to be an active participant with, but then there’s the birth, and so part of prepping for a home birth, particularly if you have not given birth before, right—  it’s a little different for somebody who’s given birth before— but if it’s your first baby in particular, you really have to be prepared for what normal physiologic birth looks like, because it does not look like what we’re taught it looks like in the movies. It’s not over typically as quickly as anybody tells us it’s supposed to be. It usually happens later than everybody tells us it’s supposed to happen.

And so you have to be prepared for the frequent reality that, it’s going to be 40 weeks and you’re going to reach your “due date,” quote-unquote, and people are going to ask you, like, “What are you going to do? Are you gonna induce?” And lots of people around you are all going to have their babies before you may be, and you’re going to have to have the space that, like, that is okay. 

And the way you have that faith, that that is okay, is that you’ve done that kind of education with your midwife or in a childbirth education class or within a doula or by listening to podcasts or by watching movies or by reading— there’s a lot of different ways to inform yourself and most home birth clients will do some variety of those.

Adriana: And I want to piggyback on that, understanding that interventions, when we talk about interventions, we’re not just referring to medical interventions, but that anything is an intervention— just having a due date is an intervention, deciding who’s going to be present is an intervention, deciding if you’re going to have that blood work as an intervention, having fetal monitoring, like, everything is an intervention when it comes to what the needs of physiological birth are, because you need to be undisturbed.

Robina: Right. Having me there is an intervention, right? Yeah, exactly right. Like, people need to understand all of that. And, it’s funny as a midwife, the longer I practice, the more my constant refrain in my head is like, “What would happen right now, if I wasn’t here?” Like, that’s always how I’m checking myself, because every single thing I do and say as an intervention, just saying to somebody, “Do you feel pressure?” is an intervention, right? Because if they’re not already actively pushing, then that gets them into their head. Like, “Well, should I be pushing… Am I feeling pressure? What’s happening?”

Adriana: Well, and my goodness, there’s research that they did in the UK where that was the control group, it was just whether the care team just mentioned the word “pressure” or didn’t mention it. And just the ones that didn’t mention it had more physiological, easier, spontaneous birth, as opposed to people who just said, “Do you feel pressure?”

Robina: Yeah, of course.

Like just not, “Do we want to push? Let’s have you push.” Just like, let’s have you check in, whether that is something that needs to be focused on.

Robina: Right? Because then you’re scrutinizing yourself and like, “Oh, maybe I do feel pressure. Maybe I should be pushing.” In my observation, if you should be pushing, you’re pushing. If you’re forcing yourself to push, you shouldn’t be pushing yet, in the absence of some kind of emergency, right? Like, I’m not going to… there are no absolutes in birth, so I don’t want to say there’s never a reason to push before somebody is physiologically ready, but in the vast majority of cases, if you’re cerebrally telling yourself to push it’s too early to push.

Adriana: Right. If you have to ask the question, if you have to think about it, then you’re thinking about it. It’s not time. And I do want to say though, like, that “everything’s an intervention,” but not all interventions are bad. Some of them are necessary and it’s great to have, you know, a doula or midwife.

Robina: I hope I’m not a bad intervention! 

Adriana: And I think, it’s a great moment to sort of suss out a little bit of what types of home births there are. And we’ve been kind of focusing more on a midwife-assisted home birth, but there are also unplanned home births that happen and planned unassisted births that happen.

And then there’s also this… which refers a little bit to what you were talking about, of undisturbed home births— that I think the movie These Are My Hours is a great example of that— where they did have a home birth midwife present, but because they were so intentional in their choices of having an undisturbed as possible birth, the midwife was sort of, like, there in the background, letting the person do everything on their own, unless they asked for something specifically.

So you do a little bit of both, is what I’m hearing?

Robina: Well, I like to think of myself as a somewhat intuitive midwife and that I can adapt to whatever a situation throws at me. Because my client demographic is not at all homogenous. I have a lot of different people who are choosing home birth for different reasons and have different expectations of what home birth looks like and have different cultural understandings of birth.

And so I really try to meet people where they are, y’know. I would say most of my births, I’m aiming for that “undisturbed birth” vibe. I’m really trying to not disturb and not hurry and to just, like, just be there to hold space. But y’know, birth is like life, it can be unpredictable. And also it’s wrapped up in lots of different things in people’s minds and emotional states.

And so, y’know, sometimes I have to be more or less of a presence depending on what people need. Obviously if there’s some kind of emergent situation then I really am, like if someone is having a hemorrhage, I’m not, y’know, standing there being like, “Well, I shouldn’t disturb this.” Right?

Like that… that is something that I will actively intervene in for the benefit of everyone involved.

Adriana: Which is why they’re having you there!

Robina: Exactly! Exactly. 

Adriana: Another part of the things that people need to prepare for, like one of the responsibilities of the home birther is to actually unlearn and really dig deep into all the cultural beliefs they have learned through their life of like, “No, but you have to have a vaginal exam,” or “You have to be told how to push.” There’s that preparation that also needs to happen depending on what type of birth they want to have.

Robina: Yeah. You know, it’s really… it is really interesting and it comes up even when you don’t expect it sometimes. So I had a client who had her first baby in the hospital and was very disappointed by the experience. And we did a lot of unpacking of it and a lot of talking about it all through her second pregnancy and just like all the different interventions that she wished she hadn’t had.

And she was so educated, like, her experience led her to just research like crazy before she came to her second birth. And in her birth, which was, y’know, which was totally straight forward— I suspect she was transitioning when this happened— but I really, really remember it where, like, sitting in this quiet dark living room, I’m sitting across from her doing nothing, everything’s quiet, she’s laboring on hands and knees on the floor. 

And she just looked up at me and she was like, “Should you check me?” And I just looked at her and I was like, “What do you think?” And she was like, “No, no.” Right? “No!” But it, y’know, like, those ingrained— even though she had done all this work and knew everything cerebrally— that cultural baggage and all those scripts we have in our head, they seep through. It’s… you’re right in that trying to do as much work ahead of time really helps you weather when it starts to seep through. There’s so much value, I think, in people going through whatever hard things they’re going through in labor emotionally or physically and getting through it. Right? So you want to set yourself up to be able to get through it by empowering yourself with as much information as you have going into it.

And I think one of those big things that we need to unpack, is like pain in labor and what that means, and how pain can have value and how it’s not just pure suffering. Like, that’s something I talk with my clients a lot about in their prenatal care, because it is a big part of choosing a home birth, right? You’re not choosing a home birth thinking, “Well, I can just go to the hospital and get an epidural if it hurts too much,” like, nobody’s going into a home birth like that! And so we have to wrap our brain around the fact that we’re going to do something really painful without any pain medications. And I think sometimes even in the quote-unquote, “natural birth” or birth advocacy spaces, we still have some focus on, like, how to minimize the pain, how to hypnotize yourself, so you don’t feel it as much, and we’ve sort of aggrandized this idea of like the calm labor and the peaceful labor and the person who breathes their baby out.

And so I feel like I have to do a lot of talking and encouraging of people to just… y”know, what I think a lot of the prenatal care is in a home birth setting is facilitating acceptance of people’s selves. Y’know, that we can just get through whatever we need to get through with how we have to get through it, and that’s okay. That’s very counter-cultural, that idea that we, like, have what it takes and whatever we do is fine is, like, something we have… I have to convince my clients because they’ve been told their whole lives, like they need all this other stuff.

Adriana: Well, and I totally appreciate the value of the pain. And we know there is a value hormonally, like, that triggers other things that are your natural opiates. And I have a whole podcast on the purpose of pain with Rhea Dempsey, which is so good, but I tell my clients the same thing is I expect you to get to a point where you say, “I can’t do this!” Marathon runners do that all the time. They hit a wall and we keep moving. It’s okay to get there. And right, the both/and, yeah?

Robina: And so part of preparing for a home birth is realizing you’re going to reach this point where you are like, “This is crazy. This is horrible.” Like, “Why am I doing this?” And then you’re going to get past it. And you’re going to have done this insanely amazing thing and tapped into this power that you did not know you have. And then, you know you have it for the rest of your life. 

Adriana: And it’s not about having to achieve this goal part and be better than others. No, I— when I have my clients, and they say, “Yeah, it was really intense”— like, they were screaming, they were cursing! They were saying, “Ow, this really hurts!” They were talking about pain. And then afterwards, in retrospect, they go, “Yeah, it was painful, but it wasn’t that painful. It was more intense.”

Robina: It’s labor! Yeah, it’s work.

Right? And, you know, going back to the “Why do people choose home birth?” question, right— if you’re interested in a physiologic birth, and you’re interested in doing birth without pain management, first of all, home birth is one of the only places where you might actually have a real good shot of that.

But that aside, it makes it easier, to— which is not to say that it’s easy— it just makes it easier to do that in a place where people are not pathologizing it, right? So people have faith with you that you can do this, that people aren’t treating it like it’s suffering, like, people who, y’know, care about you, that you’ve met before.

And that, people you care about because there’s a relationship there, like, all of that does make the pain of it, the work of it, easier to handle. Y’know, we talked a lot about, like, how people choose home birth because they want that autonomy. They want that individualized care. They want a physiologic birth. They want an unmedicated birth. But we should also talk about the benefits of home birth beyond just, like, the laboring person’s— I dunno how to say it— “sense of autonomy”? Which is the most important thing, probably.

But in terms of, like, when we talk about, y’know, the best outcome for the birth is a healthy baby, which when people say that in the hospital, they really mean an alive baby, y’know, like, it’s really like they’re saying, “Well, aren’t you glad you came out of this with you and your baby alive?” Because “alive” is not “thriving,” right? “Alive” is not necessarily the same thing. Yeah, I think people, when they think about me as home birth midwife, I feel like there’s sort of a stereotype, like maybe I’m a home birth midwife because I have some philosophical attachment or aesthetic attachment to “natural birth” and like, I have, like, some judgment that that’s better, y’know, and people should feel some kind of way about their birth, when really the truth of the matter is I’m a home birth midwife after practicing the hospital, because I believe I can give better care and because I believe that for the vast majority of low-risk people it is safer.

Y’know, when you’re looking at whether you should give birth in a hospital or you should give birth at home, a lot of people see it as like I’m choosing the hospital, which is known to be safe, or the home birth, which is maybe less safe, right? That’s not really what the calculation is. Both the hospital and home have certain risks. And so what you are doing when you’re choosing between the two is choosing which set of risks you have more tolerance for. So if you’re choosing to give birth in the medical industrial complex, your risk of having some intervention that may physically or emotionally cause some kind of trauma to you or your baby is probably likely. When you’re looking at a home birth, you’re choosing a very small risk that some kind of emergency might pop up for which it would be better if there was a whole team there, but that’s not that likely to happen. You’re sort of weighing that and that’s an individual process, but I will say that we know that home birth comes with a lot of benefits like better respiratory transition for the baby, less suturing for the client, obviously more have much higher rates of vaginal birth, increased rates of breastfeeding (which is huge from a long-time health perspective), typically less postpartum depression and emotional trauma.

So there are actually physical benefits to choosing, to give birth at home as well, in addition to many, many emotional ones.

Adriana: You have seen an uptick, and your colleagues as well have seen an uptick, in terms of requests for home birth. I want to put it into perspective: like, right now in the U.S., less than 2% of all births happen at home.

Robina: Right. I don’t know if there’s going to be a lasting increase in home birth. I think if there is, it’s not going to be huge. Like we’re not going to go from 2% to 16% or something, y’know— it might go up a percent or two, if that. It takes a really long time for these kinds of cultural beliefs to shift.

But what I notice is that I am seeing more diverse populations look into it. People who didn’t think they had access to home birth suddenly were like, “Do I have access to home birth?” And so you didn’t have to have the same amount of cultural capital to know that it’s an option. So it’s been nice for me to know that there is increasing access (or ideas about access) for home birth.

Adriana: And we all benefit from more choices!

Robina: Yeah, absolutely.

Adriana: Robina, thank you so very much for this fabulous conversation!

Robina: You’re so welcome. Thanks for having me.

Adriana: That was homebirth midwife Robina Khalid, owner of Small Things Grow Midwifery, a thriving home birth practice in New York City. Robina loves the art and the science of midwifery and the way it’s constantly challenging her to grow. You can find her on Instagram @smallthingsgrowhomebirth. 

And you can connect with us @birthfulpodcast. In fact, if you are not driving, we would love it if you would take a screenshot of this episode right now and post it to Instagram sharing your biggest takeaway from the episode. Make sure to tag @BirthfulPodcast so we can see it and share it.

You can find the in-depth show notes and transcript of this episode at birthful.com, where you can also learn more about my birth and postpartum preparation classes, and download your free postpartum preparation plan.

Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte. This episode was produced in part by LWC Studios: Paulina Velasco, Jen Chien, and Kojin Tashiro.

Thank you so much for listening and sharing Birthful. Be sure to follow us on Goodpods, Apple Podcasts, Spotify, Amazon Music, and everywhere you listen. 

Come back for more ways to inform your intuition. 

CITATION: 

Lozada, Adriana, host. “Is Homebirth for You?” Birthful, Birthful, May 18, 2022. Birthful.com.