I met an interesting midwife on Monday who had some very thoughtful things to say about both homebirth and birth in general. Her main feelings on why women should stay home to give birth revolved around the hormone cocktail that is released during labor, and how that hormone cocktail is most effectively released when a woman feels safe. Conversely, when we don't feel safe, our sympathetic nervous system (otherwise known as "fight or flight") kicks in, and coindicentally enough, the hormones that are released under this system directly counteract the hormones necessary for women to relax and let go for labor. Since most of us feel safest and relaxed in our homes, the ideal place for birth is clear.
This is nothing new, these hormonal principles are what Michel Odent and others have used for decades to promote the idea that birth goes best when women are comfortable and either at home or at least in home-like settings. It makes a lot of sense especially when confronted with the staggeringly high statistics of artificially augmented and induced labors (Jennifer Block reports 40% of women answered that their labors were induced in the 2006 Listening to Mothers survey compiled by Childbirth Connection) in hospitals. While the reasons women are given for their induction being "medically necessary" are wide and varied, the message is clear: we don't trust your body to handle this process on its own. We don't trust it to know when your baby is prepared to arrive, we don't trust it to establish the contraction patterns we like (and what we call "normal"), and we don't trust it to expel your baby anywhere near quickly enough.
My thoughts stray to all the birth stories I've heard where the woman tells me that her uterus "conked out" or that her contractions weren't "regular" enough. The messages all imply a failure on the mother and her body. Or the mothers who have grown babies who were "too big" had pelvises that were "too small" (more than likely too small to birth in the lithotomy position"). Or the mothers whose babies overstay their welcome in the womb by a few days or weeks. All of these are candidates for induced or augmented labor.
This same midwife brought up the fact that women who give birth unassisted by anyone but themselves have remarkably good outcomes. In my quest to verify this, I obviously haven't come up with much in the way of randomized controlled trials studying the safety of giving birth unassisted. What I did find was a very much anecdotal and unverified poll from mothering.com, (it's here if you're interested) reporting a 2.1% Cesarean rate (after a transfer to the hospital, of course) compared to the national average hovering 30%, and a .72% rate of stillbirth, which is lower than or comparable to both home and hospital perinatal mortality rates. Fairly impressive considering these are births completely unattended by any medical professional. The midwife chalked this up to trust. Simple trust in the process and the body, that the day of birth is the same as any other day except you are having a baby. Now, I personally don't advocate for unassisted childbirth. My own belief is that birth is safest when quietly observed and unobtrusively monitored by a trained, experienced professional. However, I find the facts absolutely compelling. These women aren't magically growing babies that are just the right size coming on just the right date at exactly the right rate of progress during labor. The only thing that is different about these women is their intuitive trust in their bodies and their babies. I am also considerably awed that they have been able to cultivate this level of trust from within our culture of fear.
I read an article about a year ago about two doctors who delivered a baby unexpectedly on a plane. Neither doctor was a type of doctor that deals with birth on a regular basis, but they both seemed completely shocked that things had gone off without a hitch. One of the quotes that I remember most distinctly was one of the doctors saying "I wasn't sure how we were going to have enough room to deliver this baby. I mean, there wasn't even room for her to lay down!" Little did he realize that her at least semi-upright position was probably working in her favor.
Our culture has become so reliant on technology in birth that we don't even realize that it works without it. Arguably, for low-risk healthy women, it works better without it. Birth actually functions quite beautifully, even if it doesn't conform to pretty charts and graphs.