Home Birth

Is home birth right for you?

Susan Esserman-Schack is no stranger to being a mom: "I delivered my first two sons in free-standing birth centers with midwives in attendance. They were my guides and mentors and taught me what to expect," she says. "Theyhelped me handle the natural pain associated with labor and birth. They encouraged me to trust my body and what it was doing."

When Susan and her second husband, Barton Schack of Teaneck, New Jersey, determined that they wantedto have a child together, they decided that not only would they use midwives, but that they would have a home birth as well. "I remembered all I had learned about pregnancy and birth from my first two pregnancies, (the last one being ten years ago) and I wanted to integrate my knowledge into this experience," says Susan. "I also knew that I wanted to be in control. I wanted to truly birth my baby; I wanted to be the one to catch my baby. I knew that my physical sensations and my emotions and instincts would guide me as to what I needed to do during my labor and birth."

The couple chose Georgia Blair, CNM of BirthWise Midwifery Care in Shrewsbury, New Jersey, and her associates Linda McHale and Dina Aurichio. Although Blair's group offers prenatal and well-woman care at their office in Shrewsbury, in home settings they only "catch babies," as midwives refer to delivery.

Though this would be Susan's first home birth, it was number 170 for Blair. "I knew we would make a great team," says Susan. Both Susan and Barton have children from their first marriages. She has two sons, Zachary, 12, and Joshua, 10, and he is the father of Arielle, 15, and Ilana, 13.Their first attempt to have a child together ended in disappointment when Susan miscarried at 11 weeks. When she became pregnant again a year later, she was determined to have the kind of birthing experience that she wanted - to have her baby at home, attended by midwives, supported by her husband and children.

For many, the idea of a home birth is associated with granola-eating, Birkenstock wearing flower children living on a commune. But Susan and Barton's Tudor-styled home on a tree lined street in New Jersey is about as far as you can get from a hippie commune. It's smack-dab in a suburb of the Big Apple. Susan is a perinatal social worker, Barton works in finance, and neither of them owns Birkenstock sandals. They've got the dog, the family car, the Little League trophies and everything else that tells you that this family is just like the one who lives next door to you.

Why a midwife? For Susan, the question of whether to use a midwife was a no-brainer: "I used midwives for my gynecological checkups even before I became pregnant for the first time," she says. "Once you start with that kind of personalized care, there's no way to go back." But choosing a midwife for gynecologic or obstetric care isn't an all-or-nothing proposition. After suffering her miscarriage, Susan consulted with a reproductive endocrinologist to make sure that there weren't any health issues that had caused the loss or had limited her fertility. Once she became pregnant again, she saw the doctor for a few visits and then returned to the midwives for her prenatal care. At 16 weeks, an obstetrician performed an amniocentesis and forwarded the results to Blair. "You need to mix in what you need. I'm not opposed to medical care," Susan points out.

Why a home birth? Susan wanted the comfort and intimacy that being at home would offer. "I loved the idea of laboring in my own home - in our bedroom, in our bathroom, in my own shower. It felt very intimate and special to me. The baby would come into the world in the same way it was created: in love."

Birthing, both Susan and her midwives maintain, is not a medical event, it's a natural process. "I had complete faith in the process," Susan says. "I believed my midwives would know if there were a problem, and would have insisted we go to the hospital if necessary. I strongly believe that I know how to give birth on my own, but I fully appreciated the security of having a midwife there to help with the unexpected or emergency situation."

Blair points out that she has a transfer-to hospital rate of approximately 7 percent, where delivery is handled by an obstetrician. She and her assistants are skilled at resuscitation. And most importantly, Susan understood the risks and benefits of each one of her birthing decisions. "I was willing to take the responsibility for my choices," she says.

On a practical note, the family's health insurance covered the midwife fees. Initially, the insurance company only offered to pay out-of-network costs, but Susan challenged the decision pointing out that there was no in-network provider who offered a home-birth option. At that point, the insurance company reversed its decision and paid the full in-network fee.

Birth as a family event. Susan didn't just want to birth at home; she wanted her family around for support. Her husband was a given. He was as fully committed to a home birth as his wife, attended almost every prenatal visit and, according to Blair, "he asked more questions than Susan did." But how would Susan's two preteen sons feel about the event? Zach had been at Josh's birth, but he was only 2 at the time. "Birth is a family event, not a medical one. It was like getting married. This would unite us as a family," Susan says.

But she was also respectful of her sons' feelings, both as the pregnancy progressed and during the birthing process. Zach made it clear from day one: "I don't want to hear or see you in labor. I'll be in the basement. Call me when you and the baby are cleaned up and dressed."

Josh, on the other hand, was very involved. "He watched every birth video with us, he pored over my birth plan, he was intent on being there," says Susan. Barton's two daughters also had planned to be at the birth, but they were unable to attend.

Josh stayed with his mother when she started her contractions at around 7 pm, but as the night wore on, he went to his room and fell asleep. Zach, hearing his mother labor, told her, "I'd rather be with you." And when Benjamin was born at 2:30 am, her younger son, sleepy and disoriented, elected not to be present, while her older son stayed for the entire delivery. The key she believes was that she "was always open with them and respectful of their choices."

Susan spent the early hours of her labor on the first floor of her home, moving between the living room, the dining room, and the kitchen. She used comfort measures like a birth ball, a hot sock, and counter-pressure, provided by her husband. But as the contractions became more intense, she moved upstairs to her bedroom, where a birthing tub had been set up and filled with warm water.

The natural buoyancy of water offers labor relief. Susan had used water as a comfort measure in her previous pregnancies, but this time she and Barton decided they wanted a water birth. Because the baby is in amniotic fluid in the uterus, some believe that the transition from the uterus to a warm-water bath makes birthing a gentler process. The baby doesn't inhale until he is exposed to air, so there is no danger of drowning and he continues to receive oxygen through the umbilical cord and the placenta. The baby is lifted from the water once the full body is birthed. In Blair's practice, 40 percent of women opt for water births.

Barton had been concerned that there would be too many people around and worried that the intimacy of the birth experience would be lost. But, as Susan says, "the midwives understood and were respectful of his fears. Being in the tub actually gave us a kind of separate space. And while we knew they were there, we could focus on each other and on birthing our baby."

After 37 minutes of pushing, 8-pound, 14-ounce Benjamin was born into his parent's hands. "That was one of the most satisfying parts of our experience, that we were the first to touch our baby. I instinctively brought him out of the water and held him on my chest while Barton held us both. It was beautiful. The atmosphere was quiet, with lights dimmed. All you heard were our voices and the voice of our new baby boy. After 15 minutes, I got out of the tub and birthed the placenta. What happened next was wonderful - I climbed into bed with my new baby and my husband. We breastfed, introduced Benjamin to the people that there with us and snuggled in for a good sleep."

Susan's attention to detail paid off. It was exactly the kind of birth experience she wanted for her baby, herself and her family. But, she adds, "every pregnant woman should know, no matter where she chooses to birth her baby or whom she chooses as her health care provider, that she can have a more satisfying birth experience by being an involved participant in the decisions about labor and birth."

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* taken from "Welcome Benjamin! The Home-birth Experience" by Marian Edelman Borden, Every Baby magazine, Issue Three.