Can we give birth at home (ADD)?

Peut-on accoucher à domicile (ADD) ?

Did you know that according to a January 2021 IFOP study, 19% of French women would like to give birth at home and 17% are seriously considering homebirth. And you, did you wonder about the place of birth when you were pregnant or for a future baby?

Home birth or home birth:

First of all you will need to find a midwife. If I announced at the beginning of the article that 36% of women consider AAD (home birth), only 0.5% can do it because of a shortage of midwives. It is therefore important to find out early. More and more women are choosing a midwife for their gynecological follow-up who practices home birth (AAD). Thus, a link has already been created and if there are any contraindications related to your state of health, you will be informed and oriented as best as possible in order to consider an alternative or to put in place corrective measures when possible.

Once the midwife has been found, the follow-up will depend on your aspirations as a couple - from the most natural to the most medical - and on the evolution of the pregnancy. It will begin with an interview, ideally with the couple and before the 3rd trimester, in order to give you all the information you need to confirm your choice, answer all your questions and understand your project. The guiding principle of an AAD accompaniment is to favor the conditions of a physiological birth, both on the medical and psycho-emotional levels. Therefore, you will alternate moments that are more related to the clinical follow-up of the pregnancy and others that allow you to progress and prepare yourself for the birth.

How many women actually give birth at home?

88% of women who go into labor at home will give birth at home without any problems. When it is a second or more child, the risk of transfer is divided by 5! Most women who are transferred will be transferred without an emergency, simply going back to the maternity hospital where they were registered. 1% of transfers require an EMS, most of the time following a hemorrhage. It is also to avoid these rare and urgent cases that your midwife regularly evaluates your health condition and that we sometimes refuse to accompany certain families.

And if I had given birth at the hospital, would I have had less risk of complications?

No more, no less according to international studies, even a decrease in the risk of undergoing interventions. To give just a few examples, the 0.3% ofepisiotomy in AAD versus the 20.1% in hospital, 1% of severe delivery hemorrhage versus 1.8%, 2.2% of cesarean section versus 20.4% and 1% of neonatal resuscitation versus 6.3%, allow us to affirm the legitimacy of this way of giving birth in France.

However, for rare cases requiring an urgent intervention, not being in the hospital increases the delay of access to advanced care. Your midwife will obviously be able to start the first steps and stabilize the situation thanks to her skills and equipment (oxygen, respiratory insufflator, anti-hemorrhagic drugs, infusion or suture set...). You will need to weigh all aspects of your decision carefully and take the time to feel the one you feel most aligned with.

Advantages of a home birth:

There is no one ideal birthing location for all women. It is up to each woman to find where she feels both physically and emotionally safe. Homebirth with a midwife, as this is what this post is about, has the advantage of bringing the two together. In a way, a middle way, between giving birth alone in a secluded place for intimacy and "giving birth" under the control of machines and drugs for safety. Let's not be caricatural either, birthing centers and certain maternity teams can also be places of compromise. However, they remain "places where we go" and not the mother's familiar space.

The big day has arrived, how does a home birth go?

Imagine yourself, contractions have started, you feel that this is the big day. You tell your midwife, she gives you some advice if you need it and gets ready. You just let yourself slip into labor, riding the contractions without asking yourself any logistical questions.

Do you have to turn your house into a hospital branch, tarp and disinfect the place?

Not at all! At the end of the 8th month, your midwife came to your house and advised you on how to prepare it. Nothing complicated: protect the mattresses, bring plenty of towels, go to the pharmacy to get some products. So everything is ready, or almost ready.

Can seniors attend the birth at home?

Again, no stress! It is night time and they are sleeping, let them go to bed, they will discover baby at breakfast for a wonderful family moment. During the day, some of them will want to stay and watch the birth, others will prefer to go and play with their grandparents, a friend, or go to school. Talk to them beforehand for the older ones, explain to the little ones with books dedicated to home birth. In any case, have a plan B for childcare in case you need to go to the hospital.

Who can attend the home birth?

It's up to you who you want to attend your birth. Again, you are at home. Just keep in mind that no matter who is present, you will need to be intimate enough with her to dare to be naked in front of her, defecate or be vulnerable as a cro-magnon. This may sound crude, but if not, it could inhibit your delivery. Ideally, all the people involved should have met at least once before to agree on their respective roles and to accompany you as best as possible. Don't forget that intimacy often rhymes with small, or even very small committees.

How does the moment of birth go?

Let's go back to our visualization, labor is now intensifying, no need to worry about knowing when to leave, you call your midwife. She knows you, knows how you work, she will join you when it's the right time. While waiting for her, you can take a bath, relax in your environment, curl up in your partner's arms or isolate yourself in the garden. You are at home, everything is possible, it's up to you.

The baby's labor and well-being are monitored in a non-invasive way and when the baby starts to push, we let you accompany him/her in your own way. You choose the position, the rhythm, the place and welcome your baby with your own hands. Now all you have to do is enjoy.

This vision is beautiful, but is it always that simple?

As you might expect, no. Midwives have not existed in all times and civilizations for nothing. If in most cases, the woman has all the instincts and feelings in her to do it without any intervention, sometimes, mother nature makes whims.

And for the aftermath of childbirth, still no doctor?

Your midwife will stay 2 to 6 hours after the birth to accompany you, take care of you and make sure that everything is going well. When she leaves, she will give you your baby's health record, the birth certificate, a report of the delivery and all other useful documents. She or one of her colleagues, depending on what you have planned, will come the next day and then at least on the third day for the Guthrie test and on the 5th and/or 10th day. The medical examination on the 8th day is done with a doctor and a certificate is issued. It can be your general practitioner who comes to your home or a pediatrician that you consult at his office or at the maternity hospital.

Without any break or change of environment, the baby adapts easily to his new life and breastfeeding is often facilitated. The bond with the co-parent and siblings is also more favorable.

Why do we wonder about the best birth place for us?

Childbirth is an intimate and instinctive process controlled by our reptilian brain - the instincts. From this we could conclude that women should give birth in a known place, with few people, so that they can give in to their "wild woman" instinct. We know that the reptilian brain is inhibited by the neocortex, which is itself stimulated by anything that makes us think (when to leave, answering questions about admission to the hospital, hearing the sound of machines...). In short, we can conclude that the hospital chosen by the majority of women is not really adapted to live a birth.

However, unlike the lioness or the gazelle, we are eminently cultural female mammals. Therefore, we are impregnated with the beliefs of our society and our time. So for some women, the place where they could most surely let go is where they have all the technology and a plethora of tests. Through these interventions they could stop thinking and worrying and let themselves go into contractions and openness, feeling safe and "taken care of".

Also, there is not one ideal birth place for all women. It is up to each woman to find a place where she feels both physically and emotionally safe.

So finally, what would be your choice?

For more information, you can contact APAAD or CDAAD. Never forget, there is no right or wrong way to give birth. There is what you can according to your life path, both medical and emotional, and how the pregnancy and the delivery will unfold. But one thing is for sure, if you have given yourself the means to live what you hope for and that you have remained an actor, whatever happens you will be at peace with your decisions. So, whether or not you choose to have a baby is an essential question.

To accompany you from your pregnancy to your return from childbirth, our menstrual panties are ideal!

Article written by Floriane Stauffer-Obrecht, liberal midwife accompanying AAD, co-director of APAAD


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