[Editor's Note: I have asked several of Lamaze International's 2009 Annual Conference speakers to contribute to Science & Sensibility over the next several weeks. Each guest contributor will share a sneak peak of their conference presentation. Some of them have conducted their own research while others have expertise in communicating research findings and evidence-based maternity care to childbearing women. Enjoy these guest posts and we hope to see you October 1-4 in Orlando at the Lamaze International 2009 Annual Conference. - AMR]

Judith Lothian, PhD, RN, LCCE

I became interested in home birth about 15 years ago. As birth became more medicalized I became increasingly discouraged with the lack of options that women actually had in a hospital. Routine intravenous, continuous electronic monitoring, and restrictions on movement during labor, and then the escalating epidural rate, and eventually the shocking rise in the cesarean rate became the back-drop for my column in the Journal of Perinatal Education, and more recently writing with Charlotte DeVries The Official Lamaze Guide: Giving Birth with Confidence. Over those years, I read more about home birth, and discovered an increasing number of research studies that document the safety of planned home birth for healthy women (Leslie and Romano, 2007). I became increasingly convinced that planned home birth offered women a chance to have a safe, healthy birth without the restrictions and the frustration that too often characterized obstetrician managed (and sometimes midwifery managed) hospital birth (Lothian 2006). Although I had never actually been at a home birth, I began writing about planned home birth as a safe option for healthy women who wanted a natural birth. Then, my oldest daughter had her third baby at home and my world changed (Lothian 2002). I was overwhelmed with just how simple birth is meant to be.

Less than 1% of women in the US have planned home births. The reasons for this are complex but I kept thinking 'If more women knew what it was like to give birth at home, more women would choose to have a planned home birth'. Although there is research on the experience of home birth in the Netherlands (Devries 2001), the UK (Edwards 2005) and Ireland (O'Connor 1995) there is no research that describes the experience of planned home birth in the US. So, the purpose of my research was to describe the experience of planned home birth for women and their midwives in the US. I will be presenting the findings related to making the decision to have a planned home birth at the 2009 Lamaze Annual Conference in Orlando.

In this qualitative study, I used the ethnographic techniques of informal interview and participant observation to obtain rich descriptions of women's experience planning (and then having) a home birth. Twenty women representing diverse backgrounds were interviewed and observed in their homes. Interviews were audio-recorded and transcribed. Guidelines to insure trustworthiness and protection of human subjects were followed. The data were analyzed using standard qualitative techniques - developing codes, categories and themes. I'll share more about the ins and outs of the research methodology in my presentation. (I promise it will be interesting.)

Many of the findings of the research surprised me. Women made their decision to have a planned home birth before becoming pregnant, early in the pregnancy, or sometimes as late as 30 weeks into the pregnancy. I was surprised that all of the women described themselves as 'mainstream'. They all wanted a natural birth. All the women came to believe that 'intervention intensive' maternity care increased risk for them and their babies. They valued the personal relationship with their midwife and believed that this relationship increased safety. They believed they could manage the work of labor more easily and more safely in their own homes. They all expressed confidence that a hospital and skilled physician care were available if needed. 'Being Safe' emerged as the theme that captured the essence of women's decision to plan a home birth. In stark contrast to the current thinking, that birth is safer in hospitals under the care of an obstetrician, these women believe that giving birth at home is safer for them and their babies.

In a powerful way, the findings suggest that we need to look closely at the meaning of safety for women, and whether women and their babies are indeed safe in the current system.

At the conference I will share the women stories, in their own words. You will follow in their footsteps as they struggled to make sense of their options, resolved doubts and ultimately made the decision to have a planned home birth.

Judith Lothian, PhD, RN, LCCE, is a nurse and childbirth educator. She is an Associate Professor of Nursing at Seton Hall University and the Associate Editor of the Journal of Perinatal Education. She writes a regular column for the JPE and is the co-author of The Official Lamaze Guide: Giving Birth with Confidence. Judith lives in Brooklyn, NY and has five grown children and eight grandchildren.

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