Why I Decided to Have a Home Birth

ORIGINALLY PUBLISHED in PEOPLE MAGAZINE.

The path to parenthood was full of decisions for actress Ashley Williams, like whether to deliver at the hospital or have a home birth.

And as she considered her options for welcoming her son into the world, Williams, a certified doula, knew there was one place she wanted to give birth: at home with husband Neal Dodson and a trusted birthing team by her side.

On Oct. 5, the couple became parents to baby boy Gus, who was born at home on the living room floor, surrounded by Williams’ strong support system.

Following the release of a recent study on home births, the new mom and star of the upcoming Jim Gaffigan Show, 36, is sharing six questions other parents should consider when putting together their own birthing plans.

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This past summer an obstetrician in a crowded pub in Hudson, New York, told me I was crazy. She saw my swollen belly and asked who my doctor was — I told her I was having a home birth and she nearly spilled her (large) glass of wine.

“You are insane,” she diagnosed. “Look at the research. That is so dangerous.”

Since I became a doula seven years ago, I have immersed myself in evidence-based medicine, and a recent study out of the United Kingdomsuggests that this OB’s claim isn’t true. The study, published Dec. 3 by the National Institute for Health and Care Excellence, potentially reverses years of faulty research, deeming home births safer than hospital births for normal pregnancies.

“Women with uncomplicated pregnancies — about 45 percent of the total — were better off in the hands of the midwives than doctors during birth,” researchers concluded.

British National Health Service researchers would grant the naysaying Hudson OB one point, however. In the case of first-time mothers like me, home birth may slightly increase risks. “For women having their first baby, home birth slightly increases the risk of a poor outcome for the baby (from five in 1,000 for a hospital birth to nine in 1,000 — almost one percent — for a home birth).”

Those are only slightly different odds, which I could accept, considering the other benefits of home birth. This new information may allow for more women to consider the option of home birth versus a hospital or birthing center. The great news is that if you are having a normal pregnancy, the choice is yours and you can change your mind relatively late in pregnancy.

Here are some of the things I considered before deciding a home birth was right for me.

Do I have access to a birthing team that I trust? 

I chose a birthing “team” of people I respect to take care of me and my baby during labor, birth and immediate postpartum. I decided I needed a midwife, a doula and my (amazing) husband. I also had my chiropractor come just for a few hours. (I had a fear that the baby would get stuck and Dr. Elliot Berlinis considered a “baby spinner.”)

In addition to what we began to call “The Avengers of Birth Teams,” we also asked an obstetrician who attends home births, Dr. Stuart Fischbein, to be on call if I required forceps, vacuum, or any other obstetrical tools. We didn’t end up needing him, but he was ready to step in.

Assembling this birthing team was part science, part gut. I knew I wanted a fully accredited midwife and when I met the two midwives and their assistant, who attend all births as an intrepid trio, at Birthing Rhythm Midwifery, I found us to be a perfect fit.

I’ve worked as a doula, but I’m also an actress who cries in front of people for a living. However, the first time I wept in front of my midwives, I was surprised at what happened. Juli, the hippy-est of the bunch, left her chair, sat on the floor next to me and touched my leg. It was an honest display of physical empathy and something my OB/GYN of 10 years would never have had time to do.

It allowed me to weep in what suddenly felt like a safe space, processing emotion connected to my fears about birth. I knew immediately that I could rely on these women to guard my emotional wellbeing on the day my son was born. (I was right. See below for an excerpt from my birth story.)

Ana Paula Markel, a childbirth educator, doula, and founder of Bini Birth in Sherman Oaks, California, says that: “Ten percent of why most people hire a doula is skill and experience and 90 percent is personal connection.” Once I knew my midwife and doula were fully accredited and certified, I felt comfortable letting my gut do the rest of the work.

Where do I feel safest — at home, a birthing center or a hospital?

I spent much of my childhood in and out of the hospital due to asthma, and I remember the first time a doctor tricked me. He was my allergist in Yonkers, New York. I was 4 years old and he made a promise: “No shots today.” I believed him, relaxed and even laughed at his funny sounds.

When I saw the syringe in his hand and asked about it, he said it was a pen. He swore it: “A pen.” And then he stabbed me in the arm with it.

I flailed and roared as my mom held me. There began my distrust of doctors, which was only solidified by attending 52 hospital births as a doula and seeing how some OBs and nurses treated laboring women. I didn’t want to be one of them.

Some people feel safest in a hospital, and it’s likely that that’s where they will feel most comfortable laboring. Please understand that many OBs are respectful of their patients’ rights, and many of my friends have had wonderful, radical hospital births.

What made ME feel safe was having my (amazing) husband by my side as well as five birth professionals and two dogs. I was in charge of the lighting. Music blasted. I got to go out to the back porch and stare at my ferns. THAT’s what kept me feeling safe and, in turn, my contractions strong. I danced in between my “surges” and sang along to the music. As I had always dreamed when I pictured my home birth, I was surrounded by people I trust and fear was not in attendance.

Do I live close to a hospital and have a reliable transfer plan? 

A transfer plan spells out what to do if a woman needs to move from home to hospital during her labor. I gave birth on the living room floor of our home less than three miles from one of the best hospitals in the country. Knowing its proximity helped me to relax since help wouldn’t be far away.

I also met with a backup doctor who agreed to be on call in that hospital two weeks before my due date and two weeks after. I was relieved to know that Dr. Paul Crane, a seasoned obstetrician who has been in practice for 45 years, could be there for us if we needed to transfer.

We went to his office during my pregnancy and were able to ask questions and get to know him. We didn’t end up needing him, but knowing he was there was comforting.

Can I afford it?

The crazy thing about delivering at home is that it can be more expensive than a hospital birth. A close friend of mine, Terryn Westbrook, couldn’t find a doctor in a hospital who would do a vaginal breech birth. Instead, she had a beautiful and empowering home breech birth and then fought with her insurance company for more than a year to get reimbursement.

Out of the $8,000 that Terryn paid out of pocket for her birth, she only received $1,750 from her insurance company. “After multiple appeals and even hiring an outside party to advocate on my behalf, which was unsuccessful, I’ve finally given up,” Terryn said.

I couldn’t get my insurance company, AFTRA Health Fund, or Cedars-Sinai, the closest and most reliable hospital in my area, to call me back with any numbers about what deliveries cost without insurance, nor how much the insurance companies are billed for the delivery. So I did what any woman of our time seeking a hive-mind consensus would do. I conducted a Facebook poll.

My post was: “Hey, hot mammas! How much did you pay out of pocket for your hospital birth?” Of the 32 friends who responded to my post, responses ranged from zero to $3,000. The entirety of my home birth care cost me $6,000.

Please know that my birthing team earned every penny. They tirelessly monitored all physical and emotional aspects of my care in our two-hour prenatal meetings every two weeks. They tracked my daily diet. They dropped off herbs that could help my back pain. They talked through my fears, my history, filled me in on recent studies. They came at 5:00 a.m. when I was in labor and cried with me, held my hands, my legs, my head.

Once I had my baby, they cleaned my entire house and sat on the bed with us and ate Indian food. They were on call for me 24/7 for six weeks postpartum, came by often, and checked in almost daily to see how we were doing.

So far, my insurance company hasn’t reimbursed me for this care. This is something I have a lot to say about, which I will save for a future piece, but in short, I’m baffled by the insurance companies’ unwillingness to incentivize women to have a home birth because hospitals bill insurance companies for five to 10 times the cost of the average home birth. Insurers could potentially save money if home birth numbers in this country increased.

Despite the news from Great Britain, that home births are safer in many cases than institutional deliveries, insurance companies deem it a higher risk based on out-of-date information, fiscally punishing people planning a home birth. My mommy brain can’t reconcile the idea that delivering at home is considered the low-tech/hippie/alternative option when the fact is that many middle class families can’t afford it. This needs to change.

Am I capable of handling a non-medicated birth? 

A friend asked me after my delivery experience, “Did you have to hook up the epidural in your bed?” The answer is NO, which may be a deal breaker for some women. Epidurals are highly medical procedures that can only be done in a hospital by an anesthesiologist.

I didn’t have pain medication. But what I did have turned out to be all I needed: breathing, meditation while looking into people’s eyes, massage, a hot shower and, halfway through each contraction, for my (amazing) husband to say, “It’s going to be over soon.” I needed him to say this because in the moment I was convinced each contraction would last forever.

I wasn’t scared about the pain ahead of time, although I remember thinking later that I should’ve been. At one point, I turned to my midwife, Beth, and cried, “This is a nightmare. This f—ing HURTS.” She didn’t argue. “I know. It sucks.”

But here’s the kicker. It was also awesome.

An excerpt from my birth story:

While in the throes of these excruciating 17 hours, one thought carried me. My body won’t generate more pain than I can handle. It wouldn’t kill me, this pain. It was real. Radical. Deep. MINE. As my body generated pain levels higher than I could have ever imagined, I met it with my whole heart. In my head I said, “YES. GET IN THERE,” as I greeted this pain with an open, relaxed jaw and let it enter my bones, skin, hair and teeth.

Then I dug in, shaking my head back and forth the way a lion would tear into its prey. Speaking of lions, I roared like one. Seriously. I was told later that neighbors could hear me from next door. I’ve never been more of my purest, animalistic self. It was the hardest thing I’ve ever done.

But I did it.

And when I entered motherhood and that 8 lb., 8 oz. baby was suddenly on my chest, I knew that I could do anything. And then we, my whole birthing team and my new baby, ordered Indian food and drank expensive bourbon together on our bed. Going through labor medication-free, in my own home, allowed me the confidence I needed to start being Gus’s mom. And I did it on my terms.

I deeply respect medical science and research. I think medical interventions, when used appropriately, are life-saving procedures. It is amazing that not everyone has to go through the pain I went through in order to have a baby. It is also amazing that women for whom vaginal birth isn’t possible can have a surgical birth. What incredible freedom we have, as we embark on the mind-bending adventure of motherhood, to weigh our options and make educated choices for ourselves about where we birth.

A final toast to my doubtful OB/GYN friend in the bar: I understand your diagnosis. My home birth was hard. It was painful. It was radical.

But it wasn’t crazy.

Home birth isn’t right for everyone and it isn’t even medically possible for some women. But in answering these six questions, I determined it was the sanest choice for me.

— Ashley Williams Dodson