Amy & I got married in California on Sunday, November 14, 1999, and left two weeks later, on November 28, for a honeymoon that took us through Tahiti, the Cook Islands, Fiji and New Zealand, before settling in Sydney, Australia.  We found out we were pregnant on December 28, after doing a home pregnancy test, while staying in New Zealand with the parents of a friend from Stanford University.

Upon arriving in Australia, we began to explore our options for pre-natal care and childbirth.  We discovered that midwife-based care is much more common and accepted in Australia than it is in the United States, where medical care during pregnancy and childbirth is almost completely dominated by obstetricians.  When we first arrived in Australia, we didn’t have a lot of money, because we had been traveling, and I had not been working for five months.  I had heard of homebirth before and thought that perhaps it would be a way to save money versus going to a hospital or even an ‘‘alternative birth center.’’  When I mentioned the idea to Amy, I was delighted to find, quite to my surprise, that she actually preferred the idea of a homebirth.  She felt it would be nicer to be in our own space, have our own things around us, crawl into our own bed afterward, and not to have to get to the hospital during labor and make the trip back home during the recovery period afterward.  And if it was a way to save money, that made it even better!

So then we began learning all we could about homebirth, and what we discovered resulted in a major revolution in my thinking.  It shocked me to learn that every study that has ever been done on the relative safety of home versus hospital birth and of obstetric versus midwife care has shown that homebirth is safer for both mother and baby than hospital birth, and that delivery by a midwife is safer than delivery by a doctor.  (By ‘‘safer’’ here I mean a lower incidence of death and disability for the mother and the baby.)  These studies are readily available on the Internet and in print sources.  Nevertheless, the vast majority of women continue to choose to give birth in the hospital.

The following tables, for example, show comparative death rates for babies born at home and in the hospital, cared for by doctors and midwives, in Britain and the Netherlands, in 1958, 1970 and 1986.  They are from the book Homebirth by Sheila Kitzinger, a widely published Australian childbirth educator (1991, Doubleday, pp. 42-44):

So we were very happy to learn that homebirth was not only less expensive but was actually safer than hospital birth.  We then made contact with a local organization named Homebirth Access Sydney, which provides information about homebirth and referals to midwives who attend homebirths.  We chose two midwives, Robyn Dempsey and Nicole Thompson. Their service included all of our pre-natal care, attendance at the birth, and post-natal follow-up.  We also attended a series of classes offered by Lyn Wallace, a childbirth educator and lactation consultant.  We were delighted with the midwife care provided by Robyn and Nicole, and with Lyn’s classes, and we highly recommend all three of them to any prospective parents in the Sydney area.

Before the rise of the modern obstetric profession in the twentieth century, midwives helped women give birth at home for thousands of years.  Here, for example, are a couple of passages referring to the practice of midwifery in the Bible:

When the time came for [Tamar] to give birth, there were twin boys in her womb.  As she was giving birth, one of them put out his hand; so the midwife took a scarlet thread and tied it on his wrist and said, ‘‘This one came out first.’’  (Genesis 38:27-28)

The king of Egypt said to the Hebrew midwives, whose names were Shiphrah and Puah, ‘‘When you help the Hebrew women in childbirth and observe them on the delivery stool, if it is a boy, kill him; but if it is a girl, let her live.’’  The midwives, however, feared God and did not do what the king of Egypt had told them to do; they let the boys live.  Then the king of Egypt summoned the midwives and asked them, ‘‘Why have you done this?  Why have you let the boys live?’’  The midwives answered Pharaoh, ‘‘Hebrew women are not like Egyptian women; they are vigorous and give birth before the midwives arrive.’’  So God was kind to the midwives and the people increased and became even more numerous.  And because the midwives feared God, he gave them families of their own.  (Exodus 1:15-21)

Nevertheless, I must admit that when we first started considering the option of homebirth, I was a bit apprehensive -- not sure about how much pain and bleeding there might be, and concerned about the possibility of a complication that might require medical intervention.

Through books, classes, pre-natal sessions with our midwives, and other resources, we began learning as much as we could about the whole process of pregnancy, labor and birth.  In a section summarizing the contributions of various childbirth ‘‘philosophers,’’ the following quote highlights one of the common themes we heard again and again in our studies:

Dr. [Grantley] Dick-Read was the first obstetrician to realize that fear of giving birth was one of the main causes of pain during labour, and he brought the principles of natural childbirth to the attention of not only the medical world, but to parents as well.  He introduced proper education of mothers through antenatal classes and teaching, and also provided emotional support, in the idea of eliminating fear and tension.  His teaching was so fundamental that it is now taken for granted by all centres, and there is no method of childbirth that does not rely on his ideas, which included breathing exercises, breathing control, and complete relaxation.  Dr. Dick-Read’s watchword was preparation -- not only by getting information about childbirth, but also by seeking reassurance and sympathy.  (Dr. Miriam Stoppard, Antenatal Care, 1998, Dorling Kindersley, p. 36)

Although Amy seemed from the beginning to be quite comfortable with the idea of having a homebirth, I felt that for myself, the books we read, the materials we studied and the information that was made available to us really helped to allay my fears about the labor and to embrace homebirth enthusiastically.

One of the ideas behind the ‘‘homebirth’’ movement of the past 20-30 years is that childbirth is a ‘‘normal’’ and ‘‘natural’’ life occurrence rather than a disease, and that it need not be a medical event.  The following passages from Homebirth by Sheila Kitzinger express well this perspective on birth:

Traditionally a woman in childbirth has always had other women helping her.  As well as the midwife, there were friends, family members, and neighbours who gave emotional and practical support...  Other women still give support to women in childbirth in most Third World countries.  When anthropologists are present at a birth, it is often quite difficult for them to find out who exactly the midwife is, because she is one of a group of women helpers engaged in a task within a non-medical context.  Childbirth is like bread-baking, laundering, or cheese-making -- activities that involve a community of women working together.  In our own past, and cross-culturally, every adult woman was expected to know what to do in childbirth and how to help other women...  (pp. 124-125)

All of us who approach childbirth with no experience of it, no idea of what happens except what can be gained from books and films, are in some sense deprived.  Girls growing up without any awareness of what it feels like to give birth, other than the fear of pain and injury, are especially deprived.  In medicalizing birth and removing it from the home, our culture has made birth, like dying, a fearful ordeal that can be dealt with only by trained experts, that is no longer part of our shared lives...  (p. 128)

The sudden, dramatic dash to hospital, sirens screaming; the grey and floppy baby who is barely breathing; the woman haemorrhaging massively -- these fears are in the back of all our minds.  But, because labor at home and in small GP units or alternative birth centres does not suffer the aggressive intervention to which many hospital labours are subjected, these are extremely rare events.  A carefully planned and lovingly conducted home birth, in which the rhythms of nature are respected and the woman is nurtured by attendants who have the knowledge and understanding to support the spontaneous unfolding of life, is the safest kind of birth there is, and the most deeply satisfying for everyone involved.  (p. 163)

In spite of all the preparation, though, I don’t think that anyone who has never witnessed a birth can be fully ‘‘prepared’’ for the intensity of the experience.

The power of birth is like the strength of water cascading in a mighty rush down the hillside. It is the power of seas and tides, the power of mountains moving. There is no way of ignoring it. You cannot fight it. No amount of technique can enable you to be in control of it as you might be in control of a car or a computer. Your birth partner should aim not to manage, conduct, or coach you through this experience, but rather to give you strength and confidence as you allow your body to open and your baby to press through it to life.  (p. 121)

Our baby Garrett Lazar Swearingen was born at home on August 22, 2000.  In the days after his birth, I found myself looking frequently at the many pictures we took during Amy’s labor, and I was struck by the ‘‘homeyness’’ of the atmosphere displayed in those pictures.  No white curtains, hospital beds, staff in gowns and face masks, surgical tools, electronic equipment or other paraphernalia.  Instead the pictures show the midwives in their blue jeans and sterile gloves, me in my everyday clothes, and, in the background, our bed, our heater, our icons, pictures and wall decorations, our blinds and sheets and towels -- all the familiar trappings of home.

When our priest came to visit us after the birth, he commented on the contrast between the environment in our home and the hospital environment he had encountered the last time he visited a parishioner after the birth of a baby.  He said at the hospital there were curtains around the bed, other people in the room, people walking up and down the corridor outside, talking and making noise.  Here in our home it was quiet and calm.  The instructor for our childbirth classes also came to visit a few days afterward, and she too remarked that the peacefulness of our home offered a place with the appropriate ‘‘reverence’’ for bringing a new life into the world.

We were very pleased with our decision to give birth at home, and we consider it to have been a most blessed event.