Cape Town-based couple Dawn & Dean McFarlane share their recent experience of birthing their second child at home with HBSA.
For our first birth, we were under the care of an obstetrician at a private hospital. At 37 weeks I was diagnosed with intrauterine growth retardation (IUGR) and was told I would need to be induced to birth my baby safely. Although I ended up birthing my baby vaginally, it was not quite the “natural” birth I had hoped for. The usual cascade of interventions meant I needed the relief of an epidural when the pains became unbearable and the most traumatic part was the manual removal of my placenta performed by the doctor a mere 5 minutes after my son was born. I knew that I wanted a different experience this time.
What made you decide on a homebirth for your second pregnancy?
I was doing my doula training after the birth of my first child and had heard from the women there who had these amazing experiences at home. It definitely piqued my interest. I was seeing a gynae for my prenatal care in the second pregnancy when she informed me at 13 weeks that the medical aid plan I was on no longer covered her fees and I would, therefore, have to make a significant co-payment or find another doctor on my network. So this change also prompted the decision to explore homebirth.
What was your husband’s reaction to your decision to birth at home?
His response was a resounding “NO!” His concerns were around safety – “what if something went wrong?” “What about the blood?” and also what about all the noise as we live on the same property as my in-laws! So although he had said no, I asked him to keep an open mind and come and meet with a midwife who could answer all those questions, as they were concerns of mine too.
How did you find your midwife and what were your criteria for selecting her?
I had contacted a few midwives and I can’t say that there were many options as some didn’t offer services in my area and some didn’t respond to my initial contact and because I was due in the middle of December, many were on leave and therefore unavailable. But I managed to find one midwife who was happy to meet with us and answer our questions – and luckily had availability when we were due. She satisfied all our questions in terms of situations that would risk out homebirth and she advised on having the back up of the public hospital in our area and made arrangements for us to consult with an obstetrician there. She also suggested we attend an information session at a homebirth gathering to help us come to a decision either way. We left that initial meeting feeling comfortable that we were on the right track but decided to wait to make our final decision once we had attended the homebirth gathering.
What was your experience of prenatal care with a midwife like?
One of the advantages for us was that the midwife was willing to do all our prenatal care at our home on days when hubby could be present. The visits were usually an hour long each time and so we had many opportunities to discuss any concerns or questions we had. What was also nice was being able to whats app her whenever I had any questions in between our visits which she’d always respond to. She arranged for us to consult with an obstetrician at our local referral hospital as part of our back up plan. Because of my previous history of intrauterine growth restriction and the baby presenting breech in this pregnancy, we ended up having 3 consultations at the public hospital. We were very pleasantly surprised by how efficient and pleasant the public hospital service was. Even the admin and security staff remembered us by our 2nd and 3rd visits and we got to see the same doctor for all 3 visits. This really helped us feel secure in knowing we had a good back up.
Why did you feel it necessary to have a doula, and how did you go about selecting one and how was her role different to that of the midwife?
Having done some doula training myself I knew the advantages of having a doula and it was something I definitely could have done with my first birth. We met with two doulas and knew instantly with the doula we chose as she made our 1st meeting feel like we were just having a relaxed conversation. For me, it wasn’t important that the doula have any homebirth experience or had a homebirth herself but rather that she was passionate about being a doula, that she made both of us feel at ease and that her presence was unobtrusive. She ended up going above and beyond what our expectations were with advice and support in the pregnancy and in the labour she was of support to my husband as well. She just knew what I needed, when I needed it without me having to say anything. She took the most amazing photos of the labour for which I will be forever grateful. I can’t overemphasize how important it is to have the right doula for you – it should just flow organically.
What was the cost of having a home birth?
In our case, choosing a homebirth with a midwife and doula ended up costing us more out of pocket than if we had chosen to birth in a hospital with a doctor which would have been fully covered by our medical aid. However I knew that statistically, being due in December, had I stayed with a gynae in the private sector, I would have ended up being pressured into being induced and given the way my labour turned out, most likely be forced into some form of augmentation that was most likely not needed. We made a conscious decision to give ourselves the best chance to birth in a more empowered way and in the end that’s exactly what we got. To be clear though, the total cost for the birth at home, with a midwife, doula and hire of the birth pool came to roughly R10k. Had we chosen to birth in a hospital with a gynae it would have been double that amount, covered by the medical aid.
What did you do to prepare for your homebirth?
For us, the most important thing was to not tell anyone at all of our plans to birth at home! Only our midwife and doula knew…later on in my pregnancy I told my sister and gave her the option of attending my birth with very strict instructions as to what she could and could not do on the day. In hindsight, this decision was probably the best preparation we could have done as it just eliminated any questions or objections from anyone who was not part of the birth process. It’s enough to have to deal with your own internal doubts that do crop up now and again, and we didn’t feel the need to have to justify our decisions to anyone else. The rest of our preparation was watching positive birth videos and our interactions with our doula and midwife. That felt like enough for us.
Please tell us about the actual labour and birth
My labour started slowly and gently in my 39th week on a Tuesday evening and I ended up birthing my baby on the Thursday midday. For the most part, it was just Dean and me which was nice. We went out to supper on Tuesday and went about our day as usual on Wednesday (Dean took off from work at our midwife’s suggestion) and we just pottered about ignoring most of the surges. On the Thursday morning at 5:30 am, I told Dean “we need to go for a walk!”
Dean recalls that this was the only time in the whole process he had a mild moment of panic as taking a stroll in the neighbourhood at 5:30 am with people on their way to work to the train station was an odd thing to do!
Fortunately, after one lap around the block, I was happy to stay indoors. We let our midwife and doula know that things seem stronger but that we didn’t need them just yet. Our son was next door with my in-laws, who were oblivious to our homebirth plans!
Dean kept in touch with our midwife and doula but at some point misplaced his phone just as our doula arrived. She thankfully kept the midwife updated who eventually arrived at some point. As soon as our doula arrived was when I needed to focus inward to manage each surge. My sense of time was distorted and I was expecting to be going for quite a while but as it turns out, I didn’t have long to wait.
During our antenatal visits, one of my requests with my midwife was to avoid doing vaginal exams. She explained that it was not something she did routinely anyway as she had a “hands-off” approach when all is going well and that I should prepare to catch my baby myself. I didn’t give that part much thought afterwards but as it turns out, that’s what I instinctively did once I felt my baby move down with each surge. I felt the head crowning, I felt its body wriggling! I was doing this! As the head emerged Dean shouted, “I see the head” and with the next second the whole body was expelled into the birth pool. The baby had the umbilical cord around its neck which my midwife quickly looped over the head while still under water. I lifted her up to my chest and since we kept the gender a surprise, I had a peek and was thrilled to discover we had a daughter!
Those moments after the birth were quiet and completely unhurried. We could gaze at our baby and take our time getting to know her. We waited until the umbilical cord had stopped pulsating and Dean cut the cord and got to do some skin to skin with her. Now it was my time to deal with birthing the placenta.
This was the part of the birth that I was afraid of given how traumatic my previous experience was when 5 minutes after my son was born, the doctor went in an did a manual removal of my placenta.
My midwife reassured me that I could birth my placenta easily and guided me on what to do whenever I had a contraction. After a while, I admitted that I felt afraid and she offered to assist me by suggesting a better position and guiding me again on using very gentle traction on the cord…and out it came 40 minutes after I had birthed my baby! We all had a look at the placenta which was so fascinating to be able to see where out baby lived in its little watery cocoon. I got to touch and feel each side and that was an amazing, healing thing to have done too.
I hardly bled at all after the birth and we snuggled in bed and then invited our son to come and meet his little sister which was just such a precious moment. (My mother in law still had no idea we had birthed our baby!) Our son called her to come over to “come see the baby” and she was in complete shock and disbelief that we had just birthed at home! She’s since been bragging about her granddaughter who was born at home!
My midwife and doula finished up what they needed to do for baby & I and left. By which time my parents arrived from Sedgefield and were absolutely shocked as well that we had given birth at home.
What sort of care did you have postnatally?
Our midwife had scheduled to see us the following morning but was called to attend another birth and so our lovely doula came to check in on us. It was lovely to reminisce with her about the birth and have her reassure us regarding the breastfeeding. Our midwife did three more visits at home monitoring our baby for signs of jaundice (our son had jaundice) but thankfully that didn’t happen this time around as well as weight checks and postnatal self-care for me.
What has been the impact of having a homebirth for all of you?
Dean – “I know it’s cliché’ but I really went from being anti-homebirth (fearing the unknown) to homebirth advocate. I can’t recommend it enough! Inform yourself, do your own research and protect your process in whatever way works for you. It really helped to keep our plans to ourselves.”
Dawn –“ I can say that it has been profound and at the same time “normal”. Our baby was born here at home while our son played with his granny next door. We laboured in between preparing for an upcoming holiday away, laundry that needs doing and dishes that needed cleaning. Our life has just taken on a new sense of normal. I really appreciate not having visiting hours for my husband enforced on me and our newborn as they were in the hospital or possibly having our son not be able to spend time with us right after the birth of his sister. He has accepted her presence with ease and is loving and gentle towards her.
I am an even bigger advocate of midwifery and doula support for women. I see and feel the difference in myself as a mother and a woman at how you are treated through all of this makes you feel on the other side. We need birth support that is empowering and encouraging of our abilities.
I loved my homebirth!”