Homebirth in the Hospital: Integrating Natural Childbirth with Modern Medicine

by Stacey Marie Kerr MD

The personalized and empowering experience of a home birth can also occur in a hospital setting. This book presents fifteen powerful testimonies about this kind of emotionally satisfying birth. The stories show that expectant mothers can minimize fear and put technology where it belongs.Dr. Kerr focuses on the Five C' Choice, Communication, Continuity, Confidence, and Control of protocols. Prospective parents will learn what questions to ask when searching for a provider and how to make their hospital birth the fulfilling experience they desire.

Genres: Nonfiction, Parenting, Health

224 pages, Paperback

First published October 25, 2008

Reviews

[Crystal · Rating 2 out of 5]

This was pretty disappointing. I thought it would be how to have a completely natural birth in a hospital setting. It wasn't. It was how to integrate medicine with as natural a birth as possible. The author believes in natural childbirth, but of the many birth stories in this book, I don't think any of the women's actually had an unmedicated birth. This book was more of an apology for modern medicine's intervention in the natural process of childbirth than an encouraging book to help those who sincerely seek an unmedicated, normal birth in a hospital setting. Makes me wonder: is the hospital really the best place for this kind of birth?

Other things that bugged me:

The author described part of her own homebirth as similar to the good acid trips she had in college. I guess most people can relate to an acid trip. I think that's terrible. I guess it just shows that birth can be a natural high, but really, relating it to illegal, dangerous behavior is not a good analogy.

Most of the birth stories were about women who didn't believe they could give birth. The most common drug they had was "a shot of nubain." No explaination of how the narcotic affects mother or baby.

Overall, it just wasn't an empowering book. Even if you aren't planning a natural birth, don't waste your time with this book. Try the Birth Partner by Penny Simpkin instead.

[Tasha · Rating 3 out of 5]

I really wish the stories had been organized differently. Ending with stories that had progressively more medical intervention left me feeling uneasy about the whole book instead of inspired and confident about a hospital birth.

[Alice Williams · Rating 1 out of 5]

Misleading title.

[Rachel · Rating 1 out of 5]

Not what you think when you read the title. Nothing helpful about this book for a woman who truly wants a homebirth like experience in a hospital. Each of the birth stories seems to have at least one unnecessary intervention and some have several. I was looking for inspiration. I got dissappointment from the very beginning. Unfortunately I love birth stories and found myself reading, or really just skimming through the whole book.

The other thing I hated about this book is that every story ends with a negative comment about birth plans. You would think that the real point of the book is to tell women not to create a birth plan or take a childbirth prep class but just to find a doc that they're comfortable with and go with it. In my opinion its most important for a mother to be informed and knowledgeable about what interventions there are and what she can and can't avoid. This knowledge comes through frequent open discussions with one's care provider and birth place staff and inevitably a birth plan is formed in the woman's mind. As a doula I know how unique every mother is in her birthing decisions and to "just go with it" is not as easy when there is no birth plan to know what that particular mother wants and doesn't want.

[Lauren · Rating 1 out of 5]

I'd give this book no stars if I could. Awful. I was really optimistic in the beginning of the book. I don't understand how a woman who has had a baby at the Farm has such an obscure definition of natural birth. Natural does not mean vaginal. Natural means unmedicated and preferably, without intervention. Almost every single birth story she shared had an unnecessary intervention. Several were induced (but the doc was quick to give a 'logical' explanation for the induction). Most of the moms had some sort of pharmaceutical pain relief, either narcotics or an epidural. I was hoping to add this to my lending library for doula clients but there is no way I'd recommend this book. It's not much better than What to Expect when You're expecting.

[Katie · Rating 4 out of 5]

Basically, this book is just a bunch of people's stories about giving birth. For that, I really enjoyed it and found it very interesting and informative. Each woman, baby, family, and birth is unique, which is ultimately the entire point. The thesis of the book is not how to have a totally unmedicated birth in the hospital (though there are stories of that), it's how good communication and mother/family-centered treatment can and should be used in all kinds of circumstances, including high risk situations/pregnancies where more medical management is needed (or just desired by the mother), to ultimately result in an emotionally fulfilling and meaningful (even spiritual for some) experience. There are stories of pregnancy loss, so be aware.

I took one star off because I thought it did feel a bit dated -- this book was published in 2008 and it seems like most of these births took place in the 90s. I wonder how much has changed since then in your typical hospital birth and the traditional medical establishment's approach towards birth. I think some of the things she talks about as unusual in a hospital setting have since been more widely adopted (eg, rooming baby in with mom).

[Heather · Rating 1 out of 5]

This book is grossly misnamed.

While I believe the author has good intentions, this book is not what you think it is.

It is definitely not a guide to having a homebirth in a hospital.

The author claims to promote natural, intervention free birth, but literally every single story includes heavily intervention friendly technology, from pitocin to water breaking and everything in between. Most are induction stories, and one is a birth in which a cesarean was chosen( for some valid reasons, I’m just not sure why it was included here).

Homebirths are hands off as much as possible, and this provider is absolutely the opposite.

What this book does teach is to abandon birth plans, and if your provider discusses an option with you- you probably need to do it regardless of how you really feel, since at the least, benefits and risks were explained.

This book does not advocate for autonomy in birth- almost at all.

[Lucy · Rating 4 out of 5]

This is written by a midwife who works in a hospital with a collection of stories of people's experience doing births with less medication and interventions while still being a hospital. Another good read!

[Kelly Knopf · Rating 4 out of 5]

Great book! Loved all the birth stories shared from a more natural perspective within the hospital. I was expecting some of them to be even more natural but still a great read overall! Birth stories are so helpful and eye opening!

[Katieloowho · Rating 4 out of 5]

A good point of view on ways to make hospital births more respectful and compassionate.

[Greta Slabach · Rating 5 out of 5]

Loved the stories of real hospital births conducted in natural, more homebirth-like ways from the perspective of both the women laboring and their doula/medical caregiver. So beautiful and exciting.

[Julie · Rating 3 out of 5]

Not really as advertised. She does have a good perspective as a doctor who believes in the "midwife model of care", but the book really doesn't contain a lot of information. After 17 pages of introduction, and 13 pages of good information, most of the rest of the book is a series of personal experiences that really DON'T support what she's stated previously. She has about 10 pages at the end that are supposed to be for doctors.

Among her 13 good pages is perhaps the best advice for choosing a good doctor: most doctors will tell you that they'll let you choose, but if you pick somebody who's big on epidurals or episiotomies or pit that's probably what you'll get in the end. She talks about what to ask and how to tell if that's REALLY the doctor (or midwife) you want.

After saying 85-95% of babies can be delivered safely under the "midwife model of care" with no surgery or instruments and minimal interference, and talking about how well mother nature usually takes care of things without people messing it up with drugs or other interventions, every single one of her specific stories of birth give continuous examples of the opposite: women who for different reasons couldn't cope or had complications and wanted or needed drugs, interventions, or had a really difficult time. I found it a really negative collection of experiences, overall. You get the impression that homebirth or midwife-style are a nice idea but not really practical, and you might as well throw out what you want because you won't get it anyway. "Burn the birth plan", indeed! The insidious thing is she still seems like she supports natural birth, but leaves the reader with a negative impression of it. This is alarming to me because lack of confidence that natural birth is possible or desirable can actually change birth outcomes, and these stories are more likely to break down confidence rather than build it up.

That being said, she does have some really good information about how to make a desired natural birth more likely in a hospital system that overall is not really supportive of natural birth. (pg 17-29)

Many natural childbirth books and methods neglect this information, and many couples study these diligently and plan an ideal birth only to find at labor time that the doctor is not really as supportive as s/he seemed (or just isn't there) and unbendable hospital policies get in the way of what was wanted. She has some nice pointers for how to choose providers that really are supportive of natural childbirth, instead of claiming to be, but then claiming a bunch of intervention is "necessary" when the time comes.

(pg 30-31) is a checklist of questions to help evaluate potential providers, probably the most useful and concise part of the whole book

[Lynne · Rating 4 out of 5]

My doula gave me this book to read. I think that the title is a bit misleading, but for someone like me, this really was an excellent book to read for my upcoming labor/delivery. This book is NOT for someone who wants a true home birth. This is for the person who would like as many aspects as possible of a home birth in a hospital setting, for whatever reason. In many of the cases in the book, the women had some kind of risk that left a true home birth out of the question. That is the type of person whom this book is aimed at. In my own case, I have a history of high blood pressure in all of my previous pregnancies, and we can only expect the same to happen in this current one. For me, a hospital birth is the only really logical way to go (in both cases in the past, I had complications that would have been dangerous at home, and I am grateful that I was in a setting where I could be helped rather than having to quickly transfer to a hospital). But this book gives me some ideas as to how to keep my labor/delivery as un-medicalized as possible given the complication that I have.

One thing that Dr. Kerr includes among the stories are commentary about where things might have gone differently. For instance, in a situation where the nurse offers pain medication, she comments that this is what the nurses have to offer. Just because they are offering does not mean that they are "pushing" it, it's just that they only have the tools that they have. Bringing your own tools to the party, so to speak, gives you the ability to make more decisions for yourself.

I read this right before also reading "Birth Happy" by Margie Brandquist, which is so new it is not on Goodreads yet. The books go very well together, as Homebirth in the Hospital gave me ideas for trying to keep my labor and delivery as un-medicalized as possibe, while Birth Happy was a great guide to create a "wish list" (as opposed to a Birth Plan).

If you're able to do and want to do a home birth, then by all means, you should do so! (and this book isn't the book for you!). But if you're like me and would like to keep better control of your birth process while doing so in a hospital setting, I would definitely recommend this book.

[Yana · Rating 4 out of 5]

I find it interesting that this book has so many negative reviews, including many disappointed that it doesn't tell you "how to have a completely natural birth in a hospital setting", since this book does not advertise itself as being that kind of guide. Instead, this book is about how to integrate natural and medical birthing methods and to use just the right amount of medical interventions in order to achieve the ultimate goal of a safe, healthy, and positive delivery.

There is a lot of influence here from natural birthing champions like Ina May Gaskin, and the book is even written in the same format as her "Guide to Chidbirth", with a focus on first-person birthing stories. It's for those of us who love Gaskin's ideas of birthing without fear and respecting the mind/body connection, and want to have as much of that in the hospital as possible, but understand that sometimes there is a time and a place for medical interventions. It's for those of us who want to have a homebirth and don't want doctors to induce and speed up our labors, but understand that sometimes that's unavoidable.

I kept thinking about this book in reflecting on my own labor & delivery story of my firstborn. It involved many unmedical elements such as a doula, unassisted water breaking and labor, eating as much food as I wanted, not being hooked up to a constant monitor (even though I was supposed to...) or IV, and using all kinds of natural pain relief like baths/showers. But it also involved 5 hours of pushing that led me to cry for an epidural when I was exhausted, with a beautiful nap and then coming back to pushing with a dose of pitocin. That epidural gave me the energy to push through and avoid a c-section, and have a happy healthy baby. My doula and I agreed this was a true homebirth in the hospital in that I got to have the environment I wanted and avoided most medical interventions, and then finally used a medical intervention to help my body do what it needed to do and not go into surgery.

I was happy with my experience, and I think this book helped me understand that you can be happy with your hospital birth even if it doesn't go the perfectly natural route you might be hoping for.

[Liz · Rating 2 out of 5]

This book started off so well and was so disappointing in the end. I like the premise that the author tries to establish in the beginning: birth can be an integrative process that can be both natural and safe. You can have an empowering and natural childbirth while in the 'safety net' environment of a hospital.

But really... she ends up contradicting herself with the 15 birth stories told throughout the birth. She attended all of them, and she often talks about all of the interventions she performed to "save" the baby. Some of the births she describes were downright traumatic horror stories, with all sorts of ill effects from narcotics, epidurals, pitocin, etc. She talked about breaking a woman's waters as a completely safe way to "help Mother Nature along," even when a baby's head isn't engaged in the pelvis (even though this actually can lead to the life-threatening complication of a cord prolapse). She mentions giving one of the mothers an episiotomy that she later admits wasn't necessary. She mentions a mantra at her practice several times of "Burn the Birth Plan!", which seemed to mean that if women would just lower their expectations of birth and allow her to manage it extensively and intervene excessively, women would have a better birth experience. It almost seemed to suggest that if you expect a traumatic birth, then you won't be disappointed.

Overall, I agree with the premise that women should be treated on an individual basis and not according to hospital protocols or a doctor's preconceived ideas of how things should go, but the OB writing this did not do a good job of illustrating how this would be possible. In the end, I came away with the feeling that, while an empowering experience in a hospital is possible, it requires a provider who is willing to actually listen to you and not bully you into the experience he/she believes you need when evidence would dictate to the contrary. And the author of this book would not be my first (or 3,567th) choice.

[Becky · Rating 5 out of 5]

Initially I didn't understand the purpose of the book, or when the author was going to give advice and not just tell birth stories. But when I realized she was doing both at the same time, I appreciate the different style of birth book. It was nice to read as someone who is definitely delivering in a hospital, but interested in natural techniques. Also to see how nature can still have a place despite cases that require medical intervention.

[Jennifer Jones · Rating 1 out of 5]

Written by a physician who traveled an unlikely path to becoming a doctor, the title of this book would indicate that the context is focused on how to have a patient-directed birth in a hospital setting. This is not the case. The book starts off with good intentions and the background of the author is quite interesting - she lived a bit of a hippie life and had two natural births herself before attending medical school and becoming a physician. She strongly believes in the midwife model of care and delivery, with little interference in the birth process, and cites Ina May in a few places, having spent time on The Farm in Tennessee.

But, the rest of the book is a compilation of birth stories from people who have given birth in hospital settings without offering any helpful information. There is no information on options in a hospital, no information on what a patient may be confronted with when entering a hospital setting, no insight provided to the reader on how to work within the hospital system to have a patient-directed birth. I found this book completely useless.

If you're looking for a book that offers information that may be helpful to you in regards to a natural birth in a hospital setting, try Pushed by Jennifer Block. Pushed gives the reader useful information and sparks questions you may want to ask your healthcare provider by offering a variety of birthing scenarios. If the reader knows what kind of birth they desire, and how and why a hospital functions the way it does, the reader can ask the appropriate questions of their care provider. Pushed offers this information, Homebirth in the Hospital does not.

[Danielle Sullivan · Rating 3 out of 5]

A family physician interested in promoting natural childbirth collects 15 stories from patients of hers who tried to have a birth as close to natural as possible in a hospital setting. I borrowed this from the midwives at my last appointment because it seemed to discuss the very thing we're hoping to do when I give birth.

The physician herself is trained in the midwife model and promotes it, but almost all of the birth stories collected here are full of medical interventions, and not what you'd usually call natural births. On the one hand, the book was very helpful for me in thinking about what interventions might be okay for me in which circumstances, and why interventions might be medically necessary in some sporadic cases. At the same time, it was frustrating to read about doctors, nurses, and other hospital staff who were unsupportive of natural birth, who wanted to intervene in the process without good reasons, and who generally made the jobs of the laboring woman and her partner much more difficult than they needed to be.

I'm already worried enough about being unsupported in my birth that I'm worried this book might have done more damage than good. It's disappointing to pick up a book that purports to support the midwifery model and then stomps all over it at every step.

[V · Rating 5 out of 5]

This was the single best book I read to prepare myself for giving birth. It's basically a collection of birth stories, with the perspective that each mother wanted to give birth with the "homebirth" mentality -- in general, as intervention-free as appropriate -- but in a hospital. The stories range from "completely natural" deliveries to Caesarean births, and a major theme that echoes through that book is that even when unplanned, interventions are an appropriate part of an "integrative birth" when the family has understood them in context and has accepted them. That was my biggest take-away and what helped me most in my own delivery (which did NOT go according to plan).

I also appreciated reading so many stories because I got to hear about some of the "side effects" that for some reason no one tells you about (like, it's common for women in labor vomit). Toward the end of my labor, I was shaking violently (just from the contractions), and a nurse told me it was normal, but it was that fact that I'd already seen it in print that helped me not be too terrified by it.

It's also a good easy read for your commute, etc, since the stories are independent.

[Crystal · Rating 3 out of 5]

This book was recommended by a friend after my dream of a homebirth fell through due to pregnancy complications. This book was written by an OB who stives to provide as close to the mdiwife model of care as possible in what is a highly medical setting.

I had high hopes for this book, and was expecting practical advice that would help me achieve a more natural, family-centered birth in a hospital setting. Instead, it consisted of a short chapter of advice on how to choose your care provider (which could be valuable, but was nothing I hadn't come across before, and nothing that truly helps if you have a "bait-and-switch" OB) followed by the birth stories of women who she cared for. I was surprised by the interventions in so many of these "natural" births -- inductions, pitocin to augment labor, artificial rupturing of the membranes, nubain and epidurals, etc. This book just wasn't what I was expecting, nor was it was I was needing in my search to learn whatever I can to empower myself to have as natural of a birth as possible while in a hospital setting.

[Maralyn · Rating 2 out of 5]

I liked the idea of this book better than I liked the actual book. It was just a bunch of birth stories, mostly from the mothers' points of view, which I guess I didn't really expect. Sure, some of them were helpful, but certainly not life-changing.

When it comes to birth, I agree with the philosophy--that integrative medicine is a healthy blend of having faith in the ability of the human body while being ready to accept the miracle of modern medicinal advances when necessary. In theory, it's a perfect, balanced approach and the author had a good take on this. I'm glad I read the book because the birth stories were positive reinforcements of ridding fear and setting informed goals, all while being willing to peacefully accept unexpected pathways; hopefully that helps somewhat with my next birth experience. That said, I'm not sure it had much of a significant or lasting effect on me. It was kind of superficial and I had hoped for more depth in terms of content.

And it definitely wasn't spewing out any real scientific knowledge on the subject.

[Christina · Rating 3 out of 5]

Written by a physician who wants to give more midwife care, this book was realistic in its approach to birth. With an obvious bias towards natural delivery, the birth stories also included stories of women who needed intervention and how that went for them. I like the realistic approach.

My one problem with the book, and maybe I just have had exceptionally good doctors, is that the author goes on and on about her philosophy of care and how she allows women in her practice to make their own decisions and such, yet she only shows up for the last twenty minutes to catch the baby. I couldn't help thinking, "how is that different than the experience I've had with three different doctors? They've all been just as supportive of how I wanted to birth and that's how long I saw them, too." But perhaps her ideas are less mainstream in other areas of the country.

[Emily · Rating 1 out of 5]

I read this while thinking about where I want to give birth this time. I was also interested in it as a possible book to lend to my clients, since I work as a doula. Unfortunately, the title is a misnomer. The book begins with a short and interesting memoir of how the author became a doctor, but the majority of the book is made up of birth stories. And far from being natural or anything like homebirth, every story includes interventions, pain medications, epidurals, inductions, you name it. I honestly had a hard time finishing the book because it was so depressing. The author meant these to be positive stories, and clearly thinks that they are examples of "homebirth in the hospital" but I have had a homebirth and assisted at others; these were nothing like it. I definitely can't recommend this book to clients. And I think I will birth my growing baby at home.

[Laura]

The title is a misnomer in that nearly all of the birth stories presented in this collection involve many interventions. In some aspect that was good information for me as a reader in what to realistically anticipate with a hospital birth. I was a bit disappointed though that the narratives seemed to recount many details about the process of labor and delivery but didn't elaborate much on the emotional process that happened during some of the choices or hospital protocol other than brief acknowledgment ("I was disappointed I couldn't start labor on my own." or "I wish my doctor had been there other than a stranger with a power trip.") For the most part, I found these stories a bit generic (what I would find on blogs about giving birth) and not enough practical advice to advocate for myself and an integrative birth in a hospital setting.

[Rori · Rating 4 out of 5]

I was relieved to find out that there are physicians (or at least one) interested in providing midwifery-model care in the hospital environment. I enjoyed reading Kerr's perspective on maternity care and the birth stories she provided. I wish more physicians had her mindset and were willing to provide this style of care. Unfortunately I think she is the exception rather than the rule, and her advice may be incredibly difficult to follow depending on one's location. However, I am glad that she provides this resource for families, including appropriate questions to ask a potential provider, and the importance of taking labor and birth one step at a time and not expecting it to follow a set plan.

[Laura Dallas · Rating 3 out of 5]

The author lived on The Farm, a well-established commune that includes well-known midwives, and then went to medical school, so she is well qualified. The short introduction summarizes the title but much of it I already knew from other books. the rest of the book is birth stories. I found a few to be helpful, encouraging, and humorous. The others were mostly about complications in childbirth and how medical interventions can help. Many of them are special cases that did not apply to me so I skipped them. There is a short end chapter written to medical professionals. I am fortunate that my hospital already uses many of these suggestions, but if yours doesn't, you might find this book helpful. Otherwise, I would recommend Ina May Gaskin's books over this one.

[Sarah Milner · Rating 4 out of 5]

I'm tending to agree with the other reviews I have seen posted. I enjoyed it, simply because I love to read women's birth stories. But if you picked this up thinking she would give you advice concerning how to advocate for yourself, you would be mistaken. And there were a TON of interventions that surprised me - not that medical interventions aren't a good thing, when done in communication with the mom and birth team. And perhaps the audience she is writing this book for, this is as natural as it gets.

In all, it was decent. Just don't expect to walk away having a checklist of questions for the hospital, concerning their procedures.

[Bridget Jeffries · Rating 2 out of 5]

Dr. Kerr seems like a really sweet woman. I really, really wanted to like her book, which is a collection of personal essays by her patients concerning their hospital births. However, there was just too much “hospital” and not enough “homebirth,” IMO. What I mean is, too many of the stories involved entirely elective or unnecessary interventions. Several of them involved women who never would have been good candidates for homebirth to begin with. As I said above, I’m not an NCB/homebirth advocate, but this book did not leave me particularly reassured on the prospects of having a natural childbirth in the hospital.

[Janie · Rating 3 out of 5]

This is not about how to have an intervention-free birth in a hospital. This is primarily a collection of birth stories written by birthmoms. Most of the births run into complications. Most are augmented. Some are extreme, medical events.

I like reading birth stories so I thought it was great, even though it's nothing like I would want for myself.

I learned how much hospital policy -- beyond personality, outlook, and experience of the OBs and nurses -- determines what may happen in a hospital birth.

[Christina Kaslow-trujillo · Rating 2 out of 5]

the very beginning is wonderful. its a great introduction however most of the book is comprised of birth stories. stories I would never advise a first time mom to read or any mom interested in this to read. births filled with pain and fear. the book also lacks the how to or a detailed information on how to actually go about having this homebirth in a hospital; ie which protocols are and arnt necessary or what can be fought. ie: delayed cord clamping, lighting, suctioning, immediate skin to skin...