Homebirth has once again come up as the hot topic du jour, and Jamie (the blogger, not the toddler) has written with her usual eloquence on the subject. (Do go and read the post if you haven't already. Apart from anything else, it's the only way you'll ever find out what the title of this post means, since I'm too lazy to explain it.)
If anyone was thinking "Oh, brilliant - now we can get a doctor's opinion on the subject!" then I'm afraid you're going to be disappointed, since I'm not going to weigh in with my own opinions.* This is because I've already written my comments on the original post, and there simply isn't anything left for me to say on the subject right now that Jamie hasn't already said more articulately and with better references than I could manage. I'm posting purely for a bit of reminiscing about my own personal decisions on the subject, in response to Jamie's question (the fourth and non-rhetorical question, that is).
Yes, I would consider and have considered a homebirth, although I didn't have one and probably won't - my son was born in a birthing centre, and Hoped-For Sibling most likely will be as well. My reasons (for considering homebirth, and for not choosing it) are not going to add much to the philosophy of this debate, as they're entirely practical. I have a pragmatic approach to birth - for me, it's about getting a baby out of my body with the minimum short- and long-term unpleasantness to me and to the baby. I'm not out for some kind of deeply spiritual experience in which I explore the core of my essential womanness, but I do have a strong preference for avoiding incisions in my abdomen or genitals, needles in my spine, the possible side-effects of opiates, and other similarly unattractive prospects. In other words, I did not make my decisions in order to have a good experience, as the Neonatal Doc scornfully comments; I made them in an attempt to avoid bad experiences.
This meant that hospital promptly went to the bottom of the list, for starters. Avoiding opiates (Pethidine or epidurals) is a pretty effective way of avoiding opiate side-effects, and there is evidence that it may reduce the risk of Caesarean/forceps/vacuum delivery. Whether I'd be able to deal with an opiate-free labour was something I obviously couldn't know in advance, but I felt it made sense to maximise my chances as much as possible, and one way of doing this was to make it harder for me to get the darned things. I knew I could transfer to hospital if the pain became too much for me to bear, but I figured that if I was tempted to go for the epidural when the going got tough, it would be less tempting if I knew that it involved getting in an ambulance and going somewhere else rather than just asking. Besides, hospitals are full of sick people, which means they're full of germs, which didn't strike me as the environment to which I most wanted a brand-new baby exposed.
If there hadn't been a local birthing centre, homebirth would therefore have taken the top slot by default. However, since there was, that was the option I preferred. This wasn't so much because I cared at which of the two places the actual birth took place, but because the after-effects of birth were hopefully going to include the need to take care of a newborn. This was a decidedly alarming prospect. Personally, I felt a lot more comfortable about the thought of spending the first day or two in the company of people who had more experience of the task than me. I know that midwives come round to the house to check on you after a homebirth; I know that they'd only be a phone call away if I wanted any advice; but, as a novice parent, I felt a lot easier in myself knowing that I could speak to someone in person just by shuffling into the next room.
For the prospective second time around, I'm still approaching the decision pragmatically, but obviously the factors under consideration are somewhat different. On the one hand, having had one baby, I have enough of a clue about their care that I feel comfortable with the thought of muddling along between midwife visits. On the other hand, I also have more experience in giving birth than I did before, and managing one labour has left me with a lot more confidence in my ability to manage another; I no longer feel that a hospital birth would have me yelling for the painkillers just because they were there. So neither of those factors is going to play a part in my decision.
The main factor next time around is going to be my husband's utter opposition to the idea of homebirth (which obviously existed last time around as well, but wasn't really an issue then since I preferred the idea of the birthing centre anyway). I honestly don't care all that much any more where the birth takes place, as long as it can do so with the minimum of hassle, so, unless health factors in the next pregnancy make the decision for me, it is going to boil down largely to whether arguing the homebirth case with my husband is going to be more or less difficult than getting to somewhere other than my home while in labour. Currently, the latter option looks decidedly better (although if the rumoured closure of the local hospital, which houses the homebirth unit, actually takes place, that decision might start looking considerably different). Another factor is Jamie (the toddler, not the blogger) - I yelled uncontrollably through the end of my labour, and I think that's something he'd find very frightening if I was within earshot of him this time. So, all in all, a birthing centre is currently my top choice for next time around as well.
By the way, in case you're interested, last time went spectacularly well. I had a straightforward, opiate-free, manageable labour with a hasty last-minute journey to the birthing centre when things went faster than I'd expected and a normal, uncomplicated delivery half an hour after that. I could not have wished for better. I honestly don't care all that much where my next delivery takes place - if it goes as smoothly as my last one, then it will be an experience that I will be extremely happy with.
*I do, however, want to correct Jamie on one point. I know I must have had detailed knowledge of the Krebs cycle at one point, because that was the only way anybody ever passed first-year biochemistry. But if you think that my knowledge can accurately be described in the present tense, then, dude, you're being waaaaay optimistic.