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Tuesday, August 2, 2011

on home birth

little miss helping to examine mama at a
midwives appointment
To start off, I am not one to set off debates. I was the peacemaker in my family. Come on, can we ALL JUST GET ALONG?? Confrontation and heated debates make me very edgy. Ask my husband. His family has a tendency to talk, joke, argue LOUD. When we first got married I would be in tears over a discussion on where to go for dinner. "Do you have to YELL at me???" So, I don't write about a lot of topics here that might get people's goats. (And I do have strong opinions about things for sure.) I want mamas to find common ground, rather than circle the wagons over the rifts we create in our parenting journeys. 

The thing is though, in order to write about little missy girl's birth I need to tell you about our choice to do a home birth and the reasons why we chose home birth.

So. Here you go.

At first I thought about entitling this post "in defense" of home birth but I hate to start out assuming a defensive stance when it comes to our birth choice. That said, even if people are supportive of our choice I often get a lot of well, curiousity, I guess. How does THAT work? Kind of sentiment. So I think that is what I mean by defending it.

Now that all that is out of the way.

So, where we left off, little man's story, is where we would have to pick up again. A c-section. That I was very unhappy about, for weeks, months, after. The recovery was hard, sure, but it wasn't that. It was that I felt tricked into getting one. I couldv'e done it, if they had given me the time to labor. I am SURE of that. I felt, frankly, gypped, ripped off. Like I had spent months and months training for a marathon, then hours and hours running, only to be politely stopped before the final stretch and told "Your body can't handle this. Sorry, no more running." And, in case you havent picked up on it, I am a stubborn bee-atch. I don't like being told I CAN'T do something.

So it stung me, for a long time. At my six week check up my OB (who wasn't there to deliver little man, as they had a rotating provider service, something I didnt realize until nearly at my due date! DUH.) told me that I would be a "perfect candidate" for "trying" a VBAC (vaginal birth after cesarean). I was relieved to hear this and told myself that is what we would do when baby #2 came along.

Two years later, at 9 weeks pregnant, I sat in her office HORRIFIED listening to her tell me about all the "risks" of VBAC, how I would be "allowed" a "trial labor" and the long list of conditions that would be required for me to be granted this generosity (I couldnt be a single day past my due date, I couldn't need pitocin, and the baby couldn't be estimated to be a "big" baby - even though these estimations are routinely waaaaaaay off, not to mention, whose idea of "big" we would be following)

My heart sank as the list grew. Her whole attitude reeked of negativity. How was I going to manage a VBAC with a doctor like that?

I left the office shaking and called dada in tears. I was NOT going to birth with these people breathing down my neck, telling me what to do, putting all this fear in me. I needed support. Love. People who believed in me and believed in my body's ability to push a baby out!

Luckily we had started networking with a group of "hippy" "alternative" "non-traditional" parenting folks in our area and knew of many people who had home-birthed or worked with midwives in a hospital setting.

I went to a play group with some of these mamas the next week and timidly starting asking about midwives and home birth midwives in the area.

Dada and I had never seriously considered it before this moment. Midwives in a hospital, sure. I could do that. But, at home? Ew, right? And then all the dreadful what-ifs that run through your head. Why risk that, right?

But the thing we started to realize was, well, the risk of intervention is greater at a hospital, and those interventions cause more risks than the likelihood of needing real life-saving immediate interventions in a home birth.

First, I called around to midwife programs at various hospitals. Surprisingly I got the same schtick from all of them about VBACs being "allowed" under various conditions. Also I learned most of these worked under the guidance of OBs who would be the ultimate authority when it came to whether or not I would be "allowed." Been there, done that, no thank you.

So, we started calling to interview homebirth midwives and I started reading and doing mad research on VBAC safety, homebirth safety.

Here is what I came up with that swayed me:
The risk of infection, maternal death, or accidental cutting of an infant by having a repeat C-section is GREATER - by far - than the risk of uterine rupture, the big scary complication doctors like to talk about. In this study of 11,000 women attempting VBACs 5 out of 1,000 women experienced rupture and 3 out of 1,000 experienced partial rupture. There was one infant death in these ruptures. The primary reason for ruptures when they did occur was due to the use of pitocin to augment labor.

In addition, 30% of women develop a life threatening infection following a cesarean and the maternal death rate for women undergoing cesarean is TWICE as high as for those giving birth vaginally. (see here for more stats)

You see where I am going with this. Not to scare people about c-section, it can save lives and is legimately needed in some cases (my own sister needed one, and I am glad the technology is there to help her and those like her!) but it IS a dangerous procedure and much overused in our society, out of convenience sometimes!

I was going to avoid it, and by doing so, by choosing home birth, I learned SO much about myself, as a woman, powerful and capable, and as a human, designed beautifully to give birth.

Here is where I have to interrupt myself. I am all for choice in birth. You feel safer in a hospital? Go for it. Some women like that reassurance, knowing that all that technology and medical prowess is available for the what-ifs. For me though, I feel less safe in that environment. I look around and see all kinds of power displays and personalities and sheer moneymaking that impacts MY child's birth, and I don't like that.

But I respect other people's choices, honestly I do. You have to birth where you feel empowered and respected. If you find that in a hospital setting - as millions of women do every year - then that IS the best place for you.

So, to the questions we get about home birth...

Many people, some close to us, questioned our decision. But when we laid out the stats above and answered a few questions, well, it became clear this was not a decision we were taking lightly.

1) What about the WHAT IFs? In case of emergency we have state of the art Children's Hospital (where little miss was well cared for recently) just a few minutes away. In the time it would take us to get there our midwives would call ahead and they would easily be prepared for whatever emergency we faced.

2) But really, what IF???? Okay, so down to the nitty gritty, our midwives have been delivering babies for decades (in and out of hospital settings) and are trained and equipped for infant recucsitation, post-partum bleeding, and more. And, lets be frank, if there was some reason to suspect at all that my delivery was out of the norm I WOULD transfer to a hospital (such as early delivery - before 37 weeks - or if I developed high blood pressure or other signs of pre-eclampsia, etc etc) My midwives help help consult with us about the need for that, if anything out of the ordinary develops.

3) But, my endocrinologist asked recently, isn't it so messy and gross?? Ummm. You know, I dont really remember. By the time the haze of birth had passed my mom and midwives had washed up any bloody sheets (just a 1/4 cup of hydrogen peroxide per load gets any stains out) cleaned up supplies used and done the dishes to boot.

4) What about all the stuff you need? They sell home birth kits all over the internet with all the pads and gloves and everything you could need. Simple.

5) But, really, is it safe? There are several small studies showing that it is actually safer. A study done in Germany found that out of 1,148 planned home births the perinatal mortality rate was 5.4 per 1,000 at home. The hospital PMR was 27.8 per 1,000 (low-risk, normal) births, that is, factoring out high risk births that might give birth at the hospital out of necessity. The same study documented better outcomes for births at home as well "The percentage of infants born with breathing difficulties (9.3% in hospital versus 3.3% at home), the death rate associated with breathing difficulties (0.94% versus 0.19%), and the transfer rate to neonatal intensive care units for infants with breathing problems who survived six hours (62.0% versus 26.2%) were all higher in the hospital (all p<0.001), further evidence that hospital interventions do not avert poor outcomes"

6) But, but.... well, huh. Really? Yes. Really.

And here is the thing. Birth is natural. It is a function of the female body, like digestion, it happens without needing - most of the time - intervention. So, why surround yourself with an environment that is more conducive to intervention?

And, well, I loved giving birth at home. I was able to labor all around my house in the middle of the night with no worries about little man, who was two at the time and asleep. And when it came time, I gave birth on the pull-out couch in our family room, in front of the fire on a cold February day. And after she came, quietly cooing into the world, I was able to lay there, in my home, with no pokes or prods, for a few hours, enjoying my baby. Little man, just awake from his nap, came down in dada's arms to meet missy girl. And then, when I was ready, I hobbled to the shower, got cleaned up, and collapsed in my own bed for a well-deserved night's sleep.

new little family of four
 The next day I was checked on by our returning midwives, with an examination for baby too, and then again in a few days, and in another week. I didn't have to do anything or go anywhere. No one poking me in the middle of the night. No fear of getting a "mean nurse" on rotation. No worries of whether or not my OB would be on vacation. No visiting hours. No student doctors. No hospital food. No sleeping on a chair for dada. No separation from little man. Just us, in our little home, welcoming our little friend into the world.

two of our midwives checking on mama and baby, little man
(so little!) getting out "tools" to "help"
 And I didn't even mention the differences in prenatal care! Appointments where they hug you, give you tea, and play half the time with your precocious two year old. Asking YOU what YOU think about how things are going, or whether you WANT a certain test or not. I mean, I recently texted one of my midwives about whether or not a certain sleep aid was safe. And she texted me back while I was still in the store!

So, that is that. If you want here are a few books I read while researching all this. (Pushed, by Jennifer Block, Misconceptions, by Naomi Wolf and The Thinking Woman's Guide to a Better Birth, by Henci Goer.) And if you have any questions I am happy to answer...its a curious thing to consider in our society but, well, I am convinced it is the way to go, for us anyhow.

Hugs and happy births (and birth memories) to all you mamas, regardless of where or how!


  1. What a lovely, well-written post. Home birth was right for me, and I'm so happy I chose it -- despite the fact that my baby was surprise footling breech(!). I still gave birth relatively easily (though certainly not painlessly) without any other complications. I would choose home birth again. I should mention, too, that I did have ultrasounds at a fancy-schmancy place and plenty of medical care during my pregnancy, and the fact that we didn't know the baby had turned is not because I didn't have quality care. The sobering truth for me is that if I'd been in the hospital, I would have had an automatic "emergency" C-section for something that, as it turned out, my body was well-equipped to do.

    I'm all for choice, like you say. So I, too, support women who choose the hospital, and I think the world should also support those who choose home births. And I'm going to use your post as one more reference when people ask me why I chose what I did. Thanks!

  2. Our insurance wouldn't cover a homebirth... so I did car instead. :P Seriously though next time I really want to do a HB, I hate being at the hospital feeling like I can't make my own decisions or decisions for my baby.

    Can't wait to read your third story!

  3. Loved this. And you're so good at getting your opinion across nicely and gracefully without being polarizing (which is something I still need to learn).

  4. I loved reading this, Sara. I suspect that E. Chikeles will never have a baby in a hospital again if she can help it. Really though, even though we didn't plan for her to deliver in my car, it was easier than after the birth when she was bombarded about every fifteen minutes by someone else who needed to check something else - and this was in a hospital known to be a bit more hippy hands off friendly! (Like that run on sentence?) Anyway, prior to this my experiences with home birth were not the greatest, but having been forced to go through our latest experience with Beth I'd have to say I've definitely swayed in a different direction. Thanks for sharing.

  5. this is great Sara - after working in RH issues in the developing world, and reading so much... a home birth to me seems so normal, that i wonder why so many women in the US who have this as an option dont chose it... thanks for sharing your story:)

  6. jenny - thanks for your comments...and you are so right, we need to work toward better awareness of birth options, that home birth is viable and safe and a good choice for most!
    allison - thanks, like i said, i run from confrontation. HA HA.
    beth - HA HA. you would be surprised at how flexible many midwives are in terms of payments. we are lucky, our insurance pays every cent...and then some...but many midwives will accept payment plans and are very reasonably priced. you definitely should look into it for baby 3 (if baby #3 happens that is. one at a time, right? HA)
    tammy - such a crazy story, beths birth! and yes, it is a great option! like anything there are good and bad experiences but i'd say i have heard far more positive home birth stories...

  7. sarah - i would love to talk with you about your experiences with maternal health care in india! we need to get together when you get back!!

  8. Great Commentary/ story for women to read! Birth is our vision quest. When we get to make our own informed choices we grow from the experience and become better mom's. Midwife in SP, ID

  9. The local hospital is actually baby-friendly, so it wasn't a big deal to do a hospital birth. (Being in an apartment, I'm sure the neighbours appreciated that the 2am screaming wasn't at our place). I don't know what I'll do when/if there's another baby after we move.

    The best part about having a midwife for my birth was that I really didn't have to worry when labour seemed to be going really quickly. You never have to choose between having the baby without medical personnel on hand or risking a car birth.

  10. ha. no worries for car birth here in any case melissa. my births take FOREVER. ha. thanks for reading :)


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