Thursday, January 8, 2009

"Why Would You Choose a Homebirth?"

I have a friend I went to college with that I have recently reconnected with through Facebook. He and his wife are pregnant with their 3rd baby. I told him about our last two babies being born at home and I just wanted to share some of our dialogue:

"Let me ask you - and this is for my education only - but if you could have your babies at a hospital, with all the necessary staff and equipment standing by should anything bad happen, why wouldn't you? Seriously, just curious."

I wrote back:

"Good question. After teaching for almost 6 years and reading dozens of books on childbirth, I believe that what makes birth dangerous is all the interventions and drugs. When you know how your body works, along with the baby, in labor and birth, even a single intervention can interfere with that delicate process. I am also convinced that what makes birth "dangerous" is all the media and junk that we believe about it. ER has really done a number on our perceptions! Birth is a normal, healthy process that a woman doesn't need to be "delivered" or rescued from. We had midwives attend 3 out of 4 of our births, and they do have "necessary equipment" on hand. I just don't believe that birth is an emergency waiting to happen.

You and your wife should rent (Netflix) "The Business of Being Born" before you have this baby. You will find it fascinating. There have been lots of birth movies released this last year, but I think this is still my favorite one. Enjoy!"

I have found something interesting over the years: Women love to share their (mostly) horrific birth stories with other women, usually at those wonderful baby showers. Almost like they are trying to out do one another! About 3 years ago, I was at a dinner with several women, none of which I knew very well. One was pregnant and was commenting, "Why is it that everyone wants to tell you their worst birth story when you are pregnant?!" She was laughing about it and I told her that I could tell her story after story of wonderful birth stories, but they don't involve medication and intervention. The entire table got quiet. Not because they were dying to hear these moving stories, but because of the awkwardness. It was one of those "baby shower" moments for me.

Let's face it: We love the drama. Normal, unmedicated birth lacks drama. It's a lot of things, but "dramatic" typically isn't one of them. I've probably told hundreds of people over the years that I have my babies at home. I have found something so fascinating about that: They don't ask for details. Wouldn't you think that people would ask, "Wow, what was that like?" They don't.

People want to think that they need the hospital and all the "necessary equipment." It validates their birth choices. Plus, they just spent a lot of money on this birth in the hospital. They need to believe that all the interventions were necessary in order for their baby to be born. It's hard to accept that it would have just happened naturally without all the "professionals" helping to remove the baby from it's mother's body. I spent $2500 on both of our homebirths. (Yes, that includes pre-natal, birth, and postpartum.)

I have been called irresponsible a time or two. When you give birth in a hospital, choices are made for you. Your opinion is often not even asked for. (Ex: Do you know why your baby was given the eye drops? Probably not, it was just done.) When you give birth at home, you are making decisions about every thing that happens there, even what to do with the placenta. You have to be educated. I had to accept much more responsibility in my homebirths than my hospital births.

I have also been told on occasion, things like, "My baby would have died if I would have had him at home" or "I would have died if I had tried that." Again, however, as I've stated before, most of the time, the reason for those complications, usually trace back to the interventions or the drugs. Their births likely were safe until they started intervening with the natural process. That is what makes birth dangerous.

I absolutely believe that home is more safe than a hospital to birth your baby. The hospital staff just cannot seem to leave things alone. Even if you are not having drugs, you are having vaginal exams, (usually) excessive fetal monitoring, often an IV, and ultimately you have a bunch of clock watchers. This leads to problems, such as the use of forceps or vacuum extraction of the baby or a C-section.

It is important to note that in order to give birth at home, you must meet certain "criteria" and be low risk, as more than 90% of women are. There are so many competent, compassionate, wonderful midwives out there. Interview them. Find out how wonderful your birth can be. For the umpteenth time: Trust your body. It grew the baby, it will birth the baby. As one of our midwives said, "Birth is 90% in your head and 10% what happens to you." I believe this.


Sarah said...

In general, I totally agree with your statement about interventions and drugs being the things that make birth dangerous. I also agree that we create our own drama by being uneducated or unprepared to deal with the things we'll face birthing in the hospital. And, like you, I've noticed that horrific drama wins when stories are passed around. There are some people who, deep down, really *want* the drama; *not* a good experience. Sometimes even at the expense of their baby's well-being. I've observed this with people I know in pregnancy and birth. It's sickening.
It's also a shame that women who have experienced too-interveined-in situations are mentally handicapped from making different choices the next time. It's like they're brainwashed to think their bodies don't/won't work right and they should never have less intervention, only more, "because of what happened last time." They don't consider the possibility that the interventions may have caused the emergency they encountered, that they may have had a no-frills birth had it not been for everything the hospital did to them. Being so glad they didn't have that baby at home because "my baby would have died, since I needed a c-section." As if they needed a c-section the moment they checked into the hospital! Do they really believe this? It's so sad to me what all that drama does to a woman's thinking. Birth can be such an empowering experience, but in these cases,it can be so handicapping.
Keep up the challenging posts!

Leigh said...

Love this post! So well stated. Cheers!

motherly prosody said...

Donna, this is great! I have, count 'em, SIX pregnant friends right now, two of which were told they "had" to have C-sections for their first babies. I send them to your blog for almost every post and will CERTAINLY send them here for this one. Thank you for taking the time to say these things so passionately and eloquently for those who have never heard them!

middle aged mama said...

nice blog. for me, I;d turn the question around, "if you could give birth at home, and feel as safe as possible with whatever choices seemed msot appropriate to your birthingm, your baby, and your body,beand your home seemed the est place, why wouldn;t you birth there?"

Anonymous said...

I check your blog a lot, and I have a question. I have one baby and much of the 'drama' happened to me. After reading your posts, it kind of "clicks" as to why certain things may have happened. I didn't have a C-section but almost had to. I am not one who loves drama, but I just didn't know. question. I plan on having more kids, and honestly, most likely in a hospital again. (don't hate me) What all can I do away with as far as normal procedure at the hospital. You mentioned vaginal exams in this post. Is that mandatory if birthing at a hospital? What are some things you would suggest that I request (or demand) at the hospital next time.

middle aged mama said...

this is for "anonymous" who wants to know what she can request (or demand) in a hospital.

well, it depends on the hospital. so if you know for sure you are birthing at a hospital,visit ahead of time and also talk with women who have given birth there fairly recently to get their experience. nurses, DNMs, doctors all vary greatly as to how much they will listen to your "birth plans" (which I think are more likely "birth wishes" in a lo of cases. andhospital pilicy itself varies from one lace to the next in terms of how much they will customize care.

I;ve worked as a suport person/doula at a local hospital and over the years, there was a real shift in how much the hospital encouraged or supported patient wishes - in fact it changed several times. I honestly think you have to remember you are on THEIR turf there and while elgally they can;t force you to do anything without a court order, there will be pre3ssuer if your choices are :agasinst medical advice" (this is a legal term) or hospital procedure.

so if you are sure you are having a hospital birth and you know that tehre are some aspects of your birth plans that may be controversial - this is where a good doula who represents YOU is important, i feel. you are not going to feel like arguing over how you specified no internal monitoring, for example, when you are 6 or 7 cetimeters dialted and tired, msot likely. you may have decided you didn;t want an epidural and when you are tired and struggling, may eb wavering on it, and they will want to encourage you to take it - if you know in advance that the ebst thng a dould can do for you is to remind you ":you can do it"...there she is. I don;t count on husbands/partners/family memebrs in this respect tha often, though some are fabulous that way - generally as teh fatehr or grandma or aunt or whatever to be, it;s easy to feel overwhelmed at critical times,

I recommend Penny Simkin;s book :The Birth partner" she has a great exercise in tehre where you rate how important each of several possible chioces is for you, then write your birth plan from there. then meet with as many of teh representatives of teh hospital as you can ahead of time to find out whetehr they are going to want to work with you (or see if your insurance will let you choose another facility!) and find a doula or lay midwife working as a doula who will be your advocate.

incidentalyl, I;d disagree that wonderful, noninterventive birth stories are lacking in dramatic appeal - a birth, even a really easy birthing, is always a big deal. anthropologist Robie Davis-FLoyd wrote a book maybe 15 eyars ago called Birth as an American Rite of Passage. for some, the dealing with the medical staff is a big part of the rite,a nd they bond through sharing the gory details of tat. for others, the choices to decline the rituals of eh hospital and use whatever rituals of home birth make sense is the defining rite, and this i why home brthing women like to tell birth stories and bond with one another aroudn THAT (and sometiems get competitive about the "right" wasy to birth at home, besides.)

the only person I know of who died following giving birth in the past 40 years (my parents knew her) died of complications from a Cesarean in teh hospital. it;s rare, but it puts another spin on the "I would have died" canard, if you ask me. she was well prepared and healthy, a schoolteacher with a husband who taught at the same private school, and had been through Lamaze or similar type classes.

anyway, it's not my intention tos care anyone planning a hospital birth; this is RARE as I say.

I AM saying that if you know what you want and want it that deeply, be prepared to work for it and ask lots of questions and have people on your side.

this goes for anyone planning a home birth as well.

Donna Ryan said...

"Anonymous," I loved your comment/question. First of all, let me just tell you how pleased I am that you have picked up some of the reasons for the "drama" in your previous birth through my blog and will do things differently next time around. Been there, done that!

Second, I don't hate you (!!) for wanting to have your next baby in a hospital! If you are not comfortable birthing outside of a hospital, your labor and birth will be harder, not better or easier. Being comfortable with your birth place and attendants play into your "emotional relaxation." You need to do what feels right to you.

Based on what you said in your comment, I assume that you will most likely switch your birth attendant and/or hospital and will not be having medication with the next baby. I assume you had meds the first time around.

With those assumptions in place, I do have some suggestions. First off, in order to avoid as many routines in the hospital as possible, you really need to labor at home as much as possible. Think of birthing at the hospital, not laboring there. No induction, as that automatically puts you on that road of intervention and possible C-section.

You are choosing to birth in the hospital, so there are some routines that will be unavoidable. These include: initial vaginal exam, initial monitoring strip (usually 20 min.), blood pressure check, etc.
Some of these are not such a big deal, but others are. If you are chained to a fetal monitor (EFM) the entire labor, you will not be able to help your baby out with the use of gravity and movement. These are essential to labor. Intermittent monitoring is worth fighting for.

I don't know where you live, and all hospitals have different policies, so it's important that you find out their monitoring policy. This is a legal issue, not a medical one. In fact, medically, you are better off to have intermittent monitoring, usually once an hour through a couple of contractions and between them as well. A baby who is truly in distress will be picked up. EFM has a high false-positive rate and has contributed heavily to our outrageous C-section rate in this country. You will find that hospitals that do not require continuous monitoring have a lower C-section rate. This is often a hospital policy, but it's possible that your doctor or midwife will sign that off in your chart that intermittent monitoring will be fine for you because you have no drugs in your system. If you have drugs, of course, you actually do need to be monitored because of the dangers to the baby.

Another policy to avoid is the routine vaginal exam. The number two reason for a C-section in this country is "failure to progress." I like to call it, "failed to progress on our time schedule." If a woman is left alone, without the pressure of performing, feeling comfortable with the people attending her birth, supporting her, she will give birth in her own time. The hospital is very unlikely to let you hang out laboring for longer than 24 hours. A lot of the time, we think of this as an issue of the time limits enforced for a broken bag of waters (another topic for another day), but I see this all the time. Insurance is also an issue here. They don't want you laboring, taking up space, for 40 hours. If you are not having vaginal exams (which really don't mean a darn thing), they can't tell you that you are not dilating. Again, you need to know the hospital's policy and also your doctor's. If you both come to an agreement that is acceptable to you, make sure it's in your chart. Better yet, labor at home and be dilated to a 7 by the time you get to the hospital! This will solve a lot of problems.

"Middle Aged Mama" had recommended a doula. I would tend to agree. Recently, I had a student who was at a hospital that had some crazy policies; no walking after your water has broken, continuous monitoring, and vaginal exams every 2 hours. What labor can progress under those circumstances?! No wonder North Texas has a 50% C-section rate! Their doula got them to agree to intermittent monitoring, being out of bed walking the halls, and vaginal exams every 4 hours (still too excessive in my book), but great improvement. It was a long labor and without their doula advocating for them, I am almost certain this woman would have had a C-section.

As far as "demanding" your wishes, I feel like that is never a good idea. It is crucial that you do the footwork early in the pregnancy, interviewing and touring the hospitals in your area. I liked the advice to talk with other women who have birthed there recently. A piece of advice, however, be sure that they had the kind of birth that you want. If they loved their doctor and hospital but had an induction, epidural, and possibly a c-section, I'd suggest looking elsewhere!

Be prepared (I'd love to see you in my class -- DFW area -- or take my class by DVD!). But be polite. No one wants to be accommodating to a rude, bossy woman, or father, for that matter! Kindness and knowledge will get you closer to the birth you desire.

Know your options. Change providers or hospitals if you have to. You will only give birth to this next baby one time. You can do it. It's YOUR birth.

This was such a great question, I'm going to go ahead and use it as a post, in case they skipped the comments. Let me know if you have any more questions. I hope this has been helpful.

publichealthdoula said...

I have sometimes felt anger or irritation with women who shared their negative stories about birth. I've thought "Why are they scaring other women, and feeding them horror stories?"

Then someone suggested to me that it is how some women process their birth trauma. Women who have had frightening, traumatic births are not supposed to talk about them. They're supposed to be happy that they are alive and have a healthy baby. They may process these births (and reconfirm to themselves that everything that happened was "necessary") by telling their horror stories on the very few occasions that they get the chance - often, when they get the ear of a pregnant woman.

I still don't like this practice, but it makes me feel much more compassionate when I hear this happening!

HaleeBurch said...

How does one identify whether or not they are "low risk" I am not pregnant now/yet. But when I am I desperately want to have a birth like you have described. But my husband is very against it, and I can't get him to do any research into the possibilities. His biggest argument has been our own deliveries him being 2 months premature and mine being an emergency c section due to cord strangulation combined with a breech position. When I try to explain to him that that has nothing to do with me he begins arguing that I am way too tiny to deliver one of his children. I guess he assumes his babies will be born with his huge head. lol