Monday, May 3, 2010

Forced Into a Hospital Birth or Unassisted Homebirth

One of my former students-turned-Bradley-Instructor asked me a question this week on Facebook, in light of all the midwifery issues going on in NY.

If Donna Ryan was forced to have a hospital birth, or an unassisted birth, which would she pick? This was my answer.

First, there are many things to consider. I believe in prenatal care. If you choose unassisted birth, you are likely choosing no prenatal care. A Licensed Midwife evaluates each woman and pregnancy and determines if she is a good candidate for homebirth. Most women are.

I know everyone thinks my answer will be a resounding "Yes, go unassisted!" It's not that simple. I believe in having a good midwife at your side, no matter where you are giving birth. Women have the right to a midwife and they have the right to birth where they feel safest. For many women, this is at home, and for many, it is in the hospital. Educate yourself and make the best decision for you and your family.

As far as what is happening in NYC, the problem is that they are shutting down the hospital where most of the out-of-hospital midwives have backup from an OB. In order to be a LM in NYC, you have to have an OB back you up. St. Vincent was a very midwife-friendly hospital, and they have shut their doors. The midwives cannot practice, legally, without that backup. So, they either need to find other OBs to back them, not practice anymore, or do it illegally.

One of my friends birthed a baby at home in ID before it was legal for midwives to practice openly. (It is legal for them to practice in ID now.) There are still a number of states where homebirth is illegal, but midwifery is alive and well. You know the risks as a midwife, but also as a consumer. I just talked with a local midwife this week who is originally from Missouri, where homebirth is illegal. She would love to go home, but she said she's not ready to deal with the risks of practicing illegally. The state of TX has some great laws in place for out-of-hospital midwives.

So my point is, that a woman doesn't really need to be forced into the hospital if she doesn't want to be there. She also doesn't have to choose an unassisted birth as her only other option. I've known women who have jumped state lines. There are midwives that are willing to risk their own hide so that women have access to homebirth.

I will never tell a woman I think she should have her baby unassisted. That is a risky position for me, as a childbirth educator. I do not give medical advice, but I think my opinion is weighed pretty heavily by a lot of my students. If you know me, you know that I am so NOT a fear monger (trust your body, trust in birth), but I've seen strange things happen in labor, birth, and immediate postpartum. Things that I would want a midwife attending to. I know women who have had unassisted births and everything was great, actually with all of them. And I do believe that it will be fine most of the time. I still like to see a midwife by all womens' side, no matter where they are giving birth, and whether they are practicing legally or illegally.


Anonymous said...

You can let your friend know that the law changed in Missouri and midwives are now practicing legally! Hope good news will come from NY too.

Sarah C said...

I too would never suggest a UC birth- but the more I talk to women the more I understand why they go that direction. Though it is true that even when midwifery is illegal there are still usually midwives practicing, it is not true that a woman can always find a midwife willing to serve her. I have a friend who had had two c-sections, then a hospital VBAC, and it was next to impossible to find a midwife who would assist her. There were other factors in her choice- but even in TX, many homebirth midwives will not attend a double vbac. Sadly, these c-section mamas are finding it harder and harder to vbac, even with midwives.

Sondra Rose said...

Ummm...I think you may want to check your facts--especially as a childbirth educator. To the best of my knowledge, homebirth is NOT illegal anywhere--otherwise all thos moms who have accidental unassisted births would be liable for prosecution.

Of course, if you mean states where midwifery is illegal--that is another matter!

Moms who wish to educate themselves for a planned unassisted birth have a wealth of resources available. Try or, for starters.

Donna Ryan said...

Obviously, I was talking about the licensing of midwives -- or the lack thereof -- is what makes "homebirth" illegal. Sorry if my wording offended you.

I do believe that parents would have a legal battle on their hands if they have a bad outcome (death) and did not/could not hire a midwife because of the state's laws.

And yes, there are lots of resources on unassisted birth. Because I am not advocating that route, I did not list them. But there they are.

Ivy said...

Shortly before my fourth baby was born, the state laws in Wyoming changed, not allowing midwives to practice outside of a hospital. They had already been denied the right to provide prenatal and postnatal care in the state. We got around this by meeting in Idaho (which has had recent changes in their laws also). Since I had already had two unassisted births, due to the baby coming too fast, we decided to go that route. It was a hard choice to make, but meeting in Idaho was an option, if I changed my mind.

There are always legal ways around these laws. Most of the time, the midwife can not be charged with practicing if she/he is not charging. This has been taken to Court and proved the case in more than one state.

Cassie said...

Great post, I am just so impressed by your candor and topics. I believe I know your local (Grand Prairie?) midwife friend as I believe she was my doula for my VBAC with the UNT Midwives. She is lovely and though I would love to use her again, I hope the changes in the MO law allows her to be with her family!

Donna Ryan said...

Cassie, thanks for all your comments today. I would like to invite you to be a part of the Tarrant Co. Birth Network. Our meeting this week is sharing Birth Stories. You can find all the info here, if you haven't already!! Welcome to Banned From Baby Showers.

eulogos said...

It isn't necessarily true that those who birth unassisted don't get prenatal care.

I had prenatal care from a family practice doc, had my fourth with a friend who had been to about 30 births as a helper, sort of a midwife in training, my fifth with someone with an unknown amount of midwifery training but had been the primary attendant at some births, and my sixth, seventh, and eighth with just my husband there. The FP was available during the births on the phone for consult, and he came afterwards to examine me and the baby. (He would have loved to come to the births, but had been told he would lose OB privileges at his hospital if he did any more home births, and he needed those to teach OB to FP students, as he was primarily med school faculty.) He also took the cord blood we had saved to the lab for crossmatch and brought back my RhoGam shot. For my ninth, when I had moved far from my FP and was also 45 minutes from any hospital, I had a CNM, whose supervising doc made an exception to the no home VBAC rule for me. (my first was a C section, then two hospital VBACS, then the home births.) By the I really didn't know quite what to do with her; had trouble laboring with anyone outside my family there. But I am sure it was a sensible precaution.

It would never have occurred to me not to have prenatal care, although it did occur to me that seeing the doctor didn't really do anything to help my baby develop well, it was only a monitoring for certain problems which might occur. The real prenatal care is in what the mother eats, and how she moves (exercise), sleeps(a reasonable amount), and so on, and in avoiding harmful things like smoking, alcohol and so on. Still, I always went to all the visits. They didn't do such extensive testing back then.

Susan Peterson

Rain Clair said...

My mother had all three of us UC because it is illegal for midwives to do home births in Kentucky. However, she had regular prenatal care with a midwife in another state and with a local OB in town. She even toured and registered at the local hospital in case she needed to transfer in case of an emergency. I only know a tiny fraction of the fraction of people who UC that UP as well. My mom's circle of friends all UC'd because they had no access to midwives and they all received great prenatal care from the local OB. He even gave my mom & her friends books to read and taught them things to do in case of an emergency. He was against UC, but said if they were going to do it he might as well try to prevent the babies being lost to common complications that could be corrected quickly.

Devra said...

I would agree with prenatal care comment more if there were actually midwives who offered that and postnatal follow-ups without actually insisting on attending the births. My issue is that past experience with OBs and Midwives consistently revealed a habit of fearmongering at each prenatal visit. I just get tired of hearing all the doomsday posibilities when I've been absolutely healthy with no risk factors in any of my pregnancies (unless you want to count long gestation periods as an actual risk factor which I don't).
We are unassisted homebirthers (on our third) because of strong religious beliefs surrounding the connotations of birth and it's relation to the marriage bed. Having anyone other than my husband present not only causes me to be nervous and anxious, it is akin to having observers while being intimate with my husband. However, I don't advocate all birthing women go unassisted either. It should be a personal conviction backed by education, not just a whim or fancy.
Beyond all that, I absolutely support midwives as a choice and option for all birthing women and will continue to fight to keep them legal and available everywhere!

SavingGrace said...

As of right now I am being forced to either birth at home unassisted or in a hospital setting. It is illegal in the state of SC for midwives to care for VBAC clients as they pawned us as "high risk". It is absurd especially since I have already had a VBAC at home in another state!!!

eulogos said...

I was in that situation back in the late 70's early 80's and had my fourth and subsequent children at home (after two hospital VBACS.) But I had the support of a good FP-he couldn't come to the birth but he was available for consultation and came afterwards to examine me and the baby.

I finally had a CNM at my last homebirth, because I had moved away from that doctor and at the time lived a long way from a hospital. Her supervising MD said he thought my uterus had "proved itself. " It was good of her to do it and she was a good midwife, but by then, I was used to birthing with just my family and really didn't know what to do with her.

You won't be happy if you go back to a hospital. Do you have a friend who has been to some births and studied a lot on her own to be with you, if you don't feel comfortable with just your partner?

Susan Peterson