(the above pictures are of Simone's birth in 2007--wouldn't want anyone to think I just had another baby!)
I’ve had a few people ask me about homebirth recently. It generally catches me off guard when people have questions, because it takes some time to explain. I don’t want to bore anyone with the details, if all they wanted was a short answer. Last year I rented the documentary the Business of Being Born. I loved it, and highly recommend it to anyone interested in childbirth issues. Even if you are not a self proclaimed "birth junkie" I think every mom would learn a lot from seeing the show.
About six years ago, I was talking to my so very normal friend, and discovered that she’d had two babies at home—on purpose! I was shocked. After all, why wouldn’t you want to have your babies in the hospital? What about the risks? How can any responsible (and normal) person choose that? I was fascinated though. Although I’d heard of homebirth, I wrote it off as something for crazy people. So when my friend whom I’d admired admitted she’d had two, I was very intrigued.
Fast forward a couple of years. I was pregnant with my third, and more interested in knowing about all of my birth options. I’d had two babies at the hospital, and though I felt like both were good experiences, I wanted to know more about having a baby at home. I think at first it was mostly just to show that the hospital was by far the safer and best route. Then as I learned more about the different risks of a hospital vs. home, I realized that for me with my very uncomplicated and fast labors, home was probably a very safe option.
I read several books and every research article I could find on homebirth and looked at the statistics and how they were arrived at. I read both sides of the debate. The bottom line for me was the safety of my baby, and there wasn’t a single study that could show that homebirth resulted in more unfavorable outcomes for the baby. I think that if hospitals did things differently, homebirth might be the riskier of the two. But sometimes more technology actually hinders the normal birth process. So when choosing a place of birth, you have two locations that have equal outcomes, but different sets of risks. The hospital is more favorable in an emergency situation, though homebirths and the minimal interference with normal labors may actually prevent some emergencies. Many women who have low risk labors choose to have their baby at home rather than fight the hospital protocol in the very vulnerable state of being in labor.
I ended up choosing a homebirth for Miles. We chose an experienced well known midwife. We had lots of questions for her relating to emergency situations, and her answers made sense. Of course, if you go into labor early, you go to the hospital. If you have any other preliminary signs of complications, you go to the hospital instead of attempting a homebirth. Her hospital transfer rate is ten percent, only a small fraction of those are emergencies. Most of the transfers are for first time moms who want pain relief. For a mom like me, homebirth had some real advantages.
What I loved about homebirth:
--No car ride (driving to the hospital dilated to an 8 is not fun)
--My other kids can be involved.
--Labor is not timed or actively managed and can proceed without intervention
--Midwife checks heart rate by a more reliable method of external auscultation with a doppler—no external monitor, hence no laying flat on your back in bed
--No loud beeps and bleeps keeping me up all night
--My own food
--My own bed
--Not "on the clock" as far as labor goes
--No unnecessary machinery like warmers—who thought of this anyway? I couldn’t hold Elise for a half hour after she was born because she was “cold.” Hello, give me some blankets and a space heater. I’ll warm up my own baby thank you very much. She was rooting around and crying and I could do nothing.
I ended up having a very fast labor with Miles. I woke up at 12:35am with a contraction and timed a couple more to convince myself I really was in labor. I called the midwife at about 1:00 am to give her a heads up. Although the phone call sounded something like this, "Hi sorry to bother you, I think I *might* be in labor. I'm not sure, so I'll just call you back when they get stronger." She was a very smart midwife and was already on the road when I called her back a few minutes later to say that "Yes, I was for sure in labor!" Then I called my friends and family and walked around the house for a bit. I started having hard contractions at about 1:35 and my midwife arrived at 1:38. She checked me, ran out to her car to grab her oxygen, then Miles was born at 1:41am. I had no clue I’d have a baby in an hour when my contractions started, and I’m pretty sure he would have been a side-of-the-road baby if I hadn’t been at home. Anyway, Simone’s birth was just as easy, though I had her in the evening and my labor was more like two hours I think.
The number one question that people want to know is if it is messy. Nope. Not for me anyways. Once I knew I was in labor, I wore a Depends. Lovely image I am sure. But like every other mom out there, I didn’t want my water rupturing all over the bed or carpet. My water doesn’t rupture until my babies are crowning. So that was never an issue anyway. The birth kit I bought had everything I needed to completely contain all of that fun stuff. The midwife has a towel service for the non-disposable stuff.
After Miles was born, we woke up Elise and Monet and they got to come in and hold their baby brother. Elise cut the cord. When Simone was born, Monet got to do the honors. Both girls wanted to be there during the birth for Simone’s birth. That was by far my favorite part of it. Having a baby in my own home with my family around was very comforting and comparatively easy. There was very little pain involved. Probably less than 15 minutes during each labor. I know that a big part of that is genetics, but I also think that confidence and lack of fear also plays a part, and being at home really made me feel safe and comfortable.
I am the kind of patient who hates to ask for things. I don't even like asking the nurses to get me a drink of water. I don’t want to be a bother. And I don't like being dependent on anyone. I also worry that voicing my requests for labor will mark me as a "difficult" patient, so instead, I am fairly timid. The OB who delivered Elise took full advantage of that, and told me outright when I said very that I’d prefer not to have an IV, drugs, etc. “You won’t be able to do it.” I am still in awe that a doctor would actually discourage a mom from trying something that would lower her rate of cesarean and make it easier to push the baby out. I was only 22 and looked even younger. I am sure that she figured I’d just do what she told me. She was hoping I would be induced prior to my due date to make things easier on her, which should have been my first clue that she was not a good fit for me. After Elise was born, the last thing she said to me, after a beautiful and relatively easy labor was, “Next time, get the epidural.” I can see why it is hard for many women to stand their ground when it comes to their childbirth wishes. No one wants to be one of "those" ladies. And it is hard to be assertive when you are in labor.
I have a friend who recently delivered in Germany, and hearing her birth story and how birth is treated there was so interesting to me. Their whole approach just made sense—encouraging active upright birth with stools, fancy extra deep tubs, and having midwives attend all births, with an OB available in case of c/s. In one state, the c/s rate is 14% and the mortality rates are much lower than the U.S. The hospital even served healthy food! Here, people who want that stuff are sometimes seen as difficult. To some healthcare professionals, birth plans are somewhat of a joke. And while I understand that they have a job to do, the women choosing to give birth at their hospitals are their customers and should be treated with respect and regard to their wishes when possible. The nurses I had with Elise were fantastic and so encouraging and really did whatever they could to make me comfortable. I really appreciated how wonderful they were. My own little sister is a labor and delivery nurse and she is amazing. I would love to be one of her patients.
Homebirth certainly isn't for everyone, but it should be a valid option for women like me. There is an ongoing effort by some professional organizations who seek to discredit the work that midwives do. Their intent is to restrict homebirth to the point that very few women would be able to legally have a homebirth. Their restrictions are so broad that even I wouldn't have qualified--in fact, only ten percent of women who currently birth at home would qualify. I think that the reason for this current bill is that more and more people are starting to consider homebirth as an acceptable birth practice.
Restricting homebirth and refusing to address the current problems with hospital births isn't going to help anyone. It wasn’t that long ago a father waited for his baby’s arrival in the waiting room, or women were knocked out with the “twilight sleep” during one of the most momentous events of their lives. Thankfully that practice has been discontinued because people questioned what was happening and found a better way. It is almost completely unbelievable to me that "twilight sleep" was ever acceptable. But I think there are practices in place now that are similarly ridiculous and need to be reconsidered, but are somehow standard, such as augmenting nearly every labor with pitocin and putting women on the clock as soon as their water breaks. There are risks associated with prolonged rupture of membranes. But the idea that a woman has to give birth within 24 hours is embraced by hospitals because it helps their bottom line. There are alternative to pitocin. Episiotomies were standard for years, and now are becoming more rare because we found that most of them did more harm than good.
It is not homebirth that we need to fear. It is the idea that everything we are currently doing is 100% static and improvement is unnecessary. I hope that in the future having more birth options will make all births more safe by encouraging hospitals to make women as comfortable as possible without compromising safety, and those of us who choose to labor at home will be supported.
