I've spoken before about how I never know what will be controversial to write, and what will not. I know going into this one that how we give birth is a hot topic. Since I chose to have a planned home-birth this time around, and it's not a common choice, Knut and I are fairly certain that most of our friends and family will see that we have fallen off the edge into the world of hippie-dom. I thought that at some point, I would share a bit about our decision.
Since I am too much in vacation mode to post anything new these days, I thought I'd go ahead and post this pre-written one from before Ingrid was born. If you'd like to read the story of her birth at home, you can find it here.
I will disclaim that this is written based off of my mommy-brain memory of the research done. I'm not sitting writing this with all the scientific data in front of me, so you may find mistakes, and I encourage you to do your own research. I'll try my best not to exaggerate, or leave out important things, but do not use this post as some sort of scientific article on the subject. This is more the "chat over coffee" version of this information.
In the past few years, as I have gathered with women, mostly in crafty circumstances, I have more than once heard someone's homebirth be brought up. As I know it's something most unusual in our culture, it's something people will talk about. I've heard people say about women I know: "but she's an educated woman! How could she even consider?" or "They must think the best healthcare in the world isn't good enough for them." So knowing there may be gossip, and everyone may have a thought on why we decided to go this way this time around. So if you are actually curious on hearing from us on why we chose a homebirth...read on.
Well, get yourself a snack or something first because it will get long.
Here's what our decision/home-birth is NOT:
1. It is not some sort of anti-hospital statement, or fear of hospitals. I like doctors. I like nurses. I think they save lives. I have many as friends, and I thank God that we have them. I think it's pretty common knowledge that we live in a law-suit happy country, though. This area of most U.S. hospitals is the most sued. When you think about it, if something goes wrong with someone who is 90 years old, people just say "It was just their time." If something goes wrong with a newborn, or mother, people are eager to point fingers. Injuries at birth often lead to the necessity of long term care, and law suits are often the avenue to pay for that long term care. We cannot fathom it could be someone's time at that stage, and I understand that.
In the 8 years that Knut and I have been parents (with me being in the hospital during all previous 4 births, Elias' NICU stay, and his 2 other lung/RSV related stays, as well as scattered ER trips here and there for various kids), we've come to this conclusion: hospitals are wonderful to be at when you're sick or hurt, and annoying and frustrating to be at when you're well. It's not that we don't like hospitals, it's that we don't like being there when we're healthy.
I know with many hospitals, but certainly in this part of hospitals, there are very strict procedures on how everything needs to be done. What bothered Knut and I, after going through 4 hospital births previously, is that many of these procedures are put into place by the hospitals' malpractice insurance, and are based off of what is less likely to get them sued, and not based off of good science. There's a lot of "routine" procedures, and opting out of any of them is work. It's human nature. It's good business. If we're against anything, it's stupid insurance policies that tie the hands of the OBs...not the OBs themselves.
In this area of the different hospitals I've given birth in, choices are limited. Showing up is basically giving up any power of decision. At least that's how it felt. It was like being put on an assembly line, and being processed through. That was far more true with the big city hospital we went to with our first 2 kids, as we both felt the smallish country hospital of our last 2 kids was less restrictive. There were still lots of silly rules, but there wasn't the time pressure as much with the second hospital. For a very long time, this lack of choices felt very normal to us.
2. It is not a reckless choice. I know that as Americans, we love to feel like our hospitals are the best. We are aware that people come from all over the world to be treated for things that cannot be treated elsewhere. We have some of the smartest doctors in the world in our country, and I would wholeheartedly agree with that. However, when looking specifically in the department of maternity care, the United States sits #47 among the developed countries. That means 46 other countries in the world lose less mommies and babies than we do. We also have the second highest c-section rate...so all those c-sections aren't saving a lot of babies and mommies. Actually that "complication" is causing many deaths.
One has to ask "why?" Why is maternity death rate, and infant mortality rate one of the highest among developed countries? I looked into this research a bit more because I figured that the W.H.O. (World Health Organization) that put this statistic out must be overlooking something, like we attempt to save more pre-term babies than other countries, or something like that. However, that's not what I found. What I found is the data got worse. According to an article I read by Ina May Gaskin, while the other countries reported all their stats on the issue of maternal and infant mortality, the United States doesn't have a universal way to collect that data, as only 37 states require this information on death certificates. That means we were #47 on the list with only 37 states reporting. That's not even all of our deaths reported, against the full data in other countries. Only Brazil was below us in the "developed countries" category, and that's probably because 90% of their births are done by c-section. I've heard it said that the only way to deliver a baby naturally in Brazil is to get stuck in traffic.
So the curious brain of mine wanted to know what countries who were very high on the list of excellent maternal care like the Netherlands, Japan, and Great Britain were doing. What made their maternal/infant death rates so low? It turns out that all the countries on the top of this list had very high rates of home-births attended by qualified midwives. As in 30-60% of the births as compared to the 1% in the United States. Also, midwives attend way more hospital births in those countries.
You see, in those countries, healthy women with low-risk pregnancies are encouraged to give birth at home with midwives, and un-healthy or high risk women are encouraged to go to hospitals. Sick women or complicated pregnancies with several red flags go to hospitals. Healthy women get midwives and little intervention. Midwives are there as a safety net for pregnancies that are completely normal, and are qualified to handle all but 2 things: medicinal pain relief and c-sections. Pretty much everything else they're trained to handle. Many people are questioning all of the "routine" procedures done on healthy women that actually make things unintentionally worse.
Now, there are several studies done on home-birth vs. hospital births and outcomes. I found when looking at the research it's important you check to see how they define "home birth". If the study included ALL home-births vs. ALL hospital births (in other words, it included home-births that were unintentionally at home, without a midwife, or in the car on the way to the hospital, etc, etc.) than hospital births were safer. If the study compared qualified home-births (low-risk pregnancy attended by midwife) vs. low risk women in hospital births, there was no question it is safer to give birth at home. I should point out, that the edge in either version on the study was a thousandth of a percent difference, or something like that.
Basically the conclusion I got from international sources is that pregnancies objectively qualifying as "low risk" had better outcomes with a midwife, and pregnancies objectively qualifying as "high risk" had better outcomes with a doctor. There is no across-the-board right place or attendant for birth.
So while I know there are many stories that can be told of: "My baby could have died if I had not been in a hospital" I do not wish to argue with that. Hospital births are necessary, and we should be grateful we have that option when things go wrong. I do not wish to say that ALL woman should give birth at home, because that's just not good science. I most certainly do not wish to say that my home is the best home to give birth in, because I don't want you all coming over here to have your babies. ;)
I think what is important is that as women, we educate ourselves about our body, and take control of decisions being made about our body. We should ask good questions from smart people, and make decisions, and not leave the decision making to someone else. After all, when all is said and done, we're the ones who have to live with the body that remains, and live with the decisions that were made.
I love this quote from G.K. Chesterton (a friend and contemporary of C.S. Lewis): "Without education, we are in horrible and deadly danger of taking educated people seriously."
3. It's not some sort of feminist masochism: I didn't choose this because I wanted the rush, or because I just love pain so much. I don't feel I'm superwoman, or have something to prove. Maybe there's a bit of my control-freakness coming out, but I hope that involving Knut in this decision would even balance me out a bit.
Also, it's not because I want to fully live the "Prairie Life" out here on the farm. Actually, I think that those living in a city would have quite a few more midwives to choose from than I did.
When I was pregnant with our first child, my birth plan read like this:
"Drug me in the parking lot, please."
I had a lot of fear, and a lot of unknowns. Everything ever presented to me about birth was mostly done by Hollywood, and we know how accurate they are in presenting facts. For them it's about entertainment. The birthing class we took at the hospital back in the city told us more about how to be a good patient than how to have a healthy birth.
I shouldn't have relied on an entertainment source for my information. Most moms are like me and do more research on which phone or car to buy than how and with whom should I give birth. In my mind, what I did for my first birth was the equivalent to walking into just one dealership, and buying whatever the salesman told me I needed.
My first epidural went as everyone promised. It worked great. With my second birth, it came too late and I had to deal with the natural pain, without any mental preparation for it. That was horrific. It deserves to be written again: horrific. I was not at all mentally prepared or equipped to deal with that sort of pain. With my third birth, I tried to mentally prepare for the normal pain, and manged much better, but out of fear it getting worse, opted for another epidural, which I got to enjoy for no more than 10 minutes because labor was going so fast. I regretted getting it because I get such terrible headaches that last for days from epidurals, and it wasn't worth it for 10 minutes of pain relief.
With my 4th birth I wanted to avoid the epidural. The 2 previous births it was not worth it, and I still had to deal with the side effects like not being able to move awhile after birth and the severe headaches. So I mentally prepared for the pain, and practiced many pain management techniques, and things went so, so well! We almost chose a home-birth last time. Knut was all for it. I was the one who backed out thinking, "We're just not home-birth people." I knew if it was the status quo, I'd pick it without a second thought, but I wasn't sure I felt strong enough to go against the grain and face any judgment or defend my choice against people who thought we were being very, very stupid. I just didn't want to turn this amazing experience of birth into a debate.
Ironically, our families did not fight us, as we anticipated them doing. In fact, we heard lots of positive feedback from many people. Not too surprisingly, most people who supported our decision the most were people who have spent significant amounts of time outside the U.S. I found that interesting. Perhaps they were just more comfortable with ideas outside our normal culture. I don't know.
I remember, though, as I was laboring at home before we went to the hospital, that Knut and I were both joking "Is it too late to see if a midwife can deliver this one?" We didn't want to go to the hospital. Hospitals are GREAT and giving you drugs for pain. However, if you know that drugs are not for you, they don't allow many common pain managing techniques.
For one example, every hospital I've given birth in has required you give birth on your back, with your legs in the air. Well, actually all of them said we'd have the choice of how to position me for birth, but when it came down to it, they moved me against my will however they liked. Maybe they didn't know it was against my will because they never read my birth plan, and I was in too much pain to talk, and when Knut advocated for me, they treated him like a controlling husband and told him to step back.
Now, there's a few reasons they like you on your back. First, most women are drugged and numb and this is the only position they can physically do. When I say most, think 90% of women need to be on their backs because of the epidural. Second, the doctor can get a good view of things going on while he's sitting comfortably. They deliver sometimes several babies a day, and they don't want to be crawling around on the floor getting a good view. Back deliveries are the status quo.
However, this is the MOST difficult position to give birth in for most women. You can't argue with the science on that. First off, it physically makes your pelvic opening smaller. Babies are most likely to get stuck in this position. Interventions like vacuum and forceps are more likely in this position. You're more likely to tear in this position. Gravity is not on your side.
Since most women in the U.S. are drugged and can't be in any other position, that is the position that is chosen for you, regardless of what you would like to do. It's protocol. It can cause several complications that the hospital than "saves" the woman from, and we all say "Good thing she was at the hospital!" This is just one example.
Now, I know that some hospitals our there are bringing in midwives who are the experts in "alternative" birthing methods to the typical medicated birth that doctors are experts in. Some allow water births, birthing chairs, squatting and birthing any way you want. I have not had that experience, and currently don't have that option. I think it's a good trend, though!
So here I am, knowing I typically give birth too quickly for drugs. So I'm looking to reduce the pain in other ways. I'm trying to avoid pain and still be safe like every other mother in the world. So I go through all the relaxation techniques. I learn about using water, birthing balls and hot and cold compresses. I decide to go to an expert on natural pain relief instead of going to a hospital where they are experts in medicated pain relief. I pick a midwife who has been delivering babies for about 30 years, and transfers about 10% of births to a hospital, and always before the emergency. She said that there are 2 main reasons that she orders a hospital transfer during labor: mom has been laboring for many hours and just wants to go (which she said is more common among first time moms), the second reason is questionable fetal heart tones. If the baby's heart rate is not behaving normally, and cannot be improved with basic position changes, she'll order a transfer to get it checked out more thoroughly.
Now, my midwife does not have hospital privileges, so if I were transferred, I would be under a doctor's care, and back in hospital protocol. However, she offers to stick around to be the doula and advocate at the hospital birth at that point. Of all her births, 3% of them have ended up in c-sections at the hospital. She's not anti-c-section, but her rate is much lower than that of a hospital where surgeons are put in charge of birth.
Also, a common question is in regard to being cared for after birth. I mean, who wants to clean up their own birth and go fix themselves some food? My midwife and her assistants run all of that. They do home visits weeks leading up to the birth to see where you keep stuff, how you like things done. My job is to drink in and cuddle my baby. My midwife's job is to make sure we're doing well. Her assistants' jobs are to be an extra set of hands in an emergency, and clean everything up, throw a load of laundry in the washer, do some dishes and bring up some food. Her assistants are both trained "doulas" (which is another post I'll probably never write. Just go google what it is.) with extra training in emergency situations so that they can be midwife assistants as well. They'll run errands, prepare food, help out with older kids (though we chose not to have our kids at the birth) and pretty much be willing to be a help in any way they can. Just like at a hospital, my job is to rest...except I get to rest in my own bed and no one flashes the lights on at 7am during a nurse shift change and announces cheerfully "time to take your temperature!" I cannot even begin to tell you how much MORE rest I got at home compared to a hospital. Part of that was just some amazing support here at home.
4. It's not lacking in modern science. In fact, we found our midwife to be more current not only in studies done in the United States, but studies done around the world. She doesn't stop with papers put out by the American College of Gynecology and Obstetrics, she could tell you what OBs in Australia, Japan, and England do. Our midwife is not like a Little House on the Prairie neighbor lady next door midwife. It's not like the stories of past of "O, my great-grandma was a midwife for someone once." She brings oxygen, pitocin, sutures, and many other medicinal things, as well as several natural ones. She brings 1-2 trained assistants to the birth to be an extra set of hands. She discusses with me and orders up labs during the pregnancy to see if any red flags are coming up. She educates me during our hour long prenatal appointments on how we can avoid various complications with preventative measures.
When looking into midwives, you hear the term "evidenced-based care" vs. "routine care" of hospitals quite a lot. I've found that most midwives are very reluctant to use any intervention that hasn't been thoroughly proven as beneficial. Hospitals are more willing to allow procedures (mostly that the mother wants and asks for) with some risk because they have the back up of a c-section if that risk becomes a reality. And history has showed them that you can't get sued if you gave them a c-section. A c-section in the courts means you did everything in your power to save the mother/baby. Hospitals are rarely sued for unnecessary c-sections.
After this pregnancy, if someone were to ask me where I learned the most about managing a healthy pregnancy, I'd say I learned 10% of what I know from my 1st 4 pregnancies, and 90% in this last pregnancy. I just got so much information and guidance that was fitted to my body, and my unique needs.
I bet I heard Knut say 7 different times throughout the pregnancy: "You're handling this pregnancy so much better than I've ever seen you handle pregnancy before!" This was my first pregnancy where I had no anemia, no GBS, my heartburn was cut down to about 1/4 of what it was in other pregnancies, and no signs at all of preterm labor. To me, that was the difference of midwife-lead care. My midwife had so many solutions I had never even thought of. She would listen to every complaint of mine, and come up with some herb, some diet change, some exercise, some stretch, and problems started diminishing.
Even though we're not in a hospital, she works with the NACPM model of care:
"The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events and includes:
- monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle;
- providing the mother with individualized education, counseling and prenatal care,
- continuous hands-on assistance during labor and delivery and postpartum support;
- minimizing technological interventions; and
- identifying and referring women who require obstetrical attention.
I also like this quote from her: "I believe in trusting the birth process, woman-led birth practices, supporting the mother-baby unit, and using technology judiciously."
What I also love about her is how much she left Knut and I in control of our family. It was such a new approach for us! For instance, before the birth, she went over all of the newborn procedures for us to research first. Let's just pull one example out, and that was the vitamin K shot. At the hospital, they just do it. In fact, with several newborn procedures in some hospitals, if parents question what is being done to their child, social services are called. It's a new trend in maternity care I've been hearing a lot about.
Our midwife gave us research supporting the vitamin K shot, research supporting oral dosages of vitamin K, and research supporting not giving the shot at all, as different schools of medicine have different opinions on this procedure. Only after we had read the research was she willing to give her opinion on it when we asked. She believes it's our decision, and she brings both injections and oral options to the birth. There was so much respect offered and exchanged in this relationship. She gave the ownership and responsibility of the birth to us, and it wasn't just showing up and being put through a system. For us, it was an amazing experience throughout the whole pregnancy.
There is no personal responsibility in the hospital. Law suits and insurance companies have told them so, so you can't really blame them. Our legal system has told them that they hold all the responsibilities therefore they hold all the decisions. I still remember my mom telling me the story of when she had first child and asked her doctor what she should expect for labor. He just smiled and said, "You just let me worry about that. You just have to show up." That is not okay, and no woman should be reassured by that. I know she wasn't. That idea is still around, though among women. It's the idea that doctors know how we should give birth, and we should just be quiet and do what we are told. I'm not trying to advocate one way of giving birth or another, but I am advocating that we as women do our own research, follow our guts, and do what we think is best for us and our children.
Legally they have to ask you permission to do a procedure to your child, but you're not exactly allowed to refuse care either, at least that was our impression. We were told at 2 different births that if we refused care that the doctor wanted to do, and sign a waiver, our insurance company could refuse to pay for the whole birth. Whether or not that is true, we never found out.
(For those wondering, we have chosen the oral vitamin K, an option not available in most US hospitals. I assume the reasoning is parents are really bad at coming back for multiple treatments as this option requires. It requires a few strong doses over the course of a few weeks, instead of one massive dose given as an injection, but our midwife was willing to come to us to give the dose so it wasn't any greater inconvenience to us.)
If someone wants to look into birth more or find out how midwives differ from obstetricians, I highly recommend the documentary "Business of Being Born" although, like all documentaries, you'll have to sift a bit through the facts. You can find in on Netflix and pretty much everywhere else. I thought it was inspiring, and removed a lot of fear about birth, not instilled it. So if you're pregnant, this isn't a "scary" movie. It's a "I can do this!" sort of movie. It was so empowering and eye opening.
It also talks a bit about how midwives and OBs work together in other countries, much to the benefit of women and babies, but in our country they're in an economic battle between OBs and midwives and they rarely work together as the "same birth for all" approach gets pushed through the courts. (As well as the fact that births attended by midwives earn hospitals roughly 1/3 the income of OB attended births as midwives charge less and use less interventions, and women usually recover faster, and many hospitals are not so eager to lose that income.)
The only reason I set you a bit on guard for the movie is that some of the scientists make some claims in the last 1/4 of the movie that are based off of evolutionary suspicions, and draw conclusions about drugs during birth's effect on how much a mother loves her child. I did not like those thoughts, and personally thought they were untrue for me personally as a mother who has given birth with drugs and without drugs, and thought it was insulting to those adoptive mothers out there too. Sure, bonding sometimes takes longer with more drugs or longer recoveries, and I assume through adoptive procedures as well, but bonding does happen, and it's powerful. We are not chimps. That was my only beef with the movie and it was really lightly stated near the end. I have a beef with most documentaries on some small point.
I also thought a good read on the subject was Baby Catcher: Chronicles of a Modern Midwife which are the memoirs of a labor and delivery nurse who ended up becoming a midwife that worked both in and out of hospitals. It has an entertaining and educational look into both worlds, and her personal battle with insurance companies. My only warnings with this book is that she highlights several births that were memorable, but not necessarily "normal." They're certainly entertaining, though! Also, her client list is extremely varied from the extreme communal hippies to business-like lawyers to conservative Muslim women. So know that going into reading it. I found it fascinating.
Again, I want to point out: I just had a baby, so keep that in mind when commenting. I didn't post this in order to start a debate or a conversation. I'm not going to spend a bunch of time monitoring the comment section, and if I do find a big debate going on in there with this hot topic, I may decide to just shut the comments down for this post. The biggest fear I had about a home birth was not any danger factor, but having to defend myself against the judgment of others. I'm not sure what that says about me, but there you have it. I don't care if you give birth in a hospital or birthing center or at home. I have simply witnessed gossip about this topic with other women, and want to get some information out there.
My only wish is that mothers are given good information and good choices, and then they can decide what is best for them. I know our choice is not the norm in our area, and I post this for the purpose of heading up any speculation or worry those who care about me may have. We loved our home birth, and although we have not made any big, definite decision about whether or not we'll have any more children, I can tell you we'd only go back to the hospital kicking and screaming. The transition to having one more child in this house has been so smooth and restful in so many ways.
And now, I will slowly and shyly step down from the soap box.