Awhile ago, there was an article that has generated a lot of controversy and, judging by the 700+ responses, it has become more fuel in taking a serious look at WHY women choose to birth at home instead of in a hospital.
I am a strong supporter of a woman’s right to birth where she wants, with whom she wants and how she wants. However, I still support the efforts for all midwives to be credentialed (prove they are qualified and skilled) and for all midwives to attend peer reviews on their transports.
The reasons for choosing home birth have changed since I had my firstborn in 1980. Back then, I chose home birth because of my lifestyle and spirituality. I had been traveling and living off the land for 3 years prior. I wanted to be as close to nature as possible. I wanted to experience the spirituality of childbirth in the fullest sense, I trusted God to get me pregnant (it took a few years) and I wanted to trust Him to be with me during birth. I did not want bright lights, a busy delivery room full of doctors and nurse and I wanted to be surrounded by my own things. I didn't even know what a midwife was, but when I met one, asked her questions about training and experience, I knew this was an option for me and I settled into blissful pregnancy with an assurance that all is well and planned for.
The women who chose home birth back then also wanted to avoid the ‘interventions’ of the day: no food or drink, IV fluids, induction, repeat Cesarean deliveries, pain medication, episiotomies, separation of mom/baby, etc. Of course, I had no idea of any of those things. There was no internet in any homes. I lived away from family in the country and long distance phone calls were expensive so I rarely made any. I had no books except what my midwife let me borrow, her text books, which I gleaned over. I had nieces and nephews, but I had no idea what my sister’s births were like, except they had episiotomies and medication. I really had no idea what they went through nor what to expect for myself.
I don’t recall worrying about any of those things. When I asked the midwife about ‘Lamaze classes’ to learn how to breathe, she simply stated that it was my choice, but she would correct my breathing if it wasn't productive for labor. I chose to not take any classes because 1) they were most likely over 30 miles away since we lived in a small town 30 miles from any hospital and 2) I trusted what she told me and that she would help me.
When labor came, I somehow went deep into myself; I breathed, I moaned from intense back labor, I laid in bed the whole time only getting up to empty my bladder but I managed to finish labor within 7 hours (average 1st time mom's labor is 14-24 hours). I was a lucky first time mom. I was lucky to have labored so effectively. I was lucky to have been left alone with no one suggesting things to me; I breathed my cervix away like you are taught in your hypno-birthing classes but no one taught me this. And I was lucky because I managed to do this even though my baby was mal-presented; she was coming through my pelvis as a brow (left frontum anterior, actually) which required a Cesarean delivery. My sister, who delivered in the hospital a couple years earlier, had a Cesarean for the same reason. Apparently, we women with large pelvises can have babies come down with arms, hands and any old way they choose. 2.5 years later, my son chose to present posterior when he was laboring down, because he had plenty of room to do so, and turned anterior at my pelvic outlet - ouch!
Back to my first birth: Once my midwife realized the baby’s position, she gave me the option of going in to the hospital for a Cesarean delivery OR she would try to fix the presentation and have me stay at home. Of course I chose to stay home, in fact I told her she would be successful because I had God‘s blessings (or something to that effect). Whatever she did was painful and threw me completely off my game, labor became unmanageable then. My water broke soon afterwards and there was meconium - a lot of it. (I was unaware or oblivious to that). Suddenly, I was encouraged to push her out NOW. This was in 1980, remember. Back then meconium was one of the worst things to happen and babies were routinely suctioned on the perineum. Because everyone was yelling at me to push and push NOW, I ended up screaming my baby out. She was born screaming, too - all 7lbs 3ozs and filled with vernix. Her smell was exhilarating to me. She was not a 42.5-weeks-past-LMP baby! I learned later she had a nucal cord around her neck twice,which most likely caused the extension of her chin and when her head was flexed she released the meconium.
This can be a common occurrence when a baby needs some help to be born. Nucal cords occur in 1 out of 4 babies, meconium stained fluid occurs in many births (all four of my babies released meconium before birth - why? one I know why, the other 3 I'm not sure) Some babies (1 in 10) need ventilation of their lungs to help them breath shortly after birth. One in ten babies. That’s quite a few, wouldn’t you say?
According to my chart I lost a lot of blood and my baby’s shoulders were lodged (dystocia). Being a midwife for the last 23 years, I am not surprised to read this. Oh, and I also needed to go down a flight of stairs, get into the car and drive to the back-up doctor office for extensive perineal repair soon after birth. ouch!
So, there you have it. My home birth story as a 1st time mom. In light of this article on “My True Feelings Regarding My Home Birth Experience” let me tell you MY true feelings about MY birth:
It hurt like hell. I was surprised on how painful that back labor was. I didn’t like pushing that baby out. That pushing hurt like hell. I didn’t like the pain from being stitched up. I hated the feeling of my insides falling out of me after the birth. I loved that I did it - I felt accomplished, I felt that I did something spectacular - I had a baby. At no time during labor did I worry about being home having a baby. At no time after delivery was I sorry I had that experience at home. I never felt the home birth was to be celebrated; it was birthing a baby that was to be celebrated. The home is just the place I chose to do this.
I loved that my midwife knew to leave me alone to take whatever position I needed to endure that labor. I loved that she was trained enough to recognize the potential for a complication. I loved that she gave me options. I loved that she was able to manage those complications and my daughter and I were safe. I love that she was courageous to finish what I hired her to do because when faced with the potential of a complication, your midwife needs to be courageous - she needs to be brave - OR she needs to know when she's in over her head and turn your care over to the hospital staff.
I knew the outcome could have been much worse. I knew I was lucky to have picked a talented midwife. I knew I could have been transported and ended up with a Cesarean delivery if the midwife felt she was in over her head. I knew that a Cesarean delivery would have impacted my future fertility and delivery options.
I also knew that midwives ARE trained to manage these types of complications because I had read some of the books my midwife used in her training. I knew that she knew enough. I had educated myself on what she could handle. I knew that midwives were capable of helping women have safe births at home. I knew this was an option for most women and after my first birth, I spoke about this option to anyone that would listen to me.
My birth did NOT go as I wanted it to. I was traumatized, yes. That experience impacted my future deliveries (I wasn't so naive about birth anymore) and it impacted my mothering (PTSD) of which there was no 'name or label' for how I felt back then.
BUT, it never changed my opinion of a home birth. I went on to have 3 more home births. And I’m sure from all the other 1st time moms who delivered successfully (and without incident) at home how their minds are made up about home birth. I know many who had been transported during one of their home births, yet planned their next delivery at home and succeeded.
I think home birth has become this fad or goal for many women. I think some want a home birth because their friend had a beautiful, ecstatic (?) experience at home. They love the appeal of a water birth,too. They watch many edited videos on Youtube, they romanticize about a oil-scented, soft music playing while their husbands catch the baby. That IS a beautiful thing to witness! Very special, very possible, too. And I'm not demeaning the reasons why they chose a home birth, I'm just suggesting there should be a balance.
Many first time moms are choosing home births now. They take childbirth classes that encourage them to breathe the baby down, release the baby out and into their arms. Most moms will train hard and keep that vision in their heads, yet actually achieving this can be so difficult with some labors. Some have to push very hard and for very long to birth that baby and they end up wondering what went wrong. They blame themselves or someone else. It's not because of the childbirth education, maybe the cause is in the expectation.
I find it hard as a midwife to balance a woman’s imagined birth with reality. It hard to tell a woman during prenatals the ‘what ifs’ - you don’t want to cause her to worry.
It’s hard to balance their expectations and hopes against asking them to deliver on the bed instead of in the tub because I need to monitor things more closely. There goes that dream of delivering in the water!
Or the births where I had to transport them for prolonged labors, for exhaustion, for meconium-filled water, for obvious fear-related non-progress (because they manage to progress normally at the hospital without pitocin) There goes the planned home birth, in comes the fear of what will happen now!
We midwives find it very difficult to suggest a transport at times because we get the heat from those mothers, the ones who weren't so lucky like I was when I had my first baby at home. The mothers who have to face their friends and explain how their much-talked-about home birth plans ended up in a transport. AND what if the OBs, or nursing staff or the Pediatricians challenges this tired, emotionally exhausted family by asking the to justify their reasons for the planned home birth. What if this family endures scolding and made to feel ashamed; listening to all the things that could have gone wrong and how they jeopardized their baby’s health and on and on until they can’t wait to get home. This family will also be chastised when they face family members and friends who were not supportive of the home birth plans but didn't say anything. They are forced to consider and to regret their decision to birth at home. What else can they do? They were hit square in the face with an “I told you so! What were you thinking? How could you be so reckless?’ This is why the midwife NEEDS to talk to you about the 'what ifs'. You need a good back up plan, you need to know that labor is unpredictable (please stop listening to the one-sided 'trust your birth' discussions - it is unrealistic. For all it's similarities and differences, labor tends to follow it's own course)
And the transport from home is equally hard on the midwife. She knows what lies ahead for them in choosing an out-of-hospital birth and the potential of having it become a ‘failed home birth’. She knows the disappointment because she herself is very disappointed as well and understands all the emotions these parents will navigate through. The parents and the midwife need each other to process things together, to heal together.
I think it’s human nature for everyone to look at a transport negatively. Instead of considering that the midwife knew what normal labor and birth looks like and that the midwife made the call to transfer the laboring mother so that mom/baby would remain healthy and have a healthy delivery, the midwife is blamed for something. Someone must be held accountable for this to have happened. There must be a reason why the home birth did not happen. Right? When I was a young apprentice, I remember thinking that having one of the lowest transport rates meant she was the best midwife around. Not so. How many deaths or injuries are in those statistics?
The midwife is blamed for not fully explaining the risks of a home birth, for not transporting sooner, for not recognizing a complication until it’s a full-blown urgent situation, for not wearing gloves, for having painted fingernails, for not using oxygen/for using oxygen, for being certified/not being certified, for yelling during an emergency, and on and on.
Funny thing is, you can have a wonderful birth in the hospital now-a-days. They don’t do routine IVs, episiotomies, or inductions. Some inductions are slow and can take days and don't require pain medication. They let your baby stay with you until you've breastfed. You can choose low lights, diffuse your oils, play your music. You can have just your husband and doula or your whole family. You can labor in a jetted tub or in a huge shower. You do not have to be continuously monitored. Hospitals have created beautiful birthing suites for you! There are wonderful Certified Nurse Midwives who stay with you during most of your labor and there are great OBs who are quite flexible with many things.
Things are changing, slowly, but changing. We have those strong, courageous moms to thank for this! Those moms who learned about evidenced-based practices through taking independent childbirth classes or educating themselves and spoke out and spoke loudly and got their doctors on board with the birthing plan.
I believe a person should face their fears straight on, explore them and find ways to get around or through them. If you have fears of hospitals, doctors, needles, etc. figure out why and then create a plan for yourself to go through that type of birth.
Ok now I have some tough questions to ask you:
WHY would you choose a home birth over hospital birth?
Have you thought about the 'what ifs'? What if you were transferred for a non-urgent reason? What if the transfer was urgent?
How would you tell your birth story (that ended in a transfer) to others and what would you say about your reason to deliver at home? What would you leave out?
I value your feelings about your home birth. They are yours and you should own them. You can look back and examine things, but the value in hind sight lies in making better decisions for the future, not in examining past decisions. Why? I think you made the best decision you could with the knowledge you had at the time. Parenting is the same way. We do better at parenting as we go along because we must make decisions on the go.
So, your labor & birth outcome is dependent on many factors that are outside of anyone's control.
One last question for you. Does this statement make you uneasy, that fact that labor and birth is out of your control?
I look forward to your comments.