October 22, 2005 ~ The Comforts of Home(birth)

Saturday.

"Unfortunately, I don't do deliveries anymore," my obstetrician said as she sank into her chair. "You'll be rotated though the six other obstetricians and the two nurse-practitioners here for the rest of the pregnancy."

Morgan answered, "Yes, the nurse told us..."

"Actually..." I paused, not sure how she would react to what I was about to say. "We want to transfer to the midwives over at New Dawn."

She nodded. "They're great. You'll be in good hands there."

"You've been great--in fact, you're the first obstetrician I've ever felt I could trust," I hurried to explain, and she smiled. "We just don't feel comfortable switching around between so many doctors, with no assurance about who will be at the actual birth, and if that doctor will agree with our birthing style."

"Oh, I completely understand. And the midwives will be great, very personal care for you." She paused. "The only thing that I would recommend is that you don't have a homebirth. Just... better to be in a hospital."

I nodded. "We don't plan to. We'll be having a hospital birth with them. We want to be responsible, safe."

And I meant those words, believed those words, at the time. I registered with the midwives as a hospital birth. We read up on hospital procedures, so that we'd know what to expect (and what to avoid). Although the idea of a homebirth appealed to me, most everyone we'd ever talked to had explained that homebirth was dangerous for the baby, a selfish, irresponsible choice based on the mother's comfort rather than safety. If that were truly the case, I certainly couldn't justify birthing at home.

My obstetrician's words, however, suggested something to me that I hadn't known before. "You mean, homebirth is even legal in North Carolina?" Everything I'd heard had made it sound as if it were outlawed. I found the fact that she mentioned it interesting but filed it away into the back of my mind.

In preparation, I began reading everything that I could get my hands on about pregnancy and birth. It was in one of the most mainstream, modern, scientifically backed books, though, one written by a doctor and a childbirth educator, that I found a chapter explaining the merits of homebirth. In fact, the chapter even went so far as to say that for low-risk pregnancies, modern homebirth with a Certified Nurse-Midwife is as safe or safer for the baby than hospital birth, and much, much safer for the mother. And they included several studies and statistics to back this claim--a move that those who had spoken to me against homebirth hadn't bothered to do.

I wasn't entirely convinced. I mean, this was just one chapter in one book. A seed was planted, though. Could I have the comfort of a homebirth? And would it be a safe decision for the baby?

Meanwhile, it was time for us to tour the birth center at the hospital. In the advertising literature, it sounded wonderful. Warm, home-like rooms, small staff supportive of natural birth, emphasis on keeping medical intervention to a minimum, birth pools, a nature trail for laboring women to hike, birth center philosophy rather than hospital philosophy, etc.

It was a little over an hour drive from our house to get there, and that in light Sunday afternoon traffic. I tried not to think about how uncomfortable an hour in a car would be if I were in labor. Our friend Sloan came along for the ride.

As we walked inside, I noticed the "nature trail." The paved track circled the building through the narrow landscape beds (which were mostly mulch) between the hospital and the parking lots, and the sound of traffic on the highway and slamming car doors from the parking lot echoed off the building.

At the nurse's station in the maternity ward, we met the labor and delivery nurse who would be giving us the tour, and she led us around the place. The main birth room was sterile blinding hospital white, with linoleum, florescent lights, and a long wall filled with a bank of medical equipment. ("This is the one we let the midwives use!" she announced cheerily.) Other rooms were a little better, with linoleum made to look like wood flooring, darker colored curtains and quilts on the bed, but, over all, it did not have a birth center feel, and the advertised "home-like atmosphere" was severely lacking. This was very much a traditional hospital superficially dressed up as a "birthing center." My heart sank lower the more I saw.

And then, the nurse. The things she kept emphasizing! We'd rather not be electronically monitored, since it's been proven to be no more effective than intermittent human monitoring (which the midwives do anyway), and since it often leads to so many unnecessary interventions. She said, "No, you must be hooked up to the monitor and in the bed for at least the first hour you're here, and then for several minutes out of every hour after that." (Being hooked up means being tethered to the bed, forced to lie on your back, one of the worst positions for slowing labor and making it more painful). Will I be allowed to hold the baby and nurse immediately after birth if all is well and breathing starts right away? And can we wait to cut the cord until it stops pulsing so that the baby can get as much oxygen as possible? "No, we take the baby right away over to one of those little warmer stations and give it a full check up, then you can nurse. Oh, and we usually bathe the baby first, too." We don't want an epidural, but if one becomes necessary for whatever reason, do you offer "walking epidurals"? "Walking epidural? I've never heard of one of those. Besides, you'll want an epidural, everyone does," she said, with a smug, knowing smile. And, "no cameras at the birth." And, "you can't have the lights low." And, "no, he [Morgan] can't touch the baby until we've checked it."

And on and on. Each of the things that we'd done so much careful research on, weighing all sides and all options, here this woman was telling us, "Nope. That's not allowed." Beside that, she was very unsupportive and discouraging, especially for a complete stranger who did not know me at all. Her whole attitude said, "Oh, you say you want a natural birth and a midwife for now, but I know you'll be screaming for a doctor and narcotics when labor hits." It was incredibly demeaning, insulting, and disempowering. She kept saying derogatory things about the midwife clients, "Yeah, some people even bring in little Buddhist statues or prayer rugs or essential oils or God knows what else," rolling her eyes.

As we left, we were all very quiet for a time.

"Well," said Morgan.

"Yeah," I answered.

"It's..." he searched for words.

"...a hospital," I finished. "Not a birth center."

"Yes. A rather undesirable one."

"I'm disappointed that this is the closest thing to a birth center the Asheville area has... There isn't a real birth center or birth home within two or three hours of here."

Sloan, who had been silent up until then, piped in, "Mike and Michelle had a homebirth with the midwives, and they were really happy with it."

"I guess it's time we look into homebirth. Wouldn't hurt to find out more about it..."

Turns out, homebirth is legal in North Carolina, though only under very strict circumstances. Only a Certified Nurse-Midwife can attend a homebirth, and she must be under the supervision and authority of an obstetrician, and she must have a trained assistant with her. All other types of midwives--lay midwives, direct-entry midwives, and even Certified Professional Midwives--are not able to legally practice in North Carolina in any setting, let alone the home. (Certified Nurse-Midwives apparently go through even more schooling, training, and internships than most obstetricians do! Their training often takes over ten years to complete.). Beyond that, only the lowest of low-risk mothers can have a homebirth, and only after they meet all of the many requirements, conditions, and tests to qualify.

Morgan and I began reading more and more books and articles and websites about homebirth. And we kept coming back with the same findings. Modern homebirth with a Certified Nurse-Midwife, or even a Certified Professional Midwife or Direct-Entry Midwife where they are legal is statistically just as safe or safer for the baby and far safer for the mother with far less likelihood of undesirable interventions. Episiotomies, c-sections, forceps, vacuum extractions, labor induction, narcotics like epidurals, back labor, prolonged labor, failure to progress, (and all manner of other things that Morgan and I feel we'd rather avoid) are all extremely reduced in homebirths. Also, the risk of infection or disease for the baby is greatly reduced in the home. Labors tend to go much faster at home, because the most important thing to speed labor along is for the mother to be able to completely relax, something she is unlikely to do in an unfamiliar environment with strangers interrupting her every few minutes.

Wanting to be thorough, we read arguments against homebirth as well, and we found that many of them used outdated studies from before midwives brought resuscitation equipment into the home. Or, they focused on homebirths by lay midwives in illegal areas (where the midwife, instead of taking a woman with complications to the hospital instead avoids the hospital for fear of being arrested, or, worse, abandons the woman to cope on her own). Or, they included unplanned, unassisted births outside the hospital (where the couple failed to call the midwife in time, or where the birth happened in the car on the way to the hospital) with no preparation or training for a out-of-hospital birth. Some of the studies included only high-risk pregnancies that needed more specialized medical care but for whatever reason happened away from that care.

When we weeded out the studies that stacked the odds against homebirth and looked only at studies which restricted the variables to those that would be present in our situation (Certified Nurse-Midwives, lots of education and preparation on our parts, near a hospital just in case, low risk, etc.) we found that they all concluded that a homebirth was just as safe for the baby as a hospital birth, there was less risk of infections and diseases, and with more favorable results likely for mothers.

The more we read, the more we felt that homebirth may be the right choice for us, in our circumstances. I am very low-risk. The idea of homebirth really appeals to me (and that's just as important as the others--a woman who feels uncomfortable about homebirth probably shouldn't have one). I will have a Certified Nurse-Midwife and her assistant (likely a Certified Professional Midwife) at the labor and the birth. The midwives bring with them to every homebirth all of the life-saving equipment they need (infant resuscitation equipment, oxygen, suction, anti-hemorrhage drugs, warmers, homeopathic remedies and traditional drug equivalents, etc.). In fact, they are as equipped as the "birth center" hospital is, and they are much better equipped than an ambulance is to resuscitate an infant. And the real cincher:

The "birth center" hospital is not only over an hour away--it does not have a neonatal unit. The hospital that does have a neonatal unit is only ten to fifteen minutes from our house. So, in a real emergency, we would be going from the birth center hospital all the way back to the closer hospital anyway--why not stay close to the hospital with the neonatal unit in the first place?

We spent almost two hours at our next midwife visit asking tons of questions about homebirth vs. the hospital, and she answered all of our questions thoroughly. We came out of that meeting reassured of our decision.

So.

After much research and hashing out and weighing of the options and talking to professionals, family and friends...

For our location, for my very low-risk status, for the conclusions that we have reached after much of research, for our personal preferences, for the comfort and health of our child, for all of our combined circumstances (which would be far too boring to list)...

In other words, for very complex and personal (though well-researched) reasons...

... we settled quite some time ago on the decision to have a homebirth, provided none of our circumstances change. And it has felt so right for us ever since, when before we felt uncomfortable and uncertain.

And it wasn't just the science, the statistics, the research. Birth is such a personal, intimate experience. To be in my home, with my family, just felt right for me. To not feel pressured by strangers to conform to "procedure" is very appealing. To be able to make our birthing environment welcoming and comforting for our child in our own way is invaluable to us. I don't want Morgan to have to be an advocate for me arguing against "standard procedure," rather than just being there for me and for the birth. I don't want to spend an hour drive in labor (which could be rather dangerous if my labor goes fast). And an hour drive postpartum doesn't exactly sound thrilling either. Afterward, to already be home, to be able to relax and rest in the place that we are most comfortable. And so many other reasons. For me, homebirth just feels right.

So, what has been keeping me from writing for so long? Well, no matter how many times I rewrite this entry, the defensive tone just keeps coming back. I can't help but learn from my past experience, and that experience has been that many times when Morgan and I have made a major decision and I have made it public in this journal, some people (usually not regular readers, but still) have chosen to flame us for it. This is even more the case when that decision leads us well off the beaten path. And, of course, when the well being of a child is involved, suddenly the decision apparently becomes even more "flammable," so to speak, and there are plenty of people ready to jump in and tell us what we're doing wrong. From what I've seen both in my own journal and in the online journals of many others, as soon as you bring up anything having to do with your own parenting, birthing, or even conception, suddenly many people want to make sure you know their opinion on what you're doing wrong.

Now, normally, that sort of criticism doesn't bother me at all. Doing things in a somewhat unconventional manner is hardly new to me, and criticism comes with the territory. But birthing--well. Birthing is different in a lot of ways. Giving birth requires a lot of preparation, support, and--above all--confidence. I didn't feel ready to bring something as controversial and unconventional as homebirth into the public eye and potentially have my confidence torn down before I'd even had a chance to build any up. That was a risk I didn't want to take. I needed some time to explore my own ideas about birthing and homebirth in particular, some time to journal privately, to talk more with Morgan, to talk more with the midwives and with family and friends before I could open myself to the potential of uninformed criticism that tends to come with a public journal.

Forgive me that indulgence. There have been so many things that I've wanted to tell you. But our decision for a homebirth is very interwoven with everything that we have been busy with and with who we are becoming (as individuals and as parents) that I couldn't tiptoe around the issue without revealing it. So I was quiet and introspective instead, until I felt ready. And I do now. I do.

Most of our family members have been very supportive, as have all of our friends. The negative or insensitive comments have mainly come from those who don't know us very well who somehow found out.

Still though, before you open that e-mail client or start an entry in the guestbook, please understand that this was a very personal decision with many influencing factors that would take me far too long to list here. It has been very well researched with a great deal of consultation and thought. We have considered both sides of the issue--obviously, I mean, our opinions were on the other side of the issue in the beginning. And we would never do something that could put our child in danger, no matter how comfortable or convenient it would make things for us.

There is one other thing.

I briefly mentioned in a previous entry that I hoped to have a medication-free birth, no epidural. Though the entry was about something else entirely, I still got a slew of messages trying to talk me out of it. Most were genuinely concerned, some were rather confrontive... But they all had one thing in common. They were all written by women who had had epidurals, and the defensive tone of a few of them clued me in to something.

I want to put one thing forward. Just because I've chosen not to have an epidural if I can help it, it doesn't mean that I think all women should not have one or that I think those who do are somehow wrong or weak or uninformed or whatever. And just because I have chosen to have a homebirth does not mean that I think badly of those who had a hospital birth, that I think they are somehow "wrong." Not at all. Every birth is different, every birthing woman is different. Each has very different needs. To make any blanket statement about various methods and procedures would be ridiculous.

I think that, for some reason--and especially where issues concerning parenting or childbirth are concerned--some people feel that if you make a different decision than they did, you are judging their decision as wrong or bad. No. There are plenty of situations in which an epidural is a good choice, sometimes even an absolutely necessary choice. There are plenty of women who, for whatever reason, should birth in a hospital--it is the right thing for them to do. Either their circumstances make that the safer or better option, or they simply know that a homebirth would be completely wrong for them. They wouldn't want a homebirth; it would not feel secure for them. I believe very strongly that every woman should have choices in all these aspects of childbirth; she should be free to choose what is right for her and her baby.

And that is exactly what Morgan and I have done. We have chosen what is right for us and our baby.

There is so very much out there, and a multitude of differences between each and every woman and each and every birth. How could anyone presume to know what would be right for her without living her life for a time?

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