My Homebirth Was Not About Empowerment

November 5, 2012

Very soon after I found out I was pregnant, my partner and I decided that we would find a midwife to provide care and to attend the birth of our child in our own home. I had been reading about children, pregnancy and birth for many years prior to becoming pregnant so it was not a hard decision for us. But I remember when I first read about someone having a baby at home – on purpose nonetheless – I thought: Why would anyone do that?!?? Why take the risk just to be more “comfortable” or “empowered”? Didn’t you just want a healthy baby?!?!

But, as I read more about, I got it. This is an account of my reasons for our decision.

First, being in the hospital is often dehumanizing. I realize that there are some amazing hospitals, amazing doctors, and amazing nurses that treat you like a full person, respect your wishes, and make you feel good. But, by and large, hospitals are a place where the needs of the system often take precedence over the needs of the individuals. You have doctors and nurses you don’t know well, involved in one of the most intimate parts of your life, often overworked, pressuring you, in a hurry, and often using language that implies that there is a threat to you or your child. I understand that many doctors and nurses are doing their very best – I don’t fault them, per se. But hospitals are stressful and intimidating and you depend on luck for a doctors and nurses that are supportive, gentle, and kind. For me, this wasn’t about wanting a “spa-like” birth or something. It was about wanting to be in a place that treated me, my child, my wishes for my birth and my child with basic respect and care. This, perhaps, on its own would not have led me to have a homebirth, but it was a factor.

Second, and most importantly for me, it is difficult to have a birth in a hospital where mother (and child, once born) are not subjected to interventions (or pressure for interventions) which do not improve the outcomes for either mother or baby. (And often actually increase the risk of harm to either mother or baby.) I will not review the research on this, but I spent a lot of time reading articles in medical journals and reading meta-analysis of studies about what interventions are shown to improve the outcome for mother and/or baby. I would suggest that anyone who is considering birthing at home or a hospital, take time to look at the research on outcomes. Read the journal articles, and then read the responses to them. Ask yourself, do the many interventions that frequently take place in hospitals improve outcomes for mother or baby? Do they reduce them? Am I prepared to argue with doctors and nurses about my care while in labor? Do I feel like my wishes will be honored? Will the doctors and nurses respect my right to informed consent on the procedures I am encouraged to undergo? There is no right answer about what is right for everyone, but it does make sense to know what research is available.

For instance, I am not aware of evidence that routine procedures such as electronic fetal monitoring, episiotomies, ultrasounds, labor induction, or pain reduction measures improve outcomes for mother or child although all of these practices are routine and widely encouraged for women in the U.S. There is, however, amble evidence that c-section rates are unreasonably and unnecessarily high, resulting in significantly reduced outcomes for mother and baby. And, we know that electronic fetal monitoring and inductions lead to higher c-section rates which bring with it a range of risks to mother and baby that does not occur with a vaginal birth.

So, while I honor the decisions of mothers and families to birth at home because it feels more empowering or peaceful, for me, I birthed at home because I thought it would be safer for me and my child. The birth situation in the United States is not good. Amnesty International argues that maternity care for women in the United States is a basic violation of women’s human rights, where the maternal death rate has more than doubled since 1987. I felt as thought I was likely to have a better outcome birthing at home with an experienced midwife. We know the U.S. ranks very low among industrialized nations, and often behind even developing nations, in terms of maternal and neo-natal outcomes. Thus, I found a hospital birth, and the accompanying the risk of being subjected to non-evidence-based procedures without informed consent, to be an unnecessary risk to me and my child.

For those considering your birthing options, here are some thoughts, for what they are worth:

*Ultimately, I think this is the decision of the mother and family. I am not saying you should birth at home. I am explaining why this was the best decision for us. I understand why others would make a different decision. I think the key is to be informed about the risks and options of either choice and make a judgement based on your own values. If you are able to be informed, it seems like that is an important step. I do not think you can trust most doctors to make the best decision for you. They 1) often not trained in evidence-based practices that improve outcomes for mother and baby and 2) they are trained to treat people who are sick and to deal with something when it goes wrong. For most births, nothing really goes wrong. They are not trained in supporting mothers so that they can birth without intervention and nothing going wrong. All of this said, I acknowledge that it is difficult to do this kind of research and thus honor families who simply do not feel like they can take this on.

*We were 17 minutes from the nearest hospital. If we would have been much further, I may have considered other options.

*My pregnancy was low-risk on every account. I went to 42 weeks, which may have made some folks concerned, but even the American Congress of Obstetrics and Gynecology acknowledges that post-date is after 42 weeks.

*I did not have two midwives present and I regret this. Things were fine, but if I had it to do over again, I would have requested that there be two midwives rather than a midwife and her apprentice who was less experienced than I realized.

*I found out after my birth that my midwife was a Christian Scientist. I am not sure if this impacted her decisions about my birth, which ended up going fine, but in retrospect I would have asked even more questions about her birth philosophy and philosophy of intervention (or lack thereof). We liked her a lot and she has delivered many babies. I wish, in retrospect  that I would have still asked even more questions.

*I recognize that it is a balance between the risk of an immediate, acute danger which cannot be dealt with at home and a range of (typically) less acute risks that are associated with hospital births. Because all indications were for a low-risk pregnancy, our proximity to a hospital, and my own awareness of how difficult it would have been for me to birth in a hospital environment, we opted to avoid the more likely range of risks associated with hospital births rather than the much less likely risk of an acute situation that could not be addressed at home or by a quick transfer to the hospital.

*I recognize that there are many cases where c-sections and interventions make complete sense and save the life of the mother and/or baby. My concern is that most of the time, interventions do not appear fall in this category. Thus, this is what we hoped to avoid.

*I really really hate medical situations where people don’t treat me with respect or care and/or are not aware of the most recent studies about best practices. It causes me extraordinary anxiety to be in these sorts of situations, whether it a birth situation or when my doctor doesn’t understand the risks of a medication he or she is prescribing for me because they don’t keep up with the literature. Which I get is hard for doctors but is nonetheless highly concerning to me. I knew that this would impact my ability to birth well. So that was a factor in my decision. My son was born in five hours and I’m convinced a huge part of that is because I felt comfortable with people who treated me with care and respect and trusted me to know what I needed (which was absolute silence and no one bothering me).

*I am currently within the vicinity of a hospital with an OB who is known to honor mother’s wishes for a natural, intervention-free birth except when interventions are clearly indicated based on knowledge of what improves outcomes for mother and baby. Thus, if I was to have another child while living where I do, I would probably birth a hospital because I know that the doctor and her staff are aware of best practices, would not pressure me, make an effort to honor mother’s wishes, and work to minimize interventions, with attention to the informed consent of the family. All of that is to say, if we could have the best of both worlds – hospitals that practice based on outcomes, providers that respect and care for the mother and family, I am all for hospital births.

*I hope eventually to add a collection of articles and resources to this post that helped me in my decision-making. But for now, those are some of my thoughts for those who are thinking through this issue from a home birth mother who wasn’t very interested in an empowering birth.

home birth baby

No incense or music or aromatherapy for me (although more power to you if you like that sort of thing). Mostly I just wanted a birth where I was healthy, my baby was healthy, and I was treated with care and respect. A home birth seemed like the best way for me to increase those chances.

Clergy Support for Unplanned Pregnancy?

July 2, 2009

I thought that the Religious Coalition of Reproductive Choice would have a list of clergy or other trained individuals willing to offer support to women and/or families facing an unplanned pregnancy, but I couldn’t find a list. Does such a thing exist anywhere? Or do families who face an unplanned pregnancy but have no church home just have to pick a random church and ask for support/advice?

Update: The Religious Coalition for Reproductive Choice lists local affiliates here and it seems like families or women could contact those people, but they are rather limited, so I am still happy for any other resources that people know of.

Update II: So, for instance in Ohio, you can call an all-options clergy counseling hotline. This looks super helpful. I wonder if they are available in all states? This is exactly the sort of thing I was looking for. Perhaps I will try to compile a list of these resources for all states, so if you know of other such resources, this is what I am looking for.

The Hardest Choice

June 8, 2009

The article below is a beautiful and heart-breaking piece about abortion past the first trimester. It is so difficult for me to understand how people cannot hear stories like this.

The Hardest Hardest Choice: Why I Had a Second-Term Abortion.

New Year New Year: a bit of rambling/visioning/thinking and an annoucement of sorts

January 10, 2009

Hello 2009. We are 9 days into you. I wonder how this will go?

I tend not to be a big new year resolution person because I am not really good at keeping big promises and because I am always trying to improve things and I adding to that isn’t really so helpful. Really, I don’t know. I just don’t do them much. (As I write this, I realize I did it two years ago right here on this blog where I vowed not to buy new clothes for a year and I stuck with it very well for five months. But usually I don’t do resolutions, and maybe my failure five months into my 2007 resolution helped to solidify this.)

Anyway, so I guess I want to reflect a bit on the upcoming year and how I would hope that it might go for me and my family.

So I guess I am sort of private and this blog isn’t really a personal journal, but it I suppose I will want to write about this more at some point so:

drum roll

is about a month and a half until we welcome a little baby into our family. So that makes for a very different year. I have been reading about pregnancy since I was 15, and excited about having a baby since I was old enough to hold my baby cousins. I’ve always wanted a family and it has always been a big part of how I envision my life.

I would read about or talk to women who would say that they didn’t like being pregnant, and I would think, “They must not love it enough. They must not have read enough about all the natural remedies that can make it better. They must not have a midwife and a doula and a support system.”

Until I got pregnant and have been very very very sick ever since. I do not believe in a God that teaches us lessons, but if I did, I am sure this would be one of God’s humbling lessons to Elizabeth about how you can’t control everything in your life and you shouldn’t judge other people so harshly, especially until you have walked a mile or seven and half months in their shoes.

I should probably clarify that there are women who have been more miserable than me in pregnancy and, as far as we know, nothing is really really wrong. I have not been hospitalized. Baby seems healthy. I seem healthy (enough). But every day is a day to get through. Which does not facilitate the pregnancy pre-baby, round belly, pregnancy joy that I had been envisioning.

Soooo, my point here is that in the New Year, I am going to try to let go a bit more and realize that I cannot read and plan my way out of the struggles and road bumps in life, and that sitting counting the hours and the days until something is over or better does not make for mindful, joyful living. In high school, it was “Oh, how I can’t wait until college.” In college, “Oh how I can’t wait to settle down with a partner and be done with college.” In my Masters studies, “Oh, how lovely that will be if I can get into a Ph.D. program.” Each semester: “Oh, how nice it will be to be done with papers.” And, as much as I have tried to not think it, it has often been, “Oh, how wonderful it will be for the baby to be born and not be pregnant anymore.”

And so goes our life.

My life has, far too often, been about achievement. I wanted to be the line leader in Kindergarten. The best reader. The best community service do-er. Get more scholarships. Seem more special. Write better papers. Be the best future minister.

In one way, of course, this is good. It is good to work hard, right? To do good. But, of course, we can do it too much.

And, at the end of the day month year, our wall is covered with diplomas and our drawers are stuffed with A+ papers and the congregation loves the sermon and we have missed What We Are Here For. Which, for me, is to love others. To be loved. To drink hot chocolate and hear others’ stories and be present to people and be present to myself. To cuddle the cats. To love the colors of the trees. To ease the suffering of others.

I have seen this so much in the last months as I tried to not collapse finishing my classes, waddling around like a sick hippopotamus on speed trying to read enough, write enough, do enough, and watch myself be perky and cheerful to others, as if I was watching some other person who could not turn off her fake cheer and show how tired she was.

I do not want to show this sort of life to our baby. I do not want to miss first coos, and the magic of a baby growing up while I scramble to Do It All. And I do not want him or her to learn that to live is to Do Good and Do Right and Achieve. I have not spent enough time playing. Or laughing. Or drinking hot chocolate. And I want my little one to do this more.

I know this is cliched and I almost don’t want to post it because it seems to me like it could be some sort of email spam story about treasuring our friends and our life and our children. All that is missing is a note at the end that if you don’t pass this on to 10 people you will be cursed.

It reminds me of a thousand sermons about being in the moment. A thousand books about Women Who Do Too Much and our rushed 21st Century World and how we need to Slow Down.

Perhaps there is a reason that there are so many damn books and sermons on this – because it is hard.

So, as we prepare to welcome a new little person into our lives, I have given myself a little new year nudge, realizing that it will never be a goal I will Achieve, but that it is an important path to be on and remind myself of.

Be present. Be gentle. Love. Let myself be loved. Slow down. Remember what will be important as I look back on my life.

Mess up.

Try again.

Be thankful.