Sunday, January 29, 2012

Why I chose to have a home birth

I wrote this while I was pregnant with Simon. I wanted to have written down somewhere the reasons why I chose to have a home birth. If you're curious as to why I chose home birth over hospital, grab a drink, sit back, and read away. :)

Disclaimer: The way in which a woman gives birth is a deeply personal choice. These are the reasons personally why I feel like a home birth made the most sense and was the best choice for me. Take into account that my pregnancies and previous birth have been 100% healthy, uncomplicated, and extremely low risk. This is not the case for all women so obviously home birth is not a one size fits all choice, and I believe women should decide what is best for them, their pregnancies and their births based on their individual needs, medical needs and preferences. whether it be home, hospital, or birthing center. This is what made the most sense to me personally. I hold no judgement for anyone who chooses differently. Each individual mother has the best judgement and will make the best choices for them and their babies.


Why I chose to have a home birth:

"Before the year 2008, the only case of home birth that I had ever heard of was of my Mother in Law Carolynn who delivered Brant's brother Tannin healthily at home. My first reaction to this was probably similar to many people's reactions when they first hear about home birth. Was it safe? Was she being irresponsible for not being in a hospital with Doctors in case anything went wrong? What if something went wrong? I was open to the method of birthing, but still had a little bit of a negative notion of it because I didn't know that much about it. But after doing research on the topic, I realized that birth is a natural process in life and not a medical procedure. If anything goes wrong, just as with anything else in life, you go to the hospital. If a woman has a low risk, healthy pregnancy/delivery it is probably more risky for her to drive her car for risk of accident than to let birth happen naturally assisted by a midwife or Doctor.

My interest really sparked in late 2008 when I had heard of several modern women my age (women I looked up to) giving birth at home with multiple children. I enjoyed listening to their birth stories and why they chose to birth at home with a midwife. I thought, "hmm, this is something I want to learn more about!" I had heard of the documentary called "The Business of Being Born" I figured it was a good place to start in learning about home birth. So many things said in the documentary clicked for me and made complete sense! I had just given birth in a hospital less than a year before I saw the movie, and could very easily see the validity of some of the points made. (More on my birth with Claire later). I decided to research the topic further, and find more women who had given birth at home with a midwife to learn from their experiences.

I was astounded by some of the facts I found in my research.

First off, The United States has one of the highest infant mortality rates in the developed world! How could this be? We are the greatest countries in the world with the most advanced medical community! Here's why: our Doctors and hospitals use far too much medical intervention. When I gave birth to Claire in 2008 the C section rate was 25%. After three short years, the rate has rapidly climbed to 33%! Granted, I understand that this is the best birth option for many women given many factors seen by them and their Doctors and that this is what is safest for them. It definitely has a time and a place. But it is major surgery where much higher risk of death or infection is involved. Other less invasive medical interventions are made quite commonly in the USA as well. Why is our rate parallel with countries like Qatar, Croatia and the United Arab Emirates? Why is it that countries like Sweden, Norway, France, Ireland, Australia, New Zealand, and even Cuba had a lower infant mortality rate than us? Most of their births are attended (both in and out of hospital) by a Midwife with very minimal medical intervention.

Secondly, "the norm" for women giving birth in hospitals has only been prevalent since the 1940s.
Only 70 short years ago. Before then, most all births were attended by Nurse Midwifes. In the 40s Doctors developed drugs promising women a "pain free birth". These births back then were called "Twilight Births" and the father was not allowed to be in the room. The pain of childbirth was still there and very real, but the drugs administered made the women not remember their pain or their births. They often had to tie women to the bed with cloth to keep her from harming herself because the drugs administered made them act very very loopy. In The Birth Book by Dr. William Sears, he states that "The woman got a shot of morphine at the beginning of labor to dull the pain, followed by the amnesiac scopolamine, which caused her to escape her body and forget her birth trauma, topped off with a whiff of chloroform or ether to put her out during the baby's final passage through the birth canal. With the advent of twilight sleep, the mother was demoted from the person in control to a semi conscious patient." It's obvious why they didn't want the Father in the room! (My Grandmother had a birth like this in the early 50s She had a very negative experience) Women decided to start giving birth in hospitals because Doctors told them that had all the tools necessary to help woman and child in case anything went wrong. Most of these births were forceps assisted deliveries and birthing laying down on a woman's back became the norm. It wasn't until the 60s and 70s when women took a little more charge by empowering themselves with child birth education and demanded the Fathers be allowed back in the room. Women have primarily been giving birth in hospitals ever since. But what about before the 1940s? The 1940s were only 70 years ago! How long has our species been in existence? The first record of the genus Homo was 2.5 million years ago, and 200,000 years since humans started looking the way they do today. What about all that time? How did they give birth? Most likely naturally with no intervention, and attended by other women who could help the birthing mother through the birth process. (Similar to birthing with a Certified Nurse Midwife today) Were the conditions unfavorable for giving birth and was there probably a lot of fetal death? Probably! But our species has continued to exist, grow, and thrive just fine.

Thirdly, some medical intervention is the norm for most hospital births.
81% of women are administered pitocin through IV when birthing in the hospital. Pitocin is a synthetic hormone and mimics the natural hormone oxytocin in birth which makes you have contractions. Typically, the pitocin makes a woman's contractions longer and much much stronger. Because of the strength and intensity of contractions, most women find it virtually impossible to bear the pain without relief of an epidural. A lot of time an epidural can slow labor, so they give women pitocin to speed the labor process. Pitocin administration and epidurals pretty much go hand in hand. Because the contractions on pitocin are much more intense than natural contractions, it can very easily put the baby in distress. A very common scenario is when a they see via the monitor that the baby is in stress and needs an emergency C section. This is probably a huge factor as to why our C section rate is so high.
One extremely interesting thing I learned in my findings is that having an epidural can block the rush of feel good hormones and endorphins that are released as soon as a woman gives birth. These natural hormones are primal and their purpose is to help the mother feel an immediate bond to the baby to ensure that the mother will care for the infant. Granted, mothers can still feel an extreme bond with an epidural. I loved Claire from the moment I saw her! But I want to be able to experience this hormone high! They studied chimpansees giving birth. They gave chimps epidurals, and found that chimps given the epidural completely abandoned their baby and didn't care for it because they did not have this rush of bonding hormones. Interesting huh? I know I will love and bond with my baby regardless, I just want to experience this rush.
Most hospital births mandate continuous fetal montering. They put a monitor on your stomach that hooks you to a machine to monitor the baby's heart rate and the length and strength of contractions. According to my Doctor, in normal uncomplicated low risk births, studies show that there is no benefit to continuous fetal montering vs. intermitant monitoring. She says most hospitals make it mandatory to continuously monitor to "cover their asses". If anything were to go wrong with the baby, a malpractice attorney could very easily point to the section of time when the baby wasn't being monitored and deem the hospital and staff as negligent. It also makes it easy for nurse staffing purposes for one nurse to monitor multiple women at a time by checking their computer monitors. Being strapped to a monitor or IV makes it very difficult to move around during a labor.

Fourth, birth is a natural normal process of life and not a medical procedure/emergency.
It has been for 2.5 million years. We don't rush to the hospital when other natural processes of our body take place like loosing a tooth. (Very mild example I know, but you get my point). We go to the hospital when we need help with something that is wrong or our safety is in danger. What happens if you have a stroake or heart attack? You go to the hospital. What happens if you slice your arm at work? You go to the hospital. You dont hang around the hospital "just in case" you have a heart attack. That seems silly! Can plenty of things go wrong with birth? Absolutely and when those cases arise, just like with any other emergency, you go to the hospital for help. Obviously women who are deemed high risk should birth at the hospital. And thank goodness for advances in medicine to help high risk pregnancies deliver safely! But what about low risk, normal, uncomplicated pregnancies like mine?

Fifth, births in a hospital can be very very expensive!
It is a gigantic money maker for the Doctors and hospitals! Claire's uncomplicated low risk easy breezy birth cost between 7-8 thousand dollars! I don't agree with the money making practices of it all. Have you noticed the commercials on TV on how such and such hospital "is a safe place to give birth"? There's a reason for the hospital's ad campaign. They want your $.

Midwives are safe
The great news is that Certified Nurse Midwives have the education and tools necessary to ensure a safe transfer should an emergency arise. They come with the medical equipment necessary to help a baby or mother in distress. They have excellent safety records. For example, my midwife Rebecca has a safety record I am very comfortable with. She says "Of the more than 400 labors I’ve managed in Utah, I’ve only had to transfer eighteen women during labor (none emergently) and three moms after the birth. All “my” babies have been healthy so I haven’t had any newborn transfers. My maternal and fetal mortality rate is zero. The national transfer rate for out-of-hospital births is around 10% for moms and 3% for babies so I’ve been very fortunate." Her education is quite extensive up to a Masters in Nursing in addition to a Bachelors in Nursing and a certificate of Nurse Midwifery. She states "The concept of “women-centered care” is at the heart of my healthcare provider philosophy. I am an advanced nurse practitioner with training in obstetrics, gynecology, family planning and women’s health issues. As a certified nurse-midwife I can prescribe medication, make referrals to other healthcare providers if needed, as well as order any necessary laboratory or diagnostic testing." This made a lot of sense to me seeing that I have very healthy, uncomplicated, normal and low risk pregnancies.

My hospital experience birthing Claire
Seeing that Claire was my first experience with pregnancy and birth, I chose to go the "norm" route by birthing in a hospital with an MD and an epidural. This is a choice that made sense to me. It is what my sister and sisters in law had done, and seemed like the best choice for me. Although there was some things I did not enjoy or agree with at all about my birth with Claire, for the most part it was a breeze! I was a week and a day overdue. My Doctor decided to induce me because I was overdue. I was not dialted or effaced at all. They put a medicine on my cervix to see if I would go into labor on my own instead of immediately putting me on pitocin. My contractions started and progressed beautifully on their own. After about 5 hours, I was given an epidural. It felt like a little pinch on my back and didn't hurt at all. I was given pitocin after my epidural even though my contractions progressed great on their own just to ensure they would continue to do so. I went from 5cm dialted to 10cm dialted really fast. Claire came down the birth canal fairly quickly. Because time is irrelevant to a birthing mother, and I wasn't exactly aware of the timeline, according to my mom (who was there), Claire stayed in the birth canal and crowned for 40 minutes while we waited for my Doctor to arrive at the hospital to deliver her. This made my mother a nervous wreck! She actually threatened nurse staff with if someone didn't get in there and birth that baby right away! Once my Doctor arrived, I pushed through 3 contractions and she was out in a matter of minutes. My total labor time from being 0% effaced and not dialted at all to giving birth was 12 hours. My birth was very uncomplicated, low risk and normal. It went very smoothly and quickly. All in all, it was a great experience.

What I did not agree with about my hospital experience with Claire
From the moment I set foot in that hospital, I felt that I had no control over my birth experience. I feel like the birthing mother is last on the chain of command in decision making for her birth experience. The hospital and Doctors have a protocol that the women are expected to follow and if a mother wants to deviate from that at all, all hell can break loose. It is very very difficult to have your wishes for your birth granted if they at all deviate from what they want you to do. (In my experience), You have to battle nurses and hospital staff to be heard. Their rules are very strict as far as what the mother is allowed to do. Because their rules are so strict and most nurse staff are used to women giving birth with an epidural, birthing naturally in a hospital can be quite a challenge. Whereas birthing at home or in a birth center, the woman has more control over her body and her choices. There were times in my birth experience when the nurses would come in my room and put things in my IV that I had no idea what they were! And then billed me later on them! I don't like the idea of things being put into my body (although it's most likely "safe") without my knowledge or consent. I was forced to be strapped to the monitor the entire time making it near impossible for me to move around and get comfortable. The hospital does not allow the birthing mother to eat because of the slim slim slim chance that something will go terribly wrong with the baby and they will have to put the mother under general anesthesia (be completely knocked out) and she throws up under general anesthesia and chokes and dies on her throw up. That is the only reason why they won't allow you to eat. It doesn't make much sense to me to go through a marathon physical birthing process without any fuel! They also give the babies shots after birth. One being a vitamin K shot to clot any potential bleeding on the baby's brain, and another is the Hepatitis B shot vaccination. The main reason why they give the Hepatitis B vaccine is because your'e in a hospital and newborns are susceptibel to catching the yucky virus in the hospital environment. The other thing they give babies directly after birth is they put this goopy stuff on their eyes. The reason they do this is because if by chance the mother has gonorrhea and it gets in the baby's eyes in the birth canal, the baby could go blind. Guess what people? I know for a fact that I do not have gonorrhea, so please don't put that crap in my baby's eyes! Nevertheless, I have no choice over the eye drops because it is protocol, and in some cases its the law! The other thing I wish could have been different about Claire's birth experience is the cord clamping. After the baby is born, the umbilical cord still feeds blood to the baby. Once the cord stops pulsating, that means that the cord has delivered the perfect amount of blood and fluids to the baby to be in balance. They clamped Claire's cord too soon (while it was still pulsing) and therefore she was really cold and had to be put under a warmer most of the night. There were a couple of other very minor things that were bothersome like not being able to get any sleep whatsoever because a nurse comes in every hour or so to check on something and flips the lights on in the middle of the night. And, they overwhelm the mother with a bunch of confusing paperwork and legal forms when she gets in the hospital. I wanted to say "I am not in the mindset to fill out confusing forms! I am giving birth! I will do it later!"

What I wanted to be different with my next birth, and why I ultimately chose to birth at home with a Certified Nurse Midwife
There are several big reasons, none that are listed above, why I chose that this is what was best for me, my body, and my family.
-I want to experience a natural childbirth. I have complete confidence that my body knows what to do for a birth. Hey, it magically knew how to build a nervous system, cardiovascular system and skeletal system among other amazing things to build a baby from two cells! My body is made and equipped for this. I want to experience it fully. I don't want to leave this earth and in the next life say "Crap! I had this awesome mortal body that could do such amazing things and I didn't take the opportunity to fully appreciate it and experience it!"
-I had a flawless and beautiful birth with Claire and am very confident that my risk for emergency is extremely low. My pregnancy so far with this baby has been flawless and healthy as can be. I am confident that my body can do it.
-I believe that birth works. It has worked for 2.5 million years. It is a natural process in life, not a medical emergency. It makes sense for me to have my birth my way out of a hospital.
-I want to be in charge (under the medical supervision of my midwife). I want to do what feels right for my body. If that means eating, so be it! If it means marching around, so be it! If it means getting in a warm tub or shower to ease the pain, so be it! I don't want to be last on the totem pole for decision making. It's my body, and my birth and I want to decide what feels right for me.
- I want to avoid as much medical intervention as necessary. This goes back to being in charge. I don't want anyone dictating to me what they say my body needs (unless it's an emergency). I don't want to have an IV (I'm plenty hydrated thank you!) I don't want to be continuously strapped to a monitor because I may want to move around or get in water. I don't want to be induced because I believe that baby knows when is the perfect time for him to make his appearance and when he has cooked long enough. I don't want to be given pitocin because I want my contractions to be as natural as possible. I don't want the baby to have a risk of being in distress from too long and too strong of contractions. I don't want to be given an epidural because of the complications that can arise (like an awful spinal headache) but also because I want to experience the rush of bonding feel good hormones directly after birth. I don't want one of my babies first experiences to be given painful shots. (Claire was peaceful and quiet when she was born. The first sound I heard was her wailing in pain when they gave her the Vitamin K shot). I don't want them to put that goopy eye crap in their eyes (I do not have gonorrhea thanks very much!) I want the cord to be clamped when it stops pulsing. Plus, my chances for having a painful episiotomy or C section dramatically reduce when I birth outside of a hospital.
-Because I see my midwife throughout pregnancy, she knows me, my body, and my wishes quite well. It's easier having her know my birth choices than having to explain it to nurses, and then re explain it when the shift changes. Her attitude is that birth works and is a natural process (similar to mine), not a "something terrible may happen" mindset that is prevalent in the medical community.
-When we got pregnant, Brant was not given insurance through the small business he worked for. Even with the expense of private insurance and an extremely high deductible, it made more sense financially to birth naturally out of hospital with a midwife instead of in an expensive hospital because we would be paying out of pocket for a birth to a hospital with a ridiculously high deductible.


This is why it makes sense to us. I cannot wait to experience it! I can't wait to share my birth story. I can't wait to have a sweet little baby to snuggle!"

I am not anti-doctor or anti medical community. It most definitely has it's time and place! I am so thankful for the advances in the medical community to help those moms and babies that need a little extra assistance in getting here safely. I saw both my Doctor and Midwife through the pregnancy for preventative measure to catch anything should any complication arise. Thankfully, Simon was as healthy as can be, and for that I count my blessings.

I'll end with another quote by Dr. Sears "Women need to take more responsibility for their birthing decisions. At no time in history obstetrics been more ripe for change. Health care excesses are on the hit list of evey political reformer, mothers are better informed than ever before, and obstetrics as it is now practiced is becoming less satisfying. Be a wise consumer. Exercise your options. Based on your personal needs and wants, choose the birthing attendants and place best for you and your baby... Doctors and insurance companies should not determine birthing practices -- women must. It is up to the baby bearers of the next generation to determine how they want to have their babies. Parents, the best birthing years are yet to come."

Now excuse me while I go kiss on some chubby cheeks!

P.s. you deserve a gold star if you sat and read this whole post! Go you!

1 comment:

jess said...

Gold star me now!