Posts Tagged ‘Homebirth’

Middle Ground on the Birth Place Debate

As I research and read more and more, I think I am becoming more balanced on my view of the birth place debate.

Last fall, I had a homebirth. I loved having my baby at home. I am a supporter of competent midwife-attended homebirths for low-risk women with a good emergency plan set into place. I felt safe, supported, and never under pressure.  While I am very friendly and outgoing, I still  prefer to have the most intimate moments of my life occur in private. I think that feeling comfortable and relaxed, as well as having freedom to eat, drink, and move really helped me to progress at a good rate.

I knew that most complications for low-risk women came up slowly (e.g. baby’s poor toleration of labor, true lack of progress, etc.). I honestly wasn’t too concerned for the rare complications that could happen quickly, as not even all hospitals are equipped to handle immediate emergencies in a flash. I actually felt that a complication would be caught more quickly at home than in the hospital, because I had a midwife and her assistant completely focused on me, rather than one nurse divided between four to five laboring mothers.

All that to say, that I am not anti-hospital. It’s every woman’s individual choice as to where she wants to birth. Some women might feel safer birthing in the hospital for the “just in case” emergency. Like I said above, feeling safe and comfortable is probably the best thing you can do for yourself during labor. If a hospital does that for you but a homebirth scares you out of your mind, then by all means, go to the hospital.

Some women may know right from the outset that they want pain medication, and that is absolutely their choice to take it. There are some women who need to be in a hospital for high-risk factors in labor. I am very glad that we have hospitals for women who want to birth there.

For the mother who wants a natural childbirth, birthing at  home or in a birth center are probably the options most conducive to that goal. I only say this because natural birth is not the norm in the hospital. I don’t think that most doctors are directly against natural childbirth itself, but it’s not what they are used to seeing, nor what they are used to “doing” (because a natural birth doesn’t really require much “doing” on the doctor’s part) . However, I have heard of many women who have had successful natural births in the hospital and were treated with kindness and respect.

As far as the accusations that often get thrown on each side, I do believe that the stereotypes exist. For example, I’m sure that there are doctors who get fed up with waiting around for a mom to finish laboring and order up a c-section so they can go home for dinner. I’m also sure that there are midwives who are so “trust birth” oriented that they forget that things can and sometimes do go wrong, and might ignore the warning signs. Both of these situations are tragedies that disregard the needs of mom and baby.

 Each mom has very important decisions to make regarding her birth place. She should first research her caregiver thoughtfully, as Enjoy Birth so aptly discussed. Your choice of caregiver is probably the choice which most affects how your birth will go. Make sure you agree with his or her birth philosophy and practices, and make sure that he or she knows what is important to you in a birth.

After choosing your caregiver, then you can work on choosing your birth place. I believe that if you have a competent, sensible, supportive, and qualified caregiver with plans in place for the unexpected (in any setting), you can have a safe birth where ever you please. For those who point fingers at homebirthers for being irresponsible or hospital workers for being malicious and filled with ill-intent, please see Birth Sense’s article Hurt by ___ (Home, Hospital, Unassisted) Birth?. She writes an admirable blog post that makes us realize that antecdotes from either side of the debate don’t prove the safety of either place. She instead urges us to ask the right questions: How can we make homebirth safer? How can we make hospital birth more welcoming? I must quote her:

“Instead of asking, ‘How can we eliminate home birth?’ or ‘How can we convince women that giving birth in the hospital is dangerous?’, let’s ask, ‘How can I help the woman who chooses to give birth in that setting, to have the safest birth possible within the boundaries of her choices?'”

Exactly. Well said. Each choice has its advantages and disadvantages, and things could go seriously wrong or blissfully right in any birth setting. Many studies have shown that under the proper circumstances, each birth place has similar safety levels. Let’s stop arguing and encourage women to know the pros and cons of each place, then make her own decision.

Are All Midwives Created Equal?

I had a homebirth this past fall. I absolutely loved my midwife in every way. We got along well, she took a lot of time with me at each appointment, and she cared about me personally as well as medically. As far as safety precautions, she was very reasonable: she was strict about who she took, offered proper screening (ultrasound, the same routine tests they do at an OB appointment, GBS test, etc.), and recommended we have readily available transport in case of transfer. She was  extremely well trained both through midwifery school and through internships in Africa and the Phillipines. She also was a former EMT and had a back up doctor for me. It seemed like the safest homebirth scenario possible, and I would have another homebirth with the same midwife in a heartbeat.  

Recently, however, I’ve heard a couple terrible homebirth stories with sad endings, and they have made me question what exactly went wrong. Let me be clear with my statements on this. I know that in some cases when a baby dies at a homebirth, he may have died regardless of location. I also know that there are some rare, but serious, complications that constitute true emergencies. These require fast action to be taken and sometimes could be better solved in a hospital. However, the birth stories that I read were neither of these situations.

The most frightening “homebith gone wrong” stories I’ve heard were the result of negligence or incompetence on the part of the midwife in attendance. For example, in one story, the midwife glossed over a maternal fever, contractions right on top of one another, and bright red blood clots- all of which are signs of a placental abruption, requiring immediate transfer to the hospital. This is completely alarming to me- even I know about placental abruptions, and I have no official training in any of this!  How in the world is it that a midwife, in good conscience, could ignore these warnings and not take the mother to the hospital immediately, at the very first signs?

This story is not isolated. Preventable deaths at the hands of an inept care provider is always tragic, whether it be at the hospital or home. Whenever I tell people that I support homebirth under the right conditions, I now have to add that if they want to do it they have to find a good, competent midwife. Credentials are sometimes a good indication of her knowledge and abilities, but I think it’s best to look at her individual training and experience. (For example, a DEM that follows evidence based practices and has had many years of experience might serve you better than a CNM fresh out of school. Of course, there are also times that a CNM would be the better choice.) Look into her history, the school she went to, make sure she brings the right equipment with her, and know how she handles a situation that requires transfer.

I don’t think that all midwives are equal in their practice any more than I think all OBs are equal. Both are prone to error at times, sometimes more drastically than others. I recommend that you research your individual midwife, just as I would hope that you research your individual obstetrician. Check out Birth Sense’s article, “Ten Ways to Spot an Incompetent Midwife” for excellent questions to ask a midwife before birthing with her.

Be it clear that I am pro-competent midwifery, pro-sensible obstetrics, and an advocate for homebirth under the right conditions. It is imperative that mothers research their midwife extensively when planning a homebirth to ensure safety and know that the right actions will be taken in case of unexpected scenarios. The safety of homebirth (and hospital birth too, I might add) strongly depends upon qualified and watchful attendants.

Collecting Positive Birth Stories

Many women in America today see birth as a terrifying unknown, a dreaded trial that they have to get through before they can finally meet the baby. Much of this fear is due to the current media representation of labor and delivery. Part of what I would like to do with this blog is to correct our perception of birth by sharing positive and encouraging birth stories, whether they be in written or video form, at hospital, birth center, or home births.

Birth is a life-altering experience, one that brings out the greatest weaknesses and greatest strengths that each mother posesses. Birth is not usually described as an easy process, and almost always involves pain and some aspect of unpredictability. It is my firm belief that all women should be honored when they bring children into the world, no matter what the mode of birth was. Also, I do not think that any woman should be made to feel badly if her birth was not ideal or if she had to change her plans. I do believe, however, that birth does not have to be a frightening, horrible experience. Rather, it can be a beautiful experience: one that taught you deeply about yourself, showed you that you were capable of things you never thought possible; a passage that tempered you on the way to meeting your precious child, and an event that can be fondly remembered and treasured. I believe that we can help some women to overcome their fears and work towards acheiving the type of birth they desire by sharing stories that are inspiring and empowering.

I would love to collect more positive stories to share with expectant mothers. If you have a birth story that you would like to share or a birth video that you would reccommend, please contact me at thebirthbug@gmail.com. Let’s start changing the way women see birth!

I thought I would start by sharing a lovely video of a pleasant homebirth. Enjoy!

Birth Animosity and a Guide to Sanity

I’ve been reading all sorts of blogs and forums on childbirth recently, and almost any article actively pro- or anti- ________ (fill in the blank: natural childbirth, interventions, homebirth, etc.) is followed by a long strand of back and forth comments, each series seemingly more vicious than the next. The banter is reminiscent of two kids on the playground, each convinced he knows what he’s talking about:

“Oh yeah? You think you’re so smart? Where’d you learn that?”

“Well, just listen to this story- that means it has to be true!”

“Wow! That story makes you look like a total idiot!!!”

And on and on and on…

Why is it that birth issues are discussed this way? Maybe it’s because birth is so personal, or maybe it’s because we’re so passionate about the choices we made, or maybe it’s because we were hurt by a particular experience so we speak out against it. These are valid feelings, but I need to be frank here: I’m very tired of all the name calling, credential waving, antecdotal gossiping and bragging, and arrogant and opinionated birth animosity that goes on across the web. All of this is anything but helpful for women who are trying to make educated decisions about their birth. It is not constructive for mothers to maliciously degrade others’ birthing methods, nor  is it beneficial to self-righteously exalt the Way they themselves birthed.

There are two extremes that are mainly at play here: 1) The “all natural childbirthers are presumptuous, irresponsible martyrs who are only advocating NCB for the money involved or for the sake of ther own egos” group, and 2) the “all doctors are conspiring to make higher paychecks, don’t care at all about women, and have an all-consuming control/power complex that overrides their practices” group.

It is my strong conviction that probably neither of these assumptions are usually  the case (although it’s true that sometimes each group does play into its own stereotype). Let’s be honest here- blanket statement generalizations are rarely true. (Remember the true or false questions in school? If the statement contained the words “always” or “never,” as a rule, the best answer was probably false.) And yet, this is what so many of us do, day after day- point fingers at broad groups, make assumptions based on very little evidence or experience, and go around spouting off about why we are right. I’ll be the first to admit that I have been guilty of this in many areas.

While this practice might seem gratifying and self-affirming to some, or just harmless press to others, in reality, it is hurtful and uninformative. This kind of behavior needs to stop. The following is an attempt to reintroduce some sanity into these online birth forums, and more importantly, some kindness and consideration into our relationships with others.

Women who would like a natural childbirth or homebirth- please:

  • Do not assume that doctors don’t care at all about the desires of women in birth. I’m sure that many do care. Some may have differing opinions of what is best (or what is normal in a birth), so this is where respectful discussion of your desires for birth comes in. If he or she still disagrees, find a differnt caregiver.
  • Do not assume that all doctors are money hogs. I’m sure that these doctors do exist, but we cannot presuppose the worst of everyone.
  • Do not assume that all doctors are anti-NCB. Many OBs are welcoming to women who want to birth naturally, and will work with women to acheive that goal. If yours does not support you, then find one who will.
  • Do not assume that all hospitals are evil places. It is true that lawsuits, time limits, finances, emergency mindsets, and protocols do influence hospitals a lot, and can tip the scales against natural childbirth. But hospitals do have good in them, and can sometimes save lives because of the available equiptment. There are hospitals that are more natural birth friendly than others. It is important to weigh the pros and cons of hospitals (and the likelihood of differing complications- natural or intervention-induced) carefully when considering a place of birth.
  • Do not assume that you will be mistreated if you give birth in a hospital. I have heard many sad stories where this is the case, and I am so sorry that so many women have been wronged in this way. However, I have also heard many wonderful stories where women have been treated with kindness and respect in a hospital. Try to get to know some of the people who will be there when you give birth to help determine the treatment you will receive (I know this can be difficult to get to know everyone, but you could at least try to meet with the each of the doctors and midwives in your practice who could be on call the day of your labor).
  • Do not assume that all interventions are terrible. While I believe they are widely overused, I do think that they have a place and can help a woman who is truly having natural complications in labor.
  • Do not assume that women who receive pain medication are “sissies.” I myself am not in favor of pain medication becasue of the risks involved and what they take away from the birth experience. I also strongly believe that any woman who chooses them should definitely know the pros and cons of doing so. However, absolutely no one is in any place to judge how another women feels in the middle of labor and the decisions she made.
  • Do not assume that all homebirths are perfect. While it’s rare, things can sometimes go wrong. I encourage participation in proper screening and precautions to minimize risks.
  • Do not assume that midwives are better than doctors. They each have their own strengths and they cannot compete with one another. In an ideal world, they would work together more often than they do.

Doctors who do not usually attend natural childbirths or homebirths; please:

  • Do not assume that women who want a homebirth are irresponsible. They are making informed decisions and choosing what they believe is the best for themselves and their babies, and most of them do take reasonable precautions.
  • Do not assume that NCB advocates are in it for the money. I’m sure that these people do exist, but to say that most are is just as unfair as saying that all doctors are money-hogs.
  • Do not assume that NCBers are trying to be bad patients or to purposely aggravate you. Even though you do this day in and day out, for each woman, her birth is extremely personal and she wants to make it the best she can. If she challenges your opinions or seems skeptical, please respectfully explain to her why you would like to do a certain procedure. If you don’t have a good reason other than it’s routine, then maybe you should reevaluate why you’re having her do it.
  • Do not assume that you can rush through routine things with a woman in labor. Be gentle and explain things as you go. It can make a world of difference in helping her feel calm and secure during her most difficult hour.
  • Do not assume that all homebirths go wrong. Remember, you only see the transfers, not the rest of the women who give birth peaceably at home. Treat the transfers with kindness.
  • Do not assume that women who want a natural birth just want it for their egos. Birth is a life-changing process for women, and doing it naturally is very important for some. For most, it is not so they can brag. Most women who want a natural childbirth want it because they feel it is the best for their babies and their bodies. Some also feel that experiencing the instense pain of childbirth can be an empowering and beautiful process, and can magnify the bliss of first meeting their child.
  • Do not assume that doctors are better than midwives. They each have their own strengths and they cannot compete with one another. In an ideal world, they would work together more often than they do.

I think we all need to take a step back and reevaluate our attitudes and motivation before we speak. Is it to prove we are right? Is it to make someone else look bad? I am not against having valid opinions and strong feelings about some of these matters. I am all for critical thinking and discernment when it comes to making decisions regarding birth. Also, I think it’s totally okay to disagree on what we think is the ideal birth. My point here is that we could all use a little more grace in our interactions with others, particularly in these crazy online comment boxes. Perhaps if we all followed the old adage of “think before you speak,” avoiding gross assumptions, and mixing in some tact and courtesy, the birth animosity that we see so much of would gradually diminish.

Homebirth Debate

I’ve recently been reading some writings with conflicting views on the safety of homebirth. Here are two well-written, commonsense articles that I would like to share regarding this controversy.

The article Birth Wars: Who’s Really Winning the Homebirth Debate gives great insight into how the opposing sides of the homebirth debate view evidences shown by studies. It’s definitely worth a read.

Also, I love “Opponents of Homebirth: You’re not Listening!” written by “The Midwife Next Door.” It gives information on the safety of homebirth as well as a call for careful listening to what mothers want in a birth.

Disclaimer: I am definitely a proponent of homebirth as a safe choice for low-risk expectant mothers. I do understand that not everybody should birth at home nor would everyone feel comfortable doing so. I am grateful for hosptials and modern medicine. I believe that women should know that homebirth may be a viable option for them if they so choose- and the choice of where and with whom to birth should always be made with careful consideration. Hope this is helpful!