Being a mother of two children now I have had many conversations with a large variety of people about birth and our experiences with it. I am always a little apprehensive when people ask about mine because I'm never sure what their reaction will be when I say, "I had two home births." Most of the time they look a little shocked and then say something to the effect of "Wow! Your brave!", some really love it and others clearly think that I irresponsibly put my and my children's lives at risk. I decided to write this note because I want to give a clear explination of why I had my children at home.
First I want to make a couple things clear:
- I was not motivated by some macho feminist mentality
- I did not feel like I needed to "prove" something by having a natural birth
- I do not think hospitals are evil places
- I am not trying to be trendy or a hippy
- I did not do this for crazy religious reasons
- I am not "super brave"
- I do not believe I have a higher than average pain tolerance
Now that those are out of the way, on to the reasons I did choose homebirth!
When I was pregnant with my first child (Titus) I initially looked into the local hospitals to try and find the right fit for me. I knew I wanted to try a natural birth and had read some great things about waterbirth and it's effectiveness in helping relieve pain. I also wanted to be with midwives rather than an OB. After some searching I found a hospital that met my criteria and started my prenatal visits. The staff was friendly but I felt like there was something lacking in my care. My appointments were 30 mins long but most of that was spent either with a nurse, taking my weight, blood pressure, etc and waiting around for the midwife to arrive. I only really had about 10 mins with a midwife and it mainly consisted of going down the check list of routine questions she had for me, but I had nothing really to compare it to so I just assumed that is how it is supposed to be. After a couple of visits Robert and I were asking about the hospital's policies concerning birth. There were a lot of the typical things like not eating or drinking anything after being admitted but the one that pushed Robert and I into looking for other options was this: Because we were in the height of the H1N1 scare no one would be allowed into the room with me who was not vaccinated against it. Robert and I were both firmly against the H1N1 vaccine so that did not sit well with us at all. So we began looking else where.
We watched a documentary with some friends called "The Business of Being Born" which started my investigation of homebirth. I found a homebirth midwifery group and made a consulation appointment to check them out. The appointment was an hour long and we were blown away by the knowledge, kindness and enthusiasm about birth that we encountered. We agreed that this was definitely the place for us.
As my pregnancy progressed I became thirsty for information about pregnancy and birth. I read book after book, watched documentaries, talked to lots of people and spent hours online researching different things. The things that became overwhelmingly obvious was that birth is a tranformational experience regardless of where you are, who you are or how it happens. You will be changed by it. Often our attention is so focused on the baby that we neglect the woman during the birth process! It is not just a baby that is being born but a mother as well. Because this process is so important to a woman it is essential that she not only be safe but comfortable. For some that comfort is at home, for others it is at a hosptial or a birthing center. For me, it was at home.
When I made my decision to give birth at home the most common question I was asked was "Does that mean you won't have any drugs?". Yes, it did in fact mean I would be laboring without any option of pain killers. This is usually when I would get the "Oh man! You are so brave!" or "I would never want to give birth without an epidural!" or "Aren't you scared of the pain?". Honestly, yes! I was scared of how much pain I would be in! I didn't want to be in pain and I would love to have a painless labor! So why not go the hospital and get an epidural? Because there was something that scared me even more than the pain: injury to myself or my baby. (This next part is not written in an attempt to demonize hospitals or critisize anyone who has opted for medical intervention. It is simply explaining the risks that are associated with common interventions in the birth process that are not often known.) Recieving an epidural is actually not risk free. In fact there are quite a few risks associated with it but they are often not known. When you recieve an epidural an injection is given into the spine to block the bodies ability to feel anything from the waist down. This does not work for everyone (in fact, my mom had epidurals with both my sister and myself and it only took to half of her body both times). When your body looses this sensation a few things happen. The first is an obvious side effect, you can't stand up. You loose your ability to move around, not only because of the loss of sensation but you are also hooked up to the epidual machine as well as having a cathater in place. This loss of motion can make laboring much more difficult and even more risky. When a woman lies on her back her pelvis actually becomes smaller and it becomes much more challenging to push a baby out! Standing, being on your hands and knees, squatting or just sitting up all open up the pelvis much more allowing the baby more room to come out.
When you loose the sensation of pain your body's natural pain killer, endorphins, shut off. This means that when the epidural wears off the pain is much more intense than it initially was because you don't have anything helping you cope. The loss of sensation and subsequnt altering of hormonal response can, and often times does, slow or stall labor. If this happens often a labor inducing drug is given to keep things going. Often the contractions induced from drugs are much more intense than natural contractions so the epidural is increased. The problem with this is that while you may not be feeling the contractions, your baby is. Natural contractions tend to be intense but short allowing the baby time to rest between them. Drug altered contractions tend to be long and strong cutting off the baby's oxygen flow for longer periods of time, therefore increasing the risk of fetal distress.
Assuming the epidual is still in effect when you reach the pushing stage it is remarkebly hard to push when you can't feel anything. The lack of muscle control because of numbness can lead to the need for either vacuum extraction, foreceps or even a c-section.
On top of all of those risks there is also the possibility of allergic reaction, post-partum bladder dysfunction, nausea, vomitting, maternal fever, loss of sexual sensation and function and even death. And despite what many may claim, the epidual drugs DO cross the placental barrier and can cause drowsiness at birth, poor sucking reflex and there have been new studies out linking epidurals to ADHD. The rate of epiduals in the US is around 75%. I wonder what it would be if these risks were explained to women before they went into labor.
Back to my pregnancy. My water broke at 4:30am June 19th 2010. I was finally in labor. The first few hours I had regular contractions that were coming about every 5 minutes apart and growing in intensity. By 9:30am I could no longer talk through my contractions and started to enter that "labor land" mindset. My contractions picked up and quickly became more intense. By noon I was have extrememly strong contractions lasting at least 5 minutes with about 30 seconds in between. My midwives checked my progess and found I was only 4 cm dilated. They quickly discovered that he was posterier (facing forward instead of backwards) and stuck. With the help of my mom, my doula, Robert and the midwives we spent the next 4 hours doing everything we could to get him to turn. My contractions were not letting up and were now lasting at least 5 mins up to 10 mins long with virtually no breaks in between. I will not lie, it was extremely painful. Finally around 4pm he was in position and I was fully dilated. I started to push. He was out in 27 mins. Both of us were healthy, happy and tired! Afterwards my midwives told me that I had one of the most intense labors they had ever seen. That night I was asked by a good friend if I was happy I had him at home. And my answer, YES! Why? Because of two reasons. First, had I been offered drugs I don't know that I would have refused them, as much as I didn't want to have them. Second, more than likely I would have ended up with a c-section had I labored in the hospital. The only reason my labor went as smoothly as it did was because I had at least 2 or 3 people assisting me and trying to get him to turn for close to 8 hours. That would not have happened in the hospital.
This brings me to one of my biggest reasons that I chose and will continue to choose homebirth. I do not want a c-section! The c-section rate in America is around 35%. That means one in every three births are c-sections. The World Health Organization (WHO) states that no country should have a c-section rate higher than 15%. We are more than double that. Sadly our health care system has become so broken that it is easier and actually legally safer for doctors to just jump to a c-section then it is to help women labor natually. OBs are very skilled surgeons and such a blessing to have available but have very little training for natural birth. The hospital system is geared towards very medicalized births. (I know this is a general statement and does not apply to all hospitals and is not how all OBs/nurses/midwives see things but as a general trend in the US this is true) Because of the increased likelihood of having a c-section just from going to the hospital I chose to be at home. The risks involved in having a c-section are long but the risks in having multiple are even longer. I want to have lots of children and while a c-section does not stop me from that, it would make it much more difficult. VBACs are becoming harder to do and sadly, more costly. For the safety of both myself and my children I plan on continuing to labor and birth in the safety of my home.
In America we spend more per birth than any other country in the world but we are 33rd in the world for infant mortality rates and 41st for maternal mortality rates. Clearly there is something wrong with our system of care if we are so far behind virtually every other developed country in the world for mortality rates. I want to end this note with an message to all women out there. You are strong! We were built to bring children into this world and God created us in a way to do it without help! We have been raised to fear the pain that labor brings but I want to tell you that not only can you endure the pain but that there is nothing to compare to the moment the pain ends and the exhilaration of meeting your child for the first time. Don't doubt your own ability to labor. You were created for it. :-)
