Monday, April 16, 2012

Our Journey to a Home Birth

As many of you know, Alan and I, after years of struggling with infertility, are 10 weeks along with our first child.  YAY!

What you may not know is that We have decided to pursue a midwife-assisted home birth.  We do not intend on going to the hospital and meeting with an ob at all through our pregnancy and delivery.  We will still do all of the blood tests, ultrasounds, and checkups that are recommended for a birth, and we will have all of that medical knowledge at our fingertips, but we have chosen to take a more active role in our birth process.  The part that makes me happiest, is that Alan is just as enthusiastic about it as I am, and I can go to him when I'm having my questioning days and he is there to help remind me of the reasons we chose to this path..

Our midwife is Richelle Jolley, CPM.  You can view her website here.

If you are like the vast majority of people in America, you already think that we are insane for our choice, especially with this being our first birth and given our past struggles with infertility.  I'm sure the thought crosses your mind that we are risking both my life and our baby's life by being a 15 minute drive to a hospital when we deliver.  I'm sure the risks of fetal resuscitation, the cord being wrapped around the baby's neck, postpartum hemorrhage, and the lack of instant access to pain medication and antibiotics have also crossed your mind.   I bring these things up not to increase your worry for us, but to let you know that we have considered these options and are not going into this blindly.

And we are blissfully happy and content with our decision.  Seriously, blissed-out with it.  

It was a decision we came to with much prayer and research, and it is a decision that we will continue to research throughout this pregnancy.  If things change and we feel like we should go to the hospital, I will have no hesitation with going.  If we have to have an emergency C-section, so be it, because that it what the hospital is for.  I don't expect everyone to have a home birth, nor would I recommend it to everyone.  It is a personal choice that everyone needs to make for themselves, and I do not think less of anyone for choosing a hospital birth regardless of the reason.

I wanted to address the most common objections we have had in making our decision to have a home birth.

"You're so brave!  I could never do that!"
This one is one of the most common ones, and it always makes me chuckle a bit.  The truth is that I am far more scared of going to the hospital than I am of delivering at home.  At home I am far more in control of the situation than I would be at the hospital.  Here are a few of the things that I have seen forced on laboring women in the hospital that I will not have pressure to do at home:
Forced restriction to the bed - Most often because an epidural has been administered or because the fetal monitor has been screwed into the baby's head.
Forced Catheterization -  If you cannot move you cannot get up to pee.
Constant Fetal Monitoring - They literally screw a monitor into your baby's head, so that they can monitor them all the time. Studies have shown that it is not medically necessary for constant monitoring, and that frequent  with a belly monitor is just as safe, with no damage done to your child.
Forced Starvation - Most women do not feel up to eating during labor, but for for extended labors it is a good idea to eat if you feel up to it, even if it gets thrown up immediately.  That's a long time of intense physical activity to go without feeding your body.

Only One Delivery Position 
When you deliver in the hospital, you almost always are forced to deliver on your back with your legs up in the stirrups, which is the worst position for everyone but the doctor.  When you are on your back gravity is of no help to you and is an interference.  The baby must defy gravity to move up and over your tailbone, which means you have to push harder than you would if you were squatting or kneeling.  Not to mention that it is very hard to fully engage those pushing muscles on your back, rather than a more upright position.
Pressure for Interventions - Hospitals are businesses.  Their job is to get you in and out with as short of time possible, or if not to make the most money off of you while you are there.  The longer a labor progresses, the more you are pressured into things like Pitocin or an epidural, and the more interventions you have, the easier it is to have another.  This is fine if you want those interventions from the get-go, but we do not.  Even if you have an intervention-free birth plan, you will be pressured at a time where you are most vulnerable to make decisions based on your immediate animal instincts,  you are less likely to have the focus to read over the 10 page warning label for each medication, and when you ask the Dr what the risk is and he says "It's minimal" and you sign, you have no legal leg to stand on if that medication causes serious complications.  And you're crazy if you think you're going to be the only one pressured into a procedure that you do not want.  I have heard many stories of couples who have gone to the hospital for a delivery, and the husband was told he was risking his wife and child's lives by not doing a medically unnecessary procedure like a C-section.  My parents were told by they Dr with their second child that they could either have a c-section or get out of the hospital, because it was the only safe way to deliver.  My parents bravely left the hospital in the middle of labor, and went to a different hospital, where a few hours later my sister was born healthy and happy, with no ill effects from the vaginal delivery or the delay in getting to another hospital.  Not all, but some (most) Doctors will omit the truth, exaggerate, or outright lie to you to keep them in control of the birth.
Delivery is on the Doctor's Schedule, Not Your Body's - I have never heard of a doctor who will stay with their patient through the whole labor and delivery.  Never.  It's simply not possible for them to do so.  I have heard many stories of mothers who were ready to push, and were told to wait until the Dr arrived.  In one situation with my sister in law, my niece was crowning for 10 minutes waiting for the Dr to arrive, because the nurse was too scared to deliver without the Dr there.  Fortunately, everything turned out all right, and she miraculously had no ill effects, but she could easily have died while waiting for the Dr to get there and play catcher.   For all we knew the placenta could have detached prematurely (especially as she was given Pitocin, which drastically increases the risk of premature detachment), meaning that she would have been without life-sustaining oxygen for the full 10 minutes!  A Midwife does not leave you in the middle of a birth, and is ready for you to push when you are ready to push.

"You should have an epidural so that you don't have be in pain."
Call me crazy, but who says birth has to be that painful?  The hospital does a lot of things that INCREASE the pain of childbirth, including preventing a mother from walking/moving through labor, routinely doing episiotomies, forcing you to give birth on your back, and using drugs to cause labor to progress faster, which causes harder, longer, more painful contractions.  The hospital is also a very high stress environment, which can be worse to deal with than physical pain.  I plan on having a water birth, which many women say is better at soothing pain than an epidural, without all of the negative side effects and the lack of control.  There are also therapies like meditation, which help you key in to the rush of endorphins that happen with birth.  Do I expect to feel pain?  Yes I do, but I would rather have that pain on my own terms and in my own sacred space, where I can deal with it best.  I believe that a lot of the pain of childbirth is mental, and that if you believe it will hurt it will.

"What's the point of all of these medical advances if you don't use them?"
Medicine, in particular obstetrics, does not have a good history of fully researching the medicines and advancements used BEFORE they start using them.  If you really want to see what Medicine has considered Advancements, do some research on Twilight Sleep, or on any drug that has been recalled for use in Labor and delivery.  The Business of Being Born, and Pregnant in America are two wonderful documentaries that go over all of the ways where medical advancements have NOT been as helpful as everyone seems to believe.  There are some medical advancements that are wonderful, and are a great help in pregnancy and birth, such as RH factor tests and medication, and amazing medical advances in C-sections.  Taking birth away from midwifes and away from home is not what I consider a medical advancement.  If you look at the developed countries in the world, our fatality rate for mothers and babies is second to last!  If you compare our fatality rate to the world as a whole, we rank around 50th, under some 3rd world countries!  If medical advancement has done more good than harm, then why are we ranked well below developed countries like Holland, where they have the same technology as we do (if not less advanced than ours) yet their homebirth rate is around 80%, and ours is less than 2%?  Obviously delivering at home is not a bad thing for mother and baby, if you take advantage of the medical advancements to make sure you are in the 95% of births that happen without any issues or complications.  And if you are in that 5%, well that's what hospitals and Drs are there for!

"But Midwifes can't do everything a Doctor can"
True, a midwife would not be able to do an emergency C-section.  While a CNM is unable to administer drugs such as pitocin, they are able to use herbal treatments, which often have better outcomes and have less side effects.  A midwife can also preform an episiotomy or do sutures if needed.  We chose a midwife because of the things she can do that a doctor cannot.  She will be with us every step of the way.   A doctor is obligated to be with other patients, and cannot stay with you during the entire delivery.  Additionally, a midwife is more flexible with birth positions, and will do everything possible to facilitate moving the baby into a good position, including massage, walking, and squatting.

"Your first baby you should be in a hospital because you don't know what issues could come up and you don't want to have to transport to the hospital in an emergency."
There was a recent study done on mothers with Low-Risk pregnancies who were giving birth for the first time.  They found that the mortality rate for mothers and babies in births that started out in the hospital versus those that needed to be emergently transported from home to the hospital were identical.  Statistically there is no advantage to having a low risk birth start out in the hospital or start out at home.

"My baby and/or I would have died if I had had him/her at home instead of the hospital."
I'm gonna go religious on this one.  This is the argument that concerned us the most.  No one wants to be responsible for the death of a loved one, be it wife or child.  Alan and I have both done a ton of research and then prayed about this decision, and have received the most wonderful sense of comfort and peace about it.  It was not an easy road for us to get pregnant, and we spent months in treatment and on medication to help things along.  When we did get pregnant it was when we were on a break from all of the meds.  God has definitely proven that he is in control, and will do what is best.  By allowing us to conceive, God has given us earthy stewardship over his precious son or daughter, and that means that we have the privileged to know what is best for that child.  Any mother or father has that right, and it should be something that you take advantage of.  We are constantly asking what is best, and we feel right about this decision.  I am confident that if we need to go to the hospital, we will be told that we should go to the hospital - end of story.  If there is something that we need to do to prepare, like having oxygen on hand, we will have oxygen on hand.  I am not so set on this plan that I would defy God's guidance and stay at home when I shouldn't.  Alan is just as likely to receive those prompting inspirations as I am, and we both feel very good about protecting our baby by giving birth at home.

If you want to know more about our decision, or would like some of the statistics behind our choice feel free to contact me!  We are very happy with our decision, and we welcome all comments, encouragements, and even criticism.  In my opinion, birth options should be discussed far more openly than they are now, and there is always more to learn!


jkzank said...

I admire your bravery, not necessarily for choosing a home birth but for announcing it! It's a choice that I'm sure you'll get a lot of flack for. I have to say from my experience attending hospital births that I truly believe *most* nurse/medical persons want to do what's best for the mother and baby. My only piece of advice for labor is to be prepared for anything!

Ani Schmidt said...

Kelly, I do agree, most medical professionals do want to do what's best for everyone involved, especially the mother and baby. However, I think everyone deals with things based on their expertise. Medical professionals are EXPERTS in dealing with problems in pregnancy, but not experts in un-medicated birth with no interventions. A large percentage of medical professionals have never seen a completely intervention (no epidural, episeotomy, induction, etc) and medication free birth, or if they have it's not what they specialize in. Since my birth plan right now is to not have any medication, I want an expert in those types of births. If that changes, which it may, I will be happy to have a different kind of expert (MD) attend my birth.

Krysta said...

I wish you well! My sis-in-law had a water birth at home with her second and one of my friends has also successfully done so. I can definitely see the advantages. I've personally decided on a hospital birth, but it is a small hospital and I've heard nothing but good experiences from family and friends who have gone there. I researched all the options too and it is quite interesting to read about the different experiences possible. I feel good about the hospital though, especially with my Rh stuff. (Hopefully that isn't a portent, lol.) I hope you don't get too much negativity from people about your choice - it really is up to the parents and what they feel is best, barring a medical emergency of course. I sometimes feel like I am being judged or pressured BECAUSE I'm going to a hospital instead of trying a more "natural" method. It is funny because it usually goes the other way around. A lot of it is probably just in my head though.

Becky said...

There are so many birth options out there for women now. Back in my day, going to the hospital was the only option I was aware of. I am just learning of all of the cool options out there. For instance, I just finished reading a book titled, "Unassisted Childbirth" by Laura Kaplan Shanley- which of course, is about unassisted child birth... a concept I hadn't thought about, but one that I might have considered back in the day when I was having my children... pretty interesting option...

Ani Schmidt said...

Krysta, I think it's awesome that you chose a hospital for your birth. You obviously have done a lot of research on it, and you made what you feel is the best choice for you and your baby, and no one should fault or shame you for that choice. Which hospital are you going to?

T to the Essa said...

ok this post was like... the best blog post I've ever read. I found it SO useful and informative. I guess I never thought of it as a viable option, only something that hippie-wannabes do and super risky, yadda yadda....

I kid, I kid. Kinda.

What I wanna know is the cost difference. Is it more cost effective to do it your way? That's what I am personally concerned about.

And about the dying if you weren't at the hospital bit, my mom said the same thing about my birth. I think whatever God's will is, is what God's will will be. Not sure that makes sense to anyone but me.

I am so super excited for you. And insanely jealous. But mostly excited.

Ani Schmidt said...

Thank you Tessa!

As far as the cost difference it is much cheaper for a homebirth. My midwife charges $1500 total, including monthly visits until the third trimester, when they go to biweekly, the birth, the infant checkup, and a few other things. Most midwifes are pretty comparable, though that can vary if you are giving birth at home or in a birth center.

I am still trying to find out if my insurance will cover any part of that cost, but my bet is no. Some insurances will label them an out of network provider, while others do not consider CPMs providers in any extent (though most consider a CNM a provider since they are licensed nurses).

Most people will manually submit a claim to their insurance from the midwife, and the insurance will count that as a part of their deductible or out of pocket max even if they don't actually cover any of the cost. For us it was still less expensive than the copays and percentages at the hospital, especially if there is any issue that would cause you to stay at the hospital for more than a day (which happens in most vaginal births and all c-sections in the hospital).

Ani Schmidt said...

This story is yet another reason why we are delivering at home. I know this is a total horror story and not a typical case at all, but these type of stories pop up more and more with every bit of research I do.

Ani Schmidt said...

Becky, that book is on my list to read! We decided against unassisted childbirth this time since neither Alan not I have delivered a baby before, so we're not comfortable with that method for the time being. Maybe when we have a few more under our belt though!

Krysta said...

It will be Orem Community. It has a friendly atmosphere and several friends/family members have had good experiences there. Looking at the other comments about insurance coverage, I checked and ours does not cover births outside the hospital. I think that is pretty standard since home births are still working on gaining support. I'm sure it varies slightly depending on the insurance, but perhaps more of them will cover costs in the future.

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