The Great Debate: Some Thoughts, A Prodigious Post

T and I are now considering homebirth as an option for this labor.  I have always been a strong believer in the natural ability of a woman’s body to give birth.  After all, from a genetic perspective, it’s what we are created to do. And even though the task or gift of doing a great deal of work to pass on genes has been used by The Other Half as a means of repression and subjugation throughout history, it remains that we are well-suited to usher in new life.

However. Little did I know, when I decided to look into this option for myself, that I was launching myself into a raging debate concerning perceptions of newborn safety, what exactly constitutes both risk and emergencies, women’s rights and, maybe even above all else, the medical industry’s firm belief that the hospital is the best place for delivery.

After all, you NEVER KNOW when something will happen and even a seemingly-healthy pregnancy can have drastic outcomes. Why take any risk at all?  Especially of a precious newborn life!

And yet women have been birthing successfully without medical experts for all of human history, as witnessed by the vast overtaking of homo sapien sapien of every other living species and the subjugation of most of the usable surfaces of Earth and its resouces. Yes, lives have been lost, it’s true and this is where the fear comes in. WHAT IF?  But modern medicine now provides top-quality maternity care throughout much of the industrialized world as well as top quality neonate care, if needed.  Couple that with increased sanitation, disease treatment and prevention, and increased nutrition and  you see much greater survival levels.

How can it be possible that every single woman has as great a risk of birth issues?  To read some information, a young, middle-class suburban housewife with no health issues is at equally great and grave risk of birth complications as a poor, crack-addicted woman with no access to pre-natal care.  Can that possibly be the case?  What are the rates of true emergency birth sitations in the U.S.?  It’s impossible to know. What constitues an emergency in a hospital bed (failure to progess <i.e., doc thinks things are moving along quickly enough for him to get home to dinner with his family…excuse my cynicism>? mom’s skyrocketing blood pressure? shoulder dystocia?)?  How often are interventions like “emergency” c-sections truly necessary?  OBs would certainly not admit that there were any unnecessary ones at all, it seems.  How can 30% of births actually need that kind of major intervention?  Would the human population have done as well for itself if 30% of babies had died in the chidbirth process throughout history? Is there really a statistic like that?

In trying to get a clear picture of what constitutes safety or risk in homebirth, the Internet is certainly not a friend.  For every study that shows homebirth as a safe option for low-risk mothers with professional midwifery care, you will find another study that claims the opposite is true. I have seen report results showing outcomes equally safe if not safer than hospital births and I have seen research results claiming a neonate mortality rate that is THREE TIMES that of a hospital birth.

Clearly, there are supporters and detractors. Both sides accuse the other of bias, of skewing results, of manipulation and of fear-mongering.

Which side stands to gain what?

Homebirth and other midwives support home birth as a valid option (as do some OBs and doctors as do some entire medical systems of other countries). Why?  What are their motivations?  Income? Women’s right to choose?  A desire for babies or mothers to die? Ego?  Putting “natural” before any other consideration?  Less drain on the health care system?  Personal experience of many cases of successful, normal, uncomplicated (or complications that can be dealt with through adequate midwifery training) births?  (Have they just “gotten lucky” in that case?)

The medical industry (in the US) is strongly and vitriolically oppsed to homebirth. Why?  What are their motivations?  Extensive years of training? Extensive years of training in all the potential risks of birth?  Lack of experience of uncomplicated births?  Too much experience of negative outcomes? Income?  (C-sections are expensive and highly-billable) Ego?   

There’s no way to get a straight answer.

Turn to myself then. What possible motivations do I have in considering homebirth as an option?

Am I a thrill-seeker, as the medical industry accuses moms who homebirth of being?  Certainly I am not a risk taker by any stretch of the imagination. At the slightest hint of things going south, I would prefer to go to hospital than “wait and see”.  And yet, I have lived in a foreign country for over three years, a country in which I could not initially speak the language nor could I even read the alphabet.  AND one of the things I loved best and hated most was the fact that you never, ever knew what was going to happen next; life was continally and slightly off-balance, even if some days you didn’t stumble. It was always a puzzle to figure out every day. So.

But, how can a homebirth, which typically is less quick to offer intervention, where you stay in the comfort of your own home, surrounded not by bright lights and strange people giving you orders, but by only those you know and are comfortable with and trust, immersed in a pool of warm bathwater if you so desire, how can that possible be more of a “thrill” than a rapid ride to a hospital in the middle of hard labor, not being even able to walk a step once you get there, being told to strip oncee you get there, assured that you’d soon be drugged up, told that you couldn’t possibly be ready to push because you “weren’t dilated enough” when actually the resident made a measurement mistake (how could I possibly make up the fact that I actually NEED to push, buddy?), baby taken from you because possibly his heart rate had dropped though they weren’t sure if they were hearing YOUR heart beat or his, and spending 5 days in the NICU watching your brand-new little one crying from cold and not being allowed to hold him on the off-chance that he might have birth-induced brain damage?  Now, THAT, my friends, that is High Drama! That is Thrilling!  That is the stuff from which episodes for hospital shows are created.

Am I putting my own desires for peaceful birth event above that of the safety of my unborn child? AM IA BAD MOM FOR EVEN CONSIDERING THIS?  Shouldn’t I scrap both homebirth AND birth center and just rush straight to the emergency room when I go into labor?  Isn’t that the wise thing to do?  Certainly, my bitter experience with Miles has an influence in my decision.  But I certainly don’t want to just go it alone, without resources or help, either.  If the (well-experienced) midwife says, ‘we need to go to the hospital” I’ll be the first one in the car.  But.  Will we get there in time?  Does my longing for peace, comfort and a warm bath trump my desire for a healthy and whole baby?  This one is a little murkier for me.  I would never place my own desire for the way I want birth to go over the health, safety or life of my little one.  But, am I?

Here is another question:  My first birth was 16 hours (more on that later), Miles’ birth was FOUR. What’s next with number three?  From all the women I’ve talked to with experience in this, Number Three is a wildcard. Could be longer, could be shorter. Shorter?  What, three hours? Two? An hour and a half?  What if I go into labor during the day and T has to drive 40 minutes home and then we drive 20 -25 minutes to the birth center (it would still be roughly 20 minutes to get to the closest hospital, which, by the way, has a very high c-section rate and zero tolerance for women who want to birth naturally)? What if, in the middle of February, it is snowy? Or icy? What if I feel the urge to push?  I WILL NOT have a baby in a car.  That seems even riskier that staying home to me.  Call an ambulance?  If it’s bad weather, they won’t be able to drive any faster. I WILL NOT have a baby in an abulance.  Isn’t it a much more logical option to stay home and have the midwife make the 20 minute trip to ME instead of waiting for someone to come get me and then going to the place where I can birth?  I never expected Miles’ labor to be as rapid as it was. I don’t want to get caught this time.

The homebirth midwife I am considering is extremely qualified, practical, organized and a planner (this was a big one for T^^).  She has years of experience in the facilities-setting, including several years attending births at the local charity hospital, where she saw truly at-risk women:  drug addicted moms, pre-teen moms, moms over 60 years (can you imagine??? groan). She has attended over 700 births since 2004 through her own practice.  She brings with her all types of paraphernalia including three stages of drug treatment for hemorrage, oxygen for both mom and baby, suturing and the accompanying numbing agents. She has delivered breech babies. She has resuscitated infants and is trained and certified to do so. She has experienced transfers to the hospital that is close to us (which also has an in-house NICU) and has at least a working relationship with the staff of the maternity ward. She has said that while this hospital is not natural-birth friendly, they are at least not hostile to women who have tried to homebirth and have needed to transfer.  She calls ahead to alert the staff of the situation and give them the history of the birth so far and stays with you during delivery.

(Really, isn’t that almost the best way to do it?  Try at home and then if you need true extensive, emergency medical attention, go to those who provide it?  Because the chances are, you won’t need it.)

So.  There you have it. All my thoughts so far in a not-so nutshell.  Everyone knows someone who has birthed successfully at home. Everyone knows someone (or knows someone who knows someone) who had a true emergency that required immediate attention, when even a 20 minute delay would be fatal.  Sadly, the latter instances make for much better Internet fodder than the former.

I’ll continue asking questions and thinking.  This is not a decision to take lightly and any decision, once made, can be changed if necessary.

This is not the end of the story but the beginning of a process. With time constraints!

10 more weeks and we’ll hold this precious new little one! 

Now, THAT is something to anticipate.


1 Comment (+add yours?)

  1. Emily
    Dec 24, 2010 @ 12:11:59

    You’re going to do awesome no matter what decision you make!


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