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April 19, 2006

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What a great post!
No arguments from me. I had a home birth with my 2nd child & it was an empowering, wonderful experience.

Dangers exist everywhere, and there are risks in delivering a baby in a hospital. Apart from the interventions, hospital based infections scare me.

And you know, I could choke on that piece of broccoli you cooked so well. Perhaps we should all only eat under the supervision of trained medical attendants?

nak
This is one of the most beautiful posts on the subject I have ever read.

And that's all I have to say about that. Thank you for your words.

Jamie, I am off and on going through your blog, and loving it - I am currently 31 weeks pregnant with baby #5.

My previous 4 were hospital births, 1 c-section and 3 VBACs - and I am DONE with OBs.

There is never anything ever the matter with me during the pregnancies, and yet OBs have previously sold me on early inductions because..... my babies are too big.

Well, you can't see me, but both my husband and I are tall. With my body frame it would be absolutely ridiculous to pop 7 pounders. 10 pounders and up sounds more right.

We are going to attempt a homebirth. My 3 VBACs had disastrous outcomes:
the 1st VBAC was a very, very stressful delivery, pills to dilate my cervix, meconium stained fluids and a baby with a broken collar bone;
the 2nd one was the most disastrous one with a baby boy whom the neonatologists believed was going to die because he couldn't breathe, and consequently a 4-week NICU stay with many other health issues afterwards and many very intrusive medical interventions such as bronchioscopies and treatment for possible biliary atresia, etc. Having everybody scratch their heads at such an outcome;
the 3rd one was the "best" induced VBAC as we had learnt from the previous ones, and yet my little baby boy had trouble breathing also, and had to stay in the nursery a week with a variety of follow-up exams afterwards.

So, as I said above, I am DONE with OBs - I have seen through their agenda of so-called "labor management" which is nothing else than labor control - they have their place, no doubt - but please stay where you belong and don't fix what ain't broken.

And after reading a variety of myth-shattering literature, I know what seems to puzzle them to the point where - lo and behold - they have nothing to say anymore!

We have found a homebirth midwife who has had 10 children of her own and so far has delivered close to 500 babies!!! She knows a thing or two. And already at 31 weeks my baby is so far down in the pelvis that I have no room to sit decently anymore, Braxton-Hicks are coming very frequently and becoming increasingly uncomfortable, which gives me and the midwife a good starting point - I am confident that things will go well without an OB telling me at my very first 8-week appointment that given my "history" (what history? Disastrous pit/epidural inductions????) he won't let me go past 40 weeks. Thanks, but not thanks.

Thank you for sharing - I would love to hear EVERYTHING about homebirth that you are comfortable sharing. Please pray for us - our baby Lucia Faustina, my family and my midwife and her assistants - due date around June 23rd.
Blessings, Michaela

Somehow, i'm not surprised at her view of epesiotomy. I think the doctor is questions views regarding childbirth illustrate the reason that many women choose a midwife.

I don't have the energy to go investigate her site right now, but I wonder if she's had an episiotomy herself. Or if she'd like to talk to my friend who, 16 years after the birth of her son, still has pain during intercourse from her episiotomy.

It really bugs me that women buy this crap. One of my good friends is due with her first in June, and is using a very conservative OB practice and doing nothing but taking the hospital "childbirth ed" class. I can see her heading right straight into a c-section or nasty episiotomy and a whopper of a case of self-doubt because she "couldn't" do it. But there's nothing I can do about it. My friends see me as some kind of x-treme sports advocate because I had a homebirth. I never wanted a homebirth, particularly. But after my first birth center transfer to hospital birth I knew I didn't want to be in the hospital again if I could help it. The birth center closed, so we did it at home. I have no regrets, and will choose homebirth again if we have more children. The level of stress that just wasn't there was amazing.

I also have a hard time justifying sucking resources that other women actually need. There are women and babies who need providers trained in complicated technologies, and they need those technologies themselves. Why should I, who needs nothing but a birthing ball, a whole lot of cursing, and a toilet to squat on, be using those resources? It's wasteful.

1) wait until morning. I assume he needs sleep too ;-).

2) why?

3) I dislike when people won't just give me the references. My current problem is one where a doctor says that "you can't" do a certain procedure on a breastfeeding mother. I have references that say yes, you can, though 24 hours of no breastfeeding will need to happen (not fun). response so far is just that you can't. I'm not pursuing it farther until I know that I have to have the procedure for sure. But spare me the condescending attitude of almighty doctor, especially when I have medical references (and they're even "mainstream" references!) to back up the other side, and almighty doctor just says "because". Doesn't work on my children either - they like to know why, too. (Perhaps I am taking this comment too far, and some of my own frustration is shining through in my post?)

4) Homebirth is not a good option for me, assuming that I ever get to do pregnancy again. I am not low-risk by any stretch of the imagination. If I were, I'd consider it. But I'm not, and never going to be, and I think any provider that would take me on would be making a big mistake. So I'll settle for fighting the system and having another epidural-free, episiotomy-free, hopefully no drugs either, birth in a hospital where I have to argue my way through to keep the baby with me... but hey, I did it once that way. Now, if I couldn't find a VBAC friendly doctor again? Hmmm. Different scenario. All I know is that nobody gets to just cut me open, simply because I've had a prior surgery. Sigh.

This post is great. In my situation (26 weeks pregnant with my first), I'm in the process of trying to learn as much as humanly possible. I'm trying to go into this experience with as much openmindedness (and background knowledge) as possible. I'd love to be able to give birth drug-free, but I'm not going to beat myself up if I take an epidural after 36 hours or something. However, I've always been a bit intimidated by doctors. Since it's my first baby, I'm not comfortable doing a homebirth, and Illinois does not allow birthing centers (thank you all-knowing politicians for that law). My compromise at this point is that I'm planning to hire a doula who will allow me to labor at home for as long as possible and who will advocate for me (to avoid episiotomies, allow me to move around, etc.) with doctors when my concentration is elsewhere.

I'm not sure where any of this will get me when the time comes, but I will say that I am far more confident in my own well-researched conclusions than in a doctor's opinion who 1.) barely knows me, and 2.) rarely explains the things she does decide to do.

First, on episiotomy -- I had a friend in college who was a nursing major (she's now a NICU nurse) and I have very very clear memories of her coming home from clinical with a demonstration of what an episiotomy will do to you. It involved a Kleenex -- first she tried to tear it and it wouldn't go. Then she cut it with scissors (just a small cut!) and that thing tore like no one's business. She followed that with "GIRLS! That's why you Never Ever Want an Episiotomy". It still sticks in my head, over 10 years later.

Second, pregnant with my first, and this pregnancy is actually going pretty well so far *knock wood*. Homebirth kind of scares me, even after all of Jamie's and Moxie's discussions to the contrary. It's not like I'm an uneducated person, I'm just uneducated about childbirth. I am taking "just" the childbirth classes at the hospital, but one thing I took home from last week's class is that a lot of the stuff that people say is "not possible" in a hospital birth actually IS. Pick a position that's comfy for you -- here are a TON of choices. Use the birthing ball if you want (I can't look at the balls that my yoga teacher uses in her Swiss Ball class in quite the same way anymore!). Use the shower if you want.

I don't know -- for me, a person who hates change and is apprehensive about the unknown, I'd rather have a bunch of people around that have a clue of what is going on, at least the first time. But that's me.

I don't seem to have the energy to take on this issue any more, but I sure am glad that you are, and so eloquently as well.

I've had all 3 of my births at home, and am always surprised it's not considered the norm instead of the exception. I'm pretty convinced my first would have ended in a c-section if I'd been in the hospital, the 48 hours of active labor it took would have resulted in interventions. In reality, all I needed was that extra time to walk and stay upright until she was in the best postion to be born. I also have never managed to birth a baby while lying down, not even my third. I do not know how women in hospitals suceed in pushing a baby out that way, it seems heroic to me. My 2nd birth was a classic example of Michel Odent's physiological birth ejection reflex. The attendent gave me the space and quiet support to do my own thing, and my body released the baby with one push while I was in an upright position and without too much pain or work on my part, or any tearing. Who wouldn't want to try to strive for that? It seems like the gold standard to me, to combine the safety (Yes! Safety!) of a birth at home with the transcendent beauty and spiritual experience of bringing a new soul into this world.

I ache for the woman above who was induced before dates. I'm also a tall woman who makes big babies and goes 1-2 weeks past dates. Nothing wrong with that, it's just the way I'm made and I'd hate to have anyone try to convince me otherwise while I am in the uniquely vulnerable and trusting space that birthing brings out in me.

My anecdotal experiences and wholehearted support of keeping homebirth available to women as one of many choices seem to matter little in the minds of those convinced of the opposing view. In the example you linked to, I'm shocked he'd even think for a moment that most homebirths are unmonitored or that midwives don't have oxygen readily available! Active fetal monitoring by a present birth attendent is far more reliable than being hooked up to a machine that beeps anyhow. Aargh, it just smacks of paternalism to assume that we homebirth out of ignorance or selfishness instead of making that decision from a place of perhaps being TOO widely read!
Thank you, Jamie, for sharing your views on this, and for continuing to educate and advocate about the safety of the homebirth choice.

I agree with everything you've just said, with one tiny exception: I disagree with your analogy. (The skiing one, the broccoli one was brilliant.) Everything you've said about homebirth being safe is right on, but hospital birth isn't always a ski jump. Because I found an OB who agrees that her primary role in birth is to observe, because I educated myself about birthing practices, and because I prepared myself (via hypnobirthing practice) to remain calm and collected during birth, I was able to have a hospital birth without intervention. Really, NO intervention: no IV, no drugs, no scalpels, no being forced into this position or that. I mention this, and I keep mentioning it, because I want other women to know that it's possible. More than possible, it's our right to request a hospital birth in which it is assumed that there will be no interventions unless they are truly necessary. There's a lot that we can do to make it less of a ski jump and more of a swoop down the bunny trail.

Jamie - you know my point of view. So what am I doing working in a hospital? Right now, I have no real idea, except that even hospital birthing women deserve a midwife, and maybe I can (by precepting the residents and slapping the hand that picks up the scissors - or by 'accidentally' knocking the bulb syringe on the floor) make some woman's birth a little more humane.
What is totally incomprehensible to me are all the Ob/Gyn docs who will support a woman's 'choice' to have an elective cesarean, to abort her pregnancy, to mutilate her body with surgical or chemical sterilization - and yet they won't support a woman's choice to give birth at home. It can't really be that they are about saving unborn baby's lives - otherwise why do they support prenatal euthanasia and other forms of abortion? It can't be about preserving mothers' health - else why do they support elective cesareans, birth control pills and so on? Could it be about control? Is it that they truly believe that they are possessed of superior wisdom and knowledge (much like a Gnostic initiate) and hence have not only the right but the responsibility to make decisions on behalf of their female patients? Or is it money - as insurance companies have taken a monopoly position in paying for health care, and are viciously cutting reimbursements, docs have to keep more and more patients in their practice in order to meet the financial squeeze between low reimbursements from the insurers and high liability premiums from the other hands of these self-same insurers.
I don't know. I just don't know. I just know that I am increasingly frustrated, discouraged, and downright angry over the entire chaos that has enveloped health care in the USA. And I don't even know if I am part of the problem or, god willing, part of the solution.

Homebirthing certainly is a personal choice, but don't fault physicians for being so negative about it. Their experience with homebirth is not yours. More likely their experiences are with women and babies in crisis and more often than not those births do not have remotely desirable outcomess. And many of those crisis situations are things that would not have been a big deal in a hospital setting with doctors present and waiting. From their perspective, it is better to be "safe" than sorry.

Certainly there are many births that experience surgical intervention, but we need to include women who VOLUNTARILY have C-sections for no other reason than because they want to. I have had four births, 2 with epidurals and 2 without and a different physician everytime. Both of my last two births had no medical intervention whatsoever. It is possible.

What Summer said.

My pre-birth experience mirrored Mary's almost exactly, for what it's worth. And I find myself infuriated at some of the wording people used with you. "Should have gone to dinner and a movie?" How dismissive--and I am someone who hates when women talk about "their"birth experience.

I have one small quibble--I found that the hospital was willing to work with me on establishing breastfeeding. It's about the only area I felt I got sufficient support from the hospital staff postpartum, actually. This hospital has a breastfeeding support service and I felt they did all I could have hoped for to help us be successful (which we were!).

I can answer two of your questions:

No, I don't think women birthing at home should be held to a higher standard, although I find that they often are faily well-informed from mainstream sources as well as those that reinforce their prejudices. Doctors should do so well. If I am blessed with another pregnancy I may choose a scheduled c-section and no one in the medical establshment would make me justify that choice, so why should someone who wants to go the other way and has no reason why they shouldn't have to justify theirs?

And no, I personally would not consider a home birth. Maybe if I were to have many many children I would eventually become comfortable with the idea, but I am just not, FOR MYSELF. I strongly support homebirth being a legal, viable option for anyone who wants it. I felt more comfortable with the support and availability of doctors and nurses nearby; anyone who feels otherwise deserves to birth however they see fit (although the whole "silent birth" thing is a little freaky :-) ).

And Jamie, this whole thing just underscores why I like your blog so much. Other discussions of this isssue in the blogophere have ended up mking those of us who actively wanted more medical intervention feel quite insulted. I find those who advocate strongly for homebirths rightfully demand respect for their positions but then don't reciprocate that respect the other way (case in point, a T-shirt I saw the other day saying "if women were designed to have c-sections they'd come with zippers." As if I am some hybrid of human and Barbie for having one. Nice.) This discussion, by both you and your commenters, has been very clearheaded and thoughtful and I appreciate that a great deal.

This is so, so beautiful. I want to forward it around to everyone I know, so if you see more visitors from MA, CA, and WA ... well, you're welcome :)

In answer to #4, yes, I'd consider a homebirth. Before I started reading your blog, I'd never even thought about it, but you succeeded in setting the wheels turning in my head, and your posts, coupled with other reading, have convinced me that a woman at low risk with a full-term baby should consider homebirth an option.

I'm not even engaged to be married yet (although we've already tentatively set the date for December 2007), but I'm thinking ahead. I know I'll be living in Southern California until 2011, where there are some options for homebirth and birthing centers, and presumably my first child (at least) will be born there. Boyfriend is not quite on board with the homebirth thing, but I think I'll wait til we're married to start shoving literature at him.

I would have chosen a homebirth except for the fact that my Dad is an MD (pediatrician) and he would have had a lot of difficulty dealing with it. Instead I chose an OB (in my 34th week of pregnancy, after determining that the first OB was an idiot who was proud of his 60% C-section rate) who absolutely agreed with my plan to have no interventions. My two hospital births were simple affairs where I got to be in charge of everything. The only negative was that I had to spend my precious energy arguing with dumb attendings and nurses who didn't understand my plan or my level of knowledge.

One thing about homebirth scares me, but it is not really relevant to most of us. I have one friend who intended to have a home birth, despite the fact that she is morbidly obese. She found a midwife who would work with her and when she reached term her midwife fudged her dates so that she could "legally" go beyond 42 weeks to avoid a hospital induction. They did a castor oil induction, my friend's contractions were not productive, she dilated too slowly, the baby became distressed (after 2 days of labor who wouldn't??) and they ended up at a distant hospital (that would allow midwives and not insist on a c-section) where the baby was delivered by forceps, suffered a seizure disorder and is now learning-disabled. Sigh. This same friend made a whole lot of different choices for her 2nd baby, who was delivered in a hospital via c-section and is a healthy 2nd grader now.

There is no stopping someone from doing something dumb, even though we might try to legislate around it. I'm afraid that people like my friend give homebirthing a bad rap. I'm all for it if you're low risk etc. and it makes me mad that there are MDs who refuse to consider the facts. Grr.

Wow. I am glad to have found you! I have had six pregnancies, four to term. The first was a hospital birth complete with episitomy which was performed AGAINST MY WILL. I said "You are not premitted to give me an episiotomy" and within seconds, it was done. I also received Nubain which made me sleep between contractions but did nothing to relieve the pain itself.

The next three births were at home, completely natural with direct entry midwives. I cannot tell you the beautiful stories of their births as they would take up more room and time than we have here. But, as a person who has experienced both episiotomy and tearing naturally, I'd take the tearing any day. Thank so much for this informative, well thought out post on a topic that is close and dear to my heart.

I think I will just answer #4: No, I would not consider a homebirth for myself, though I thoroughly support the reasons for which many women prefer them. I think one of the commenters on the dr's blog makes an important point: A lot of the "risk" of homebirthing depends upon how far away you live from a good hospital. I would not choose homebirth myself because I live 35 minutes from the nearest hospital, and that particular hospital is not exactly one I would ever freely choose to be admitted to. We have our babies at a larger, more modern hospital which is 60 minutes away.

I have had 7 all-natural, no medical intervention births in the hospital. Yes, we sometimes have to shoo away annoying nurses. Yes, my husband is quite practiced at refusing to let anyone stick a needle in my arm or hook me up to some good ol' pitocin as a matter of "routine" after delivery. And twice I have delivered without any dr present simply b/c no one would believe me when I said the baby was coming NOW. I didn't panic, though. I knew what I was doing. I don't have babies in the hospital in order to have an MD catch the baby at a normal, healthy delivery. I have babies at the hospital to ensure that if it should ever be necessary, we will have ready access to high quality medical care for me and/or the baby. A lot of that decision has to do with where I live, not any particular birthing philosophy.

Oh my goodness, a post after my own heart. I just had my first baby at 26 at home. 9 lbs, 3 ozs, 18 hours of labor, nearly 3 hours of pushing and it was the 2nd most amazing day of my life. (First being my baptism, 1st communion, and confirmation at the age of 19).

I worked in an office in the suburbs of Dallas before getting married and pregnant (planned) on our honeymoon. Every pregnant woman in my office during the 4 years I worked there had a c-section, some planned, some un-planned. I was petrified of walking into a hospital. Luckily, I had a friend in IL who had an illegal homebirth and I knew that was the only way for me to go. Homebirth, I think, comes down to this principle: If you are sick, go to the hospital. If you are not sick, stay home. (i love the skiing analogy, Jamie) As a pregnant woman, I was not sick. I was experiencing a natural and normal part of being a woman. And while I was in search of the most positive birthing experience possible, I was completely motivated by my love for my daughter and wanting to protect her as much as possible from crazy doctors, harsh lights and sounds and all the other craziness of a hospital birth.

The birth experience was amazing. I was so comfortable in my own home with my husband. When the midwife arrived, she contributed so positively to the experience, my husband and I bonded during labor in a way I could never have imagined, and our daughter was so happy and healthy when she was born. I never had to argue with anyone. I never had to fight for my rights or wishes. I was in my own home completely comfortable the entire day.

I read so often during my pregnancy about women who had horrible birth experiences in the hospital and decided to do a homebirth with baby #2, 3, 4, etc. I said to myself, why don't I avoid the horrible experience in the first place and choose a homebirth to begin with. My body, my baby, and my home has all benefited from that decision. And there is a piece of tile in our floor that will always be known as Gianna's tile. That is the spot of love and labor where my baby came to me.

So to everyone out there, pregnant or not, my advice is this: question everyone and everything who makes money from a decision you make. A doctor doesn't know you or your children as well as you know yourself or them. Have confidence in yourself and in your knowledge. Medical school does not teach that birth is a normal process. They have to come to that realization on their own and if it is hard for us, imagine how hard it is for them. Read everything you can get your hands on. And thanks be to God for my husband who thanked me nearly every day of our pregnancy for choosing a homebirth. He wanted to enjoy the birth of his daughter - not fight an entire hospital establishment for the rights of his family to be together and be healthy and happy.

Mary said:

"I'd rather have a bunch of people around that have a clue of what is going on, at least the first time."

I completely understand why you don't want to have a homebirth (I never would have the first time, either, although ironically the aprt that scared me the most about the idea of homebirth was thinking that I'd have to clean everything up afterwards!). SO don't think I'm attempting to get you to cahnge your mind in any way.

I would like to point out that different people have different experiences of birth. If you want to have a drug-free birth, you will only be likely to have one if the providers you've chosen have experience with drug-free birth. You wouldn't go to a midwife for a c-section, because she wouldn't have the experience to do it, even if she understood the concepts. By the same token, if you choose a hospital with a 99% epidural rate and a doctor with a 70% episiotomy rate, they don't really know much more about how to have a drug-free birth than you do.

bear in mind, also, that homebirth midwives have seen a lot. A LOT. They ar eprofessionals, and they know how to stay out of trouble and how to get out of trouble. They have no less knowledge about birth than OBs or delivery nurses, and probably way more about things most hospital-based practitioners (with the exception of midwives like Alicia) don't have much experience with (like positioning).

Just food for thought. If you know what you want, surround yourself with the people who do it that way often, not with those who talk a good story but don't have actual experience.

Having said that, I hope your birth goes the way you want it to, whichever way that is. (Also, your hospital sounds way more lenient than the ones in my area if they even mentioned a birthing ball. Here you have to get special permission not to have the continuous monitor from the minute you walk in, plus an IV port "just in case." Food? Ha. Alternate positions? Um, no.)

I'm flabbergasted by the idea of homebirths being illegal. I'm single and may or may not ever have children, but the thought of not being able to make the choice of where to give birth seems bizarre. Perhaps there's a different between the US and UK. I've no experience of either, obviously, but the stories I hear of birth experiences in the US seem hugely over-medicalised. Is it the fear of legal action, or love of technology? I know people struggle to be supported for homebirths in this country (the UK) too, but I've never heard anything as extreme as some of the histories recounted here.

I had a regular old hospital induction w/epidural with the Moosh. Although I did not have an episiotomy (no thanks to the doc -- he was across the room getting the scissors when the head popped out) I had a tear that was the equivalent of one. I think if I had been unmedicated and in a better position, the tear wouldn't have happened. My after birth experience was dismal, mainly because they kept taking him away from me.

I want to homebirth if I ever have another child, but I will have an uphill battle with my husband about it.

Great post, I agree 100%. Sorry for brevity, fussy kid in lap.

I've found this "I've got references..." thing to be very frustrating. If I ask for references to the literature, I've had MDs (or even web page curators) react with disgust that a "mere parent" like me (even if I haven't identified myself as a parent) would *dare* question the statement of Lord-High-and-Mighty Authority. Bah. How dare I try to think for myself. So much for education!

And then there are the "Look, this medical association says so" type references. Mmm-hmmm. Based on any real science, or is this just what everyone "knows"? Not to out myself as even more non-mainstream, but based on my baby who was ECed and went 6 days once at 6mo without any wet diapers, I have trouble believing the statement that "Children have no sphincter control until 18 months" (AAP). And then I have trouble stomaching any of their similarly un-substantiated pronouncements. But the media refer to such statements as "research". Mmmm....

Once again, a great post Jamie! I like your skiing analogy, and the "sometimes bunny slope" ammendment.

I'm not sure if I would be a good candidate for a VBAC at home. Besides the medical issues, I also doubt I'd have spousal support. But I would never walk into a hospital for a delivery again without a great doula.

I'd be thrilled to support any of my children or their spouses in a homebirth, assuming theirs were low-risk pregnancies. I'd have no problem with that at all.

I'm so glad to have found you, and Leery Polyp, and others discussing these things way before it becomes a decision I need to make.

I would absolutely consider a home birth, if I were low risk (the women in my family have all been pretty gynecalogically lucky), though I think a midwife in a birthing center would probably be my dream option. My mum might take some convincing, I've heard her make "crazy hippies endangering themselves" comments before.

I'm a medical researcher (pathology in vitro work and some clinical studies) interested in pursuing epidemiology, and everything I read about conventional approaches to episiotomy, c-sections, inductions become more and more routine etc etc, frankly it all gives me the screaming heebie jeebies.

Especially as a rape survivor who got freaked out by a pap smear from a very nice, very compentant physician assistant who just didn't tell me exactly what she was going to do before she did it. It wasn't even my first exam, just her style was wrong for me and my ghosts: I need the play-by-play to keep me from feeling helpless. If I'm that sensitive, with that level of need to know what's going on and to feel safe...experienced midwives please.

This issue is one of many that is making me want to move to working specifically on women's health issues and health education. There's just too much ridiculous medical dogma being used to beat down women making healthy positive low-intervention choices.

I was a home birth - and a scary one, likely due to not having a good midwife present. My sister was born in a birthing center and then my mom went back to homebirthing my brother. Would I do it? Definitely, barring any complications. I feel lucky to have grown up with it being normal - most of my childhood friends were born at home, my goddaughter was born at home, a lot of women at my church have had home births.

I'm one of those college students who has commented from time to time in the past, and I just want to thank you again for posts like this, Jamie. Before I started reading this and other blogs I had never considered a homebirth. Now I'm not only considering it but I'm growing more and more comfortable with the idea of it. My roommate and I have even discussed it several times. Heck, I've even brought it up with my boyfriend. (Who, by the way, is a little unsure of it at the moment but is open to the idea. He's all for otherwise natural, drug-free births.) I'm telling you all of this so that even when stupid doctors and other people get you down that you will know that you are indeed making a difference to women like me. I really appreciate being able to read the anecdotes of other women in addition to all of the facts. So, thank you and please do not give up!

I don't know about the other stuff, but the episiotomy... oh the episiotomy I know. Baby number 3 had the smallest head of my babies. She was also 2 pounds lighter than her 10 pound sisters, and had great presentation, BUT my ob gave me a 4th degree episiotomy. To this day I don't know why, and because he got scissor happy I farted continually for 6 months straight. Could not hold it to save my life. I sounded like a zipper. Give me the rip any day!!

As for homebirths, it's a wonder ANY of us are here given that almost ALL of our ancestors had homebirths.
R

I was risked out of the birth center with my first baby (pregnancy induced hypertension). I had probably the best in-hospital experience I could have had: intermittent doppler monitoring, no IV, no questions from the nurses about me using the bathtub or birthing ball, squat bar for pushing, midwife who stayed with me the whole time. I think choosing the right HCP is the most important factor in getting the birth you want.

An elevated risk doesn't mean you have to accept all the interventions - only the ones that are important for your particular risk factors. So I got pretty frequent blood and urine checks when my blood pressure started climbing at 36 weeks - that meant that I could avoid induction (which my midwife's backup doc preferred). As long as the test results showed the baby was okay, I was not doing an induction. And I eventually went into labor naturally and gave birth the same day.

Ok, I went to birth-class last night and this week's discussion was -- INTERVENTIONS! So, I listened with all of this discussion in the back of my head. There were a bunch of us delivering at one hospital and one couple delivering at what my husband and I have now termed "the baby factory". We also toured the L&D floor. We can have a birth-ball, a shower, a tub (some of the rooms have a jacuzzi); the rooms are actually quite nice. One of the women uses a midwife practice at the hospital (the OB/GYN department has both doctors and midwives) and she will be delivering at my hospital as well. We also talked about how if you start with one small intervention (internal monitor, for example) then it could start spiraling and you will need more and more interventions.

That said, the "baby factory" freaks me out. Who was it that posted about "too posh to push?" Anyway, that's what this seems to be. Over half of their births are inductions -- so many that they schedule them in shifts throughout the day. Something like 70% have an epidural (!). HUGE numbers of c-sections. Seems like they just want to churn the babies out and don't really give a thought to what you want.

Oh yeah and to answer some of Moxie's questions. They mentioned the birth-ball like it was no big deal and let us sit on one to try it out. We asked how you get one and they said just to ask a nurse and they will bring you one. I suppose you could bring one if you want. IV-port, yes, you do get one "just-in-case." Monitor -- depends on which hospital (there are two attached to our med center -- I could end up at either one, depending on how full the L&D floor is at the time). The one hospital, you have to be hooked up once an hour. The other is wireless so you can still wander around and be monitored.

I have learned a lot about what to look for and what to ask for and everything. And I appreciate that from all of you!

I have always wanted to do homebirth, but, I have a wonderful midwife that only does hospital births. The local homebirth company uses male doctors, and I'm sorry, home or not, I have an entire pregnancy to go through, not just the birth, and I love the midwife that cares for me.

So, I have had seven un-medicated, non-intervention births in a hospital. 4 were delivered in the standing position, 1 sidelying, one squating and 1 in the tub. I had post partum hemorhage twice, and that has always been in the back of my mind regarding homebirth (one time the bleeding became problematice 4 hours after the birth).

Now, working out having the kind of birth you want at a hospital isn't easy. It requires a health care practitioner on your side, an aggressive attitude on your part with the staff that is used to only one way of doing birth, and a husband or other help to back you up firmly while you are busy birthing.

Of all the reasons I wish I homebirthed, that stress and anxiety of negotiating with nurses while in labor, and then afterward while refusing all the other crud they feel they have to do the baby, would be reason #1. Maybe if I get the chance to birth again, I will think about homebirth once again. If only I could get the midwife that has delivered my other children to attend, that would be heaven on earth.

BTW, at one of my births the nurses were COMPLETELY on my side and made the experiece heavenly. They knew I wanted to go home ASAP, and called the ped at 9:00pm, and told him I was going to leave AMA if he didn't come clear the baby. This was not true, but it got him there and I got to sleep in my own bed the first night. That particular birth was a standing delivery, with a nursing student observing. She was completely unprepared for a birth like this, and told me later she kept waiting for me to get back in bed so I could deliver. After the baby was born, she was wiping away tears, and saying that was the most beautiful birth she had ever seen. I like to think she will be a better nurse due to that day. Lovely post, Jamie, and thanks for bringing it up!

Not much to add to all this - just that after a happy, healthy, empowering (hate that word) hospital birth, I'm thinking about a home birth for next time (DV).

Disclaimer: I have no children.

That being said, I think that doctors often suffer from over-confidence. I mean, if you've attended medical school, graduated and done your internship then undoubtedly you feel like you know more than the average person about diagnosing and treating health issues. That's obvious, right? The unfortunate side effect of this is that many doctors also feel paternalistic towards their patients, or potential patients. In other words, they believe that they "know best" and will, consciously or subconsciously, substitute their judgment for that of their patients. This is unfortunate.

For me, I would consider having a homebirth. I suspect that I would be too scared to go through with it, but I would consider it. My sister has had two children. The first she planned to have at the midwives center, but ended up in the hospital (she had high blood pressure) but the second she did have at the midwives center. And it worked out beautifully.

I agree with your statement that patients should get to make their own choices when each option is equally proven to be safe, but I'm not surprised at the doctors' opinions and I think they have some validity.

You and Jo and probably many other women have done extensive research, vetted your midwife/attendant and are open to going to the hospital if need be. I think doctors tend to see women with less than competent attendants or women who stubbornly refuse to believe that modern medicine has any value in birth at all.

Frankly, I'm not comfortable with the idea of birthing at home and my husband is completely against it. Yeah, I'm low-risk, but things do happen in childbirth. 200 years ago 1 in 3 women died in childbirth and 100 years ago it was 1 in 5. I don't entirely believe the adage that "womens' bodies are made to give birth." Empirically, that's true, but in practice you don't know until you do it. For me, 20 minutes away from the hospital even if there's only a slight chance of a serious complication is 20 minutes too far. But I am also confident in my OB, she delivers all of her own patients and is open to my opinions and ideas.

Great post! I am 26 weeks pregnant with my first, at age 43, and I'm struggling with all these questions. While my pregnancy has been low-risk so far, I find that the peace of mind of being at a hospital "just in case" is outweighing the home birth idea. Husband is not in favor of a home birth, nor too interested in trying to maximize the "experience" of the event. He just wants a healthy baby. That being said, I'm following Leah's path: hiring a doula and doing a lot of advance research so that I can feel comfortable rejecting all interventions but the ones that matter to the health of me or my baby. Would I accept an epidural? Sure, if I was totally exhausted by a long labor, and the doula advised that it may be a while longer still. Am I going to try to do it unmedicated? You bet!

I have one child. I attempted a home birth, and transferred to the hospital after 3 or 4 hours of pushing, when my baby's heart rate was fluctuating. She was born without medical intervention half an hour after I got to the hospital – except an episiotomy and some fundal pressure.

Two and a half years later I regularly have fairly severe pain from the episiotomy, but the feeling of delivering my baby after all that struggle, without drugs or instruments, and having labored almost entirely at home, was the best thing ever.

I'm heartily thankful for the wonderful midwives who were by my side and who knew when to recommend a transfer to the hospital, for the hospital staff who took care of me and welcomed me even though I had made a choice they probably didn't approve of, and for my utterly fantastic daughter.

I am not thankful for the episiotomy though. Perhaps it was necessary. My midwife asked the doctor to let me push a couple more times before doing the episiotomy, but the (female, by the way) doctor, curt and authoritarian, brushed her away like a fly. At the time I was happy for whatever was going to move the process along, but now I wish I'd had another minute or two to try. Certainly no one warned me that the pain from the episiotomy would be so severe or so long lasting.

Interesting conversion going on here! Leery Jo sent me over from her blog. My first birth happened almost 25 years ago. I missed the complete shave and enema by just months. They were just starting to "let" women labor and birth in one room, sometimes.. I wanted that, but my induction made me have to go through the whole labor and delivery thing, being pushed through the halls whilst trying my darndest not to push my kid out! I barely missed a c-sec and had a HUGE epis, 45 stitches! (He was late for his golf game and he said so!) for a 6 lb girl. With my second, my doctor told me I was too small to deliver a larger baby and was setting me up for a planned c-sec, (I am only 5 ft 2 in, and on the small side) but my heart knew better. I delivered my second, at home, 8lbs 4 oz, after about 1 1/2 hours of labor. 3rd child, at home, couple of hours of labor, 10 lbs 11 oz. 4th child, at home, 40 mins from first cx to delivery, 11 lbs! Not a tear, and only one push. I used to dream about confronting my doctor with my 11 lber and saying, "too small? Who is too small? What do you know?" I was so angry at him, for lying to me about my body! 5th baby, 3 weeks early, 8lbs 12 oz, at home. I loved all my home births and even now, as I am trying to go to sleep, I will go over the details in my mind, fingering them softly for the treasures they are, mine, my births. I chose and in that is all the trimuph.

I really want to answer number four, but I have work tomorrow, so this shall be short. Number one was a planned hospital birth, but late transfer from home with midwives. In the end I didn't really want to transfer but the midwife made me because she said opting to stay home at that time was not informed consent as I was in labour. I did NOT use that midwife the next time, and I never would have let myself be pushed around like that if I was the same person then as I am now....but time changes you. My second was a planned homebirth - who came so quickly that he was an unassisted homebirth. So empowering and so obvious to me that when it feels right it probably is. My third was another planned homebirth. But, the child who had been head down decided to flip - we caught this in labour when I opted for AROM - knowing in my heart something was weird and different about this labour and really thinking this might give me some answer as to what was going on. About 10 minutes later I checked myself and there was meconium. Bum. Foot. Fast forward to ambulance transfer to hospital and breech vaginal delivery. They weren't ready for us when we got there and we called ahead. The O.B. wasn't there - just the resident. The anaesthetist was freaking out and wasn't ready (should have been a C but she was delivering herself). So, I am not convinced that even in that situation that it would have been any safer or better *in* the hospital. It takes time to get set up. I would certainly do a homebirth again. But, word to the wise. When you wake up from a nap and the baby is clearly in a weird position, don't, I repeat do not push the baby back into the RIGHT position and continue with your day. Yup. I did a version on my own kid. Didn't even know it. Dumb Dumb Dumb.

I am a mother of four and our first child was a hospital birth, the following three were wonderful homebirths and like others here I can't begin to go into details as it would take too long.
It makes me sad to read the episiotomy info - but all I can say is that we as women need to encourage others to educate themselves and to make the choices that feel right for them.
As has been mentioned previously having a medical degree doesn't automatically make everything you say right!!

FABULOUS POST!!!!!! Love the skiing thing.

Here's my take on the numbers, and it would continue to hold EVEN IF hospital birth improved such that it were proven to be 10 times safer than home birth --- complications in either case would be, for healthy mothers and their babies, *rare in both home and hospital.* In other words, *both are basically safe.*

Kinda like walking and driving, or (since other littler people are involved) letting your son go out for hockey vs. letting your son go out for the cross-country team. Even if one's much safer than the other, do we let "experts" tell us that we MUST ALWAYS CHOOSE THE SAFER OPTION (whatever it may be?) Who cares, if there's less than a 1/1000 chance of a bad outcome in either place? Let me do what *I* think best.

I better stop before I start convincing myself that mandatory seatbelt laws are a bad idea.

another way to think about it: We have a right and a duty to seek our children's well-being, and our own well-being. "Safety" is important to well-being; unless we're in a place that meets some minimum standard of safety, we can't "be well."

But safety is not the same as well-being. If we elevate absolute safety above all else, we will decrease our well-being, replacing it with worry, isolation, inactivity, and dysfunction.

as for the commenter who wrote, "patients should get to make their own choices when each option is equally proven to be safe ...."

I wonder, in what other "medical" situation are patients only *allowed* to make choices between options that are proven to have precisely equal safety? Can you imagine taking away a cancer patient's right to choose a limited course of treatment to preserve her quality of life, or (since we're also talking about kids) taking away a parent's right to choose such a treatment course for her small child? Ugh.

I don't think homebirthers should be held to a higher standard as far as informed consent goes, *but* I think that by nature, they have a higher level of information available to them (talking about the US here). This is since it's clearly not the norm (amish/mennonite/etc... excluded), and in order to make that choice, I think there's a level of information you need that many people who deliver in hospitals don't look into.

I delivered in the hospital twice, and I'm not saying that everyone who chooses hospitals is uninformed -- because I know I wasn't! -- but I think a large portion of those who deliver in hospitals are underinformed.

Even I was underinformed with my first -- I had considered a homebirth, and decided to go with the hospital because I had gone over my plan with my OB, and she was in complete agreement, up until my water broke, at which point you'd have thought the baby turned breech and I was hours away (I was walking distance to the hospital, and the baby was head down, +2 station). She convinced me that the stories about pitocin were exaggerated (of course she was lying!), and even though I only pushed three times, she gave me an episiotomy that I'd had her swear would only be done in the event of a severe emergent threat to my baby's health. So, liar, but, I could have held stronger, too.

I don't think Dr. Amy has arms. At all.

I considered a homebirth with my second, but because of insurance and laws and crap was unable to plan one. We did, however, hire as monitrice a wonderful DEM who helped me achieve an unmedicated, no interventions birth in the hospital. I was the first the midwives at the hospital and the resident on OB rotation had seen. They were not only shocked (5 minutes from water breaking and me informing them I was pushing to baby in arms -- they'd checked me when I got there 10 minutes earlier and declared me 5 cm.), but pleased with how well it went, and I was happy for that.

I could not plan a homebirth in the future, because that second baby turned out to have a bleeding disorder, and when tested it turns out that I do too! Not that the medical professionals in the hospital noticed, nor the ones in the ER when I came back with bleeding after both births ... but we're safe now.

Y'know, I'd actually have to check with my midwife if I got pregnant again -- the hospital is less than a mile away, so maybe I wouldn't be risked out!

OMG, why did you link this? I need blood pressure medication now...

I'm skipping the comments because birth is a fairly painful subject for me. I agree with you Jamie, that's why it's painful. I "would have" a homebirth in general and I did try... now I have two sections to my "credit" and it is exceedingly unlikely that things would line up for a prudent home VBA2C (though there are almost certainly HB mw's who'd do them here, probably even legal ones now.) Put me in the "I'd be floored with gratitude to have the most medicalized VB ever if neither of us sustained more permanent, serious damage than they would have with a C/S" category for the hoped-for next time. If a VBA2C went smoothly, I'd consider homebirth in the future, though with more caution than someone who had never had a c/s at all. If I ended up with a third c/s it'd almost surely be c/s for life, unless baby came "before schedule" and easily on his or her own the time after that.

Though I'm less rah-rah homebirth than I once was, I'm so glad they treated us quite well at the hospital -- I wasn't thrilled with the nursery where our son went for observation and got stuck there in a "needs to be weaned from IV fluids" fiasco till the LC got him out -- but I didn't even know the nursery people knew we'd tried HBAC until I read the report we were discharged with. I am so grateful that when I told our own pediatrician, who practices standard Western medicine but in a rather tolerant way, she just said, "Aww, you went through all that and still ended up with a c-section?" quite sympathetically. Whew.

I just had my first baby at home 8 days ago and it was hard as hell and indescribably wonderful. We ended up with a homebirth by a strange series of insurance and political issues (my initial preference was birth center, but the birth center in the gay-friendly state didn't take our insurance while the one in the homophobic and dangerous stated did). We ended up finding amazing midwives who would do a homebirth helping us avoid some of the legal risks and birth certificate problems we'd have had in VA. But I was always a bit scared of something going wrong - until the birth started. Then it just felt so right and the birth team was so supportive and hell, I just had to concentrate on getting through the contractions so I didn't have any brain space left for that worry! I also realized during the course of the birth that I probably couldn't have managed an unmedicated birth if I were in a hospital because the drugs would have been there and I'd have had a hard time refusing them! (Maybe I sell myself short; I don't know.) Anyway, we were so glad our daughter was born in an atmosphere of love and calm -- and where, yes, we had oxygen and extensive experience and a major hospital with a Level III NICU less than 10 minutes away, had any of it been necessary. But it wasn't and it was beautiful.

Jamie,

Great post. I'll keep my comments short ... looks like most of the angles have been captured by people who beat me to it.

I am a longtime patient with a long list of autoimmune diseases. Since 13 years old, I have had 9 surgeries (I think ... maybe it's 10), chemotherapy, blood transfusions, yadda yadda. What I have learnt from my experience on my end of the examination table is that we should NEVER EVER EVER EVER trust doctors implicitly. What do doctors know about nutrition? Nothing. What do they know about health? Nothing. What do they know about nursing? Um ... less than they know about nutrition and health.

On an email list (for commercial writers of all things), there was just a thread about health care products & the FDA. I had no idea how scary an organization the FDA is. Did you know that only drugs heal and cure? Certainly, there is no homeopathic / nutrition solution for our health problems ... and don't you dare say otherwise, or the FDA will essentially bring you to ruin. We don't restrict the claims of Viagra, but it is terribly problematic to suggest that cayenne or cinnamon might have health benefits.

Excuse the digression ... to get back on track, I've had 2 c-sections. They are easy, relatively painless, fast, pre-planned ... hey, you even get a full night's sleep before you waltz in to have your stomach chopped open. From what I understand, VBAC is not an option for me w/ this baby (#3, due in Dec), as I have had 2 C's and a callous on a previously broken pelvis that would impede the exit of an infant. Or so they say ...

I totally support homebirth as an option for anyone who is in a good position to do it. ABSOLUTELY! Come on, we need to put it in perspective. A great many babies have entered the world through homebirth for thousands of years. Birth would be impossible for people in my circumstance, whose medical condition needs constant monitoring (at least, it seems to). For the <1% of the population like me who must avoid a vaginal birth or need other special interventions, hooray for hospitals and doctors. But for goodness' sake, why stick everyone in my category? For you healthy ladies in low-risk positions, why aren't more doctors open to the possibility that your sweet baby can make his entrance into the world w/o his help? Seems to me like God designed it that way.

Another thought: With both my boys, my nursing troubles and their weight loss created major difficulties. I had wars, literally, with the staff regarding things like nipple shields, sugar water, and "supplementing" with formula. In the last battle, I finally lost my patience and said to the pediatrician, "If this baby were born in the bush, he'd have to wait for my milk to come in, which will probably happen by tomorrow night. And for now, my colostrum is going to have to do ... and it's all going to be fine, so forget about giving him formula!" The doctor was mad that I didn't appreciate the need to manage this 1 day old's weight. (He'd lost 9% already, don't you know!! *sigh*) A week later, he was a pound over his *birth* weight. The doctor admitted I was right. The way I figured, I had already nursed a baby; he had probably had no training in med school about breastfeeding. Who knew more?

I like Reagan's philosophy: Trust, but verify. Jamie is right to want references. Doctors have a terrible habit of practicing a double standard in this regard. They demand data from people who have an unorthodox / non-AMA view of things, but they themselves accept the party line when it really just might be anecdotal (or their version of common sense).

Jamie, isn't it weird that you're a pioneer of sorts, when probably 100 years ago homebirth was the norm?

Yes, great post - the ski and brocoli analogies were just great.

You wrote:
"I am saddened that so few women in this country have the option of a legally attended homebirth."
...and I wholeheartedly agree. I am one of those who didn't have that option, but I was lucky enough to have no interventional natural births at a hospital setting.

Answering your 4th question: I would *LOVE* to have a home birth were I to have a 3rd child (though it would be tough to convince my husband :). Why? Because I can't think of a single thing that being in a hospital "contributed" to my two labors and deliveries (except for negative things - like being interrupted in the middle of the night for a blood draw, or for the baby's vital signs to be checked, or being almost starved because of their horrid food).

OK, there's one thing - the hot tub with jets, which I didn't have at home - but I'm still sorry that I had to come out of the hot water afte laboring in there for hours to deliver my babies lying in that bed with my feet up in stirrups... Grrrr.

The incongruences of modern, more "natural-minded" hospital "birthing centers"...

Not related to this post, Jamie, but I thought you might appreciate a tidbit from the homily our deacon gave at Mass today...it being 1am here, I guess that's yesterday, actually. He compared the peace which Christ imparts to us to the peace a mother imparts to her nursing infant, who knows he is safe in his mother's arms and that all his needs are taken care of. (The deacon took his metaphor from the Gospel--the giving of peace, obviously--and the introit for today, which was "Quasi modo genite infantes, rationabiles sine dolo lac concupiscite, alleluia.")

I'm all for home births and choices in how to deliver. Personally, I don't think my house would ever be clean enough for a home birth :)
I opted for midwives in a hospital but I realize not everyplace has that option.

I had my little guy at a hospital with midwives. I thought this was a good compromise at the time, but I think just *being* in the hospital messed me up. I would love a home birth next time around, but the annoying thing will be having to pay for it out of pocket. The insurance industry sucks too.

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