Birth Matters

How I got from There to Here: My Path to a Homebirth.

I am a Veterinarian.  What this means is, I’ve had 4 years of undergraduate education (Zoology if you are interested) and then 4 years of Medical School.  (I actually earned a Master’s Degree in Biology in between my undergraduate degree and m Doctor of Veterinary Medicine – I studied herpetology, which is the study of reptiles and amphibians, and the degree was of an Evolutionary Ecology type).  In total, I had 10 ½ years of higher education in the biological/medical field.  I’m able to critically read and assess research and I’m trained in clinical medicine. I speak “medicalese” and understand just exactly how much of medicine is science and just how much is art.  I’m not intimidated by physicians or researchers or other experts in my field.

 

I also have PCOS or Polycystic Ovarian Syndrome.  There are lots of things to be said about PCOS but suffice it to say, when I wanted to start my family, it required medical intervention.  I had 3 early miscarriages before I conceived with the aid of Clomid (a drug which promotes ovulation and then development of a healthy corpus luteum).  I took Clomid and conceived twins.  This automatically put me into a “high risk” status, which didn’t make much sense to me since as far as I knew, high risk was a status you earned, not something you started out with.

 

I certainly wasn’t your typical first time pregnant woman.  I knew that there were a number of things I wanted to avoid.  I didn’t see a need for certain prenatal tests like amniocentesis or the triple test, since if they did detect a “problem”, termination of the pregnancy would be my only option other than continuing as I was.  I knew that my chances of avoiding a cesarean were higher if I chose a Family Practitioner for my prenatal care, rather than an Obstetrician.  My husband and I took “Bradley Method or Husband Coached Childbirth” classes, rather than the “be a good patient” classes offered by the local hospitals.  I deliberately chose the hospital in my area with the lowest cesarean rate, figuring that it would be a better choice for me.

 

I also knew absolutely nothing about midwifery care.   I knew nothing about why I might want to not have ultrasounds every month (though in my defense, I did ask if it was ok to stop, since nothing of concern had ever been seen during any examination.  I was told, no, it wasn’t ok to stop because we didn’t know what “might happen”.  I’m sure the $450 they charged my insurance for each one didn’t hurt either).  I didn’t know that obstetrics (even as practiced by a family practitioner) is fundamentally a surgical specialty and fear based as well.  I didn’t know that as my pregnancy progressed, it would become harder and harder for me to take the initiative in our care.  I didn’t know that when my boys ended up in a breech position, there were things we could have done to encourage them to turn.  I didn’t know that I had options, other than a scheduled cesarean, “just in case”.

 

So, because I didn’t know enough, I had a cesarean.  Now, I’m realistic about this.  I might have had a cesarean regardless of what I knew or didn’t know.  Sometimes a cesarean is the wisest choice for a birth.  But I don’t know, and will never know for sure if MY cesarean was the wisest choice.  It might have been…but then again, it might not have been.  The best I can do is to call it “prudent”.  Nevertheless, it left me injured in more ways than I ever expected.

 

One thing that I can say about my primary care giver is that he did tell me that I could VBAC the next time.  Of course, the fact that a “next time” wasn’t guaranteed by any stretch didn’t seem to occur to him but at least he did plant that seed.  Honestly, if I thought I was relegated to surgical deliveries for the rest of my life, I would never have deliberately conceived again.  That said, when the time came for consideration of another child, I had some research to do.

 

When my boys were about 1 year old, I found ICAN (International Cesarean Awareness Network).  I found their email support group.  It was amazing.  All of the sudden, I realized that I wasn’t alone in being unhappy about my cesarean.  All of the sudden, I wasn’t a freak who didn’t love her children enough to not care about how they arrived.  And all of the sudden…I was challenged.   Really  challenged.  When I first joined the support list, when I thought about homebirth at all, I knew it was something that repressed women in restrictive religious groups did (this because I actually knew women who’d been in this situation – both from the pregnant woman viewpoint and the midwife viewpoint.  Not a very favorable review to say the least.)  Homebirth was crazy.  After all, what if something happened?  You’d certainly want to be in the hospital, just in case.

 

But…I was meeting women who steadfastly refused to fit my stereotypes.  Educated women, with advanced degrees.  Medically trained women.  Lawyers.  Women who knew the published research into the safety, or not, of homebirth.   At that time, women who were planning homebirths tended to be pretty quiet about it so it wasn’t like anyone was proselytizing me.   I had my work cut out – first I had to learn what midwifery really was and then I had to learn what homebirth really was.  I started reading and listening.  I discovered that midwifery care is woman-centered.  Midwifery assumes pregnancy is a normal healthy condition for the majority of women.  Midwives believe that prenatal care is more about nutrition and support and emotional well-being than peeing on a stick and listening to the baby’s heartbeat on some arbitrary interval.  Midwives know that “normal” is a broad category.  Midwives understand that they are partners with the parents, but that the parents have the ultimate responsibility for their child.

 

I started to learn about the dark underside of maternity care in the U.S.  I learned that Labor and Delivery is considered a “profit center” – that the revenue generated there supports other areas of the hospital that don’t make money.  I learned that hospitals all have “protocols” for various things, like VBAC or whether or not women can go without an epidural (yes, things have changed that much – now you have to be much more worried that you won’t be “allowed” not have an epidural than that you will be allowed to have one!) or how long she is allowed to labor before a baby must be produced.  I learned that factors like staffing numbers, patient to nurse ratio, in house vs. outside anesthesia, teaching status, liability insurance premiums and medical insurance reimbursement has much much more to do with the medical care any given woman receives than her personal beliefs, plans or even her health!  I finally understood that ultimately the hospital is a business.  A very big business, with corporate share holders and concerns about profit and not built around the ideal of “best health for the patient”. (Now, I’m not saying that individuals within the hospital don’t care a lot about health, many of them do.  I’m talking about the culture within which they attempt to do their jobs).  Wow, talk about a paradigm shift…

 

If you’ve ever met me, either in person or online, or if you read any amount of my writings, you probably know that I’m not exactly what would be called a timid woman.  Up until my cesarean, I’d never really experienced “giving up and giving in” to something that I absolutely did not want.  But now I was forewarned, and could prepare for that – surely I had what it takes to fight the system, right?  Possibly.  But the bigger question was did I want to?  Was the system that much better in the ways that matter to me (better outcome for me and my baby) to fight with it to get what I wanted?  If I what I wanted was to plan the safest possible birth for my baby and myself, and if the hospital was the place that would provide that, why was I going to need to fight over just about every aspect of my care?  Perhaps…the hospital wasn’t the place that would provide the safest starting plan for my next pregnancy and birth.

 

I did give a fair shake to all my local options.  I interviewed an Obstetrician who had recently attended the VBAC of a good friend of mine.  My friend really really liked this woman.  She seemed nice enough.  But she did have certain things that she required – I had to have a “hep lock” upon presentation to the hospital (this is an IV catheter that is capped off and left in your vein – it means that if they need to give you anything by IV, the access is already there. It is very convenient for the nurse/physician, there is no doubting that.  It is also extremely annoying to some patients.)  She did not feel comfortable with a breech presentation – she said it would depend on a lot of factors, given that I didn’t have a “proven pelvis” but that she did have a more experienced colleague who might be able to help me.  She worked in a group practice so it was likely that I wouldn’t actually have her there when I did go into labor.  Certainly that bothered me, how could I know if her partners would honor any decisions she and I made together? What about “hospital policy”?

 

Next, I talked to my Family Practitioner.  I liked her a lot, she trained in the United Kingdom and had a less technological view of pregnancy and birth.  But, she didn’t actually deliver babies.  She could provide me with the prenatal care and then her partner (fairly new to the practice) would actually “deliver me”.  Hmmm.  Well, that wasn’t exactly what I was looking for either.  Plus, she had admitting privileges at the big University hospital, not at the other competing hospital in town – and the competing hospital was supposed to be “better” and more “birth friendly”.  And she said that pretty much I’d be subject to whatever the specific policies of the hospital with regard to things like IV access and monitoring.  We already know I’m not a big fan of “policies” or protocols…

 

At the time I was doing my research, there weren’t any independent birthing centers anywhere near me (and I define near pretty broadly) so that choice wasn’t even an option.  (aside:  independent birth centers are not affiliated with a hospital – those “family birth centers” that you see advertised by various hospitals are just a marketing ploy to get your very valuable health care dollars and have little or nothing to do with getting technology out of birth)  Truthfully, I’m glad.  I haven’t seen much to recommend birthing centers (independent or otherwise) in the past few years so not having access to one might have just saved me another nasty surprise, when it ended up being a pretty room with a back-up liability policy – a policy that would probably end up creating protocol that I’d have to comply with in order to be “allowed” to use the birth center at all.

 

So, I called a local midwifery group and made an appointment to have a consultation.  At the time, there were 2 midwives, in partnership and 2 apprentices studying under them.  My husband went willingly but with some skepticism.  He’d already agreed to a homebirth if that’s what I wanted but I wanted him to be as sure as he could be in himself about the choices I was making.  What a breath of fresh air that consultation was!   I came in with a long list of “what if” type questions and they answered them perfectly.  They told me that they were committed to safe birth at all costs not homebirth at all costs.  They were known in the community and were generally treated fairly well when they did have to transport from home.   They were careful to make sure that we understood that by having a homebirth we were going against the social norm and were opening ourselves up to criticism, especially if something went wrong, even if it had nothing to do with the homebirth itself. They told me my pelvis was innocent until proven guilty as far as they were concerned.   They weren’t afraid of breech babies or twins.  They spent at least 2 hours with us, answering every question I could come up with, making sure my husband got his questions answered too.  I knew what I wanted.  When he told me that he was very pleasantly surprised by how professional they were, I knew he was on board with the plans too.

 

So, then I had to get pregnant.  About 6 months later, it happened.  Without drugs and imaging and measuring and testing this time.  And I called the midwives and got on the schedule.  But…here’s where the rubber meets the road.  Now it isn’t theoretical, now it isn’t something that “women I know” did or planned.  Now I have to decide things like “do we tell our families or not” (we did tell my parents, we did not tell any of my husband’s family).  And maybe hardest, I had to deal with my own “what ifs”.   I had to deal with my own inner cultural assumptions about where you have a baby.  Because even though I’d done every bit of research there was for me to do, facts only get you so far.  I found myself slipping into a mindset of “I’m going to do this, even though it is risky” even though I didn’t actually believe it was risky!  I didn’t much care if anyone else thought I was crazy but I had fits over the craziness in my own head.  I realized at that time just how brain-washed we really are, even those of us who are on the radical edge of birthing culture. 

 

I also had to come to terms with the fact that yeah, as a woman with a scar on my uterus, I have one more risk-factor than most women – my risk for a uterine rupture is significantly greater (though still very small) than a woman who hasn’t had uterine surgery.  And while most uterine ruptures aren’t catastrophic, sometimes they are.  And if that happened, the outcome for my baby and possibly me could be very bad indeed.  There wasn’t any research on women having VBACs at home vs. in the hospital for me to look at – to see if it made a difference.  So those of us who’ve planned our VBACs at home have had to extrapolate – we know that over and over, planned homebirth with a trained midwife has been shown to be as safe as or safer than hospital birth – that isn’t in dispute (well, not by anyone who’s bothered to read the research anyway).  We know that VBAC has been shown to be as safe as or safer than a repeat cesarean in most studies, particularly if you don’t use induction or augmentation drugs (something that is definitely less likely to happen at home!).  We also know that being in the hospital is not a guarantee that everything will go well – on the contrary, research shows that 10’s of thousands of people die every year because of medical mistakes, not to mention antibiotic resistant infections.  Certainly the vast majority of uterine ruptures happen in the hospital and being in the hospital doesn’t save all of those babies and mothers, even with all the monitoring and available technology.  It started to seem to me that being under the care of a trained midwife, being her only laboring client (as opposed to in the hospital where sometimes a Labor and Delivery Nurse can be responsible for multiple women at the same time) and having her undivided attention looked like it could provide me with better detection of a problem if something happened.  It started to look like the only advantage to being at the hospital for me was that if something went wrong there, people would say things like “well, they did all they could” whereas if something went wrong at home, people would talk about how irresponsible we were and how it would have been different if we’d just been at the hospital where we belonged.  And in the end, I understood that it is a game of odds.  You read the numbers and you make the best decision you can with regard to safety.  And you might choose wrong, just like anything in life.  When I made the decision to have another baby, I made the decision to not have control over it all, no matter where the baby was born.  The difference between home and hospital was that I actually did have more control at home – I took responsibility, rather than giving it over to someone else.  In the end, that was safer for me and my family than any other choice I had.

 

So we planned a homebirth.  I had a wonderful pregnancy and a wonderful labor and a wonderful birth.  An hour after Ena was born, I wanted to do it all over again.  What a difference between that and the cesarean!  And we were healthy, truly healthy.  At that moment, I knew if there were more children, I could never in good conscience plan a hospital birth unless there was clear medical reason to do so.  Because it really is about planning the safest birth for your baby, not about “the experience” like so many people accused me, not about “taking risks”, not about “proving something”.  It’s about being a responsible parent and doing what you know is best for you and your child.  For me that was a homebirth.  I don’t know what it would be for you, only you know the answer to that question.  But I do ask this – why are you making the choices you are?  How would you complete this statement:   I’m planning on having my baby at ________ because I _________.    Answer it until you have no more answers to give.   You might not be on a path to a homebirth the way I was, but I hope you are well on your way to the safest birth possible for your baby and yourself.

 

Gretchen

July 14, 2006