Is Home Birth A Scary Option?

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I have been asked, over the past 2 years, how I could possibly be willing to “take the risk of giving birth outside a hospital.”

One person asked if my “ideal birth experience” was “worth my baby’s life.”

Another actually compared it to child abuse or neglect.

I’ve tried my best (and occasionally, but not always, succeeded) to discuss these matters calmly.  I understand that people are coming from a place of concern.  Everyone wants whats best for every child.

I want what is best for my children.

I have put off writing about this here, though, for a few reasons.

Number one, I have a hard time writing a focused post of a few hundred, or even a few thousand, words on this topic.  I believe there is a lot to be said.

Number two, I wasn’t sure which aspect of the whole world of natural childbirth and home birth and c-sections and more I wanted to write about.  It’s an issue near to my heart.  Women are extremely passionate about this topic!  It’s not just our feelings on the line.  Our birthing stories are something akin to the war stories from the survivors of great battles.  We need to think about them and talk about them to process the enormity of the event and the only people who really understand where we are coming from are other women who have also “survived.”

Then I read an article on Cafemom entitled, “James Van Der Beek’s Wife’s Scary Home Birth Wasn’t Worth the Risk.”

As it turns out, Mrs. Van Der Beek’s story isn’t so very different from my first birthing story and, somehow, I felt I needed to defend her choice.  Because I chose differently and I’m not sure I did the right thing.  There’s really no way to know.  But I understand why she did what she did and I wonder, if I knew then what I know now, if I’d have done the same thing.

I’ve read a LOT and here is some of what I have learned, summed up for those who care to know why some women would “risk their lives and the lives of their children” by giving birth – even a “high-risk” birth – outside a hospital.

*A note here for my international friends:  I can only write about what I know, here in the USA.  Unless specifically noted, my facts and figures all refer to American births.  Please, by all means, share your thoughts and experiences from your own countries and cultures!

I’ll start with the hard facts that don’t tend to cause too much debate.

First, giving birth now-days, regardless of the specifics of where/when/how, is safer than it used to be.

At the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications, and approximately 100 infants died before age 1 year (1,2). From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births, and from 1900 through 1997, the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 live births (7.7 deaths per 100,000 live births in 1997)

source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm

Do bad things happen?

Yes.   Women and babies die.  It is rare, though.  It is, by far, the exception and not the rule, but things can and do sometimes go wrong.

What the numbers, above,  tell me is that the argument, “Women gave birth vaginally to premature breech quadruplets in caves without pain killers or antibiotics and they were fine,” is not valid.  They weren’t fine.  If they were it was a miracle.  (Yes, I realize that’s an exaggeration.   But you get the idea). Medical science has come a long way and saved a lot of lives and ought not be discounted.

Another important number is this one:

Around 34 percent of US births are via cesarean.

This puts the US well behind the astounding cesarean rate of 49% in China but still ranks us among the most surgical deliveries in the world.

In the Norwegian countries, the rate hovers around 14%.

Consider that Sweden , Norway and Finland are ranked as 3 of  the top 5 nations in terms of maternal/infant mortality.  They must be doing something right!

The US ranks 34th and China 94th (out of 194).

Obviously doctors are performing more risky surgeries than are really medically necessary.

Another statistic:

81% of women who give birth in hospitals in the US are given Pitocin.

In about 3% of births it is medically necessary.

And finally, consider this:

I couldn’t find an exact number because there are so many variables, but receiving prenatal care from an OB/GYN and giving birth vaginally in a hospital runs anywhere from $5,000-15,000, for a healthy woman, depending where you live.

Prenatal care and delivery by a Certified Nurse Midwife costs about $2,000 – 5,000.

OK…

So, now back to the question, “why would you take the risk?”

There is a cycle that happens with the standard, modern American labor and delivery.

It starts when we assume that every baby is going to be born at EXACTLY 40 weeks.  It doesn’t really work that way, of course.  Only about 5% of babies are born on their “due date.”  Any medical text will tell you that a baby born anywhere after 37 weeks gestation and before 42 is “due.”  That is why, in some cultures, women are given a “due month.”

Further, we watch TV shows where a woman happily walking around the mall feels a sudden twinge and, 20 minutes later, has a baby.

We are a society that is impatient and always on schedule.

The reality is, early labor can go on for weeks and a woman may or may not even be aware of it.  That’s why, at a 37 week check up the doctor may tell you that you are starting to dilate and, at 40 weeks you still don’t have a baby.

And then there is the cultural idea that we have control of everything.  We know what is going to happen and when and where and we schedule our work and social lives and everything else as if we have absolute control of the universe.

So take all that, and throw it in a pot.  Then add a large dash of doctors who would rather deliver a baby at 2 in the afternoon on a Wednesday than 2 in the morning on a Sunday and you end up with an induction rate of about 22%.

So, many women are forcing their bodies into labor when neither they, nor their baby, are ready and there is really no medical reason for it most of the time.

Ever try to force out a poo when you weren’t ready?  How’d that go for you?  Hmmm… just a thought.

Anyway…

Then you have the rest of women who show up at the hospital having gone in to labor all by themselves.

If they labor “too long,” even if there is no sign of distress for mother or baby, they are given Pitocin to speed along the process.

If they are in pain, they are immediately given drugs.  While many women are all for the pain relief, they may not realize that the drugs almost always slow their labor.  And, again,  if they labor too long they will be given Pitocin to speed things up.

Why do we need to speed things up?  Well… for all the same reasons we tend to induce.  Also, because insurance companies won’t pay for a woman to labor in a hospital for 2 or 3 days.  So, as is far too often the case, businessmen with no medical training are dictating health choices for women and babies.

Whether it is used to induce or to speed labor, Pitocin causes very hard contractions;  Much harder than most women experience naturally.  Many babies respond poorly to the stress involved and those women are now in need of a c-section.  For many women who had been laboring naturally or with minimal pain relief, the new, stronger contractions become too much and they need an epidural.

This may be a good time to mention that an epidural is a major medical procedure, not just “a shot.”  That’s why it needs to be given by a trained anesthesiologist and why the mother and baby need to have oxygen available and be hooked to heart and breathing monitors.  And they do go wrong.  A lot.  I couldn’t find a solid number, but I personally know 6 women, off the top of my head, that had serious long-term complications from their epidural.  One of them went into cardiac arrest.  I don’t think my loved ones are so different from yours.

Once a woman has had an epidural, she can’t get out of bed.  She must give birth lying down – the single worst position for giving birth.

Of course, lying down slows labor….  yada yada yada…..

More c-sections.

Every intervention increases the chance of having to intervene further.  Each intervention carries its own set of risks and consequences.  Remember those 40 weeks when you wouldn’t take an Aspirin or drink a Diet Coke?  Now all of a sudden narcotics are OK?

A woman who has a c-section has a longer recovery time, a higher chance of infection, a higher chance of severe bleeding, a higher chance of scarring and difficulties with future pregnancies and deliveries and much more.

C-section babies tend to have more breathing difficulties, feeding difficulties, low APGAR scores, and more.

Even if she has managed to get through labor and delivery without major medical intervention, it is more likely in the hospital that the baby will be taken away right away, given a pacifier or supplemental feeding, or given other medical treatment, such as vaccines, that the mother may not even be aware are taking place.

None of that even touches the concept that the woman is laboring and delivering her newborn infant into a building full of people with fatal, contagious illnesses. That always creeped me out a little.

OK – maybe hospital birth has its drawbacks – but what if?

That’s the rub.

It’s always the question.  “OK, OK.  I get all that.  But what if something goes wrong and you aren’t at a hospital?”

To answer that you have to understand what a midwife is and what she does.

A Certified Nurse Midwife has gone to college and earned a Bachelor’s degree in nursing.  Then completed years of additional school work, specifically in obstetrics.  Then completed an internship under another, experienced midwife.  In short, she has almost as much training as a doctor, but her training has been more specialized in a single, pinpoint area of expertise.  She probably has little or no training in surgery.  An OB/GYN is considered a surgeon.

There are “direct entry midwives” as well, and people who choose to have an unattended home birth, but that is so rare in this country that it is almost unheard of.   In fact, in some states, both of these things are illegal.

Most midwives will do all the prenatal care that you would expect from a physician.  They will test glucose levels and heart rates and take measurements and ask you to pee in a cup.

If these tests show ANYTHING wrong, they will send you to a physician.

They will watch a woman as she beings the early stages of labor.

If there is ANY sign of something being wrong, they will send her to a physician.

They will sit with her constantly through her labor (I have never heard of a woman under constant one-on-one care in a hospital) and at the first sign of a problem will have her transported to a hospital.

Once the baby is born, they will stay with the mother for several hours. (Again, how many women have such attentive care in a hospital?)

If there is any hint of a problem with mom or baby they will have them transported to a hospital.

Midwives are trained to spot the tiniest speck of a problem and react to it quickly.

With my second baby, a problem came when measurable contractions, lasting for several days (though far apart and not terribly powerful) continued past 42 weeks without much progress.  The midwife sent me to a specialist.  He recommended a c-section.

As it turned out, the baby had a true knot  in his cord.

“And to think! You almost killed him by trying to birth in a birth center!” More than one person has insinuated to me.

No.  I trusted my midwife to spot a problem.  She did her job.  My baby and I were just fine.  We were never in any danger because we were under the expert care of a trained professional.

A dear friend had an issue of bleeding after her delivery.  The midwife called an ambulance and had her transported to the hospital where they took care of it.

The midwife did her job.

You see, the vast majority of women who have had healthy pregnancies, are quite capable of having a healthy delivery.  Even if there are unusual circumstances, such as a breech baby, a woman is often able to have a successful vaginal birth. A trained professional should be able to deliver the baby, OR spot a problem in plenty of time to call in help from a specialist.

The instance of “something going wrong” that is so unexpected and so sudden and so severe that a woman or her baby wouldn’t be able to get to a hospital for help is one in a million.  She is more likely to be in a car accident on the way to the hospital.  (I didn’t actually run the numbers on that.  It’s just an educated guess.)

The instance of “something going wrong” because of all the interventions that the hospital requires is not really very unusual at all.

Now, in a perfect, rainbow-colored world, a woman would be able to have all the medical wonders of the hospital close at hand AND have the leisure to labor and deliver without being forced into one unnecessary medical intervention after another for the convenience of her doctor and the insurance companies and God-knows-what other reasons.

But that’s not how it is.

Hospitals won’t let you labor a long time because you’re taking up bed space and the doctor has other appointments to take care of.

You can’t attempt a VBAC because the insurance company doesn’t like the increased risk.

You can’t let your baby lie on your tummy until the cord stops pulsing because there just isn’t enough time to hold up the assembly line like that.

You mustn’t labor in the tub.  It makes it harder for the nurse to do her job.

You can’t walk around.  You might disturb the other patients.

You can’t eat or drink (at a time when you are expending more physical effort than perhaps any other moment in your life!) because it could be dangerous if they have to knock you out… which is likely because of all the interventions!

Hospitals are so used to treating birth as a medical procedure that anyone who wants to attempt it as nature intended is seen as weird or difficult.

And so,  more and more women are simply weighing one set of  risks against another and choosing to trust their bodies and their medical care providers to know if a hospital is really necessary.

It’s not about a woman’s “dream of giving birth in her own bed” as the article accused.  That may be a factor, but I don’t know anyone who chose a home birth or birth center birth for such a lame reason.  I mean… good grief… I chose my son’s car seat because I liked the color.  Not ONLY because I liked the color. Give women a little credit, already!  We aren’t that shallow.

I imagine that Mrs. Van Der Beek felt much as I did.  “I believe I can do this and if there is any sign I can’t, my midwife, whom I trust, will keep me and my baby safe.”  She wasn’t birthing alone in a barn, for goodness sake!  As it turns out, she and baby were just fine… which is only to be expected from a young healthy woman who had given birth before and who was under expert care during her delivery.

When you look at all the facts, it wasn’t such a “Scary Home Birth” at all.  I’ve heard dozens of hospital birth stories that are far more nightmarish!

Maybe the media needs to spend less time judging the choices of individual women and more time pushing our society to provide better, more informed care for everyone.

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16 responses »

  1. My son was born in a hospital 35 years ago. My crying baby was taken from me and not returned for several hours. My husband could see him through the nursery window and he cried that whole time.
    My daughter was born at home and I was attended by a midwife. It was a lovely experience.
    With my third, the midwife decided after some hours that it was best to transport me to the hospital. That’s the point. A competent midwife has a back-up plan.
    Thanks for sharing this information. Like you said, it’s a controversial subject.

  2. You make many good points, Lazy Hippie Mama. I have heard you speak on such topics many times before. I wish, for the uninitiated, you had gone a little more in-depth on a few points (such as a VBAC). A good topic should not be limited to a certain word count:)

    As you know, but your readers do not, I was hoping for a c-section from the beginning, and as my baby was breech, that is how my delivery happened. At 40 weeks, I never had a single contraction. I have no idea if I was dilated or not.

    I do agree that the hospital does not always have the time or energy to put your best interests in order. My delivery nurse asked me if I had panic attacks. I told her yes. Somehow, everyone seemed surprised when I had one while feeling the doctors rummaging around in my uterus (my baby was already out and crying). At this point the anesthesiologist asked if I wanted more drugs, to which I answered in the affirmative. My husband informs me I turned blue after this.

    Also, they almost forgot to bring my husband into the delivery room. But I digress…

    As I am a worrier, I would probably always choose the hospital. (Unless my only choice was the cave.) If you decide different, go for it. And I will worry for you:) (Even if it may not be necessary!)

    • Maybe that’s what’s at the center of all of this in my head…. “having the time or energy to put your best interests in order.” Hospitals are like assembly lines. “Get them in. Fix them up. Get them out.” As quickly as possible, or the insurance company will refuse to pay. No part of medicine should be like that. No part of birth should be hurried along. Those things are deeply personal and forcing every woman to follow the same path is lunacy.

  3. Love this discussion!

    I was fortunate enough to be low-risk, and Boof and I definitely discussed the home-birth option at length. We decided to do a hospital birth that has a tiered system, where we were attended by a midwife and if anything happened during either the pregnancy OR the delivery she could be assisted by an OB or transfer care fully to the OB for an emergency C-section. The tipping factor was having a good friend do a whole home-birth experience and a few hours into it having to be transported 40 minutes to her laboring hospital because of complications. I just did not want to risk that, feeling pretty confident it wouldn’t happen, but hoping that if I wanted as natural of a birth as possible that I would do it in the hospital, but with our midwife and (hopefully) med free (didn’t quite happen, but close!)

    I guess I don’t understand why people are so judgey about home-birth, and I thought the VanderBeek article was fab!

    • Thank you for the kind words!
      I agree – hospitals that are set up that way are sort of the best of both worlds. I had a similar thing with my daughter. It was a birth center, staffed by midwives, attached to a hospital, staffed by surgeons. Unfortunately, there are many people who don’t have access to anything like that – including me now that I live in Cowfarm, Michigan!

  4. With my 1st I was told that because my blood pressure was slightly high (125/82, which I found out later is really not a cause for concern) That I needed to be induced. I was given Pitocen, 6 hours later my water was broke by the dr. 6 hours or so later, I am in significant pain, the dr ok’s epidural, but within 3 hrs, I am feeling everything again. I’m told by the drug doctor ( i totally forget at the moment what they are called, lol) that sometimes a patient’s body “gets used it” and it no longer works. They still pumped it into my spine, but it did nothing for the pain. Finally 27 hours after labor began my ob/gyn tells me I need a c-section because I am not dilating past 6. Prior to being induced I made my intention clear that unless it was a medical emergency I did not want a c-section. But after 27 hours of hard labor, I was in no position to fight, in fact it was a welcome relief. After she was pulled from my belly the nurses commented that she had so much vernix on her that she could have gone another 2 weeks easy (no wonder my body was fighting not to deliver). Because she was delivered via c-section and my son came along only 15 months later, I had to have a scheduled c-section ( I was too afraid to find a dr who would allow a vbac). I was devastated because I feel like I missed out on a major part of pregnancy and childbirth, by not actually birthing my babies. Top that off with no lactation 1st time around and son having problems sucking strong enough to be able to nurse. I felt like a failure as a mom. It took me a long time to quit blaming myself for things that I was totally ignorant of then. I was not educated on what my options and rights were. I just went along with whatever ob.gyn said. =( I wish I knew then things I know now, but there is nothing I can do to change things.
    P.S. by far my fave sentence of yours was: “Ever try to force out a poo when you weren’t ready? How’d that go for you? Hmmm… just a thought.” Hahahahahahaha!

    • I think “not in a position to fight” is SUCH a big deal! That was very much me, with my first. I knew she was breech. It was only 37 weeks and my contractions weren’t strong. I had an appointment scheduled with a doctor (on my midwife’s advice) who was specially trained in vaginal delivery of breech babies, but then I got sick. Really REALLY sick. I had a high fever and I was shaking so hard my teeth chattered. I was vomiting – like – every few minutes. Throw in a good contraction every 5 or 10 minutes and I was feeling just greeaaaaaat! So when the doctor said, “do you want to just go ahead with the c-section?” I said yes before she’d finished the question. After it was over I had to wonder, “what the heck just happened here?!?”

  5. My mom had me in a doctor’s office and took me home in a medical supply box. She was a gifted birther. I thought I would inherit her gift, but…I’m one of those women who would have died in the wild. Still, I love the idea of a mid wife delivered birth far far away from the hospital and I really don’t love the suggestion that women who make that choice are irresponsible parents.

    • Haha! Somehow I missed this comment. You are very good at making me laugh. I would have died in the wild too. I’m pretty good at growing them, but not so good at getting them out. You say it perfectly – I don’t love the suggestions that women who make that choice are irresponsible. I’ve never met a mom who didn’t give a lot of thought to making sure her baby was delivered in the safest possible way.

  6. YES! THIS!
    *fist pump*
    You’ve said this so eloquently. My births were both led by someone else’s hand and disappointing. My first had SO MANY unnecessary interventions. I was given a *choice* for which date I could be induced on. A, B, F, H or I because those days were convenient for the doctor.

    This post has been awarded the Coffee Powered Writer Award for excellence. Here’s the award: http://coffeepoweredmom.files.wordpress.com/2012/05/coffeepoweredwriteraward400.jpg and here is the link to the award page: http://coffeepoweredmom.wordpress.com/coffee-powered-writer-award/

    • Well, thank you so much! You made my day!!!
      This was a hard post for me to write – far harder than any other, and many took it the wrong way. As if I were saying that ALL doctors and nurses are lazy drug pushers. I don’t think that’s the case at all. I was just trying to point out that it’s a horribly broken system and, in a country where women picket on the streets to have a right to do whatever they want with their bodies, we are being pushed into doing what we DON’T want at one of the most critical times in our lives.
      Anyway… don’t get me started again! hahahaha
      I really do appreciate the award, though! You made me smile in the midst of a cloudy afternoon. 🙂

      • “Business of Being Born” or “Pregnant in America” two very good documentaries that sum up everything you’ve posted about. They interview doctors as well, to all those naysayers!

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  9. While some of what you say is correct and we do have very alarming rates of csection in this country you are really in fact wrong about several things. I am a cert doula and cert cbe. I support choices and childbirth and believe that education is key. What you say about an epidural is incorrect. I have worked with several doctor that encourage women to birth off their back. With and epidural they will get women into supported squats or knees laying over backside of bed . With and epidural you are not completely left without feeling. It also does not slow down labor, while it can a lot goes into it, depends on when you get it. I ha e seen it actually speed labor up. I have been with women who stall out at 6/7 and get so tense they stop progressing, could be they are exhausted but sometime in these cases the epidural allowed them to sleep and relax and dilate. Not all interventions are bad and neither are all doctors. A lot of factors influence birth. What I think is key is to support women, give them unbiased info and allow them to make the educated choice that is right for their birth.

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