Our "risky" decision

I just got a call from a midwife at the clinic I went to throughout my pregnancy with Claire, which is the same clinic I went to for routine bloodwork at the beginning of this current pregnancy. She was calling because I haven't been back in almost 20 weeks.

After reassuring her that I was, in fact, receiving care somewhere else, there was a pause. "I'm actually planning a homebirth," I offered, not quite knowing what to expect from this hospital midwife who I knew nothing about. I am confident and completely at ease with my decision to avoid the hospital, but I have found that many people who hear our plan don't know the facts. These people have reactions ranging anywhere from a blank stare to downright horror written across their face. Some of them qualify their reaction with a self-deprecating statement like, "I'm too chicken," while the expression on their face tells me that they think my decision is anything but brave, they think it's unequivocally risky behavior. Others like to dive into the perceived dangers of this decision that they see as impulsive and irresponsible: "But you won't have a board-certified doctor in the room with you! What if you need to have an emergency c-section? What if you need drugs or equipment?"

I don't expect everybody I come into contact with to know the current statistics and common practices in childbirth, but I am alarmed by just how few are aware of the current state of affairs. First and foremost, studies show that planned homebirths with a skilled attendant have outcomes as good as or better than hospital births. The most recent study was published in the September 15, 2009, issue of the Canadian Medical Association Journal and found that women who planned homebirths had lower rates of interventions and adverse maternal outcomes than women who planned hospital births, whether the latter were attended by a midwife or a doctor. Women birthing at home were less likely to experience electronic fetal monitoring, cesarean sections, episiotomies, augmentation of labor with oxytocin or amniotomy, the use of drugs during labor, and other interventions. In addition, mothers who had a planned homebirth had far fewer tears or postpartum hemorrhage, and newborns born at home had fewer incidents of birth trauma, need for resuscitation at birth, or need for oxygen therapy beyond 24 hours. And this study, conducted in North America in 2000, was published in the British Medical Journal and echoes the results published in CMAJ.

As a low-risk woman, this planned homebirth is a safe and responsible choice. These two studies look at the risks of not going to the hospital, but what about the known risks of going? Hospital-acquired infection (MRSA, anyone? Staph? H1N1? The hospital is, after all, where sick people go), routine interventions (which surprisingly few parents and parents-to-be know the risks of), iatrogenic (doctor-caused) complications (my situation after Claire's birth would fall into this category, but that's a whole separate post.)

To address the commonly expressed fears I mentioned above: I am in the care of two wonderful midwives, one who has 30 years of professional experience under her belt, and they are doing a great job of helping me to stay healthy and low-risk. They are also trained to recognize problems that could arise, and know what to do and when to do it - and yes, that may mean a hospital transfer (although the incidence is incredibly low.) The time it would take to transfer me to the hospital in the event of an emergency requiring a cesarean is about the same amount of time it would take to prep the OR and transfer me within the hospital, so it's a wash; at home I have the added benefit of avoiding the "cascade of interventions" that usually leads to a cesarean and has contributed to the inflated cesarean rates (according to the World Health Organization, a healthy maximum for an industrialized country like the US is 15%...some hospitals in the Twin Cities are more than double that, all but one are significantly higher.) I am not comfortable with the risks of drugs or equipment in most cases, so I am doing what I can to avoid them again. My midwives do bring some along in case of emergency, and are equiped to handle such things as a postpartum hemorrhage. I had a beautiful labor and delivery with Claire, having done most of the work at home (I showed up at the hospital fully dilated and ready to push.) The problems began when the hospital staff interfered with the natural process that I had been doing just fine with all along, and their actions ultimately resulted in my need for surgery. I prefer my odds with my current homebirth team, a team who trusts birth, respects my body, and uses their equipment only when necessary.

Homebirth is not for everyone. A woman has to give birth where she is most comfortable, and some women just aren't comfortable birthing at home (whether it's because she wants to "be near medical equipment", her house is messy and reminds her of her to-do list, or she just doesn't have enough space). Homebirth is also not for women with certain risk factors, and for these situations I'm thankful we have hospitals and trained medical staff to treat these women and their babies. I am not anti-hospital or anti-doctor. I have seen, in my own experiences and through the experiences of many others, that medical intervention in most low-risk situations is unnecessary at best, and can actually cause harm...and for some reason this high rate of intervention has become the norm, so people have come to believe that it's unavoidable. The famous obstetrician Dr. Robert Bradley compared childbirth to swimming, the doctor is the lifeguard. "Both swimming and birthing carry an irreducible minimal risk, and lifeguards and doctors are necessary, but only for complications. Good swimmers and good birthers need them to be present, but just in case problems arise." Unfortunately, people have come to think that a doctor or midwife isn't doing her job unless she is intervening with the natural process even when the mother is "swimming" along just fine.

So back to this hospital nurse who had called, and who I volunteered the homebirth info to. She blew me away with her response, a heartfelt-sounding, "Oh, that is wonderful! All babies should be so lucky to be born at home. Best wishes to you!" How nice to find support from an unlikely source, especially when support is so scarce to begin with! And while I'm on the topic of support, I'd like to send a huge THANK YOU to Mark, my parents, siblings, and friends who either actively support this decision or at least care enough to want to learn more. I feel the love, and it is very much appreciated :)