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The Young Pregnant Couple–Part 4

The countdown to baby continues for Noelle and Zach.  Since my last post, they have:

  • found out they are having a boy!
  • interviewed a natural birth-friendly doctor and interviewed a midwife
  • finalized which country they will raise this wee one in
  • decided on their birth location and care provider
  • signed up for a childbirth class

After much prayer, Noelle and Zach have chosen to birth at home with a midwife.  It would have been an easy choice if their insurance would cover any part of it.  It doesn’t.  But their insurance offers fantastic hospital coverage–they would have very little out-of-pocket expense.  For a young couple preparing to quit their jobs and trust entirely on financial support for their ministry, it was a big deal to choose a homebirth.

Let me interject here that the new healthcare plan–and, no, I will not offer an opinion!–will require insurance to cover certified professional midwives at birth centers.  This change is wonderful but it reveals a common misunderstanding about birth centers.  The birth center is not different in terms of equipment and training than a home.  The homebirth midwife brings the same supplies and equipment as she uses at a birth center.  For the plan to cover one and not the other simply because of the setting seems silly to me.   

And…the wee baby boy will grow up (drum roll) in Cambodia.  His parents have spent time there before and are excited to return.  Noelle will once again be working with children who are victims of sex trafficking.  Zach will be working with an unreached people group. 

Now here is a question for my readers.  If you lived in a country with only cold water for washing clothes, which cloth diapers would you choose and how would you wash them?  Would you use bleach to kill bacteria?  Something else?  And this is a place in which bacteria can be ugly.


I’ve added a new birth to the birth story section of my blog.  Check it out!

Bri’s VBAC homebirth

A nice homebirth montage

From midwife, Pamela Hines-Powell.  Note:  this is a BIRTH slideshow so it contains images of birth.

A word or two about homebirth

Sometimes I get the impression that people think homebirth is crazy.  I dunno, maybe comments left on blogs or eyebrows raised when I mention my babes weren’t born in the hospital.  So if I might take a moment to share my thoughts on why a person might choose homebirth.  (And let’s just get this part out of the way:  obviously, I’m am not saying everyone should birth at home.  You should birth wherever you choose.  And I am not saying that interventions such as inductions or cesareans are evil when they are necessary to save lives.)

1)  Homebirth is safe. 

Numerous studies have shown that planned homebirths with a midwife is as safe as a hospital birth.  Some studies even show that they are safer.  Certainly there are fewer interventions.  “The first intervention in birth, that a healthy woman takes, is when she walks out the front door of her home, in labor. From that first intervention, all others will follow”.  Dr. Michael Rosenthal – Obstetrician

In 20 other countries, fewer babies die at birth or in their first few months of life.  Those countries have one thing in common:  most of the births are attended by midwives.  Compare that to our rate of 8% of births attended by midwives; only 1% of which are homebirths. 

A woman is four times as likely to die from a cesarean than a vaginal birth.  The US cesarean rate is over 30%.  Homebirth midwives have a cesarean rate less than 10%. 

2)  Midwives are super (and smart). 

Midwives are trained in normal birth.  Keenly aware that a hospital is the best place to be for high-risk pregnancies, midwives will transfer the care of these women prior to their birthing times.  Likewise, during labor or birth, a midwife will transfer a woman to the hospital if a complication arises. 

Midwives are trained for emergencies.  Though their focus is on prevention, certainly they are trained to respond to less common emergencies such as hemorrhage, neonatal resuscitation, shoulder dystocia, etc.  While regulations may vary from state to state, all midwives carry emergency equipment and administer certain medications when indicated. 

Part of the reason for their excellent outcomes is that midwives spend so much time prenatally with their clients.  A prenatal with a midwife typically lasts an hour.  How often does an OB spend an hour with her patients?  A midwife can more easily address nutritional concerns or emotional issues because she knows her clients and has spent time building trust. 

Midwives are the norm for most births in the world.   

3)  It is convenient.

No bags to pack.  No worrying about “when to go.”  No contractions in the car. 

Everyone comes to your home.  And they are guests.  They were invited.  That changes the entire atmosphere. 

I didn’t have to worry about someone feeding the dog or arranging childcare.  If I decided (as I did) that I wanted a grape popsicle, my freezer was just a room away.  If I decided (as I did) to play pass the pigs, then it was readily available. 

4)  It is economically sensible.

Some of my doula clients have shown me their hospital bills.  My jaw dropped when I saw the cost of an epidural.  Or an IV.  My first thought was “I don’t charge nearly enough for my services if a cervidil tampon costs more than me!”  Then they showed me the separate bill for the baby care.  Good grief.  The consumer has little control over these charges. 

Midwives charge a flat fee.  It covers your prenatal care, your birth, and postpartum care.  The postpartum care takes place in the comfort of your own bedroom.  There are no hidden charges.  You are not charged extra if your midwife gives you a tylenol or if your labor lasts 30 hours.  Of course, the fee varies.  Here, I’ve seen it range from $2600–4000.  And in SC, Medicaid covers homebirth midwives.    

5)  Easier to relax during birth and rest afterwards.

Hospitals were not designed for birth.  Women in labor need privacy, quiet, and room to move.  It is essential that our bodies relax during our birthing time.  If too much adrenaline creeps in, labor can stall.  In a hospital room, you will be monitored, you will be interrupted, you will hear unfamiliar sounds, you will sign a dozen consent forms, and you will be informed of policies. 

During your postpartum period, you will be interrupted during the night so that you may be monitored.  The nurses aren’t evil but it is their job to check on you.  If you birth at home, you will be snuggled with your partner and your little one in your own comfortable bed.   

6)  You can give birth in whichever position or room you choose.

Midwives follow birthing women around.  If she stops to push in the corner, the midwife squats down with her.  If it is dark, the midwife might use a flashlight.  If she wanders out to the back deck, the midwife will bring a few pillows.  If she wants to push on the toilet, fine.  Tub?  Fine.  Under the apple tree?  Whatever.  A midwife is accommodating.    

7)  The baby is mine.

No, I don’t mean the baby might be switched at birth.  I mean that families who choose to have their babies at home usually call the shots when it comes to the handling of their newborn.  It is assumed that the baby will be skin-to-skin with the mother for a lengthy period after birth.  In the absence of emergency, of course, the mom decides when the cord is clamped, when the baby is weighed, and if any procedures like eye ointment, vitamin K shot are administered.  I feel like homebirth gives parents “permission” to parent right from the start.      

Really, this control over how my baby was handled was my number 1 choice for choosing homebirth. 

8)  It is cleaner.

Hospitals are gross and they are filled with sick people.  Scary germs live there.  Now with swine flu and antibiotic resistent bacteria running amok, it makes sense to keep a newborn protected at home.  When a baby is born, she receives antibodies through her mama’s colostrum.  It will include antibodies for the microorganisms living in her home and places her mama frequents.  Newborns have immature immune systems and rely on this colostrum for protection.  The newborn is unable to make antibodies for foreign germs like those found in hospitals.     

9)  And this might not be the most important reason, but no hospital gown, no hospital food, and no hep-lock!

I don’t think this one needs explanation!   

Now, before anyone gets huffy with me, let me acknowledge that there are wonderful doctors and nurses.  My beloved mother is a nurse.  I grew up in doctor’s offices and hospitals.  However, there are not so wonderful regulators who enact ridiculous rules for low-risk women birthing at hospitals.  And there are frivolous lawsuits that scare the bejeebies out of otherwise accommodating physicians.  And I concede that not all midwives are angelic guardians of birth–a few are crappy.

But hopefully this list will help someone see why a person might choose the seemingly strange choice to birth at home.  Does anyone else have reasons to add?

Guest Post: Homebirth and Courage

Jenny blogs at Babyfingers about mothering, birth, and more.  These are her thoughts about her recent homebirth.

Homebirth and Courage:  You don’t have to be a hero

I’d intended to write one post comparing my two births, but then realized it would be a book, not a post. Therefore, I am breaking it up. Right now I’d like to write about courage and how it played into both of my births.

During my pregnancy with Ivey, upon revealing to others my desire for a homebirth, I was told no less than 20 times how brave I was. This is commonly said to women who birth at home, so I wasn’t surprised. (In some cases it is probably a polite way of saying have you lost your MIND?!) But taking it at face value, it didn’t fit. I wasn’t trying to be a hero; I was just doing what was best for our family and, actually, what was easiest for us. After the birth, people were more thoroughly convinced of my bravery. In particular, people who had experienced or witnessed childbirth with pain meds were impressed that I’d endured without them. Their comments were confusing for me, though, considering what an easy time I’d had compared to my hospital birth! I thought back to Suzi’s birth and realized that although it was ten times as painful and traumatic as Ivey’s, no one had told me I was brave. In fact, I felt a little like a failure after Suzi’s hospital birth. That birth required so much more courage than Ivey’s homebirth did, and courage of a different sort.

For Ivey’s birth I had a tough decision to make. Would I go with the same type of OB care that I’d had with Suzi, or would I go with a midwife and hope for something better? After what happened with Suzi’s birth I realized that, unfortunately, a woman has to study like she’s pursuing a college degree to truly optimize her birth experience. Nagging questions regarding Suzi’s birth swirled in my head. Were the things that had gone wrong my own fault, or due to some deficiency of my body? Were some things poorly handled by my doctor and nurses? I talked things over with knowledgeable friends, read books, watched films, and found blogs and articles online. I did most of this before Ivey was even a twinkle in Jordan’s eye, so by the time we realized we were pregnant we were already 99% sure we were going with a midwife. It took courage to make a break from conventional prenatal care, even though I knew in my heart that a midwife was best for me and the baby. One day when I was about six weeks pregnant, my morning sickness suddenly came to a halt and I began to wonder if it might be a sign of a miscarriage. I panicked, and we went the only place we could think of–back to our old OB’s office to beg for an early ultrasound. Ivey was fine, of course; we saw a healthy flicker of a heartbeat and were so grateful for the doctor’s help. I had mentioned my desire for a homebirth, though, so after the ultrasound we sat through a lecture in his office. He told us of a homebirth-turned-hospital-transfer he’d seen recently, during which the mother came in screaming for drugs and ended up with a c-section after what he said would have been a shoulder dystocia. The mom and baby were both fine, but he insisted things could’ve easily ended differently. The words dead baby were uttered–something you should never say to a pregnant woman. We prayed about it and I realized that my previous hospital birth was definitely not what God had intended. I knew that anyone who would use scare tactics to change my mind must be pathetically lost from what is right, and that since I knew God wanted me to have a homebirth, I should trust Him to keep me and my baby safe.

The concept of homebirth was a stretch for both my family and Jordan’s. Although we were both born naturally (meaning without pain meds), we were both born in a hospital. Jordan’s mother is a nurse and my mother is a natural-born worrier. While his mother (and grandmother, and father, etc) kept bringing up how Jordan had been born with the cord around his neck, my mother busied herself asking questions of the what-if variety. She came to the initial meeting with our midwives and got a long list of questions out of the way there. Afterwards, she was mostly satisfied with our midwives’ competency and supportive of our plans to have a homebirth. Various other family members, acquaintances and strangers, however, continued to pester us with negative comments and questions they didn’t truly want answered. It was exhausting and unproductive for us to deal with them. It takes courage to stand up to friends and family and to accept unfounded criticism.

Then our insurance refused to cover the homebirth, and that was hurtful in several ways. We knew that if we ended up transporting to the hospital during labor, we’d be responsible for the entire out-of-pocket cost of a homebirth as well as the portion of our hospital bill that our insurance didn’t cover. It stung to learn that our insurance company (we are on the SC State Plan) could do something as unfair as refusing to cover a perfectly valid and safe birth choice, but they can. We decided to have our homebirth anyway.

In my own mind, such a drastic change required me to accept that something was wrong with Suzi’s birth. It wasn’t easy to accept that my baby’s birth could have been better, but the more research I did the more obvious it became that this was true. This is something many women must accept, and I believe it is the main reason women are always telling birth “horror stories.” My midwife pointed out recently that we seek out a birth experience which will confirm what we already believe about ourselves. As an extension of that, I think some women tell their birth stories hoping to confirm things about themselves. Some women want reassurance that their birth was going to be the way it was no matter what; that there was no way, for instance, to avoid an induction which led to a c-section. In my case, I told my story looking for reassurance that I could have had a better birth if it had been managed better. I wanted to believe I had made poor decisions, not done enough research, or maybe even been a victim if it meant I could have a second chance at birthing naturally. I’ve read the stories of (or have met) some other women who have planned homebirths after bad hospital experiences, and this seems to be a fairly common sentiment.

With Suzi, I wanted a natural childbirth and I did try for one, but I was too naive to realize what I needed to do for this to happen. I planned a hospital birth with an OB who was skeptical, at best, of my ability to birth naturally. Despite our perfect attendance in childbirth class (it was the hospital-sponsored one) and all my reading (I must’ve read the wrong books) things did not go the way I’d envisioned. If you’d like to read the whole story, it’s here.

It takes a lot of courage to walk into a hospital knowing that you and your “progress” are about to be judged. To wonder which doctor you might get. To be hooked up to machines and confined to bed. To lose the ability to labor in exactly the way you wanted. The hospital can be utterly distracting for a laboring woman during a time when she needs to concentrate like she’s never concentrated before. It takes a lot of courage to (in a single evening) allow the fingers of five different strangers, some male and some female, to be inserted into your vagina. When and if a woman reaches the pushing stage, it takes courage to have her vagina put on display under a spotlight as though it’s about to perform in a Broadway musical. Women are expected to quietly accept these unacceptable conditions of a hospital birth.

There were at least ten people in my L&D room during the pushing stage. I pushed for over two hours so some people left and others came in. Once I received the “okay” to push (I had an epidural so I had no opinion on when would be best to start) a nurse said, “just a minute–we’ve got to get a few things set up.” It took two or three people to assemble the staggering collection of ominous metal objects that were evidently necessary for my birth. They laid them all out on a table at my feet, and then removed the bottom half of my hospital bed and brought down the lamp, which seemed brighter than the high-beams on my minivan. My doctor decided to try for a vacuum delivery after I’d been pushing a long time, which involves using a plunger-like device to reach into the vagina and pull the baby out by the top of her head. I wondered what it could possibly do to my baby’s head and neck. It takes courage for a woman to trust strangers to get her baby out safely, particularly when it seems everything is a big emergency.

So far I’ve mentioned parts of my own birth, which are common to many women. But what about women who have c-sections? First there are scheduled c-sections for which a woman must sit and wait, knowing what is about to happen to her. Then there are emergency c-sections, which not only require a woman to be cut open while awake, but also to suddenly face that the birth she hoped for is not going to happen, which can be devastating. In either case, most women lie behind the blue curtain acutely aware of the major surgery that is happening on the other side. After the ordeal is over, most of them do not even get to hold their babies right away. In some cases women are put under general anesthesia and this is probably even worse. This happened to one of my friends and a couple of hours passed after the birth before she even got to see her baby. There are so many other women who go through terrifying births–mothers of preemies, women with high-risk pregnancies, and women who were previously sexually abused, to name a few.

And I am brave for having a homebirth? Once we’d made the decision to have our homebirth, actually having the baby took very little courage because I wasn’t afraid. I loved knowing that Carey, not only my midwife but my friend, would be coming to help us and not just whoever was on call. She acted as though everything was as normal as it could be as she set up her supplies with a sense of urgency, but not emergency. Instead of making me constantly wear two restrictive monitor belts on my belly, she checked Ivey’s heartbeat intermittently with a handheld doppler, and I didn’t even have to get out of the tub for that. Both our midwives waited quietly during my pushing stage, and if anything had to be said they whispered it out of respect for my zone of concentration. In the comfort and familiarity of my home, my labor seemed to fly by. It never really registered as painful, because I didn’t fear what was happening. My husband was much more helpful at the homebirth because he didn’t feel brushed aside by doctors and nurses and wasn’t scared for me and the baby like he was in the hospital. When we discussed how things had gone, he told me he was glad we had not gone to the hospital because everything was made to seem like an emergency there. My favorite part of the homebirth was how we were allowed all the bonding time we wanted with our baby. All the tests and measuring were done in our presence, and were put off until we’d had time to welcome our daughter. We never had to worry where she’d been taken or what was being done to her. It felt so safe and perfect.

It’s just a myth that to consider having a homebirth a woman has to be brave, and I wish more women knew this. I frequently don’t feel brave at all (you should see me at the dentist) yet I had an amazingly successful homebirth. I feel that God gave me the birth experience I had so that I can tell others about it. Now that I’ve experienced birth both ways, if I ever have to go back to the hospital, that will require courage.

Charlotte Church and Ricki Lake?

What do they have in common?  They have both been singled out by the medical community as influencing women to have homebirths.  The difference?  While Ricki Lake was raked across the coals by the AMA and ACOG, Charlotte Church is being upheld as a role model.  In fact, the Welsh Assembly Government had a goal to INCREASE home births by 10%.  Welsh homebirths have, in fact, increased 25%! 

Isn’t it interesting that while American medical groups are making resolutions to outlaw homebirths, their peer group across the Atlantic are trying to increase homebirths?  And isn’t it interesting which countries have the best outcomes?  Did you know a mom or baby is more likely to die in childbirth in the US than in Europe (or even Havana!)?  

Doesn’t the AMA have bigger issues than the 1% of US babies born at home?

Ruffled Feathers

I’m sure most of you know about the AMA resolution already.  Quick sum-up:  the medical trade organization has joined with ACOG to pursue legislation for “safe birth.”  Safe birth, of course, being birth supervised by a doctor.  The funny part is that the resolution targets Ricki Lake for daring to discuss her homebirth on the Today show.  So Ricki has responded and I wanted to link the article

I’m really sick of reading homebirth debates.  Same old anecdotes, statistics, ignorance being tossed about.  The discussion should be about choice.  And it isn’t like families are choosing homebirth in droves!  We’re talking about a small segment of the population.  Shouldn’t the AMA be worrying about cancer, insurance, MSRA, or some other big fish?  It is really amusing that the AMA/ACOG is so ruffled about midwives.      

ETA:  Today the AMA voted to remove references to Ricki Lake from their resolution.  I guess they didn’t think anyone was paying attention?       

Not to Deliver You

Ani DiFranco talks about her homebirth.   

Quote:  “To take birthing out of women’s hands and deny us the continuum of eons of wisdom and experience is to eject us from the very seat of our power.”

but my job here
is not to deliver you
but to hold a mirror
till you see how

Beware Those Trendy Homebirthers!

Homebirths are trendy?  Fashionable?  The latest cause celebre?  Huh?  Did I miss the memo?  

These are the adjectives used in the American College of Obstetricians and Gynecologist’s (ACOG) newest statement against homebirth.  Wanna hear more? 

Why are there so many C-sections in America?  Oh, blame it on the women, according to ACOG, who attribute the US numbers to “maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.”  Hmmm…how do they explain the incredibly low rate of homebirths that end in c-sections?  Or the fact that other developed countries don’t have such high cesarean rates?  Do they really believe that more American women are unable to give birth vaginally? 

This is my favorite part:  “Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.”  Wow.  Those stupid homebirthers.  They only care about the latest trends and causes celebre.  I’,m sure they haven’t looked at the links between common hospital interventions and cesarean birth or difficulty breastfeeding.  They haven’t considered that the US ranks 2nd to last in infant mortality rates among developed countries or that the National Center for Health Statistics reports that an estimated 40% of maternal deaths were due to “quality of care.”  And I’m certain none of these homebirthers read the British Journal of Medicine’s study which concluded planned North American homebirths were safer than hospital births.  I wonder if ACOG read that study?  Obviously, these homebirthers aren’t thinking about the well-being of their baby.  They care most about “the (trendy) process of giving birth.”

Homebirthers are some of the most well-researched people I know.  They don’t choose homebirth just for the fun of it.  They do it because they believe it is the safest choice for their baby and for the mother.  And the research that ACOG says is not “rigorous” enough supports their choice.  If ACOG really wants to speak against homebirth and direct entry midwives, then ACOG should fund a study, track the outcomes, and maybe, GASP, actually attend a homebirth! 

I wonder if this latest ACOG statement is a reaction to “The Business of Being Born” release on DVD this month?  Could Rikki Lake have stirred up this venerable establishment so much?  I surely hope so.