Thursday, April 02, 2009

Why we chose to have our baby at home

An astute observer might have noticed in the pictures that we posted recently that Liz gave birth to Chris at home.  Before the birth, when we told acquaintances that we were planning a home birth, their responses often made it clear that there are a lot of misconceptions (no pun intended) about home birth, natural childbirth, and even childbirth in general.  I'd like to take a moment to explain why we decided to have a natural childbirth, why we decided to have a home birth, and why we're glad we did.

First of all, unmedicated childbirth presents a host of benefits--too numerous to mention here--to both the mother and fetus.  Among them are:
  • The fetus is more alert, and is able to help move itself out during labor.
  • Undrugged newborns breastfeed much easier.  Breastfeeding just after birth stimulates the production of breast milk, making it easier to continue breastfeeding afterward.  Breastfeeding likewise has numerous benefits for the fetus.
  • The newborn is more alert and is better able to spend quality time bonding with both mother and father.
  • The people we spoke to who had tried it both ways reported a much faster recovery time for the mother when giving birth naturally.
  • Reduced risk of needing vacuum extractor or forceps (which reduces the risk and severity of tearing)
  • Mobility during labor.  Adjusting and changing positions during labor can make things much more comfortable for the mother, but is out of the question when you have a hypodermic needle in your spine.
  • Shorter labor.
  • Avoid the side affects and complications from the epidural.
  • Reduced chance and severity of post-partum depression.
And, perhaps most convincingly of all, the people we spoke with generally fell into one of three categories:
  • Women who had only tried childbirth with an epidural generally expressed the feeling that they weren't brave enough to face the pain of a natural childbirth.
  • Women who had only tried natural childbirth were generally content to continue doing so.
  • Women who had tried both methods invariably said the natural childbirth was far better.  

Having decided that we wanted to have an unmedicated childbirth, the decision to give birth at home was a relatively simple one.  Hospitals tend to foster a culture of intervention.  After all, people only go to the hospital if they are injured or sick, right?  Apart from the rare case where a woman is at particular risk of complications, childbirth is a healthy and natural occurrence.  Luckily for us humans, women have been giving birth successfully for millennia without medical assistance.  Don't get me wrong--hospitals are very important institutions, and medical science has brought us a long way from the devastatingly high infant mortality rates of days gone by.  I would certainly prefer to be at a hospital in the case of a high-risk childbirth.  However, for the vast majority of pregnancies a birth at home is every bit as safe as a birth in the hospital.

As I said earlier, the hospital environment is geared toward taking someone who has something wrong with them and fixing it.  In the case of childbirth, the goal is to take a woman who has a baby in her tummy and remove the baby in such a way that both mother and baby survive.  If they can increase their personal revenue or the hospital's revenue at the same time, so much the better.  Very little attention is given to the comfort or wishes of mother or child unless they can charge you for it, and since doctors are busy (and human) they tend to want to do things in a way that is most convenient for the doctors.  With this in mind, drugs and surgery are the best ways to accomplish their goals.  They can easily take a perfectly healthy woman with a perfectly healthy baby and increase the hospital's profits while still ensuring, more or less, the survival of both mother and child.  Here's how:
  1. There is a moment during transition (between first-stage and second-stage labor) when the natural hormonal changes taking place inside a woman's body will cause her to feel despair.  During this stage, she will say things like "I don't think I can do this anymore."  At this same moment, the same hormonal changes make her extremely open to suggestion.  If you tell her she needs a drink of water, or to go to the bathroom, she'll probably agree with you.  If the doctor says, "How about we give you a little something for the pain," she will probably consent unquestioningly.  Now the doctor has permission to give her an epidural (this was in the fine print of the forms you signed when checking in to the hospital).  Had they waited another half-hour, the woman's mental state would have naturally changed to one of quiet determination, and she would soon be in the pushing phase.  The epidural takes about half an hour to kick in anyway.
  2. Once the epidural is administered, the anesthesia has a tendency to prolong labor, giving the doctor an opportunity to suggest "something to speed things up."  After hours of labor, and after being told that their labor is slowing down, most women will want very much to do something to get it over with.  At this point, assuming the epidural was administered properly, the woman will not notice the increased severity of the contractions as a result of the pitocin.  Indeed, the doctors and nurses will probably have to tell her when she's supposed to push because she won't feel the natural urge that normally accompanies contractions.
  3. The baby, however, is now the victim of three separate effects of events so far.  First, the anesthesia is making the baby feel groggy and slowing his vital signs.  Second, the pitocin is working to increase his heart rate.  Thirdly, the mother's contractions are now much more severe than they should naturally be, so the baby is being squeezed by the uterus more than he should be.  This trifecta of stimuli will often throw his heart rate (as measured by the external fetal monitor) into disarray, leading the medical staff to conclude that the fetus is distressed and must be extracted via C-section.
And so you see how easily the medical team can upsell their services.  A mother who would have only been charged for the hospital bed, room, and standard staff for a day or two can now be billed for the epidural kit, the anesthesiologist, the pitosin, and a full-on invasive surgery, plus the extra time she'll spend recovering.  And the doctor used every available medical technique to ensure that mother and baby survived, rendering him practically immune to litigation.  This probably explains why c-section rates in hospitals are over 30% (and rising) while out-of-hospital births have c-section rates around 4%.

Also, at home the mother has much more freedom to move around into different positions, even taking a bath or a nap if she feels like it.  We can eat or drink whatever we like whenever we like, we never have to worry about when to go to the hospital or about having the baby in the car on the way there.  Liz, like most women, feels much more relaxed at home than at the hospital, and relaxation is one of the most important ways to reduce pain during contractions.

We were able to find a really excellent (and extremely qualified) midwife named Rebecca, who came highly recommended by friends.  With our insurance, the entire birth process cost just as much as it would have at the hospital.  (If we didn't have insurance, it would have cost much less than the hospital).  She has a birth center that would have cost about $750 to use (includes meals, etc.), and we asked her what the biggest advantage would be to using the birth center instead of our home.

"Family," she replied.

"What do you mean?"

"A lot of times if you tell your family that you're planning to give birth at home they're horrified, but if you tell them you're having it in a 'birth center' it lends a certain amount of credibility to it.  I will have all the same equipment with me when I come to your house, so there's no difference in risk to you or the baby if you have it at home."

In our first appointment, Rebecca spent a couple of hours asking and answering questions, and subsequent appointments tended to last an hour or more.  We were able to develop a rapport with her that would have been impossible with most obstetricians.  (Liz still hadn't seen her OB in person after four appointments there).   Rebecca also had a knack for calming Liz down and assuaging her fears.

We also took a Bradley Methods class to educate ourselves about the childbirth process.  In addition to teaching us what to expect from labor itself, our Bradley instructor coached us on nutrition and exercise that was particularly important in ensuring that Liz would be ready for the process.  We learned pain management techniques and different birthing positions that often work best during labor.  The course lasted two hours, one day a week, for twelve weeks.  By the end of it we felt really empowered and at peace about the whole thing.  Labor was no longer something we feared.  We knew what to expect, and we knew what we would need to do to make it a successful experience.

So what was it like to have a baby at home?  In another posting I will write about the experience.  Stay tuned.
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