homebirth


Sheridan at the Enjoy Birth blog wrote a wonderful post, starting with:

Imagine the year is 2035.  People rarely cook at home anymore for a few different reasons.  They have gotten too busy and because of subsidies from the food industry eating at a restaurant is less expensive.  They actually pay more out of pocket to eat at home.  Many people look back and remember, “People actually prepared meals AT HOME!  It is amazing that they were willing to go through all that time and energy and that so many survived.”

It is an excellent analogy to the current “birth wars” that Jennifer Block wrote about here, discussing home birth versus hospital birth.

Both articles are must-reads!

Seriously?  When it comes to maternity care the emotional tie of a baby’s health can be used unscrupulously.  Of course a mother doesn’t want to do anything that would hurt her baby, but is the emotional blackmail of responses such as these really necessary?:

“Well, if you don’t care what happens to the baby…” “If you don’t do this your baby could die.” “You can choose that if you’re going to take all of the responsibility for the risks and sign this waiver.” ~ What Are They REALLY Saying?

Natural or ‘normal’ birth advocates and educators are sometimes labeled as rebellious, extreme, etc. with the opponents claiming in the same breath to also being focused on healthy birth outcomes.  Kathy Petersen, IC member, muses more about the same team issue.

There may not be an “I” in ‘team’, but there certainly is a “me.”  The only ‘team’ that exists is the one you put together and at its center is you.  You are the “me” in team.  You are an active participant in your birth and that actually benefits your practitioner because you get to give informed consent or informed refusal.   Are practitioners so afraid of the legal system that it’s easier to just have women go along with what makes a lawsuit least likely to arise?  The truth is most consumers don’t want to have to deal with a lawsuit either.  It may appear to be easier and simpler to just go along but it isn’t.  If Big Baby Bull doesn’t help you see ‘malpractice’ intertwined with emotional tugs perhaps a mother or a baby dying from the misuse of the drug Cytotec for an induction (for the suspected big baby??) will.

Informed refusal gets dicey because a practitioner must be able to prove that their client/patient was aware of the consequences of not following a specific protocol.  Yet when it comes to maternity care, a system so fraught with the overuse of technology that many in the field admit they’ve never seen a natural birth, can practitioners really convey to a mother what will happen if they refuse technology?  We can hear that conversation now: “Well, if we just sit here and wait you will have to have this baby completely on your own!”

A practitioner’s ability to understand normal birth is greatly undermined by their own failure to appreciate the litigious environment they created themselves.  ACOG recently admitted, for example, that the guidelines for external fetal monitoring are left open to interpretation.  What they are not making clear to the consumer though is that it is the obstetricians who have failed to understand and deploy external fetal monitoring prudently but it is the mothers who are shouldering the consequences, the fear of malpractice:

“Our goal with the ACOG guidelines was to define existing terminology and narrow definitions and categories so that everyone is on the same page,” says Dr. Macones. One of the problems with FHR tracings is the variability in how they’re interpreted by different people. The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22% of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings. ~ ACOG Refines Fetal Heart Rate Monitoring Guidelines, June 2009

Desirre Andrews, IC member and President of ICAN, shares Alexandra Orchard’s experiences spanning six years of trying to achieve a natural birth.   Again, as Alexandra and her family learned, it is not the VBAC itself that is to be feared but rather fear that the practitioner’s judgement, recommending surgical delivery in the first birth, will be called into question is what drives a practitioner’s loathe to attend a VBAC mother.

Last, the public itself is brought into the drama with irresponsible headlines such as this one from the New York Times blog, Refusing a C-Section, Losing Custody of a Baby.

Contrast Alexandra’s letter to her obstetrician (watch the video to the end!) to this scenario ripped from the headlines today over the mother who supposedly lost custody of her daughter solely because she refused a repeat cesarean.

Independent Childbirth supports the natural birth community through the use of quality and self-earned birth knowledge about natural childbirth.  Mothers are the birth experts.  We share normal birth and because we do, more mothers today recognize medical interventions are sometimes needed but they do not justify today’s rate of surgical deliveries, birth injuries and denying mothers of patient rights.  Let calmer heads prevail, that of a thinking mother (who isn’t?) choosing normal birth experienced practitioners who value a mother’s instincts.

**For more on “informed refusal” visit The Risk Management Handbook for Healthcare Professionals.  For more information on the New Jersey case visit Knitted in the Womb and VBAC Facts.

This is probably best read if you have something calming to do at the same time, say, while  Nursing Johnny Depp.  The oxytocin released from breastfeeding may calm you more than you’ll be fired up in our comparison of ‘medical birth for all’ issues and out of hospital birth debates today to the Vietnam era.

Can we ever be on the same team?

“Domino theory” is the phrase coined during Eisenhower’s presidency in the 1950s to justify the hastening entry of the U.S. into foreign nations in order to stop the spread of communism.  Swap out the players of Eisenhower’s era with the ‘natural childbirth’ era you’ll have an idea of how ACOG fights the legal battle to erode the protection of normal birth ~ if not home birth ~ as a right for all women living in the USA.  If just one state votes to protect home birth then neighboring states will and so on and so on.  Home birth will spread like wildfire and healthy birth outcomes for healthy women will be the norm.  Incredible.

Basically, with a normal birth experienced care provider you can expect that:

Women and babies laboring normally don’t typically fall like a line of dominos towards a cesarean, episiotomy, forceps or vacuum delivery.  It’s the interventions that push them over.  Remember the pit to distress order?  Start your birth un-naturally or make it un-natural at some point with pitocin and/or an epidural, you’ll arrive at a greater risk ratio for mechanical or surgical delivery.   The domino theory espouses there is no time to wait, each intervention must be applied now because of the one applied previously, until eventually the penultimate goal, birth, must occur now.

Natural childbirth is currently your best insurance against un-necessary interventions and insurance for a normal and healthy birth.  If, laboring at home or in an independent birth center you are transferred it is not likely to be an emergency scenario but a scenario where the need for medical observation is warranted.

Certified Nurse Midwives are on the rise as a result of increasing numbers of women seeking midwifery care.  Hospitals and OB practices that have midwives in their group “look better” to consumers.  In order to employ midwives without risk to their own profit however they must show midwifery care as the practice of medicine, which midwifery is not.  To these practitioners only such a person with medical training, in these instances nursing, is recognized as a ‘midwife’ then.  Is it a coincidence then that midwives find themselves engaged in an internal battle themselves?

The domino theory today is alive and well, hobbling maternal and newborn outcomes. Dominos don’t always fall, but ‘medical birth for all’ advocates will always try new set-ups. Stand up for birth.  Choose the integrity of midwifery care.  Deliver with both feet on the ground!

Many women choose a hospital for their first birth and talk about a home or birth center birth for the NEXT birth.  The slimmest thread firmly wound through a decades-long tapestry promoting hospital birth equates with a safe birth has effectively sewn up a veil of secrecy: home birth is not only safe, it is an inherited treasure.  A hospital birth for the normal, healthy woman (of which most of us are) denies a woman her birthright, to welcome her new family among family.  

I usually talk in my classes about how “this” is the *only* chance you’re going to get to birth *this* baby.  Sure you may go on to have other babies, but you only get *THIS* chance to birth *THIS* baby.  I also share with moms that because of this fact, the significance of this birth is infinitely greater than the significance of this birth is to your nurse, OB, midwife, etc. – Louise Delaney

So, what if our first birth is based on a myth: that hospital birth is ‘safer’?

I think there are some who choose to not deal with the reality that we tell them about, or choose not to believe that things can go so terribly awry iatrogenically because, after all, the doctors are only out to help us. When a traumatic birth does happen I think it is something of a shock for these folks. Many get angry. The survivors learn and grow from it – and these are the ones who become much more proactive the next time around, take control and do things differently “the next time.” ~ Melissa R. Bradley MethodTM Educator

OR what if our first birth is based on a friend’s outcome and not based on doing our own exploration and work for what we want?

My friend was due with her first child three months after I was due with my second. I emailed her a lot of documents from my birth classes, talked to her on the phone, bought her a few choice birth books etc. But whenever I tried to help her question some of what she told me about the midwives (medwives) that she was working with, she totally ignored me. We’ve talked about it since, and she basically told me – I knew your birth stories (two unmedicated, un-interfered with, empowering hospital births), and I figured, if you had a good hospital birth I could too. But she didn’t – I *gave* her a lot of information, which was a lot different that my own experience of taking Bradley classes and *seeking* the information I wanted/needed. For whatever reason, she had to have her own “before” birth & then learn/grow from it and have “the next time” happy, respectful, empowering birth (in a freestanding birth center, btw). ~ Christina @ Birthing Your Baby

It is a long, often solo journey a woman will take to find within herself evidence that the decision to birth at home is a good choice and that the burden to prove it is a good choice is not hers to bear.  It is the physician who holds the burden to prove his/her advice and protocol is the safe choice.  That is the crux of medical liability and is wholly relevant in the decision to choose a hospital birth.

In our society, women need to learn the hard way that fairy tales don’t happen, that no one can save you but yourself…and the people around birth should present their offerings (options) without judgement, for women to choose.  Women should be empowered and not controlled by birth professionals/facilities. ~ Randi King in Norman OK

The first birth is the pivotal birth. Every birth experience that follows builds on that one.  Our choices now are choices for the NEXT birth.  The first birth doesn’t have to be either perfect or awful and earth shattering to make us think. We don’t have to choose differently than the first birth; but it’s the first one that gives us a place to begin experiencing not just birth but ourselves as mothers, women, people. We may not all have ground shaking, earth thundering thoughts but we have them.  The experience belongs to us.  We choose what to do with it.  Choosing to do nothing different is still an influenced choice ~ made on that experience.  

Let’s say a woman has a fast hospital birth and rather than choose to just stay home next time she chooses to go early to the hospital, possibly scheduling an elective induction.  This scenario isn’t just welcomed by the state medical examining boards who have lobbied to ensure this is legal and protected under the audacity to call it an ‘option’ when in truth she has not been told home birth is a good option too!  How likely is she to find a physician today who would assure her that her fast labor is not something to fear and that perhaps she should consider a home birth?  That indeed he/she (the medical provider) may even have a home birth practitioner to refer her to?  

We do not foresee the medical world embracing the challenge to be more knowledgeable about normal birth.  The woman with the fast labors and whom the medical community embraces as having the ‘option’ of electing for a scheduled induction is more likely to end up with a cesarean even if she didn’t ‘plan on’ having one.  Then she will find herself in a battle to VBAC for her NEXT birth.  She  may not have the luxury of choosing differently for her NEXT birth.  

What will YOU do to have a first birth that leaves you with few regrets or changes for your NEXT birth?   Why not have the birth of your choosing, rooted in truth and your ability to know yourself and your baby now?

I know my cesarean was really indicated. short short cord, knotted, every time he would begin to descend his heart rate dropped a bit lower. Breech was the only way he wasn’t pulling on it (the surgeon explained this to me in minute detail since he knew my background) which explains why he stayed breech on and off for the last few weeks. I really wanted him to turn head down, and he complied (which fits his personality so far too! so cool… anyway… back to the story). But by complying with my need/desire for a head-down birth, he put himself in a position that pulled on the cord/knot. I saw the knot – I’d call it a double knot… one on top of another… He never did crash, and I never did establish a labor pattern. I just KNEW something was up. So I called in and had the surgery. That was a leap, for sure… to lay myself up on that table without a KNOWN reason. I just knew. Knew it all along really…So yeah. I trust the process more… I had a cesarean with my first baby – 15 years ago – and now again with my 5th – 3 VBACS in between. Seems I’ve come full circle in alot of ways. I trust moms more too – when someone says to me, “something doesn’t feel right” I will NEVER brush that off even for a second. Not even in my head. I don’t think I did it before, but for sure I won’t do it now.   But yeah… it wasn’t a failure, just… I still ***wish*** for my homebirth. Maybe someday.  ~ Kelly

The first birth is ‘herstory’.  It is a myth that women who seek a home birth are willfully putting themselves at risk. Women are fully capable of considering their options and choosing how to care for themselves.  It is not rational to say home birth is never safe; saying so is the product of hysteria.  Protecting choice, not limiting choice, is good, no, GREAT health care.  Tell a friend, tell your state government, tell the White House, the NEXT birth is now.

 

The more a midwife speaks to a mother and spends quality time with her, the more likely a mother is to open up and reveal more of her daily routines and habits that can affect her pregnancy and birth.  For example, the midwife will ask a mother the most basic yet critical questions like what is she eating and follow up with nutritional counseling, a topic in which the midwife owns expertise. She’ll ask her what is occurring in her life today, yesterday, expecting for tomorrow. A mother’s every day peace and stress contributes to her body’s sense of well-being and reaching the point where mother and her body believe it is time now to give birth safely and securely.

The psychology of labor is addressed during the med school L&D rotation by incorporating finding other resources for emotional and mental support.  Subsequently we have a number of practitioners in all fields lacking in bedside manner today, but in birth this aspect has an impact intangible to the practitioner but very real to the mother and her family.  The average obstetrical course of education includes fewer than three credit hours in understanding nutrition.  The focus on prenatal nutrition is only a small portion of the syllabus (do your homework choosing a careprovider!).  The home birth midwife also follows the mother into the immediate postpartum and continues home visits to see how mother and baby function as a unit.

It is the midwife who is better versed in delivering babies in various but normal birth situations.  A breech baby can be birthed safer in the hands of a midwife than a hospital attendant.  She has not let her skills fall behind because medico-legal liability has dictated a breech birth to be enough of a risk as to deem a cesarean to be the required course of action; therefore, she continues to hone both her observational and palpating skills.

The American College of Obstetricians and Gynecologists (ACOG), America’s leading organization promoting the benefits of clinical obstetrics in the sterile rooms of trained physicians, has found itself in a dilemma.  The technology and protocols ACOG promotes are the very ones that directly influence our birth statistics negatively.  The birth technology ACOG promotes to prevent or lower risks in birth for both mothers and their babies has not been proven to be beneficial, yet it is used profusely.  Birth in America rarely includes the intimacy of the act that culminated in procreation.  Images of an infant gently caught into its own mother’s arms are so rare that they cause the general public to question the safety of such an event. Debate for and against the licensing of midwifery – and the definition of midwifery itself – is gaining momentum, because statistics for hands off care of normal, natural childbirth are far better than those of managed birth.

In fact, Rebecca Watson of the New Mexico Department of Health has stated, “I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s.”

While home birth is stereotyped as dangerous because of the lack of medical supervision, it is the lack of that technology and medicine that actually makes birth at home safer than birth in a hospital under today’s protocols.

Studies have shown that once a technology is introduced and mandated, it is difficult to remove it from care practice despite being proven unsafe or unnecessary.  For instance, although the rates involving an episiotomy (cutting the perineum to create a larger opening for the baby to pass through) have dropped drastically since 1980, it is still a common practice.  Ironically, episiotomy rates today are justified as integral to the higher use of vacuum-assisted deliveries or unfounded fears that a baby is stuck because it is a large baby or presenting in a less than optimal position, (posteriors, for example, where a baby faces away from the mother’s back during labor).

America is one of the few nations where birth is managed more with technology than with the hands and eyes of the care provider, but other countries will soon catch up. In a country that boasts technology superior to other developed nations and is not known for undernourishing its citizens, our mothers and babies are faring no better at birth than underdeveloped nations such as Croatia. No improvements have been made in the maternal mortality rate in America since 1982, and  America’s infant mortality rate in the past two decades also has not improved. Our birth technology has increased and the number of routine prenatal screening tests have multiplied since the early 1960s, but our maternal and fetal outcomes have gone progressively backward.

“Despite a significant improvement in the U.S. maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that – essentially – no progress has been made in most U.S. states since 1982. Additionally, the U.S. Centers for Disease Control and Prevention has stated that most cases are probably preventable.” states C.T. Lang in a 2008 obstetrics and gynecology report.  Further, the Centers for Disease Control (CDC) reported in 1983 that the maternal mortality rate in the U.S. was 8.0 for every 100,000 live births (Monthly Vital Statistics Report).  In 1993, the rate was 12.0/100,000 live births (CDC).

Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure (World Health Organization) as well as those that are physician-caused including infection and hemorrhage.  Bacterium can be introduced first by the mother arriving in an environment where diseases are being treated as well as from infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. In addition, there are higher incidences of hemorrhage from forced delivery of the placenta as when a care provider intentionally pulls on an umbilical cord to tear the placenta away from the uterine wall of the mother’s womb. In all instances, normal birth evidence training of the professional birth attendant is critical.

Injuries and deaths related to the physician’s care range from the off-label use of medicine such as Cytotec (also known as Misoprostol) for the inducing of labor as well as the sanctified use of surgical delivery, which gives us embolism, one of the leading causes of maternal mortality and a risk directly associated with cesareans.  Cesarean rates for delivery rose by 46 percent from 1995 to 2006.

Women around the world, the time to look again at the image of women birthing with women versus a medical obstetrical group in normal birth is now. WE can improve global maternal and newborn birth outcomes and experiences. WE know birth. WE know women’s hopes and fears.  A new generation of birth wisdom and experiences is here!

Wishing you a truly happy Mother’s Day secure in the knowledge of your body’s innate wisdom!

Learn more about the wisdom of utilizing your best resource: an Independent Childbirth member led birth education class like Dorene Vaughn’s All Natural Baby!

Visit our comments section (this post) to find some of the most awesome birth wisdom posts our readers have found on the web and to add the ones you’ve found!

There are many variations on the only thesis available to opponents of home birth: What do the statistics say? Despite the enticement of a warm, peaceful and private birth that a home birth offers, the perceived importance of missing technology lingers like impending doom. In America, less than 1% of births takes place in homes. It is difficult for the other 99% of Americans to make the transition from technology as the benchmark for establishing worldwide leadership to the reality that the human body is designed to give birth and it has evolved to make many variations in labor and birth look so easy.

The Stockholm Birth Center Study followed one birth center’s outcomes over a ten-year period culminating in 2000 and comparing the outcomes to the associated hospital’s birth outcomes. The one strong observation in this study is the truism that many women will choose a birth center because of the perceived safety in having a hospital nearby. However, it is a mistake to conclude the birth center is free of institutional intervention. The study’s results are negated because of the influence of the obstetrical backup. Every woman who chose the birth center for her birth location was still subjected to the institutional care package. This is the most influential determinant in whether or not a woman is “risked out” of laboring and ultimately delivering in the birth center.

A birth center so closely associated with a hospital is not autonomous and must operate under strict supervision by institutional birth practitioners. The authors themselves state they did not study the effect of individual labor and delivery protocols, but rather the care documented in each case as a “package.” In addition, they have correctly remarked standards of maternity care do not exist, but they have again missed the mark on the importance of this statement. This is critical to interpreting the outcomes, because one solitary intervention can turn out to be the predictor of a birth outcome. For example, every care provider practices according to their comfort level; although every care provider will monitor a baby’s heart tones in labor, how the monitoring is done varies by care provider. Continuous electronic fetal monitoring (EFM) can range in definition from ten minutes hooked up to a monitor every hour on the hour to a handheld doppler check through a contraction every few hours to a telemetry unit (a girdlelike band outfitted to wirelessly transmit fetal monitoring data) that allows the mother walk more freely.

The ability to walk freely even under continuous monitoring allows the mother greater mobility for finding a position that increases her ability to cope with her contractions. Setting aside the U.S. Preventative Service’s Task Force’s findings and stance that continuous fetal monitoring provides no benefit at all – and the data showing that continuous EFM results in more cesareans – it can be argued that fetal monitoring that limits a mother’s mobility is therefore more likely to result in more intervention as the mother shows signs of distress and therefore the baby does as well.

The authors of the Stockholm Birth Center study argue that many other studies have reached conclusions similar to theirs. In the same publication we are offered a Cochrane Systematic Review of Home-Like versus Conventional Institutional Settings for Birth. Here the reviewers concluded births in home-like settings compared to purely hospital settings “provided only modest benefits including reduced medical interventions and increased maternal satisfaction.”

A hasty read of this data by institutional birth practitioners correctly supports their ingrained training that routine intervention is acceptable and “safe.” However, the paper actually clearly demonstrates that all births taking place in a hospital are going to meet up with interventions at some point during labor, and it is the overuse of technology that needs to be analyzed. Indeed that message is there somewhat cryptically as the authors instead hinder the possibility of improving on the scope of research by advising “caregivers and clients should be vigilant for signs of complications.” It is difficult for any woman who has given birth or who respects her body to hear such little value placed on the differences the studies do reveal, such as the “modest benefits” of “reduced medical interventions” and “increased maternal satisfaction.” Surely even one avoided episiotomy would be appreciated by the woman whose perineum would have been cut and would find several women healing from receiving an unnecessary episiotomy envious.

In 1998, a study of infant mortality in planned home births was conducted in Australia. Author Hilda Bastion reviewed these outcomes as neither hospital nor home births have defined what constitutes standard care. She reviewed both midwives and medical practitioners, registered and unregistered, minimal experience and heavy case load. Also included in the study were births that would be deemed risky by virtue of poor health in the mothers or other underlying health conditions. This is crucial to understanding the bias of many hospital birth proponents: It is not the intent of home birth advocates to claim home birth is best for everyone, but rather a viable option for low-risk and otherwise healthy women. The author goes so far as to note it is a disturbing trend that midwives may be encouraging and willing to take high-risk births because of the high number of low birth-weight infants counted in the statistics. In fact, it is quite possible that a woman who cannot afford good nutrition may also not be able to afford hospital birth care, and perhaps a midwife is her better choice than no care at all.

In general, birth care is divided into either purely institutional care or modified institutional care. No research exists on pure, spontaneous vaginal birth over an intact perineum without induction agents, drugs, surgery and instruments. What is available is mounds of research on what a mother or baby can “tolerate” in labor and what interventions have achieved an acceptable degree of risk. The acceptable degree of risk is not defined by an independent counsel but often influenced by the strongest or loudest lobbying effort, as witnessed by the American College of Obstetricians and Gynecologists’ (ACOG) August 2007 statement on the advance of midwifery options for consumers. ACOG’s bottom line is midwifery options must be controlled and home birth as an option must be eliminated. The average consumer misses the bias and conflict of interest: A rise in home births means a decrease in income for a field already plagued by the reality that there is no money to be made in natural childbirth.

In addition to a lack of studies of organic birth as defined above, there are no long-term, randomized longitudinal studies to confirm or deny the correlation of many interventions. For example, the impact of a mother’s drug use in labor on emotional bonding, breast-feeding, postpartum depression, later drug abuse (baby as a young adult), etc. In the 1970s, Doris Haire, the President of the American Foundation for Maternal and Child Health, said, “No drug has been proven safe and effective for use during pregnancy or childbirth.” Considering that 25% of drugs introduced in the market today are recalled or pulled off the market in 1 to 5 years, this statement has never been more true. Until such time that midwifery care can be studied with a critical but appreciative eye, we will find only the weakest of studies boxed in by outdated beliefs that American women cannot afford to birth outside of a medical institution. In fact, it is our country that cannot afford to NOT offer free standing birth centers as a birth care option for American women.

Works Cited
Bastian, Hilda, “Perinatal Death Associated with Planned Home Birth in Australia Population Based Study”: BMJ 1998; 317: 384-8

Hodnett, E.D and S. Downe and N. Edwards and D. Walsh, “Selected Cochrane Systematic Reviews: Home-like versus Conventional Institutional Settings for Birth”; BIRTH Issue 32:2; June 2005

Waldenstrom, Ulla and Charlotta Grunewald, “The Safety of Birth Centers Responses to a
Critique of the Stockholm Birth Center Study”; BIRTH Issue 32:2; June 2005

Stay tuned for our upcoming International Birth Wisdom week!  

FLEX (Spain) currently airs this ad campaign for their mattresses.  A lovely homebirth on a FLEX mattress because where you sleep, your home, is the most important place in the world.  The place that welcomes a new life into this world is a special place and the memory lingers there!

Our thanks to Birth Activist for one of many birth community members to find this ad!

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