Choosing a Home Birth
Thank you to Milon Nagi, member of Choices in Childbirth’s volunteer Program Committee, who writes about last month’s free Healthy Birth Workshop. The next workshop Comfort Measures/Coping Mechanisms is Thursday, February 16th. Click here to register.
“There was Ricki Lake, up on the screen. Naked!” Erin’s first encounter with the documentary The Business of Being Born took place as she walked into her sister’s living room. It was the start of a series of events which changed the course of her pregnancy. Erin joined new moms Dina and Grace, doula Elanna Posner, and home birth midwife Cara Muhlhahn to speak to an audience of expectant parents at January’s CiC Healthy Birth Workshop on Choosing a Home Birth.
For Erin, the journey towards home birth began when her sister encouraged her to sign up for Bradley Childbirth Education classes. The more she and her partner learned, the more they wished for a “blissful natural birth”. But they didn’t feel their OB was supportive. “Our first baby wasn’t even here yet”, she notes, “and it felt like he was going to miss out on the birth he deserved”. They had thought about having a home birth with a future baby. 30 weeks pregnant, Erin found a home birth midwife. She went on to give birth to her son in water in her own home with just her husband, doula and midwife present. “It was everything we wanted for our baby and so much more”.
Dina’s first baby was born in a hospital. “His birth was the main reason – the only reason – I had a home birth”, she says. She had wanted to give birth naturally, but alarm bells rang when her OB reacted to the suggestion of a birth plan by telling her not to bother as she’d be setting herself up for disappointment. She ended up receiving a cascade of unwanted interventions, including having her waters broken and an episiotomy, both without her prior knowledge or consent, and being separated from her baby for several days
By the time she was pregnant again, Dina had done more research and spoken with friends who had given birth at home. She knew she did not want to be separated from her baby and felt staying home was the best way to achieve the birth she wanted. One winter morning, she woke and told her husband, Paul, “I think we’re going to have a baby today”. As labor became more intense, she started to feel a sense of panic and loss of control which she remembered from her first labor. That time, she had responded by going to a hospital. This time, she called her doula. Her doula was able to come over and reassure her that labor was going just as it should.
Not long after, says Dina, “my body started to push”. This sensation took her by surprise – at her first birth the staff had questioned her ability to push. She hadn’t known her body could do that all by itself. She reached inside and felt her baby’s head. It was time to call the midwife. As Dina labored in the shower, rocking on all fours and “growling like crazy”, their older son woke and Paul and their doula took turns hanging out with him. Dina remembers hearing her midwife laugh when her baby began to cry before he was even quite out. Her second son was born into his father’s hands, while his big brother watched a movie in the next room with their doula.
Many of the expectant parents at January’s workshop were already planning home births, which made for an especially open and candid discussion. Some of the key questions on their minds centered around what may happen if things do not quite go according to plan. How do we ensure safety and what happens if we need a hospital transfer? Is there enough time to get to the hospital?
A small percentage of NYC home birth midwives’ clients transfer to hospitals. In reality, emergency transfers are rare. If one is needed, you will go to the closest hospital – which in New York City will likely not be far. Home birth midwives bring with them equipment such as oxygen and IVs to deal with most situations which may arise during a birth. They are also very good at identifying which moms and babies do need to move to a hospital, and ensuring that this happens in good time during labor.
For Grace, transferring to a hospital meant taking an hour’s drive into New Jersey, to a hospital-based midwifery practice which her home birth midwife especially recommended. While a long car ride in labor was not what she had hoped for, she had labored at home with her husband, David, and doula for over 30 hours but her baby remained high in her pelvis. She and her midwife felt an epidural may give her some rest and help labor move along. A doula herself, she was also concerned that hospitals closer to her home may be quick to move to cesarean section, especially given she was at 42 weeks, despite the fact that both she and her baby were doing fine. On arrival, she received an epidural and, on her new midwife’s suggestion, began pitocin. After many more hours, however, her baby was still not descending. By now Grace had been in labor for almost two days and, concerned about the potential effects on the baby of continued exposure to the drugs, she and her midwife made a decision.
“We had a cesarean”, says Grace. “And it was an amazing experience”. Grace’s midwife, doula and husband were with her in the OR as she gave birth to her beautiful daughter. Her doula massaged her head while her husband went with their newborn baby. She had never felt pressured into the decision to have surgery and, in addition, many aspects of her and her husband’s original birth plan were respected. They were able to keep their placenta for encapsulation. They had planned to delay cord clamping and, while this was not possible due to the surgery, the doctor did squeeze as much blood as possible from the cord into their baby before it was cut. David was able to announce their baby’s gender when she was born. And Grace was able to begin nursing within her baby’s first hour.
As Cara Muhlhahn noted, a woman’s level of satisfaction with her birth experience can vary according to whether or not she feels she had a chance to labor in the way she wished or felt railroaded into decisions. Whether with an OB, midwife or family doctor, at a hospital, birth center or at home, if we are treated with respect and our wishes honored as we labor, our birth experience becomes a different animal. But in order to do that, we first need to know what our wishes are. Read and learn about birth to figure out what you want for yourself and your baby, then interview potential care providers closely to find out whether their philosophy on birth is a good match for yours. Grace, for example, knew that her own comfort level was to labor for a maximum of around two days and she took care to find a home birth midwife whose approach matched her own needs. Wherever and with whomever we birth, the best thing we can do for ourselves and for our babies is to make educated decisions about which options are the right ones for us.