Why I chose homebirth (Part 3)

 

Here’s part three of why my husband and I have elected for me to birth our babies at home. If you’re new to this “series,” please catch up with part one of “Why I choose homebirth” and part two here. And as a refresher, please re-read the section in the first post about how I don’t care how you birth your baby. It’s really important.

Well, the clock has changed and we’re no longer counting the days until our baby’s due date, but the days since the due date. My last two babies came quite a bit early (9-10 days), so this recent development has required some attitude adjustments on my part. It’s difficult to not feel entitled to give birth on my schedule. And waiting is just hard, but one of the main tenants (if you can call it that) of home birth is that my body was created to give birth and it most likely will if I just chill and let it do it’s thing. Like my midwife always says, “She’s not going to go to kindergarten in there.”

So, now we wait and manage others expectations. Sunday tends to be a bit exhausting with all the, “You’re still pregnant?” and “When is your doctor going to induce?” as I waddle around church . Of course, the people asking me these questions are just so excited to meet this sweet baby and they all want me to not be uncomfortable. And every single person is incredibly supportive of my birthing at home once they find out. But I am tempted to just camp out at home to avoid explaining that “No, I’m not worried. She’ll emerge from the deeps eventually.”

And while I don’t feel like pregnancy will ever come to an end, I know it will. It has to, right?
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At the end of my last post, I asked for questions you’d like me to answer about homebirth. Please understand that as I answer these questions, I am speaking  from my own experience and expressing my own opinion. I am in NO way attempting to speak for the entire homebirth community or other homebirthing mothers. Take it all with a small grain of salt.

Are you concerned with “something going wrong”?

Yes and no. I understand the risks of both giving birth at home and in a hospital. When you’re at home, you don’t have immediate access to the drugs, some more sophisticated equipment and a surgical team to deal with an unforeseeable emergency.

In a hospital, the access to intervention methods is what often leads to “something going wrong.” Induction is incredibly painful (much worse than actual labor pains) which understandably leads to an epidural (remember, hook a sista up?) which often leads to complications in labor and the baby’s vitals which can lead to a cesarean and other emergency situations. Since medicated intervention is not possible at home and a woman’s body is allowed to labor naturally, many scary situations are avoided altogether.

The key to managing risk (at least in my book) is to find a midwife who is comfortable and confident in transferring her clients either to an OB’s care (before labor) or to a hospital (during labor). She has to be willing to transfer care the moment a woman or a labor moves even an inch from the low-risk category.

My midwife has made it clear from the very beginning that she will not provide care for a woman who exhibits a risk she is not trained or experienced to handle. She has a working relationship with a local children’s hospital and other area hospitals. I know that if something goes even slightly funky, we will be in the car on our way to the hospital before the situation even becomes “an emergency.”

Since my midwife is with me throughout active labor (or as early as I call her and tell her to come over) monitoring the baby and me, she is able to identify most problems well before they become emergencies.

Are emergencies planned for?

Absolutely. My midwife has a transport plan and we figure out the closest hospitals to my home before the birth. Midwives are fully trained in neo-natal resuscitation and carry various resuscitation equipment to the birth. In fact, my midwife was bragging just a few weeks ago about how good she is at infant resuscitation. When it comes to the ability to help babies breath, a bit of cocky is very reassuring.

Midwives also are trained and equipped to handle most post-birth emergencies, including hemorrhaging (they can administer petocin after birth). They know how to suture tears (not an emergency situation, but a helpful skill to have).

Again, because there is no medical intervention involved in homebirth, there are rarely complications that an experienced, trained midwife cannot handle herself at home.

What about a birthing center?

I was considering giving birth in a birthing center during my first pregnancy until one of my initial midwife interviews. I asked the midwife, who was also a naturopath, what was the difference between a homebirth and a birthing center birth. I was surprised to find that there was no difference in safety — everything a birthing center had to deal with emergencies, midwives carry with them to a homebirth. She gave three reasons a woman might consider a birthing center over a homebirth:

1. The mother lived too far away from a hospital and needed to give birth closer to it in case of a transfer.
2. The mother’s living situation was undesirable or unsafe for homebirth.
3. I can’t remember the last one (whoops).

After hearing the three reasons, I realized that a birthing center birth was only going to cost me a bunch more money (like thousands more) with no real added benefit and I opted to stay at home.

I realize that there are different types and levels of “birthing centers” but I believe my analysis above is true for birthing centers in Oregon. I am not talking about a center attached and directly affiliated with a hospital. I’m speaking of the centers where a woman basically has a “homebirth” outside her home. I’d much rather save the money and not have to travel before and after birth.

How do you find a midwife?

With our first baby, I looked online for midwifery practices in the area and then interviewed three. I had a list of questions that I asked each one and then just left some time for us to chat. All midwives expect to be interviewed and they do not charge for the appointment.

One of my primary questions was what their episiotomy rates were, which is hilarious thinking about it now. Midwifery is all about avoiding scissors and other interventions. If you have a homebirth, you probably have a .0001% chance of getting the snip and if you do, someone’s life depended on it.

If I were interviewing now, I would ask questions like:

• How long have you been in practice? How many births do you take per month? Who else will attend my birth?
• How often do you transport during labor? Tell me about your last 3 transports. The story and the re-telling of the story will be a good indication of how open the midwife is to going to a hospital and in what case she will do so.
• Do you have relationships with certain hospitals or doctors?
• If we have to transport, how will your role change during my labor? Will you be there until the end? I’ve heard that some midwives drop their clients at the door. I believe a good midwife stays with you until you no longer need her (usually after the hospital birth). My husband fully understands that if I’m transferred, my midwife gets pole position :).
• Tell me about some emergency situations and how you handled it. I want to know if the midwife has encountered a shoulder dystocia, hemorrhaging and a baby needing resuscitation. If she hasn’t personally dealt with these situations several times, she’s not ready to be my midwife quite yet.
• Who will be at my birth? When does the primary (lead) midwife show up?
• Explain the post-natal care I will receive. Who will provide breastfeeding help?

What does your family (other kids) do while you are in labor? Are they around, and if so, how do they respond?

I’ve had 3 sibling births. The first two were during the middle of the night, so my other kids just slept and woke up to a new brother. The last one was in the evening after dinner. My mother-in-law came over and dealt with the kids while we were setting up the birthing tub and I was in active labor. My daughter, who was 5.5 at the time, was in the room at the end of the birth and sat with her Nana and watched. She handled it well and I did manage a bit of my noise for her benefit. My first pushing contraction surprised me and I started yelling a bit. I quickly realized that I needed to figure out a different sound for her benefit and also because higher pitched sounds don’t help you push well.

This time around, my older two kids (6 and 8) both want to be at the birth. If it’s at night, we’ll just let the younger two sleep. If it’s during the day, I suppose they will just wander about and play with their Nana and Daddy or we might decide to ship them off to a friend’s or an aunt’s house. We’ll play that one by ear. If my youngest was much younger, I would definitely come up with a concrete plan as toddlers generally do not do well at births.

I’ve talked a bit with my older kids about how I will act during birth and what to expect, but honestly, I’m pretty nice and in control during my births, so I’m not worried about them being scared. I certainly would think twice about having them in the room if their Nana wasn’t going to be there to sit with them.

The contents of my birth kit, which is ordered from a company in the Portland area.

Who feeds your family that day, and the next? Do you cook? Does your husband? Do people bring you meals?

I try to have some food on hand, but I pretty much depend on my husband’s family and friends to bring something over. I do get Pizza Hut after all my births (’cause I’m trashy like that), so everyone can join in the fun. If I didn’t have people just waiting to bring us food, I would probably make more of a plan. My husband is totally capable of coming up with food for everyone, but I realize that is not realistic for all husbands :).

Tell me more about waterbirth.

Ah, waterbirth. It’s truly lovely (okay, total exaggeration. Birth is not lovely.). I have been able to give birth to all four of my kids in the birthing tub. It really helps with pain management, getting into good positions for pushing and dealing with the post-birth messy stuff.

My husband sets up the birthing tub in our bedroom (we sometimes have to rearrange furniture a bit) once I hit active labor. We use a new, potable hose to fill it with hot water and I get in when my midwives tell me to — usually when I’m dilated to 7-8 centimeters. You don’t want to get in too early in case the water ends up slowing your labor down, which is possible.

I stay in the tub for pushing as well as the baby coming out. The best birth was my third, Nathan. His head popped out and then the contraction ended before I could push out his shoulders, so his head was just hanging out for awhile. Actually a long while as my body decided that it was going to give me a big break. My husband said he watched Nate just move his head, looking around in the water. With the next contraction, I pushed the rest of him out.

You typically stay in the tub until you birth the placenta. Once everything is out, I hop in the shower to rinse off and get in bed. The midwives eventually drain the tub into the toilet with an electric pump.

What about the mess?

Again, one of the major benefits of a waterbirth, at least in my book, is that lack of mess. Most of it ends up in the toilet with the tub water.

This is where all the birthing supplies are stored right now. Top are all the towels and washcloths. Middle are the baby’s clothes. Bottom are the supplies.

The rest of the “stuff” is handled with the items in your birth kit, which include chux pads and various other absorbent items. You also provide a bunch of towels, washcloths and receiving blankets that are washed afterwards by the midwives. You can also purchase a mattress cover for your bed — you put the fitted sheet that you want to recover on on the bottom, cover with  the plastic pad, then cover with a fitted sheet that you can labor on (and will most likely be thrown away). After the birth, the midwives just strip the top sheet and the plastic and you have a clean sheet to rest on.

Most of the supplies — note the Depends Undergarments in the back. I am serious, Depends are the best post-birth item. You don’t have to worry about getting your underwear ruined or getting the pads to fit correctly. Just Depends it for a week or so (plus you can pee your pants if you need to).

We cover the floor under the birthing tub and then the path to the bathroom with painter’s plastic from The Home Depot to protect against stains and water. After the birth, the midwives just throw it away with everything else.

The midwives deal with the placenta disposal once they’ve inspected it. You, of course, can keep it if you want. I’m not a big collector of body organs, so I let my midwife take it.

If you’re looking for postpartum help at home, consider hiring a postpartum doula. I’ve heard great things about ABC Doula in the Portland area.

How does one prepare for a medication-free birth?

I think the first thing you must do is just come to terms that it is going to suck, but that you have the ability to do it. Women who give birth without medication are not super human or heroic or especially brave. We are simply regular women who have decided that the benefits of a non-medicated birth outweigh the physical pain during labor she is going to endure. We are also convinced that we were created to give birth (relax, we were created for other things as well) and it will most likely work the way God intended.

Next, get as much knowledge about how birth naturally progresses as possible. Watch videos, read books and talk to women who have experienced a non-medicated birth. Be warned that many videos have women birthing without shirts on, so preview them before you show them to the entire family if you’re concerned (for the record, I don’t care how you birth, but that doesn’t mean my husband needs to see a random woman’s breasts hanging out).

Take a birthing class that is all about natural birth. We took a Birthing from Within class (I think) — it was a bit, well, fruity, but it did give me several pain management techniques. You’ll also watch videos during most classes. And draw pictures (the fruity part…).

Last, get prepared to follow your midwife or care provider’s lead. That’s the best part of a homebirth — you’re most likely laboring with one person the entire time (no nurse shift changes) and that person is an expert at helping women labor naturally and all of her attention is on you. She will know when to encourage you, when to challenge you and when to keep quiet. My midwife knows that when I say, “I don’t know what to do” that I’m probably in transition. I just do what she says to do and she magically manages my whining and whimpiness when it arises.

My husband and I are very realistic about his role during my labor and birth. I love him dearly and want him there, but let’s be honest, men don’t know anything about birthin’. I think it’s unfair to expect them to do or be something other than a spectator, hand-holder and leg holder. I love that my midwife is in charge of everything. It takes the pressure off my husband to be something that he is not prepared to be. We believe this is one of the major benefits of a homebirth.

Just for fun, you can read my short post from 2009 when I gave birth to our fourth baby, Matthew.

I think I covered most of the questions. Feel free to ask more in the comments below!

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