Friday, 1 March 2013

Having a Home Birth Doesn't Mean I'm Brave

Three years ago this weekend we welcomed our third daughter at home, with midwives and a doula. This was how I had always dreamed about giving birth, and the experience lived up to everything I wanted it to be. It was beautiful, magical and perfect.

When I tell people I had a home birth, often their first reaction is, "Wow, you're brave!" Or they may say, "I would be worried about an emergency. What if something goes wrong?" So maybe they aren't saying I was brave, but that I was reckless for endangering my baby's health, or my own.

I don't believe that I am either brave or reckless. I did research into home births, becoming informed about evidence based birth practices, and I asked my midwife many questions. Like most people, I wanted to know about the "what ifs"; what if there is excessive bleeding; what if the baby is in distress; what if I have to transfer to a hospital? In reality I wanted to know the answers to these questions to tell other people, because we are conditioned to see birth as a possible crisis situation. Midwives are trained in dealing with most situations and I was convinced that this was the birth option for me. I had two prior hospital births with an obstetrician and I had already made up my mind about I wanted.

After two prior miscarriages, the second being a second trimester miscarriage, it was discovered that I had antiphospholipid antibody syndrome (APS). In a nutshell my body was creating antibodies that were attacking cells in my blood vessels, forming blood clots and resulting in miscarriages. All I had to do was give myself subcutaneous heparin (blood thinner) injections twice a day and my chances of carrying a healthy baby to term were greatly improved. However, I was told that I was now officially high risk, needing close monitoring by an obstetrician and hematologist to ensure that my pregnancy was safe. No midwife for me. 
I love this stand up by Jim Gaffigan: "We were going to have a home birth, 
but we wanted our baby to live...There was also a midwife there, 
because we believe in witchcraft." Too funny!

To say I was terrified when I became pregnant again is a gross understatement. I was afraid I would lose another baby, and I wasn't sure I could go through that again. I was willing to do anything my obstetrician told me. I had multiple ultrasounds throughout the pregnancy, weekly non-stress tests in the last weeks of my pregnancy, charting the baby's movements several times a day and going immediately into the hospital if I did not detect movement. I was overly anxious about everything because everything was being monitored and charted. 

In my third trimester my obstetrician (who I loved) sent me to the anesthesiologist for a consultation, "just in case" I needed an emergency cesarean section. The anesthesiologist wore a button that read, "Every woman should have a pain free birth" and spent most of the appointment trying to convince me I should willingly sign up for a c-section. I added a new fear to my list - that of an unwanted, unnecessary c-section. This fear increased when I was told that due to my high risk I would need to be induced if I did not go into labour on or before my due date. I was beginning to feel like a c-section was inevitable, because c-sections often result from "failure to progress", which should really should be seen as "failure to wait". I even asked at the breast feeding class I went to about any complications with breast feeding after a c-section.

My induction had a happy ending (healthy baby), despite taking three days to initiate. It could have gone very differently, as this link demonstrates. I attribute the positive outcome to having a wonderful doula, Jacquie, to advocate for me. What I did not appreciate was the constant fetal monitoring, alterting the staff to minute changes which did not increase my chances of a positive outcome. In some cases this has led to interventions that were unnecessary because of perceived distress. This constant monitoring meant that I could not move around and find more comfortable positions because the band would not stay in place. I don't know if I could have laboured in alternate positions, but I do remember being asked to get up on the bed when it was time to push, and I do not like this position for birth at all. I also had an IV for the induction drugs and fluids, which remained on my hand for hours after birth. I remember a whole team of people I had never met before coming in at the end, and I remember lots of beeps and noises that are typical in a hospital. Not the most calming of situations. I have nothing but positive things to say about the labour and delivery nurses at the hospital however; they were thoughtful and gentle, which isn't surprising as some of them were trained midwives from Britain.

After my beautiful first daughter was born we entered the recovery ward. My daughter was developing jaundice and the postnatal nurses kept pressuring me to feed her more so her jaundice would clear up. They grabbed my breasts and tweaked my nipples in an attempt to show me what to do. They repeatedly asked me to try the football hold to help my daughter have a good latch and I tried to tell them that this was a very uncomfortable position for me. When I tried to latch in a way that felt comfortable they said I would cause damage to breast tissue and I shouldn't do it (this ended up being the only way that worked for me for all three daughters). I do not blame the nurses for my breastfeeding problems, but they certainly made me doubt anything that seemed to feel right, and new mothers do not need more self-doubt than they already place upon themselves. We stayed in hospital for two days and I could not wait to get home to my own bed and to my own home where I could make mistakes and figure things out without someone watching me and correcting me. 

My experience in hospital with my second daughter was similar to my first, even though her birth was very different. It was a spontaneous birth two days before her estimated due date, which made me very happy because I was scheduled for another induction. It was also very quick; she was born a little over thirty minutes after arriving at the hospital, and a little over an hour after active labour started. The drive to the hospital was hellishly painful and I never wanted to go through that  again. At least this time my obstetrician was present for my baby's birth because he was working at the hospital that weekend. My new baby was immediately separated from me because she was blue after being born with the cord around her neck. Once again I credit my doula, Jacquie, for guiding us through this experience and assuring us every step of the way.

I thought I would be more confident because I had been through this before but once again I had nurses insisting on charting every poop, pee and breast feeding session because she was jaundiced (as was my first) making me obsessed, which I am good at all on my own. At home my husband even created a spread sheet for me to record everything, including daily weight gain because of concerns. And once again I had people grabbing my breasts, tweaking my nipples and telling me which position to feed my baby, despite what I was telling them. In some ways the second time around was worse than the first because I expected it to be different.

I did not think that having a midwife as a care provider for my third pregnancy was possible, but after talking with my doula, Jacquie, I approached Jane at South Delta Midwifery and she felt that it would work, despite what I had been told in the past. We began discussing birth options and when I shared that I had always dreamed about a home birth, she reassured me that this was an option. I was thrilled! I appreciated how she presented prenatal care options in an unbiased way and answered all my questions so that I could make an informed choice, rather than being told to go for this test or to have that done. I went to an obstetrician for a consultation due to my risk factors and the obstetrician was agast that I was considering a home birth. In her mind this was the most irresponsible thing I could do. Doubt began creeping into my mind. But when I asked her if she was completely against home births in general or just in my case, she confirmed that she thought home births were unsafe because of all the things that "could" go wrong; I felt even more clear in my resolve to have a home birth.
Life, it's worth screaming about!

Words cannot describe how I feel about my home birth. The midwives did not do one vaginal exam (I remember multiple exams in my other births and they were excruciating). They did not do constant fetal monitoring; just every so often after a contraction. The lights were low and my husband put on all my favourite calming music (a playlist he lovingly created for me). My older daughters slept upstairs while I laboured downstairs in the living room. I reclined on the couch, I walked down the hall, I kneeled on the floor and leaned against my couch. No one told me what to do; they trusted me and let me go into my cave and follow my instincts. Everyone spoke in hushed voices so that my focus was not pulled out of my cave.
                                             
My husband woke up my oldest daughter, five and a half at the time, to come downstairs to witness the birth of her baby sister (we did months of preparation, reading, talking, going to midwife appointments). Shortly after her sister was born we woke up my middle daughter, who was three, to meet her baby sister, making it a wonderful family experience. 
The student midwife weighing my baby in my bedroom.

My new daughter did not leave my arms for some time after her birth; in fact not until we had lots of skin-to-skin time, we initiated breast feeding (letting her do some initial breast crawl close to my breast), I was checked and I went up for an amazing shower in my own bathroom. I remember wondering in the shower how much she weighed because they had not done that yet. I believe that all of these factors are directly related to the lack of breast feeding issues I had the third time around. 

My five year old wanted to stay home from school the day our baby was born so 
we declared a pyjama day and snuggled in bed with the newest addition all morning.

Another benefit of a home birth was it allowed us to bond as a new family of five immediately. I remember after my second daughter was born my oldest was very emotionally fragile when we came home from the hospital and although she was beyond thrilled to have a baby sister, she was trying to figure out how she fit in all of it. This time both older girls were part of the process. I believe that their adjustment went smoothly because of a home birth.

I had a home birth because I was scared. I did not want to risk another possible induction that could end in cascading interventions. I did not want to repeat the experiences I had with my hospital births. I had no birth trauma and good memories of my births but I did not enjoy my experiences after my babies were born. I get upset when people say, "all that matters is a healthy baby." Of course mothers want a healthy baby! But we also want to have a birth that makes us feel safe and that allows our bodies to do what they need to do, that trusts our bodies to do what women have been doing for centuries. We are not sick and birth is usually not an emergency situation so we need to stop seeing it that way, talking about it that way and treating it that way. Interventions in a hospital setting are life-saving when needed and thank goodness we have them so that we have positive birth outcomes when the mother's or baby's health is at risk. But to treat every birth as if it could end in this is not right and does not follow best practices. In fact, it may be a reason for the high cesarean rate, which is 29% at the hospital where I gave birth; the WHO recommends a c-section rate of no more than 15%.
In my own bed ready to get a few minutes sleep before my 
daughters came in and begged to hold their new sister.

So having a home birth doesn't mean I'm brave. It means I wanted a safe birth that honoured the natural process of birthing. 

9 comments:

  1. I love your birth story.
    After having Sarah in at the hospital with an OB/GYN, I was convinced I wanted a midwife. I wanted to have a med free birth where pain was accepted and celebrated rather than feared. I got everything I wanted and Jane and her student at the time, Yarra supported me every step of the way.

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    1. Thanks Lisa. Wow, you had Jane as your midwife? Small world. :-)

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  2. So happy for you and your healthy birth! I think it is so important for the mama to feel comfortable and safe, wherever that may be. Also important to be well-informed, of course. For my third birth, I personally opted for very mama-friendly midwives in a very mama-friendly hospital b/c that's what I felt most comfortable with.

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    1. I agree, the most important thing is for the mama to be informed and feel safe and supported, no matter what choice she makes.

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  3. Hi, every day I visit a number of blog sites but I'm very happy to read your post Thanks for sharing the informative blog post about Prenatal Pregnancy NH .

    ReplyDelete