Thoughts on homebirth

A local dramaversy is unfolding surrounding a baby's death during a homebirth gone wrong. According to the WashingtonPost, a 43-year-old woman wanted to deliver the family’s first baby at home. She sought out an Alexandria, Va., midwife practice, BirthCare & Women’s HealthCertified Nurse-Midwives. But there was a complication; the baby was in the breech position, meaning that it was upside-down rather than having its head closest to the birth canal. BirthCare advised the mother that the case was too complicated for a home delivery, but she preferred to deliver at home. So she sought out a midwife with a reputation for experience with difficult deliveries. The outcome was tragic.

The discussion about the incident, and homebirth in general, has gotten a bit out of hand, though, as seen on the DC Urban Moms (DCUM) website thread.

I had a homebirth myself, with a midwife from BirthCare, a certified nurse midwife (CNM), and my Bradley birth class teacher is the birth assistant, allegedly connected with the case. While I feel sorry for the woman who lost her baby and I can't comment on the qualifications of the indicted midwife or the details of the case (since I was not there), I will say that, reading many of the comments on the DCUM thread, and comments on a post from the notoriously psycho Dr. Amy on the recent homebirth of The Feminist Breeder's new baby, pisses me off a tad bit.

The attitude that a healthy woman with a normal pregnancy having a homebirth is somehow reckless or selfish or in any way worthy of reproach is ridiculous. Sadly, the woman in the Alexandria case who lost her baby was risked out by moderate—some would argue conservative—homebirth midwives (who also practice in their own birth center and have hospital privileges at RNs) because of her age AND the position of the baby (and possibly other undisclosed factors).

So, in thinking through what I had to say about this all NOW—as someone who's had a homebirth safely and found it very empowering, but is cautious in recommending it wholesale to others because I really do think it takes a certain kind of mindset/personal makeup to do it—I came across something I'd written when I was pregnant that addresses why I made the choice I did.

Misunderstandings about birth

This is from the Boston Globe last summer. I stumbled upon it tonight while looking for stats on what percentage of women give birth naturally…

The author completely ignores any data on how interventions beget more interventions and thinks that women who choose natural childbirth do so as some rite of passage in which pain ushers them into some quasi-religious experience.

“It’s an interesting secular variation on a religious narrative where unbearable pain suddenly transmutes to boundless joy – just as it is believed that the brutal crucifixion of Christ led to the opening of heaven’s gates, or, for that matter, just as men blowing themselves to bits with suicide bombs think they will immediately appear in a paradise of virgins,” he writes.

He later says, “If anything, reliance on pain to create meaning during childbirth indicates a constricted imagination. Surely there must be more innovative challenges than voluntarily refusing effective, safe, and available pain relief during labor. ”

For me, I am choosing natural childbirth not because I need to feel pain to create meaning during childbirth, but because I believe that giving birth is a natural body function and that my body was designed to do it–so why should it be treated as an illness? Additionally, I believe that each medical intervention one accepts opens the door to another and another, and that can snowball to a situation where it’s not about the mother and baby but about hospital protocols and schedules. Furthermore, I’m not convinced that I will feel this pain that’s often described because I’ve read about and heard from other women who say differently.

He is completely closed to the idea that it is possible not to feel pain, as is explained in Grantly Dick-Read’s books and the HypnoBirthing book, or that the pain may not be “unbearable” but manageable with the proper preparation. What’s more, he quotes Sylvia Plath, using her description of labor as an illustration. For those who don’t know, she was NOT a healthy, well-adjusted woman!

Anyway, I’d be curious to hear other women’s reasons for choosing natural childbirth…and whether one-sided articles (the Ina May quotes notwithstanding) piss them off too.

I was much less rambly then, I guess! Need to work back toward that...

People who "hate" just don't get it, and I imagine no amount of going on is going to change their view. I guess this can be a lesson for me that might be applied to other matters I used to want to argue with people about online.

My baby's birth story

For those interested, to go with an upcoming post on homebirth...this is now old news, but worth reading for those with an interest in natural birth.

I count labor as starting at about 5:00 am on Friday morning, since that's when I was awake for good and able to really identify and time contractions, but in my mind, it all started with a little pop around 12:15 am Friday when my water broke, since I knew then that labor would need to begin within a certain amount of time.

I decided to clean up, sleep it off and call the midwives' practice, BirthCare, and my birth assistant, later in the morning since there was no sign of meconium in the water, the baby was moving and I was experiencing only a little abdominal achiness and very light cramps. (I was told later I should have called them right away...so any future mamas out there, do that!)

The midwife on call, advised me to take castor oil to help labor along and get me going within the 24-hour limit I'd have to give birth after the water breaking. We walked over to some nearby shops to restock on just a few groceries (fresh fruit!) and the castor oil. I took it at 8:30 am and its work began, slowly, behind the scenes. We hung out around the house for a bit and got a feel for how the contractions were going. They were coming about 7 minutes apart, lasting less than a minute, for some time, and quite manageable.

We went for another short walk around the neighborhood for about 30 minutes. I remember saying to my husband that I could handle contractions, like, ten times worse than what I was having at that time (little did I know what was coming).

After getting back home, we wanted to have some lunch before 12:30 pm, when we were supposed to call back the midwives and birth assistant. By now, the contractions were becoming a little more intense so that I ate most of my lunch but had to stop before eating it all. When I called in, I was told that the midwife at BirthCare with whom I'd developed a special connection, agreed to take over with my birth that day. That was great news, so I checked in with her and she advised a nap to be well-rested for what laid ahead.

The nap didn't pan out so great. I sleep a little, on and off for about an hour, as the contractions started to come a little more quickly and intensely. By this time, they were coming five minutes apart and lasting a good 70 seconds. I had to stand up and sway my hips, or bend over and hug a pillow, moaning in a low tone, in order to handle the contractions. I tried my best to rest in between them. My husband was coaching me through it all, at first comforting me with gentle, relaxing touches between contractions—we tried a little back massaging during them, but that wasn't working for me. Really, just him being there and being engaged in the labor with me was good, with me knowing I could call upon him as needed. He also helped by bringing me water, and making calls to the midwife and birth assistant when I couldn't deal with talking to anyone anymore. I managed to snack just a little from time to time for energy between contractions, even as they were getting tougher.

It's difficult to describe what the contractions felt like. Some women say they're not painful, but just a discomfort. I would say they were painful, but a productive pain. My understanding of what the uterine muscles were doing with each contraction helped me deal with how it felt.

I started to get a little concerned about the birth being imminent because I really had no idea how long it could go or how bad it could get, and it had gotten pretty intense by now. I was starting to feel alot more pressure with the contractions. I threw up once, and I was going from hot to cold and back, which I had heard were signs of transition, and though I wasn't thinking "I can't do this" (another sign of transition) I sure was thinking, "I don't want to do this...why did I choose to do this this way, with no medication..." so I thought I was reaching my limit. I was so wrong. I'm not really sure when transition was, officially.

Eventually, after a few back and forth phone updates between my husband, the midwife and the birth assistance, we decided we would do the birth at home and they'd be on their way over. I couldn't imaging coping with the contractions during a car ride. Even though it might only be twenty minutes, my need to stand, squat, curl over a pillow and the primitivism of my moaning just didn't seem suited to car travel.

When the midwife arrived, I was no longer paying attention to timing contractions, they were just coming and I was just hanging on and dealing with them any way I could. I think I threw up again.

The midwife gave me words of encouragement and praise for my ways of coping with the contractions and also talked to me a bit about our house, the yard with all its different trees, the nice deck. Eventually, she suggested we go outside for a bit, if I was comfortable with that. I think we all knew that the fresh air and change of scenery would give me a second wind and change up the energy a little bit.

It was a lovely evening by then, with cool summer breezes. Labor continued to be very intense, but with the midwife's advice, my husband's comfort and now, my birth assistant, too, there providing her support, I just took it one contraction at a time, as they say you're supposed to, and tried my best to chill out, rest, and gear up for the next one in between the contractions.

I began to start feeling the intense pressure and the urge to push and was grunting away out on the deck for a while. The castor oil was in full effect and things would have gotten extremely messy were it not for the endless expert and astute changing of Chux pads beneath me by the midwife and birth assistant. Being a wild woman in labor, I cared nothing about the flying fluids and mess and even found all the fussiness annoying at the time. However, looking back, I am grateful and amazed at how neat they kept the birth, and how much of my dignity they preserved by doing so.

Although I had the urge to push, the midwife checked me and noted I was only dilated 8 cm, so I had to hold back. Not pushing when I felt this intense urge was very difficult. She advised that if I breathed out during the contractions when the urge was building, it would keep me from pushing too much too soon. In order to do this, I had to grip my husband's hands really, really tight and I needed the midwife and birth assistant to work on my lower back as a counter pressure. I rested in between contractions while they took care of preparations for the next phase, and I called them back with each contraction for more help on my back. I must have squeezed my husband's hands so hard, but he took it all and supported me the whole time. He was there to remind me to blow out and coach me through the challenge as the intense contractions worked to open me more. The midwife sensed that the birth could happen soon and advised we move inside the house since it was getting cool and breezy for a new baby.

There still was another hurdle I had to clear before giving birth, though, which was that even as the cervix was dilating, there was a little lip that was in the way. After some time, the midwife said she could try easing it out of the way during a contraction to help move the labor along. I knew from other birth stories that it would not be pleasant, and would be a bit painful, but I really wanted to go forward with the labor as quickly now as possible and meet my baby.

The midwife expertly moved the lip and it was now time to push, which meant much more hard work. Pushing was tough. Maybe the toughest part because it was now about more than just coping with pain. I now had to accomplish something. I took in as much breath as I could, held it and pushed so hard for what seemed like the longest time. I pushed and pushed with each contraction, I thought it would never end. The midwife talked me through how to push with control as my husband and birth assistant comforted me. With each push, I felt burning and stretching. They later told me I had good control and followed the midwife's direction well to avoid tearing and damage to my perineum.

Everyone was getting excited and they told me they could see more and more of the baby's head with each push. With the last push, I thought they actually had to cut me because I felt a little something acutely sharp before the final relief, but they didn't. The next thing I knew, there was this sense of elation and the midwife was handing me my baby.

Holding her, I was filled with complete joy. She was absolutely beautiful, so soft and pink (for whatever reason, she came out very clean with little vernix on her at all). I felt such relief and love and peace. My husband cuddled us and held her for a moment, too, as we finished the birthing and basked in our happiness.

True luxuries come at a different price

Today in the Post, I read about how "Luxury Services for Pregnant Women are Booming" and became nauseated by more "news" illustrating how Americans think they are due these outrageous luxuries because they are "taking care of themselves" or "taking time for themselves" when they're really just spending loads of money on bullshit.

As the mama of an eleven month old, I still remember pregnancy. Ah, these were glory days. Sure, I wasn't able to run as much or weight train or drink, but boy did my husband treat me well. He brought me my nightly snacks, rubbed my back and feet. He was nice! Plus, I could still go to movies, I could still dine out without wrestling a little one in and out of a high chair. I enjoyed getting special care and attention and I took good care of myself. I even got a few massages down on my lunch breaks (I worked up til the day before I gave birth). But, all this over-the-top spa culture of extreme pampering, at crazy prices, to me seems nutso. The article even cites posh preggos paying $25 to take a nap. Come on!

The article also gives voice to one woman carrying on about how she was obsessing about where to get apple green bedding for her baby's crib, and I had to laugh. I remember I spent a weekend furiously web surfing for special crib bedding, marveling at all the cute designs out there, but stopping short and just getting a cute jungle set from Target once I saw the price tags. Good thing. We don't use the crib for much more than storage, or a cooling off jail cell for the baby when she can't calm down before bed. Instead, we do a sort of transitional co-sleeping dealio on a futon. It's the best.

I believe that the non-marketed, figure-it-out yourself discoveries and other variations on "official" philosophies/practices (attachment parenting, etc.) are what makes my life my own, what keeps it real and authentic. A little pampering is good, of course, but Americans are becoming more and more luxury-driven (when we can afford it less and less) while at the same time becoming dumber about how to do anything for ourselves and think things through practically.

What about women who read articles like this and think, "I deserve to feel good about myself. I need that, too. I am worth it..." and then they go chasing after these pricey extravagances to try and feel something? I ask, what kind of births will these women have? What kind of motherhood will they experience? I wonder, after they get sucked into the accoutrements and trappings of pregnancy and motherhood, how engaged will they be in their babies' births and their babies' lives? How many will be drugged out and turn over the power of their birth experience to more service people (doctors, nurses, etc.)? How many will then turn over the very caring for of their babies to service people (daycare, nannies)?

I know, some people have to have medicated births and some have to send their infants to daycare, but many choose to, and of course, it's their choice. But how many even consider other options? My view is that they are only cheating themselves out of truly priceless experiences when you have other people do so much for you. Are you really living your own life, or are you just in a constant cycle of earning and spending. I think people need to get reacquainted with the simpler pleasures in life—give me a foot massage from my husband and a pint of Häagen-Dazs and I'm good!

Honestly, what provided me with the best luxury of all—taking this special time in my life to relish being mama to a baby by working part time from home, rather than shipping her off to daycare as an infant—was being prudent with savings and working hard before she was born. Not blowing thousands of dollars on pampering.

Cultural clues in the business section: Drifting further away from nature, we need to hold on to some of our animal attributes

You can find some of the most interesting cultural commentaries by reading between the lines of the business section. Take the story in Friday’s New York Times about Nair marketing hair removal products to 10-15-year olds:

“When a girl removes hair for the first time, it’s a life-changing moment,” the VP of marketing for the company selling Nair is quoted in the Times.

We laughed when we first read this, my husband and I, but then I realized—she’s right. The ritualization and symbolism of hair removal is, in fact, nothing new. Wikipedia has some basic background on hair removal for social, cultural, and religious reasons—and more. But I wonder if our contemporary culture’s growing obsession with depilation may be loaded with new meaning.

The Times article notes, “It seems that Nair, which had just a few products in the 1970s and now has 25 (including waxes and bleaches) is gearing up to remove body hair from nearly every member of the household but the family pet.”

So basically, everyone wants to be smooth and mostly hairless like highly-stylized anime characters or human robots. So clean so perfect. So un-animalistic. So un-natural. I think this trend might be linked to our increasing reliance and ever-tightening embrace of technology. We are moving further and further away from nature. And we must nip, or wax, or burn off with chemicals, the hair as soon as it starts to grow.

“The whole hair removal situation has changed,” another exec says in the Times article. “Now people are removing hair from eyebrows to toes, and using all kinds of different products. People are more open about it and they feel more confident, cleaner.”

I think that the distance growing between humans (especially Americans) and nature, evidenced by bigger things like our disregard for the environment and other animals, and our birthing practices, is symbolized by a smaller thing—our eschewing our natural hairiness.

Digressing for a look at the birth example, this month’s issue of Mothering magazine had an article on the large percentage of Cesarean births today in America (5 percent in 1970, 30 percent today). The story tied this to our “fascination with and blind faith in science and technology as the ultimate antidotes” to our culture’s fear of letting go and letting natural processes take their course. What could be more natural than birth? Yet, a woman giving birth in a U.S. hospital “may have to contend with up to 16 tubes, drugs, or attachments while in labor.”

Now, I am no luddite or hater of technology. I am writing on a blog. I design websites. Technology has made it possible for me to work from home. I love much about technology. Yay iPod! Yay online banking and bill-paying! But, there are some places where nature should be respected. When nature does a better job, for example. Foods. Birth. And I think we should hold on to more of our hair as a symbol of respect for nature. We may use computers to manage our lives, but why not live a life in balance. Step away from the computer for a good portion of each day. Step away from the razors and the Nair. Go outside. Play with some animals. Even if the animals are just other people, play with them really, not just online.

I wonder what clever ways we can come up with to provide balance in our lives between the natural, animal world and technology?