Choices

– Posted by Leah

“What hospital are you delivering at?”

“Are you getting an epidural?”

“Do you want a C-section?”

These are some of the questions I’ve been asked since I started telling people that I’m pregnant. So, in answer to those questions and more…

Mark and I are planning to have a homebirth, attended by an experienced midwife, for the birth of Baby Rox. This is something we’ve thought about, talked about, and researched for several years – before we even decided to get pregnant. I believe a family’s choices are personal, and while I am open to sharing our choices and the reasons behind them – I don’t expect everyone to agree with or support my choices. Each family makes different choices, and we’ve chosen what we feel works best for our family. It does not mean that if you make different choices, I think you are wrong/bad/less than/etc. There is WAY too much judgment around parenting – styles, methods, etc. I’m not judging here, I’m just laying out the reasons we came to this decision. A few years ago, I just assumed that all births took place in hospitals and the doctor delivered the baby and that was that. When a friend of mine took an entirely different approach to her pregnancy and delivery, it really opened my eyes to the range of choices that exist for this very momentous occasion.

Is childbirth dangerous? It can be. Just as some women have painful, disruptive menstrual cycles – childbirth can also run into complications. But it IS an inherently natural process that does not always need medical intervention. Several studies have shown that for a low-risk mother, a midwife-attended homebirth is just as safe, if not safer, than a physician-attended hospital birth. Why? Because the medical interventions designed to make childbirth safer and less complicated have a host of complications of their own. These days, it is very difficult to give birth in a hospital without any medical intervention – from Pitocin, which is used to induce labor and strengthen contractions, to Electronic Fetal Monitoring (which has been proven to be ineffective and can even lead to unnecessary C-sections), to the use of forceps, vacuum extraction, and episiotomy to aid delivery… as with any medical intervention, each of these common practices carries with it a risk…or two or three.

In labor, the body releases hormones to soften the cervix and cause contractions. Pitocin is the synthetic version of the natural hormone oxytocin. While oxytocin and Pitocin both cause contractions, only oxytocin carries the additional benefit of stimulating feelings of closeness and nurturing. It is known as the “love hormone” and it plays an important role in mother-and-child bonding and stimulating the release of milk for breastfeeding. Additionally, the body produces increasing levels of endorphins during unmedicated labor. Endorphins are the body’s natural painkillers, and can result in a blissed-out, euphoric “high” between contractions. When my friend who chose an unmedicated, midwife-assisted waterbirth was between contractions, she looked like she was on Cloud 9. It was pretty amazing, and you could feel the sense of calm and happiness beaming out into the room. When synthetic hormones or epidurals are introduced to the system, endorphin levels drop dramatically. While the epidural can relieve the pain of labor, it won’t induce that feeling of bliss. The calmness that results from the labor endorphins is also beneficial to labor progressing. A sense of calm and relaxation keeps adrenaline – the stress hormone – in check. Adrenaline can cause women to tense up, which causes more pain during contractions, and can result in labor stalling or contractions becoming irregular. A build-up of adrenaline can also cause fetal distress, and a sense of panic in the mother.

Furthermore, Pitocin is difficult to regulate. It can cause contractions that are much, MUCH stronger than natural contractions – and without the endorphins to help lessen the pain, it can often become unbearable for the mother. Additionally, strong contractions put stress on the baby. When the uterus contracts, the umbilical cord can become compressed and result in less bloodflow to the fetus…resulting in fetal distress. If the fetal distress continues, it often results in an emergency C-section.

But let’s say there isn’t fetal distress, just killer contractions. Many women request an epidural. Once you get an epidural, you usually can’t move around much. Walking, squatting, kneeling, etc. are all important tools during labor for helping the baby descend and get in the best position for delivery, and for relieving some of the pain of contractions – especially if you are experiencing back labor. The pelvis is at its most narrow point when you are lying on your back. This makes it more difficult for the baby’s head to fit through an already-small opening, not to mention that pushing takes extraordinary effort when you must fight gravity to push the baby out. The bed-and-stirrups position for delivery is convenient for the doctor, but it makes little sense in terms of the physics and anatomy of childbirth. When the baby is having trouble crowning, forceps or a vacuum extractor may be used. Forceps can cause lacerations or bruises to the baby, and sometimes even hematomas or intracranial hemorrhaging. Likewise, vacuum extraction also poses a risk for hematomas and hemorrhaging. Episiotomy – used in conjunction with a forceps or vacuum delivery, or own its own – is a surgical incision of the vaginal wall and perineum. It is done to prevent tears, but it can lead to infection, incontinence, and long-term discomfort.

All of these interventions are, at times, needed and necessary to ensure a safe delivery. When the life of the mother or the child is truly at risk, the benefits of these procedures certainly outweigh the risks and I myself will not hesitate to accept intervention when it is clear that it is medically necessary. However, because most OB/GYNs are not trained in a range of other, more natural methods for handling common childbirth complications, these medical interventions are being used with increasing frequency and are NOT always needed or beneficial for the mother and child. Low-risk mothers find it difficult to have intervention-free births in most hospital settings, which might explain why the rates of out-of-hospital births have been on the rise since 2005.

So far, I am a low-risk pregnant lady. Baby Rox is healthy, and I am eating a variety of nutritious foods and doing everything I can to ensure a wonderful pregnancy, labor, and delivery. For me and Mark, this means giving birth outside of a hospital. Since Atlanta does not currently have a birthing center (which will hopefully change in the next few years!), our only option is to give birth at home. My homebirth midwife has, thus far, given the green light to proceed with a home delivery. So at this point in my pregnancy, I fully intend to have an uncomplicated, peaceful labor in the privacy of my own home, surrounded by a small team of empowering, supportive people.

Those are my intentions. I am aware, however, that labor does not always go according to “plan” – so we have a backup plan in place, as well. I am currently receiving double prenatal care, because I wanted to be established with a hospital practice, too. So I’m also seeing a group of nurse-midwives overseen by an OB/GYN and would deliver at the hospital with this group should things change from my current healthy, low-risk state.

I will say that even though the midwives with the hospital practice are wonderful, the overall experience of seeing them has been much less enjoyable than visits with my homebirth midwife. The hospital visits include an hour and a half to two-hour wait, followed by 15 to 20 minutes of face time with one of the midwives. I’m sure they would stay longer if I had more questions – I do get the sense that they care about their patients and want to be as helpful as possible – but after waiting so long, I’m usually ready to get out of there.

Visits with the homebirth midwife, on the other hand, have 0 wait time and last about an hour. She reviews my food log to make sure I’m getting proper nutrition, we listen to the baby’s heartbeat, she checks my blood and weight and urine, and we talk about a wide range of things, from what childbirth classes I plan on taking, to how we’re feeling about the birth, to pediatrician recommendations, to a really great restaurant she tried that I might like. We do this while I sit on a comfy queen-size bed. It’s like hanging out with a friend who just happens to deliver babies all the time. I can also text her or email her whenever I have a question, and she responds immediately – unless she’s attending a birth. And even then she gets back to me within less than 24 hours. It’s quite a difference in the level of care between the hospital practice and the homebirth one. And while the hospital midwives are experienced and I trust in their abilities, they are not nearly as experienced as our homebirth midwife, who has been practicing for 20 years and has encountered a wide range of difficult situations. She’s delivered breech babies and multiples, she’s handled postpartum hemorrhage, stalled labors, and cords wrapped around the baby’s neck. And in spite of her ability to handle all of these situations, she will not hesitate to transfer me to the hospital if she feels it is needed. We feel comfortable with and confident in the care we are receiving from her, and we are so looking forward to the birth of our child!

If you’d like more information on homebirth, unmedicated childbirth options, or anything else related to something I’ve mentioned in this post, please don’t hesitate to email me! (Leah@leahandmark.com) I’ve built up quite the library over the past few years and I’m happy to share any information or resources I have with anyone who is interested.

 

– Posted by Leah

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