“We have a secret in our culture, and it’s not that birth is painful. It’s that women are strong”
– Laura Stavoe Harm (borrowed from Shannon)
I think it’s important to start here: Labor is hard, intense work. No, wait. I think it’s more important to start here: Women are amazing. And, labor is hard, intense work. And, whatever way a woman decides to bring a child into the world should be respected and, frankly, commended – because it is a hard, intense process. Molly is only three weeks old but so far, our two mantras have been “one day (and night) at at time, and “our parenting philosophy is whatever works.” This post is about how and why Lee and I decided on a home birth – it ended up being what worked for us but I don’t think it’s the end all and be all to a successful birth. As you’ll see, there is no such thing as a “textbook” birth (or after birth…) and in the end, every mama and partner should make the decision that works best for them.
So. Why home birth? Hmm. Where did we start? Probably with me reading Ina May’s Guide to Childbirth. That book set me on the path of low-to-no intervention birth, for sure. It actually made me want a home birth, but at the time I was going to a OB who was connected to CPMC, the “nicest” hospital in SF (with views!!). This meant that we got to do all the prenatal genetic testing at a fancy hospital with cool 4D movie screens, which, hi, first time parents! We could see the baby’s brain and heart chambers and spine and count fingers and toes! Anyway, CPMC has excellent technology but they are also known as a “baby factory” in SF – which means they deliver 500ish babies a month. And, they have a 50% caesarian rate and a 95% epidural rate (note: stats are from Berkeley Parent’s Network, so who knows how accurate they actually are). Whenever I expressed concerns to my OB, she would reassure me that “It wasn’t the 70’s” and if I wanted to have a natural birth, I could do so at CPMC no problem. So, Lee and I decided to find a doula. “What is a doula?” you may wonder (because I did). A doula supports the mama and partner before, during, and after the birth. In a hospital birth setting, doulas can help advocate for the parents, keep everyone calm, and generally just be an extra support person in the room – and, in a hospital where epidurals are the norm, we thought it would be great to have an extra advocate in the room with us. Except, it turns out that CPMC is the only hospital in SF that doesn’t allow doulas (or home birth transfers, for that matter). Well then.
In the middle of all of our thinking about labor and delivery, we found out that I had gestational diabetes. I decided that, since I had to register for a diabetes program to get the blood testing kit and go for frequent check-in appointments (which ended up being not too frequent because I essentially kicked gestational diabetes’ ass. But that’s another story.), it would be easier to go to St. Luke’s, which was much closer to my house and also happened to have a much lower birth rate (maybe 50ish deliveries per month), epidural rate, and c-section rate, in additional to a midwife model of care. Okay, so St. Luke’s is not a brand new fancy pants state of the art hospital, but they do support natural childbirth and have a staff full of midwives. And they let doulas in and allow home birth transfers as walk-ins. So about the time we found Shannon, we were already thinking about alternatives to CPMC and/or whether we wanted a hospital birth at all, and once we chatted with her, we came around to home birth as an option. From there, we interviewed a few midwives and decided that we wanted Maria to be ours. Once we started learning about home birth, it kind of just clicked as our best option. Neither Lee or I had ever been admitted to a hospital, and just the thought of going made me feel anxious. I couldn’t imagine being in active labor and having to get in the car, ride to a hospital, check in, and get settled in a hospital bed to push out the baby. I also really couldn’t imagine having to stay in the hospital overnight. It sounded terrifying to me (not rationally terrifying, but terrifying nonetheless).
An important point: When we first met with Maria, we talked about how home birth is not “home birth at all costs.” That means that the ultimate goal of birth was healthy mama, healthy baby – and if that means that something were to happen and we ended up at the hospital, if that made us successful in our ultimate goal – it would still be a successful birth. I think having this mantra from the get-go helped Lee and I set realistic expectations for the birth.
I also think it’s important to acknowledge that Lee and I did a lot of work to prepare for the birth. We did a ton of research and took six weeks of classes. We read everything we could about home birth – the risks and benefits – and everything we learned reinstated our belief that this was going to be the best choice for us. We learned about the fear-adrenaline-pain continuum (in short, the emotion fear increases the hormone adrenaline which triggers the feeling pain, and around and around and around it goes); we learned a myriad of different pain management techniques; we wrote affirmations and visualized our perfect home birth, all with the “healthy mama, healthy baby” mantra in mind. By the time I finally went into labor, I felt completely calm – and all throughout labor, I was able to stay calm because nothing surprised me. When I got the shakes; when I threw up; when I couldn’t get comfortable; through the whole process, I can honestly say that fear did not once enter the picture. Because I felt so well prepared and so knowledgeable about birth, I was able to trust the process. There was no fear because I knew that everything that was happening was my body’s normal process of helping get the baby out.
It turns out this lack of fear, this lack of anxiety and apprehension, the complete trust in the process, in the doulas and the midwives and my body, ended up helping me not only in birth, but also afterwards. When Molly came out, she took a lot of my blood with her (after I found out I was anemic during pregnancy, Lee and I started calling her the little vampire baby. The bit of drama she caused on her way out may of been her way of telling us she didn’t appreciate the nickname!). My placenta had only detached partially and we had a hard time getting it out, which caused some hemorrhaging (apparently you’re only supposed to lose 2 cups of blood, and I lost 8. Impressive, right?!). I remember, after Molly’s cord had stopped pulsing and Lee had cut it, Maria asked me to sit up and get back on the birth stool so we could get the placenta out. I sat up and heard blood pouring out of me. Maybe it was all the blood loss, but I stayed calm. In fact, I stayed calm even when Maria said I need to focus on getting the placenta out and I don’t have time to explain what I’m doing right now (although it helped that Shannon was at my side the whole time). I stayed calm when everything started to go dark and I told Nile (the 2nd midwife who Maria called in when I was ready to push, who had facilitated our birth classes and Lee and I could not have been happier that she ended up being at Molly’s birth) that I couldn’t see straight (she told me to keep talking). I stayed calm when they put an oxygen mask on me. I said “ouch” but stayed calm when Nile gave me a shot and then a 2nd shot of pitocin. I stayed calm when Lee punched a hole in the wall with a screwdriver (and then a 2nd hole up higher) so that my mom didn’t have to hold the IV bag any longer. Oh, and I stayed calm when Maria inserted the IV (and then inserted it again…in hindsight, why did everything take two tries?!) I complained with vigor, but stayed calm when Maria had to insert a catheter (although I still maintain that if she had just waited five more minutes, I would have peed on my own!) and stitched me up (ten stitches, by the way. TEN. I’ll be reminding Molly of those ten stitches when she’s a mean and angry teenager. Oh, and yes, because I’m sure you’re wondering – I was numbed and didn’t feel a thing. Even so. Ten stitches.). I stayed calm when I finally went to pee and almost passed out on the way to the bathroom…and when I had to crawl back to bed (I remember seeing my mom out of the corner of my eye and saying something like, sorry Mom! I know this looks scary but I’m okay…I just need to lie on the floor for a little while!). Also – I remember Maria lying on the floor next to me, rubbing my back. Also, she fed me oranges in bed. She literally peeled oranges and handed me slices (and after 12 weeks on a gestational diabetes diet consisting of very limited fruit, you can probably imagine how happy I was to be able to eat oranges again). Best. Midwife. Ever. Through it all, I was calm. Lee was right there and Maria was there and Nile and Shannon and Joy and my mom and I just trusted everyone and knew that they were going to fix me. Molly was fine and I was going to be okay. I had complete faith in the people around me and again, I trusted the process and trusted my body and it didn’t occur to me to be scared.
Now, there is no doubt in my mind that everything would have turned out just fine had I been in the hospital – but I can’t help but imagine the scene playing out very differently in a hospital setting. I imagine during labor, I would have constantly have to be saying “no thanks” when offered an epidural or other interventions. Actually, I imagine I would have ended up with an IV and fetal heart monitor right off the bat – unless Lee and I had the energy to request (and stick to our convictions) no interventions. I imagine the (proverbial) clock would have started when I got to the hospital, and had my labor not progressed as efficiently as it had, would possibly been told that pitocin was necessary to “speed things along.” Again, I imagine it would have been hard to say no, in the moment. I imagine that once Molly was born and the complications started, Lee and my mom probably would have been ushered out of the room, Molly would have been taken away from me, and a bunch of nurses would have rushed in without anyone talking to me or telling me what was going on. I imagine I would have been terrified and thought I was in real danger (whether or not I was in fact in danger is still something I’m unclear on, and to be honest I’d rather not know. I think part of having a relatively easy recovery stemmed from believing that I was pretty much fine.), and wouldn’t have had the opportunity to spend Molly’s first seconds and minutes with her. When I fell asleep in my own bed that night, with my whole body achingly tired, I couldn’t help but imagine how I would feel in a hospital, with nurses coming in and out all night, a roommate, Lee in a chair besides me, and Molly who knows where. Because we chose home birth, I got to sleep in my own bed, with my husband next to me and our daughter in the same room. I’ve never slept more soundly and I don’t think I’ve ever felt as safe and secure – and I can’t imagine I would have felt the same way had I been in the hospital.
A few additional thoughts on home birth vs. hospital birth: Having my mom there was vital. Now, not everyone has a mom like mine and not everyone has the close relationship that my mom and I do (side story: when Maria and I were talking during one of our prenatal appointments, she brought up the Life Cycle and asked me what I had learned to tap into that helped me go forward when I was exhausted during the ride. I responded that my mom took care of us for the two nights in the middle of the ride, and that really got me through.), but having someone stay with us during recovery was really important. I am beyond glad that my mom was there to see Molly be born but I am really above and beyond glad she was there for the aftermath. I was really weak from the blood loss and my mom took such good care of me. She walked me to the bathroom (someone had to go with me for the first 24 hours after birth in case I passed out); she helped me take a shower (another side note: no shower in the universe feels better than the shower you will take after you’ve had a baby. It was absolutely glorious.); she brought me my vitamins and reminded me to drink lots of water and tea and made me chicken soup and forced me to stay in bed and rest. I was so weak I could barely hold Molly, and my mom took care of her baby (me!) while Lee took care of ours. I can not express enough how grateful I was to have my mom there (Lee and I are keeping a list of thank you’s to write as we’ve gotten gifts for the baby. Next to my mom’s name I wrote “Everything.”). In a hospital, I would have had nurses. At home, I had my mom.
Another thought: Home birth is expensive. Maria works with a company that navigates your insurance for you and it turns out that neither mine or Lee’s insurance covered home birth. Between midwife and doula care (including prenatal and postpartum care) our home birth tab ran almost $7,000 (tax deductible, but still). If we had gone to a hospital, even if I had ended up with a C-section, the cost of birth would have been around $500 out of pocket (the cost of a deductible). And, the hospital would have ended up charging my insurance, what? $10,000-$25,000? Probably needless to say, but I think this is ridiculous and annoying and (insert rant about healthcare and insurance here). I hate to think that the cost of home birth would prohibit people from exploring it, but of course it would – and, sadly, for good reason, when hospital birth is so much cheaper. There are also a few extra bureaucratic steps that we wouldn’t have had to contend with at a hospital birth – for example, the birth certificate, which we needed for state disability, required all three of us to make an appointment at the Dept. of Health. At the hospital, we would have just left with the birth certificate. I think these are minor inconveniences that are far outweighed by having the birth experience that we did, but they are worth mentioning.
I think it’s best to end where I started. Women are amazing. Labor is hard. Information is powerful. Birth is transforming. Home birth is an option. When all is said and done, I’m so glad we chose it as ours.