Birth: Realizing I Have A Choice

The only thing I heard from the women around concerning birth growing up was how awful it was. Painful. Long. Something to dread for nine months. I watched TV like everyone else so I knew how it would go. My water would break and we would rush to the hospital, where I would begin screaming and crying out, probably in a shared room with another screaming and crying woman. I would beg for drugs. An army of nurses and doctors would be present to ward off the dangerous situations likely to happen. The doctor would come in and tell me when to push, if I was lucky enough to be able to push because chances are high I would have to have a c-section, and then a screaming baby would appear and all would be well once again. I would be able to join the ranks of battle scarred women who endured one of the worst experiences a person can ever go through.

Source

20 years after I tortured my own mother in this way, I signed up for a class called Intro to Women’s Studies. One of the sections involved dividing the classroom into groups and assigning a book for each group to read and present on. I was placed in the group that read A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812. During the group presentation we discussed many different aspects of female life during this time period but it was the time we spent discussing midwifery and childbirth that really stuck with me. Birthing stools, babies born outside of a hospital, the perils and triumphs of childbirth. It all felt so new and exciting, and I knew that I would never be satisfied if I “settled” for letting those around me dictate the kind of experience I would have during childbirth.

One of the members of my group invited her sister in to come in and talk about her birthing experience. This woman had created something called a “birth plan”, a document which detailed the kind of hospital experience she hoped to have. She presented it to the hospital staff and rejected some of the standard procedures while embracing others. In short, she educated herself about the birth process before it occurred, and then she put that knowledge to good use.  She handed out a copy of her plan, something I’ve held onto through all the moves and life-changing events I’ve experienced since that time.

I knew that when I had a baby, I was going to educate, plan, and execute. I would be prepared, and I was going to have a better birthing experience than the childhood version of myself ever thought possible.

78 thoughts on “Birth: Realizing I Have A Choice

  1. I think birth is so fascinating and it is great that you have educated yourself about it and have such strong ideas.

    I think that while in some ways the medical profession has negatively impacted birth (e.g C-Sections being scheduled at 38 weeks before babies are fully ‘cooked’) I also feel that the movement towards completely shunning medical involvement in birth is equally as negative. I’m not suggesting that this is your plan, but I do feel that some women feel that i they need medical intervention that they have somehow failed or been failed. I think a birth plan is great, I just hope that people still have a dedicated OBGYN who is trained to deal with the disasters and not just a straight forward birth.

    My cousin’s wife had a very specific birth plan and in the end their son was in distress and there was meconium (faecal matter) evident in amongst the various fluids involved in birth. This is extremely dangerous and it was immediately recommended that the birth plan be abandoned and a C-Section performed in the best interests of the child.

    Another acquaintance had the same thing and did not have an OBGYN, just a doula/midwife. This woman was simply not qualified to deal with the issue and the results have been quite disastrous.

    While I hope to have a natural birth one day (hopefully I’ll be luck – my mother had extremely short births with no painkillers) I don’t think I’ll assume that medical intervention is a negative. There’s a reason why we have lower infant and other mortality rates in the first world. I know that regardless of my plan, I would want to be in the care of people who could do something the very instant that something is proven to be seriously wrong. A huge part of this is that we have a family history of cord strangulation (it happened to myself and two babies in my grandmother’s generation died during birth as a result) and this is something that needs to be handled quickly. If I did a home birth or a completely ‘alternative’ birth I would always fear that these essentials were not available.

    I guess my concern is that the medical profession overall has been demonised when it comes to childbirth thanks to the misdeeds of a few. I know of many doctors who hate the number of scans other obgyns book essentially for profit and that c-sections are recommended to simplify the dr’s life. But I don’t think that this means we should assume medical intervention = a negative experience.

    I want to reiterate that I don’t think YOU plan to go without any medical intervention (from what I can gather) but just a general comment about attitudes towards the birth process in western medicine.

    Mrs. D Reply:

    Jenna, I think it is so great that you are taking an active involvement in your birth plan. We are so incredibly lucky to have choices like this. I’m a huge believer in researching your medical options for any health issue – I think it can make something unknowable into something clear, and it can change confusion into confidence.

    Hannah brings up a good point though. The topic of birth really does raise a lot of interesting questions about our “rights” as patients, and the trust (or lack thereof) we have for medical professionals (many of whom have trained for years), and the ultimate lack of control we sometimes have over circumstances surrounding our own bodies and care. I hope you discuss it more as your pregnancy progresses.

    I don’t want to weigh in on any “side,” although I admit I get a little sad when I hear people – and I’m not saying YOU are doing this – advocating against physician involvement. It’s completely a personal choice – but sometimes it seems like physicians have to bear up against a lot of suspicion and distrust. (Yes, I do have a fondness for doctors, as my father is a physician and so is my husband!)

    Anyway, I hope you find a physician or a midwife who makes you feel 100% comfortable, who helps you develop a birth plan you love, who is open with you about all options and potential deviations from that plan, and who is above all well-trained. Thank you for sharing this personal and exciting journey with your readers!

    Evelyn Reply:

    A desire to do a birth natural with minimal, or even no, medical intervention does not necessarily mean there is distrust of doctors and medicine.

    There are many loud voices/personalities out there in support of unmedicated births which also demonize doctors, but all their attitudes/opinions are not shared by every woman, or even the majority, who wants an unmedicated birth.

    Over the last 150 years or so there has been a trend wherein we have stopped trusting and listening to our bodies that generally come equipped to face birth, a natural–not medical–process, and started listening solely to numbers, statistics, and those who are trained to weigh risks and make decisions and perform procedures based on those decisions.

    Most ob-gyn surgeons (because that’s what they are) are not even trained or experienced on the basic ways to change a baby’s position when in breech. While certain breech positions require surgery, many can be changed naturally. If you specialize in using a scalpel and a situation outside the scientifically decided “norm” comes up, most surgeons are going to opt for a c-section because that is what they are for.

    One of my dearest friends is an ob-gyn and after discussing my birth experience (which was in a hospital, with the assistance of a doula & a birth plan, and completely unmedicated) she has repeatedly told me that my doctor failed me and has told me that in the future, if I were her patient, she would refer me to a midwife. Most women who find out they are pregnant immediately turn to an ob-gyn, not a family doctor they’ve seen for years, nor a midwife. This isn’t the best comparison, but it’s kind of like just going straight to the foot specialist for athlete’s foot, rather than seeing your PCP first.

    One of the reasons our country has outrageous health insurance costs is because we are treated for more than we need. The majority of women are not at-risk and could easily receive care and labor assistance from a midwife (or even a family doctor–they generally run fewer tests & have fewer appts) and be more satisfied with their care when all is said and done.

    I know you aren’t doing this, but one thing I have seen is that in an attempt to defend doctors midwives are demonized, which is just as wrong as demonizing the doctors. I believe I have heard/read that midwives are generally more experienced with natural births than ob-gyn. It makes sense since they have to know how to handle any situation to get an outcome of happy & healthy mom & baby without the “luxury” of devising a different route for the baby to leave the mom.

    Kelli Reply:

    I just want to briefly address a couple of things you mentioned (but not bash or anything). First, about infant mortality rates. This country SUCKS when it comes to that. We’re rated around number 40 or so as far as infant mortality rates and maternal mortality rates when compared to the other industrialized nations. There’s a lot more we need to be doing to protecting the safety of women and children.

    Second, I’ve been present at 5 or 6 births, a few home births, one at a birthing center, one epidural free at a hospital, and one home birth transfer to hospital c-section (and I was in the room for the c-section). With the research I’ve done and the knowledge and experience I’ve gained I have a pretty good idea on what I would like to do and what is and what isn’t safe, but I will always have a back-up plan and will do what I think is best for me and the baby and do as much as possible to prepare for the worst. Obviously, not everything is for everyone and I don’t advocate that anyone goes for a homebirth without fully preparing, BUT for low-risk, full-term pregnancies that have not had medical problems (preeclampsia or gestational diabetes or anything else) birth outside of a hospital is perfectly safe (many would argue that it’s safer in most instances). I’m not anti-hospitals at all, I just think people should be educated before having a baby (whether home, birth center, hospital, or in a taxi on the way there). Oh, and a doula and midwife are COMPLETELY different. A doula is mostly about emotional support, but doesn’t make medical decisions or have medical training and a midwife is fully trained in emergency situations as well as normal births.

    I totally agree that there can be great doctors and midwives who are total crazies, but choosing one is part of the ‘being educated’ part. I hope you find an amazing one that you love love love, Jenna!

    Jenna, I’m so so so excited to read more posts and thanks so much for letting me borrow that book! I can’t wait to read it!

    HamiHarri Reply:

    Hannah, I think you worded your comment wonderfully, and I totally agree!

    Hannah Reply:

    Hi Kelli – I think it is worth noting that I am Australian so this was written from a bit of a different perspective. I think we’re (Australia) ranked at 29 (the US is ranked 46 out of 224). Our healthcare system is much more universal and I am sure that this would make a big difference to our statistics versus yours – e.g. Sweden has entirely universal healthcare and their mortality rate is extremely low.

    I think it is also worth noting that the coming in at 46th involves 6.46 deaths /100 live births versus Angola’s 180.2 deaths/100 live births. I simply can’t accept that medical intervention is more dangerous. I underastand some other issues impact this, but the difference is still so start that it can’t be just written off. The US, realistically, has a far better record than over 180 other countries. You don’t actually suck, overall, at all. It seems to be an issue of universal healthcare more than anything else, in my opinion and I don’t agree that a home birth is safer ‘in most instances’.

    I’d also be interested to see how many of these deaths happen in hospital, as a result of still birth or happen in ‘alternative’ circumstances.

    I know the difference between a midwife and a doula (I actually started studying to be a midwife). I personally believe that even a midwife (in western circumstances) isn’t necessarily qualified to make the calls necessary WHEN necessary. I don’t know about the US, but in Australia doulas are presenting themselves as midwives and encouraging women to labour at home with just them and it is such a step backwards, not forwards. There is a reason countires with excellent healthcare have excellent infant mortality rankings. Because medical intervention HAS improved the outcome for women and babies overall.

    A normal and low risk pregnancy can turn into a dangerous labour at the drop of a hat. My mother had a normal pregnancy and an easy labour but in the end I had to be vacuumed out because the cord was around my neck, my heart rate was dropping and I was blue. My cousin’s wife’s pregnancy was totally normal (and her midwife was pressuring for a home birth), had she been their baby would have aspirated and possibly died.

    Like I said, I don’t think Jenna plans to just stay at home with no medical intervention, but I do feel there’s a movement against medical intervention at birth and I personall feel it is a huge risk. And this is coming from someone who planned to be a widwife for a lot of their life.

    kay Reply:

    Hannah, I don’t mean to be rude at all, but there are several statements you made that are just beliefs, and not based on fact.

    “but sometimes it seems like physicians have to bear up against a lot of suspicion and distrust.”

    And for good reason.

    Statistically, which means based on research (not personal feelings/thoughts) home birth is AS SAFE as hospital birth in regular pregnancies – sometimes it’s even found to be safer. There are multiple places you can access this information.

    “My mother had a normal pregnancy and an easy labour but in the end I had to be vacuumed out because the cord was around my neck, my heart rate was dropping and I was blue”

    - This can also be dealt with by midwives. They are trained to handle this somewhat common problem. They know positions you can get in, and some of them even carry hospital equipment.

    “I personally believe that even a midwife (in western circumstances) isn’t necessarily qualified to make the calls necessary WHEN necessary.”

    Many midwives are also nurses. Nurses are often the ones in hospital rooms who make the calls necessary when necessary. If you are about 15 minutes away or less from a hospital, you are just as “safe” as if you are in a hospital (that’s how long, on average, it takes them to set up an ER operating room). Also remember that ambulances have equipment designed to help babies (and adults) survive horrid circumstances – including deadly car crashes, suicide attempts, etc.

    It’s obvious that your personal experiences have helped shape your views on home birth, but unfortunately they’re simply not based on fact.

    Some good books I’d recommend for you:
    -Birth
    -Ina May’s Guide to Childbirth
    -A Mother’s Intention
    -Home Birth: A Practical Guide

    Some good movies to research:
    -Business of Being Born
    -Orgasmic Birth

    Hannah Reply:

    Kay,

    To argue that my beliefs aren’t based on fact when they are based on factual events seems a little odd, don’t you think? I never denied that home births can’t go swimmingly. They can. My concern is that people are inflexible and in some ways romanticise birth to the point that they view physician involvement as their own failure and as entirely negative. While I think it is great to hope for a easy, natural birth (and I hope when the time comes, I’ll be able to have one) I think it is also good not to become to bull-headed about resisting the positives that can come from having immediate access to emergency medical care – including emergency Caesars.

    Ambulances might be equipped to deal with all sorts of horrific things; however I don’t see the value in putting yourself in the position where this is necessary. They also don’t always make it. My friend’s father died because an ambulance that should have taken seven minutes took forty five because of a lack of resources and traffic it couldn’t get around. I just wouldn’t want to go, well if the poop hits the fan, we can always get the ambos down. Do you know what I mean?

    What happens if an ambulance doesn’t get to you within fifteen minutes time? What happens if your particular birth plan doesn’t include heart monitoring and you don’t even know that the baby is in distress? What happens if the midwife isn’t one who happens to carry equipment? Then what do you do, wait for fifteen minutes (at the very least) while your baby strangles? Or in the case of my cousin’s wife and her friend, while the baby aspirates its own faeces with possibly fatal results? I don’t mean to be facetious or overdramatic, but I really fail to see how people can be so negative about the obvious bonuses of physician ‘interference’ in the birth process.

    I actually have a huge amount of time for midwives (duh, I wanted to be one) but I think that some people who choose alternative birth plans choose doulas and think it is the same thing. It isn’t and if something does go wrong, it is dangerous. I am concerned that I have given the wrong impression – if so I must reiterate that I believe midwives are saints and well educated people. However they simply don’t have the same training or rights (in Australia) as an obstetrician does when it comes to having things happen fast. Unfortunately, in Australia at least, they have a reputation for encouraging their patients to resist physician ‘interference’ and countless women I know have ending up having hideously protracted and sometimes dangerous births.

    Again, I am coming from an Australian perspective. Yes you have to a nurse to be a midwife here, but in Australia there are a lot of limitations places on what decisions nurses can make. They often can’t even place an IV without the direction of a doctor – I know because I was just in ICU and everything that was done had to be run past a doctor. I experienced the same thing when I had my appendix out last year too. So they can’t just ‘make the call’ within minutes in the same way a doctor can. I am not sure if it is different in the US, but my understanding was that nurses the same limited rights there too.

    I have to agree that another reason Australia is ranked as ‘highly’ as 29 is that we too count births as ‘live’ from 20 weeks. This significantly increases the mortality rating per 1000 births (I wrote 100 before – I had just woken up!). I’d be interested to see how much these mortality in the US and Australia are impacted by the inclusion of extremely premature babies who pass on.

    I guess I am also uncomfortable with the notion that if a woman has a birth that involved medication or medical intervention, they have somehow failed or been failed. I think the movements that are against intervention can be equally obtuse as those who are for it. I am personally sitting on the fence. When the time comes (God willing) I hope to have a natural birth but I don’t have any qualms about having IMMEDIATE access to everything I may need in case of emergency.

    I guess I have to agree with the people who have maintained that flexibility is essential. That was really the crux of my point and to my mind I don’t see how choosing to give birth outside of a hospital leaves much place for flexibility should things get really bad.

    Hannah Reply:

    I also just want to point out that I have huge issues with the unnecessary scans, unnecessary c-sections etc that has become a part of the industry of birth. It is invasive, symptomatic of uncaring/money hungry physicians. However at the end of the day I don’t believe that these issues should make one unwilling to accept that stuff goes wrong during birth, a lot, and that sometimes a home birth or totally natural birth stops being an options and you want others available to you, instantly.

    Lindsey Reply:

    I agree with a lot of what Hannah is saying. My mom is an OB nurse, so she works with both doctors and midwives. We have talked about this subject quite a bit, since she had 4 kids naturally without any pain medication (in a hospital) and I am terrified of childbirth. Based on her own experience as a mother and as a nurse, she thinks it’s fine to have a birth plan as long as you are willing to be flexible and go with what’s happening. She has seen a number of home births with midwives go wrong, and the midwife is not trained to handle such situations, so the woman ends up in the hospital anyway. Obviously this does not happen all the time, and some midwives are trained better than others, but it seems to happen enough that she personally does not think a home birth is a good idea.

    My own personal feeling is that whether I choose to go with a midwife or an OB, I’d feel more comfortable giving birth in a hospital, just in case something goes wrong. At my mom’s hospital, women are free to walk around, they have a birthing pool, in short, you can do many of the things you would want to do at home, aside from giving birth in your own bed.

    It’s such a personal decision, and I know I will want to do more research when I am ready to have children, but I just really don’t understand people that bash US hospitals or OB-GYNs.

    Erin Reply:

    I disagree – unnecessary scans/c-sections/etc. is not “symptomatic of uncaring/money hungry physicians.” I think it is symptomatic of our overly litigious society. In order for docs/hospitals to defend themselves against attorneys (like John Edwards) they need to show that they ran every possible test. I would also argue that health insurance problems also stem more from our litigious society and lack of preventative care than from doctors.

    Hannah Reply:

    As I have repeatedly stated, I am coming from an Australian perspective on this. We haven’t reached the stages of litigation at the drop of the hat that you have in the US. C-sections are literally advised by lots of obs here because ‘it is easier to schedule’ and, frankly, because it is not something covered by Medicare as a elective option so they make more money out of it. There is a lot of pressure currently on doctors to stop doing it.

    I never said it was all doctors. I simply said that the motivations, from what I have seen and experienced in the industry, are not so much about avoiding litigation but rather about making their jobs Monday-Friday, 9-5.

    Hannah Reply:

    Also, our public system is essentially universal and there is a far higher standard of care. Given that so many people are accessing public care there is les in the way of drop-of-the-hat litigation because you’re not just taking on the doctor, you’re taking on the State. This can be good and bad, though. My point is that possibly the perspective I am offering is different simply by virtue of different nation’s approaches to healthcare and therefore birth.

    Jenna Reply:

    Hannah,

    I’m sorry, but your just not basing your claims on facts.

    “What happens if an ambulance doesn’t get to you within fifteen minutes time?”

    I believe this argument would be valid IF statistics showed that infant mortality rates for outside of hospital births were higher than in hospital births. BUT THEY ARE NOT. This study (http://www.bmj.com/cgi/content/full/330/7505/1416c) concluded: “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.” I have only read or heard of ONE study out of many many studies that has suggested that hospital birth is “safer”, and that was funded by (surprise! surprise!) the American College of Obstetricians and Gynecologists. The emergency transfer argument just doesn’t hold up for me because statistically, home birth and hospital birth mortality rates are just about equal. There are risks for both home and hospital births, and in my opinion, with the way births are treated in hospitals, they are just about equal. A woman who chooses a hospital birth avoids an emergency transfer situation, but her chance of having a c-section, going under anesthesia, or coming down with serious infection (among other things) significantly increase. Both in and out of hospital births come with risks, and both must be weighed and considered carefully before a choice is made.

    What happens if your particular birth plan doesn’t include heart monitoring and you don’t even know that the baby is in distress?

    Continuous EFM is actually not essential for low risk pregnancies/labors (although the hospitals here in the US don’t seem to know that!). In fact The American College of Obstetricians and Gynecologists (ACOG) recommends that for healthy, low-risk women (which according to statistics is close to 95% of pregnancies), fetal heart rate be monitored with a fetoscope or Doppler every 30 minutes in active labor and every 15 minutes during pushing. The World Heath Organization (WHO) encourages intermittent manual listening and warns that EFM is often used inappropriately. (http://www.lamaze.org/ExpectantParents/PregnancyandBirthResources/MoreTipsandTools/InterventionIndications/EFM/tabid/395/Default.aspx) I’d love you to find something that discredits this, but every single thing I have read says that EFM does not make labor safer for baby. Why is it used so frequently? Because it’s essential for women who are given pitocin or an epidural. Epidurals are impossible outside of a hospital, and a good midwife will either monitor more frequently if she administers pitocin or transfer to a hospital. This study (http://www3.interscience.wiley.com/journal/119286169/abstract?CRETRY=1&SRETRY=0) found “There were no significant differences in the immediate neonatal outcome in terms of umbilical artery pH, Apgar scores, or admissions to the neonatal care unit” between intermittent and continuous fetal monitoring.

    What happens if the midwife isn’t one who happens to carry equipment?

    I’m sorry, but this is just absurd. Any woman who chooses a midwife who doesn’t carry the appropriate equipment did not do the proper research. These are questions that should be asked when interviewing a midwife and a well-researched prepared mother will already know the answers she wants to hear. Women who aren’t willing to educate themselves about the dangers and pitfalls of hospital birth, and how to deal with those situations, should NOT be giving birth outside of a hospital, in my opinion.

    Then what do you do, wait for fifteen minutes (at the very least) while your baby strangles?

    It sounds like you have had a lot of experience with cord prolapse, cord being wrapped around that babies neck, and other issues with the umbilical cord at birth. However, I think you may be confusing the difference between cord prolapse (extremely dangerous situation) with the baby having the cord wrapped around its neck. Cord prolapse occurs in somewhere between 0.14% and 0.62% of all births and I believe is a situation where mothers would be better off in the hospital. But it’s important to remember that even not all hospital situations featuring cord prolapses have positive outcomes, with between 11-17% of those cord prolapse situations ending in death for the fetus (http://en.wikipedia.org/wiki/Cord_prolapse). In this study (http://www.homebirth.org.uk/homebirth2.htm) of home birth v. hospital birth in the UK cord prolapse occurred once and cause death for one fetus out of 5971. Wikipedia (http://en.wikipedia.org/wiki/Cord_prolapse) cites that cord prolapse death is given as 11-17%[6]. This applies to hospital births or very quick transfers in a first world environment. One might try to argue that the “first world” births in this instance (meaning home birth) swayed the data, however, in the United States only 1% of births occur outside of hospitals. So, again, cord prolapse is a risk, but must be weighed against all of the other risks involved AND is not necessarily solved by choosing a hospital birth. As far as other complications with the umbilical cord, you might find this article interesting: http://www.drspock.com/article/0,1510,5332,00.html. Also, this site talks about Nuchal Cord situations, something I believe midwives are actually better prepared to handle than doctors: http://www.homebirth.org.uk/whatif.htm#cord

    Or in the case of my cousin’s wife and her friend, while the baby aspirates its own faeces with possibly fatal results?

    A Canadian study found that infants born at home were also 0.45 times less likely to have aspirate meconium (inhaling a mixture of their feces and amniotic fluid). (Reference: http://www.cbc.ca/health/story/2009/08/31/midwife-home-births.html) Also, meconium is easily detected in the amniotic fluid and a mother in such a situation would be advised by a competent midwife of the risks to her baby upon delivery and possibly advised to move to the hospital (http://www.homebirth.org.uk/meconium.htm) According to Wikipedia Meconium passage into the amniotic fluid occurs in about 5-20 percent of all births. This is more common in postdate births. Of the cases where meconium is found in the amniotic fluid Meconium Aspiration Syndrome develops less than 5 percent of the time (a situation to which you seemed to be referring with your cousin’s wife). An educated intelligent mother who is taking charge of her own birth should know the risks of meconium aspiration (and that there is a significant increase of such a thing happening with overdue births) and should have a competent and experienced midwife who understands the warning signs and dangers if such a thing were to happen. I think it’s important to note that distressed babies are more likely to have problems with meconium aspiration (http://kidshealth.org/parent/medical/lungs/meconium.html#), and distressed babies are more likely to be found in hospitals where interventions such as epidurals and pitocin are routinely administered.

    Hannah I don’t want you to think I am singling you out and attacking your opinions, but I find them to be very anecdotal and not based on facts or statistics. If you are going to mention situations or ask questions that may come across as critical of others choices, I believe they should be well-researched ones that will encourage those you are targeting to think intelligently about their choices and seek to educate themselves about the risks. I encourage you to continue to educate yourself as well.

    Cristin Reply:

    Hey Jenna,

    your study between in & out if home mortality rates is for “low risk pregnancies.” you later go on to say that 95% of pregnancies are in fact low risk. Normally I would not ask, but since you cited everything else… Where did you get the 95% number from? I worked in L&D before, in a non-medical capacity, and id never heard that (I’m not disagreeing, but I was encouraged by this figure!). If it’s easily accessible, would you share?

    Jenna Reply:

    I’m a believer in the statistics provided in the experience on The Farm run by Ina May because I think 2028 birth experiences count for something, and I don’t believe that the women who chose to have their babies on the farm are physiologically any different than women who birth in hospitals. The difference? The type of care.

    On The Farm, 95.1% of the births were completed without transport to the hospital. Of the 2028 births there were 13 total deaths (including 4 deaths which happened within the first week, not during labor), including babies who were transported to the hospital. # of c-sections? 1.4% Number of inductions? 5.4% Number of intact perineums? 68.8% If you know anything about hospital statistics you know that The Farm blows hospitals out of the water when it comes to maternal morbidity. As for mortality rates? Just about equal to what you find in a hospital.

    You should check out the appendix in the back of “Ina May’s Guide To Childbirth”, I think you’ll find it interesting.

    Another example of how normal childbirth can be is found in her book as well. Catharina Schrader practiced in what is now the Netherlands from 1693 until 1745 and attended 3017 births. Number of spontaneous births for her was 95%. C-section was not an option during that time. Of the 3017 cases Schrader recorded, only 20 women died.

    Again, for me it’s about looking at what has changed. Have women’s bodies physiologically changed to force us to need a 30% c-section rate and and episiotomy rate of 90%, or has care changed?

    Evelyn Reply:

    The points you bring up are highly emotional evidence for your “argument”. (To be clear–I’m not saying you are emotional.)

    When I was pregnant and had my second doctors appt at 8 weeks I verified my desires regarding ultrasound to a nurse and then was ushered into the doctors office where the doctor proceeded to listen for a heartbeat and found one. He then proceeded to go on about how he had never heard a heart beat that early (he had been practicing at least 30+ years, but anyone can tell you that is BUNK), and that he thought my baby was older than 8 weeks. He told me that if I didn’t get the ultrasounds they wanted me to, when they wanted to do them, my baby could be born later than anticipated and they wouldn’t know for sure when my baby was really supposed to be born and could in fact end up stillborn. It’s kind of a strange and convoluted transition, but that is flow of our conversation. He was totally playing on my emotions (and pregnant ones at that!) to defend his point and get the outcome he wanted…

    Things like that do happen. Things like you have suggested do also happen, have happened, etc. But when educated fact-based decisions are made those outcomes you suggest are so terribly rare some would say they are practically (although not realistically) unheard of.

    I tell you this, because I think you should carefully read and research these topics ( find solid, reliable sources) because I think you will find that research and evidence line up with what Jenna shows you below.

    Also… regarding doulas: In the US it is totally illegal to have a doula birth you. A lot of people don’t know what a doula is, but I’m pretty sure that basically anyone that knows what a doula is knows they are not trained or experienced to birth a baby. I haven’t heard of any doulas trying to usurp more “power” than they are supposed to have either… =)

    Melissa Reply:

    Just a note: One of the reasons that the US has a high infant mortality rate is because we count any baby born after 20 weeks that takes a breath as living. Some countries don’t count the baby as living unless it is born after a certain point (such at 26 weeks). THAT is part of the reason our birth rate looks so bad–we count every baby born alive as “alive,” regardless of prognosis of staying alive.

    Evelyn Reply:

    Actually, I’m pretty sure the standard in the US is 24 weeks…

    Melissa Reply:

    Once President Bush signed the “Born Alive” act, that changed. We routinely have 23 weekers on our unit, and we count their live births as a live birth, and if/when they die, that is counted in that “infant mortality.” We’ve had a 22 weeker born with a heartbeat and, therefore, we’ve had to intubate it. When the baby died a day later, that birth also went into the “infant mortality” rate. Many countries wouldn’t even attempt to save the life of a baby born that young, but we have to because of the Born Alive act.

  2. Hi Jenna,

    I am usually a lurker but an amazing documentary you must watch is “The Business of Being Born.”

    kathy Reply:

    agreed. it was eye opening.

    Katherine (a.k.a. Sparkles) Reply:

    I watched it too- I’ve even lent it out to some pregnant friends who say they enjoyed the historical perspectives filmed. I actually enjoyed it! (I’m not generally a Ricki Lake fan)

    Julie Reply:

    I agree with “The Business of Being Born Suggestion.” I’d also check out the book, “Your best birth.”

    bekapaige Reply:

    Ditto Julie- Business of Being Born and Your Best Birth are fantastic works. And very non-judgemental, both towards mothers who choose natural birth and towards mothers who choose medical intervention.

  3. I think a plan is great, but I also think you need a Plan B and a Plan C for when things go wrong. And things go wrong a lot – childbirth was the leading cause of mortality among women before the 20th century. (Please remember in April that if anything does go wrong, it’s not your fault.)
    I agree that the lack of control women have in hospitals is a Bad Thing. (I hear the documentary “The Business of Being Born” is very good, btw.) Some hospitals still tie women down or don’t follow what they want, and yes, a birth plan helps combat that.
    But I’ve also seen people who have a birth plan have somebody stick to it too hard – my friend, after being in labor for more than 40 hours, decided to screw her birth plan and go with a C-Section. The midwife didn’t want to hear it, and basically forced her to try the vacuum, which wound up leaving a scar on the baby which took awhile to heal, and didn’t work.
    I think having a plan is great. I think educating yourself as much as possible on your options is fantastic. You should also research as much as possible about the common problems during labor – breach birth, baby being upside down, baby getting caught behind the pubic bone, cord strangulation, merconium, baby having a giant head… (Is there any way you could do that for credit, btw? Maybe write an independent research paper on it?) But make sure you have a plan in place for when your first plan doesn’t work – know when you will want to bail on your plan – will it be that after 24 or 36 hours at 5cm that you opt for an epidural on the chance it might help you dilate more (which my mom found with both her pregnancies)? When will you decide to go for a C-section, if your plan isn’t working out? If you have a C-section, how do you want it to go? The key to being well prepared is to plan for every possible scenario, not just the ideal scenario that you would like to see executed on a birth plan.

  4. I’m sure you will do whatever is best for you and baby. There are so many options. I have a friend who gave birth at home with a midwife. All natural and she loved it. I on the other hand have had 3 c-sections. If things don’t go according to the “plan” just keep in mind that the end goal is to make it home with a healthy baby and a healthy mommy. Find a dr. or a midwife who you trust and feel comfortable with. You don’t want to spend this time second guessing their advice.

  5. I agree with Ellie. Have a back up, just in case. While an ideal birth will go according to plan, not very many do. I know I will have to have at least two versions of my birth plan, if nothing else, to avoid disappointment. :)

  6. I’m going to weigh in from the other angle now. Not that I wholly disagree with what you other ladies have said. I don’t want to argue and I don’t want to take “sides”.
    I very much agree that one needs to have an open mind and be flexible when things go differently than they had planned and their delivery is all together different than what they “wanted”.
    But there is reason to back away from the medical establishment. Most hospitals view labor and delivery as a process that needs to be helped along. They treat it as an emergency until the baby is born and it’s proven that it was not after all the emergency they thought it would be. Mothers are told that they’ll be too tired to push, be in too much pain to relax, etc., etc. So the doctor (or anesthesiologist) comes in and saves the day. There is no trust in the woman’s body. This (and the fact that c-sections bring in more money and are more convenient) is the reason why the US has a c-section rate is up to almost 33%. Almost 1 out of 3 women here in the US give birth by way of c-section. C-section is major abdominal surgery that carries more risk to mom and baby than a natural, mother-led vaginal delivery. And to a commenter above who mentioned how much better our infant mortality rate is because of these interventions: the US has a HIGHER maternal/infant mortality rate than many third-world countries. And it’s only gone up in the last 2 or 3 decades, since technology has supposedly gotten better. And thank God for that technology! It has its time and its place. It saves lives.
    But in the countries with the best maternal/infant mortality rates (the Netherlands and Scandinavia, I think), c-section rates are down around 10%. Low- and medium risk mothers are cared for by midwives. The majority of births take place at home or in a birthing center with midwives.
    And I didn’t want to come across as being totally pro-midwife or anti-doctor. You can have a wonderful birthing experience in the hospital, although it will require a lot of firmness on your part, as well as common sense when the doctor comes in a plays the “dead baby” card.
    But most people seem to think that midwives are not prepared to handle complications. They think they show up in an apron and headkerchief, with some towels and herbs and proceed to do witchcraft. No. Midwives and birth centers are equipped with oxygen for baby and mom, IVs in case of dehydration, drugs to stop hemorrhaging, etc. And they are trained how to use those things. They are know what to do in case of a true complication. They can turn breach babies right better than most doctors. They know how to deal with problems involving the cord. They are aware of which positions can help the baby down, around, out, etc. About the only thing a midwife cannot do at home or in a birthing center is a c-section. And most midwives’ c-section rate is around 5% or less. And when I talk about midwives, I mean home birth and birth center midwives, not hospital “medwives” (some, not all, obviously) Oh, and home birth midwives don’t carry forceps or vacuum extractors, simply because they are not needed in a home birth situation.
    So I guess what I’m trying to say in a long-winded kind of way is to do your research! And I don’t mean just research all the things that can go wrong. Educate yourself on how your body is made and how birth really works. Our bodies were created to give birth, plain and simple. Sure, not all women are quite built right for the task, but MOST of us are. Birth is not something to fear or dread. It’s an incredible process that involves the beginning of a new, independent human being! And just so you know: I don’t think anyone has died from the pain yet. Yes, it’s labor. Yes, it’s intense. Yes, it HURTS at times. But there are natural ways of dealing with the pain that, if left alone, a woman who is not afraid of what her body needs to do will intuitively find.
    Ok. I’ll stop now. Sorry for the tangent.
    My name is Regina and I am a home birth mom of a precious, healthy 9-month-old. We did our research and choose the option that was the best for us. I had a totally natural, 26 hour labor (that would very likely have ended up in a c-section in the hospital), 8 minute pushing stage, no tears or stitches, up and around within an hour of giving birth, and a totally healthy mom and baby as a result.

    Evelyn Reply:

    Well said. Many of the points you brought up were just what I was thinking…! =)

    kay Reply:

    Thank God. That’s all I have to say about your post. :)

    So many beliefs are based on fear & horror stories of personal experiences. Beliefs should be rooted in fact, in my opinion, and the fact is that home birth is a safe option.

  7. So if you go to The Bump.com they have a checklist birth plan that you can use. I looked through it and was amazing at all the different options mothers have. It’s really crazy that you posted about the possibility of using a midwife because it’s something I’ve been considering lately. When, eventually, I give birth I want to be as comfortable and relaxed as I can. A birthing center using a midwife and doula are definitely something to think about.

  8. My birth plan was to have a healthy child and to trust my OB and nurses to make the best recommendations for me. I also allowed my husband to override any of my decisions because I am stubborn and knew I wouldn’t make the best decision. I did educate myself on my options but knew the only thing that truly mattered was a healthy child.

    That attitude allowed me to go with the flow when my pain became more than I could handle (hello drugs, loved ya) and when after a few pushes the OB realized Baby wasn’t coming out. One emergency c-section later and I had a beautiful, healthy baby girl – who would have been harmed if we had continued v- delivery.

    Was labor painful, yes. Was it a horrible experience, no. Am I looking forward to doing it again? Heck yea, because the results are worth it.

    As a friend said, pregnancy is 9/10 months of pain, sickness and general odd things. Labor is a couple hours of pain but it sure ain’t 9 months of it.

  9. Good for you! Of course things can go wrong, but I honestly believe a lot of the problems that result in c-sections are caused by medical intervention.

    Two cases of people I know:

    Case #1: Doctor thought baby was too big and scheduled the mother to be induced early. Baby was actually on the small side and resulted in an emergency c-section.

    Case #1: First time mom wanted to have her baby naturally. After 36 hours of labor (not uncommon for a first baby) baby was still not “ready” and she was given pitocin to speed things up. Baby responded badly to pitocin and the result was an emergency c-section.

    I’m the oldest of 5 kids, and my mother had all of us naturally–no drugs or anything. Of course, she is a pretty tough lady, but having a plan helped her.

    Baby #1 (me) was born in a hospital with a midwife. Mom hated the hospital–they didn’t treat her with much dignity and screwed a lot of things up.

    Babies 2-4 were born at home with an ob/gyn who did home births. My siblings were 9 lbs, 9lbs, and a whopping 11 lbs. My mom amazingly did it naturally, and said being at home helped.

    Baby 5 was born at home with a midwife. Mom said she was amazing–she had delivered hundreds of babies naturally and had hospital rights.

    I don’t know if I will be having my children at home, but I will be looking into birthing centers

  10. One more thing–mom also said the difference between using a birthing stool at home and lying on her back in the hospital was huge! The birthing stool made it soo much easier, in her opinion

  11. This is a really interesting topic, one that a lot of women feel very strongly about. I am just going to tell you a little about my experience and try to not be offended by the way some people have posted about c-sections.

    I am 23 years old and I am 5’0 tall. I carried my twins to 37 weeks. At 37 weeks I went in because I thought my water broke, come to find it out, it was just leaking. However, that put my daughter at risk. So the decision that my doctor and I made TOGETHER (she did not push anything on me) was to induce. She gave me petocin and broke my water. I was in labor for over 18 hours and only dilated to a 3 and I was in excruciating pain. I am one of the women who’s body is not built for birthing as well as others (I had a rough pregnancy as well, but that’s a whole different story). I desperately wanted to give birth vaginally and my doctor (who I love) wanted that for me as well. However, it was not possible. We waited 2 more hours to decide and the c-section was my best choice. Because I did not respond to the epidural the way I should have, I had to have complete anesthesia. So for some that is a worst case scenario because I had anesthesia, which means so did my babies. But Jenna, I am so lucky!! Elizabeth weighed 5lbs 15 oz and Jaxson weighed 4lbs 2.5oz. Jaxson was only in NICU for four hours for testing and Ellie never went. That is not a common accomplishment with twins. Ellie went home with us and Jaxson got to come home the next day. I am blessed and I know that my doctors and my c-section and the hospital staff (my labor nurse was awesome! Her name was Elizabeth and it just solidified that it was the perfect name for my daughter) were the best thing for me and my babies.

    That’s what you really have to figure out. What’s best for you. Don’t let anyone else’s opinion sway yours.

  12. I took an intro. to world religion class in college, and really the only thing I remember from that class that has stayed with me is the information on Natural Family Planning. Somehow that has intrigued me so much.. checking basal temperatures.. truly listening to our bodies. I hope to use NFP one day when I’m ready for kids (newly married).

    I love that you still have that woman’s birthing plan. College DOES make an impact on us, doesn’t it.

  13. Just… please… if things don’t go according to plan, don’t consider yourself a failure. A friend of mine had a very comprehensive birth plan, but over the 40+ hours of labor almost every single part of it was changed or reversed. Somewhere after hour 30, the father left for almost an hour to cry in the bathroom. The whole thing was terribly traumatic because they WOULD NOT DEVIATE FROM THE PLAN.

    It ended with a C-section, and I she was ashamed of herself and disappointed in her baby for a while because they didn’t do birth “right”. That kid is beautiful. It made me a bit sick.

    Before that, I was 100% about birth plans. Now… I still believe women should choose what they think is best, but we should all be flexible for the unexpected.

    Hannah Reply:

    I totally agree. I think this is my biggest concern (and I am nto sure I am articulating it well). I really feel the natural/non intervention movement can equally pressure women into hating the idea of medical care and makign them feel like failures when problems arise and things don’t go to plan. Yes, it is devestating because you wanted something else, but by no means is it a failure!

  14. In general, I am/was a gun-ho western medicine is there for a reason so use it! type of person. My thought was, Why of why put your self through all that pain when they’ve developed a single shot to ease it. And then i watched a documentary (whos title i am totally blanking on) that examined the increase of children social disorders (ADD, ADHD, and anti social behanvior) and found a DIRECT link to the increase in epidurals. (By direct link i mean that graph it out and the inclines are exactly the same.) Because when you have an epidural, you body doesnt release a bunch of other cascading hormones that end up with a natural dopamine that floods your body at the very end and gets transmitted to baby… thus causing an intense sense of euphoria and the key bonding moment. Doctors can replace all teh other chemicals your body release except that doped up high, and that is a cause they now believe for so many social dis orders in kids. I am not saying this is all perfect clear science, but it sure was enough to make me stop and think and I’ll probably be at a birthing center near a hospital screaming adn biting my husbands hand. (And just so no one is insulted, I was a c-section and I am ADHD and I realize not all kids are.)

    Erin Reply:

    They did not make a “direct link” – they showed a correlation. Use of ADD has gone up, and so has use of epidurals. That does NOT mean they are related. A correlation is not causation and these junk science articles and tv shows thrive on finding correlations and acting as if they mean something. There is a correlation between iphone users and Twilight fans. The number of iphone users has increased and the number of Twilight fans – and neither caused the others. There have been numerous empirical scientific studies that have shown that epidurals do not harm the child in any way. I do NOT want an epidural, but I also do not want falsities spread as facts.

    Erin Reply:

    Change in second sentence: Diagnosis of ADHD has gone increased – not use?!

    Starry-Eyed Barefoot Bride Reply:

    Erin, I didn’t say that they said it was a causation, I said link. I also didn’t say that it was harming the baby. And, I qualified it all by saying this was what I had seen that had changed my mind – nothing else. So ease on the nasty attack just because you disagree with what I typed – its called an opinion and I’m entitled to mine.

  15. When friends of mine are pregnant I always share the story of my friend Cindy. She is so down to earth and take things as they go. She had such an amazing birth, just being able to let the process happen. She just followed her body and was in no pain. Isn’t that amazing!!!!!! She really just let it happen, all natural, never had classes. So I thought I just throw this out there.

  16. Yes, this is a very vocal topic – I could talk for hours about this!

    A small portion of what I’ve learned (take this for what you will:) – -

    *Definately good to have a birth plan – but be FLEXIBLE on some things, especially the moment the baby arrives because THEY then dictate what will happen based on their health, etc. (for instance, I said I didn’t want to do the whole pacifer thing before Grant…then he was born, couldn’t eat by mouth and HAD to have a pacifer to stimulate sucking while he recovered from surgery. I certainly didn’t see all that coming!)

    *Trust doctors BUT realize that you don’t have to blindly follow what they say. Ask questions-assert what is most important to you – and make them treat you like an equal in this process (unless you’re lucky to have a doctor that already does that)

    *Don’t think of due dates as the ‘Gospel truth’ for when you’re baby should arrive. So many women go crazy when their baby goes a day over their due date – we really should be told “due at the beginning of the month” “the end” or “middle of the month” because we are all so different in our cycles and babies are unique for precisely how long they need to “cook”. Unless problems are discovered – - don’t let people/doctors influence you too much into inducing (inducing can bring on a host of problems that could have avoided and for most of my friends/peers, the reason for inducing was “I’m sick of being pregnant”.

    *Your birth only has to be as miserable and awful as you allow it! If you decide to go pain-free because that would help you have a better experience-great! If you decide to get some pain relief – great! You know yourself and what would help you have a in-control, happy experience. Do your best to make that happen, but don’t feel bad if you change your mind (even on that delivery bed!)

    You’ll do great and in the end when you finally meet your baby, you’ll be blown away by the love you’ll feel so quickly and so unconditionally for someone you’ve just met.

    Jenna Reply:

    You’ll never hear me talk about my due date ;) I’m not revealing it to anyone except husband and immediate family because I don’t want to deal with the pressure/questions/insinuations if I go over!

    Starry-Eyed Barefoot Bride Reply:

    So you’re going to keep us on pins!? I guess we’ll just have to keep checking for updates! :-D Once again, many congrats on everything.

    Katy Reply:

    That’s smart! I avoided gonig to church the day before he was born because I didn’t want everyone saying “You STILL haven’t had the baby??” (I was about 11 days over).

    I’m a complete hospital-birthing-epidural-getting woman, but the fact that I didn’t want to induce if/when I reach 42 weeks or unless there was a problem…well, you would think I was a medical rarity. Even hosptial staff were so surprised when I’d go in for tests passed my due date and I wasn’t yet asking for an induction. Baby was doing fine so I saw no reason (until 42 weeks) to kick him out. Sure I was uncomfortable, but my own comfort didn’t seem like a good enough reason. Besides – when you have a baby, you don’t just snap back into perfect feeling again. It takes a little while. Sure you might not sleep well the last month, but hey – when that baby gets there you won’t be sleeping through the night for some time either.

    I guess the whole induction discussion is only worth it depending on how much getting a C-section bothers you. I want to avoid c-sections at (almost) all costs, and since quite a number of inductions lead to c-sections…well that’s partly why. Some women aren’t all that bothered by a c-section, so inducing and possibly getting that end result wouldn’t bother them.

  17. Jenna

    I love hearing how it is you became interested in a different type of birth! I am glad you put the title of the book because it’s one I’ve heard about a lot, but haven’t read… I don’t know if the quote is in the book or if it was in the notes or what, but I know Ulrich’s work with this book is what originated the quote about the only woman who make history are those behaving badly. Makes you want to read about this woman who made history without having to “behave badly.” =D

  18. I read Midwife’s Tale in one of my American Studies classes in college. It really was eye-opening and totally fascinating. I echo the recommendations of the documentary Business of Being Born. I’m like you. I’m not yet pregnant, but I want to do a ton of research and weigh my options. I intend to interview midwives and possibly do a homebirth or use a birthday center when the time comes.

  19. I haven’t ever commented before, but I was SO happy to see this post. It really bothers me when (especially first-time) mothers don’t even research or consider any other options besides the stereotypical birthing scene. My older sister has had 4 children naturally, 3 at home and 1 in a birthing center. She’s always had a birthing plan, although it wasn’t followed at the birthing center resulting in a lot of stress and a much less comfortable birth for her. Like many of the women before me said, it’s so important to listen to your body and not be led into things blindly. I’m so glad to see you’re doing that and I know you’ll choose what feels right for you!

  20. I found a written birth plan unnecessary in my situation and have no regrets. We planned a homebirth, I trusted my midwife and she knew our wishes. I still trust her better than an OB to deal with “emergencies” such as a cord wrapped around the neck (happens in 25% of births, it’s totally normal and not a problem; babies don’t breathe, and therefore can’t be strangled. What can happen is a knot in the cord that cuts off oxygen, or the cord being compressed between a shoulder and pubic bone), or a breech baby. I knew that if I transferred to the hospital, it would be for medical intervention, in which case the bulk of the plan wouldn’t matter much anymore. My husband and sister knew my wishes in regards to labor and baby care in case something went wrong and I was unable to voice these myself. I ended up with a cesarean after more than 2 days of labor and a baby in a crappy position and I know that chances are, she wouldn’t have come out on her own. It’s not because she was big (don’t let people scare you with that one), it’s not because I couldn’t handle the pain of labor (just ignore the people that will tell you you can’t do it). (By the way, if I had been forced to labor in bed, I’m not sure how long I would have made it! Standing, kneeling, squatting, walking, swaying, even doing lunges was better than laying in bed which was torture!) I was completely lucid throughout the entire experience and had no problem remembering the things that were important to me. I was able to tell the hospital midwife I didn’t want an episiotomy (when vaginal birth was still the plan). I was able to tell the OB that I wanted the best chance for a future VBAC (transverse cut, double sutures). I was able to remind the nurses during my cesarean that our baby was not to have eye ointment. And I still believe with my whole heart that homebirth was the best and safest option for me to choose, I don’t regret it at all.

    I also want to say shame on people that discount others’ experiences. You (this is a general you) do not know the trauma or pain they go through. Everyone has a plan, whether it is written down or not, and there will be disappointment if things aren’t perfect (it’s a mother’s guilt). You have no right to judge a person’s feelings. If you are happy and confident about a cesarean or other birth, no one should tell you that you shouldn’t be. If you are upset and devastated about a cesarean, no one should tell you that you shouldn’t be. Mothers know that there are worse things than having a surgical birth. They would go to hell and back to ensure a happy and healthy baby. But the baby’s health is not the only thing that matters and birth plans are made with the health of both mother and baby in mind. I labored for 2 days because I know the risks of an epidural, that babies born by cesarean are 3 times more likely to die (among other health problems), that my future births would all be affected by this one. I made my decisions with my child in mind and when things didn’t work out as I hoped? Yes, I was sad. When I couldn’t attend to my screaming newborn because I was stuck in bed, I cried. I look at her and am in love with the gorgeous person I created. But it doesn’t change my feelings on our birth. And those are my feelings that I will acknowledge and work through in my own time. And they in no way affect how I feel about my child. It also isn’t just the *idea* of natural birth that I grieved, but everything that came with having surgery. The risks to both of us, immediate and future, the inability to care for either one of us, and everything else in between. I’m not sure why it’s ok for everyone in this country to have a dream and a goal except for pregnant women. And if that dream is lost, it’s ok feel hurt. But it also doesn’t dictate what my life as a mother will be, I’m more than this birth. I am grateful for medicine to be there when it is needed, very grateful. But it is used much, much more often than that, to the detriment of women and children (as evidenced by our horrible mortality rate).

    Some interesting posts I recently read, especially the comments!

    http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2006/8/12/when-you-buy-the-hospital-ticket.html

    http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2008/10/25/updated-birth-plan-template.html

    Evelyn Reply:

    Brie

    You are obviously very well read and educated on the issue and have done a great job of focusing on the real feelings behind emotions obvious to outside observers when a birth does not go as hoped.

    Thank you for sharing your experience and bringing some necessary perspective to the discussion.

  21. My baby girl was born 23 weeks ago. I was like you and wanted to educate myself. I think the most important part is finding a midwife or doctor you TOTALLY trust, and knows what you want to do. My doctor, named Safely (I chose him for his name, :) ) was perfect for me, avoided anything invasive.

    I was always scared of childbirth. Terrified. But I look at that day as the happiest day of my life–more than my wedding day. It was beautiful. Jane was perfect.

    Best wishes!

  22. Jenna, I just want to encourage you to keep doing your research and exploring as you have been. You are onto something here, and don’t let any horror stories scare you away from it (why women do that to each other – I will NEVER know). No watching TLC’s Baby Story, no letting all that crap that is Western birth get into your head. Do things your way & whatever way that is will be right. :)

  23. Just wanted to clarify something above, “babies don’t breathe, and therefore can’t be strangled.” True, but consider this: what would happen if you press really hard on your carotid arteries and kept breathing? Hypoxic brain injury.

    Hannah Reply:

    Exactly. It is essentially strangulation and it HAS killed countless babies. Including two in my own family in addition to nearly killing me and four of my cousins during birth. Not a ‘real’ risk? I don’t think so.

    Jenna Reply:

    You might find this study interesting: http://www.homebirth.org.uk/whatif.htm#cord

    Cord prolapse is a large risk… for high risk births. But no one in their right mind argues for out-of-hospital birth for high risk pregnancies.

    Evelyn Reply:

    My sister’s second baby was born at home with a midwife. My mom was one of her supports. As she was pushing they could see the cord on top of the head, it was in fact a prolapsed cord. the midwife was experienced and knew what to do. 1st she didn’t freak my sister out and tell her there was something wrong, 2nd she was able to manage the delivery so that my little niece was born quickly and her needs immediately attended to. She is a happy and bouncing three year old. Like doctors, midwives are educated and trained and have to meet minimum requirements and be certified. Like doctors, there are some bad ones out there, but also like doctors, most of them are well trained and experienced in their trade and perfectly able to handle the various “complications” which arise. =)

    Jenna Reply:

    I just can’t buy into the “cord strangulation = hospital essential theory”. On Ina May’s midwifery “farm” they attended 2028 births over a 30 year period. During that time they experienced 0 maternal mortalities and 8 neonatal mortalities excluding lethal anomalies, and 4 of those deaths occured during the first week of life, including a crib death (and still, only 13 deaths total in the history of the farm, including babies that were emergency transfers). Of those 8 deaths excluding lethal anomalies their were only 2 prolapsed cords.

    Plus, according to Wikipedia death from prolapsed cord is at 11-17%, which would include hospital statistics (actually because of the extremely small amount of women who give birth outside of hospitals I imagine those statistics must largely be from hospitals). Death is present both in and out of hospital births.

    *Note that their statistics count all labors initiated on the farm, whether those labors ended on the farm or now. From her book “Our statistics reflect the outcomes of every mother who is give prenatal care by the Farm midwives, whether they planned a home birth attended by us or a hospital birth attended by physicians near The Farm.”

  24. If I move back home, this point is moot for me because midwifes are illegal in Alabama. I’ve had several friends and my sister give birth. My sister’s placenta ruptured resulting in an emergency c-section that saved both her life and the life of my niece. It really was a miracle. She had a doctor who specialized in high risk pregnancies. I’ve also had friends who have given birth in hospital and the experience is nothing like you would think. It’s extremely organized, and your birth plan is followed to a t. One close friend just gave birth naturally, and the doctor wouldn’t do anything without asking her. I’m a HUGE fan of modern medicine and could not conceive of giving birth outside of a hospital, where help is there if I need it. Different strokes, different folks.

    Hannah Reply:

    I totally agree. I think my big issue is that the very women who hate the ‘pressure’ to accept western medical intervention EQUALLY pressure women not to.

    catherine Reply:

    FYI Alabama doesn’t certify independent midwives, but there are plenty of Certified Nurse Midwives practicing (and legal) there. : )

    Rebekah Reply:

    You have to give birth in a hospital, right? I thought the point of having a midwife was to be able to give birth at home or at a birthing center.

    Evelyn Reply:

    Oh definitely not! Midwives practice/deliver in a variety of settings, including hospitals.

    The basic care and treatment you receive with a midwife throughout your pregnancy is usually different with a midwife than an ob. The midwife gets all the same info from you as an ob would, but tends to focus on you, how you are feeling, what your activities and diet are like, etc. I think it’s probably one of the reasons why women like them so much. When you go to an ob you get weighed, have your blood checked, a nurse asks you how you feel, your doctor checks your cervix tells you what he can, asks you if you have any questions, and your usually done. It’s not usually as “personal” (although there are always exceptionally personal obs who aren’t so “NEXT” minded… if you know what I mean).

  25. I agree. I’m not sure if it’s part of the American culture, or just human instinct. It’s ok to say, “This is what’s right for me. It may not be for you, but this is what I’ve decided is right for me.”

  26. I read all the comments. Yay me! My thoughts: I would like a doula, a midwife, and an OB-GYN – not pregnant, haven’t overly researched it – but I know what I don’t want, to have a birth at home. Where would I do it? Would it stain the carpet? And what if the kitchen/bathroom has grout – so hard to clean. And I want to come home from the birthing center/hospital to a perfectly clean house (I’m putting Maid on my baby registry – I go into labor, people show up to clean – just the thought of that makes me smile). If you birth at home, when do you clean? You’d want it to be clean when all these people come to your house to help you birth – but do you want to be cleaning right before you start labor. And when do you clean up the mess – you have a newborn. And again, blood stains.
    So while all of you have been bickering over the triumphs, shortcomings, and evils of western medicine – I’m trying to figure out if its easier to clean up dried blood and if you use tarps do you use the blue ones?

    Starry-Eyed Barefoot Bride Reply:

    I’ve said that to people and I get a “get your priorities straight, clean up isn’t the focus here.” But really, I want gloves on for cleaning my toilets, I can’t imagine what I’d need for cleaning up birthing mess! Which makes me really like teh idea of a birthing center near a hospital (just in case).

    Regina Lynn Reply:

    I’m not here to change your mind or anything, but I just wanted to say that when a midwife attends a homebirth, they clean everything up as well. And I mean everything- the mom, the baby, the sheets, the floor etc.
    But when our son was born at home, it was only me, the baby and the sheets that needed washing- and the sheets barely had anything on them as the midwives did an awesome job of keeping them all covered with chux and making sure the mess stayed on the chux. There was not one blood stain anywhere on our carpet, or in the house for that matter.

    Erin Reply:

    Wow! I had to google Chux, but that sure sounds very clean. Impressive! I think I’m going to go the birthing center with Starry – but I firmly believe everyone should choose whatever they want, and I’m glad that the families choosing home births won’t have blood stains!

    Regina Lynn Reply:

    Haha! Imagine walking in to a homebirthing family’s home to find a huge dark stain on the carpet outside the bathroom. You ask what it is and the dad says to you, “Oh, that? That happened when Johnny was born.” Later you come across another stain on the couch and are informed, “That one’s from Susie’s birth!”
    Sorry, I have a weird mind that conjures up crazy mental images, but that’s all I could think of when I thought about blood stains and messes all over the house- LOL!

  27. I started doing a lot of research on birth choices when I got pregnant, and there is a LOT of stuff out there. Much of it is noise and agenda. I think my biggest hurdle to overcome was 1. Realizing I needed to work with what I had (at this point, that means hoping to find anyone with professional baby catching experience with any amount or kinds of letters behind their name who will take me as a new patient at 34 weeks as we make an emergency move cross country), and realizing that my baby’s birth is MY experience to be satisfied or dissatisfied with, not anything that needs to prove anyone’s point or further anyone’s crusade. I have a lot of sympathy and support for those who fight for natural childbirth, but at the end of the day I am just me and I will do what it takes to get me and the baby healthy and happy — but that also means knowing my stuff so that I am aware of common problems and possible medical interventions so when the time comes I am able to make informed decisions.

  28. What a wonderful way to start your life with your child! My sister-in-law ended up having 3 c-sections, and that terrifies me. I’m one of those strange people who dreams about being pregnant one day instead of dreaming about the kid yet being terrified of the pregnancy and the birth. I want to enjoy and be mentally present for as much of it as I can, including those crucial first days of the baby’s life when so many mothers are knocked out from the painkillers and the trauma of surgery. I’ll definitely be filing this away for the day when I’m lucky enough to be planning my own pregnancy.

  29. Oh Jenna, you’re going to love my birth story. It was truly an amazing experience. I know with complications birth can become a difficult thing, but a straightforward, natural birth (for those who are lucky enough to have one) is not something to be dreaded or “endured”. It couldn’t be further from “one of the worst experiences a person can ever go through.”

    Anyway, you know all that. I can’t wait to share my story with you soon. But, you know, newborn in the house! So, be patient ;)

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