Birth: Outside The Hospital

Please note that I have scientific data backing up every claim marked with an *. Please contact me for references where you can read these studies and papers for yourself. All quotes and statistics are taken from a fabulous book titled Obstetric Myths Versus Research Realities by Henci Goer.

I’m about to make lots o’ people real nervous (namely my grandma and family who have no experience with or frame of reference for any type of birth other than hopsital birth) by declaring that this baby isn’t going to be born in a hospital unless absolutely medically necessary. Please note that I do believe high-risk pregnancies should be taken care of by a qualified OBGYN and labor should happen in a hospital where they can address the emergencies than can arise because of this classification. According to OBGYN Catherine Buerchner 15-20% of pregnancies are considered high-risk. Ina May Gaskin, arguably the most famous midwife in America, thinks that percentage is closer to 5%. Barring a diagnosis that places me in the high-risk category or a medical reason necessitating transfer during labor, I’m having the baby outside of a hospital.

Are you someone who would never consider out of hospital birth because you believe it to be incredibly dangerous? In 1992 Fullerton and Severino did a study titled “In-hopsital care for low-risk childbirth: comparison with results from the National Birth Center Study,” which compared outcomes for women from 15 hospital-based midwifery services with women in the National Birth Center Study to examine the function that site of birth plays in labor outcomes.  To quote from that study:

[Low risk] women in hospital were more likely to receive an interventive style of labor and birth management [than similar women in birth centers]. Neonatal outcomes were … similar, although the incidence of sustained fetal distress, prolapsed cord, and difficulty in establishing respirations were significantly greater in the hospital sample. Hospital care did not offer any advantage .. and it was associated with increased intervention. The results of this study provide support for the National Birth Center Study’s conclusion that birth centers offer a safe and acceptable alternative for selected pregnant women.

Study after study shows the same thing*. Most of those who insist that choosing to birth outside of a hospital is more dangerous than giving birth inside of a hospital are not speaking against this choice based on facts and statistics they have spent time researching and learning. They are using cultural bias, personal belief systems, anecdotal evidence, or emotions (specifically fear) to back their statements, and the data doesn’t prove that this approach is best for mother or baby*.

I don’t want to give birth in the hospital because I want the least amount of interventions possible, which just isn’t a possibility in a hospital without putting up a huge fight against the system. The hospital really doesn’t want me there either. Would you want someone coming in to your work environment and telling you how to best do your job? Although some of the policies and practices listed below may be different than what you might have experienced or heard of, I believe them to be the standard, not the exception.

Reasons I’m Not Planning a Hospital Birth

  • Hospital c-section rates are on average around 30% nationally*, and for some doctors and hospitals those numbers are much, much higher. According to studies average birth center cesarean section rates are less than 5%*.  I’ll write a later post about why I’m so passionate about avoiding a c-section in the first place, but I’m far  less likely to have one just by staying out of the hospital.
  • I want to be as relaxed as possible, laboring in a quiet, dark room with the least amount of interruptions possible.
  • I want to choose who is present at the birth. If I want mom, sister, grandma, photographer, husband, best friend, and a whole host of other visitors talking and laughing with me at any time, that wouldn’t be possible at a hospital. I also want to be able to kick EVERYONE out at a moments notice, even the midwife if I need some time to myself.
  • I want the fewest amount of vaginal exams possible, and I don’t want to be told how far along I am. I believe there is a strong connection between the mind and body during labor, and I’d like to labor under the assumption that I’m doing well. My body knows when and how to push, and I’ll get there when I get there.
  • I do not want to labor on my back, feet in stirrups. Upright positions improve quality of contractions and promote progress of labor*. Upright positions reduce the need for pain medication and oxytocin*. Upright positions for pushing make pushing more comfortable, help limit damage to the perineum, and shorten the second stage of labor*. Moving around and avoiding laboring on the back also improve labor progress by rotating posterior presentations*. I want to labor in the position of my choice. (Even on the toilet if I so choose!)
  • I want option of a water birth. Though this is available in some, it is not available in all hospitals. Some hospitals allow patients to labor in the water, but force them to get out when the baby is born. I do not know of any studies to date that suggest maternal or fetal outcomes are worse when birth in water is permitted.
  • I want to eat and drink whatever I want throughout labor. Why are women in hospitals forced to have an IV and told no eating or drinking during labor? Fear of aspiration (vomiting and inhaling the vomitus into the lungs) and the belief that forbidding anything by mouth prevents aspiration. Both untrue*. In 1988 McKay and Mahan concluded that eating and drinking during labor is generally a “safe, healthy, and natural practice”*. You know what does increase the risk of vomiting and aspiration? Policies that forbid food or drink during labor, narcotics, IVs, etc*.
  • I don’t want continuous EFM (electronic fetal monitoring). EFM prevents mothers from moving around and changing positions during labor (remember all the studies above that show that laboring on the back without moving around is not the best?) EFM increases the odds of cesarean or instrumental delivery*. In 1987 Prentice and Lind said “On the basis of evidence there is no justification for a policy of routine monitoring for all women in labor. Indeed such a policy will probably expose mothers and their babies to a higher rate of morbidity because of the increased operative intervention*.” Hospitals don’t use EFM because the evidence suggests it, they use it because they don’t have the staff to replace EFM with regular intermittent auscultation (using a doppler to listen through the belly)*. I don’t want to birth in a setting where they make policies based on what is best for them, not what is best for me or my baby.
  • NO EPISIOTOMY! You keep those surgical instruments away from my perineum mister. I’ll write a whole post about this one, but the belief that episiotomies are better than tearing naturally is false, false, false,  false, false, false, false*. I can’t say it enough. Episiotomies are not easier to repair than tears, do not heal better than tears, are not less painful than tears, and do not prevent birth injuries or fetal brain damage*. Women giving birth outside the hospital are less likely to have an episiotomy and more likely to have an intact perineum*. Intact perineum is very important to both husband and myself.
  • I believe oxytocin is overused in hospitals. The overuse of oxytocin can harm the baby*. Using oxytocin increases the risk of cesarean*. Oxytocin makes labor more painful*.
  • As with all other interventions, the use of instruments such as forceps or vacuum during labor are lower outside of a hospital setting*. Use of these instruments increases the risk of having an episiotomy,  something I’ve already said quite clearly I want to avoid if at all possible.
  • Neonatal and maternal mortality rates are similar for both in hospital and out of hospital births*.  Both the baby and I are statistically as likely to die both in and out of the hospital. Even better, maternal and fetal morbidity rates are lower outside of the hospital*. I choose out of hospital birth because it means my baby and I have a much higher chance of coming out of the experience intact, both physically and emotionally. It’s what is best for both of us.

I think I could keep going but I’ll stop there, as I think these address the most common policies and interventions present in hospital births. Note that all of the reasons on this list cannot be addressed simply by switching to a different OB/GYN or switching hospitals. Some, like the water birth, are hospital policy. Others, like episiotomy, are based on OB/GYN practices and beliefs. Therefore, the best way to get everything I want is to birth outside of a hospital. So I am.

P.S.-Some of you are thinking “You don’t know how your birth will go! You might need a c-section! The cord could prolapse! You could hemorrhage! You could develop gestational diabetes! You could have placenta previa! Your baby could be breech!” As with all major life decisions we realize there are risks involved with every decision, and we are doing the best we can to prepare for incidences would would create a departure from the plan. By educating ourselves (meaning TH and I) we feel we have collected enough data to weigh the risks of our decisions against other possibilities and that our education gives us the necessary means to develop alternative plans.

162 thoughts on “Birth: Outside The Hospital

  1. Interesting information. I myself, have never even thought of having a midwife… I honestly didn’t know you could do that these days. With your information, when the times comes, it might be something I consider.

    I will have to check out more about this, in addition to some of the books you’ve talked about.

    Thanks!

  2. Jenna, I’m so looking forward to reading more of these posts. My hubby and I are TTC, and I’ve never really given much though to birth before. Honestly, I’d always figured I’d have a c-section. Why? No real reason, except that’s what my mom did. Reading your research, reading your views, even I don’t agree with all of them, is enlightening. And I love, love that you are so passionate about your beliefs in this. Gotta respect that!

  3. Holy moly. When you said you did research, you weren’t kidding! :-) Good for you on making an informed decision. I’ve always figured hospital births are safer “in case something goes wrong”, but you make a convincing case. And I would love to be able to walk around and eat and drink whatever I want. I am a firm believer in things like, “If your body tells you it wants food/water, it DOES.” If you’re craving salt, it’s for a reason, so eat it. If you’re repulsed by fresh fruit juice, even if you’ve had it every day of your life, don’t drink it. Obviously your body desn’t want it.

    Sarah Reply:

    Off topic, side note… I just read that if you are craving salt you might actually be low in calcium ;) Go figure!?

  4. My mother had 4 of her 5 children at home (including my 11 lb. whopper of a brother) and loved it. I think you will too :)

  5. Hi Jenna,
    Did you ever respond to the questions in the last baby post about getting a midwife/obgyn? There was a lot of confusion over whether you had not gotten any prenatal care up to this point or if you had but just had yet to pick your specific midwife for your pregnancy. Last time I checked, you’d never responded to those questions in that post. I’m genuinely curious what the answer is, and I think a lot of your readers were. Can you clear that up for us please?
    Thanks you! Looking forward to posts like the one today- I enjoy hearing your plans even if they don’t mirror what I think mine will be!

    Jenna Reply:

    Megan,

    I’m debating writing a post about it. I haven’t decided yet.

    phruphru Reply:

    Sounds like you are giving us an answer with this. If it is indeed the case that you are not seeking prenatal care, you should definitely write a post explaining why. I know of people who have given birth at home and I have learned even more about it through your posts, but I have not heard anything about the idea of not going to a doctor, etc. for pregnancy checkups and would like to hear why this is the avenue you have chosen.

    phruphru Reply:

    p.s. I 100 percent respect your decision to give birth at home and hope you continue to tell us more about it.

  6. I just wanted to add a few things. Although the United States C-Section rate has climbed steadily over the past 11 years (50% increase in the last decade!) It has not lead to better outcomes. In fact, the US has one of the WORST infant mortality rates of any developed country. It has gotten worse in the last 50 years, its not improving.

    Although the US currently has a c-section rate of over 31%, The World Health Organization (WHO) recommends that the cesarean section rate should not be higher than 10% to 15%, and in fact anything higher is unnecessary and excessive.

    It is also ridiculous that hospitals are limiting food and drink during labor since finally even our own American College of Obstetricians and Gynecologists have admitted that women should be able to drink should they choose. Labor is one of the most physically demanding things your body will EVER go though. Who would run a marathon without any nutrition or fluids?

    It is so important to educate yourselves. Our hospitals are run to make things more convenient for the doctors (insane c-section rates, women delivering on their backs, time limits on labor and pushing), and not in regards to research or with the laboring woman’s best interests in mind.

    If you’re just starting to research unmedicated natural labors and deliveries, a good place to start is with the movie “The Business of Being Born.” If you want something more in depth, Ina May Gaskin’s “Guide to Childbirth” is excellent as well.

    Cesarean delivery rate article and graph:
    http://www.theunnecesarean.com/blog/2009/3/18/c-section-rate-rises-2007-us-cesarean-rate-hit-318-percent.html

    NY Times graph showing infant mortality rates by country 1960-2004:
    http://www.nytimes.com/imagepages/2009/04/06/health/infant_stats.html

    WHO bulletin about c-section rates:
    http://www.who.int/bulletin/volumes/85/10/06-039289/en/index.html

    ACOG Recommendations Relax on Liquid Intake during Labor:
    http://www.acog.org/from_home/publications/press_releases/nr08-21-09-2.cfm

  7. I love reading all your posts about birth. I’ve only been married for two months, so no babies any time soon. But I’m definitely thinking along the same lines as you. There is even a hospital very close to us that offers doulas and birthing tubs. :)

  8. Yes, yes, YES! I agree so much with this post! You are so right on about the myth of episiotomies and everything else too. You have put pretty much all my reasons for home birth, as well as studies and quotes that demonstrate that it is a safe alternative for low risk women into one blog post! I may just have to link people to this when I get those questions during my next pregnancy.
    Our first baby was born at home and, if at all possible, we want to continue to have all of our children at home. With my son, I was in labor for 26 hours, which is far longer than most hospitals will let a woman labor without “augmentation” (pitocin, of course). I was able to do pretty much whatever I felt like doing- heck, I was blogging at 6 cm.! When pushing stage (finally!) came, I actually ended up delivering on my back because that’s where I was when the midwife checked to make sure I was completely dilated and my son was born 8 minutes after the first pushing contraction. Had my pushing stage been longer, I no doubt would have taken another position for delivery, but when that first urge to push came, he was right there- I think they could see his head with my first push! After that I pushed just because the intense pressure, not even waiting for the next contraction. BUT I could feel everything and could therefore push much more effectively. I don’t know how, but my body knew exactly when to push, how hard, and when to let off a little bit. And even though I was not in the optimal pushing position and I wasn’t waiting for the contractions, by letting off when it burned and , basically, just listening to my body, I came through with the equivalent of a brush burn- pretty much nothing, definitely no need for stitches. And my son was out for no more than 2 seconds (I am SO not kidding you) I sat up and asked, “Can I have him?” (even though we’d had some ultrasounds, we’d chosen not find out what the sex was, but I had a strong hunch) and grabbed him out of the midwife’s hands before she had a chance to answer. The only reason I remember this is because my husband and midwife told me and were chuckling over it. All the midwife said was, “You worked HARD for that baby, of course you can have him!”
    Afterwards, while getting all cleaned up, delivering the placenta, etc. The midwife said that I already looked almost back to normal down there. There was no swelling, no big nasty cuts or tears, nothing.
    So yeah, compared to the fact that I very likely would have had a c-section in the hospital, I would so much rather go for the home birth experience again.

  9. Hi. I read your blog on a daily basis because of your free spirit in blogging on what you believe. I commend you.
    My cousins are both doulas and they love every minute of it. The one had a home birth and it was beautiful (she took photos and video) and now the other one is pregnant and is doing the same. When it’s time for me to have a baby I think I would really lean on home birthing…it’s a completely different experience.
    Happy pregnancy! Happy delivery! Happy life!

  10. You are so brave Jenna! I hope that I am as well researched and feel as powerful about my decisions when the time comes.

  11. I was wondering how you feel about the UK birthing system? It seems like it would appeal to you, since you are interested in a non-intervention birth attended by midwives, rather than doctors. That is how most UK births proceed, in hospitals, provided there are not complications. All of my friends with babies have had them in UK hospitals, attended by midwives, rather than doctors, without drugs. They’ve been very pleased with the experience. I have often wondered why a similar option isn’t available in America, since so many births proceed without incident or complication.

    Jenna Reply:

    Oh how I would LOVE to be in the UK for one of my births. I’ll cross my fingers for a good job there for TH someday. Other places I want to give birth in include the Sweden and UCSD medical center in San Diego.

    Kasia Fink Reply:

    Do you mean to say that in the U.S. you do not have an option to have a midwife-assisted delivery in a hospital? Wow, I didn’t know that.

    Well if you’re thinking about it, you don’t have to go all the way to the UK – come up to Canada. Deliveries by midwives in hospitals is quickly gaining popularity here among mothers who want all the same things you mentioned in your post but also the security (a lot of it psychological, I’d imagine) of being in a hospital.

    Midwives here are covered by the Canadian public heath care system so there is no extra fee to be delivered by a midwife than a doctor.

    We are lucky, I know. This option should definitely be universal.

    Jenna Reply:

    In the United States there are two classifications for midwives. Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM).

    CNMs start as nurses and take two years of extra schooling to become certified as midwives.

    CPMS are also known as direct-entry midwives, as they don’t do the years of nursing school beforehand. Certification for what classifies someone as a CPM varies from state to state (of course!)

    Although CNMs have more medical training, both classifications have the same amount of midwife training.

    The majority of CNMs practice in hospitals and birth centers attached to hospitals. CPMs practice in freestanding birth centers and home births. CPMs absolutely cannot work in a hospital, and there are very, very few CNMs that practice outside of hospitals, and even less that do home births.

    As I said above, for me it’s about staying outside of the hospital in the first place, where policies like nothing but ice chips, how long you can labor, how you can labor (no water), etc, are forced on midwives. If we are ever really poor in the future though, and can’t afford to pay for the home birth, I’ll be looking for a CNM in a hospital. I love the UK approach of using a midwife as the primary, and OB as the backup when things really do go wrong.

    Kasia Fink Reply:

    That’s interesting! By contrast, in Canada Government regulated midwives (and hence covered by health care) “must be competent and willing to provide care in a variety of settngs, including home, birth centres, and hospitals”. This means that here, it is truly up to the mother as to where she gives birth; indeed, she can change her mind at any point during the process, allowing her to stay at home if she had planned a hospital birth, and vice versa.

    About hospital policies being forced on midwives, I don’t think this is always the case in Canada. But it’s a good point and I do think it’s the responsibility of the couple in labor to ask those questions.

    HamiHarri Reply:

    Yay Canada!

    HamiHarri Reply:

    Oops – double post ;)

    HamiHarri Reply:

    Yay Canada! I *heart* my country :)

    Woodentulip Reply:

    As an interesting note, Alberta only just listed midwifery as a covered service this past spring. Prior to that, costs associated with the care of a midwife were the responsibility of the patient. As such, demand was not that great, and the province only has approximately 35 registered midwives…not nearly enough to cover the demand for service now that it is covered!

    Steph Reply:

    Another big difference between CPM’s and CNM’s are that they are certified by different organizations. A CNM receives certification according to the requirements of the American College of Nurse-Midwives, whereas a CPM means they have met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only *international credential* that requires knowledge about and experience in out-of-hospital settings. CNM’s often do not practice all the aspects of the Midwifery Model of care because they are usually more “medically minded” and are working under an OB. For example, one CNM practice in our area has episiotomity rate of 15%.

    Some CPM’s can and do practice in hospitals. They just have to defer to an OB should a complication arise (just like a CNM would). Gaskin is a CPM and has attended many hospital births. Our city’s CPM will support you for a hospital birth should you be required or choose to go that route. Many insurance companies will not cover a CPM, whereas they will cover a CNM because most CNM’s are part of an OB’s office.

    Besides CPM’s and CNM’s, there are also CM’s which are individuals educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives. They are not allowed to practice in all states.

    There are also direct-entry midwifes (DEM’s). They are independent practitioners educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings. Most CPM’s begin as DEM’s, then go on to receive their certification. Not all DEM’s become CPM’s.

    Also licensed midwifes. LM’s are midwifes who are licensed to practice in a particular jurisdiction (usually a state or province).

    Different states have different regulations about what type of midwife may or may not attend births. The best states for a DEM would be: Washington, Florida, Oregon, California, New Mexico, Arizona, Arkansas, South Carolina, Alaska, Colorado, Louisiana, Montana, New Hampshire, Texas, Tennessee, and Kansas. The worst; New York, and now, Illinois. The others fall in the middle and it can vary from one county to another.

    http://mana.org/definitions.html

    Kelli Nicole Reply:

    To answer everyone’s questions, midwives ARE available in most (some?) hospitals and my sisters delivered most of their babies in hospitals with midwives (though that option was recently taken away from the hospital my sister works at). I think she means that it’s just much more common there than it is in America.

    Evelyn Reply:

    I think it’s really only SOME hospitals. I’ve been researching that information in my new home area, the DC area, but mostly NOVA, and there really aren’t that many options. So far I’ve only found 2 practices that have midwives with hospital permissions in a 75 mile radius. And I believe those midwives only have access to 2 hospitals. (I’m still researching, but that’s what I’ve found so far.) I think midwives are more commonly able to deliver in hospitals in large metropolitan areas, but when you consider how large an area is, how many hospitals there are, and then how few hospitals give permission to midwives, there really aren’t that many midwives in hospitals. So sad.

    Kelli Nicole Reply:

    Wow, that sucks!! One of my sisters just moved near Minneapolis and they have great hospitals there with great midwife care, but I know everyone’s not so lucky, I just didn’t realize it was so bad in some places!

    MrsW Reply:

    Minneapolis has wonderful options (I’m originally from there), but try finding a midwife in Jackson, MS. I think there are maybe 3 in the entire state.

    Becky Reply:

    I don’t know whether it’s not an option in the US, but in the UK, like in Canada, a midwife assisted birth is “standard” on the National Health Insurance (public health care). Of course, if there is a complication, there are OBGYNs in the hospital to care for the baby and the mother (again, free of charge. Three cheers for public health care!). Also, anesthesiologists are on hand to administer an epidural if the mother chooses one. This system of having a midwife as standard, rather than a team of doctors, seems like a much less alarmist way to approach childbirth.

    Brandy Reply:

    Just wanted to add more to the Canadian view…when my sister had her daughter(induced in a hospital, don’t even get me started on that, told she was too short to have her baby! My Nanny gave birth to twins and she was 5 foot!!) she was allowed to have whoever she wanted in the room, encouraged to eat whatever she felt like, told to walk around, there was a ball in the room if she felt like labouring there. The hospital policies were great that way…her ob/gyn was a horrid man who basically walked in the room and told her if she didn’t have her baby by the time his shift was over she was getting a C section.

  12. I am really struck by the fact that you are quoting data that is 21 & 22 years old. I have not gotten pregnant yet, so I havn’t done any research on my own. I have no way to know if this old evidence is still correct, but when reading your arguments….when you use data that is two decades old, I think it weakens that argument. I wonder “is this stuff even still true? Has it been proven wrong since?”

    TH Reply:

    We’d love to find studies that are more up to date (the research can be quite difficult), but in many cases it shouldn’t affect the outcome. For example, the study about aspiration after eating is as likely to be true today as it was 20 or 100 years ago, because no new technology has been invented to materially affect the outcome. In other cases, it would be great to have newer studies, but in absence of finding anything we’re following the last studies we know of.

    Laura Reply:

    Interesting. It’s unfortunate that there is not a lot more information out there.

    Laura Reply:

    Interesting. Fair enough

    Ellie Reply:

    C-Section rates are actually up at a lot of hospitals, I was reading recently. I think somewhere was saying it’s up to almost 50%?
    What I find more striking is the fact that these studies are 20 years old and hospitals still haven’t changed their policies (and in many ways have gotten worse!)

    Jenna Reply:

    I would say there are two reasons why I’m not quoting more recent research

    1. I have a life, and I’m not ready to devote it to reading through stacks of difficult to interpret medical literature. Plus, remember that statistical data found in studies like this is always going to be “old” because it takes time to compile and analyze. If you want quotes from websites (that say the same thing actually) that is more up to date, I can use it, but I don’t think it’s as credible as peer reviewed data published in medical journals.

    and

    2. As Steph quoted above, the US has a rather awful mortality rate and has actually declined in its rank compared with other countries. And since birth and bodies are the same around the world, the only conclusion I can come to is we aren’t doing it better by intervening more. As medical intervention rates rise, maternal and fetal death rates are NOT falling. If the newest developments were really helpful, they would.

    HamiHarri Reply:

    I was going to say the same thing Laura…I would be reluctant to use sources older than 10-15 years old ;) Granted, Jenna made her point when she said this isn’t her full time job ;)

    Katie Apker Reply:

    The data Jenna referenced has been reaffirmed countless times throughout the last 20 years. Check out Jennifer Block’s book “Pushed (2008)” – it’s a compilation of the most up-to-date peer-reviewed scientific literature on midwifery and home births v. hospital biths.

    Jenna Reply:

    FYI, people who read this comment, Katie Apker is the most intelligent person I have EVER MET. She actually had a scholarship that paid her to go to school. Yep, she made money going to college! And then she got accepted to law school. You can bet she’s done her research. :)

    UP Reply:

    Not to mention that because the citations aren’t even listed, there is no way to tell if they are from reputable sources. There is a lot of junk science out there… though I didn’t find any glaring errors that stood out on my first read through.

    I’ve just taken care of too many kids in the NICU who are neurologically devastated from their “very natural” home birth.

    Everyone has their own tolerance for risk, and I’m fully aware that mine is informed by the bad outcomes that I’ve seen.

    But if you haven’t sought pre-natal care and don’t even know if you are having twins or have other complications then it’s pretty hard to definitively say that a home birth is a good idea…

    But to each her own.

    Jenna Reply:

    Up, would you like the references? I didn’t take the extra 2 hours adding them in because I knew that NO ONE WOULD ACTUALLY READ THEM. If you really want them, email me and I’ll give you every single one.

  13. Jenna,

    I 100% respect your right to choose the way you will have your baby. I hope your birth is everything you hope it will be.

    I just also hope that you respect women who choose to go the hospital route and that had to have interventions for one reason or another. It comes across a tiny bit hurtful how negative you are about these things.

    I do not mean that in an aggresive, mean commenter way at all. I just wanted to say what I have been thinking when reading your blog lately (especially since I had to have a c-section not even 5 months ago).

    Heather

    Anna Reply:

    Heather,

    Jenna’s presentation of her reasons did not reflect judgement of mothers who choose hospital births. It just gave evidence of hospital practices and why she is choosing a home birth.

    Heather @ Sellers Gang Mama Reply:

    Anna,

    I was trying to be clear in my comment that I wasn’t being ugly. I wasn’t even saying that Jenna was being judgmental, just a bit negative.

    And the reason that I mentioned that I felt that way while reading LATELY is because I wasn’t referring to this particular post. I was instead referring to an overall tone while discussing birth.

    I hope that’s more clear. And Jenna, I hope you don’t think I am being rude. I am just a bit sensitive about this topic as many people are very cruel about c-sections and sometimes you have to have one to do what is best for your child, which is what I did. I just want to point out a different perspective.

    Heather

    Ellie Reply:

    I think that Jenna does respect women that go the hospital route, but she’s having trouble articulating that. I think this post did a much better job than her past posts about explaining why she is making the choices she is making.

    I think in every choice any person makes, there is always a grain of judgment, because there are two alternatives and you have to pick one that is better for you, which inherently says that one choice is not as good, and it is very hard for those of us who made a different choice to not feel that our choices are being judged. I don’t think Jenna means to sound so harsh, but I think she’s in a tough spot where she is really trying to explain why this is what she thinks is best for her and it is almost impossible to do it without sounding judgmental, especially when you feel this strongly about something. It’s also particularly touchy in an area like c-sections where a lot of people don’t really have a “choice” per se, because something went wrong, they had a pre-existing conditions, they had insurance issues, etc. It’s just a deeply personal subject and it’s very hard to not seem judgmental, or not to feel judged.

  14. That’s awesome. You make me want to seriously consider a home birth.

    One question: are you having a midwife that is medically trained? Lay midwives are the only objection I have. I think there is a reason people are trained for years in medicine and nursing.

    Jenna Reply:

    I was only able to find one CNM (certified nurse midwife) in Dallas who could attend my home birth and she wasn’t available in April. We searched really hard for one because our insurance would likely cover with a CNM but absolutely won’t with a lay midwife. I’m completely comfortable with a lay midwife though.

    Most medically trained midwives (CNM) work in hospitals. I just read that only 2% of CNMs nationwide do home births.

    UP Reply:

    Please don’t let anyone else convince you about home birth. Do your own research and find your own resources. It’s your babies life and health, and you owe it to yourself to not be influenced by others.

  15. Regarding the debate on the actual incidence rate of high-risk pregnancies (Catherine Buerchner stated 15-20%, Gaskin stated 5%) I believe the discrepancy in the numbers is due to the time period those women were referring too. If you are over the age of 35, you are automatically considered a high-risk pregnancy by both hospitals and midwives. Same if you are having twins. Since the age that women are giving birth is increasing and the rate of twins is increasing, thus the incidence of high-risk pregnancies are increasing. So both women were likely “correct” – they were just quoted in different decades.
    It bothers me that once you crest 35 you are automatically considered high-risk.

    Jenna Reply:

    Excellent point Erin. I was listening to a podcast on high risk pregnancies and one of the women was hoping to get pregnant before she turned 35 just so she could avoid falling into that category! It’s a little frustrating that we can’t evaluate each pregnancy on an individual level.

    Steph Reply:

    Actually, most midwifes, especially DEM’s and CPM’s do not consider either twins, previous c-sections, or women over 35 to be high risk.

    Also, Ina Gaskin has maintained an intervention rate (forceps, vacuum extraction and c-section combined) of under 3% (1.4% for c-sections). That was from the 1970′s through the present, her stats have not increased over time.

    Here is a link that has some of the data from 1070-2000. At that time the midwives had attended around 2000 births. It is now almost 3000: http://www.naturalbirthandbabycare.com/farm-statistics.html

    You can find a lot of statistics in her books as well :)

    Erin Reply:

    I’m unsure if what is practiced differs from the definition, I just know that at the birthing centers I’ve researched in Southern California, you can’t be pregnant with twins. Or triplets. Just one. :( For home births (which I really don’t want – see my past comments on fears of staining the carpet), since midwives are like independent contractors, maybe they can decide what they are willing to do at home (twins, over 35, etc.). I just really want twins AND I really want to birth at a birthing center. Hopefully I’ll get everything I want :)

  16. I have no clue what an episiotomy is but it doesn’t sound good. I think a home birth is a great idea. I wouldn’t do it personally but I think it’s best for the baby for the mom to feel at ease. I like the idea of being able to eat during pregnancy. I want a smoothie not an IV.

    Evelyn Reply:

    Ha! what a good idea… the smoothie would replace the IV and the abominable ice chips they offer! =D

    Lillindy Reply:

    Episiotomy = http://en.wikipedia.org/wiki/Episiotomy

    Now that you know, OUCH, right!?! I know for sure I don’t want one when I have babies.

    Starry-Eyed Barefoot Bride Reply:

    No kidding!! I googled it halfway through reading Jenna’s post and cringed. NO THANK YOU!!!

    Amanda W Reply:

    I had one and I was terrified about it, but when it was needed, it wasn’t that bad. They numb the area and do it while you are having a contraction and pushing. I didn’t feel it at all. I also felt no pain afterwards as well, but each doctor is different. I was lucky to get a VERY good one. I have heard horror stories about episiotomies going wrong!

  17. In nursing school I witnessed a typical hospital birth. I was struck by the disparity of what we, as nurses are taught about birth being a natural experience and what I actually witnessed- interventions simply to “move things along” to fit a phydicians schedule, not the mom and baby. Seeing the home birth on TLC of the newest Duggar addition I was overwhelmed by how natural the birth seemed. Like the natural part of life it is. And how miving for the father to be an active and natural participant. I can only hope your family has a likewise experience. It seems you’ve thought this through!

  18. I agree with your post and believe that the less interference with the natural birth process the better.

    I do take issue, however, with the statistics about hospital and home birth mortality rates. There are too many confounding variables to take these statistics at face value. For example, since the hospitals are dealing with all the high risk pregnancies – including multiple births (which have also increased hugely because of invitro and other fertility methods) it follows logically that they would have an increased mortality rate than if they limited their services to delivering low-risk pregnancies.

    Further, on the comment about U.S. mortality rates in comparison with other developed countries it is important to note that most of these other countries only count the life after the baby has survived for one week while the U.S. begins the count right at birth. Therefore, you can’t compare U.S. infant mortality rates with those other nations who count differently.

    Finally, I think your intent is good but I had a friend who lost a baby during labor. Is the fight to not have an episiotomy or to be able to push from any position worth that risk in the end?

    Anna Reply:

    I’m sorry to hear of your friend’s loss. What was the loss due to?

    TH Reply:

    Little Debbie, I think your last paragraph makes a lot of assumptions that may or may not be true (e.g. has your friend had a home birth, would that birth be saved in hospital setting, etc.). I think the point you are trying to make is whether birthing at home is worth the risk of infant mortality.

    None of the studies we have seen indicates that infant mortality or morbidity is higher with home births vs. hospital births, in fact, the data points to the contrary. While you argue that the statistic is flawed because hospitals handle more high-risk births, there are no studies I have seen that show hospitals to be safer for low-risk births. If hospitals (or ACOG) wanted to show they’re better by releasing low-risk statistics, they could easily prove home births inferior. The fact that they only point to weaknesses in the aformentioned study means that they don’t want to release these statistics either because (1) they don’t want to commit the resources or (2) they’re not confident in the answer it would give. Given how many resources are committed to studies of lesser significance than this one, I’m guessing it’s the latter.

    Cristin Reply:

    TH! I love when you play along with us and comment!

    I think LD’s point was just that saying all hospital births are not as safe as all home births is an unfair comparison. I think (think!) her point was just the same as yours – there is no apples to apples comparison about low-risk births in both locations. I think you are right that it would involve a high number of resources to find women willing to participate in both settings and then find enough women to match all of the variables that occur in pregnancy to actually have an apples to apples comparison (as in – just calling a woman low risk isn’t enough to compare, you’d need to match age, para/gravida, pre-natal care, etc across both locations).

    I agree with her statement that all hospital births cannot be compared to all midwifery/out-of-hospital births, because there are simply too many variables.

    Cristin Reply:

    I agree with Little Debbie’s point about confounding variables. Different countries measure infant survival in multiple ways. Similarly, higher rates of American obesity, diabetes and heart disease contribute to higher infant mortality rates as well – to attribute higher mortality with increased birth intervention alone (or even substantially) is unfair.

    Jenna’s right – these studies take years to produce and to be approved. Studies have biases (who is paying for the study? What is the background of the researchers? Who is the population? Where are they from?) and its unsafe to extrapolate conclusions that haven’t been approved by the peer reviews.

    I certainly enjoyed the change in perspective that Jenna offered and look forward to learning more about her experience.

    TH Reply:

    PS. Debbie, could you point me to the infant mortality criteria in US vs. other developed nations (i.e. that US is one of the few countries that counts mortality right after birth). This would be a *major* flaw, and nobody in the NY Times article points to it. Their quote from CDC is “We think the increase in preterm birth and preterm-related causes of death are major factors inhibiting further declines in infant mortality.” If I were CDC or ACOG I’d be running to the NYT about how the study is completely flawed to begin with, but that’s conspicuously missing here.

    MrsW Reply:

    TH, here is a blog post I have read that links articles discussing this issue. I think Jenna already reads this blog, as she linked to it the other day, but I don’t know how far in the archives she has read:
    http://womantowomancbe.wordpress.com/2009/08/31/comparing-apples-to-oranges/

    While I agree that it is significant that the US’s system of pathologizing birth has lead to worse outcomes than necessary, I think our attempts to save the lives of extreme pretermers also has an effect on our infant mortality rate.

    Cristin Reply:

    Hi TH –
    I am in a Masters program for Healthcare administration, and I know that I’ve heard this complaint several times in classes. I can dig harder to find it in my academic literature, but quick googling revealed:

    Healthcare Financing Review, Summer 1992 “International infant mortality rankings: a look behind the numbers” (free version here: http://findarticles.com/p/articles/mi_m0795/is_n4_v13/ai_13359858/?tag=content;col1)

    and another one here from National Center of Policy Research in DC (http://www.nationalcenter.org/NPA547ComparativeHealth.html), which offers, for example, that Switzerland only counts infant mortality if the infant is over 30 centimeters.

    Here’s an article on a Human Rights website that quotes a UNICEF press release about how former Soviet countries measure infant mortality and how it under represents the numbers. http://www.reliefweb.int/rwarchive/rwb.nsf/db900sid/SZIE-5ZALBR?OpenDocument

    As to your comment about the CDC not running to the NYT… I think that if every governing body chased the newspapers every time a story was slanted or omitted information, the government agencies would never get anything done.

    TH Reply:

    Cristin, thanks for the details and backup data. I’ve looked at the articles you pointed to and I was still surprised that reputable organizations would use studies when they know of such serious flaws (it basically makes the whole comparison nonsensical).

    I decided to go to Wikipedia, as articles on these types of things tend to have a balanced opinion from both sides of the argument. Here’s what they say: “While the United States reports every case of infant mortality (according to the WHO definition), it is often claimed that some other developed countries do not[.] However, all of the countries named adopted the WHO definitions in the late 1980s or early 1990s, which are used throughout the European union.” So some of the articles may just be too dated to account for this solution. Also, UNICEF apparently decided that if you want the job done right, you’ve got to do it yourself, so they came up with their own model of normalizing the data set. Wikipedia points to the results here: http://mdgs.un.org/unsd/mdg/SeriesDetail.aspx?srid=562.
    The US still comes in in the 40′s, which helps triangulate the previous statistic.

    All in all, I don’t think infant mortality is really a good indication of whether hospital birth is better than home birth, because of all the variables involved, but US seems to be doing worse than expected in the category.

    PS. To continue this tangent… as far as CDC/ACOG running to the NYT, the CDC was already commenting about the statistic (attributing it to preterm birth), so all they had to do is say that the data was flawed. However, it turns out that they are the ones who released the study, so either they adjusted the data or didn’t want to make themselves look bad or they wanted to show things as badly as possible. But again, if CDC releases a study that says, in short, “US infant mortality sucks” and if in reality it’s fine, I would expect ACOG or *someone* to speak up and say the study is bogus.

    Jenna Reply:

    Just a note-Credible studies published in peer reviewed journals are going to be as standardized as possible. No respectable scientist would want to tarnish their reputation by publishing a study that compares low-risk birth to high-risk birth. In the studies I’ve read they note things like “standardized based on age, parity, hyptertension/toxemia, prenatal risk predicution score, method of delivery, and birth weight”, “women were stratified by socioeconomic factors and grouped by pregnancy and labor risk scores”, “this study matched 250 low-risk women who started labor at a Miami birth center to women of similar age, parity, ethnic background, financial status, and risk stuts who labored at its associated tertiary care hospital”, “Populations were similar in age, parity, marity status, and education through high”. I think most researchers who care about their reputation among their peers are going to do their best to release data that is based on statistically sound comparisons.

    Evelyn Reply:

    “For example, since the hospitals are dealing with all the high risk pregnancies – including multiple births (which have also increased hugely because of invitro and other fertility methods) it follows logically that they would have an increased mortality rate than if they limited their services to delivering low-risk pregnancies.”

    One of the reasons why Jenna’s research is so enlightening to so many is that for YEARS the hospital has not been the place where only high-risk births occur. It is the place were MOST births occur. Regardless of risk factors.

    Jenna wrote:

    “I’m about to make lots o’ people real nervous (namely my grandma and family who have no experience with or frame of reference for any type of birth other than hopsital birth) by declaring that this baby isn’t going to be born in a hospital unless absolutely medically necessary…

    “Most of those who insist that choosing to birth outside of a hospital is more dangerous than giving birth inside of a hospital … are using cultural bias, personal belief systems, anecdotal evidence, or emotions (specifically fear) to back their statements, and the data doesn’t prove that this approach is best for mother or baby.”

    Although I do not have the statistical numbers, I am certain we can all attest to the fact that MOST births in the United States are in HOSPITALS, regardless of low or high risk. I know plenty of low-risk women that found themselves with c-sections, and in most instances, it had more to do with interventions, hospital and doctor protocol and lack of understanding of the body’s timetable than the woman’s ability to deliver a healthy baby vaginally.

  19. It’s fair to bring up that this information is correct. One of the reasons, though, that C-sections are high is because of medical malpractice lawsuits. Malpractice insurance and lawsuits are expensive for doctors. Doctors are scared ___less. Because every woman is different during labor and complications can quickly arise, doctors are quick to operate. There are times that women have complications arise and a doctor will want to see it through and a child can suffer damage. This is where lawsuits can occur. Not stating an opinion in one way or another. I have been very objective. Just stating the facts. Jenna’s facts are correct. And not to blame doctors, either. They are just wanting to save their tail and sadly, this is just the way it is. But, one day I hope it changes.

  20. I’m not pushing for hospitals or for home birth, I appreciate Cristin and TH’s comments about the competing agendas. I do think that home births, midwives, doulahs deserve more attention and respect. I think they are great, but I think that hospital intervention isn’t a bad thing – obviously, the woman should be in the environment where she feels the most comfortable. For some that means hooked up to IVs and monitors, for others it’s in their home.

    My friend gave birth in a hospital – I don’t know the details except that she was considered a low risk and something just went wrong during the delivery.

  21. Just a quick something about the episiotomy… one of my best friends had a natural hospital birth but labored most of the time in her mother’s home; her mom is an OB nurse and was able to check her and get the baby’s heart rate and make sure she was progressing. When she got to 7cm and was transitioning, she went to the hospital. She had no drugs or IV. She didn’t want an episiotomy, but when she was pushing, her little girl just wasn’t coming, and the doctor suggested an episiotomy. It was 1/8 of an inch, and she said it was the worst part of childbirth. However, the baby was born 2 minutes later. She said it was the right decision at the time for her and the baby. Since it was only an 1/8 of an inch, she healed very quickly. She was supposed to be on “pelvic rest” (no sex) for 6 weeks… she and her husband lasted 3 weeks and she decided she was fine, and she was.

    Episiotomies aren’t always terrible, especially if it’s teeny tiny.

    Contrast this with her sister-in-law, another good friend of mine, who did not have an episiotomy and tore quite a bit, down as well as across…..

    Just sayin’.

    I’d rather have 1/8 inch tiny cut with stitches than an inch long tear in two directions. OUCH!!!!

    schmei Reply:

    A midwife friend of mine told me that episiotomies are a bad idea for women who plan to have more than one child, because the natural tears that happen in childbirth tend to happen to weaker tissue, which then heals over with stronger scar tissue. Episiotomies just randomly cut strong tissue and don’t heal up as well…

    I’m not explaining it as well as the midwife did, but tearing in and of itself is not the end of the world. Sometimes it can leave a woman stronger, especially for her second delivery.

    JessicaMayBe Reply:

    Hmm I haven’t heard that. My friend who needed one isn’t planning on having any more babies, so I guess it’s okay in her case :)

  22. I have had a weird, weird pregnancy so far, not in terms of health, but just life circumstances. I had to make a cross country move with a subsequent doctor change at 34 weeks, and the new doc is mandating continuous EFM, but says he will support me in natural childbirth. I’m a little skeptical, but I appreciated his honesty when he told me why he does continuous EFM: “If your baby is born damaged because of something I missed that I could have caught through EFM, I don’t care how much you tell me now you won’t sue, because you’ll need the money to take care of your special needs baby.” I still disagree with him on the necessity of EFM, but it was nice to have him be upfront with me about it. :) He did say that there is lots of movement I will be able to do on EFM, just that I will have to stay within the range of the cords.

    Next time around, I really want to have a birth center or home birth, but this time around, I’m just having to make due — if anyone else reading this post wants to have a low-intervention birth but for some reason has to be in a hospital, just know that it is possible! You have to be a little more creative but there is definitely hope. :)

    Kelli Nicole Reply:

    They have wireless EFM now in some places so it might be worth it to ask for that if you’re going to do it! Then you can move around a lot more :).

  23. Since you are having a home birth without drugs, I’m curious as to whether you will be using cloth diapers, and what you will do as far as vaccinations. I personally plan to use cloth diapers and I do not want to start vaccinating until my child is 2 years old, but I get a good amount of flack about it, especially since I work at a doctor’s office.

    Evelyn Reply:

    Interesting. I think you must be a really strong person to be willing to voice your opinion and decision contrary to cultural norms when you work in that kind of setting!

    We chose to vaccinate our daughter (and started a little earlier) because we were going to be living in a 3rd world country during most of her first year and didn’t want to chance her getting anything there, but it was kinda scary!

    JessicaMayBe Reply:

    Oh wow! If I were living in a 3rd world country with my newborn, I think I’d vaccinate too! My sister-in-law got whooping cough when she was 4 months old and was hospitalized; things like that make me nervous to NOT vaccinate. However, the increase in autism, adhd, and the two years I spent working as a behavioral aid with an autistic boy make me really nervous to do ANYTHING that could contribute (not cause) autism. It’s a scary world!

    Justin Reply:

    There still are no credible studies that show that vaccination contributes or causes autism. Worrying that it COULD cause or contribute is just as valid as worrying that increasing amounts of high fructose corn syrup or TV COULD contribute or cause these disorders.

    That’s not meant to sound as rude as it probably comes off. What I’m trying to say is that in absence of knowing what is causing autism and similar diagnosis increases there is no reason to suspect vaccines any more than any other thing your child might be exposed to.

    Evelyn Reply:

    Um… I believe there have been strong correlations between the two, or at least greater reason to suspect or wonder if vaccination is related. Obviously, there is no absolute proof to show they are related but the fears we expressed are real and valid. Especially when you consider how many children shows signs of autism (sometimes immediately) after vaccination. If you will notice, I did vaccinate my daughter and JessicaMayBe plans to vaccinate her children, just on a slightly different schedule than usual. Obviously we are not being ruled by our fears or the fears of those around us, so you don’t need to try and tout your argument to us.

    If it sounds rude… it probably is… we aren’t a bunch of fear-mongerers. Our decisions and what we said are proof enough of that fact.

    Justin Reply:

    I’m not saying your fears aren’t real or valid. Everyone worries about their children’s health. I also still let all my patients make their own decision about whether or not to vaccinate. It’s still their personal decision and not something I can dictate. But I do encourage them to read the literature (or ask me about it) since the literature does not show a causative correlation.

    Part of the problem is that autism presents at the same age as we recommend vaccination and there is simply no way to unadminister the vaccine to see if a child would have developed autism regardless.

    The most prominent study which linked autism with vaccination was discounted by the majority of the researchers who first published it. All further studies, at least the ones which I am aware of in the literature, have failed to produce the correlation shown in that first study. Furthermore, the focus of most concern is related to the preservative thimerosal which, while again shown to not correlate in several studies, has been eliminated and/or severely reduced in all routine pediatric (<6 yrs) vaccinations. This effort was due to a panel which determined that while there was not enough evidence to support or disprove a link to neural development disorders that it was nevertheless biologically possible. Consequently thimerosal has been widely reduced to less than 1 microgram or eliminated in pediatric vaccines altogether.

    There has been some interested research done on the MMR vaccine that warrants further investigation into this vaccine or switch to aerosol delivery.

    Nevertheless, there is a lot of hindsight bias when a disease shows up. We tend to blame it on an easily viewable event in the recent past. Similar to how most people find someone to “blame” when they come down with a cold when they might have just as likely picked it up off a countertop or door handle.

    Jenna has been very very good about backing up her opinion with studies and many here have reiterated that anecdotal experience often runs counter to statistical analysis. While my heart goes out to those parents who care for autistic children I can’t in good conscience endorse a link that there just isn’t research and data to enforce no matter what an individual experience is.

    It’s obviously a very personal and sensitive topic. Quite frankly, while I’m more than willing to have the conversation with my patients regarding vaccination I’m not willing any longer to “tout [my] argument”. I find that most families come to me with their minds already made up and I have other significant areas to cover and arguing the point would damage the relationship with the family more than it would help.

    JessicaMayBe Reply:

    Well, there actually is some evidence that the new immunization schedule can be bad for children. When we were kids we got much, much less shots. Now kids are given as many as 5 shots on the same day. Some of these shots are being given to kiddos who are fighting a cold or sniffles. They have tiny, fragile immune systems. I’m not saying one shot causes autism… but I do believe that if a child is already at risk for Autism based on genetics and environmental concerns, then immunizations could possibly be the straw that breaks the camel’s back.

    My sister-in-law has Aspbergers, and I was told that my husband and brother-in-law displayed certain traits that have me worried about possible genetics. My husband was prone to sitting alone outside for hours by himself, just sitting. His brother still repeatedly pulls at his shirt. My husband no longer just sits and stares like he did when he was 6, but he does still experience a good amount of social anxiety. This coupled with my sister-in-law’s Aspberger’s makes me wonder if we could have a child with Autism.

    With these worries in mind, I have decided that it would not be prudent to inoculate our children based on the current vaccine guideline. Instead I will be using an alternative vaccine schedule, such as the one found here:

    http://www.generationrescue.org/pdf/user_friendly.pdf

    I will also hopefully be feeding my children mainly organic foods when they young. No high fructose corn syrup and no partially hydrogenated oils. My husband and I try out best not to eat these either.

    I do think there are things you can do that put you kid at less risk for ADD, ADHD and Autism. If I’m wrong, that’s okay. If I’m right though, and I am able to help my child…. I feel good about that. They will still get the majority of their shots, but only the ones that are necessary. No flu shot, no varicella, etc.

    I’ve worked with too many Autistic kiddos in the past two years to NOT be on guard.

  24. Jenna, I applaud you for researching the heck out of this issue, making a brave and informed choice, and providing such a wonderful abundance of information to everyone who reads your blog. Yay!

    That said, I would like to offer some encouragement to any women who just do not have the option of an out-of-hospital birth, either because they ARE high-risk, or because like me, they just don’t want to fight that fight (in my case, there are no birth centers nearby, and my DH is very uncomfortable with a home birth–sometimes you just have to choose your battles). While it is certainly *easier* to get all the things that you want in a home birth, it is not *impossible* to get them in a hospital birth.

    Most important is the issue of informed consent. While I am lucky enough to be working with a WONDERFUL midwife group that practices in a very pro-unmedicated-birth hospital, NO medical personnel can force you to do ANYTHING to which you expressly do not consent. A key thing here is having a brief, positive, and clear birth plan, and a partner/doula who knows your wishes. If you refuse a particular intervention, they cannot force you to do it. Period. So if you have to labor in a hospital, know what you want and ask for it!

    The second thing is, if you can, finding a supportive provider and third, a supportive hospital. If your OB or midwife is on board with your wishes, they can battle the nurces and hospital policy for you. But even if not, you can still say no!

    To address your specific concerns:

    - C-section rate: Your provider’s rate is MUCH more important than your hospital’s rate, because the OB or midwife is the one who will call for it. My midwives have a rate of about 10%, and I’m comfortable with that.

    - Quite, dark room: Many hospitals have opened new birthing wings with all-private, homey birthing suites with adjustablwe lighting, and all-private recovery rooms with rooming in encouraged.

    - Choose who is present: Getting around this hospital policy is probably the most difficultm because the rules are there to protect other patients as well as yourself. You may have luck working through your provider to get permission for an extra guest or two. On the other end, you should be able to kick most everyone out most of the time, unless you are in immediate danger (and I think in a home birth the same rule would apply).

    - Fewest vaginal exams: In a hospital you can request this, and refuse any you think are excessive.

    - Labor positions: In a hospital you can request this, and many hospitals have started stocking things like birth balls, chairs, and bars to support this. You can also bring your own (if it is portable enough).

    - Water birth: Many hospitals allow labor, if not delivery in a tub (although I know if one MD hosital wich does allow even delivery), and provide tubs or showers in some or all rooms. In my case, the only reason women are not allowed to actually deliver in the tub is because they are not situated such that medical personnel have 360 degree access, so it isn’t safe. In a home birth, you’d set up a tub in the middle of a room to allow this access.

    - Eating and drinking: Hospital says you can’t? do it anyway–they can’t stoip you! Better if your provider is on board though. However, note that the reason for the restriction is also in case you need general anesthesia for a c-section; you’d normally have to be on an empty stomach for that. However, gen. anesth. is rare (but not unheard of) these days.

    - Continuous EFM: In a hospital you can refuse this. Best if you agree to intermittent monitoring though, either with the belt that is taken off when you don’t need it, or with your provider+a doppler. If you refuse ALL monitoring, you may be upgraded automatically to the highest risk category.

    - Episiotomies: In a hospital you can refuse to consent to this! Best if stated up front in your birth plan and to the doc and nurses when you arrive. However, note that their are rare cases where one is needed to get the baby out fast in instances of demonstrable fetal distress where you don’t have time to stretch/tear naturally. If one is suggested to you after you’ve said you don’t want it, make sure you understand WHY they are asking.

    - Oxytocin: In a hospital you can refuse to consent to this! Best if stated up front in your birth plan and to the doc and nurses when you arrive. Also know before you go in other methods of helping labor to progress as a bckup.

    - Forceps/vacumn: AS with c-sections, your provider’s rate is more important than the hospital’s. Mine is <2%. Also as with episiotomies, their are rare cases where one is needed to get the baby out fast in instances of demonstrable fetal distress.

    - Mortality rates: Are not WORSE in a hospital, so if you have to use one, you’re still okay!

    Personally, I feel that the only way hospital births in this country will get better are if more and more women request these types of accomodations, and bring them into the mainstream. I strongly upport the home birth crowd, but feel equally confident in my own choice of a hospital birth and want to make sure everyone knows that it is still a good option!

    I wish you the best of luck in your birth journey!

    B Reply:

    I think you bring up a very good point, which is that while Jenna has actively found research to support *her* decision, this is solely based on confirming and feeling confident in her decision to have a home birth. It should in no way reflect that hospital births are “bad” and that home births are “good”, because you ultimately are accountable for your choices, unless it is medicall necessary to do otherwise. All of these choices are available at a hospital, with the exception of some (the water birth at some hospitals, etc). Beginning from the post where labor was compared to a marathon, it seems that all the positive connotations are being associated with a home birth and there is a very strong negative connotation being associated with a hospital birth. I know it is not meant to be a judgement towards women who choose to give birth in a hospital, it comes off slightly that way because it seems her stance is “anti-hospital”. While Jenna may feel this way, it is solely her opinion based on *her* research. There is no study that will make such a grand assumption to say that hands-down a home birth is superior to a hospital birth, or vice versa. Certain variables may be analyzed, but it is important to consider that although participants are “similar” in many aspects of life, it is humanly impossible to ensure you compare apples-to-apples when dealing with the human body and the components that make up each individual. There are numerous variables and life experiences that affect each person differently, and may contribute to why one person reacts differently to childbirth than another. While studies do their best to ascertain their results as fact, the truth is they are all studies. If true fact existed, one method or the other would be the clear frontrunner. It is also difficult to touch upon this very controversial without using personal bias, etc, which comes into play here as well. This is TH & TW’s personal opinion, and they would like to educate others regarding this. I appreciate the information, though I share a different point of view. But if I were a mother I can see how some would feel sensitive or criticized that someone believed my childbirth experience to be “lacking” because it did not fulfill their own personal criteria.

    Evelyn Reply:

    The fact of the matter is Yes, you can choose the options Anya outlined. I did. But you also have to deal with pressures in a hospital to change your mind or do things the way the nurses and doctors want you to. I was lucky to have a doula that made sure each nurse that entered the room saw and read my birth plan and the nurses were generally pretty “tolerant” of my doing things “differently” but I know of women who birthed at the same hospital who had different nurses with very different (negative) attitudes. I am glad Anya included the input she did because there are options out there if a hospital birth is what you choose, but it’s also important for all mothers to know that outlining your birth plan and wishes doesn’t mean the nurses and doctors will treat you kindly when it becomes “inconvenient” for them (even if you have no risks or issues). It is very difficult to have to not just have a baby but fight the system while you do it. And unfortunately, it does happen.

    Hannah Reply:

    I could not agree more. I think a lot of people’s big issue with this series in general is that the research has been done when a bias in a certain direction has already been developed and the result seems to be articulated as though hospital births are less safe when it is simply not fact.

    While I believe, and appreciate, that Jenna has taken more care with her tone here I still feel as though she is extremely anti-hospital and that her research choices reflect that bias. While I am fine with her researching to confirm that her choices aren’t dangerous, I am concerned by the implied message to other women that hospital isn’t safe for birth. This is simply not fact.

    As for the US infant mortality issue, again, I looked at the standardised result and while the US could perform better it is simply ridiculous to argue that their statistics suck compared with the 130 or so other nations that rank below them. US healthcare inefficiencies and choice might inflate it, but I would hardly use it as justification that hospital births aren’t safe.

    Birth might be natural but the fact that it was and is a leading cause of death for both women and infants in situations where limited to no prenatal and birth care is available makes it quite clear that while a sensible home birth plan might be safe, it is ridiculous to argue that hospital births being safer is an issue of ‘to the contrary’. There are too many variables and indeed too much evidence to the contrary for that to be a logical argument.

    Jenna Reply:

    Hannah if you want to know if this is biased RESEARCH IT FOR YOURSELF. I am so sick of people saying this information is crap, when they have done absolutely nothing themselves to learn otherwise. Do you actually know ANYTHING about research and statistics that prove ANY of this wrong or biased?

    Also, read the dang post. Did I ever, ever ever ever ever ever ever, on my ENTIRE BLOG say that either hospital birth or home birth are safer than the other? Nope. In terms of death, both maternal and fetal, hospital and home birth are statistically equal. The reason home birth women have to fight so hard is that they are instantly judged for putting their baby at risk, then the data doesn’t justify the judgment.

    If you’d like the information about these studies, so you can read and research them for yourself. I encourage you to do so!

    Laura Reply:

    I appreciate Jenna’s original post, and also this response, Anya. Thank you for offering up hospital versions of the many reasons that home-birth is popular, and for doing it with such a positive attitude!

    Jenna Reply:

    Anya,

    Thanks so much for the WONDERFUL comment. I wish that women didn’t have to fight so hard during their birth experience to have evidence based medical practices used on them.

    A lot of women feel more comfortable in the hospital (which is huge, who would want to be pushing in a place they don’t feel safe?) and I hope that those who do will read your comment and speak up for themselves. Of course they need to spend some time educating themselves so they know what they are speaking out against, first!

  25. Jenna! I love this post! FACTS!!! I was just with my friend that did the “birth circle” which helped her have a natural, positive, birth (her second time around) and it was so exciting to put Addie down for her nap and see these FACTS in your post. I love that your blog is helping women to become aware of information and alternatives that so many don’t even know exist!!!

  26. Here, here, Jenna! I don’t agree with you on most of your other opinions (I still read you! You’re a great writer and photographer…just a different in opinions!), but I’m all for home/birth center births. My mom had both my sister and I in a birth center and it seems like it was so relaxed.

    Another pro of birth center births is that you go home the SAME day you deliver. You don’t have to wait extra time (and spend extra money, if you live in the US) to recover in your OWN bed, in your OWN house, where you are most comfortable.

    Bravo on this great post and thanks!

  27. Thanks, Anya, for summing up ex-ACTLY what I was going to say.

    It’s a little too easy to say hospital birth = c-section, episiotomy, reclined laboring position, etc. While that SOMEtimes may be the case, MANY times it’s not.

    I think it’s important for women to know you can still exercise a lot of control over your labor experience while in the hospital. It’s just about finding the right one.

  28. I’ve been a lurker up until now, but birth posts always make me comment. I had a hospital birth with my first, but it went about 95% the way I wanted so I was fairly happy. I want a home birth with my second though for practically every reason you wrote. I hope you get the birth you want!

  29. Jenna,

    I think your “PS” said it best. This type of birth plan is what you see as best for you and your baby. I think it is great to be focused, but please save a small spot in your heart to be open to the birthing experience and what comes your way.

    Cheers!
    Ashley

  30. Couldn’t agree more Jenna- I think that a lot of people just simple aren’t educated about birth and their options. If you want a hospital birth, go for it! But don’t just do it because you didn’t think about it. Same with a midwife- research and do it if you want. What is shocking to me is how so many women, going through pregnancy, such an important thing, are given such little information about it, and are not encouraged to look into the options. But maybe I should be sad that our culture doesn’t talk more about normal birth so that these women could know that those options are out there. Who can say. All I know is, from my personal experience, I have rarely met someone who has done as much research as I have, or you have, and who has decided a hospital birth. Most of my friends who had hospital births just did it because they assumed that was just the way that you did things, if that makes sense. Just my personal experience.

  31. My friends who had a homebirth LOVED them. Both of them had CNM (not a lay midwife), and it went really well! I don’t know what route you’re planning for a midwife, but I strongly urge you to NOT go for a lay midwife. While they may have seen a lot, there is something to be said about being an RN (especially one with L&D experience) who is trained to pick up subtle changes. A CNM should be certified in neonatal resucitation (NRP), carry oxygen (and hopefully pitocin in case of maternal bleeding and intubation supplies in case of newborn breathing difficulties), and be very strong in her beliefs about when it is safe at home and when a hospital transport is necessary. I have absolutely no problems with homebirths, but as a NICU nurse, I have seen even beautiful births end up with something going not “quite right”–which is why I urge you to have a good heart-to-heart talk with your midwife about the “what if’s”!

    Shannon Reply:

    Hi, it probably depends on the state and the MW, but my CPM (lay) team carries oxygen, is certified in NRP, has pitocin and can do the emergency care you mentioned. It’s important for any prospective homebirther to interview their potential care provider and address those issues, but ours at least did fulfill that criteria. And I suspect with over a decade and 1000+ babies, she has a leg up on many RNs with less years of experience.

  32. My first baby I wanted to do all natural but baby was breach and couldn’t be turned – c section. second baby I was to scared to try it natural – c section.
    My third baby I wanted to do natural but was told that I coulnd’t c – section.

    It took me until my third to realize that doctors can sometimes bully you into tests etc.

    i am very impressed with all the research you have done and how you have set you mind on what you want to do.

    I am wondering though (because I don’t know a whole lot about at home/midwife births) how does all the prenatal stuff work. Do you still get regular checkups, blood work, ultrasounds etc. or do you skip it.

    I would like to hear more about that aspect of your pregnancy.

    Lollymom Reply:

    Another thing to consider is that birth is truly an unchanging process. Millions of woman have birthed across the world through millennia. As such much information is timeless and while new studies come out all the time most lead back to the same conclusions – our bodies are made for this! Interventions typically cause a cascade of other interventions, and what could’ve been a healthy birth turns ugly because of unnatural contractions and positions.

    Lollymom Reply:

    Sorry, this was meant to go on another comment thread. But came up when I was commenting to you-

    I am on week 38 with my wonderful liscenced midwife. She preforms all the checkups. She takes my blood and urine samples and sends them to a lab. She has a sonogram and checks babys heart every appointment. She carefully tracks my blood pressure and growth.
    Should I need or request any further testing or ultrasound she sends me to a clinic.
    She is extremely knowledgable and always leaves me feeling well cared for.

  33. I had my first child last month at a hospital. I was delivered by a CNM and was pleasantly surprised by (most of) my birthing experience. I drank water at will, used a birthing bar to help bring my son down, was repeatedly asked if I had a birthing plan, and ended up delivering in a quiet room with only my husband, the midwife and a nurse present. Oh, and I was never offered drugs.

    Of course, I had a midwife to advocate for me if needed, but looking back, I’m pleased with what I was able to accomplish in a hospital setting. I originally wanted to go to a birthing center, but insurance restrictions kept me at the hospital. After my sister had severe complications during her son’s delivery at a birthing center (had to be rushed to the hospital while hemorraghing and would have died had she been further from one), I was actually relieved to not have that option. There were no signs whatsoever that she would have problems, so it did freak me out quite a bit.

    Regardless, I’m glad you are offering this information. Every couple should feel free to choose the birthing option that suits them as individuals. I hope you have an amazing birth!

    schmei Reply:

    I just wanna say: congrats! Always good to read stories like this.

  34. i think its awesome that you are doing what YOU want to do WHERE you want to do it. more power to you for educating yourself.

    women delivered babies for thousands of years outside hospitals, i think you’ll be just fine :)

  35. I don’t know much about this topic, but my brother and I were both born in a birthing center with a midwife. My dad is a doctor and my mom a nurse, so I can only assume they made an informed decision! I really never considered anything but a hospital birth for my own children but I’m really glad to hear about home births because it makes me think about my other options. Thanks, Jenna!

  36. Jenna, I want to throw this out: see all this discussion? You did that, by shifting your tone just a bit. Instead of a shrill, defensive shouting match, you’ve got a nice discussion brewing, with links and stories and comparisons. It’s what we all generally expect from you, which is why nobody’s commenting on it, I guess. But I wanted to give you a high-five for bringing it back to your usual standards.

    Keep up the good work. :-)

  37. Let me ask you a question…Is the best way to get unbiased opinions about the current presidency of Barack Obama by reading a book written by either a left or right wing liberal. How about showing some research that is unbiased, and may I add current. And if you don’t take the time to actually read the research articles, how in the world do you know the research process, methods, and conclusions are in fact solid and verifiable. I also think it is ridiculous to quote all of these “quality research articles” without actually telling us the publication info so that we may actually read them ourselves. So based on your “research” am I convinced about why it is better to have your child in your home….there is absolutely no way in hell.

    Sophia Reply:

    Maybe this could motivate you to do your own research Taylor- the world health organization has tons of research in this area. There are tons of interesting books and movies on the subject. Simply look up things like infant mortality rates and correlate that to home birth rates- in many Scandinavian countries one out of four people are born at home with lay midwives and their infant and maternal mortality rates are lower than ours, for example. I would also note that for things like aspiration, as TH noted, humans haven’t randomly and radically evolved so much in the last 20 years that that data would have changed. You said yourself that you feel Jenna didn’t give you enough, or quality, information, yet you then emphatically state that based on that information you’ve made a decision- home birth is dangerous- instead of making the decision “hey, this isn’t enough info, I want to do some research on my own, but thanks for getting me thinking about it”.

    Taylor Reply:

    To me, people can have kids in their pants if they want to. Her way of trying to convince others with “research” from an obvious biased book is bogus. Now maybe that was her purpose; to make an argument with weak sketchy data to attract the most amount of people to the site (heck, the only reason I stumbled on is through a friend’s wife relation to the person). That is what I have problems with. Give hard concrete data with peer-reviewed journal articles that others can read instead of listing facts that some book has compiled about research that helped their book sell copies.

    Hannah Reply:

    I have to agree with Taylor, I personally think a lot of the material referenced here is quite biased and I simply don’t agree that a home birth is SAFER than hospital. It is not a fair comparison to make because hospitals care for many more mothers than are cared for in home births so the rate of infant mortality is inevitable going to be higher.

    Hospital does not have to automatically equal stirrups, epidural and episiotomy. You are right, Jenna, it is about education. I guess I still feel that you believe that if people don’t choose a home birth with minimal assistance that they either aren’t educated or have chosen the wrong path once educated.

    The Farm might have had a low rate of issues but it was a facility dedicated to childbirth. I really worry about an at-home birth with a lay midwife. I really do. There is a reason that doctors and midwives study as long as they do – because there is reason to. Despite all this evidence you put forward, I still can’t agree that hospitals and intervention have worsened the outcome women and infants in childbirth. It is simply not true.

    With regard to the episiotomy issue, I think it really depends on the doctor. Some cut from ‘top to bottom’ for the sake of it, others cut when they can see the potential for a tear to ease the pressure and help prevent two or three way splits. I know I would rather cm long cut than a multiple, messy tears.

    On the other hand, I do want to thank Jenna for taking a less ‘militant’ approach to expressing her opinion. I personally needed to take a break from her blog for a bit after the ‘Mountain’ posts etc because I was really upset and offended by the level of judgement implied in them.

    I also want to point out that infant mortality rates are reported differently from country to country and are subject to myriad issues. The US systems include quite a wide definition when approaching it including extremely pre-term babies. This alone would significantly inflate the infant mortality results.

    I just hope you have found pre-natal care. I have been terribly worried about it as another friend of mine just had a missed miscarriage and it was extremely problematic. I would seriously hate to see that happen to you.

    Again, any perceived criticism from most people comes out of concern more than anything else. Some people can be nasty, it most are simply well-meaning.

    B Reply:

    Hannah, you specified my thoughts exactly. I think when I start writing I tend to sound a bit harsh myself once I re-read, but I don’t mean it to be that way at all, I think it is just a very passionate topic and it is difficult to reel emotions in. I am not a mother but felt the sting of judgement with previous posts, and this post has a significantly different tone, which I appreciated. I completely agree with you, Hannah, on everything you said. Although I see things differently with Jenna’s POV, I am appreciative that Jenna has been strong enough to weather what I am sure has been a myriad of negative comments by posting about this controversial topic. Just as she has done, though, I hope others don’t solely take her personal writing/research to be complete fact and follow-up with their own research before formulating an opinion.

    Evelyn Reply:

    Have you ever considered that reason for jenna’s tone is because she is as equally passionate about the topic as you say you are? Remember, in one of her first posts she mentioned that the idea of a birth like what she is not aiming for never even occurred to her. While you may not like her citations, or lack thereof, and you may not agree with this or that, she’s not here to convince, I think think she is simply trying to share the amazing things she has, and is, learning. And while you may not believe it to be sufficient information, Jenna’s job is not to prove each things she says, she speaks her opinion, shares why she has that opinion and often spends some time in comments defending it.

    Evelyn Reply:

    **like what she is now aiming for

    Patrick Reply:

    I would have to also agree with Taylor. Books that are going to sell you on an issue will generally not try to make their argument weaker by laying out the opposite opinion. One thing I would like to add is that just because it is peer reviewed doesn’t make it an all knowing source. There are a lot of peer reviewed articles out there that have flawed research methods, or may be funded by a interested source, etc..

    I noticed in your article that you were concerned about episiotomy and an “intact perineum” because it is “Very important to both husband and myself” If you were implying what I think you were implying then it would make sense that you would consider that aspect of c-section as a positive since c-sections make is so there is less damage down there.

    Also, I noticed in some comments there was mention of not vaccinating. I just want to put it out there that the benefits greatly outweigh the risks. Just because you don’t hear of the disease doesn’t mean the pathogens aren’t out there. Just look at what happened to the soviet union when they lost their healthcare infrastructure and were unable to keep up with the pertussis vaccine. Lot of people died.

    And just to offer another view of the birthing process. Our first child, we got an epideral and all the bells and whistles and we had a great experience. I watched “the office” my wife slept until it was time to push what more could you want?

    Jenna Reply:

    Patrick I have no words for that lost paragraph. Other than you would be torn to shred by a pack of angry birth advocate wolves if you were to keep repeating that in multiple forums.

  38. My siblings and I were born at home with a midwife and are all perfectly fine and healthy. :) People are always “???!!!” when I tell them, because it’s not the “norm” for today’s world, but who cares?! Do what you want and feel is right! Kudos! :)

  39. my husband and i are still a loong way from kids, but i’m beginning to think about things like this. i like to be way prepared. :)

    i never thought i’d consider a home birth. ever. BUT, then i happened to see the TLC episode about the duggars’ (the giant family of 19 kids) granddaughter being born… they had a home birth, and it looked SO much more pleasant than any of the hospital births i’ve seen! i don’t want an episiotomy, i don’t want meds, i want to be able to eat… and so i’m considering a home birth more and more. we’ll see where i end up in five years or so. :)

    thanks for your posts about this… it really gave me something to think about!

  40. So a little different direction, but you all are so knowledgable! I’m recovering currently from a laparotomy for an ovarian cyst removal. Basically I had the c-section without the fun part (baby). I was wondering if any of you know why women who get a c-section once are usually told they have to have them on future births? I have heard of vaginal births after c-sections, but only secondhand. I would like to never experience this again – especially if each child I had after an initial c-section would be the same delivery. Is that a result of hospitals avoiding risk, or mediclly necessary? Does anyone know?

    B Reply:

    Korey, I am sure in some cases it may be medically necessary, but it most cases it is to minimize risk. In major cities you will be hard-pressed to find an OBGYN who will perform VBACs (vaginal birth after Caesarean); if someone does want to have one, however, it is possible to find a doctor (or doula, midwife, etc) who performs them. If people were not so inclined to sue for malpractice for insignificant reasons (or solely to get money), then more and more doctors would be willing to perform them, but medical malpractice insurance premiums are high enough and most are just not willing to take the risk. Also bear in mind that (and I know how this may sound, please bear in mind I agree I am making a generalization) many people who seek out “alternative” birth options, are different from the “sue-happy” type of individuals.

    Evelyn Reply:

    Just want to clarify: Doulas absolutely, positively do NOT perform births. They are emotional support to women who are giving birth and nothing more. They have nothing to do with the medical aspect of giving birth.

    I think it does have a lot to do with the doc’s being willing to perform the VBAC, but I’ve read a lot of things lately that seem to show it has just as much, maybe even more to do with hospital policy.

    Cécy Reply:

    From watching TV programs… the reason why Dr tend not to want a VBAC is because of the scaring. C-section creates scars on the uterus. The contractions and the stain of the labor can make the scar tear and create bleeding. Lost of Dr by fear of this choose to do a 2nd c-section. However when once you are at your second c-section there is almost no turning back to vaginal delivery.

    Jenna Reply:

    All kinds of VBAC info can be found here.

    http://www.theunnecesarean.com/vbac/

  41. In the past two months, I’ve had two co-workers who chose at-home births. They both had birthing pools in their home, and visited midwives, had everything ready for their at home events. Friend one had a great at home experience, would not have changed it for the world. Friend two was in labor for 48 hours and then had to go have a C-section in a hospital.

    I’m all for the at home concept and would consider it myself. I think it’s good to be prepared for the possibility of heading to the hospital if needed.

    Kelli Nicole Reply:

    My sister was also in labor for 50 hours and then had a c-section (started as a home birth) and she still wouldn’t change a thing. Of course, if she could have had the baby at home I she’d change that :), but with the way things went she’s very happy she planned a home birth, even though it ended the way it did.

  42. I do want you to know that you can have exactly the kind of birth you are talking about in a hospital. I did, twice. No drugs. I did have episiotomies though, but I was the first my doctor had done in 6 months and it was because he said I would have torn through my entire perineum. It’s all about the doctor you choose. It’s possible that it’s easier in California, but this was over 20 years ago and it was still possible.

  43. I fear childbirth like no other, and am comforted by reading your posts. I love that you offer a lot of information (thanks for doing all of that research!!).

    Obviously, this won’t happen to 99.9% of babies born in hospitals, but one of our best friends babies died at 3 days after picking up a bacterial in the hospital. They will NEVER deliver in a hospital again.

    I know for a fact that I do NOT want an episiotomy & will probably have a panic attack if one is suggested &/or done. I am not pregnant, but I think about these things!

    Thanks Jenna :)

    phruphru Reply:

    Even just reading about episiotomies on here makes me queasy. I cannot imagine what it’s like when you’re actually in the moment!

  44. I want to tell you about my friend Susan. Susan is one of THE most WONDERFUL friends and mothers I have ever known in my entire life. Susan and her husband love the Lord and they love kids. Lots and lots of kids! After they had their third child, Patrick and Susan had already decided together that they would have as many children as the Lord decided to give them. When Susan found out she was pregnant with their 4th, they were again as happy as they could be. However, at about 12 weeks, she miscarried. That was quite a blow to Susan and she was truly devastated.

    It wasn’t long though and Susan was pregnant again. She was so excited!! It filled her heart with joy and helped ease some of the pain in her heart from losing the baby before. A few months into the pregnancy, Susan called me at work to ask my opinion about something. I was working as a nurse for one of our mutual friends from church, a family practice doc. I had been working in the medical field for nearly 20 years and she knew I had a lot of experience. I had even delivered quite a few babies working as a medic on the ambulance. She said she and Patrick were considering using a midwife and having a home birth when their baby was born. I gave her my honest opinion and she thanked me for it. We never spoke about it again but I later found out they had decided to do it.

    When the day came for Baby Isaac to be born, it was such a happy day! The whole family had gone out that morning to eat breakfast, then to run errands and such in their new van they had just bought to accommodate their growing family. They were laughing and singing and having a good time. A praise song came on the radio that they all loved, so they worshiped the Lord together as they sang, ‘Blessed Be Your Name’.

    Susan had began having some contractions while they were out and she noticed they were getting progressively stronger. This was not her first rodeo so she knew to start timing them and what to watch for and anticipate. When they got back home, Susan called the midwife and then got a quick shower and Patrick called the sitter who was going to come and stay with the other children while Susan was laboring. It wasn’t long and the midwife arrived as did the sitter. Everything progressed as planned and a few hours later, Susan was ready to deliver the newest member of their family. However, as soon baby Isaac was being delivered the midwife knew something was terribly wrong. The cord was wrapped around his neck when he was born and Baby Isaac was in respiratory distress as soon as he was delivered. The seasoned midwife, for lack of a better term, ‘freaked out’. She tried very hard to revive the baby but she did not have the equipment that was truly necessary to help a neonate in that kind of distress. An ambulance was called and the medics worked him all the way to the hospital but it was futile. Baby Isaac went to be with Jesus on his birthday.

    This story was not pulled from a bunch of 20 year old statistics. It did not come from ‘peer reviewed data published in medical journals’. It did not come from a book that someone is trying to sell. This came from REAL LIFE! It came from pain and suffering that my friends went through and my family went through with them.

    And before you try to pick apart my friend or say anything about what she and/or her midwife did or did not do – DON’T! My friend did as much and probably more research than you have done. She had already had four previous pregnancies and knew EXACTLY what she was doing. She is a spectacular SAHM. I only wish I was 1/2 the mom and woman she is. Her midwife did all her homework. She did all the monitoring during labor like you have described midwives doing. However, when Isaac became distressed toward the end, during the pushing/transition, there was no way to tell because he was not being monitored then. If they had been in a hospital, the nurse(s) and/or doctor would have notices a decel in the heart rate and could have adjusted Susan’s position. If this did not work, then an emergency C-Section could possibly have been done. However, they did not know he had the cord around his neck, he was laying on it and was in distress. This caused him to release his bowel content (meconium) and then he aspirated it. Therefore, when he was finally delivered, he could not breathe because of the meconium in his lungs. The midwife did not have the equipment nor the skills necessary to resuscitate this precious baby and he died on the way to the hospital.

    Would Baby Isaac have lived if his mom had made a different decision about her ‘Birthing Plan’? Would he still be alive today if he had been born in a hospital? There is absolutely no way we will ever know the answer to that question. However, I would be willing to bet that I know the answer.

    You have never witnessed pain until you have seen a mother, your friend, crying over the body of her beautifully perfect baby boy in his little tiny casket. Until you see her three small children asking her why ‘their baby’ is sleeping and won’t wake up. You have never witnessed true love and joy until you’ve seen that same family sing ‘Blessed Be Your Name’ together at their baby’s Celebration of Life service!

    So, when you start to put everything into perspective, suddenly things like episiotomies, laboring positions, forceps, vacuums, stirrups, vaginal exams, water births, etc. do not seem all that significant or important in the grand scheme of things anymore, do they?

    It is VERY hurtful and quite telling of your maturity level when you sit in your ‘holier than thou’ judgment seat and tell grown women what is right and what is wrong when it comes to having their babies, especially you’ve never, ever walked a mile in our shoes.

    Jessica Reply:

    Jenna doesn’t seem to see this situation as a “right or wrong” thing, she just cares about what is BEST for HER and HER BABY. She is explaining WHY she’s doing things the natural way, not mandating HOW others should do it.

    It’s absolutely appalling that your second-to-last paragraph implies Jenna cares more about the circumstances of the birth more than the “success” of the birth itself, the life of her child. You obviously have missed the months of prayers, journals, and blogs about how much she loves and desires her baby-as almost any mother naturally does.

    Lastly, having an opinion/philosophy/ a system of beliefs, is not automatically judgement of all other beliefs and the people who hold them. I thought we all were entitled to using our own brains, and explaining ourselves when others question and attack us?

    Jessica Reply:

    Furthermore, horror stories about home births AND hospital births abound. But you can’t base your opinions on stories, you have to base them on medical research (hundreds of stories analyzed and compared.) My mother *almost* died while delivering me in a hospital, and I think it would have been a much healthier birth for the both of us if she had done it at home, but does this prove anything? No way. Can’t stake a mother’s or baby’s life on any kind of anecdote.

    Teresa Reply:

    First of all, I have been reading Jenna’s blog for quite a while. I have even praised her before, like when she was being berated for standing up for her husband when people felt he most certainly didn’t deserve it. I was very proud of her for taking the stand she did.

    However, since she announced her pregnancy, I have been very disappointed in the way she has spoken to her readers. It is one thing to have an opinion and stick to your guns, it is another to insult people. And that is exactly what I think she has done since she wrote her post ‘I’m Gonna Climb That Mountain’. I really thought after that one she would regroup and handle things a little differently, with a little more sensitivity, but I see that I was clearly wrong.

    You say she doesn’t seem to see this situation as ‘right or wrong’ – well, I beg to differ. Have you read ‘I’m Gonna Climb That Mountain’?!?

    You also said you find it appalling that I would imply that ‘Jenna cares more about about the circumstances of the birth more than the “success” of the birth itself, the life of her child.’ Uh, no M’am! Jenna did that all by herself. Here are her words, not mine, taken from a comment she wrote after IGCTM:

    “You know what? I don’t only care about my baby. I care about myself too. I care about recovery times, damage to my perineum, my ability to have many children in the future, my emotional well being and sense of satisfaction garnered from my childbirth experience, my ability to breastfeed with a body free of chemicals and extraneous fluids, my ability to bond with my child and feel oxtyocin coursing through my body after the birth. So no, having a safe, healthy child is not my goal.”

    How in the world can anyone say that ‘having a safe, healthy child is not my goal?’ Is that not every mother’s goal when they intentionally get pregnant and are looking forward to their child being born? How can all the other stuff be THAT important if the baby is born safely?

    I agree with Jenna on some of the things she is trying to say but I think her presentation is flawed. I also believe that just because she has been doing some ‘research’ over the last few months does not make her an expert. Her point of view and the way she makes it is very judgmental and very hurtful to those who are already mothers and especially to those who have ever had difficult deliveries and not been able to have their ideal birthing plan.

    Just because it is her blog and she can say whatever she wants doesn’t necessarily mean she should. KYWIM??

    Jenna Reply:

    Well I really should learn to proofread. I went back and edited that original comment to add in the word “only” as I intended. “So no, having a safe, healthy child is not my only goal.”

    *Sigh*, of course that won’t matter to some. Or they will claim I am lying about the change. That I don’t really care about my baby at all. Which makes total sense. People who push children out of their vaginas willingly and then change smelly diapers and fund school field trips for years are usually selfish, aren’t they?

    Jenna Reply:

    Thank you dearly for this rational comment in what I see as a storm of irrationality. Statistics seem to be hard for people to grasp when they have their own story to tell.

    TH Reply:

    Teresa, that is a very sad story and I think it underscores why all this research is so important. Earlier there was a comment about a baby that died at a hospital of an infection, which was no doubt as devastating as what happened to your friend, and without all the research and statistics it would be impossible to know which path one should choose. None of the statistics we have seen indicate that hospital is safer for low-risk births (they do point to the contrary) but if as a nurse you know of studies like that we would appreciate a reference to them, as we are genuinely trying to make the best choices for both TW and our baby.

    On your last point, the Mountain post did upset a lot of people, which wasn’t its intent. I think TW used comparisons which she doesn’t find offensive when applied to her, but which a lot of her readers did find offensive. However, I think this post really clears up her true desire, which is to explain her plans and the reasons behind them.

  45. Jenna,

    This is a really great discussion. I’m 25 weeks pregnant and after a lot of research (and a decision to attempt anintervention free birth) I am still choosing to give birth in a hospital. There are a couple of reasons – my husband and I did not feel comfortable with a home birth scenario and unfortunately there isn’t a birth center in Minneapolis where we live.

    This topic always gets everyone so fired up because it is VERY personal. I think the important thing here is to encourage women to do their research and find out the questions they should be asking their care providers in order to make an informed decision on the type of birth that is best for them. Whether it is a birth with interventions or one without, a hospital birth or a home birth, a birth attended by an OBGYN or a midwife, whatever that individual chooses is the RIGHT way that they should give birth. It is so personal.

    You are right that there are people out there that do not research and it is suprising. My husband and I are taking birth/infant care classes at the hospital where we will be giving birth and one of the women in our class didn’t know what an episiotomy is and she is 30+ weeks pregnant. Lots of others had never heard of pitocin or didn’t know that epidurals do carry a risk of side effects. I am not making fun of these people, but I was shocked that they hadn’t done their research and had they not taken this class they would have been in a position where they had to have things explained on the spot while in labor. In the end I think the point is to inform women that there are choices – even in a hospital. Your personal birth decision is never wrong.

    Anya – your post was awesome and the very same things have been echoed in the birthing class that I am taking, which is facilitated by our hospital. Maybe they are starting to come around.

    Jenna – good luck to you in this journey. I just love being pregnant and I am guessing from your passion on this topic that you do too. Your home birth will be beautiful and I truly hope it is everything that you hope and wish for. I hope the very same for all ladies on here – may you have the birth that is best for you when the time comes.

  46. I take it that with all of the time you’ve put into researching your desires for birth, you’ve had the time to seek out some prenatal care? I’m very excited to see what you choose– there are so many options! Love these posts– they will be very useful in the future :)

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