Friday, December 02, 2011

A Midwife Helped Me Out: Birth, Done Right at Home

Previously I wrote about a few of the ways prenatal care with my midwives has been pleasant, personalized, and has contributed to keeping my pregnancy healthy and low-risk. While aiming not to be too graphic, I would like to highlight a few things about giving birth with midwives at home that were healthier, more evidence-based, or more pleasant than my experience giving birth with a doctor in a hospital. Some of these things could be done in a hospital, but were not, and some are specific advantages to giving birth at home.
  • No pressure to induce labor. I was "measuring small" again this pregnancy, but it seemed to be that Malachi was up far enough in my ribs that we just couldn't get an accurate measurement, a much more reasonable diagnosis than IUGR (which is what Tobias's records stated, although I didn't know that until I saw Tobias's records during this pregnancy).
  • Less exposure to germs such as MRSA or various flu bugs and illnesses during birth and postpartum visits
  • Water birth: provides significant pain relief, also lessens tearing and swelling. Laboring in water was encouraged at the Sunnyside Hospital, to their credit, and was beneficial to me, but I had to get out for delivery. And for the curious, babies don't breathe until they feel air on their face. It's pretty cool!
  • In the hospital, delivering while laying in a reclined semi-laying position was the default, and I was in no condition to argue. This position contributes to tearing, and also oxygen shortage to the baby, both of which we experienced to some degree with Tobias. Malachi ended up coming out while I was kneeling in the water. I did most of the work, but it doesn't hurt to have gravity on your side too.
  • Spontaneous pushing (pushing when/how you feel you need to) instead of directed pushing: again, less risk of tearing and oxygen shortage for the baby. Also, it felt a lot more comfortable and I think was a big factor in how great I felt afterwards (very minimal tearing and no swelling or soreness at all).
  • Umbilical cord was allowed to finish pumping important blood and stem cells into the baby. Evidence supports this as the healthiest (reduces risk of anemia and respiratory distress among other things), but my doctor would not allow it even though I asked.
  • Comfort/Personalization: we could have Tobias come home and meet Malachi when we were ready (no visiting hours), I got to enjoy hot cider, pumpkin oatmeal muffins, and chicken soup while in labor as opposed to little cans of juice and the food that we snuck into the hospital with us, no riding in the car while in labor, having all the baby clothes and equipment close by instead of having to decide what to pack.
  • Home court advantage: being in familiar, safe surroundings and having less distractions (no filling out paperwork or drawing blood during labor) lowers the stress hormones that would otherwise slow labor and make it more painful. Overall, the day was very laid-back (and exciting at the same time!).
  • Kristin was very "hands-off" during labor. She did check my blood pressure and listen to Malachi's heartbeat with the doppler, as well as ask me questions about what I was feeling and occasionally listen/watch how I was dealing with the contractions. She stayed in the dining room most of the time. No cervical checks was obvious without them that labor was progressing.
  • Choosing which procedures we wanted. For example, we declined the newborn eye ointment because we don't have STDs.
  • Thousands of dollars cheaper
As far as disadvantages, some things were more "work": having various supplies, including food on hand for during and after the birth, preparing the birth tub, etc. And those table trays in the hospital that allow you to easily eat in bed...those are kind of nice. Other than that, I can't think of any big disadvantages.

Safety-wise, many large studies show that for low-risk women, home birth is equally safe as hospital birth when you compare the rates of death for mom and baby (one recent Canadian study even reported it to be safer). It is much safer in terms of the incidences of c-sections, infections, etc. that happen in hospitals. Most cases of needing to transfer from home to the hospital are not time-sensitive emergencies. Midwives are thoroughly trained and licensed and carry a lot of equipment/medication with them for more common needs as well as bigger emergencies. Hopefully you all know me well enough that you know I wouldn't do something that is unsafe!

Unfortunately, there are many entire states (including my home state of Iowa) where giving birth at home with a midwife is not even a legal option; CPMs are not allowed to be licensed and there are very few or no CNMs that offer home birth services. Currently about 1% of babies are born at home, but as the number of people choosing and supporting home birth grows, I hope that more states will make this choice available to families.

For those of you who are pregnant or will be in the future: wherever you give birth (home isn't for everyone!), find a caregiver that will listen to and respect you, and insist on evidence-based practices that keep you and your baby as safe as possible!

Please feel free to ask me questions about anything if you're curious or facing some of these same decisions yourself!