I urge you to read it, if only to understand me better, or if you are so inclined, to understand home birthers in general. It is fantastically written and explains it all so well, but I'm going to hack it up and give you some excerpts, because I'm doubting that most of you will read the article. Needless to say I also have some thoughts...
When hearing the news that I had my last baby at home and am planning to have this one at home as well, the first response from most people is, "You're so brave."
This has to be one of the most irritating things that people say to homebirthers. The implication is that birth is dangerous and that we are willing to take on a tremendous risk to do it anywhere but a hospital. It negates the research and planning that we've done to come to this decision.
And after reading this article I started actually responding to these comments, which I also get frequently. Now when you say something like this to me, I respond by saying, "I think people who birth in hospitals are brave." And no, I'm not trying to be funny. Hospital births carry with them a number of risks. Many are detailed in the article, and I'm quoting a couple...
In 2003, over 20% of women had their labors induced, with a rate closer to 40% in many hospitals... Approximately 40-50% of inductions fail... and most failed inductions end in cesarean section. Inductions increase labor pain and length, and create, among other problems, an increased risk of fetal distress, uterine rupture, and cesarean section.
And in case you think c-sections are a walk in the park...
Over 30% of women in the US have cesarean sections, while overwhelming research has led the World Health Organization to set an ideal standard rate of cesarean sections at 10-12%... Cesarean sections increase the likelihood of maternal death by as much as 4 times, and have other immediate and long-term heath risks for mothers that include, but are not limited to, infection, bowel or bladder perforation, hysterectomy, future infertility, and increased risk of uterine rupture for future pregnancies. Risks for the baby include respiratory distress, fetal injury, prematurity (if result of schedule section or failed induction), and breastfeeding difficulties.It's difficult to get into a discussion with most women who've had c-sections. Some of them have had truly emergent situations and I will forever say thank goodness for hospitals and surgeons for those situations; I am personally counting on their availability should any issues arise that my midwife deems emergent.
A trickier set of individuals to discuss this with are the ones who have been told by their doctors that they needed a c-section for x, y, z reasons and then they go off into the world saying, "thank goodness for hospitals, because I would have died if not for my OB." Thing is... a large baby (obviously not as large as that 19+ lb one in Indonesia) is not a reason for most people, and 'failure to progress' is extremely subjective. My labor with Regin lasted about 48 hours. There are few OBs out there who would have allowed me to go on that long. Even the one I saw recently when my midwife dumped me who was totally pro natural birth and has a great relationship with many of the local midwives (including the one I'm currently working with) told me he wouldn't let me go that long. But true 'failure to progress' would be more than simply having contractions for several days, because that is actually PERFECTLY normal, and it wouldn't necessarily be something those electronic fetal monitors picked up either. That increase of information can make OBs jumpier and significantly increases the likelihood of c-section.
Further complicating this issue of whether a c-section is necessitated or not is the set of women for whom the c-section became necessary as a result of a chain of events that began with 'benign' interventions such as the administration of Pitocin - a drug routinely used in hospital births to intensify contractions and thus hopefully speed up labor. For an illustration of how giving pitocin can lead to problems here is a clip from Business of Being Born. I much prefer the related segment from Orgasmic Birth, but I couldn't find the clip on YouTube. (You can start at about 1m 20s without missing much).
And here is another clip about a few of the other interventions that have been used over the years.
Haha. I love it... "The best thing to do is get the hell out of the hospital." And this guy (an M.D. himself) used to be the director of women's & children's health for the World Health Organization. Point is... just because a doctor says an intervention is ok, doesn't mean it is. Case in point: I was advised in the emergency room in October (when I went in for dizziness, cold sweats, and chest pain) to get a CT scan of my lungs. The doctor said they were routinely done on pregnant women, no problem. My gut said no, but he made it sound like I could die if I didn't get the scan. Turns out, my gut may have been right. My own doctor was upset that they did the scan, and didn't think it was at all necessary or safe for the baby, and he was visibly appalled that they hadn't covered my abdomen during the scan.
Anyway... back to c-sections...
While this and many pro-homebirth articles focus their attention on unplanned c-sections, I think it's especially important to note the issues with c-sections for those who are planning them. The whole 'too-posh-to-push' craze freaks me out when you look at all of the data on c-sections. Planned c-sections are one of the hardest things for me to understand. C-sections are risky. They are major surgery. And the recovery is longer. (Though I continuously hear of women who go out and shop or do heavy housework within days of a c-section. We've become so used to the idea that c-sections are no big deal, but I can't imagine anyone doing anything so strenuous within days of other kinds of major abdominal surgery. My midwife wanted me on bed rest for 2+ weeks after birth and I had a long but uncomplicated vaginal delivery!!)
And this is one point I return to again and again:
The vast majority of women in the US give birth in hospitals, and yet the US's maternal death rate is the worst among 28 industrialized nations and the neonatal mortality rate is the second worst. The Netherlands, where 36% of babies are born at home, has lower maternal and neonatal mortality rates than the US.We're supposed to have these great hospitals and doctors that people travel from all over to get better medical care from. And yet... our mortality rate is horrendous! For more info on what we can do to reduce infant mortality, watch this short film:
Reducing Infant Mortality from Debby Takikawa on Vimeo.
And my final quote from that home birth article:
My decision to homebirth wasn't made in a void, but based upon years of research. I wonder how much research the average woman puts into her hospital birth?
Yes, yes, a thousand times yes! That's not to be smug or superior about the research I've done. That is simply in response to the assumption that we home birth out of bravery or some touchy-feely, new-agey reason. I, and all those I have come across who've done this, have done this after an unbelievable amount of research and soul-searching. This is a completely information, data-based, well-reasoned-out decision. Well, for the first one it was, this time I also have a lot of personal comfort reasons I'm adding. We have thoroughly assessed the risks (as best we can) on both sides, and determined this to be, to the best of our knowledge, the less risky option. So to imply to a home birther that they have chosen it for some hippy reason, or because celebrities are doing it, or anything else that isn't based on research and reason is completely offensive.
Basically, when you boil it down, we choose the home for the same reason most of you choose the hospital: we feel it to be the least risky option and will be most likely to provide the best outcome for mother and baby.
Wow. I was going to let the article speak for me, but I guess I had some stuff to get off my chest!
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Another cool thing about this piece is I have a new word to add to my vocab: iatrogenic. It is the "inadvertent adverse effects or complications caused by or resulting from medical treatment or advice." It amazes me how many totally useful and very specific words there are like that in our language. It's like when I learned the word 'jingoism' after September 11th.



























