Monday, May 28, 2007

Home Birth vs. Hospital Birth, Part I

Note: This entry along with Home Birth Vs. Hospital Birth, Part II, is incredibly long. I don't expect people to work their way through either one, actually, unless someone is so inclined. It was more a matter of just needing to get this out, and get it put down somewhere. So, if you're still inclined to read, do so at your own risk.

As I may have mentioned, I read medblogs quite a bit. Lately I've been reading blogs by two neonatologists: NeoNatal Doc and ExUtero. Both of them in the past couple months (NeoNatal Doc's post was in January, and I believe ExUtero's was in April, but I could be mistaken) have posted about home birth. NeoNatal Doc posted another entry about home birth about a year ago, and the most recent was a follow-up to that which was rather balanced, and really got me thinking.

The general feeling I got from reading ExUtero's entry and NeoNatal Doc's first "Home" entry and the comments spawned by them is that homebirthers are ultimately selfish by choosing to birth their children away from the resources of a hospital. That to have a home birth just for "the experience" is ridiculous. That sometimes we have to put up with things we don't like to assure our children's safety.

I can certainly agree that at times we as parents have to just suck it up and deal with things we'd rather not, in the best interests of our children. But to call all homebirthers "selfish" and to indicate they're all in it "just for the experience," is not... complete. It doesn't look at the whole picture of why different women choose home birth.

I've mentioned before that my first child was born in the hospital and my second was a home birth attended by a licensed midwife (RN, former L&D nurse, former NICU nurse), her assistant, and an apprentice midwife. And yeah, part of me was, well honestly, outraged, that all home birthing mothers are being tarred with the "selfish" label, that we're all seen as risking our baby's health just for "an experience." I mean, what mother wants to think that about herself?

So I've been thinking quite a bit in the past couple of days just why I opted to have my second son at home. Why did I choose to have my baby away from the resources of a NICU, an OR? Why did I choose to have him away from the possibility of pain relief via an epidural, or other options? Why in the world would I take the risk, however small, that something that couldn't be foretold could happen rendering a normal birth emergent within just moments?

I can't give an answer. If something had gone terribly, terribly wrong at my homebirth I would never, ever have gotten over it. But I can give the background about why I made the decision I did.

I put a great deal of time and thought into how my second child was going to be born, primarily because of the experience I had at the hospital with my first son's birth. I'd already been on L&D once before at 37 weeks with son #1 for monitoring, because at a routine OB appointment, my doctor couldn't find the baby's heartbeat. Yes, we were all in a panic. Once the contraction I was having eased off (I have Braxton Hicks for about the entire third trimester), his heartbeat came back, and was normal. Still, scary, and it bore watching.

I started out being monitored at the OB's office, and then when my parents arrived (my husband was, at that time, traveling from state to state working for a DOD contractor), I was sent to the hospital for further monitoring. My nurse was awesome. I got hooked up to the monitor and proceeded to Braxton-Hicks away for the next two hours. When my nurse would come in, we'd discuss different things about the birth process. I wanted to avoid an epidural since a) the thought of needles near my back makes me a tad bit squeamish, and b) I knew women in my family had a history of fast labors, so it wasn't like I was going to be dealing with a long period of painful labor. My nurse had had two unmedicated births herself and said it absolutely was possible, even with pitocin, although it's definitely more of a challenge.

She also made it clear that at 37 weeks, and considering that my cervix wasn't at all favorable for induction, it would be best to leave the little guy where he was unless it was medically indicated to induce for his safety. Although at that point I was done being pregnant (I tend to feel "done" at about 28 weeks anyway... something about the whole beached whale thing), I agreed with her. It would be better, all things being equal, to go into labor on my own rather than chemically.

At any rate, the Elder's heartrate stayed fine my entire two hours in the hospital. My OB (same guy I'm currently bitching about as my GYN, bless his heart... but this whole saga I just mentioned is why I do still feel he has his good points) came to check me, reviewed the monitor strip, checked my cervix, and sent me on home. I wasn't dilating, baby was now doing fine, all was well.

I stayed pregnant for another four and a half weeks. Apparently the kid liked where he was just fine. I'd gone in for another visit with my OB's office on a Tuesday, and saw Dr. K who ultimately ended up delivering my son. We reviewed everything (she'd offered to induce me the prior week, but I still wanted to avoid pitocin if I could), and as the 42 week mark was coming up it was determined that if I hadn't gone into labor by Friday I'd be going back to the hospital to be induced.

Frankly, at that point I'd have been willing to give birth through my nose just to get the kid out, so that worked for me.

Fortunately, I went into labor at about 1:30 Wednesday morning. My husband and I had just finished some "nuptial nookie" and had crawled under the covers to get some sleep. I heard a muffled pop, and at first assumed my dog Little Guy had passed some gas (he slept in the bed with me for years). But then I noticed things felt a little different. So I got out of bed and went to the bathroom. Sure enough, my water had broken. It was mec stained, like the color of weak green tea, and contractions started within just a few minutes, so I called my OB's answering service.

Thank goodness Dr. K was on call that night. The answering service told me to go to the ER, but Dr. K had very clearly told me that I was NOT to show up at the ER, but to ask to speak directly with her should I go into labor, especially due to my family's history of pretty quick labor. This pissed off the answering service lady, but I did get to talk to Dr. K. I told her about the light meconium staining and that contractions had started and were running every 5 minutes for about 45 seconds. She told me I could get a shower but not to dawdle and to come straight up to L&D.

So I did. We arrived at the hospital, and I was told to walk on up to the L&D floor. I verified they wanted me to do this, since my water had broken and usually hospitals are all about the safety factor, but yes, I was to walk up. Okie-dokie! So we walked (actually, my husband walked... I was doing more of a waddle thanks to my 41 wk/ 4 day pregnancy and the huge pad to soak up the amniotic fluid).

At this point I was feeling really good about things since I'd had a great experience with the nurse several weeks prior during my monitoring, and since Dr. K was on call. Once we got to my room, though...

Well, it started out okay. I was sent to change into the charming hospital gown (no biggie for me -- birth is messy, etc.) and the two nurses assigned to me for that shift were asking my husband questions about what was had been happening.

The problem there was that he couldn't answer their questions because he'd been asleep. Once I knew my water had broken I told him just to go back to sleep and I'd wake him up when he needed to do something. Man-like, he followed my instructions. Now once I'd gotten the word to head to the hospital I did wake him up, but I was in the shower and basically hadn't shared much information with him as I was busy hosing off and breathing (shaving legs while in active labor? Not an experience I'll ever repeat). So anyway, when I heard him doing the "I don't know" and the "I guess it was about..." and being totally wrong, I piped up from the bathroom with the correct answers.

The nurses told me to be quiet and just relax. I told them he'd been asleep and didn't know the progression of events. They looked at me as if I were crazy. What? The guy had been sleeping. He was flat clueless. Was that so hard to believe?

At any rate, I got into the bed and was checked to see if my water had actually broken. It had (no surprise to me, but the nurses seemed shocked, and I don't know why). I was also 4-5 cm dilated, and was having to work with the contractions.

So, of course, now that labor is going harder, this is when I needed to answer the questions on the intake form (which I'd already answered when I pre-registered, so the point of pre-registering was what?), and then I got blood drawn.

I don't like needles, but it wasn't to the point back then where it is now, where I get lightheaded and pale when someone comes at me with one intending to draw my blood. Back then it was merely unpleasant, but something that could be dealt with. Unfortunately, the nurse got a bad stick and it hurt. That, along with being in increasingly hard labor and with a nurse who proceeded ignore me and to talk with my husband about Chicago (he was across the room as needles REALLY freak him out... and was told by me later that would NEVER happen again, he could just stand by me and look in the opposite direction from the needle site) and ignore the fact that I had tears rolling down my face from the bad stick put me near the edge. The final straw was when she looked at me and snapped, "Why are you still crying? The needle is out and the IV is in."

I'm still crying because it hurts, bitch, because it was a bad stick which you'd know if you'd been paying any attention to me beyond "Oh god, it's a birth plan mother, I've got to get out of here as quickly as I can before I snap her neck."

You know what? I'm sorry that I wanted to do birth unmedicated. I'm sorry I was naive and put some stupid things on the birth plan (like the shaving and enema thing, which were totally unnecessary to list). I'm sorry that I was talkative and happy in between contractions until I was treated like a naughty kindergartener. I'm sorry I walked up to L&D after my water had broken, obviously creating a potential liability for the hospital even though I had clarified that yes, indeed, my water had broken and was lightly mec stained and made sure they wanted me to walk up. I'm sorry that I cried when I was in pain, not from the contractions, but from the horrible needle stick. I had a bruise for two weeks afterward at the IV site, and I still bear the scar 8 years later. It's not a big deal, but it's there whereas the mark from the heplock I had a few weeks ago at the ER doesn't even show anymore.

Crap. Over eight years later and I still get upset.

So anyway, after all that, I was offered some Nubane. I was restricted to the bed because hospital policy dictated that after a mother's water broke she was a liability walking around even in her own room (apparently wearing some sort of pad to avoid spillage was out of the question). I could find no position that made the contractions less painful, especially being tied up with the blood pressure cuff, the IV, and the monitors which they never detatched. So hey, drugs. Sounds good! God, anything to feel less upset. The Nubane was good and I figured, "What the hell, let's go for the epidural too."

Even though I'd planned for an unmedicated birth, I did go ahead and do the "pre-epidural class" which was required if we thought we might want medication. I was sure I wouldn't, but I also knew that just because my mother was fast with the labor thing didn't mean the same would necessarily hold for me, and should labor drag on forever, I wanted the option if I was just getting too exhausted to go on.

Well, it only took me about two hours to get too exhausted, apparently. Dr. K had come in and we discussed the epidural. The anesthesiologist got there after she'd left, and putting the epidural in was decidedly less than fun. He couldn't get it placed, and at one point I said, "I've changed my mind. Stop. I don't want it." They just kept going, refused to stop. It took over an hour to get it in. I had a bad bruise, and a backache for a month.

This was about 5:00 a.m. I took a nap for a couple of hours. My now-GYN came in to check me at 6:00 a.m., and had a scheduled c-section going on that morning, so he and Dr. K decided she'd stay to help me deliver (thank God). Another dilation check, and I was at a 10.

I felt no urge to push. I was numb from the chest down. Dr. K decided to turn off the epidural and let me labor down for a bit, so from 7:00 to 8:00 I drifted in and out of sleep. I was exhausted and I hadn't done anything yet.

I ended up pushing for over three hours, with very little progress. I told the nurses I wanted to be more upright to push as they were lowering the back of the bed behind me and they told me, "No, all the doctors deliver this way." Who the hell was pushing this kid out? Dr. K came in at that point and said to leave me alone, we'd discussed it and I could push in any position I wanted, which though limited severely by the dense epidural, was still appreciated.

Time went on. I was told my uterus was tiring out and I needed pitocin. At first I said no (I was exhausted and a bit out of focus by that point), but once it was explained to me that yes, it really was necessary, I gave the go ahead. The nurse didn't hang it, and I said, "Where's the pitocin?" She said, "I didn't know if you knew what you were saying."

Okay, so, "Stop the epidural," is totally ignored, and "Go ahead with the pitocin," is also totally ignored. Marvelous.

Finally, Dr. K ended up cutting an episiotomy and delivering my son via vacuum extraction. I had a 3rd degree extension of the episiotomy. It was either that or a c-section, so I was fine with the episiotomy, although I'd hoped to avoid one.

My baby was whisked over to a corner of the room by the NICU staff due to fears of meconium aspiration. Again, this was fine. I am all about the safety of my kids, and even though I had wanted him just handed to me, which Dr. K usually did, this was different.

After they were done, the nurse (the same young "I didn't know if you knew what you were saying" one) went to wash my baby. Dr. K said, "Excuse me, but didn't you read Amanda's birth plan? Having her baby with her as soon as possible was very important to her." So they stopped the bath, and brought my son over to me. He was beautiful and healthy, minimal moulding outside of the caput from the vacuum. 8 lbs., 2 oz, 20 1/2 inches long. HUGE freaking head. Heh.

The crap didn't stop there, though. For some reason the nurses didn't leave me, my husband, and son alone at any time for me to attempt breastfeeding. I was trying to get him latched on with them literally hovering over me. Finally, the same young nurse referenced earlier grabbed my breast and started playing with my nipple without a by-your-leave, and then tried to get him to latch on.

I was in shock. You don't just grab me, grab my breast and start playing with my nipple without asking, "Hey, can I try to help out some?"

Good grief, it's common courtesy, I'd think? It's not like a medical emergency where you can't even have time to think if this is what you'd like, it's just flat necessary and you freaking consent. This was different. She could have asked.

The rest of the stay (48 hours after the birth) pretty much went downhill from there. I was awakened every two hours during every night to breastfeed, and each time I was told that if I'd just give the baby some formula they'd let me sleep for four hours rather than two. I finally gave in on the last night because I was so exhausted and gave him some formula. The nurse failed to note it in the chart, the shift changed, and I was again awakened less than an hour later (as two hours had elapsed since the last time I had been awakened to breastfeed).

Unfortunately, I lost it. "I gave him formula just like I was told because I'm desperate to sleep. And now you're waking me up less than an hour later again!" I was so damn exhausted. I'm sorry I screamed, but I'm also sorry the nurse who promised me four hours of sleep (that I desperately needed) didn't note the freaking FORMULA in the chart that would have guaranteed me some sleep, barring my son waking sooner.

Good god. Breastfeeding friendly? Not. Waving the lure of sleep under an exhausted mother's nose everytime you wake her in the middle of the night to feed her child (who's sleeping contentedly, by the way, and has no indicators for blood sugar issues or anything) by mentioning formula when you know she's trying to exclusively breastfeed is just... not right. It wouldn't hurt the baby to go one four hour stretch of night, if he desired, without feeding. Not just one four hour stretch, so an exhasted new mother who was in pain could get a little much needed rest.

Then there was the nurse who I asked for help changing my son's diaper on my second day in. I'd been changing it the whole time (there was 100% rooming in), but this particular day he'd peed on me four times already and I just needed an extra set of hands. She was pissed off (I'd never seen this particular nurse before) and said, "You're going to have to know how to do that by yourself once you get home, you know."

Uhm, no, I'm not. My husband will be there, for one thing. Plus I know how to change a diaper, as noted by the fact that I've been changing him since he was born. All I wanted was a little help. I was sleep deprived, in pain from the episiotomy and the epidural bruise, and had just been whizzed on repeatedly, to add insult to injury. I'm sorry I just needed a little hand.

I finally went home, exhausted and upset. I was overjoyed with my son, but I didn't get any sleep as he decided to wake up once we left the hospital and entertained us thoughout every night with his howls that lasted for hours. It was months before I started to feel even semi normal again, and all through that time, I kept wondering...

What could I have done differently? Should I have kept my mouth shut at the hospital and let my husband give incorrect information? What about the nurse who about bit my head off about the crying with her lousy stick? I didn't say anything to her. Should I have complained? Should I have...

I just don't know. All I knew then, which I still know now, is that I was never going to give birth in that hospital again (which, insurance-wise, was my only option), barring medical necessity.

I'm going to break this into two posts. This one has gone on long enough.


Ninotchka said...

Hi -- I came over here from neonataldoc's blog.

I just wanted to say that

1) I'm so sorry you had such a crappy time. That makes me so freaking mad. There's no excuse for that nonsense. If the medical profession wants to stop home births, they'll have to start treating laboring women like human beings. I am particularly appalled by the nipple-grabbing nurse.

2) I read the whole thing :D Thanks, I'm looking forward to finishing my lunch with Part II!

Amanda said...

Hey, thanks for stopping by, Nintchka :)

Yeah, having that nipple-grabbing nurse was quite the experience. When I'm feeling kind I think that she must have just been rather young and new, and wasn't thinking so much about, "Hey, we don't GRAB the breasts of grown women and tweak their nipples without asking," but was thinking more along the lines of "I need to help this along."

But good God. Really. ASK the woman if she wants you grabbing at her breast.

And as for the rest of the nurses, I really believe they all meant well with the exception of the one who did my blood draw. Fracking bitch, that one. The rest were tired (I arrived the late part of the middle-of-the-night shift), saw a birth plan mother coming into a hospital with very archaic birth practices, sighed, and tried to get her into line.

That plus they were used to dealing with the Good Old Boys' network of OBs down here who don't permit delivery in any position but flat on the back. The nurses I've spoken to, every last one, LOVED Dr. K because she treated them as colleagues, not handmaidens. To me, that says a hell of a lot about them that I wasn't able to see while I was in L&D. I wish their appreciation of Dr. K had extended to her patients who shared her philosophy... oh well.

Simply put, the birth policies and practices down here have just got to change. And you're right, if the medical profession wants to stop homebirths, or decrease that already very tiny subset of the population, they're going to have to start treating laboring women like humans. I know that not all hospitals are like mine, but enough are that many more women than just me have had this type of experience.

I'm impressed you made it all the way through! I hope you enjoyed Part II.

Amanda said...

::frantically fixing spelling first poster's name::

Ninotchka. Because I kan spel.

Long day.

liz said...

Oh, sounds awful, I'm sorry. I read both parts...they weren't that long, really. Here in VA if the baby is sleeping we will let them wait 4 hours to breatfeed at night. And we ask before grabbing you!

Amanda said...

Liz, I'm glad you made it through! And thank you for the kind words.

You have nothing to apologize for. It was just a crappy situation in general, I guess. I am glad to hear your hospital lets nursing mothers sleep for a bit longer if their babies are sleeping and that they do the pre-grab asking!

Of all the things I experienced, that one floors me most. Sheesh! Looking back it is a bit amusing, though :)

Anonymous said...


Thank you for writing your birth story. My experiences with the birth of my second child were similar to yours, with a nurse who treated me like I was dirty and an on call doc that barely spoke to me. Nine years later and I still have issues with the medical system. Maybe that's why I read medical blogs, too.

I wish you health and happiness. Thanks again.

Amanda said...

Anon 11:46,

It's amazing how much our children's births can affect us, even years later. I mean, I'm mostly over it (mostly because if I really think about it I still get mad/upset), but dang... no person should be treated like that.

I really enjoyed writing these entries. It's interesting looking at the differences between the births, between the personnel, etc. I am so grateful for all the medbloggers out there, because they're instrumental in letting us patients know that in many cases they're just as frustrated as we are about various things in the medical field, they give us a different perspective on issues, and they just bring the humanity into it.

I've said it before, but it bears repeating: the medbloggers have likely helped me be a better patient and a better mother of a patient. That just can't be a bad thing.