Monday, May 28, 2007

Home Birth vs. Hospital Birth, Part II

Note: This entry along with Home Birth Vs. Hospital Birth, Part I, 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.

In between writing parts one and two of this topic, I took the time to read the "Baby Toby" story, co-written by ExUtero and Dream Mom. Looking at both sides of the medical experience, be it a case where a baby is in the NICU, or a childbirth issue, or whathaveyou, is enlightening to say the least.

All parties involved, no matter the situation, come into it with different life experiences, different "triggers," different mindsets, different expectations. The big thing I think we all agree on as far as childbirth is concerned is that the goal of the process is a healthy baby and a healthy mother.

After my birth experience with my elder son though, we had only part of that equation right. My son was healthy, but I wasn't. Physically I recovered, but mentally took quite some time longer. I ended up with a form of PPD, which was possibly exacerbated by how I experienced my hospital stay, plus I kept wondering just where I went wrong in the whole process. I'd heard about how things were at this hospital in the past, but I just went on blindly hoping that things had improved in the past ten years because, as I previously stated, I didn't have any other options due to my insurance.

I thought I was pretty much over it. I no longer thought about the situation every day, and I had chalked up much of the experience to just having caught some bad shifts and assignments, nursing-wise. But I got a wake-up call when I found out I was expecting #2.

Oh God, could I go through that again? I knew there were good nurses on L&D at my hospital, but I hadn't seen many of them during my first stay there. Should I trust fate to make things better this time? Pray? I didn't know what to do.

The first thing I did was call Dr. K's old office, but I found out she'd left. Later I learned that her contract wasn't renewed, and while the official reason wasn't stated, the unofficial reason was that Dr. K was the only OB in our area who "allowed" laboring women to move around, to push in whatever position they needed, to deliver in whatever position they wanted... and the Good Old Boy's network down here Didn't. Like. It. One. Bit. They didn't like having to explain to their patients why their friend, who had Dr. K, was allowed to move around and they weren't. They didn't like having to explain why their friends with Dr. K could do many things during their hospital birth that they couldn't. And so, she went.

Well, crap. Dr. K was the only person I really felt was "on my side" at the hospital, and that was after I'd gone in feeling pretty good about things at the start. But as the situation deteriorated, she was the only person who paid attention to what I had wanted outside of strictly a healthy baby, to what she and I had discussed throughout my rotating visits with her throughout my first pregnancy. She actually knew me; we'd built a relationship that wasn't based on me being in labor, but on me being my normal merely-pregnancy-enhanced self. That affected her ability to deal with me when things got rough.

So I started to scramble. I looked into whether there was any way I could deliver in another hospital, but none took my insurance. I'm not sure that would have done any good anyway, as it appears most hospitals down my way (central Florida) tend to be a bit behind the times as far as advances are concerned in childbirth. It's the south, and things take a bit longer to filter down here from the northeast and west coasts.

I thought about the situation I'd had back with my elder son a bit more, but rather than trying to figure out what I could have changed back then, I looked at what I could figure caused some of the problems. The biggest thing I could see was that I was a) giving birth with people who didn't know me from Adam, and who were drawing their opinions about who I was strictly from a tremendously long "guaranteed c-section" birth plan and how I acted while in labor, and b) trying to have as few interventions as possible in an environment where this was not welcome. I didn't want to repeat this scenario, and I definitely didn't want to repeat the stress issues I'd had after the Elder's birth.

Okay, first step, where was I going to be able to have the kind of birth I needed to give my kids the best chance at having a sane mother after the second child arrived? And second step, how could I have people with me during the birth who supported my desires for a low-intervention birth if medically feasible and who would know me outside of my hormonal, laboring state? I'll be the first to admit that I have a somewhat warped sense of humor, that also tends to be a bit dry. It falls flat for some people. And that's fine, not everyone needs to like me, but I think I stand a better chance of connecting with someone outside of hard labor.

The best way for me to handle this, in fact, the only way, was to go to our local birth center, which is situated near the hospital. A birth center birth would guarantee me people present who knew me throughout the pregnancy rather than meeting me when I walked into L&D in labor. It also was very definitely low-intervention, which fit in with my preference. The midwives at the birth center don't have privileges at the hospital but do have a very good relationship with several local OB's including the area's high risk OB who is their immediate back-up. Even in the event of a hospital transfer, many of the practices locally were fine with having the midwives go ahead and handle the labor and delivery once mother and baby were stabilized. So I started out with this group intending to be a birth center birth.

Time passed, and I began thinking more and more about homebirth, which was another option offered by the midwifery practice. My first labor, medicalized as it was, still was under 10 hours from start to finish. I knew my next one had a chance to be shorter, and wasn't sure how much I wanted to be driving around in hard labor, then go into the birth center where other pregnant women would be having their exams while I labored. I eventually did opt for a home birth.

Looking back now I'm not sure if I'd make the same choice, due to different things I've learned. But I still might have. Regardless, at that point in my life, it made perfect sense. I had an older son who needed me at home, and as I wouldn't have been staying at the birth center more than six hours after the birth anyway, I might as well stay at home.

I had all the typical blood tests and fetal screenings done with this birth, same as with the previous. Quadscreen (as opposed to triplescreen with the first), glucose tolerance test, strep B, ultrasound... I think that was it. Shoot, it's been a few years. Everything was fine. No abnormalities showed on any test.

But #2 son was similar to his elder brother in the respect that he, too, prefered the uterine environment to the outside world. Week 40 passed, then week 41. I was edging up on being 42 weeks pregnant and was sent to the backup OB for a non-stress test and ultrasound. This was when I was 41 weeks, 4 days pregnant, the same day that I'd finally had my elder son. I mean, how rude... isn't the second one supposed to come more quickly? Darn those kids for not reading the rule book anyway.

The appointment went well overall. The little guy's heartbeat and reactivity were great. The only down point was that my amniotic fluid was getting low. The OB told me quite plainly that if I were his patient he'd send me in to induce, but since I was a birth center client and wanted to avoid that if possible, he'd let me go to 42 weeks, which was about 72 hours away at that point. If I hadn't had the baby by that Friday (this was a Tuesday), I was to show up at the hospital at 8:00 that morning for induction.

On the one hand, eek! Hospital. On the other hand, HOORAY, come hell or high water this kid was going to get born soon. I would have risked out of the midwifery practice at 42 weeks anyway. I'm not a woman who feels that unassisted birthing is the norm, nor is it my preference. If I couldn't have my midwives, you can bet your bippy I'd be at the hospital, even though I'd definitely be a nervous wreck.

So, all worried about a repeat of my situation with the Elder at the hospital plus the potential joys of Pitocin, I headed straight over to the midwifery office and told them what was up. I asked if they knew of any doula who would take on a client this late, should I need to go to the hospital, as I was determined this time to go in with someone who knew it was her job to remind me that yes, I could do this, rather than my husband who just kind of stood there with the first child with the typical deer-in-the-headlights look. Then I got the first and only surprise of my pregnancy with this practice. The midwife just looked at me and said, "If you have to go to the hospital to be induced, we'll all go with you."

My jaw hit the floor, and I felt the biggest load lift off me. I wouldn't be alone with just my family. I'd have the folks with me who knew me, knew my pregnancy, and would be able to help me handle what was going on. I've learned that respect breeds respect, and hoped that seeing these women interact with me as if I were a normal (i.e., non-laboring) woman would help anyone else to also treat me like a human.

I went home and called my husband, who was somewhere out in Kansas driving a truck at this point, and told him he needed to be heading home since we were definitely having a baby by Friday at the latest. He was tickled pink. I also was writing a thank you note to a friend of my mother's that night for a cute little matching set of outfits she got for both boys, and in the note I mentioned the little fellow had gotten his "eviction papers," which tickled my mother's friend to death when she received and read the note.

I woke up the next morning at 6:37 to the feeling of a contraction. Huh. Could be Braxton-Hicks. I'd been having those for about three months. But then another one hit seven minutes later and all I could think was that I didn't want to be driving my extra-utero child to school in the middle of one of those.

Hmm. Show time!

Call the midwife, tell her not to rush, contractions are 7 minutes apart, about 30-45 seconds long and I can talk through them. Call my mother and tell her I needed help getting the child to school. Call my husband's dispatcher and tell her to get him moving home NOW, because his wife is having a baby. Yes, I'm that wife. Yes, I'm really in labor. Get son dressed and off to school. Call brother and sister to tell them new nephew is on the way. Call local friend to come over and distract me (she'd had a homebirth with this same midwife about 7 months prior). Make up the bed for the birth, plastic sheet, one set of sheets, another plastic sheet, another set of sheets. Double-check birth supplies (chux pads, dermaplast for afterward, hydrogen peroxide for any weird blood splotches, incontinence pads for early heavy lochia flow -- those things rock, by the way, as they're much better than standard sanitary pads for heavy-duty flow).

Call midwife to scratch the "no need to rush" order from 30 minutes ago. Contractions are 5 minutes apart and 60+ seconds long and speaking while one going on is out of the question. Get in the shower, wash hair, look at legs with a couple days stubble on them, think, "Hell no, not this time," and get out of shower to the sound of my mother returning from taking the elder son to school, and the midwife & crew's simultaneous arrival.

I got on my old comfie flannel nightgown (this was one week before Christmas and yes, even Florida can get chilly around that time), and we did a quick dilation check. 6 cm, intact BOW. My blood pressure was normal. Doppler showed good fetal heart tones.

I sat down on my exercise ball and blew my hair dry, then proceeded to put on all my make up. Yes, all of it. It was my distraction technique and it worked quite nicely. My friend arrived while I was attempting to apply liquid eyeliner between contractions (okay, not the best choice I ever made) and just sort of stared at me sitting there primping.

I hadn't eaten anything yet that morning, so my mother fixed me a little sandwich. She forgot to fold the meat like I like it folded. Transition, anyone?

I got off the ball and kicked it down the hall to the family room where we sat out my labor, checking heart tones every 15 minutes and my blood pressure at other times. Everything was good, except for when the little Welches Grape Juice girl came on a commercial and annoyed the living daylights out of me.

Yep, definitely transition. No nausea, just huge internal bitchery and quiet cursing at the beginning of a contraction. On the other hand, I was also making sure everyone knew where the food was in between contractions. Yet another distraction technique for me, yes. And it kept me calm (other than the cursing).

Eventually it was time to get the baby out. I went back to the bedroom with the birth center staff and was checked and found to be 10 cm. I then stated that no one but the midwife, assistant, and apprentice were allowed in the bedroom (no, I don't need a circus for a birth, thankyouverymuch).

I learned that I hate pushing. Hate it, hate it, HATE IT. I'd rather stay in transition for the rest of my life than push. Here's where I'd have inserted my own epidural with an icepick if I could have. OUCH!

45 minutes and four changes of position later, my younger son made his way into the world with no incident, under 5 hours from the onset of labor, wimpy pushing mother notwithstanding. 8 lbs. 14 oz, 20 1/2 inches long (chunky little bugger), and again, HUGE head. I blame my Irish ancestry for that one.

So, why would I perhaps do things differently if things went this well with a home birth? It's that niggling fear that something *could* go wrong the next time. It's the "what if" factor.

But I'll tell you this, I didn't have near the issues post-partum with #2 as I had with #1. The birth was calm, I was able to sleep a few hours at night (not great sleep -- we know most newborns aren't really into that -- but at least I woke when he needed me to, not when someone else thought I should). I felt like a competent mother, not a freak. I felt like a person, not an annoyance. I felt normal for wanting to do this without medication, not some sort of deluded martyr who needed to be brought down a peg or two.

I was treated with respect.

And that, I think, is what it boils down to. That is what will have some women (a tiny percentage, but still some) leaving the hospital to have their children in alternative settings. If there were a birth center attached to a hospital, but with its own protocols in place for low-intervention birth, so the NICU and OR were moments away if needed, that would be an option I'd like. And if I had to be in the hospital proper for a child's birth, I'd prefer to know that I'd be treated kindly and politely by whoever I got assigned as a nurse, rather than snapped at and grabbed. But at this time there's no birth center that close to any hospital in this area. At this point there's no way for expectant mothers to form any type of relationship prior to labor insanity with their primary care providers during labor: the nurses.

Something's got to give. I believe every woman should be able to choose whether or not she wants pain medication (assuming it's not contraindicated by other factors) and not be made to feel stupid for either choice. I believe that every woman should be able to give birth in the location where she feels most safe, after risk factors are considered, be it hospital, birth center, or home.

I just wish that the hospital felt more safe. If it did, I wouldn't be having this conversation with myself.


Angel said...

One of the best posts I've read about Homebirth vs. Hospital birth, truly. It brought up a lot of feelings for me, since I had similar issues with my 2 births (hospital for #1, homebirth for #2).

That anyone would dare write off our reasons for a homebirth....I know that both myself and my son were much healthier for *not* being in a hospital.

Brava, my dear!

Amanda said...

Yeah, I know what you mean, Angel. My biggest concern with #2 was that I not be all nutty after his birth. I now had two kids' wellbeing depending on my sanity. For this area, home birth was really the only assurance I had that I at least had a chance of not dealing with the insanity at Big Local Hospital.

Healthy baby *and* healthy mom. I knew I had a much better chance of achieving both if I avoided BLH in its entirety, although I'd have certainly been there (with nervously ringing bells on, even!) had it been necessary.

I do understand the doctors' thoughts, though. Especially in a neonatal specialty, you're bound to see more tragic outcomes. And of course, there are times when a totally normal seeming labor and baby will freakishly tank.

But something's got to give with the hospital birth mode. Hospitals need to learn that laboring women are still adults and are not sick until a complication presents. Nurses need to keep in mind that laboring mothers sometimes act against type when they're in labor, and also that a ridiculous birth plan doesn't mean the mother is seriously out of line. And of course, it goes without saying, that mothers screaming at the nurses (blush) isn't something that's really a good thing do to, even in cases of extreme exhaustion and frustration.

We've all got to work together. I just don't know quite how we're going to accomplish it.

And thank you VERY much for the "brava" :) Damn, I'm impressed anyone read that far. Of course, if anyone would, you would. Grin.

A Mom Who Thinks Too Much said...
This comment has been removed by the author.
Rural Felicity said...

I just finished reading through your homebirth/hospital posts. A very good read. :) I had my first daughter in the hospital, my second and third kids were born at home, and my fourth was born in the hospital.

For me, the first birth was planned at home, but I developed high blood pressure and decided to have a hospital birth. My other two were uncomplicated. Number four I felt a strong sense something wasn't right, requested an u/s, found out he had spina bifida, and I had him at the hospital. On my terms!

It wasn't just about the birth experience for me. I wanted a homebirth from the get go. I felt strongly that it would be better for baby, unless there were indications it wasn't. Birth in the hospital gives one false assurance, I think.

That being said, I'm not a hardcore homebirther, but I do believe in it being a very viable and safe choice. I very much enjoyed reading your thoughts about hospital/home birth.

Amanda said...

Rural Felicity, thank you for coming by!

You point out a very good reason why we do have hospitals and OBs... because sometimes nature goes wonky. Sometimes kids have an issue, or moms do, and that's why it's vital that we have all these medical techniques in place to take care of matters when these things arise.

I loved my homebirth and if I could be assured of everything coming out okay I would do it again in a heartbeat. If (heavens forfend) I got pregnant again, I might still do it as our hospital down here is still pretty danged awful when it comes to childbirth (my SIL just had her first child there less than 6 months ago).

It just kills me that people can call women selfish and claim that they're in homebirth "for the experience" when they themselves haven't experienced the hospital situation in each woman's area. If I could have had a low-intervention hospital birth with calm, kind attendants, I'd have been fine with that. I loved having my son at home and there were so many positives to being in my own place, but it would have been wonderful to be able to not fret about risking out of the midwifery practice and being trapped in that atmosphere again.

I'm babbling now (cold meds, and my head hurts) so I'll hush now.

Again, thanks for stopping by!

Kasey said...

I really enjoyed reading your birth story, so thank you for posting it. I am having a similar situation with my health care provider pressuring me to induce at 41 weeks, even though both baby and I are fine. I too would like to see a familiar face in L&D, but this HMO doesn't work that way. The midwives I've been seeing all along are not allowed in the hospital where I'll be delivering. I just wish they'd start treating us like normal people instead of patients with an "ailment". Pregnancy is not a disease! Thanks again.

Amanda said...

Kasey, how stressful! And thank you for stopping by.

I hope your little one decided to make his/her way out in the time it's been since you posted the comment!

Best of wishes.