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I’m a natural birth enthusiast. Have been ever since I got (literally) yelled at by my OB almost 18 years ago for wondering if I really needed an IV. I never went back.
The reader who valiantly wades through all my birth stories will notice a recurring theme – over the years, I never felt fully satisfied with my birth venue. Most of my births occurred in the hospital, under care of a midwife. In those years, I would consider home birth, or a birth center birth, and for various reasons (often financial) always ended up at the hospital.
Then, at long last, I decided to have my seventh baby at a birth center. I batted around having her at home, especially as it was financially viable at that time, and the midwives at the birth center we chose also provided services for home birth. But I ended up opting for the center out of logistical concerns – with a large brood and a small house, I knew that my privacy was at risk if I stayed home, and I am not the type to want my kids present at birth. I get very private when in labor, and I also want to be free to yell all I want with no one to frighten. Sure, I could have sent them all to their grandparents’ house – but did I really want to arrange that? At the time, it was a 50 minute drive, and there were six kids, two of whom were capable of babysitting without adult help.
Given my history of precipitous birth, and also the decent chance that all this might happen at 2 am, I took the simpler route – leave the kids at home, and go to the birth center.
But, while my birth center birth went just fine, there were some things about it that I didn’t love.
The birth center is closed at night; when you need to come in, you call your midwife, she’ll evaluate over the phone, and meet you there if it seems warranted.
It’s a sensible plan, and probably the only one that they can practically do, not being busy enough to warrant staffing it at night.
But, if the midwife was delayed or didn’t think my always-quirky labor signs warranted getting checked, I would have a problem. I couldn’t just show up in advanced labor and get whisked away like I could at the ER. Anybody can have a crazy fast birth, but with a previous history, it’s not at all unlikely for me to have another.
This worked out all right, but the stress of fretting about it was real.
This is a tough, tough topic, and one that I have held different opinions on over time. I think where you come down on this is overall going to be extremely individual and personal – and I think that is exactly how it should be.
There’s two basic factors, here:
1. Birth is natural and normal.
The female body is designed to carry and deliver babies, and the vast majority of the time, this goes smoothly. It’s been argued (and argued very well) that being in a hospital leads to unnecessary interventions which increase, rather than decrease, risk. For a really well-done and moving documentary from the home birth point of view, I highly recommend The Business of Being Born. I find this argument compelling, and it drove my birthing mindset for most of my childbearing years. It’s still a topic very close to my heart, with important implications in Western medicine.
2. Birth is a major medical event with specific risks and potential for life-threatening emergencies.
Stuff happens in labor. Most of the time, especially for low-risk moms, everything goes just fine. Most of the rest of the time, anything that does happen can be detected early enough to transfer to a hospital for care.
But very rarely, things happen too fast to wait for transfer or paramedics. Honestly, my opinion here has been deeply affected by the death of a mother a couple of years ago in an online community of mine; she was birthing at home and suffered an amniotic fluid embolism. They rushed her to the hospital at the first sign of trouble, but she didn’t survive. A good website on this complication (run by a survivor, I believe) can be found at AFE Foundation. Of course, being in the hospital might not have saved her – but her chances would have been better.
So really, we all have to strike a balance of the two sides:
Birth is natural and normal, but it is also a major physical event with specific risks and potential for life-threatening emergencies.
That’s not earth-shattering. It’s what the vast majority of people actually think, but that can get lost in the politics of birth. Us natural-minded moms don’t like to scare other moms. It’s not good for a laboring mom to be scared of all the stuff that probably won’t happen, so we (rightly) focus on the positive and the safe.
More medically minded folks, though, worry that too little fear will lead moms to unknowingly take foolish risks. It’s important to take those concerns seriously, not dismiss them out of hand.
When parents and caregivers acknowledge that balance between the normal and the hazardous, that’s when there is a solid foundation to build sane birth practices upon.
Local, individual caregivers and local hospital policies, naturally, have a huge impact on safe birthing decisions. I have been blessed with caregivers and hospitals which were overall very forward thinking and friendly to principles of natural childbirth and newborn care, which certainly influences my inclination to take advantage of the safety net there. That isn’t the case everywhere – depending on the medical climate where you live, there may be so much unnecessary intervention that it would drive a moderate mama like me back home for fear of cascading interference in my birth.
(Of course, if you can’t decide, I recommend the hospital elevator. All the safety of having a doctor nearby, none of the unnecessary interventions.) (Um, that’s not medical advice. Always consult your physician before giving birth in an elevator, please.)
Postpartum and Newborn Care
A lot of natural birth minded mamas consider early discharge to be a big advantage of a birthing center. It turns out I didn’t like that. I missed being cared for by nurses, and came to appreciate how reassuring that care can be. Without having nurses tracking our vitals, I worried constantly about Emily in the first few days – was her color alright? Does she feel a little warm? A little cool? Do I need to take her temperature? Infection in a newborn can be disastrous, and hours matter. I worried more about myself, too – about infection, hemorrhage, blood clots. I was used to being monitored for those things while I enjoyed my baby, not worrying about them myself.
Does this offset the additional risk of infection that might come with a hospital stay? Well, that’s the big question, isn’t it, and I’m sure not going to be able to put an end to the debate. Unfortunately, the answer probably largely depends on the bias, experiences, and background of who you ask. It also depends on your hospital. If you are satisfied with the practices and safety record of your hospital, that’s different than ending up in a crowded ward with poor ratings.
Home birth, hospital birth, freestanding birthing center…all those options have great things to recommend them and some scary stuff to run you off, because birth. It’s one of those wild cards life hands us, and there’s no knowing exactly how it’s going to go.
I have had good experiences over the years with midwife-attended hospital births. I have usually felt free enough from overmedicalization and unnecessary interventions. A good midwife can really help with this. I’m sure I’ve been lucky.
That’s my experience. I don’t know if I’ll have any more babies, but if I do I will be faced with answering these questions all over again, as the medical culture here in North Carolina is quite different than in Utah.
If you like this post, you may also like my eight birth stories.
Linked up at Wonderful Wednesday.