For my second child, I decided to have a planned home birth. I never thought I was a home birth kinda person but I can say now that it was the best decision for myself and my family. The whole experience before, during and after birth was exactly how I wanted it to be. In Part 1 I shared what this was like. Here in Part 2, I will explain why I decided against birthing in a hospital a second time.
Why did I choose a home birth?
When I was pregnant with my daughter, I was determined that I did not want an epidural during the birth. I wanted to birth actively and participate fully. Epidurals limit mobility, which interferes with bringing the baby into position, and usually blocks the sensation of contractions so that you have to rely on someone else to tell you when to push. They can also slow labour down. Since then I also discovered that they interfere with the release of hormones that not only help the mother birth and deal with pain, but also provide pain relief for the baby.
Unfortunately I found the pain I experienced more that I thought I could bear for very long.In fact I have described myself that day as being in a “bubble of pain”, buzzing all around my entire body. I was entirely focused inwards and unaware of what was happening around me. My husband apparently massaged my back till his hands were numb but I don’t remember that. After a few hours, when I found out that I was only 5cm dilated, my determination faltered and I asked for an epidural. As a consequence, my pushing wasn’t very effective and when I had been pushing for an hour my obstetrician came in to insist on a vacuum extraction.
While I didn’t experience a perineal tear, I received a vaginal graze which healed from the inside out. I thought I could feel the tear for weeks afterwards. I was also very swollen and bruised. I was completely shocked by how uncomfortable I was, how much damage had occurred, how long it took to heal, and experienced anxious thoughts that maybe I was permanently damaged. Some mums may read this and think, “she’s over-reacting, at least she didn’t have an emergency caesarian (like I did)”, but damage to your sexual organs is a very intimate thing, and feeling “wrong” down there sparks fears akin to receiving a facial injury.
When I reflected upon the birth, I felt that surely I could have had a better birth experience than I did? I learned later that the doctor had performed a vacuum extraction simply because it was hospital protocol to do so after pushing for an hour. Nothing had actually gone WRONG yet, my daughter was never in distress, never in any danger. And yet I was still subject to so much intervention. Why? If things had been veering towards a dangerous situation, it wasn’t because my birth was fated to go wrong or that I was intrinsically unable to birth naturally, but because I had used an epidural, which lead me to take too long pushing.
I concluded that if I wanted to birth naturally, without an epidural, I had to manage pain more effectively. I also felt that birthing in the hospital failed to allow me to manage labour pain effectively: no one reminded me to get up and move around. I was sitting on a fitball next to the bed, using TENS and gas for a few hours. This was obviously not working for me, so I should have been reminded to try something else (including the bath that was available in my room?!). I was also restricted by continuous foetal monitoring, for which there was no reason given. Every time I lay my upper body down on the bed, the monitor would lose my daughters heartbeat and the midwife would insist that I had to sit up (I didn’t know that I could have refused continuous foetal monitoring). No one was really supporting me to give birth naturally.
I further concluded that if I wanted to manage pain effectively and avoid an epidural, I could not give birth in a hospital. In that vulnerable situation I knew that I would not have the assertiveness to question or oppose the medical staff in decisions despite the fact that ultimately I should be responsible for making decisions about my body and my baby. I needed carers who respected and trusted the natural process, and who would only step in when absolutely necessary (i.e. when I would choose to step in if I were them). In other words, I needed carers I could trust like I trust myself.
At first I felt that I wasn’t a home birth sort of person, but I knew a few mums who had done it. And after choosing a midwife, I became totally comfortable with my decision. I do not regret it one bit.
This time around I had zero issues with my nether regions. Even though I had a first degree tear, there was no stinging, no bruising. I felt great. This is certainly not every mums experience with a natural birth, but it was mine.
Was I taking an unnecessary risk?
All the research I did beforehand indicates that I did not take an unnecessary risk. There are some studies that show that home births are more dangerous. But what I have learned is that it is not the home birth on its own that is more dangerous. There are other studies which show that home births are as safe. These are in countries where home births are relatively common and they are supported by the country’s health system. Home births are attended by midwives, group midwifery is practiced, and there is good integration between home birth and hospital (it’s easy to transfer into the hospital).
When you look into the studies that show home births are dangerous, you realise there are a few flaws in them: the studies include unplanned and unattended home births for one. This may be because the family didn’t leave for the hospital in time, or they live a long way from care. In the US, in some states, attending a home birth is illegal, so parents only have a choice of a hospital birth (where they may not be given the choice of a vaginal birth) or an unattended home birth (that includes home births attended by uncertified midwives). If they choose a home birth they may not be allowed or they are too frightened of prosecution to transfer to hospital when problems arise. These situations are clearly setting up births to be dangerous.
I had an uncomplicated, low risk pregnancy, and I had all the necessary care required for a safe home birth: a qualified midwife (who has all the equipment and skill to perform lifesaving treatment for myself and my baby when necessary) and an easy transfer backup hospital. I feel that this is a situation that must continue to be supported in Australia to give women safe choices.
I also think that if our doctors and our health system were to take World Health Organisation recommendations seriously, and commit to decreasing the rates of caesarian sections, then integrating home births into the health system is certainly one of a raft of measures that should be supported. Vaginal births save women recovery time during a critical period when their effort should be directed elsewhere (on a baby), and saves the health system (and therefore all of us) a lot of money.
A natural birth is an empowering experience, and women definitely need more empowering when it comes to what happens to their bodies. Like completing a triathalon, my birth has given me confidence in the strength of my own physical and mental resources to undertake the most important challenge, that of raising my baby.
Belly Belly http://www.bellybelly.com.au/
The Belly Belly website is an essential reference source for pregnancy, birth and breastfeeding. I highly recommend this website for women who want to make informed choices about pregnancy and birthing decisions.
Evolutionary Parenting http://evolutionaryparenting.com/homebirth-risks-in-the-news-again/
EP is a great blog on a variety of parenting topics but especially good if you want a dissection of the latest media and research claims by an expert in statistics, research methodology and psychology.
Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block https://www.goodreads.com/book/show/607901.Pushed
Extremely eye opening book on maternity care in the USA. As Australia is more similar to the US than UK or Sweden, and is becoming increasingly so, it’s a dire warning about the direction of our healthcare (note: Albania has better maternal and infant death rates than the United States…)
Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank by Randi Hutter Epstein https://www.goodreads.com/book/show/6466144-get-me-out
An interesting read on the history of childbirth.