Tuesday, April 10, 2007


So my friend Hack Mommy is pregnant with her fourth child. I think she's trying to prove something.
Anyway, today she posted about why she births her children at home, and invited me to comment. Since I'm notoriously verbose, I decided not to put my comments in her comment section, but to let the logorrhea spill forth here.

For my first trimester, I had all intentions of birthing at the hospital down the street, Scripps Encinitas, which by all accounts is a great, natural-friendly hospital They even have midwives there if you choose to do your care with one. I was considering a midwife, but I started out with an OB-Gyn and everything. And I knew what I didn't want to happen: my mom had a C-section after being induced because I was "late", and I wanted to avoid her very traumatic birth experience. So I read (me, read? Big surprise, right?) a lot about birth. I read "Journey Into Motherhood" which is a charmingly granola book, and "The Pregnancy Book" by the Sears' (much less crunchy, but very informative), and "Birthing From Within". And "(Mis)Conceptions by Naomi Wolff, which was quite eye opening.
From said books, had a laundry list of interventions I wanted to avoid. (Besides a caesarian).

Here's the short list:
1. Being induced because I was "late" (I put "late" in quotes since the definition varies--in Europe you have two more weeks than in the US). I asked my fairly crunchy (big on natural birth) OB-Gyn if she routinely induced because of 'lateness'. Answer: yes.
2. An epidural unless I absolutely had to have one. I have nothing against drugs, per-se, but if you take them, you increase the likelihood of caesarian.
3. Timetables. Hospitals are notorious for telling you you need to have the baby "in the next x hours". Guys, the human body doesn't really work that way.
4. Electronic Fetal Monitoring (EFT). Studies agree this technology doesn't help the mom, or the baby. Who does it help? The malpractice lawyers when they're trying to show that the hospital did 'everything possible' to avoid negative outcomes.
5. An episiotomy. Probably my Ob-gyn wouldn't have done one as a matter of course, but what if I got the doctor on call? This procedure is also often unnecessary.
6. Not being able to move around to help me deal with the discomfort of labor. (#4 doesn't help with this)

Anyway, with list in hand, Dyami and I went to go visit Scripps. When I was four months pregnant, with no discernible bump.
It was a little awkward walking up to the group for the tour. I was the least pregnant by at least 5 months. Everyone there was clearly days or weeks from birth. I had assumed people would be 'shopping around' for their hospital--but for everyone there, the decision had clearly already been made.
And the tour guide definitely noticed how little pregnant I was. (She was super nice, by the way) I almost felt like I was faking pregnancy just to have a chance to see the maternity ward. (That would be a good date night for couples, don't you think?)
So the group of us got buzzed into the ward and made our way through the halls. I had expected something kind of, well, homey. But the maternity ward looked like a hospital ward. I focused mostly on the tiled floors. What if I want to be on the floor? I thought. I don't want to be on cold tile.
The tour guide led us into one of the labor and delivery rooms. She showed us how the bed could morph into different positions, the warmer that might be used for the baby in some circumstances.
Everyone was nodding and looking around. I raised my hand. "Do you have to be hooked up to an EFT?"
She looked a little surprised to get a question, but smiled to respond. First she explained what an EFT was. Then she said if we'd only absolutely have to have monitoring every fifteen minutes.
That sounded like a lot to me. "Do you have mobile units that we can take with us while we walk?"
They did not. So it would be back to bed every fifteen minutes for the duration of my labor.
I raised my hand again. "Do the midwives work in this ward, or is there a separate birth center?"
She looked confused. "We don't have midwives here."
"Really?" I said. "I'd heard you did."
"Nope," she smiled.
"Do most women here have birth plan?" I asked. A birth plan is a written explanation that the mother and father create, specifying what they would like to happen--and not to happen--during labor. Sort of like my laundry list.
"Ah," she said. "If you do write a birth plan, make it short--a page or less--because the nurses and doctors weren't likely to read it otherwise. And remember that the shifts change, and that the staff is busy, so not everyone may be familiar with the plan."
To my ears, this sounded sort of like "Feel free to write a birth plan--but we may not have time to read it."
"All right, everyone. Let's go out to the recovery rooms."
Did I mention that I was the only one that asked any questions?

We saw the rooms, which looked fine, except for the fact that there's often no bed for the dads. And most of the rooms are shared, (though they aren't always at capacity) At Scripps, they let you keep your baby with you, which is nice. And they encourage breastfeeding--not all hospitals do for some reason.
She went through all of the security procedures: everyone gets a wristband, and if Dad goes home, he must not take it off, because then he won't be let back into the ward. How not to leave your baby alone. How you couldn't have smelly foods (like bananas). Or latex balloons. Or if people brought flowers, they also needed to bring vases because the ward didn't supply them.

None of it was horrible. But the general impression was that this was their show, and we were merely participants, subject to their rules and regulations. If we wanted to run the show differently, we'd have to do a lot of work to swim upstream. And again--this was in a natural-childbirth-friendly hospital.

When we finally got back to the lobby, the tour guide stopped us all before we left. "I checked with one of the nurses in the ward, and it turns out Heather was right--we do have nurse-midwives here. Apparently half of the births use nurse-midwives instead of OB-Gyns."
That the tour guide for the ward didn't know that fact kind of bothered me; it might be a wrong impression, but it seemed like the hospital didn't take the midwives seriously. Or, at the very least, they were considered 'alternative', even though they did half the work.

Again, nothing about the tour or the hospital was bad, but I was just underwhelmed. And when we got home, and I had a few days to think about it, I realized I was thinking about entering the hospital like entering hostile territory. I felt as though I would have to defend myself once I got there to keep the situation from rapidly becoming one I didn't want.

Defending oneself in labor isn't usually too easy. As I later learned, you don't have energy to do much of anything but be in labor, in labor.

So suddenly homebirth, which still seemed kind of radical, also seemed less scary than the alternative. I knew I could get completely competent care, close to home, and close to a hospital if I were to transfer. I knew I could count on the experience being in my hands, rather than in a strangers'. I knew labor wouldn't be in my control, but it wouldn't be in the control of hospital regulations, either. And I knew if I did have a caesarian, it would have been necessary, not inadvertent.
So I have to agree with Melissa--homebirth wasn't the brave option for me. It was the cowardly, safe one. And I also agree that I don't have much invested in where other women choose to labor. If a hospital makes them feel most safe, most secure, then they should be there! Birth is about the woman, not about what other people think is best for the woman.
For me, though, that meant home birth. And having done one, I'm not going to a hospital for my kids any time soon.

1 comment:

Melissa said...

Hmmm, I wonder what I might be trying to prove. And... is there a simpler method?