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Wednesday, July 22, 2009

Five (or rather ten) Things to Know Before Giving Birth or "Is it Possible to Have a Homebirth in the Hospital?"

(Disclaimer: I wrote the post below about ways to improve you chances of having a natural intervention free birth. But i wanted to come back and write a disclaimer because as a huge homebirth advocate I believe to have the best chance at an empowering, intrervention free, gentle birth for you and your baby, you should STAY HOME!! However, I know that some can't for health reasons, and still others would never be comfortable at home. These are the people who 'may' benefit most from my thoughts/rants below)

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Homebirth in the Hospital" What do you think when you read that? I know what I think, it is an oxymoron for one thing. It is . . . my friends . . . impossible!!! And it is the title of a new book out by Stacey Marie Kerr, MD. She is a family physician with a leaning in Midwifery who has worked with (and birthed with) Ina May at The Farm (along with assisting many families in hospital births). Now I am not going to review the book because I haven't read it (and honestly I probably never will as I have a whole bookshelf full of positive parenting, unschooling, birthing, natural health books waiting to be read . . .who has time?). I am sure she has good intentions, and it is probably a pretty good book, but I take a little issue with the title. I just don't like it and find it misleading. But I'll get to that later.

My point in writing is that Dr Kerr wrote an article that I read recently at www.mindful-mama.com entitled Five Things Every Woman Should Know Before Giving Birth. I thought it was interesting and a nice read, so I thought I would share a quick run down of the 5 things she suggests (though for the extended version, just read the article).

Dr Kerr states the 5 things as

  1. "First, take responsibility for your choices. Each woman has a choice about where she delivers, who she chooses to provide her care, and who she invites to support her during her birth."
  2. "Expect communication to be open and flowing both ways—between your provider, your birth team, and yourself. Expectations, fears, and preferences should be shared long before the first contraction."
  3. "Pay attention to continuity of care, because it can support a safe environment. If your primary provider may not be there when you go into labor, find out who will be."
  4. "The confidence you have in your provider and in your birth team is essential. When you give birth you should have no questions about the competency or the trustworthiness of your companions. Spend your months of pregnancy developing relationships built on trust so you can let your team care for you completely during labor and birth."
  5. In any hospital, there must be control of protocols. Every woman is different, every labor is different, and forcing all women to have babies according to set protocols is unrealistic. As long as the baby and the mom are doing well, women should be allowed to go into labor and give birth at their own pace, in their own style. And if non-emergent interventions seem to be needed, they should be discussed and agreed upon, rather than used according to impersonal rules.
She then lists a sixth thing . . . " the sixth C to consider, the one that should never be allowed into a birth: conflict. Conflict releases stress hormones that work against the powerful hormones that facilitate birth."

I agree with most of what she says, well I mean what is not to agree with? But I think it is almost too simplified, or maybe she isn't as cynical as I am. I mean sure, you cannot know what will happen with your labor, but what you also cannot know is how your providers will react to the situation. You cannot guarantee yourself anything, not how the birth will progress or that your providers, the nurses on staff etc. won't be harassing and pressuring you to do things their way. You can talk to them before hand, you can think you trust them explicitly, they can answer all your questions the 'right' way and act like the perfect Dr for you, but I have read too many birth stories where the Dr at your appointments becomes a different person during the birth, and the birth plan (which I think she downplays a little too much) goes out the window. And this can happen even if you think you know and trust them well. In most large practices you can't guarantee who will attend your birth, and though you meet with each dr, do you really spend enough time with them to know them well and for them to know you well enough? And in birth, IMO, it is those around you who can have the largest impact on the outcome.
Am I showing my cynical side and my lack of trust of Drs here? LOL!! I could go on and on but I won't. I think that there are ways that you can help better ensure that those who are working for you are really working with you . . . so maybe I'd add some things to her list above.

If I had to write 5 things to recommend people do to ensure the best natural hospital birth they would be . . .
  1. Find a good midwife!! Not all midwifes are wonderful and not all midwives are the same (Get references and check them out) but you are far more likely to find a midwife who won't manage your birth and who has more trust and faith in birth than a medical Dr. A great thing about midwives too is that they are usually in smaller practices (or alone) so you would have fewer to rotate through, and your visits with them will usually be longer than if you are using an OB. So there is time for you to get to know them and vice/versa and this is important in building trust. If a midwife isn't possible then a family practice dr will probably be more hands off than an OB. If you must use an OB then please get references. Ask around and talk to moms who have used OB's for natural births. Ask how their births went and how the OB's acted (and whether the birth was textbook or out of the ordinary will matter too, since intervention is more likely if the birth doesn't follow the standard pattern . . . like 4 of my 5, LOL). Another thing to consider is the hospital where they practice. There may be a great Dr who practices at a crappy hospital with horrible policies, so it would be worth it to drive further for a better hospital.
  2. Hire a DOULA. Moms who use doulas have shorter labors, reduced risk for c-sections, less use of epidurals, pitocin, and forceps delivery. A great thing about a doula is that she will come to your home in early labor and can often help you decide when it is the best time to go to the hospital (because you do NOT want to go to the hospital too early. The longer you wait to go in, the better chance you have of avoiding intervention). But not all doulas are the same either, so again, get references if possible. They are wonderful for supporting you and your husband during a natural birth (they know all the tricks and comfort measures) but they should also be your advocate when you can't speak up for yourself, and ideally, you shouldn't have to worry about advocating for yourself, you should be able to focus completely on the birth. So make sure your doula is willing and able to do this for you. They should be able, IMO, to ensure that the hospital personnel are following your birth plan and to step in on your behalf if needed (like if you are having a contraction and your husband is beside himself and neither of you can tell the nurse for the 15th time that you refuse the IV or hep lock and to just leave you the heck alone!!!). Which brings me to point 3 . . .
  3. Write a birth plan. And I am talking detailed birth plan. I haven't searched the web but I am sure there are great ones you can create and print. Make sure you leave nothing out, include everything, even the smallest little things, and then when you arrive at the hospital, have copies handy for every person who steps foot in your room (your dh can hand them out). Tape a copy to your hospital room door (along with your "Respect and quiet please . . . natural birth in progress" sign) and above the bed or wherever you feel it is needed. I'd even highlight the most important parts (and your doula should know it all by heart).
  4. Take a good, independent childbirth class. Please don't take a hospital affiliated class as your only class. What is taught there is pretty much determined (or approved) by the hospital and it is usually telling you what to expect when you come in, assuming most moms are going to follow along and be good 'patients', want the epidural asap etc. Take a class that covers all the possible interventions, as well as comfort measures etc. (relaxing and listening to your body are so important). Then go online or buy some books (Henci Goer is wonderful) and DO YOUR OWN RESEARCH so that when you are in labor and the Dr tells you that "X MUST be done" you can tell him that he is full of crap and throw some statistics at him, LOL!! Though hopefully if you follow the first 3 above none of that would be needed (like I said, you should be focusing on laboring and not worrying about having to advocate for yourself and your baby). And yes, at times intervention may be needed. But if you are doing things naturally and listening to your instincts and are not being managed, then needed intervention is rare. If you know your rights, and are educated and listening to your instincts, you will be able to determine if an intervention that is suggested is really needed in your case. You will be making an informed decision.
  5. Remember that YOU are in charge. This is YOUR birth, no one is 'delivering' you or your baby. You are doing all the work, they are merely assisting you, and you have chosen them for the job. You are paying them and they should be working for you. Have you ever heard a mom say "the Dr wouldn't let me walk around, or go past my due date, or use the squat bar or whatever". No Dr "allows" you to do anything. You tell them what you are doing and if they don't like it they are more than happy to express this to you (and they will, as they should as your assistant). And when you tell them you are doing it anyway, they will just have to deal with it (though hopefully they know you well enough to know what to expect and won't be shocked if you end up on all fours on the bed, butt in the air, pushing a baby out!!). But if you have a wonderful birthing assistant, who is hands off, respects you and trusts birth, then there shouldn't be any conflict, just mutual respect and decision making. You can also do other things to claim 'authority' over your birth. Wear your own clothes (not the hospital gown) bring items from home (music, lighting, pillow etc.) place a sign on your door, fire the staff (nurses) if you don't like how they treat you and request new more respectful nurses. You deserve to be treated with respect and anyone not doing that shouldn't have the privilege of attending your birth.
So those are my 5 recommendations. Keep in mind they are coming from a cynical, non-trusting, proactive, natural homebirthing (whose births would have screamed 'intervention' where they in the hospital) mama of 5, LOL!! I am sure I could come up with more than 5 tips but geez, this is already a novel, LOL!! While I think in a sense you do have to be a little 'on guard' in the hospital (well, at least I would be), if you are educated, surround yourself with supportive people, make your wishes known, have others advocating for you and are comfortable enough to listen to your instincts then things should go well (and a quick textbook labor/birth wouldn't hurt either, LOL)

I have known several people who had positive natural hospital births. My sister Kim has had 5 fairly intervention free natural births. Though of course her births are so textbook and so quick that by the time she gets to the hospital the Dr doesn't have time to do anything but catch the baby (nooooo, I am not envious or jealous of her short births at all . . . LOL). I have one friend in particular who had a simply beautiful natural hospital birth with her first (she had a great midwife and great nurses on staff that day). Were they like "homebirths in the hospital" though? I am going to say no (though hers was probably as close as it gets). Why? Because there is just no such thing and I think to imply that you can have a homebirth in the hospital is doing a disservice to, well, homebirth, LOL!

Not all women can have a homebirth and not all women want one and that absolutely is fine.
I know"homebirth in the hospital" it isn't supposed to be taken literally but I am sorry, you can't have the best of both worlds, you can't be home and have access to everything the hospital offers (though midwives do come with equipment and are very prepared) and you can't be in the hospital and have all the comfort, familiarity, simplicity and authority that you have in your own home. You can have a "home like" atmosphere, and for some they may even be able to feel as free and comfortable and be able to birth as instinctively in the hospital as they would at home. But the hospital doesn't smell like your home. It doesn't have your bed, your personal bathroom, your clothes, your refrigerator, and it has much different germs! And with a homebirth you are not having to get dressed, get the kids dressed, get in the car and drive somewhere in the middle of labor UGH!!

I think if someone wants a homebirth, they should just stay home!! If they want or need a hospital birth, then they can take steps to have the best, most natural, empowering and gentle birth possible for them and their baby. No matter what a person decides, ultimately it is their responsibility.

To say "Homebirth in the Hospital" . . . well, it does sound compelling and may get peoples attention, but I think perhaps a better, more accurate title would be "Empowering birth in the Hospital" or "Instinctive Natural Hospital Birth". But, what do I know? Maybe I am just being nit picky. ;0)

4 comments:

MMartin said...

Thanks for posting this Kelley...good stuff. :)

The Rupley's said...

This is great info.... because I did not realize how important it was to find an OB who was pro-home birth, my high-risk preganancy (which became low risk at 20 weeks) turned into a nightmere. I truly feel that if I would have found an ob who was pro midwife, my little baby girl would not have been a premature.

Anyway, If I would have had this check list, my pregnancy and delivery would have gone exactly how I wanted it to!

Kelley said...

Thanks guys,
The Rupley's, so sorry to hear that your little girl was premature. Your story is, I am sure, one that is shared by many others.
Even still, a checklist can only go so far in ensuring a good gentle birth for and your baby . . . some of how things turn out is in Gods hands. I was very prepared and educated when I gave birth to my first (far more than most first time moms) and it still didn't turn out how I had planned. I just trust that it was Gods will and that something good (other than my ds of course) came out of it.

myrmom said...

I couldn't agree more Kelly, I have had 3 beautiful sons, two in the hospital and one at home. My first birth though beautiful becasue it gave me my first son was far from what I wanted or expected from birth, it was as hospital and medical as a birth can get. My second was what some people could refer to as a "homebirth in the hospital" I was there less then an hour, it was quick, non medical, natural and everything I wanted at the time...but it was not a homebirth. It didn't have my smells, my comforts, my peace. Those only came with the birth of my third son who arrived this past october at home.

I had an amazing second birth in the hospital and I do not regret one moment of it, but it was not a homebirth in a hospital it was a natural, empowering and gentle birth in a hospital.

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