I’ve been prepping our home for my upcoming homebirth for the last few weeks. I thought you may be interested in seeing how things have panned out. There will be further explanations, links, lists, and recipes in the coming days and weeks so check back again!
Please note: I did not “stage” anything. This is exactly how it looks every day. You’ll see my dirty laundry basket, a random screwdriver on our changing table, and that bag of amazing gluten free brownies that I am desperately trying not to eat. My three year old is part of the video, too. I want to show that homebirth is very accesible. You don’t need a huge home (we live in 1300 sq feet, in a second floor apartment), nor do you need any fancy set-up or lots of money. (This differs widely – our hospital birth was $5K – almost $2K more than a homebirth, but for others with better insurance, hospital births cost less out of pocket.) I bartered with my midwives for the use of one of the birth tubs as our bathtub is so small that half my belly sticks out. All of the supplies I need for birth have been borrowed, found at the back of the linen closet, or purchased from discount stores.
This post is the first in a series I hope to complete before the arrival of my second child, who I plan to birth in our home under the care of a midwife in the coming weeks. I’m always a bit reticent and feel somewhat tender when discussing birth preferences and experiences (my own and those of others) because I full-heartedly feel that birth preferences and experiences are sacred things, things to be respected and honored, no matter what your birth looks like. It’s in that spirit that I compose these posts–in a spirit that respects and honors this milestone in my family’s life and in a spirit that perhaps respects and honors your curiosity and concerns about the processes involved in home birth. These posts are not intended to be prescriptive, but rather as a peek into what has informed my decisions so far. Please tread gently.
A bit ago I wrote a post sharing my question about where to birth my daughter–in the hospital or in my home. Several of you shared your insight and support on that matter, and I’m genuinely grateful for the time you took to lend some perspective. A couple of weeks after that post my husband and I came to our decision: we chose to plan a home birth, and I transferred my records from my obstetrician to a midwife.
photo credit: eyeliam, Flickr Creative Commons
Briefly, these are the factors that bolstered my interest in and my ultimate decision to pursue a home birth: I want to have a birth experience that is inclusive and supportive of the whole family; I wanted a provider who felt more like an invested partner in my maternity care, rather than the commander-in-chief of my care; I had an unmedicated vaginal birth with my son, and I feel confident in my ability to do this again; my previous pregnancy was and my current pregnancy is healthy and low-risk; and my previous birth experience (in a hospital) was supportive and generally pretty positive, illustrating clearly to me how invaluable this amplitude of support can be during birthing. My decision to pursue home birth was never made from an anti-maternity establishment frame of mind, as some have assumed; it was my positive hospital birth experience with my first pregnancy, in fact, that underscored how invaluable and necessary respect, support, comfort, and confidence are in any birth experience.
There is an overwhelming amount of fear-mongering about birth out in the vast interwebz. Trust me, I stepped in a lot of steaming, fear-stoking crap as I forged my path to my birth choice both times. You owe it to yourself and your baby to be thoroughly educated about your options and the procedures and processes involved in birthing, no matter where/how you plan to have your baby. You are not merely a passenger in your birth experience. And if you are reading this as someone, like me, who struggled to get and/or stay pregnant, you especially deserve to reclaim some power on your path to motherhood; there is much about the infertility and loss experience that erodes our sense of self-determination and our confidence in our body’s capacity to get things right.
There is a good amount of insightful, balanced reading out there for those seeking to shore up a decent perspective on birth options. My favorite book (I read it during my first pregnancy and then revisited it for my current one) is The Thinking Woman’s Guide to a Better Birth by Henci Goer. I also enjoyed Active Birth: The New Approach to Giving Birth Naturally by Janet Balaskas. I read many others, but these were the standouts for me. Other very popular and instantly recommended books in the”natural” childbirth community are those written by renowned midwife Ina May Gaskin. (You can also find some additional birth education recommendations from TOBB here.)
Finding My Provider
My initial debate surrounding the venue of this birth had much to do with being in a brand new city with limited insight into community resources surrounding birth and a limited understanding of the birth culture in this new locale. I’ve always been attracted to the midwifery model of care. It pretty much sounds like a dream come true, no? (I think this brochure is a perfect frame of reference for selecting any prenatal care provider, even if you feel more comfortable with or have a medical indication requiring obstetrical care.)
I had an OB for my first pregnancy because there were only two certified nurse midwives practicing in my small former home city, and both of them practiced in large OB practices. My professional experience as a hospital social worker on a women’s & children’s unit (L&D, mother-baby, NICU, pediatrics) gave me priceless perspective on the limitations of large OB practices, and I knew I would not be pursing prenatal care with either of those big practices. Instead, I sought out an OB who practiced independently, as I felt this would give me a better shot at individualized care. Sure, either of those midwives at the other practices would have been able to give me this kind of care…but only on their rotation. I knew that a merry-go-round of OBs (with several of whom I’d repeatedly had dissatisfied professional experiences) was not for me. I didn’t want to run the risk that one of these disliked OBs would be on call the day my birthing began, because that would have been my luck.
So, now here in St. Louis and apparently pregnant, I immediately began asking other moms for recommendations for prenatal care providers, hoping to find a certified nurse midwife this go ’round. I was advised that there is only ONE certified nurse midwife in all of St. Louis who delivers in the hospital. (How is that even possible in a city this size with not one, but TWO schools of medicine?) I belong to an attachment parenting group here, so I lobbed my prenatal care quandary at those moms, knowing that we likely shared some of the same gentle birth ideas and that these women have had broad birth experiences–hospital/birth center/home/high-risk/low-risk/vaginal/with pain support and without/emergency cesarean/planned cesarean. They were a wellspring of knowledge. And this is where I learned that the majority of the other midwives practicing in the STL area are certified professional midwives who deliver babies at home.
There is a difference between certified nurse midwives and certified professional midwives (and lay midwives and direct entry midwives, etc.). Did you know there were so many types? I didn’t. This explains the differences in experience, education and credentialing.
Many of the moms I talked to had birthed their babies at home, and while home birth wasn’t something I’d been considering at the time, I listened to their experiences with an open mind. And I jotted down their providers’ names, just in case.
As I mentioned, I began my prenatal care for this second pregnancy at a small “natural birth-friendly” OB office (with two OBs) in my insurance’s network while I continued to suss out additional resources. At this point in time I was planning to attempt to repeat my previous birth experience: an unmedicated, Hypnobabies-bolstered, doula-assisted hospital birth surrounded by caregivers who value individualized care and who are experienced in supporting mothers through this kind of birth. As my appointments ticked away from 8 weeks to 20 weeks, it became evident to me that my hopes were a little too high for this particular office. I was constantly being shuffled to the nurse practitioner instead of my OB for appointments, even when I had specifically requested to see the OB and had been told I would see the OB; the nurse practitioner told me she was unable to answer many of my birth-related questions because she was not the provider who would be attending my birth, and instead she gave me vague and contradicting answers. In the appointments I was able to have with my OB, she was non-committal and dodgy in her answers:
“I would really like to try a water birth; how do you help manage water births at your hospital?”
–Well, I can’t say right now that you can have a water birth. There are lots of things that could happen that might prohibit that. You just never know.
Ummm-hmmm. While this is clearly true–you simply can’t guarantee how a birth will unfold–an ongoing pattern of this kind of answer and attitude made my care feel like a bait-and-switch deal. There are better/kinder/gentler ways to convey the message that birthing is not predictable and that perhaps we might discover that I am not a good candidate for this means of birthing support. All of my questions were met with these evasive and glass-half-empty answers. It made me uncomfortable, to say the least. Especially coming from a provider who described herself as “natural birth-friendly.” If *this* was friendly…
Maybe this sounds nit-pitcky. Perhaps to some it is. But what I deeply felt is that I did not want to approach my birth with apprehension about a lack of support or with a foreboding expectation that I’d have to arm wrestle my OB and nurses for consideration of my birth preferences…while laboring.
I began interviewing recommended area midwives, one of which is heading up the opening of a birth center about an hour outside of the city. She was warm, encouraging, and insightful. The birth center’s opening had been pushed back again–this has been an ongoing three-year effort, apparently–and this midwife (a certified nurse midwife) was still delivering babies at home in the meantime. She (and the birth center) are located about an hour from where I live. Not exactly ideal. She casually said, “You do know that you have a couple of exceptional midwives in your very own neighborhood, don’t you?” And she specifically recommended one of these midwives to me. (This particular midwife had also been recommended repeatedly by other mamas in that AP group.)
I interviewed her next. I was instantly comfortable with her–her style, her personality, her frank and articulate answers to my questions, even her office environment. And I especially liked that she was trained/experienced in two skills that were non-negotiable for me: neonatal resuscitation and stitching. I had a third degree tear with my son, who was both posterior and compound. I recognize it’s likely that I will tear again. And I am not a “let it heal naturally” kind of girl if the tear is significant.
I combed the interwebz for interview questions for my midwife interviews, and culled a list of questions from here and here. Our interview (because, yes, she was also interviewing me–was *I* a good candidate for homebirth?) was more of a comfortable conversation, and halfway through, this midwife asked for my list of questions and just went down the list, answering completely each and every question I’d brought. This was such a contrast to my OB experience, where the answers to my questions were foggy, and where questions, in general, felt like an intrusion on her time.
A few weeks passed before I made the switch from my OB to my midwife. I am an over-processor by nature, constantly turning something over in my hands to an anxious, nauseating fault. For me, historically, it’s the process of making the decision that overwhelms me. And then, one morning, I woke up and realized, This is what I want and need to do. Once I filtered out all the static, the picture was clear. And when I walked into my OB’s office to fill out paperwork to transfer my records to my new provider, I did it confidently and comfortably and with a great measure of relief. Listening to your gut–honoring your instincts–is a feeling that can’t be overstated.
In the term of my care under my midwife, I’ve done the same kinds of tests that I would have received under my OB’s care, such as a glucose tolerance and GBS tests. She takes my blood pressure and pulse, checks my urine and weighs me, and listens to the baby with either a fetoscope or doppler. She measures my fundal height and palpates to determine the baby’s position. The difference in the care, wholly, is the quality of the interaction. This kind of maternity care has been a good fit for me.
And that’s ultimately what it comes down to–what feels like a good fit for you? What kind/venue of care makes you feel more supported about birth? Because if giving birth in your home feels scary or uncertain, it’s not for you. You need to feel confident, and sometimes that confidence comes from knowing you can deliver in home-like environment (a birth center) or within the structure of the medical model (hospital). Wherever makes you feel emboldened and safe about birthing is where you need to be. If home birth is something that appeals to you here are a couple of posts written by other home birth mamas about their experiences: here and here and here.
Tell us about your birth experience: Where did you birth/where are you planning to birth? What informed your decision? How did you find your provider? Do you have any suggestions for handy resources for informing yourself about birthing?
Rhianna is currently 39 weeks pregnant and feeling every bit of it. There’s an inflatable birth pool in her closet and a length of hose coiled next to her bathroom sink, and she is ready to put them to use. Stay tuned for her next post on home birth supplies and her home birth to-do list. She lives in St. Louis with her husband and two-year old.
As I creep towards the halfway mark of my second pregnancy, I’m confronted by questions around which I’ve been tip-toeing: Where, oh where, will my baby be born? Should I go the hospital route again? Should I get my homebirth on this time?
Between my heavy crush on the idea of birthing my baby in the intimacy of my own home and the biting admonitions of a certain blogging skeptical obstetrician, I’m kind of, well, lost. I know what I want, and I know what I absolutely do not want, and I’m feeling a bit uptight and weary about the ability to marry the two.
You see, I got a whole lotta love for my first birthing experience. It was empowering, awe-stoking, and filled with support and respect. My birth plan was honored nearly to the letter (there was a small hiccup with my request for delayed cord clamping), and even if I could I wouldn’t change a single thing about how my unmedicated, doula-assisted, Hypnobabies-bolstered hospital birth unfolded. (Okay, maybe I could have done without the stubbornly posterior bebe and the third degree tear.)
2012 National Rally for Change in St. Louis, MO, advocating for informed consent and evidence-based maternity care.*
But what I recognize about my hospital birth is this: the circumstances of my hospital birth experience aren’t du jour. In fact, I don’t think it’d be improper to describe those circumstances as exceptional. I worked in the women’s and children’s care center in the hospital where I delivered my son. Day in and day out for years preceeding my pregnancy and my son’s birth, I worked elbow-to-elbow with those professionals–the L&D/postpartum care/NICU nurses, lactation consultants, obstetricians, neonatologists, and pediatricians– in the position to care for me and my baby.
When the time came for me to choose an OB, I already had a pretty sound understanding, based on my professional experience, of which ones I didn’t want anywhere near my vag. When I had questions about how experienced my nurse co-workers were in supporting a patient aiming for an unmedicated birth, or how receptive they would be to the presence of my doula, or if I would be able to take my placenta home with me, I simply walked a few short strides from my office to that of the L&D nurse manager, plopped my pregnant rump down across from her, and asked my questions. When I had questions about breastfeeding resources and support, all I had to do was wave over one of my fantastic lactation consultant colleagues, and they eagerly shared their insight. I had a ton of support and intel at my fingertips long before I was wheeled up to L&D rockin’ 9cm of righteous dilation in my amniotic fluid-soaked yoga pants.
I will openly admit that I enjoyed an uncommon measure of comfort, privilege and preferential treatment birthing my baby and recovering amongst my hospital friends and co-workers. I do not hesitate to credit my unique circumstances for much of the ease I experienced navigating hospital birthing care. The biggest takeaway from my birth experience was this: the relationship you have with your care providers is integral, immeasurable, and irreplaceable.
Happy birthday, my sweet boy
I left that employment for stay-home mamahood, and our family has since relocated out of state to St. Louis. While I understand that each pregnancy and birthing experience is unique, I am acutely aware that the level of care and support I received in the past simply cannot be replicated here. And I have deeply felt reservations about a hospital birth this go ’round.
I’m currently under the care of an OB who as a reputation for supporting patients who desire a less interventive birthing, but I’m full of uncertainty about the hospital where she delivers. Sure, I could switch care providers; I could select an OB who delivers at a hospital with a better rep. Even still, I am nail-biting my way around the implicit fact that a hospital birth here would involve a few things on which I do not wish to compromise. (For example, I want my son to be integrated, when appropriate, into the birth experience of his sibling. And I do not want to be seperated from him for any great length of time, and especially not overnight. We’ve never spent a night apart.)
All signs seem to point to homebirth. Except, you know, those angrily flashing ones on the blog of a certain skeptical obstetrician. I fell down that rabbit hole, reading post after post about the inherent irresponsibility and acute risk of birthing your baby anywhere but a hospital. My cage? Rattled.
I interviewed a highly and repeatedly recommended certified professional midwife here in my neighhborhood, and I left feeling a bit lighter about the prospect of a homebirth. I am considering transferring to her care. In the coming days I will be following up with my insurance company to ascertain the extent of my benefits for an out-of-hospital birth. If nothing was covered at all and I needed to pay the full cost out of pocket, the math shows that I’d be spending just a couple of hundred dollars more than what I paid for my OB and hospital birth with my son. Cost, as I understand it at this point, is not a deterrent.
There is a birthing center scheduled to open this fall about an hour’s drive from where I live in the city. I’ve spoken with the certified nurse midwife heading up that effort, and she, too, was lovely and resourceful. Still, I’m uncertain about the idea of driving an hour away to have my baby. But maybe it’d be worth it?
Help a hormotional pregnant lady out: Did you struggle with the question of where to birth your baby/ies? What helped you confidently forge a decision? What resources/reading did you find particularly helpful?
*Wanna know more about informed consent and evidence-based maternity care? Check it out here.
Rhianna blogs from her adopted hometown of St. Louis, and never before has she missed her former hometown (and its awesome nurses) as much as she does right now. Things keeping her awake at night: crane-kicks to the kidneys courtesy of her bedsharing toddler; in utero dance party courtesy of wiggly fetus; and the anxiety surrounding the place in which the two will meet for the first time.
Megan McGrory Massaro is a mother, freelance writer, and author. She wrote The Other Baby Book: A Natural Approach to Baby’s First Year to empower women to make the best choices for their families.
the other baby blog 