Hospital vs. Homebirth

The birth story I want to share starts with my own adventure of researching birth and Westernized birthing practices. After watching the acclaimed video by Ricki Lake “The business of being born”, I was obsessed with an alternative to the common hospital birth in this country.

A common birth in the US may start with a woman being taken to the hospital after her contractions are close enough or her water breaks. At the hospital she is asked to wear a gown and lay down for an examination to determine if she is indeed in labor. Her contractions are monitored closely, along with the fetal heartbeat. An IV or intravenous drip may be started in case other medications are needed. She is asked to lie down, tolerate the pain as best as possible and wait for the monitoring to continue. She is then given a choice to have an epidural or pain management medications. She is told not to eat or drink and stay within the confinement of the bed as the monitoring equipment is strapped around her body. She is given very little options to manage the pain other than to tolerate it or take the epidural. At this point many women opt to have the drugs, after all most of their friends rave about it. The epidural offer instant relief of the pain and at last the uncomfortable position is not too bad to tolerate. Monitoring continues and so on and so forth the contractions will go unnoticed… Finally a nurse or a doctor will decide that the woman has dilated to the correct 10 centimeters we know a baby needs in order to fit through the cervix and of course the woman is cut with an episiotomy to prevent tearing. Other time labor stalls, powerful drugs will be given to speed up the process, cervadil or Pitocin. If labor progresses and the medical staff say it’s time to push the woman is asked to bear down, her feet up in stir-ups and she is told in a very proactive manner to push and push until the baby is born. If unfortunately the medications do not allow contractions to open the cervix or pushing the baby in the position does not bring the baby down, a woman might be rushed to the operating table for a cesarean section or more commonly known a c-section. In both cases the baby is received by the medical staff cleaned, weight and measure for accurate records. Wrapped in blankets and then presented to the exhausted mother as a tiny bundle of joy all cute and ready to nurse. However, within the next couple of hours the baby needs to be monitored closely so he will be whisked away for a few hours to warm up under a lamp and observed by more staff while mom recuperates in another room… Watch “A birthing story” or the other spin-off TLC shows about birth… you will probably see this happening over and over again.

But the birth story I want to share is different. It is the birth of my second child, Ella, at home. As I was saying watching Ricki Lake’s movie made me want to give birth in another way. My first child was born in a typical hospital in the more customary way. She was born healthy, vaginal delivery. I had an epidural, IV fluids and no complications to speak of. However, thinking back I was not satisfied with her birth. I wanted more for my next experience. What exactly? I wasn’t sure until Ella was ready to be born…

It was 8pm on a warm summer night. I had been walking and moving with bad abdominal cramps that had plague me the entire day. I had been ignoring them because I had been in pain for the past weeks. Late pregnancy had been rough on my lower back. In particular the past few days I had digestive irritability, so the cramping was another complaint to the list. Nonetheless, my spouse called Jeannette, our supportive midwife, to ask for reassurance. I was only 37 weeks pregnant and we were not planning on giving birth just yet. Jeannette had advice to keep me hydrated as it is common for dehydration to cause unusually powerful Braxton hicks contractions; those are the ‘fake’ or preparatory drills as she called them. She decided to pay me a visit that night since she had to practice her route to my apartment in any case before my actual birth at home. Yes, I was planning to give birth at home. Most folks that heard me state this thought I was nuts for attempting such a ‘third’ world type of thing. The truth is that hospitalized birth in America is the standard, anything else is seen as odd. I reassured my family and friends that I was quite sane and that my choice to birth at home had been made after extensive research. Both my spouse and I were making an informed decision.

By 9ish Jeannette arrived with a friend midwife who was visiting from Switzerland.  As they walk in I am bent over out of breath due to a quite powerful Braxton hicks contraction. “Hmmm, maybe we should just take a peak…” said Jeannette.  As I tried to lie down another contraction hit and I jumped from the bed and started to rock. Movement made these awful cramps lessen. So I walked and rocked, swayed and danced. Massaged my aching back and went to sit on my yoga ball. I did whatever felt natural and what made my body feel better. Heck, I was practicing for labor after all! At last the cramps subsided long enough for Jeannette to examine me. To our surprise she said I was close to seven centimeters dilated! I was in very active labor. At this moment, I realized I was experiencing my actual birth and not a drill! I turned off the lights of the room. I put own some relaxation music and lit a candle. I was left in the room to rest and move as I needed to. I kept walking and dancing. I’m not going to say it was pain free, but it was tolerable. I shifted positions as needed and no wired or beeping machine prevented me from doing so. My spouse came in at times to check on me and to hold me as I needed to be held. I felt loved. I felt safe. I felt in control. In between contractions, I was in a narcotic state of mind and felt very numbed as if I had been drinking (hmm, possibly due to the endorphins released by my own body, these are very powerful natural drugs our own body makes). When a new wave of pain would hit, my body would find a position a breath or a kind touch from my spouse to ease the discomfort. At one point I took a shower, and then proceeded to take my clothes off, yep in that order (the clothes got wet). By 11ish my water broke by itself with one particularly strong contraction. We just placed a towel on my yoga ball and continued laboring. A few minutes later the contractions started to come in one after the other in a rhythmic unstoppable motion. It was like a high power aerobics class on steroids gone wild. By 11:40pm I was ready to take a nap. All of the working through contractions had really taken a toll on my muscles. I was hot, sweaty and beat. I had never been so exhausted! I started to ask for a break. And got up to the bathroom saying “okay I need a break I need a break, I’m done. Thank you every one but this baby is going to have to wait. I can’t any more. I’m done” (This of course is what I was told I said, I don’t remember much). Then Jeannette said that I could nap after the baby was born. So I said let’s push the little sucker out because I’m ready for a nap! I squatted on a birthing stool, hands on the ground and started to push. Jeannette allowed me to do whatever I had to do. I pushed and pushed but I couldn’t find the right way. I was not coached or coaxed into changing. I naturally moved in the direction my body adjusted. My spouse came behind me for assistance and support as I had some trouble maneuvering with the bulge in front. Then something inside told me to just surrender and let the body push the baby out. I clearly remember the moment I surrender to the pushing. Lan, my spouse, was still behind me gingerly spooning me to support my tired body. I inhaled deeply and then exhale the most powerful animalistic groan. It was an intense feeling, nothing like I had ever felt before. I reached down and felt her head, she was coming! In an instant this strong energy went through my body and a second growl exploded from me… In a heartbeat she was born into my hands. Jeannette unraveled the umbilical cord that had been around her neck. She placed her in my arms against my skin and I stared into her tiny little face. She was red, wet and screaming from the top of her lungs. She was mine and there would be no one whisking her away. The nap and the exhaustion were forgotten. IT was an incredibly empowering feeling. I gave birth on my own terms, when both Ella and I were ready. It was 11:49pm.

Lan holding and supporting me while I held baby Ella.

It was an amazing birthing experience!

Big sister Emmalee, holding Ella a few minutes later...

My first shirt says "Born at Home"

Ella Marie Labarca- Born June 7, 2011 at 11:49pm, weight 6lbs 8oz, 19inches long

Addendum:

Re-reading the blog assignment, I realized that simply comparing two different types of births within the United States may not be sufficient to address the birth research part of the question. Hence, let me elaborate on comparing my birth experience with births outside of the US.

If we take a look at Sweden statistically we would see their maternal mortality rates (1/11,400) and their neonatal mortality rate (1/1000) is lower than the US rates of 1/2100 and 4/1000 births respectively.  One might wonder, what is the difference among both of these developed countries? One might also realize that Sweden is one of the developed countries with the lowest C-section rate <15% (Berger, 2009). Births in Sweden hospitals are kinder, gentler and it is evident midwives are in charge, as one blogger mentions “The entire process around birth is managed with as little intervention (ingrepp) as possible.”(Gabriel, 2010)

Let’s also compare the statistics of a developing country against US statistics. I was shocked to see Chile with one of the highest C-section rates (40%) had very similar mortality rates to the US (1/2000 and 5/1000 births) (Unicef, 2010). What influences these similarities may be more complex than the scope of this blog post. However, the midwifery profession is starting to understand how birthing practices needs less disruption from a medical personal, and a kinder approach (Davis-Floyd,Pascal-Bonaro, Davies, & Gomez Ponce de Leon, 2010).

I guess my take on all of this is that the home birth was only a better choice, for me, because I felt there would be less unnecessary medical intervention (drugs, IV, monitoring). If I had been given a choice to birth in a supportive environment within a health care facility, like a Swedish hospital or a birthing center, I probably would have chosen this option. It is unkind and disruptive interventions that need remedy by improving training of medical personal. Perhaps, we need more evidence-based practice approach to really understand what role the hospital staff should play in the birthing process. We also want a global change for kinder birthing practices where women do have access to skilled birth professionals (Davis-Floyd,Pascal-Bonaro, Davies, & Gomez Ponce de Leon, 2010). Let me reiterate how I did my homework and my birth was safe because I was being assisted by a skilled midwife.

Thank you for reading!

References

Berger, K. S. (2009). The developing person through childhood (5th ed.). New York, NY: Worth Publishers.

Davis-Floyd, R., Pascal-Bonaro, D., Davies, R., & Gomez Ponce de Leon, R. (2010). The International      

MotherBaby Childbirth Initiative: A human rights approach to optimal maternity care. Midwifery Today. 

Retrieved on March 1, 2012 from http://www.midwiferytoday.com/articles/imbci.asp

Gabriel. (2010, January 7). Giving birth in Sweden. [Blog post]. Retrieved on March 1, 2012 from 

http://www.transparent.com/swedish/giving-birth-in-sweden

Unicef. (2010, March). At a glance: Chile. [Website]. Retrieved on March 1, 2012 from http://www.unicef.org/infobycountry/chile_statistics.html

Unicef. (2010, March). At a glance: Sweden. [Website]. Retrieved on March 1, 2012 from 

http://www.unicef.org/infobycountry/sweden_statistics.html

Unicef. (2010, March). At a glance: United States of America. [Website]. Retrieved on March 1, 2012 from 

http://www.unicef.org/infobycountry/usa_statistics.html