Monday Musing… In Support of Home Birth

About a week and a half ago I doula’d a wonderful sista…  We’ll call her Baby J’s Mom.  It was FABULOUS.   She had no medications during labor.  Her significant other was present and cut the baby’s umbilical cord. She nursed her newborn shortly after birth. She expressed satisfaction in the way her labor and birth happened as she got pretty much everything she wanted except the use of the large labor tub at the hospital which she didnt use because she delivered within an hour of arriving to the hospital.  She gave me permission to write a post about her birth and so here it is. I wanted to share her story because while she was happy with her birth experience, it was a perfect example of why many women should and do stay home to birth their babies…. Following is not the complete birth story but hopefully it’s enough to paint the picture. This is indeed a post In Support of Home birth.

Baby J’s Mom initially called me around 2:30 am. “I think it’s starting. I’m having contractions,” she told me.  I offered to join her and she declined at that time saying she would be okay alone.  She called me back almost four hours later and I could hear the difference in her voice. I jumped into action.  I arrived to her home around 6:45 AM. She was rockin and rollin!! Around 8 AM she wanted to be checked.  She was 8 cm.  We headed to the hospital where the basic routines ensued.

A medical history/interview was done with what seemed like 100 questions…  most not pertinent to the immediate business at hand.  There were a slew of papers to sign “Hold off on that one… you said you wanted to wait until the pediatrician’s office to ask about that remember?”   Oh yea she replies and then decides to give consent on the spot anyway. The Electronic Fetal Monitor was applied and her IV was started.  She told me, as many women in transition do, that she sort of, kind of, wanted an epidural. With that, her nurse started an IV Bolus and ordered labs.  I could tell by the speed of the nurse’s activity that she was going through the motions with little hope that Baby J’s Mom would be in labor long enough to actually get an epidural.  And she did not have to worry because before the labs were even drawn, the doctor was there ready to “get her into stirrups.”

He arrived ready for delivery even though no one… not Baby J’s Mom, not the nurse, not me, no one called him for delivery or led him to believe that Baby J’s Mom was ready to birth her baby.  Aw no need for an epidural he said.  You can just get this all done and be finished with the pain.  Initially, from the outside it may have seemed like he knew her plan for an un-medicated birth and was being supportive.  BUT…  if you know like I know…. You understand that he was really being impatient.  He knew if she proceeded to get the epidural, her delivery would have been delayed at least an hour, possibly more as we waited for lab results to be obtained and the epidural to be placed.

He had no patience for birth and after doing one vaginal check on Baby J’s Mom he began coaching her to do long, closed-glottis, purple-faced pushing even though she had NO.   URGE.   TO.   PUSH!!!!  As she pushed, he placed his hand inside of her vagina and gave counter pressure against her cervix to make her dilate faster. His hand, and the counter pressure he applied caused more pain than the baby and the contractions themselves.  I made a few comments and asked a few questions out loud to encourage Baby J’s Mom to speak up about the pain and to remind the doctor that she was not a vagina. She is a woman, and while yes she is a STRONG woman, she is a woman with feelings in spite of the fact that she was not yelling out in pain.

After a few contractions this way, Baby J’s Mom had an urge to push and in a few pushes Baby J was born.  “A” (her significant other) cut the cord, which was one of the biggest goals for this birth, and Baby J was placed on mom’s chest.

In spite of having NO medications on board, the baby had a difficult transition after birth and needed a little help to get her to breathe.  Some may argue that it was good that we were in the hospital because they had the necessary oxygen set up to help the baby.  For those of you who don’t know, that same oxygen set up IS available during a home birth and the midwives who do home births are more than equipped to handle such a situation.  What’s even more important to note here… as we speak in support of home birth … a mother without medication, except for the VERY  VERY  VERY  rare occasion needs no coaching or instruction on when or how to push.  Women know when and how to push and waiting and allowing the woman to guide the second stage of labor as she feels an urge to push changes things and as she follows her body’s direction, her pushing will not usually include the long closed glottis “purple pushing”  that can effectively cut off oxygen to the baby for thirty seconds or more.  I’m sure that had something to do with the way Baby J responded after delivery.  Additionally, if we had waited until the cord stopped pulsating Baby J’s transition may have been a lot easier.   The idea of waiting for the cord to stop pulsating is not done routinely in hospitals here.   At home Baby J’s Mom would not have been pushing without an urge. She would have followed her body’s cues of when to push. Her pushing stage would have been shorter.  The cord would not have been cut until after it stopped pulsating.   I can’t say for certain how Baby J would have done with these changes.  What I can say is research supports the notion that the resuscitation would not have been necessary.

Moving on… I was still at the head of the bed with Baby J’s Mom and I noticed the physician was doing a LOT around the delivery of the placenta and I thought… Is she bleeding?? Then, I realized the placenta had not been delivered and in his haste he had pulled the umbilical cord and it completely detached from the placenta.   Now he was attempting to remove it manually and until I made a statement to question what was happening he wasn’t even interested in telling her.  A mother without an epidural can certainly birth her placenta spontaneously, even if the cord has detached. In the hospital world however, when this happens the solution is always manual removal of the placenta… this means the doctor has to place his hand and forearm into mom’s vagina to remove her placenta from the inside of her uterus  with his/her hand.   This is NOT a pleasant experience as one can imagine. Had he been patient and simply waited for signs of placental separation instead of rushing to pull it out this would have been avoided.  During home birth this would not have happened.  Yes women have retained placentas during home births. But not because the midwife was impatient and pulled off the cord within minutes of the birth.

Baby J’s Mom expressed satisfaction with her birth experience.  She felt empowered.   She was happy her boyfriend cut the cord.  She was happy she did not get medicated. She was a rock star! And when it was all over I said to myself…. She DEFINITELY could have stayed home and next time I hope she will.  Her birth story IMO is a great example of how many of the birth “emergencies” we hear about are iatrogenic supporting the FACT that you may truly be better off at home. I hope you will consider these things as your plan your next birth.

Did something happen during your birth that you know was iatrogenic… caused by the doctor or hospital staff… something that would have been avoided had you stayed home?  Share your story… In Support of Home Birth.

Don’t Take a Detour Miss Harris…

In December, The Grio posted a few of articles re: doulas and home birth.  One of them was:  Home birthing helps black women reconnect with African roots. The title, the article, and the accompanying video left a LOT to be desired.  None-the-less, I was happy to see that homebirth was being discussed in a forum widely read by African American women. The way I see it, the more we talk about it, the more women will know that they have options and alternatives.

Last week, I came across another article, a response of sorts to that Grio piece:  If Natural Homebirth Brings Me Closer to My Roots, I’ll Take a Detour.  Intrigued by the title, I read it and shared the link.  The reactions to the article were strong, and we were all concerned about the lack of informed information presented in the article.

Initially, I was simply going to make a comment at the end of the article.  Then I decided it deserved more time and attention. My response follows below. But before you get to it, let me clarify that while I am a natural birth advocate and supporter of home birth, I understand that not everyone will, nor should everyone deliver at home.  And, I don’t believe we can make any blanket statements re: homebirth having anything to do with “going back to ones roots.”  The reality is, regardless of race, a woman should birth where she is safest and most comfortable. FYI, the hospital may or may NOT be that place.

Now on to the above mentioned article. Per Miss Janelle Harris… “Our foremothers may have been able to stretch out in their homes with a supportive doula by their sides, but they also weren’t battling external stressors like money and relationships and health care and family medical leave and jobs and transportation issues.  It was a different, simpler world”  

*Coughing and choking* HUH??? So I guess slavery, Jim Crow, abject poverty, segregation, discrimination, mutilation, lynchings…. None of those were external stressors.  And while I suppose picking cotton for Massa did come with a sort of “job security,” I don’t think it was accompanied by a stellar salary or medical benefits. Transportation? Yep walking was always a sure fire way for our foremothers to get from place to place.  Relationships?? Between the selling, and lynching of chosen partners, and rape from others….  Yea… a  “different simpler world.”

Miss Harris preceded that statement by saying:  “But most of Black women’s issues lie not in the hospitalization during labor, but the health risk we suffer leading up to childbirth”  There is one truth here. Yes, many African American women have health risks leading up to birth.  What I can assure you however is that there are MANY things that take place INSIDE the hospital to high and low risk mothers alike that affect outcomes. And African American women with no medical risk factors, high soci-economic status, great prenatal care and good education suffer at the hands of the medical obstetrical establishment. Don’t believe me? Check out  “When the bough breaks” Episode 2 of the ground breaking PBS documentary “Unnatural Causes, Is Inequality making us Sick”

One of the things that annoyed me most while reading this article was Miss Harris’ lack of knowledge about the preparation, training, and skill sets of doulas, midwives, and obstetricians. She says:  “I don’t discredit the wisdom and ability of a doula to do what a doula does or a midwife to do what a midwife does, folks go to medical school for a reason and learn things you and I and madame doula and midwife wouldn’t begin to know because that’s not our training”

The reality is Madame Harris while it may not be part of YOUR training it is a part of MY training and you my sister are WRONG.  In fact, Midwives are MASTERS at normal birth. Obstetricians on the other hand are educated in intervention, surgery, and problems. In theUnited States1 out of 3 women has a cesarean section not all because she originally needed one or because her pregnancy was high risk. It’s often because those “folk” who go to medical school learn about surgery more than they learn about labor and quite frankly they enjoy the pay check that comes from a 30 min surgery instead of helping a mother with a 16 hour labor. As a midwife, I have taught many a physician a thing or two or three about normal birth.  Midwives not only BEGIN to know more about normal birth than OB/GYNs we FINISH knowing.  And for the record, midwives are trained and are VERY knowledgeable and skilled to handle birth emergencies.

I found it quite interesting that as Miss Harris shares her personal birth story, she tells us that she had plans for a natural child birth: “I’m not knocking natural birth. I had my daughter naturally… I didn’t pop so much as a Tylenol before she made her grand debut.  That was always the plan way before I went into labor.”  She did not share with us why that was her plan, but it leads me to believe she did some research and then made an educated, conscious decision to avoid meds during pregnancy AND labor. Kudos Miss Harris for that!!

Like most first time laboring women, after 16 hours of labor and getting to transition, during a car ride to the hospital, she found herself asking for medicine. This is not uncommon. Anyone who is in the birthing profession has seen this happen many times. Transition ain’t easy and without proper support from a doula, midwife, or family member with natural birth experience this happens often.  Per her account, she was unable to get medication because by the time she arrived she was ready for delivery.  She has no idea how lucky she was.

It’s so interesting to me that Ms. Harris labored at home without a midwife or a doula. She arrived to the hospital just in time to give birth but has a negative response to the idea of home birth. The way her story reads, a few minutes more and she would have been having her baby on the side of the road… She was moments away from a Free Birth which is in fact an out of hospital birth without a trained provider.

I challenge the notion she gives in her article that the hospital means rapid, appropriate, safe help is within immediate reach. From the article:  “When it comes to bringing my baby into this side of life, I want it done as safely as possible.  The moments when things go wrong are precious.  I want someone there who knows how to handle them. Like right there. In the room, not a hop-in-the-car or cab ride away”

I am not sure how many labor and delivery units Miss Harris has worked on but I can tell you from almost 18 years of experience, it’s a RARE occasion that any physician, except in a teaching institution is like “right there.”  I have been the person making multiple calls, and placing many pages to a physician who is asleep, out to dinner, at a party, etc who takes their sweet ole time to hop in a cab or car to get to the hospital. Most often in these cases, what is now an emergency in the middle of the night is the direct result of the medications and procedures ordered in the name of a safe hospital birth.

Madame Harris, my dear sister, you had the wonderful opportunity to labor at home.  You did not LABOR in the hospital.  You were not strapped to a bed for more than 24 hours because your provider decided to induce you before your body was ready. You were not denied movement, drink or food. You were able to ambulate, and to go to the bathroom as you wished.  While you did not birth at home you actually had a totally unassisted/unmonitored labor which is actually more radical to some than a having a home birth with a trained professional.  The great part is as a result of you staying home you were able to listen to your instincts; to listen to your body; and do what was needed to ensure your baby moved through your pelvis safely and normally.  Believe me when I tell you… in the hospital that would not have been possible.

So I say to Madame Harris and to all the women who don’t understand the realities of hospital birth… while home birth is NOT for everyone, PLEASE don’t be fooled by the false security of the hospital.  The VAST majority of emergencies that happen in hospitals happen because we cause them. We restrict movement, we give meds, we starve women, we rupture bags of water, we use continuous monitoring and ALL of these things can cause problems. Miss Harris, I ask that the next time you make a decision to write an article about the value of hospital birth you do a bit more research, and may the information you find help you to Birth Something Beautiful™

In Birth and Love
Nicole