A Home Birth

I'm going to preface this post with saying that any person who endeavors to raise a child/children is amazing and any woman who gives birth is also amazing.  The process of birthing is a life-altering, emotionally/physically/spiritually challenging time regardless of how or where it is done.  Any woman who gives birth should feel proud of her accomplishments and her partner should feel equally proud about being present at whatever level possible.

While women have been giving birth for millenia, no two birth stories are the same, and this is as it should be.  Throughout the hours or days that a woman labors, throughout the 40 weeks that she has been pregnant, throughout her life reaching back to her own conception, thousands upon thousands of genetic and environmental variables have contributed to the particular path that a birth will follow.  Some of these variables are within her control; most are not.

I had the great privilege of witnessing a home birth earlier this week.  While I'm still processing the entire experience, there are several points I'd like to elucidate here.  Women tend not to give birth at home for two reasons.  First, they are scared about potential problems.  Second, the amount of pain during a natural childbirth seems unmanageable.

To address the first, we are all very grateful that hospitals exist in case there is a complication.  However, the event of one is unlikely.  Really.  Assuming the mother is reasonably healthy, if allowed to follow their natural course, over 90% of births will result in a healthy baby and a healthy mom without any interventions. Since the midwife follows her client carefully for at least 8 months prior to birth, she can pick up on any problem before the mom actually goes into labor (pregnancy toxemia, placenta previa, etc). If indicated, care is then transferred over to the medical specialists.    If issues arise during the actual labor or delivery, including if the mom doesn't feel that she can truly labor through the pain (the couple and midwife usually agree upon a code word for this before labor), there is a hospital transfer.  People who choose a home birth are not jeopardizing the life of their child. What we see happening in western medicine is that birth is approached as if there is always going to be a problem.  The midwifery model of care is prepared to deal with minor problems, will transfer for major ones, but does not expect that there will inherently be issues.  Birth is a normal process, not an illness.  It is also beneficial to remind ourselves that there is a very wide range of "normal" when it comes to birth.  Some women, like this new mom, are actively pushing for 5 hours.  I know of one woman who was in active labor for 42 hours.  She labored at home for 39 of them because she wanted to be in control of her environment although she did not feel comfortable actually giving birth at home.  As long as it was clear that the baby was not in distress, she did not want to go to the hospital until the very last minute. 

The above examples point out a huge benefit of home births (and to a varying extents, giving birth in a birth center or with a very progressive hospital staff): control over one's body and environment.  In the case of my sister-in-law, she chose who was going to be at her birth (her husband, her midwife, her sister-in-law and one of her best friends) and who was not going to be at her birth (sorry Sam,  no dogs).  She was intimately familiar with her environment.  She chose where she was most comfortable laboring and giving birth. During early labor, she and her husband walked circles around their living room.  When I arrived, she was in bed on her side.  Throughout labor, she moved to several different locations, and experimented with several different positions, ultimately deciding that the best position for her was on her back in her own bed.  But these were her choices. She was allowed to stay hydrated with her favorite drink (grape juice), and if she felt like it she could have had something to eat.  She had meditative rain DVDs cycling through the entire labor experience as well. The noises from the street below were all familiar to her because she was in her own home.   She felt a sense of safety because if anything did go wrong her midwife, whom she had grown to love and trust, would tell her.  She relied on the midwife's skill and expertise, and was comforted to know her midwife was there for the entire time my sister-in-law needed her. 

As for the pain, my sister-in-law did say it was the worst pain she had ever felt in her life.  There are philosophical, physical and emotional reasons why some women choose to have unmedicated births, but I'm not going to address those here.  I'm simply going to tell my story as a witness.   During the labor and birth, for the most part, my sister-in-law was relatively calm and focused.  She maintained her sense of humor throughout.  There was a period of time about four hours before the baby was born, probably when she was transitioning, where she hit a mental wall and was clearly distressed and overwhelmed by the pain.  The midwife acknowledged her distress and said that she will find her way when she needs to.  Instead of demanding that the mom push through these horrible contractions, she suggested that the mom could simply breathe through them.  The midwife also explained that the baby "needed to turn that corner" and it would be necessary to work through that pain as much as it hurt but she will find her way just like the baby was finding his way.  And, the new mom did find her way.  She turned that corner with the baby, got into a new position, found her groove and methodically pushed through the pain, bringing her son into the world.  Women's bodies are made to endure this pain.   It was really interesting how in the last hour of pushing we all sort of got into a rhythm which was almost unspoken.  Mom would nod, her support people would help support her, and she would push through the contraction.  Then she would have two minutes of rest which were much needed (incidentally, inducing with pitocin can bring on such sudden, severe contractions that the down time between contractions is not there, which often leads to the intervention cascade of epidural followed by C-section.  This is also why most hospitals now refuse to do VBACs, because pitocin contractions are so much more violent than natural contractions and do risk rupturing previous incisions in the uterine wall).

What is it that I find so particularly awesome about home birth midwives?  For starters they've attended hundreds of births and have seen the entire range of normal.  They approach the birth with an aura of calmness combined with love and wisdom.  After the birth, the midwife sat down next to my sister-in-law and her new baby and mentioned that every woman goes through that self-doubt phase and they all come out of it.  Obviously, this would not have been necessarily helpful to say in the midst of labor.  She wouldn't have believed those words. When my sister-in-law exclaimed in the throes of transition that she could not do it and that all her effort and pain was not helping at all, we, as her support people, just said "you are doing it!  You are awesome!  You are amazing!"  Her midwife kept reassuring her "You are doing fantastic.  You are doing it just right!"  Because in essence, she was.  There is no right way to birth.  And for a first time mom, it is a learning experience to figure out how to push to effectively move the baby through.  But there was no sense of urgency among anybody present.  There was no rush to get anything done.  Obviously, mom wanted the baby out (as did the rest of us), but her support people, including the midwife, were there to provide emotional and some physical support to her as she figured it all out and worked within her own body at her own pace.  The midwife consistently checked the baby's heart beat, which remained strong throughout, and certainly provided significant technical assistance (and reassurance), but she was not actively "managing" the birth.  She sat at the foot of the bed for the last few hours, while the rest of the support people surrounded the mom.  The last hour of pushing was very effective, and about 15 hours from the onset of contractions (early first stage of labor), my brother and sister-in-law welcomed their son into the world.

The midwife stayed for another two or three hours. Baby rested on mom with dad close by for about an hour before the midwife stitched up a small tear and examined the baby.  During that resting time, the midwife  completed some necessary paperwork and then showed us the placenta, explaining how the different parts functioned, as well as creating some fabulous placenta tree-of-life prints. While examining the baby, she showed the couple how to care for the umbilical stump, and answered any questions they had. She pronounced the baby "practically perfect in every single way" (which he is).  She made sure mom's bleeding was under control and that the baby was well on his way to figuring out nursing before she left.   Her standard protocol is to come back the day after the baby is born, the third day after the baby is born, and then at a week, two weeks, four weeks, and six weeks. 

It is worth noting that my brother and sister-in-law were well-prepared to birth at home.  In a day where not many people go through home births and therefore expecting couples are not hearing about stories or experiences from their own mothers or close friends, it is wise to be educated from other sources.  They had taken a 24 hour Bradley course as well as another overview class about what to expect during birth.  My sister-in-law went to prenatal yoga classes and learned more relaxation techniques and how to breathe deep from her belly. They would also call or email their midwife whenever they had questions.  Likewise, for the last two months of prenatals, the midwife came to their apartment for appointments so she could develop a pretty good lay of the land and know how to maneuver comfortably within their environment.  

As a future midwife, and particularly one is who is studying via the Certified Nurse Midwife route where I will see and assist in a lot of hospital births, I feel so fortunate and honored to have been able to witness a home birth as my first birth.  If and when the fear-mongering western paradigm gets to me, I will be always be able to reset my internal compass back to my nephew's birth.