Monday, September 8, 2008

Risky Behavior

As we get closer and closer to the end of my pregnancy I am frequently asked how things are going. Instead of answering with a generalized "oh we're fine" lately I have (somewhat mistakenly) opted to be a little more open and expressed my excitement about getting further in our quest for a natural, midwife attended, home birth. Much to my surprise I have been faced with a lot of shock and very little support. Doug says that I should just smile and nod and not be so upset by it. He says that I should not take it quite so personally and that everyone is just expressing concern for our well-being. I will concede that perhaps I am being a tad emotional - but this is something that I have been struggling with and hoping for since before I was pregnant. I do understand that with my history and with my family history that most would find that I am tempting fate to even consider not spending the last precious weeks of my pregnancy under the tight supervision of trained medical staff. However, like Doug is so fond of reminding me, this time is different - that continued dwelling on the past difficulties will make them current difficulties. Are we not evolved enough for mind over matter? Do I not have the right to want, desire, expect and even DEMAND that this time it is different and better? That is what we have decided that we are going to do. We are treating this as if it as new of an experience for me as it is for Doug.
I do understand every one's concern and I am grateful for it. I know it must have been difficult to stand idly by and watch someone you love struggle and the worry that they will have to go through those things again.
I thought the best way was to answer the questions that I am so often getting. To reassure those that have not yet had the opportunity to voice their concerns, and to calm the minds of those who weren't entirely convinced. In researching my birth options I came across a website from a midwife in Mountain View, California, Ronnie Falcao. In her FAQ section I found a list of questions and answers that I thought I would post here. Hopefully this reassures some people, or at least prompts them to study further.
I would hope that this would go without saying, however, because it has come up SO many times let me say -
Yes, if I do go into pre-term labor I will go to the hospital!! Doug and I would NEVER put our child at risk. This is our decision when (we choose not to think in terms of IF) I am full term and Fiona chooses to make her appearance. Should we encounter the complication of labor before 37 weeks we will be under the best possible care at a near by hospital.
  • Is a home birth safe for you and your baby?

Yes, definitely. Evidence has shown that, overall, home birth is safer than a hospital birth for both me and our baby. Some study results follow:
Perinatal mortality rate for home birth was 9.5 per 1000 compared to 20.3 per 1000 for hospital births in California. Mehl LE et al. Outcomes of elective home births: a series of 1146 cases. J Reprod Med 1977.
Neonatal mortality rate for hospital birth in North Carolina was 7 per 1000 and for home birth was 4 per 1000. Burnett CA et al. Home delivery and neonatal mortality in North Carolina. JAMA 1980.
Neonatal mortality at out-of-hospital births in Kentucky from 1981-83 was 3.5 per 1000. Hinds MW, Bergeisen GH, and Allen DT. Neonatal outcome in planned v unplanned out-of-hospital births in Kentucky. JAMA 1985.
“There is no evidence to support the claim that the safest policy is for all women to give birth in the hospital.” Campbell R and MacFarlane A. Place of delivery: a review. Br J Obstet Gynaecol 1986.
Perinatal mortality rate with OBs was 24.3 per 1000 babies. PMR at homebirths was 2.4 per 1000. Eskes TK. Home deliveries in the Netherlands--perinatal mortality and morbidity. Int J Gynaecol Obstet 1992.
One book summed up home birth outcomes as follows: “Excellent outcomes with much lower intervention rates are achieved at home births. This may be because the overuse of interventions in hospital births introduces risks or the home environment promotes problem-free labors.” Goer, Henci. Obstetric Myths vs. Research Realities, 1995.

  • Why would you want to have the baby at home when there is high technology available at the hospital?

The short answer: Hospitals are for sick or injured people, and a woman giving birth is not sick or injured. The long answer: Technology used routinely actually causes more problems than it solves. Hospital procedures, including routine IVs, external or internal fetal monitoring, taking nothing by mouth, and episiotomy all increase the risk to both mother and baby. Of course when used appropriately, technology can be life saving. Another couple of incentives to stay away from hospitals: A recent study reported in major media showed that the number one cause of death in hospitals is medical error. Also, a hospital hosts a variety of unpleasant bacteria which you will not find at home.

  • What if you or the baby has a problem--what does the midwife do?

My team of midwives is fully experienced with the normal course of labor and birth, so that they are able to identify anything that could be problematic as soon as it comes up. In the event of an emergency, they are certified in infant resuscitation. They carry necessary equipment such as oxygen and medication to control bleeding. They either resolve emergency situations or control them during transfer to a local hospital for care with the backup OB.

  • But, didn’t you have a cesarean with Allie? Shouldn’t you be in the hospital?

Being in the hospital is one of the reasons I had a cesarean with Allie. If I go back to the hospital, my risk of cesarean is even higher this time because OBs insist on managing VBAC (vaginal birth after cesarean) as a high risk situation. In most cases the cesarean is actually more risky for both me and our baby. The only increased risk in VBAC is an unlikely uterine rupture. Because rupture is so rare, less common than both prolapsed cord and placenta previa, there is no reason for my labor to be considered more high risk than anyone else’s. If you believe VBAC is too risky, then it follows that every woman should have a cesarean before labor starts. Ridiculous, right?

  • But you will feel horrible if something happens to your baby at home!

Of course I will be devastated should something happen to our baby. But, I actually see it just the opposite. If I were in the hospital and something happened, I would feel worse, because I would know that that outcome would have been less likely to happen at home.

  • Don’t you think you are taking a big risk by doing something like this?

Life is full of risks, and there are no guarantees of absolute safety in any endeavor. However, we have weighed the risks and benefits of these options over the last few months, and there is no doubt in our minds that home is the better place to be.

  • And a final question we hope you will ask-- What can I do to help?

We hope you can see that we have made the best choice for us. Even if you don’t agree with us, we hope that you will respect us enough to support us and not criticize us. We need your support, encouragement, and prayers. Practical help after the baby is born will also be welcomed. Thank you for your love and support!

We understand that the criticism and questions come only from love. So does our decision to birth our baby at home.

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