Monday, December 5, 2011

Do You Have a Plan B?

Due to a concern that I may sound more judgmental regarding medical practices than I actually am, I've added a few things to this blog--all in italics. 

Again, I am not making a judgment about people who have a hospital birth AT ALL. Hospitals are amazing and important facilities that save lives. I have known so many children who are here ONLY because of a life-saving intervention. However, having had a very low-risk pregnancy thus far (the only kind of pregnancy where a home birth is a good idea), Brian and I have decided to take a different path. This blog is about OUR research, OUR choices and OUR decision--not about the research, choices and decisions of others.

This is a question I get fairly frequently when people hear we are planning a home birth. Actually, I try to head people off the pass by telling them that we are planning a home birth with a midwife, but that we have an OB and will transfer to a local hospital if necessary.

Today, I made a random post on my Facebook page with the realization that I need to start collecting stuff for the actual birth. Unbeknownst to me, since I was at work, quite a few of my friends started posting about home birth and having a Plan B.  It was then that I remembered that in all the talk on this blog about this pregnancy and barnacle-like baby, that I have talked about my midwife and alluded to planning a home birth, I have never actually talked about WHY we are planning a home birth.

On the one hand, I tend to think "why is it anyone's business why we are planning a home birth?" On the other hand, everyone who is reading this is a concerned friend or family member. Plus, if it helps open the eyes of at least one person to the possibility of home birth, then so much the better!

So, to answer some questions I (or Brian) have been asked:

Why a Home Birth? 
First off, home birth is not for everyone. I get that. In fact, before I started reading about it, I would NEVER have considered it. I didn't even understand why you would want a natural birth. I mean, everyone knows that birth is painful. Why be a martyr?

But as I started reading, watching films and talking to people, I realized that people who are planning a natural birth are NOT martyrs. They are only doing what they feel is right for them and their baby. We spend 9 months avoiding things like sushi, caffeine, nitrates and nitrites and most medications and painkillers so as not to harm the baby. Then just as the baby is about to be born, we start pumping them full of painkillers? Many babies who are born with an epidural are sluggish when born or have difficulty breastfeeding.

In addition, epidurals can start a vicious cycle of interventions. Epidurals block the pain, but they also dull the contractions, which make it difficult to push. So, the doctor prescribes pitocin. Pitocin is a synthetic drug that mimics Oxytocin (a hormone that promotes that "love" feeling, helps with bonding and even causes uterine contractions which helps you heal faster after giving birth--you make it when you give birth, breastfeed and when you have an orgasm). Unfortunately, pitocin mimics the uterine contractions but not the whole "love/bonding" part of oxytocin. So to recap, you get an epidural. The epidural numbs the pain, but you can't feel the contractions. So you get pitocin to speed up labor and help with contractions. But now, instead of having slower contractions, you get fast and hard contractions, one on top of the other. Each contraction is squeezing the umbilical cord, squeezing the baby, causing a stressed out baby. Oh no. No the baby is in distress! What do you do? In many cases, you get a C-Section.

Now, I'm not saying this happens to every birth. But it happens a lot. In the bay area, there is a 40% C-Section rate. There is an 80-90% epidural rate. I also want to say that there is definitely a time and a place for medical interventions. We are so lucky that we have these interventions available to us--there are so many births that could end in tragedy without them! I just know that Brian and I want to try to this without medical interventions, if possible!

OK. But why a home birth? Why not just have a natural birth in a hospital?
Reason #1: timetables
Actually, I originally considered just giving birth at a hospital or birthing center. However, there is one problem with hospitals and hospital birthing centers that I just could not get over: timetables. Say you start having early labor contractions on Monday at 10 pm. Maybe your water breaks at around 6 am the next morning. You have 24 hours to have that baby before the doctor wants to induce you (start you on pitocin) for fear of infection (starting that vicious cycle).

Alternately, maybe you are 40 weeks pregnant and haven't started having contractions yet. Maybe you are 41 weeks pregnant.  If you go past that date, many doctors want to induce you. They worry that the baby is in distress. So then you get membranes stripped (doesn't that sound like fun) and hopefully you start contractions. Then if it still doesn't work, the doctor wants break your water for you, which will hopefully jump start those contractions. If THAT doesn't happen, then you get the pitocin...I think you see where I am heading here. Estimated due dates are just that: ESTIMATES. A  baby can be born anywhere from 37 to 42 weeks. And as MANY people have told me, babies are on their own schedule. You can't predict them.

So timetables. If you are in a hospital or a hospital birthing center, the doctors and nurses are required to follow them. Midwives, in general, let nature take it's course. Of course, if we get close or go past that 42 week mark and it looks like the baby is in distress, then clearly there is a problem and we need to go to the hospital.

Reason #2: Who are you again?
In most hospitals and birthing centers, you may get your OB. You may not. You may get your midwife. You may not. It often depends on who is on rotation that day/night. Maybe you start with an awesome nurse or midwife--she meshes well with you and your partner, understands your needs, etc--but then her shift ends. Now you are further in labor, maybe active labor or transition, and you get a brand new nurse or midwife that you don't know. Maybe you have an amazing OB (and I do)--they are on board with your birth plan, you have been seeing them every month for the last 9--but he or she is not on rotation that night, so you get someone who is not supportive of your birth plan or just has a sucky bedside manner or just isn't the same doctor you have been working with.

Now with a home birth midwife, unless someone else is giving birth at the exact same time or she is out of town for some reason, you will have that same midwife at your birth. You will have that prior relationship with a person who knows you, your partner, your kids, your dogs and your home.

Reason #3: Fight or Flight
Where are you most comfortable? In your quiet living room or bedroom, maybe with the lights turned low, with your partner next to you, or in a brightly lit room with (gasp!) florescent lights, lots of beeping machines, weird smells and half a dozen or more doctors and nurses you may or may not know in and out of the room?

When you are tense and uncomfortable, it is harder to labor. When you are comfortable and relaxed, it is easier to labor. In fact, at my last birthing class, the instructor told everyone to stay at home as long as possible, since that is where you will be more comfortable and will be easier to progress. Many people have 4-1-1 contractions (a contraction every 4 minutes) at home, then go to the hospital and then contractions slow down. In that vein, why go to the hospital at all, if it is easier to labor and give birth at home?

In the end, I know me. Brian knows me. I am most relaxed at home. At this point, I plan on staying home with Brian and my dogs (they relax me, too), with low lights. Maybe we'll watch a movie (we've been cuing movies just for when I'm home during maternity leave. When labor gets a lot harder, we'll call our midwife and get our birthing tub set up. We'll kick the dogs out into the backyard or maybe call a friend to take them to her house. We'll time contractions by how many music videos we can watch between contractions. Women have been doing this for years. I can too.

Again, a recap. We chose a home birth because we want to have this baby on her time, we want to have our own midwife--not a potential stranger--deliver her, and we want to be comfortable in our own home.

But do you have a Plan B?
Yes. You know me. I research and plan. Not only do I look before I leap, I look, then I look again, then maybe I read a review on Yelp. Then I cross-reference with a review on Amazon. Then I ask opinions of people who have leaped before. Then, when I am confident in my decision, I leap.

So Plan A: home birth with my midwife.
Plan B: Transfer to our hospital with my OB. If the issue is induction, we try natural methods first. If that doesn't work, then we'll try something else. If we have to have pitocin, so be it. If we have to have a C-section, well that sucks, but so be it. But rest assured, Brian will be there asking questions the whole way (those poor poor doctors and nurses!)

Our plan is to have a home birth, but our goal is a healthy baby.

So does this answer the question of Why Home Birth and Do You Have a Plan B? God I hope so. This is the longest blog I've ever written!

1 comment:

  1. Way to go! Natural birth is definitely painful, but so worth it! As someone who experienced a c-section, then a vbac with an epidural, and finally a natural birth, I definitely recommend going natural. It was the easiest and quickest labor, delivery, and recovery of all. Good luck with everything!!