Saturday, January 29, 2011

Home is where the heart is...

Sometimes the questions are complicated and the answers are simple. ~Dr Seuss


A few days ago I posted about my wandering mind, and doing home births (or avoiding them and instead cowering in the "safety" of the hospital/birth center setting... however backward that may be). A reader commented on this - the irony that for many women, birthing in the hospital setting is scarier than in the privacy and protection of their homes, away from the germs and interventions housed in the walls of most care facilities. On the flip side, many other women would be terrified of delivering without the comfort they feel is provided by having doctors, nurses, and technology close at hand.

Personally, as an OB nurse and almost-nurse midwife - I LOVE homebirths, and think that for the majority of women (basically, meaning a healthy mom and healthy baby), attended by an
experienced, qualified attendant (whether a nurse-midwife or certified/licensed midwife, etc), they are as safe 0r - in many cases - possibly safer than hospital births. As any midwife (or woman who has birthed at home or attended a homebirth) would attest, for couples who are 100% on-board with home birth - preparing throughout the pregnancy with that mindset, remaining relaxed and positive, as well as hanging out in that mythical "low risk" category - the energy present as a baby meets his or her loved ones for the first time, uninterrupted by routine medical tasks, is indescribable. Relationships are strengthened, bonds are cemented, and a deep sense of family is forever rooted by the experience.

But.... on the other hand.

I am not an experienced nurse-midwife. Yet. The fear that I carry comes from that little detail. I worry that I don't have quite enough critical thinking; nearly enough attention to the little things; the right amount of intuition. The catch-22 of working on the L&D unit is that a person gains an unhealthy sort of dependence on fetal monitors, lab tests, and the proximity of "just in case" scenarios; while it's great to have the collective knowledge of scores of other nurses and
providers (many of whom revere the sacredness of natural birth), it becomes increasingly more difficult to see the clarity of birth
through the fog that is the medical model's view of pregnancy and birth as an accident waiting to go wrong.

This fog is still pretty thick throughout my mind, body, and being. Wisp by wisp, it seems to be clearing - but it will certainly be a gradual process. With each normal, natural birth - devoid of "routine" (read: unnecessary, "provider convenience" or "just-because-because-we-always-do-it") interventions, I feel closer to the births that nature creates.

Will I ever perform home births? I think so... I hope so... When this fog clears, I think that question may be a much less complicated one than it seems right now.
I recently met a first-time mother; she was young, and labor started spontaneously right around 37 or 38 weeks. She had great support from her female family members, although the father of the baby wasn't involved. She progressed wonderfully throughout labor, working with her body and changing positions without directions or suggestions from anyone else; sitting, side-to-side, up to the toilet - she did everything, as her body told her. Other than the minimal monitoring necessitated by protocol (ugh), she was free from monitor belts and IV's (though she did receive 30 minutes of IV antibiotics for a positive antipartum GBS screen). Per her choice she did receive a bit of IV narcotic, but - and this is just my opinion, so please take it with a grain of salt :) ! - I think had she been a little more prepared and a wee bit less scared of the process, she would have sailed through labor just as easily without anything. (Either way, it was, of course, her choice.) Soon she ruptured her bag of waters, rapidly progressed to complete dilation, and spontaneously began pushing in a hands-and-knees position - and delivered a beautiful, radiant baby girl in that same position. No one told her to flip over to her back and yank her legs back (not even the male physician who happened to be nearby and called into the room as she precipitously delivered); no one counted to '10' and directed her to push hard to the point that blood vessels would burst; instead, she was encouraged with cool washcloths, soft words between pushes and cheering during them.

It wasn't a home birth; not by any means. After birth, the cord was clamped fairly quickly, and baby was taken to the warmer to be "dried off" - which led to at least a 30 minute delay in mom/baby snuggling. (The reason? Besides the obvious inconvenience of mom being in the hands/knees position - something that could be remedied rather quickly! - the amniotic fluid had shown itself to be mixed with a fair amount of thin meconium, and baby was mec stained.) So - although babe was quite vigorous - screaming her little head off! - she was across the room getting toasty while mom was birthing the placenta, receiving a few stitches, and being cleaned up. While mama didn't mind - I did (once I had a chance to realize how much time had passed).

But, on the other hand, it was a very, very sweet birth. Home birthers may read this story and think, "My god! How awful that the baby wasn't in that mom's arms!" or wonder about the fact that mama got Nubain... or antibiotics... Other women might wonder why in the world she didn't get an epidural right away. Some women are more than happy to have their babies "cleaned up" (just my opinion again, of course -- but how dirty are they, really?!) before they get that first really good snuggle in... and some are in no rush for a bath.

The important thing was that mama was happy with her birth experience - in that beautiful post-birth euphoria, she glowed when she talked about her day. She had a gorgeous, healthy daughter, and she felt wonderful.


... and the fog just cleared a little more.


  1. Know that the fog can and does lift. I, too, worked for many years in the hospital setting and felt the effects of the haze. Also, the confidence builds over time as well....

  2. What a fabulous explanation of your position! Thank you for addressing with such clarity and transparency how you are personally pondering the home or hospital debate. Very enlightening to read!