I am the mother of five children. None were born at home (although by number five, it was clear to me that her intent was to arrive in this world before I arrived at the hospital!) After the birth of each child, I admit it: I wanted to be at home… in my own ‘nest’ and away from the kind, concerned eyes of my colleagues at the hospital. Only days before I gave birth, I chatted casually with, and even borrowed a pen from the person who was now responsible for assessing my uterus and bowel habits. They were all epitome of professional and compassionate, but it does feel odd to say that my colleagues, the hospital staff I work with most days were tasked and successful at offering up ‘good help to those in need.’
And I am not a very good patient. It’s hard to swap your doctor hat for a patient hat, and I know on which side of the stethoscope I prefer! I am not a good patient.
As I read the AAP’s policy statement on Planned Home Birth, I was instantly transported back to the day when I seriously considered home birth as an option for me. After my first child was born, for health reasons, I was not a candidate for epidural anesthesia and the hospital experience of Number Two’s birth was miserable (induction with IV Pitocin increased every few minutes catapulting me into instant hard labor.) It was not an experience I would wish on anyone. I could have used someone to help me understand this experience, and my obstetric provider was seeing patients in her office. She’s an amazing doctor, and I trust her implicitly; but her responsibilities did not allow her to be present at the bedside during my labor. When we talked about this many months later, she reminded me of the valuable contribution made by the midwives and doulas we know. They provide just this kind of presence allowing birth to progress with a reassured confidence that things are unfolding just as they should.
The experience of pregnancy, labor and delivery with a certified nurse midwife and my obstetrician teamed together was something I had in the subsequent births of my children. I knew that the ‘medical machine’ delivers healthy babies day after day, but there aren’t many of us who need something other than what hospitals are accustomed to doing. I had to find a better solution for my needs, and I’m proud to say I was an ‘engaged patient’ before the term was even coined.
As the AAP Policy Statement asserts, hospitals and birthing centers are the safest places to have a baby, and with the millions of babies delivered, they have Big Data to back them up. This data may not represent the whole truth. It is important to remember that only 1% of women in the U.S. give birth at home, so comparing hospital Big Data to home birth Little Data may not tell the whole story about what’s really true when it comes to safe birthing and successful deliveries. We know that twice as many third and fourth degree lacerations happen with hospital births, and twice the C-section rate occurs (when compared to countries where access to hospital deliveries is not as routine as in the U.S.) There are three times as many maternal infections in hospital births compared to home births so perhaps the definition of ‘safest’ matters when we must compare hospital deliveries to home births. For centuries, maternal and infant mortality were the focus of safety, and sadly, this is why: world-wide, twice as many newborn deaths occur at home than in the hospital.
I admit that I was unaware of all these statistics when my children were born. I had only my cherished women’s intuition to guide me. I knew that if I chose a home birth and anything went wrong with my deliveries … I would never forgive my physician-self if the NICU was down the street and not down the hallway. I chose to have my children in the hospital because I couldn’t escape my background as a physician. And I hoped that the staff would forgive me for being the abysmal patient that I’m sure I was. I included a nurse-midwife on my team to help with many of the aspects of labor and delivery that were hard for me, especially in the absence of an epidural.
To Alice Hirata, MD and Nancy Giglio, CNM… I owe a great debt of gratitude. They are my providers. I am lucky to live in a city where a wide variety of obstetric providers are available to women. There is a wonderful network of women assisting other women in the birthing process, and many work closely together across lines that are less firmly drawn in Richmond than in some other cities. This group improves the both quality and the variety of care for all women and their newborns. My hope is that as home births increase, people will continue to support this birthing option and track outcomes to ensure that it remains a safe option for mothers. Likewise, I hope those women who are told that they are not good candidates for a home birth will listen and understand why. Both home and hospital births have room to improve their statistics; they have much to learn from one another; and both approaches seek the same outcome: dads who email the family “both mother and baby are doing fine.”
Disclaimer: The legal team insists I tell you that I’m not endorsing any of the providers I’ve mentioned above in telling you about their part in my children’s arrival into this world. Done. (So silly, but… whatever.)