Thought Provoking

By now most people involved in childbirth advocacy are aware that ACOG released a statement reaffirming its opposition to homebirth.  I was directed – via Bellies and Babies and Enjoy Birth- to House of Harris’s response and dissection of the statement. 

People who read my weblog know that I’m certainly all for a woman’s choice of childbirth venue.  I’d like to think that birth can be empowering regarless of venue, but the most likely location for empowering, rewarding, and safe birth is home, assuming that you feel safe in your home.  I am not suggesting that homebirth is necessarily safer than hospital birth.  But I cannot show any evidence that hospital birth is necessarily safer than homebirth for low-risk women and babies.  Even though I bear a cesarean scar, I am not “high risk”.

One thing that concerns me as I consider and plan for a homebirth in the Fall is what might happen to me and the baby should we need to transfer.  I’ve asked the midwives I interviewed about their experiences with transfers.  Most of them say that it really depends on which OB is on call.  Great.

Team Harris addresses this in the comments section of the above post:

I’ve heard the argument that it’s inconvenient for hospitals to have to rally around and scramble when a homebirth mother takes that risk and it fails. While I see what these people are saying, I must also point out that we also rally around for every other emergency in life. We don’t judge the drug addicts who come in overdosed – we treat them. We don’t judge the obese who come in with MI’s. – we treat them. We don’t judge the diabetic who refuses to take his meds yet wants medical help when he has a diabetic crisis – we treat him. We don’t judge the elderly for forgetting their CHF meds and overloading – we treat them. We don’t judge many other behaviors which really ARE obviously poor choices – because they are just that – choices. Mothers deserve the same treatment.

What an excellent point!  Why is it that homebirth transfers are treated as “trainwrecks” and sometimes subjected to chastisement, intimidation, and contempt at a particularly vulnerable time?  I wish OBs who have no appreciation for and understanding of homebirth would take the above comment to heart.

I know in our area, the midwives are very good about calling ahead to apprise of situations so that we CAN have all hands on deck when they arrive. In fact, we did a section recently for a homebirth transfer (a very needed section) and the timing was perfect. Midwife called ahead to warn us. We called the team, and everyone arrived at the same time. Will it always work out that easily? Sadly, no. But that is life. I’ve had to really learn to come to grips with what life is all about. Sometimes bad things happen. And while it’s tragic and horrific, we can’t save the world.

Again, I read last night in Marsden Wagner’s Birth Plan book that the decision to incision time is about 30 minutes, even if a woman has been laboring in a hospital.  Because homebirth midwives are in direct and regular contact with normal/natural birth, they are better able to recognize emergent problems that can only be rectified at the hospital.  In most cases there should be enough time to transfer and receive an emergent cesarean should it be necessary.  I live 10 minutes away from our hospital, so I feel comfortable with the choice to birth at home.

When I was conducting my interviews I learned that the midwives are required to call the hospital and let them know that a woman is in labor at home.  The midwives are not sure what the hospital does with this information.  I wonder that myself and should probably investigate . . .

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5 responses to “Thought Provoking

  1. This was a great post. I love the first quote. What a good point about not judging those you treat!

    I had a home birth with my 2nd and it was great. My midwife was very clear about emergency transfer plans and she inspired a lot of confidence in me. Thankfully I did not need to use those plans as everything went smoothly, but it was good to know they were in place.

  2. excellent post. i’m so glad you shared it.

    that first quote is wonderful. such an excellent point. why is there the disdain toward mothers?

    it sounds like you have an excellent plan in place, including that you are 10 minutes to the hospital. i had a home birth with baby #2 and was so glad i did. he ended up being a surprise breech and had i been in the hospital, it would’ve been an automatic c-section. he was born at home and is 14 months old now. :)

    btw, i love your quote : “helping change our birth culture, one post at a time” :)
    i’m adding your blog to my feed reader :)

  3. Thank you all for the comments and your interest in my blog.

    LAURA, this is my first journey home as well. Keep in touch!

    CRUNCHY, thanks and “ditto”! :)

    HEATHER, good point – since these appointments will be more extensive and involve birth education, I am sure my confidence in the process will only grow! My midwife has a warm peaceful aura. It just feels “right”!

  4. I am good friends with a couple of NICU charge nurses. My understanding is that the hospital (particularly NICU charge nurses) are kept in the loop on all laboring women who may need a NICU team present. This is pretty much all women, really. At any point there could be discovery of a meconium delivery, etc. At the hospital where these nurses work, it is just a way of having an idea of how many women are laboring that *could* need help.

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