What Drew Me To Home Birth And What Turned Me Away, Part 3

I’m trying to be as thorough as possible without leaving anything important out… there's really no other way to describe the my change of mind/heart without filling you all in on the moments that all played their part, however small they may be. My apologies for being so long-winded. Especially for this entry...

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So I passed 40 weeks. My OB, trying hard not to crush my dreams by bringing up the "i" word (induction!!), wanted me to come in for an NST and ultrasound that week. So I did. When I got in the room, the nurse said “are we scheduling your induction today?” Ugh… great. Here we go. My OB came in and again brought up induction “I know you don’t want to and hopefully you won’t need to, but when you come back in a couple days for your 41 week appointment, we’ll at least need to put it on the schedule, ok?” Ultrasound tech also asked me if I was having an induction soon, too. Ugh! I was so hurt! I felt betrayed. I wouldn’t need an induction. There was no need. I promptly went home and had a little Facebook vent:

“doctor appt today for check up plus ultrasound & non-stress test. Induce, induce, induce is all I heard from doctor, nurses, techs, etc!! I don't care if I'm 3 weeks late w/ a 12 pound baby & they schedule me for one... this pregnant lady isn't going to show up. I am NOT getting induced unless baby is in danger, people! Ultrasound & NST both showed our baby is healthy & happy!”

(I’m cringing right now reading that. That’s exactly what I wrote a few years ago on Facebook – copy and pasted.)

Anyway. No need to worry more about induction because I went into labor that evening. I labored at home for 24 hours. Our doula joined us around hour 20.

We arrived at the hospital in the evening and I did not know it at the time, but I had 12 more hours of labor ahead of me. I thought I was nearing transition but was crushed when I found out I was only 4cm. I cried. 

My nurse was…. amazing. I couldn’t believe it. The hospital overall was so nice, people-wise. Our room was mellow, lights were dim, and I was in and out of the shower. I hated being monitored some times, but sometimes it didn’t matter because I was happy laying down anyway. I drank coconut water and was offered food but there was no way I could eat anything. No way.

I couldn’t believe how nice everything was for us. Aside from the monitoring, our nurse and the on-call OB (I’d never met her before) left us alone. And were kind to us.

I was so happy/overwhelmed when I had the urge to push (and nurse confirmed I was complete) but so, so tired. I had no idea where I would get the strength to push. I’d been in labor for over 34 hours now. I tried different positions… but my favorite – which was shocking to me – was on my back. My legs were jell-o at this point. All I wanted was to do was sleep in between contractions.

Our nurse stayed with me the whole time and encouraged me with every push. She brought in a fan that she would turn off or on, as I requested, because I kept going back and forth between being hot and cold. She held me up when I tried squatting. She dabbed my head with a cold wash cloth. She encouraged me to reach down to feel our baby's head when baby was crowning... I did and it gave me a boost of energy to keep going. She was so amazing. Her shift ended but she stayed with me until after the baby was born. I couldn’t believe it.

After an hour and a half of pushing, our baby was born.

He went straight on my chest where he stayed until I couldn’t hold him any longer… because of my postpartum hemorrhage.

I wasn’t fully paying attention as I had my new baby and he was nursing and I was in la la land so I didn’t really know what was going on. Though the crazy fundal massage snapped me back to reality. The new nurse said “OK Danielle, we are having a hard time getting your bleeding under control and we’d like to give you the Pitocin now.” I said “yes, ok, yes do whatever you need to do” and was getting freaked out. I got a shot in my thigh. More fundal massage. And now I was feeling woozy. I had to pass off our baby to my husband because I was getting too weak to hold him. And freezing cold. I was thankful for the hot blankets the nurses piled on top of me. It’s all a blur. I remember getting pretty scared and asking the nurse “am I going to die? Am I going to need a blood transfusion?” She said they were doing everything they could to keep me from needing a transfusion but I was still bleeding a lot and they didn't know why but I might need a transfusion. What?? I asked again if I was going to die and I told her I was scared. She said I wouldn’t die and was comforting me but all the while trying to help me, too. I now had an IV of Pitocin and Cytotec suppository and more crazy fundal massage.The doctor let out an "OK, here we go" / sigh of relief as two giant and gross clots came out. Finally the panic started to subside as the bleeding was slowing down / stopping. A boggy uterus and two large clots is not a good combination, apparently.

After that I was on heavy watch by the nurses for the remainder of our stay to make sure the bleeding didn’t pick up again.

I texted the yoga midwife later on the day of the birth and I told her about the postpartum hemorrhage. She told me that home birth midwives carry Pitocin with them, too.

I felt weird after all of that. Confused. I thought I had done everything right to avoid PPH. And I know home birth midwives carry Pitocin but that didn’t do the trick for me. The shot and fundal massage, it wasn't enough. Would I have ended up transferring after our baby was born if we were at home? That thought lingered. I didn’t focus on it because it worried me. So it just lingered.

I was happy that I had my unmedicated birth and my healthy baby. It all worked out at the hospital. I didn’t even have to fight. There were things I picked apart afterwards, thoughts like “well, this would have been better at home,” but for the most part, I knew my experience was good. I cannot lie and say that I didn't want to hate it, though.

Trying to fast forward a bit as I know this is such a long story… 

We changed our insurance at the next enrollment period so that our new insurance would cover future births at home. I started the official doula training process, aside from the book list which I had already started during pregnancy. I had my doula training workshop and met a new friend. Doula friend and I instantly clicked. She quickly became someone I would call one of my dearest friends. We became each other’s back-ups as doulas.

Around this time something else interesting happened… I was a member of a large, local doula group and someone sent out an email about hearing a woman named Dr. Amy, I believe she was on NPR (or some other radio station). Quite a few emails came through of people chiming in about her saying, basically saying she was awful and anti-home birth and her website is horrible. I was curious but vowed never to give her site the traffic. I asked about her here and there, though, to people I knew in the home birth community. More of the same responses. It was odd to me that someone would be “speaking out” against home birth. So I was very curious about this. It’s a safe option. Of course it was an obstetrician against home birth. Typical. Probably just doesn’t know or understand the normal process… Oh well. I let it go for the time being. 

I began doing an “internship” (with doula friend) with a local group of midwives – they were CNMs. During this time at the internship, my love of home birth midwifery only grew. I was attending births now, too, as a doula. At home, birth center and hospital. I knew I wanted to be a midwife for sure but didn’t know which route I wanted to go. It appealed to me to go the CPM or LM route because it would be faster. But I didn’t like that I wouldn’t be legally allowed to work in every state. What was with that?? As a CNM I would be legally recognized in all 50 states. It would be a lot longer route though and even with my 4 year degree I might still be starting from scratch, basically, since my degree was not science related at all. I went back and forth… I still had the impression that skill set and training was very similar, just different routes. One took longer because you had to earn a nursing degree – which I liked the idea of some days, and other days I didn’t.

I now struggled with the thought of which midwife to choose for future pregnancies. I now had these midwives I loved too, in addition to yoga midwife. How would I choose?

Doula friend and I met a new friend around this time, too. She was a childbirth educator. We became a quite the trio of birth lovers – a funny way to put it but our love of childbirth is what really formed that initial bond, that and the fact that we were just compatible as friends. I loved those two gals. Both are two of the most wonderful and kindest women I’ve ever met.

The last home birth I attended was one that was one of the biggest turning points for me. It was a home birth transfer for fetal distress. And it was very, very scary.

This was a low risk, young, fit, healthy mother. When she got to 9cm, the heart rate started dipping down very, very low. The CNM looked a little worried so she had the mom get into a different position. Heart rate, again, was not good. CNM told her to try her other side. Same. Then hands and knees. It was better for a bit then it dipped down again. As I’m typing it makes it seem like it happened so quickly but there were a few minutes tried in each position. It seemed like time had slowed down while we were listening to those little heart tones. Everyone seemed worried by this point. And now the heartrate wasn’t recovering in between contractions. Why?? What was going on? The CNM suggested we needed to transfer. She kept checking the heartrate and then said “yes, we need to go now.” The husband asked if he should call an ambulance but the CNM said it would take too long. Everyone was gathering their things quickly so we could go. Where are the keys? Where are clothes for the mom? Where are shoes? Etc, etc... rushing around. Keep in mind, the mom was 9cm at that point. Tiny, petite gal and even with her husband pretty much carrying her around, it was a process just getting out of the house. CNM gave a shot of muscle relaxer type meds to the mom to help the contractions slow down. I drove behind them in my car. The midwife stayed in the backseat monitoring the mom. Heart rate was better once the contractions stopped because of the muscle relaxer that she administered. I was sobbing in my car on the way there, called my husband and cried to him, I was so freaked out that the baby was going to die. Everyone was freaked out. Arrived at the hospital and they had her in a room, hooked up to monitors… Contractions started up again and down went the heartrate. They tried having her push because baby was low but it wasn’t going to be quick enough. Heartrate was not. good. OB rushed it, lots of commotion, episiotomy, vacuum, baby born.

I walked away stunned.

For a while I didn’t let it soak in completely. At the postpartum visit I had with the mother, our conversation left me shaken. There were just too many unanswered questions. I thought maybe her take on it would help me figure things out… as if she might offer up something that I missed, I don’t know. But it didn’t. So many questions. She didn't understand either. How did that happen??

After a while, I finally started really thinking about that birth. I couldn’t initially and it took me some time to get there. At first, I just sort-of… carried on. Went about life like nothing happened with my home birth midwifery friends and such. Though I did voice my concerns and worries a couple times to doula friend and childbirth ed friend.

I wanted to process what had happened, though. I wanted to make sense of it but I couldn’t. What if there had been traffic on our way to the hospital? Do all midwives carry such meds that the CNM had? Would a CPM or LM be able to carry those meds? What if that baby was in distress the whole way to the hospital without those meds… would that baby be alive? Or alive but with neurological damage? What if that midwife hadn’t been monitoring her so closely? I couldn't believe how long the transfer took... and we were going so fast... but it still took so much time... it felt like time stopped and was taking forever and yet it felt like it only took 5 minutes. But in reality it took much, much longer.

One night, my curiosity got the better of me and… I found myself at a website I swore I would never visit…

The Skeptical OB

Ugh! I hated myself for looking, for giving the traffic. But I just felt drawn. I had to see what she had to say. What if there are pieces to the puzzle that I’d find on her site? I don’t know. I don’t know why I went there other than my curiosity just had the better of me in that moment.

I thought I’d read one post and leave… but I didn’t. I stayed. And read quite a few. My face was burning red and my heart was racing. I will never forget it. Ugh. I felt mad at her. She was so…. mean with her posts. But I also felt confused. I read posts of hers that only were about home birth (because she covers other topics as well). One I read was about a home birth of twins where the second baby didn’t survive. One was discussing Doppler versus Electronic Fetal Monitoring. In other posts, I read about infant mortality versus perinatal mortality. There was more…

I read Hurt by Home Birth. Even then I made excuses like those midwives were just horrible… my midwives would never be so negligent. I was sobbing reading the stories though... and these stories, too, began to linger.

After a few hours of reading, I shut my laptop and tried to erase it all. But I couldn’t… I was so confused. And I did not like Dr. Amy. She was so harsh and so extreme.

Oh man did I have questions now… what the heck was all that??!

So I started asking questions to people I knew. I sent one of the blog posts by Dr. Amy to a couple of my birth world friends. I thought they could help me shed some light on it and say “no, this is false.” But that’s not what I heard. I heard “she’s too extreme, it’s unhealthy to be that extreme” and even heard “I’m having a hard time taking her seriously because there are grammatical errors in that post!” This did not give me any answers.

I read Dr. Amy's critique of the Johnson and Davis study (Outcomes of Planned Home Births with a CPM in the British Medical Journal) ---- a study that I loved and trusted and served as my "proof" of safety of home birth here in our country ---- I sent the critique to my cousin, she was in the process of becoming a home birth midwife. She didn't have any answers. She sent it to two of her midwife friends, she forwarded me the responses. Which I still have. I don’t know if it’s legal or not to post their responses so I will just paraphrase…

The first midwife said that Dr. Amy was the biggest anti-home birth doc in the USA. She twisted around stats to make things sound worse than they were. She comments on every home birth article that pops up.

The second midwife said that Dr. Amy was old news. She was way, way against home birth and is well-known and despised in the home birth community. As far as her critique of the Johnson and Davis study, all you need to consider is the source.

Again, no answers.

There was no resolve. So I looked at the numbers myself. It took a while. A long while. But… Dr. Amy was right… the study showed an increase risk, double to triple, at home with a CPM versus in a hospital.

And that wasn’t the only flaw in the study.

So now I had other things I just had to look at myself. Does infant mortality reflect childbirth or are we really supposed to look at perinatal mortality? So I looked up the definitions. I looked at what the World Health Organization had to say about it. I had my answer: perinatal mortality is the best indicator for childbirth / maternity care safety. It’s the only mortality rate that includes intrapartum deaths – deaths that happen during labor and delivery. It includes prematurity, antepartum mortality, intrapartum mortality and neonatal mortality. And the US does really well with perinatal mortality – tied with countries like France and Japan, and actually better than countries like the Netherlands and the UK. Next best measure is neonatal mortality. Infant mortality is not at all the correct mortality rate to consider.

So did the movies I had watched and books I had read know this and purposely try to mislead? Or did they all just not know what they were talking about?

I started looking at different perinatal and neonatal mortality rates, too, here in the US. Different papers and vital statistics data from as current as I could get all the way back to the 60s. I looked at the different studies for home birth and looked at their neonatal and intrapartum deaths… they shocked me.

That phrase I heard… that comment… “babies die in hospitals, too.” That comment was just… well, it was crap. It’s deceiving. Incredibly deceiving. Because the truth is: No. Full term babies don’t just die in hospitals here in the USA. And more importantly, they don’t die in hospitals at as high of a rate as they do at home. I stopped listening to the way the stats were cherry-picked and/or misrepresented and/or simply left out by home birth advocates and started looking directly at the statistics myself. Home birth in the USA is not a safe option. Not as it is currently offered (and there doesn't seem to be any real effort to improve it).

There was a lot that started going on during and after this time.

The group of CNMs talked to me about working part-time as a coordinator for them. I was excited at the idea of it and said yes, I was interested… but I was stressed out about it. I still had so many unanswered questions and I didn’t know if I was OK with home birth for us now… I just had more to figure out. And if I had a job with them, well then, how could I not have them as my hired care givers for future pregnancies? Thankfully, they ended up wanting someone full time and found someone else for the job. I felt so happy it all worked out. I felt so relieved.

Before all of this - before the transfer, before Skeptical OB - I never went in search of home births with bad outcomes. I had read so much, so many birth stories, but the bad stories… stories of death and injury… were missing. They are missing unless you pretty much seek them out. And it’s not because they aren’t happening.

There were other people out there voicing their concerns over midwifery here in the US… blogs like Navelgazing Midwife and The Reformed CPM. More blogs that left me with questions and concerns.

And now weird things were happening when I started asking questions. I started being censored. I asked a question on the blog of a very outspoken home birth advocate. My question was regarding safety and worries I had. And the comment was not only deleted but I was banned from ever being able to visit the blog again. What the heck?

That was the first time my comments questioning home birth safety were deleted… but it was certainly not the last.

And then there were home births that ended with death and certain stories that made it in the news… and I was appalled at the comments I read. Parents of babies that died were blamed by others in the home birth community! The midwife was protected, comments like “this midwife delivered my baby and was wonderful! The parents need to own up to this!” And this sort of thing… it was happening over and over and over again. Midwives were protected even if clearly negligent. This didn’t make sense to me! I thought having a home birth was all about having a passionate care giver who gave evidence based care, the best care… better than what you could find in a hospital. But how can we be certain we are getting the best care at home if accountability doesn’t exist?? When negligent midwives continue to practice without being reprimanded and without a track record that is made public… then how do we know who is negligent and who is not? And why are these midwives protected by the other midwives and the community as a whole? And the families that seek accountability, why are they vilified?

And the hypocrisy of this was astounding! An adverse outcome or bad experience in the hospital? The doctor and hospital were wrong! The community gathers around the mother. An adverse outcome or bad experience at a home birth? The community gathers around the midwife.

I also started looking deeper into the differences in midwives here in our country versus other countries. Majority of home births in the USA are attended by a CPM, LM or lay midwife. The education and training is so different than midwives in countries like Netherlands, where it is part of a 4 year university program, where midwives have earned hospital privileges. That is not so for CPM and LMs. But when I looked at websites like MANA and other home birth advocacy websites, they always site studies from other countries to show proof of safety of home birth here in the USA... but how did this make sense? How can we use studies based in other countries where the whole midwifery system and the education and training and health care as a whole is totally different than what we have here in the USA? 

I had more questions and concerns… more stuff I needed to figure out... and now we were pregnant with our second child... more to come in Part 4 on what the final decision was...

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You are reading Part 3 of "What Drew Me To Home Birth And What Turned Me Away." Click to view:

Part 1

Part 2

Part 3 (currently reading)

Part 4