HBAC - Home Birth After Cesarean

Let's discuss HBAC a little more. Again, for those not familiar with the acronyms:

VBAC -- Vaginal Birth After Cesarean
HBAC -- Home Birth After Cesarean
TOLAC -- Trial Of Labor After Cesarean (attempting a VBAC)
ERCD -- Elective Repeat Cesarean Delivery
RCS -- Repeat Cesarean Section

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April 4, 2017 Update: a new study from the Midwives Alliance of North America (MANA) confirms that attempting a VBAC at home comes with a much higher risk of neonatal death. The study Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States looked at planned, midwife-attended births in a home or freestanding birth center. (Note: in the study, they use the term LAC (Labor after Cesarean) instead of using the term TOLAC or attempted VBAC.)
Here are the neonatal mortality rates for women attempting birth at home or freestanding birth center:
Women with prior vaginal birth, no cesarean history: 1.03/1000
Women attempting VBAC with prior vaginal birth: 1.27/1000
Women attempting VBAC without prior vaginal birth: 10.2/1000

Yes, you read that outrageously awful rate correctly: 10 neonatal deaths per one thousand! Once again, all of these rates are far too high, but especially for women attempting a VBAC who have never had a vaginal birth.

Compare those rates to neonatal mortality rates for USA hospitals: 
Hospital CNMs (lower risk pregnancies) = 0.35/1000 to 0.55/1000
Hospital MDs (higher risk pregnancies) = 0.43/1000 to 0.63/1000
Hospital attempted VBACs* = 1.3/1000
Hospital repeat cesarean = 0.5/1000

The neonatal mortality rate for women attempting a VBAC with a midwife at home or in a freestanding birth center is an alarming, tragically high rate. Far too many babies dying preventable deaths.

* The hospital attempted VBAC group includes a higher risk group of women. It includes women with and without prior vaginal birth, with and without higher risk medical conditions and also includes fetal deaths - death of baby in uterus prior to onset of labor from 28 weeks gestation and beyond. Fetal deaths and higher risk pregnancies were not included in the home and birth center rates above (meaning, the mortality rates would be even higher for the home and birth center births if they were included).

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Perhaps you are wondering if 1052 HBACs in the MANA study is a large enough sample to draw any conclusions?

In short, the answer is yes. In long, keep reading.

How to Handle a Home Birth Debate in 5 Steps

Step 1: When you hear: “There are plenty of studies that show that home birth is as safe as hospital birth.”

Kindly remind them that home birth studies performed in other countries do not apply to home births in the United States due to our vastly different midwifery training requirements and health care systems.

And then share with them that in the United States.... (click here to continue reading)

Considering Home Birth?

Home Birth in the USA

There are some things you may not know about home birth in the USA. For example, if you were told that "home birth is as safe as hospital birth" then you need to know that is, in fact, not true... not in America... not even for low risk women. Here is some information regarding midwives, birth centers, home birth, studies, statistics, guidelines, and more, that you may find useful for learning more about home birth in our country. There is a lot to read here but it is important information in order for you to make a fully informed decision.

Let's start with an introduction for those who have never stopped by before. My name is Dani. I'm a birth doula and former home birth advocate. Here's my story:

What Drew Me to Home Birth and What Turned Me Away

* MIDWIVES *
One key issue with home birth here is the many different types of midwives we have in the USA: CNMs, CMs, CPMs, LMs, LDMs, lay midwives..... So many!! Each type has different standards for education and training (or no standards at all). Here is an easy-to-read series that touches on the three main types of midwives:

American Midwives series

Most home births in the USA are attended by a Certified Professional Midwife (CPM) or Licensed Midwife (LM) (CPMs and LMs are very similar). It's important to know that CPMs and LMs would not be able to be licensed in any other first world country. The standards simply are not rigorous enough. They are only legal in 26 states, do NOT earn hospital privileges as a part of their training process nor do they have any higher level education requirements -- as opposed to American CNMs/CMs and midwives in countries like the Netherlands, Canada and the UK. Safer Midwifery for Michigan has an eye-opening post that explains how little it potentially takes to earn the title “Certified Professional Midwife”:

CPM education: The bar is too low

Here is a great series exploring what it takes to become a midwife in other countries: The Education of Midwives Around the World

Many home birth midwives do not carry malpractice insurance. Why is insurance important? Insurance protects you. It means that if something happens that causes death or injury, you are able to have recourse and accountability. It means that if your child suffers an injury during birth, you can have compensation to help pay for life long care that may be needed.

There is no transparency for home birth midwives. They do not have a publicly accessible board where any disciplinary measures would be listed. How do you know if your midwife has ever practiced negligently, resulting in the death or injury of a baby or mother? What is your midwife's real record? How can you verify it? How do you know for certain how many births she has attended? Far too many mothers have trusted their midwives, trusted the friendship they developed with their midwives, trusted their judgement and reputation, only to find out after a bad outcome that their midwife was less than forthcoming.


* BIRTH CENTERS *
Is a freestanding birth center safer than a home birth? That depends. In many ways, a freestanding birth center birth is just a home birth in someone else's home. What equipment does your birth center offer that wouldn't be available at home? Is the distance to the hospital closer? What types of midwives are running the center and who will attend your birth? The 2013 Birth Center study shows that out-of-hospital birth can be a reasonably safe option. However, it's important to know that this study does NOT reflect all birth centers in the USA. It was a select group of birth centers, majority of which were run by CNMs. The birth centers met certain criteria and were CABC-accredited. Out of 248 freestanding birth centers in the USA, only 79 were included in the study. Read more about the Birth Center Study here:

5 Things to Know about the Birth Center Study

* HOME BIRTH STUDIES AND STATISTICS *
Here are studies and statistics regarding home birth safety. It's important to look at studies done in the USA. Studies regarding home birth in other countries do not reflect home birth in America: different midwives, different health care systems. Outcomes will be better in countries where, for example, midwives have high standards for education and training and where the midwives have hospital privileges. These links are studies regarding home birth in America... and every single study shows a significant increase risk for babies born at home:

1. The 2014 MANA study, showing an increase risk of intrapartum and neonatal death of 3-5x for babies born to low risk women: Mortality rates from the new study by the Midwives Alliance of America 

2. Studies in the USA, current as of January 2014: Home birth studies 

3. 2013 studies (USA and internationally) and CDC data: 2013 Home birth studies and statistics 

4. The latest study on home birth in the USA (Feb 2014): New Cornell study shows home birth has 4x higher death rate than comparable risk hospital birth 

5. Risk of brain injury and home birth: Risk of anoxic brain injury is more than 18 times higher at home birth

* INFANT MORTALITY *
Advocates of the home birth movement use infant mortality to try to scare women away from our hospitals / maternity care.

Infant mortality is not the correct mortality rate to use to gauge safety of obstetrics / maternity care. Infant mortality is live birth through the entire first year. It does not include stillborn babies. It includes any and all deaths like accidents, disease, SIDS, etc that may happen day 4, day 204 or day 364... death at any time, for any reason for the first full year of life. Perinatal mortality is a much more accurate measure for maternity care (even the World Health Organization acknowledges this). It includes prematurity, fetal mortality (death of baby in utero), intrapartum mortality (death of baby during labor and delivery) and neonatal mortality (death of baby during first 27 days of life).

So why don’t the leaders of the home birth movement discuss perinatal mortality? Because the United States does very well with perinatal mortality, tied with countries like France and Japan, and actually better than countries like the Netherlands and the UK.

When will they stop trying to scare women using the wrong mortality rate?


* THE LIES AND MISINFORMATION *
Home birth in our country is sadly built on a foundation of lies and misinformation. An example is the press release written by MANA for the new MANA study: it's lies, cherry-picked info and misinformation. I shared more about this in an interview with SteadyHealth (as well as thoughts on HBAC/VBAC). To touch on this issue of the MANA study, I tried to put things into perspective:

"A home birth mortality rate of 1.62/1000 [from the new MANA study] for babies born to low risk women might not mean much of anything without having something to compare it to. 1.62/1000 just sounds low. However, when you compare it to the 2013 Birth Center study, for example, which has a mortality rate of 0.87/1000 for babies born to comparable risk women, then it makes you wonder why is the MANA study mortality rate twice as high?

These numbers all seem low, though. But it’s important to remember how many babies are born every year in the USA, specifically how many are born in an out-of-hospital setting. According to the CDC Wonder Database, in 2012 there were 38,997 midwife-attended out-of-hospital births - some in birth centers, some at home. So just for the sake of illustrating a point here, let’s round up to 40,000 births and let’s pretend they are all low risk women. According to the MANA study mortality rate of 1.62/1000, approximately 65 babies would die out of 40,000. According to the Birth Center study mortality rate of 0.87/1000, approximately 35 babies would die. According to the hospital mortality rate of 0.38-0.58/1000, approximately 15-23 babies would die. That’s a huge difference in the number of babies born at home that would not survive either childbirth or the first month of life. Now those mortality rates don’t seem so small.

What is home birth in America doing so wrong that their mortality rates are so much worse than hospitals and (certain) CABC-accredited birth centers? 1.62/1000 is the mortality rate for babies born to low risk women. This is not acceptable. Instead of addressing this issue and figuring out ways to make home birth better, safer they instead are spending their time trying to pull the wool over everyone’s eyes. They want people to think that 1.62/1000 is good. But it isn’t."

Read more here: SteadyHealth Interview

Another big source of misinformation is the popular film “The Business of Being Born.” Here is my critique of the film, which hits on misleading information that is widely shared, not just in this movie:

The Business of Being Misled

* GUIDELINES, EQUIPMENT & WHAT TO ASK YOUR MIDWIFE *
What makes home birth a reasonably safe option? Here are some guidelines:

Home Birth Guidelines for Safety

What equipment is available at home versus in a hospital?
Home vs Hospital: The Equipment

What questions should you ask your midwife?
Considering Out-of-Hospital Birth?

Have questions or more suggested reading material? Share in the comments below or here on Facebook:
https://www.facebook.com/douladanielle/posts/646718472063552

Not Buried Twice

Babies are dying preventable deaths... because of a deeply flawed home birth system. The time has come for change. And if we want change – if we want home birth to be a truly safe option – then it will have to be a consumer driven change. Women don’t deserve lies. Women don’t deserve the censored, twisted version of the “facts” about home birth. Women don’t deserve pseudoscience and misinformation. We deserve the TRUTH. We deserve the REAL statistics. We deserve the best care, accountability, and ethically driven care providers who err on the side of caution, not personal philosophy.

The purpose of the video and the #notburiedtwice campaign is to raise awareness. Planned home birth for LOW RISK women in the USA increases the risk of intrapartum and neonatal death at least 3-5 times compared to low risk women giving birth in a hospital. These are preventable deaths.

We are here to let those families know they are not alone. We support them. Their stories matter. Their babies matter. Home birth advocates are trying to silence them and pretend that their babies never existed. They try to bury these babies twice: once in tiny coffins in the ground, and a second time by erasing them from the public consciousness. We aren't going to let that happen. They won't be buried twice.

Be your own advocate. Don’t be fooled by good bedside manner. Don’t be fooled by the misinformation and lies. Learn the truth about home birth in the USA, learn the truth about the studies and statistics, read more here: Home Birth in the USA

For a quick breakdown of the numbers, comparing the 2014 MANA study (Midwives Alliance of North America), the CPM 2000 study (by Johnson and Davis, published in the BMJ), the 2013 Birth Center study (select CABC-accredited birth centers, majority of which were run by CNMs) and USA hospitals using CDC data, the mortality rates are as follows...

For each mortality rate below, it is intrapartum mortality (death during labor and delivery) plus neonatal mortality. And these numbers represent low risk women.

MANA study = 1.62/1000

CPM 2000 study = 1.70/1000

Birth Center study = 0.87/1000

USA hospitals (includes some high risk births) = 0.35/1000 - 0.55/1000

What does this mean?

Planned home birth has a mortality rate at least 3-5 times higher than hospital birth and twice as high as birth center birth (select CABC-accredited centers, that is).

For a more in-depth breakdown of the numbers and references, please click here.

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The people in this video are real people, with real concerns, with real stories of loss, with a common goal to raise awareness and raise the standards for out-of-hospital birth. A big THANK YOU to everyone who volunteered to participate. A special thank you to the mothers of Gavin, Ligia, Brody, Magnus, Mary Beth and Clara for your continued bravery. I know it is not easy to speak up and share your stories – which is why many home birth loss mothers won’t speak up publicly. So thank you, thank you, THANK YOU.

To all of you watching? Thank you for doing so. Please share this video to help prevent more preventable loss, to honor those that have died and the families that mourn those mothers and babies, and to take a stand for a change that is greatly needed.

The idea for this video came to me after watching my friend, Megan, shared her home birth story on YouTube. After many hours of writing, assigning, organizing the layout, gathering and editing individual clips of footage, I handed it over to my friend, Nick Murphy, to edit and put it all together. Thank you so much, Nick! The “#notburiedtwice” campaign was started by Dr. Amy Tuteur, MD in the aftermath of the death of Gavin Michael. If you’d like to read more about when and why this campaign was started, click here: Let's Hold Them Accountable.

Gavin's mother shared her son's story, an attempted home birth, on a Facebook page dedicated to her son. Gavin died at 42 weeks, 2 days due to meconium aspiration. His midwife went online, asking in a public forum about the risks and for advice, after it was discovered at 42 weeks, 1 day that Gavin's mother didn't have any amniotic fluid. Read Gavin's story here: In Light of Gavin Michael

Clara's mother shared her daughter's story, an attempted home birth, on her blog. After two days of hard labor at home, Clara's mother transferred to the hospital, where they discovered there was no longer a heartbeat. Clara died at 42 weeks, 3 days due to meconium aspiration. Read her story here: She Was Stillborn

Mary Beth's mother shared her daughter's story, a home birth, on the website "Hurt by Homebirth." Mary Beth was born at 36 weeks, 5 days. She died approximately 7 hours later, due to prematurity. Her midwife failed to recognize clear signs that Mary Beth was not receiving enough oxygen and ignored the concerns by Mary Beth's parents. Read Mary Beth's story here: Mary Beth's Story

Brody’s mother shared her son's story, an attempted home birth after cesarean, as a guest post on the blog “TheNavelgazing Midwife.” Brody died during labor, while his mother was being transporting to the hospital, due to uterine rupture. Read Brody’s story here: Anna's Uterine Rupture Story

Magnus’ mother shared her son's story, an attempted planned breech birth at a freestanding birth center, on the website “Hurt by Homebirth.” She also created the website “Safer Midwifery forMichigan” as an educational resource for anyone considering the care of a midwife in Michigan, or anyone who has experienced negligent midwifery. Magnus died 13 days after he was born due to complications during birth when his head became entrapped and he was deprived of oxygen. Read Magnus’ story here: Magnus's Story

At this time, Ligia's parents would like the details of their daughter's home birth and death to remain private.

Do you trust birth? Do you believe what home birth advocates tell you about home birth safety? Do you trust your midwife? Do you believe your midwife is incredibly capable, experienced, amazing, ethical, trustworthy?

These women did. 

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Not Buried Twice

We won’t let them bury you twice.

We aren’t going to let them forget.

Because you are profoundly loved.

And deeply mourned.

Because you mattered from the moment your mother found out about you.

And you will always matter.

More and more mothers, fathers and families are falling for the lies and misinformation.

More and more babies are dying preventable deaths.

More and more families are left with empty arms,

Broken hearts,

And wondering what just happened…

how did that happen?

Because they chose home birth.

Because people don't know the truth.

People don’t know how broken our home birth midwifery system is here in the United States.

Midwifery Today wants you to forget about Gavin Michael,

Deleting comments and banning anyone who asks about him.

But we aren’t going to let them forget.

We aren’t going to let them forget about my son, Gavin.

Or my daughter, Clara Edith.

Or my son, Brody.

Or my son, Magnus.

Or my daughter, Ligia.

Or any of the many other babies that didn’t need to die or who were needlessly injured during birth.

The Midwives Alliance of North America wants you to believe that home birth is just as safe as hospital birth.

But their own data shows that it is far from being “just as safe” as hospital birth,

Along with the data from every other study we have on home birth in the USA.

Out-of-hospital birth, especially with a non-nurse midwife, isn’t just as safe as hospital birth.

Not here in the USA.

Not even for low risk women.

It’s far riskier.

And people deserve to know that.

But they don't want you to know that.

They don’t want you to know how risky it is.

They don’t want people to know about the loss.

The preventable loss.

They don’t want you to know about our heartbreak.

Your precious, perfect little bodies have already been buried once.

And they are trying to bury you a second time,

by erasing your very existence.

But we aren’t going to let them.

You will not be buried twice.


Please share this video to help raise awareness, using the hashtag #notburiedtwice
Here is the video link: http://youtu.be/CRhkZKUNyMY

Homebirth After C-Section A Gamble - SteadyHealth Article

I was recently interviewed by SteadyHealth. Very nervous but excited to share this. :) Here is a sneak peak from the article:

You were once a homebirth advocate yourself. Can you describe what led you to change your mind?

It was a combination of factors. It started with being involved in an emergency home birth transfer as a doula. From there, it just took off into several different avenues, searching for answers to the mounting questions and concerns I had. The process and the aftermath have made me a much more skeptical person. In the end, I realized I was duped by all of the home birth propaganda. I realized I only had part of the story when we were hoping/planning for our home birth.

MANA Study Part 4: Vaginal Birth After Cesarean

You are reading Part 4 of my MANA study series. Click to view:

MANA Study Part 1: Intrapartum Mortality Rates

MANA Study Part 2: Neonatal Mortality Rates

MANA Study Part 3: Total Mortality Rates

MANA Study Part 4: Vaginal Birth after Cesarean (currently reading)

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April 4, 2017 Update: a new study from the Midwives Alliance of North America (MANA) confirms that attempting a VBAC at home comes with a much higher risk of neonatal death. The study Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States looked at planned, midwife-attended births in a home or freestanding birth center. In the study, they use the term LAC (Labor after Cesarean) instead of using the term TOLAC or attempted VBAC.
Rates are as follows for women attempting birth at home or freestanding birth center:
Women with prior vaginal birth, no cesarean history: 1.03/1000
Women attempting VBAC with prior vaginal birth: 1.27/1000
Women attempting VBAC without prior vaginal birth: 10.2/1000

Yes, you read that outrageously awful rate correctly: 10 neonatal deaths per one thousand!

Compare those rates to USA hospitals: 
Hospital CNMs (lower risk pregnancies) = 0.35/1000 to 0.55/1000
Hospital MDs (higher risk pregnancies) = 0.43/1000 to 0.63/1000
Hospital attempted VBACs* = 1.3/1000
Hospital repeat cesarean = 0.5/1000

* The hospital attempted VBAC group includes a higher risk group of women. It includes women with and without prior vaginal birth, with and without higher risk medical conditions and also includes fetal deaths - death of baby in uterus prior to onset of labor from 28 weeks gestation and beyond. Fetal deaths were not included in the home and birth center rates above (meaning, the rates would be higher for the home and birth center births if fetal deaths were included).

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For today's post I am discussing VBAC, HBAC and the MANA study outcomes for HBACs. Let's first lay out the different acronyms:

VBAC -- Vaginal Birth After Cesarean
HBAC -- Home Birth After Cesarean
TOLAC -- Trial Of Labor After Cesarean
ERCD -- Elective Repeat Cesarean Delivery
RCS -- Repeat Cesarean Section

TOLAC refers to all women who have had a previous cesarean section (or more than one) who attempt a vaginal birth. The outcome for TOLAC may be vaginal birth (VBAC) or it may be repeat cesarean section. TOLAC therefore includes outcomes for both.

ERCD refers to all women who decided to forgo an attempt at vaginal birth. ERCD is a bit of a deceiving term. While a cesarean section in this group is labeled as “elective” it also includes women who medically needed cesarean sections for reasons aside from having a previous cesarean section (which would mean it is not actually an elective cesarean section). Because women with chronic illnesses, or other such medical contraindications for TOLAC, are lumped into the ERCD group, the risks of ERCD may be overestimated.

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I'm briefly going to discuss various aspects surrounding VBAC before discussing the startling increased risk for babies born at home to mothers attempting a HBAC.

What Drew Me To Home Birth and What Turned Me Away, Part 4

I feel so conflicted with how to wrap this up… I have so much to say, so much that was going on, so much that I was thinking about… hopefully I can get it out in a way that makes sense outside of my head...

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So here I was pregnant with baby #2… and go figure, options were wide open for a home birth, insurance is all set to cover it… and now I was actually leaning toward hospital birth. But I didn’t know. I still wanted a home birth – and partially for my pride at this point.

But the questions and concerns…. Oh so many…

I talked to my two good friends (doula friend and childbirth ed friend) about everything I was going through… I felt so conflicted… and now, to add more confusion for me, a recent birth of a dear family friend had me even more confused and conflicted. At dinner with them one evening, I told them as much as I could about what I was thinking and concerned about and what I had recently learned about that birth: "our family friends just had a baby with a diaphragmatic hernia, perfect low risk pregnancy, she would have been considered a perfect home birth candidate, this was her third vaginal birth with no previous issues in other pregnancies/children. The hernia developed after the 20 week scan so they had no clue their baby would be born with this huge issue. The baby couldn't breathe when born… she couldn’t get enough air… and oxygen wasn’t enough, she needed a ventilator to breathe/stay alive until surgery.... what if that baby were born at home?" I looked at them desperately wanting an answer as I was crying to them… and doula friend said nothing and childbirth ed friend hopelessly said “I don’t know…”

I knew the answer. The chance of that baby surviving had she not been born at a hospital was slim to none.

(On a side note, I was recently reading the Birth Center study that came out in 2013 and one of the babies that died had this exact issue: diaphragmatic hernia. Very similar circumstance as our family friend. It developed after the 20 week scan so they were unaware this would be an issue at birth. The baby in the Birth Center study did not survive. I couldn’t believe it when I read it.)

I went into my search for information on home birth and its safety coming from the perspective of someone who was already sold on home birth. I wanted to believe. I wanted everything to point toward home birth. Sometimes when your searching for the answers to something, the results you find can be tainted by your own personal desires... what I mean is, if you want to believe in something badly enough, sometimes you can find a reason to believe because your desire is so strong. I thought my search would bring me to the conclusion - an even more well-informed, well-rounded conclusion - that home birth is safe. As I felt before. But that's not where I ended up.

By now, I felt so... turned off by the home birth system as a whole in our country. It all felt like it was based off of misleading information, protection of the reputation of midwifery at nearly all costs, a stunning lack of accountability, and stifling those who brought up their concerns.

I had read too many stories of negligent midwives, home birth losses that were very likely preventable... and I realized I had no way of knowing who I'd be hiring as a midwife. It made me sick to my stomach over it... I loved and felt I could trust our midwives implicitly and I believed in their skills... but I have yet to hear a home birth loss story where the mother didn't feel the same about her midwives... midwives who later betrayed the trust by taking chances or with flat out negligence. I felt more confident going the CNM route because I know they have their nursing board to hold them accountable. But even then, there's no guarantee... even if they are completely ethical and do everything right, what if I am that small statistic that faces an issue that can only be resolved in a hospital..... my house isn't that close to a hospital. It would take quite a bit of time, especially if it were during rush hour. It just..... it felt like a gamble.

And I realize in the hospital, it is also a gamble. You never know the doctor or nurse you will get. You never know what kind of day they are having. You never know what their philosophy is. You never know how outdated their standards of care may be. To a certain extent, you have to put blind faith in a care giver. But at least in a hospital, you have accountability. Accountability is crucial. And I've looked at the numbers... vital statistics, hospital stats, studies, etc... our hospitals in the USA do a very good job of making sure our babies are born alive and safe and healthy.

I believe there is a certain element of childbirth that is mental. I, personally, wanted to take this into consideration as well. It's mental in that.... it's the woman feeling comfortable and safe and letting her body do what it needs to do. In that mode, that safe space, a woman's body functions at 100%, the hormones, the labor, everything... it just functions better. I think that there is a lot of propaganda out there in the home birth world that leads women (or maybe just me) to believe that being at home, in that familiar place, that that is where birth needs to happen to allow the woman to feel that way.

My own hospital experience was quite nice with our first. And I understand that it may not be the norm. I have experienced other hospital settings as a doula where things weren't as nice and where there was some fight needed by a mother/couple to get evidence based care. And like I said in my first post, I read many, many stories of hospital experiences that were not as nice at all. 

The childbirth ed midwife said to me once, during my first pregnancy: “you have to decide: where do you place your risk?” So that’s what I had to do. I had to decide where I would place my risk. I had to think about my options…

What are the true, unbiased risks?

What risks could happen at home that could only be remedied in a hospital?

What risks could happen at a hospital that could only be avoided by being at home?

I took everything into account that I could... infections that can be caught at home and/or in water (water birth), infections that can be caught in a hospital, childbirth risks that can happen to anyone/anywhere...

I had my answer.

In a hospital is where I needed to have our baby.

I felt I had the best of both worlds in the hospital, with my birth team: my husband and my doula. I can hope for another fantastic nurse, I can hope for another lovely doctor... but there is no guarantee. But there is a guarantee that my birth team that I trust will help me ask questions, help me ask for options, help protect my space, help me feel uninhibited and unembarrassed and safe and able to surrender to the process, help my experience to be as close to my desired experience as possible. The doctor and nurse(s) may add to that team or may make it a challenge for that team but regardless, they will be there to keep us safe. They will have the interventions and equipment if needed or wanted readily available.

This is what worked for us. I felt that while home birth can sometimes be a safe option (and I wrote a blog post where I put together a list of things, based on my fairly extensive research, of what makes for a safe home birth option). But it wasn't going to be the right fit for us.

By Spring/Summer (ish) of 2012, I was 100% confident in my choice to have another hospital birth. But not only that, I felt compelled to share my journey, through my blog, shared the things I learned along the way, to process it all, and to maybe even help others that may be in the same boat I found myself in.

I knew publishing my first blog post would change certain things for me in my life. Specifically, it would change certain relationships. And it has. As you can imagine, it ended certain friendships. Our doula backed out of being with us for our birth. I was told by a birth world friend that my blog was "too negative, too extreme, I was advocating that women live life in fear." But that's not what it was about for me at all. I had so many "what ifs" running through my head when I was in the process of making the decision of where to have our 2nd baby... so much fear that I'd make the wrong choice (and other fears, too)... I had to hash it out. I wanted to make an informed decision. I wanted to feel confident in my choice. This is how my blog earned it's name... it's not about living life in fear or in a constant state of being bogged down by "what ifs." It was about allowing those "what ifs and fears" to guide me to gathering more information so I could feel confident in my choice; feel empowered and well-informed.

My blog started me down the path of advocating for change.

I believe education and standards and insurance and transparency are so incredibly important for home birth midwifery. My advocacy comes from a place of not trying to limit options -- it's from a place of believing that women deserve the best options.

**If you'd like to read more about home birth in our country, birth centers, studies and statistics, and more, click here. 

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You are reading Part 4 of "What Drew Me To Home Birth And What Turned Me Away." Click to view:

Part 1

Part 2

Part 3

Part 4 (currently reading)

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:

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What Drew Me To Home Birth And What Turned Me Away, Part 2

So I reluctantly met with a new OB. She was my friend’s OB – we were pregnant at the same time. The new OB was nice and I felt comfortable enough with her in our first appointment that I decided to continue going back to her.

But I wasn't giving up hope! The insurance fight continued.

In the meantime, I was learning even more about home birth midwifery and natural childbirth, too. It seemed like the resources were never-ending! I now knew there were different types of midwives, which I didn't know from the start. The childbirth ed teacher said this to me during one chat: “just make sure your midwife is certified.” So I knew there were at least certified midwives and non-certified midwives out there for home births. But as I dove deeper into learning about home birth, I learned there were more than just two different types. I learned there were CPMs, LMs and CNMs. There are more, actually, that I learned about after the birth of our first child. Anyway. At one point the insurance company was starting to bend the rules for us a bit by allowing the home birth but only if we had a nurse midwife from our network. I asked yoga teacher if she was a nurse midwife as well, because I knew someone could be both a nurse midwife and a CPM or LM. She told me she was not but wrote me a text message saying that if I wasn’t able to have a home birth with her but instead had a home birth with a nurse midwife it would be “the next best thing.”

Turns out we didn't have any nurse midwives in our network.

At that point in time, I wasn’t fully aware of the differences in education and training between Certified Nurse Midwives, Certified Professional Midwives, and Licensed Midwives - not as I am now. I also was not aware of the differences between our midwives here versus midwives in other first world countries, like the Netherlands. I made the assumption that the process to be called a licensed professional meant something… surely, not just anyone can be called a licensed professional and be able to “oversee” a woman in labor and a newborn baby. I trusted that a Licensed Midwife would be capable, that the certification meant a certain level of competency… I don’t mean the midwives we knew specifically, I mean the title in general. The certification. It’s a national certification. Surely it is a thorough process. It is birth, after all. As much as I believed in birth so much and the beauty of it and simplicity of the physiological process… so simple yet different every time… I knew it also was important to have a skilled care giver present, as birth can “rarely” mean life or death… and a skilled care giver can make that difference. Complications can necessitate someone trained in resolving them.

I had read about childbirth complications. Midwives are trained to handle them at home, though. And chances of experiencing them at home, without intervention, were less. If all else fails, you go to the hospital. Another film I watched at the time, I remember hearing the midwife say that midwives will know ahead of time, before it becomes an emergency. The film echoed what I had heard and read. And plus, we had the proof. We had the studies to show that home birth was just as safe, as far as numbers were concerned.

There’s no guarantee anywhere you give birth. This I knew. This I had read and been told. Safety was a huge priority to us. Pardon me, it was the priority for us. It’s why we were having a home birth. The USA doesn’t compare well at all to other countries for infant mortality. Our maternal mortality… yikes. Our obstetric system is flawed. Big time. That’s why hospitals aren’t a safe place for having babies. Home is. 

These are things I believed.

I had faith... I had my trust in birth, my low risk pregnancy, my impeccable diet (I learned so much about nutrition from the home birth midwives – especially the one teaching our childbirth ed class)… I knew the chances that anything would go wrong for us and our birth were so, so slim. We just needed to be home. If our baby was going to die at home, our baby was going to die at the hospital. It would be a rare situation, if that were the case. 

These are things I believed.

(Neurological and physical injury were not things I looked into much. I will be honest. I was trying hard to learn as much as I could but it’s a lot to take in in a short amount of time (9 months))

Back to my OB…

I’d have visits with her and she was lovely. I was, ummmm, a pain in the butt, to put it mildly. I didn’t think so at the time but looking back… yikes. I had so many assumptions and just this sour attitude because of my now fairly strong fear of OBs and hospitals. I distinctly remember discussing with her cutting the cord after birth and Pitocin after birth. I wanted delayed clamping and did not want Pitocin. As far as I was concerned, Pitocin was the Devil. I didn’t want it anywhere near me! Not even after the baby was born, unless I truly needed it. Delayed clamping was no big deal, though she was skeptical of its benefits. I told the childbirth ed midwife about what the OB said when she expressed her skepticism of delayed cord clamping and midwife replied “well your OB just doesn’t know. She just doesn’t know.”

My OB was concerned that I didn’t want the Pitocin after the birth. She said it was standard procedure at the hospital to do Pitocin after baby was born – an IM shot. No, no. Not unless I needed it. (And I was certain I wouldn’t need it. I was certain I wouldn’t need any interventions.) I could tell it might still be an issue so I wrote on our birth plan that I refuse Pitocin unless I need it and unless I give consent. There. It was in writing. I felt better. :)

The OBs kindness was unexpected for me. I appreciated it but still thought it was… I don’t know… maybe a trap? Maybe it wasn’t real? I sound crazy, I know… but I’d heard too many stories of OBs that seemed on board then it’s a different story at the hospital.

The midwives helped me put together my birth plan. Oh, and I had a doula, too, now! So she double checked the birth plan, too. The childbirth ed midwife said my first draft sounded too harsh. I’m glad she said that. It was too harsh. Thankful that we edited to sound nicer… not so militant in my demands. I should post it sometime on my blog.

Every time I looked at the plan it made me feel a huge mix of emotions: hopeful that I wouldn’t need it because a last minute miracle would come up and we’d have our home birth. Nervous and scared that one of our items would be ignored or purposefully dismissed by hospital staff. Worried that my baby would end up getting swept away after birth and poked with a shot that I didn’t want near my sweet baby. Angry that I needed the plan, that I'd need to fight for our experience... it was my body, my baby, my birth and I didn't need anyone interfering or taking away control of what was mine. And of course, I also felt excited for birth and to meet our baby.

Sometimes I look back and think I was so extreme in my views… like the fringe of the fringe… but then I hop on a childbirth forum geared toward home birth and/or NUCB and nope. I wasn’t extreme. I was right there in the middle.

I was starting to consider becoming a midwife around this time (something I am still set on doing to this day... when our kids are in school so I can be in school, too). I just had so much... I don't know... adoration for the midwives. I think that's the right word. They had an answer for me about everything birth-related and made it all sound so… easy/uncomplicated/normal/beautiful. I heard their stories of even high risk births like twins born at home. I was in awe. Twins run in my family and I was happy to know we could have our twins at home if we ever were pregnant with them. Breech births, too. As they say in the home birth and NUCB communities, just “variations of normal.” The birth stories were amazing. I felt I was on the path to my calling in life (still feel that way).

Sigh…

A letter back from the Department of Managed Healthcare sealed our fate. The fight was officially over. Our insurance company wasn’t budging and there was nothing we could do about it. We were stuck with the hospital and I was devastated.

I had become Facebook friends a while back with yoga midwife - our midwife - and after every birth she attended, she would give a Facebook shout out of congrats about the birth… the strong, empowered mama… the beautiful water birth. Usually a photograph was included, too. I loved seeing them. I remember thinking that I couldn’t wait for our shout out and water birth photo on Facebook! I know it sounds silly but I just felt it was an opportunity to inspire another mother to have a baby born at home… where they should be born. Now that fleeting little thought… that small way of inspiring another… it was lost. With each new birth post she shared, to accompany the awe and excitement I always felt, now came along a bit of jealousy and hopelessness. I was crushed.

I felt comforted that we at least knew what we needed to do going forward. We are fortunate to have other options of health insurance through my husband’s work and we made plans to switch insurance companies during the next open enrollment to one that would cover a home birth (and we did do so). As much as I felt sad about not having our home birth this time, I felt excited and at peace that it would be all squared away for our future births, knowing they’d all be at home.

By the end of the pregnancy, when I hit 39 weeks, I felt OK with the fact that we’d be in the hospital. Not thrilled by any means… but OK. I knew it would help me, actually, going forward as a doula and childbirth educator and midwife. A hospital birth would be good for me to experience. I felt confident with how badly I wanted to avoid interventions. I had my husband on board. We had an awesome doula. I was just ready to meet our baby. If I had to fight for it, I was ready because I knew my birth team would help me stay strong. And hopefully the See’s Candy I bought to take with us to the hospital would help the nurses get on “our side.”

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You are reading Part 2 of "What Drew Me To Home Birth And What Turned Me Away." Click to view:

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