Can I have a homebirth

[Katie Han]

Hi everyone, I'm new to this site and hopefully someone can give me some good news. I just found I'm pregnant, it will be my first, and I have a few questions about vaginal and homebirths. I'm lucky enough to have several "crunchy" moms who have filled me in about the horrors of hospital births. I really really really want a home birth bad. I only want the very best for my baby and nothing less will do. Problem is that I'm HIV-positive and have been told my doctors that I must have a C-section. I've read all of the stats of natural vaginal birth versus C-section and it's doesn't look good. But I have also been informed by many of my friends how that data is "played" with by the medical community to force woman like myself to give birth in a hospital. Is a homebirth possible for me? Do I need to find a specially trained midwife? Is there anyway to avoid a C-section. I've gone though so much to create this little life, I want to give him/her the most perfect start to it. Thanks in advance for any advice on how to avoid a hospital birth.

[sanguine_speed]

Originally Posted by Katie Han

Is there anyway to avoid a C-section, I really don't want to be one of "those" women who are not tough enough to give birth naturally. .

Mama, I don't know the specifics about whether a home birth is a safe possibility for your circumstances or not.

However, I do want to suggest that you consider reframing your beliefs around who has what kind of birth. There are many women who do not have 'natural' births, who had very good reasons for their birth interventions. It's condescending to say "those" women who are not tough enough to give birth naturally...

Aside from being condescending, it sets you yourself up for feelings of guilt, shame or regret if you are not able to acheive your own definition of 'natural birth'. There are many valid reasons for being unable to give birth at home, or for having interventions such as pain relief or cesarean section, and before you find yourself in one of those (you might be already), you should really rethink your judgements on the topic.

[Katie Han]

Originally Posted by sanguine_speed

Mama, I don't know the specifics about whether a home birth is a safe possibility for your circumstances or not.

However, I do want to suggest that you consider reframing your beliefs around who has what kind of birth. There are many women who do not have 'natural' births, who had very good reasons for their birth interventions. It's condescending to say "those" women who are not tough enough to give birth naturally...

Aside from being condescending, it sets you yourself up for feelings of guilt, shame or regret if you are not able to acheive your own definition of 'natural birth'. There are many valid reasons for being unable to give birth at home, or for having interventions such as pain relief or cesarean section, and before you find yourself in one of those (you might be already), you should really rethink your judgements on the topic.

I'm really sorry, looking at it again I do sound like a horrible person. I will edit it out. I'm just surround by my friends, who are looking out for my best interest, who love to talk about the damage a C-section creates. My words were not directed at those who had an emergency C-section, there is nothing weak about doing something to save your baby. But rather those who choose one for scheduling/not wanting to go thought the pain of a birth. One again please accept my apologizes, I'm really bad about turning what I'm thinking into words, that's why I usually don't use online forums.

[ticklemegreen]

I also wanted to add, I don't think having a c-section because you're HIV positive means you are not tough enough to have a natural birth. All it means is you chose to have a c-section because that's what was best for you and your child.

[babycatcher12]

I don't think having a c-section because you're HIV positive means you are not tough enough to have a natural birth. All it means is you chose to have a c-section because that's what was best for you and your child.

I agree!

I think you really have to weigh the risk vs benefits here. Not that I don't agree that the medical community can sometimes skew statistics, but there have been many many research studies about the risks of a vaginal birth and transmission of HIV vs c/s. Both in the US and outside the US. It really depends a lot on your viral load and what your current health is. It kind of boils down to...are you willing to take the increased risk of transmitting the HIV virus to your child during the birth, and the subsequent consequences that will have on your baby. I think you might be hardpressed to find someone willing to attend your homebirth for that reason alone, but that doesn't mean they aren't out there.

I'm also curious if you would plan a homebirth, are you going to transfer to the hospital shortly after birth so that your baby can have the necessary lab work and administration of antiviral medication to lessen the chances of HIV infection? I'm thinking specifically of the viral loads and medications that need to be initiated shortly after birth. (are you or will you be taking antivirals throughout your pregnancy to decrease the risk of transmission?)

Best of luck to you and your birthing decisions.

[soso-lynn]

Depending on how well your treatment is going and on your viral load, a natural vaginal birth might be safest for you. C-sections are proven safest in women who have a high viral load or who are not properly treated. In the case of women with undectable viral loads (as it might be the case for you if you are treated), a natural vaginal birth does not increase transmission rates in comparison to a c-section, assuming you plan on treating the baby as well and there are no other complications (things like having your water broken for too long can be dangerous in your case).

I would suggest consulting with a specialist (there should be a dedicated clinic in a local hospital for pregnant HIV-positive women if you live in a large city, if not it is definitely worth taking the trip to the nearest one). You can establish a relationship with a homebirth midwife as well if that's your goal, although it might be difficult to find one who will attend you.

Most OBs you specialize in HIV-positive cases will be very well informed of the imperative to avoid any interventions in a vaginal birth to prevent transmission so you might be able to have a great natural birth in a hospital with them if you can't have a homebirth.

In my city, the transmission rate for women being followed in the special HIV clinic have had a zero transmission rate for several years. I really think it is worth being under their care even if you choose to birth at home. At all costs, you must avoid an OB who does not explicitely specialize in HIV because many of them are grossly misinformed and sometimes prejudiced and that can be very dangerous for you and your baby.

[MeepyCat]

Originally Posted by Katie Han

I'm really sorry, looking at it again I do sound like a horrible person. I will edit it out. I'm just surround by my friends, who are looking out for my best interest, who love to talk about the damage a C-section creates. My words were not directed at those who had an emergency C-section, there is nothing weak about doing something to save your baby. But rather those who choose one for scheduling/not wanting to go thought the pain of a birth. One again please accept my apologizes, I'm really bad about turning what I'm thinking into words, that's why I usually don't use online forums.

I have to speak to the bolded part.

I had an emergency c-section with my daughter. It was an odd emergency section in that we knew fairly early on that I might need emergency surgery to have the baby, but until the night it happened, we didn't know when. I wanted a natural birth and am deeply embedded in a community that believes in and supports natural birth. But I learned this: People who love to talk about the damage caused by c-section are not good friends to women who genuinely need c-sections. Not unless they can change the subject for nine months, or, ideally, the rest of your life. (Because you don't need all your friends to stand around pitying you and narrating their opinions about your experience, while you have the baby, recover, and develop feelings of your own about her birth.)

By all means - see a specialist, get second opinions, talk to OBs and homebirth midwives and every kind of expert you can think of. But you do not need to sit through any conversations in which people trash c-sections.

C-sections aren't without problems. They're overused in this country, for example, and recovery can absolutely suck. Regardless, there are some cases in which a c-section is in the best interests of the mother or the baby or both. There are cases where c-sections are life-saving surgery. There are cases when the problems of surgical recovery pale in comparison to the complications of natural birth. I don't know whether your case is one of them, but from what you've said, your case is a situation in which c-section needs to be rationally considered.

There is no difference between the c-section horror stories and the rest of the l&d horror stories - neither set of stories is helpful to pregnant women who are hoping for a positive birth experience. (I'm not saying that it's not okay to talk about birth trauma - there's a difference between seeking support for your own experience and telling gruesome stories because it gives you a thrill.)

[annekh23]

Originally Posted by MeepyCat

There are cases when the problems of surgical recovery pale in comparison to the complications of natural birth.

That would be me, many would deem my c-section unnecessary, but I'm more recovered from my c-section nearly 10 mths ago than the complicated birth 4 years prior.

[nikirj]

The stats suggest not doing a routine c-sec for HIV positive women who are otherwise healthy. I'd call providers in your area and see what you can come up with. One practitioner saying his/her "you need a c-section" piece doesn't mean everyone in the community will agree, or even if they DO think routine c-section is better, that they won't let you decide to have a vaginal birth anyway. I do know that some homebirth midwives are willing and able to work with HIV positive women, but this also depends on the level of care you need, the legality of midwifery in your state, the presence of a specialist who is willing to work with your MW, and many other factors. If you do your ground work early (ask around, interview many practitioners, etc) it will pay off.

[cathicog]

maybe talk to someone at The Farm, in Summertown TN? if noone is available in your area....I am sure enough time has passed that HIV positive status can be handled better than it used to 10 years ago...I agree with pp, find out what options are available locally. That special clinic sounds like a great idea! I didn't know they existed...

[mntnmom]

I can't speak to your chances of having a homebirth, or even a vaginal birth, except to wish you luck. But if a c-section is in your future, there are a lot of things you can do to make it safer, and more satisfying as an experience. Contact ICAN (international caesarean awareness record), for starters.
You can have an empowered birth. It's about doing your research and making your own choices. Good Luck, and Congratulations!!!