i realize what i'm about to say is against the mdc prevailing thought .. and i have great respect for mdc and learned more here than anywhere else, been supported more here than anywhere else. i've wanted to post for months but always chickened out because i'm sure someone will get angry and i don't feel strong enough right now after what happened. but i think it's important that i say this. it might save a life.
all my life - well since 14 when i saw my first h/b - i've thought h/b is the way to go, avoiding all the bad things that can happen in hospitals, the cascade of interventions, the fights over 'it's our policy do do this and that' and so on.
so when i was pregnant i devoured ina may's books, michael odent, websites on homebirth, practised hypnobirthing, planned to use water and tubs in labor, read everything about relaxation, normal course of labor, complications, scientific studies on safety and so on (i'm married to a doc,) found a midwife i thought i gelled with - a very experienced woman for sure. paid out of pocket for her services as my insurance wouldn't cover it. i felt with every inch of my body that i did not want interventions and that i wanted to be left alone to find my own rhythm of birth, without being told 'you must do this or that, it's been X hours, yadayada' i also strongly strongly felt i did not want any drugs in my baby and as you know, labor drugs pass the placenta and we don't know the long term effects of this.
so this is what happened and why i don't feel having a baby outside a hospital is worth the risk if you want to have the best chance to go home alive and with a healthy baby..BUT hear me out and read why and what i think the solution is.. until we have a third choice.
i had a completely normal pregnancy. labor started with one intense excruciating contraction that went on and on, then stopped for a few minutes then started again. i was in terrible pain, couldn't speak, tried to crawl to the shower, hypnotherapy didn't work, nothing did. i was 1cm dil. i said i had to go to the hospital as i felt something was wrong. the m/w said i was acting as though i had the pain of transition. but i was 1cm.
we went to the hospital, a 15 min car ride, and to cut a long story short i had an epidural shortly after as morphine didn't work. pain was off the charts. yes i know older studies suggested early epidurals increase the chance of c section. newer studies have refuted this.
the rest of labor was uneventful, apart from me feeling a bit of a failure. after 24 hours of so of labor, eventually had pitocin because stalled at 4, a well placed epidural that allowed me to walk around so i could try to make him descend. no progression. eventually talk of c section as the baby's heart was slowing periodically (yes a known cause of pit augmentation but that could not have caused what happened next.. so don't jump at me (:
c section, baby was apgar 9/9 and in excellent health and weight
as soon as he was out i started hemorrhaging. badly. within seconds. the docs were not tugging on the placenta, (i.e. they didn't cause it.. my husband was watching) but the blood was gushing out from around where the placenta was and the plac was partly stuck too deeply and partly coming off in chunks as they watched. i lost 4 (i think) liters of blood (some of the stuff they put in me came right out) had many units of tranfused blood and other assorted stuff, by a miracle they saved the uterus (ask me how if you're interested), i passed out from lack of blood (bp was something like 50/30 at one point) for a few secs. this bleeding happened in the space of 5 minutes immediately after birth, all from where the placenta was attached.
i was taken to the ICU and didn't see my son till day 2 - though i'm happy to report that breastfeeding was great when i started and it continued till he was a year. no probs with that at all. i had further transfusions and was sent home after a week. my diagnosis was formally 'placenta accreta', meaning the placenta was embedded too deeply into the uterus. (necessarily a clinical diagnosis i.e. from what they saw and what happened, as i still had my uterus so they could not slice that up to look at the structure of it. however the placental side strongly suggested accreta because of cellular abnormalities and other things (ask if interested)
most women lose their uterus with this, about 10-20% die (check the stats, i'm doing this from memory). you can lose most of the blood in your body in 5-10 minutes. so it was a blessing that i was in an OR when this happened and that i had insisted on going to the hospital. i can't claim great foresight.. i just felt that labors do not start with excruciating pain at 1cm dilation.
i was VERY lucky. i am very lucky to be alive. i can say with all honesty that if he had been born at home i would likely be dead because of how quickly i lost so much blood. accreta is happening more and more as women have more c sections and thus have more scar tissue where the placenta can dig in too deep, but i'd never had a c section.
my point is this.. there are some obstetric emergencies that can kill you wherever you are but you stand a much better chance in the hospital. one of these is accreta, another is amniotic fluid embolism (the biggest killer of women in birth. i had a mild form of this too), another is a ruptured uterus (yes you have warning sometimes that this is happening, but sometimes it's sudden and the baby would die before you were able to get to the hospital.) and that's not to mention sudden problems with the baby that can happen.
these things are RARE, very rare, incredibly rare (i think accreta is something like 1/60,000 births) BUT if you are in a hospital you have a greater chance of living and to my mind it's just not worth the risk to stay home.
in the complications i listed above there's sadly nothing you can do at a homebirth - manually compressing the uterus to stop bleeding would not have stopped it in my case (the docs had the whole uterus in their hands and squeezing like crazy.. nothing..), in the case of amniotic fluid embolism you need massive interventions, will prob go into cardiac arrest in seconds and even in a hospital some 60-70% of women die. it happens randomly, no way of knowing if it'll be you.
now, having said that.. i think what is lacking in most cities is a 'third way', a place run by midwives (san francisco had st lukes'..futon on floor, candles, tubs etc) in a hospital but allowing a homebirth birth with all the best that a midwife can provide, the emotional support, handholding, experience with normal births and so on, BUT with emergency life support measures in the building if needed in those rare rare cases. (but it could be you remember)
so where does that leave most women who don't want to sign up for a medicalized birth in a hospital yet have nowhere else to do this but home.
i think for now.. until there are more 'homebirth in hospital' type places, the safest choice is hospital BUT i believe it's also the responsibility of every woman to prepare herself by reading and studying and asking questions about all the things a hospital will want to do and how you can refuse those you don't think are necessary, and by having a doula or support person who can be firm about what you want and don't want, thus allowing you to focus on birthing as naturally as you can.
we don't need to choose the hospital and just throw up our hands and be helpless and feel that the process is out of our hands. it isn't - WE are still in control and making decisions, or at least we should be.
i think we should spend more time learning and thinking about birth than choosing a car.. yet it seems the opposite at times.
i think if hospitals weren't so pushy with routine things, if they provided more choice in the things that can make a difference between a relaxed, happy mom managing her own birth and a woman who is 'delivered of a baby' as the victorians used to say, then we wouldn't see the high c section rates and all the birth interventions that are often neither necessary nor helpful. (i suspect liability fears are at the base of many interventions.. you'll get sued for not doing something but not for doing it) but there's no reason we have to have any of these things done to us.
there's no real reason why midwives shouldn't work in hospitals as they would in a woman's home, why hospitals shouldn't have all the things that make for a good safe birth. i believe that birth is a natural, normal event and that is should be supported by people who know the natural event best - midwives - but that the safety net should be there, just as you probably would choose to use safety measures in any other activity in life, if they were available.
well i'm an idealist and i also know that birth is a business.. it costs more to have more nurses looking after a women 1:1 rather than one nurse at the nurses' station monitoring contractions of 15 women via electronic fetal monitoring. sure - and that's probably why my ideal solution isn't happening in many places. BUT we can get as close as possible by bringing in our own doula and/or midwife who does give us 1:1 care and knows what to look out for and knows the type of encouragement we need. we can do this. we can also visit hospitals in advance and know the layout, ask questions, decide if hosp A or B is best, lobby for this 'third choice' when talking with our Obs or with the hospital authorities themselves. it's a business remember, so they would hopefully respond to market demand (:
we can say no to routine interventions we believe are unnecessary, but we have to be informed, know what we are saying no to and realize that life is fragile and it is, in my opinion, not worth risking the life of one mother when such a risk is not necessary.