Monday, June 27, 2011

Philosophy Series: Pregnancy and Childbirth

I started writing this post in August 2010 but never got around to posting it, and now that I've come across it again I realize that it fits perfectly into my philosophy series. The original post focused on Cesarean sections, since it was based on a piece I heard on the radio and that was their topic, but what I want to talk about now is much more broad.

My stance:
My thoughts about pregnancy--like my thoughts on pretty much everything else in life--are that it should be as natural a process as possible. My ideal childbirth would take place at home, not at a hospital; with a midwife instead of a doctor; and without any drugs.

This is a particularly sensitive issue for women, so let me first say that I am not criticizing anyone's choice. I understand how mystifying the whole process can feel, and I understand how terrifying it is to think about something happening to your baby. I understand that everyone's body and experiences are different, and that your views about childbirth depend greatly on the way your parents dealt with it. 

So to give you background about my views: My mother had six children, all at home with a midwife (except for one, where I think I maybe remember something about the labor going so fast that the midwife didn't even make it there in time). My siblings and I didn't go to doctors when we were sick growing up; we jammed our immune systems with vitamin C, echinacea, and goldenseal, were sick for about three days, and got over it (and then had trouble getting an excused absence from school because of our lack of doctor's note). As near as I can count, I have set foot in a hospital six times in my life (three as a patient and three as a visitor). The only times I ever remember going to the doctor were for a physical before Girl's Camp and to get immunizations for school (and no, I wasn't immunized as a baby; none of us were). 

I believe that the best environment for a baby to come into the world is the baby's home, where the mother is comfortable and has the full attention of her midwife. I've always hated the atmosphere in a hospital, where everything is freezing cold and sterile and full of strangers. I honestly think I might choose giving birth outside over doing it in a hospital--although if we're being honest, I don't know that I'd agree with myself when it really came down to it. :)

I also believe that most women are perfectly capable of having a baby at home, if they decide to do some research and educate themselves about what needs to happen. Midwives are capable, well-educated and usually certified professionals, and they are trained to handle things like breech births, twins, and other things that women often think are deadly if encountered outside a hospital. (My mom can attest to this, as I myself was born with the umbilical cord wrapped around my neck twice.) This quote is one I came across when I was writing the original post last year, and I love the sentiment it expresses:

"How you view childbirth is a reflection of your philosophy of life. One of the things I feel really sad about is our culture where the message is that women can't have a good childbirth experience without turning themselves over to the control and interventions of the medical community. Starting parenthood with the notion that somebody else has to manage the process is not empowering. This is something that I think about, but I suspect many of my colleagues would say, 'What is she talking about?' I was really proud of my own ability to birth my 9-pound 13-ounce son vaginally without anesthesia. I remember touching his head at my vaginal opening and holding him on the delivery table and being in love. I was his mother. I am not opposed to C-sections, but I'm pretty sure a 30 to 40 percent rate is not justified."

-Marcie K. Richardson, OB and instructor at Harvard Medical School

Women have been having babies for thousands of years, and I believe that we are fully capable of handling the process without medical intervention. This is not to say that I think it's wrong to have a baby in a hospital, or anything like that; I just believe that it's not necessary, and I would never choose to do it myself. Childbirth is a beautiful, natural process--something that can be approached with excitement and confidence, not fear. 

I should also say that I do know there are some circumstances under which a doctor and a hospital might be necessary. Women have been having babies for thousands of years, and in that time there have also been a lot of birth-related deaths. (Many of them were caused by the inferior living conditions, not complications inherent to childbirth, but it's still a valid point.) Sometimes there is a serious complication, and in that case, the intervention of modern medicine is a wonderful thing that could save the life of a child or mother that may have been lost in a different time. I definitely understand that. 

But I do believe that those are rare circumstances. I believe that in preparation for childbirth, parents don't need to be thinking about all the things that can go wrong. I think parents should have a plan in case something serious does happen--and after having made that plan, do everything they can to educate themselves and become comfortable with the process. Childbirth is one of the most basic functions of nature, and we are qualified to deal with it.


  1. I think for some people, the control and empowerment is a big part of childbirth (I think of Jenna Cole at That Wife, for example). For me, though, I didn't WANT to be the one controlling the whole process. I had a fantastic hospital experience (it was a midwife birth - about 70% of the births at the hospital I was at are midwife assisted) and I would do it over again in a heartbeat.

    I sometimes get the impression that people who are strongly in favor of homebirth think that everyone who doesn't give birth at home has a really lousy experience, but are just afraid of things going wrong or having no drugs, but I think a hospital birth can be fantastic and fulfilling and personal as well. And frankly, I don't WANT to be in my home to give birth.

  2. Unfortunately for me, I don't even have a choice if I want myself or a baby to have a chance at survival, it's lots of doctor visits and the hospital for sure for us, and lots of worrying while pregnant. But, I hope things go very smoothly for you when the time comes and that you have a beautiful experience in the comfort of your own home- it's a very happy thought!

  3. Lis, you would definitely be one of the exceptions I talked about, and I can't imagine how difficult that must be. My only personal experience with pregnancy so far didn't actually end well, so I obviously don't know how things are going to go for me either. I can only hope for the best.

    Janssen, don't worry, I do know that not all hospital births are horrible experiences. :) For some people it isn't about fear, it's just that the hospital sounds totally preferable to having a baby at home, and that's a perfectly valid choice. Like I said, I absolutely don't condemn anyone for preferring the hospital--I just wouldn't choose it for myself.

  4. I know we've talked about this before, and I totally respect your position, but I want to add that although yes, there were a lot of infant deaths during those thousands of years of women giving birth, there were lots of women who died during those years because they couldn't stop the bleeding. I know that midwives can deal with some of those circumstances, but can they sew you up if you start bleeding like crazy after the birth? (Have you read Miss Nemesis's birth story where she wanted everything to be pretty natural and then ended up with a million stitches after like 12 hours of labor and getting an epidural because she was getting so tired the midwives were afraid she wouldn't have the strength to push the baby out?) I agree with Janssen that I just don't like the idea of having a child in my home, but I also think we talked about how a lot of that probably has to do with the way we were raised. Anyway, it was interesting to read either way. :)

  5. I do remember having this conversation at least once, Megan, and probably more. It's always a fun one. :)

    Yes, a midwife can sew you up if you've torn. (Happened to my mom with Benjamin, who weighed over 9 pounds. Also, random interesting tidbit: I was the only baby my mom had that was under 8 pounds.)

    In fact, many midwives are nurse-midwives, who are required to hold a Master's degree of some kind in nursing. There are midwives who don't have medical certification, but they still have to be licensed by the state, which means that they have extensive knowledge and education and have fulfilled whatever requirements the state deems necessary--and obviously no one has to choose a midwife whose background they're not comfortable with.

  6. Unfortunately nowadays, it's even hard to find a midwife who is legally allowed and trained to deliver breech or multiples. I think there's only one here in Utah County who does. It might be different where you are.

    But folks, home birth midwives have much more training than people think. They can sew up tears; they carry drugs to stop excessive bleeding; they know CPR and neonatal resuscitation; they carry oxygen to the birth...this is just a short list. They also know when a hospital transfer is necessary.

    And for those who are not comfortable with the idea of home birth, but don't want to go to the hospital, there are freestanding birth centers. I'm considering that for when I do get pregnant, mainly because I live in a tiny apartment and fear disturbing the neighbors.

    I think the most important thing is to trust your body and your intuition. If you feel like you do need to give birth in a hospital with a doctor, trust that feeling. But if you deeply feel that an out-of-hospital birth is the right thing for you, then trust that feeling too :)

  7. Laura, I love everything you said, with only one caveat. It's fine for women to decide they want to give birth in the hospital, but I don't think they should just trust their feelings until they've seriously researched home births first. Otherwise they're not making an informed decision, and that choice will be made based on fear (of the unknown) and assumptions (because there is--clearly--a serious lack of understanding about home births and midwives).

    I also think it's important that, rather than just doing research online, women talk to other women who've had experience with it, and it's even better if they can meet with a midwife themselves. As bizarre as it is considering how information-based our society is, there is not a lot of balanced information about home births and midwifery out there. Anyone who talked to my mom or my sister Dafni, for example, would come away with a very different feeling about the whole process.

  8. Also, Laura, I was surprised by what you said about Utah County. I went to to see what options there were in my area, and I had no problem finding two centers within 20 minutes of me (which, in north Texas at least, is about as far as we have to drive for everything). In the valley, though, I found only one center in Murray. I guess that's a testament to how little people actually know about this issue, because frankly, Utah is a place where I would expect to see more than the average number of midwives. (Granted I'm only looking at the results from this one search, so I don't know, there may be better methods of finding one.)

  9. I should have mentioned that women should research all their options before making a decision along with all the others. Why did I not include that? I guess I was still waking up when I wrote my comment ;)

    The birthing center in Murray you're speaking of is the only "true" birthing center in northern Utah and it is run by a CNM, but there are two birthing "suites" in Utah County alone, maybe more that I don't know of. Both of them are 10-15 minutes away from me. I think the difference is in legalities.

    Yeah, can you tell I've done a lot of research?

  10. I can, and I think it is awesome. :)

  11. I respect the decision to give birth at home, but there are a lot of reasons why hospitals and doctors exists. Like Megan said, many women died because of complications from child birth, which can be treated now in the proper setting. Women are at greater risk for bleeding complications for up to 48 hours after delivering, which can result in major surgery, including a hysterectomy. Mid wives are trained, but I'm not sure that they are certified to perform major surgery. A lot of problems can happen with the newborn as well. CPR is great, but not a supplement for ventilators, which newborns might need when their lungs aren't fully developed. I hate the stigma associated with hospitals and doctors. They are there for the purpose of helping people and saving lives :)

  12. I think there's a stigma on everything depending on what angle you're coming from, Gabi. I mean, if you're talking about something with a stigma, I don't think you can GET more stigmaed than natural home births. :)

    I have a lot of respect for doctors--I have an uncle and a cousin who are doctors, and two aunts and a grandmother who are RNs. I know how hard they work, and I know that many of them are pretty much heroic in their work to help people. And like Janssen said, many people do have excellent hospital birth experiences. That's not in question, and it's wonderful for those women.

    What is in question in this conversation is all the negativity surrounding natural birth. If women know what all the options are and choose to have a baby in a hospital, that is fine. But when women base their opinions on incorrect information and stigma, that is not good for anyone.

    Of course midwives don't perform major surgery, but then, most deliveries don't require surgery. Like we've said, if surgery is necessary, a midwife will have the mother transferred to a hospital.

    Basically the message here is that pregnancy is a normal part of life, and women don't need to assume the worst about what could happen; it is unlikely that there will be an emergency if you are prepared, but if there is one, then yes, that's why we have hospitals. Choosing to deliver at home does not mean you'll just figure it out as you go and if something goes wrong, you're stuck--but that seems to be what people think.

  13. Sorry if I sounded like a little biatch, I wrote the response during a sleep deprived moment. I don't wanna be bashing people's opinions...your openness in sharing how you feel and believe is one of the things I admire about you (yeah, I'm a blog stalker). I would just be scared to think of having a home birth in the event that something did go wrong, cause one trained midwife is a great resource, but an entire hospital just seems safer.

  14. Haha no worries Gabi, you didn't. Your comment was actually a lot milder than many. :) Sorry if I sounded like I thought you were! Something about the way I write often makes people think I'm upset with them, but I'm usually not.

    I had no idea you read my blog, but I have no problem with blog stalkers (especially when they're people I actually know). And thank you! This is something I've been working on developing, because it's always been hard for me to share my opinions when I know people will disagree with me.

    And like I said, I also completely understand how scary it is--I obviously haven't done it myself, and I would be silly not to admit that there's a part of me that's apprehensive. But the part I'm afraid of is mostly how I will handle it, not really that something will go wrong. Knowing that my mom has done it six times, and that of course she will be there with me in addition to a midwife I trust, makes me a lot more confident that everything will be okay.

  15. I had a regular doctor with Dan and he wasn't there at the birth--his partner--who I had seen-- was there, which is pretty normal unfortunately. The one I was really impressed with was the delivery nurse. She was really the one that knew what was going on with me (and the other 7 women who were there with me).When the time came (I went really fast once I reached the hospital--1 1/2 hour from arrival), the doctor said he was going to do a c-section and the nurse stopped him and said he had to come NOW and she was right. THEREFORE, I was totally comfortable using a certified nurse midwife for the next three children. I still wanted a hospital birth with all the amenities just in case but I wanted the care of a female midwife (who as you said is an RN with midwifery as a Master's--also she had the full back up of a doctor if needed). She came and stayed with me the entire time and she had another midwife come if you overstayed her shift. You were never left alone. Plus they were women who had gone through childbirth themselves. All the difference in the world. I did not want a home birth so I felt I had the best of both world in the Orem Community Hospital birthing suites. You just have to do what you are comfortable with. :)

  16. I agree with you Miri, that it is a very personal matter for each individual woman. A good friend of mine had 5 children, the first one was in the hospital and the next four at home with a midwife. The last home birth happened to be twins where one of their waters had broken and was delivered healthily, the other was deprived of that needed fluid and was born struggling, and had to be revived. Several times. He ended up spending three weeks in the hospital hooked up to ventilators etc. After that I knew that I would never feel comfortable giving birth at home where I know I couldn't do everything possible to save my child's life. He ended up being ok, but the mom said she would have never forgiven herself for choosing a home birth had he died.

    It was interesting when you said you would prefer the mother to be home where she is comfortable. I spend the majority of my labor at home where I was absolutely in misery. When I finally decided to go to the hospital I was almost dialated to a 6 and ready for my epidural. Once I had my epidural everything became more clear, and focused and I was able to enjoy every moment. Since my daughter came so fast (first baby and I only pushed for 15 minutes) I had three degree tears. I couldn't imagine being at home being sewn up for fifteen minutes with little to no pain relief.

    Like you said it is a personal decision. I was grateful for my experience and was very comfortable and happy in the hospital and look forward to doing it again real soon!

  17. Choosing to have your baby at home is very different from waiting at home until it's time to go to the hospital, so it's no surprise that you were uncomfortable until you got your epidural! I can only imagine. Natural childbirth is largely about your mindset; that's why so many people find hypnobirthing classes helpful. (Contrary to what it sounds like, hypnobirthing doesn't actually involve hypnosis--it's just a term for learning focus and relaxation.) If you're intending to have your delivery in the hospital, then being in labor at home is probably quite difficult. Luckily that's not what it's like with a home birth.

    You're actually more likely to experience higher levels of pain in a hospital birth than in a home birth, because the different environment causes your body to release adrenaline, which inhibits the hormones necessary for labor (oxytocin and endorphins). (Of course, if you didn't want to deliver at home, that's completely different--your fear will cause you to produce adrenaline anyway.) When you've chosen and prepared for a home birth, your body is significantly more relaxed, so you're in less pain to begin with.

    But it's also a mistake to think that a home delivery means no pain relief, because there are a lot of options that don't involve drugs. Delivering without medication doesn't mean delivering without pain relief--and, like I said, if you've prepared yourself, you'll likely experience less pain in the first place.

    Here's the thing--if you've never done the things that women do to prepare for a home birth, there's no way it's going to sound like a good idea to you. We come from a culture where pregnancy is seen as something dangerous, so when someone says they don't want a hospital or a doctor, of course that sounds insane. I totally get that.

    I also understand that a lot of women have had a bad experience, or know a woman who has, and they take that as evidence that a home birth isn't for them. But if you think about it, there are just as many horror stories about hospital births, just as many experiences that could make you say "Wow, I will never give birth in a hospital." You hear stories about women whose doctors barely even made an appearance, or who were strapped down for a C-section, or whose nurses were irritable and insensitive, and you know that that was just one person's experience, and not all are like that. It's the same with home birth. As a practice it is not any less safe than hospital birth, and if that's hard for you to understand, you can think of it this way--hospitals are better when there's an emergency, but home births make it much less likely that there will be an emergency in the first place. It's like a preventative measure, if you will. :)

    Anyway. The moral of the story is, once you do the research--once you learn what midwives are capable of, learn how to relax and focus and control your emotions and body, learn what all the options are--then it doesn't seem scary at all. In fact, it makes a ridiculous amount of sense.

  18. I've wanted an un-medicated birth since I started reading the way that hospital interventions can have a domino effect and are a huge money-maker for hospitals. However, I would NOT want a home birth. My mom had two births with epidurals and two unmedicated and she told me she felt so much better afterwards when she wasn't medicated. I want my birth to be an experience where I trust my body and my instincts. That means more research for me, but also (hopefully) a more empowering experience.

    In Tucson we have a very capable birthing center staffed with midwives and an OB and that's where I hope to give birth. Maybe this is shallow, but the idea of having all that birthing mess in my house is quite unappealing to me. I want an environment where I can take charge of my own birth, but I want to do it where someone else can clean up after men.

    So yeah. You posted this like 6 months ago, but I love reading about birth issues. Which is admittedly sort of weird.

  19. Well, it might be weird, but it's not uncommon. And I don't think it is that weird. :) I love your reasoning and I think that's a perfectly good reason to have your baby outside your home. I don't like when people say it's because birth is "gross" or unsanitary, but I can fully understand wanting to not have to deal with the mess! That sounds quite appealing, not gonna lie.