Why Homebirth?

Before I tell Liam's birth story, I feel that I must first talk about our decision to have a homebirth.  I'm not seeking to justify my decision because it's not a decision I need others to love or agree with. I think, however, homebirth needs a voice.  Less than 2% of all births in the United States take place outside the hospital (source), either in a birth center or at home.  It's no wonder that people nearly have a heart attack once they learn we had our baby at home. On purpose.

We fear what we don't understand. The anti-homebirth voices often silence the minority of women who choose to deliver outside of the hospital because they are loud, spew hate, and misconstrue facts and statistics for their benefit.

I won't cower any longer hoping that nobody will notice that we had our son at home.

Yes, we had a homebirth. 

This doesn't make me better than women who deliver in the hospital, but it certainly doesn't make me uneducated, naive or reckless.  I'm not brave. Rodney wasn't coerced into this decision. Together, we simply made a different, less common choice based on research and much prayer.

I won't defend homebirth. I think the statistics speak for themselves, which state that homebirth is a safe, alternative option for low-risk women who hire a competent midwife or obstetrician. (And, yes, there are obstetricians who deliver at home; I met with one through this pregnancy. She collaborates with my midwife.) 

I realize that we can look at the exact same research and come to different conclusions. Where and how we have our babies is a personal decision. 

This is simply my journey.

------------------------------------------------------------

Paxton was born by cesarean. It was a very traumatic experience and after requesting my hospital records and nurse's notes months after his birth, we discovered that it was an unnecessary cesarean. Sadly, we were mislead by the on-call doctor. My labor notes indicate that my cesarean was my request, which was an absolute blatant lie. I later learned that our hospital had one of the highest c-section rates in the Dallas/Fort Worth area.

I was told repeatedly throughout my pregnancy with Paxton, labor, delivery and at my postpartum checkup that Pax was too big to deliver vaginally. Ironically, he has been our smallest baby at 8lbs 14oz. Crew was 10lbs born at 39 weeks with a head and shoulders in the 99th percentile. Liam was 9lbs 2oz born at 37 weeks, 2 days.

After pouring over research, I knew I wanted to have a VBAC (Vaginal Birth After Cesarean).

Why VBAC?

Longer-term impacts relate to both future reproductive capacity and a woman’s ongoing health. A cesarean section puts a woman at higher risk for future ectopic pregnancies, including a type known as “cesarean scar pregnancy” that develops within the scar from a past c-section. Her future fertility is lower than a woman who has a vaginal birth. In future pregnancies, a woman who has had a cesarean is more likely to experience serious problems with the placenta – for example, growing across the cervix (placenta previa) or into the scar (placenta accrete), or coming apart from the uterus too early (placental abruption). And the scar in her uterus is also more likely to open, whether she has a vaginal or cesarean birth. Uterine rupture is commonly attributed to vaginal birth: we need to recognize that nearly all cases in more affluent countries occur in women who have had a cesarean. The evidence that we reviewed found that babies from future pregnancies are more likely to die before or shortly after the birth if the mother has previously had a cesarean section. Pre-term birth and low birth weight may also be concerns. And future babies appear to be at increased risk for a physical abnormality or injury to their brain or spinal cord. Investigators have hypothesized that these problems are due to “placental insufficiency.” The likelihood of a number of these future reproductive harms increases as the number of previous cesareans increases. Fortunately, with just one or two previous cesareans, most of these outcomes occur infrequently. Unfortunately, however, most of these are serious and even life-threatening for mothers and babies. Many pregnancies are unplanned, and some women who don’t intend to have more children change their minds. And a growing number of pregnant women lack access to vaginal birth after cesarean (VBAC), which leaves them no choice but repeat cesarean. Moreover, there are other longer-term effects of cesarean on women, beyond childbearing, that appear to be a consequence of scarring and adhesions that often accompany surgery. Women who have had a cesarean are at increased risk for chronic pelvic pain and for bowel obstruction, and the tough adhesion tissue can complicate procedures that a woman may need in the future, such as gynecologic surgery. (Found here).

Throughout Crew's pregnancy I discovered I-CAN (International Cesarean Awareness Network) and watched The Business of Being Born while also learning more about birth in the United States compared to birth throughout the world. I started to ask questions, like why is the United States the only developed country in the world with a rising maternity mortality rate? (Source here.) Why is the United State's maternal death rate triple the rate of the United Kingdom, or even double the rate of Saudi Arabia? (Source here.) Why is C-section rate in the United States more than double the rate recommended by the World Health Organization? (Elaboration here and here.)  Women in the United States are 70% more likely to die in childbirth than women in Europe (source here). Why?

The United States spends the most on maternity care than anywhere in the world (source here), yet our outcomes are a disaster. I came to the conclusion that, perhaps, in this setting, more isn't better. We spend copious amounts of money, use more machines, perform more procedures on low risk mothers, induce more without medical necessity, and intervene in the birthing process more.  

We considered an out of hospital birth-center birth and interviewed midwives. To change providers that late in pregnancy, however, was too costly, so we stuck with our hospital birth plans.

Crew had his own plans, though. From my first contraction to feeling the urge to push was about 2.5 hours, something I hadn't anticipated or expected based on my labor pattern with Pax. My doula, after Rod called her and let her know I needed to push, called a few midwives she knew and thankfully two midwives were in our area that morning. They made it to our home before Crew was born. Everybody was happy and healthy and I was left awe-struck by the whole experience.

From the very beginning of this pregnancy, we wanted a homebirth. Our experience with the midwives at Crew's very unplanned birth laid the foundation, but what solidified our decision was an early appointment with an Obstetrician.  She was horrified by the size of our babies. She spoke in great detail of every complication and tragic outcome that could occur, conveniently forgetting, of course, to mention how incredibly rare such complications were, especially since I had already delivered a 10lb baby.  She was digging up in fear everything I had planted in faith.

I left that appointment in tears; I had always been and would always continue to be a liability in the eyes of these providers. Rod was fuming. He was growing tired of the fear-mongering, aggressive, non-evidence based care being offered. We knew delivering vaginally in the hospital would be an absolute uphill battle. We left the hospital that day and never looked back.

We found a fabulous Certified Nurse Midwife here in California who has years of experience in both the hospital and homebirth setting. We loved her model of care, we loved the hour long appointments we shared, and we loved having her personal cell phone number to use whenever we needed. I never felt rushed or flustered at appointments. I never left appointments in tears or consumed in panic like I had with my previous pregnancies. We focused on keeping me low risk by eating a very high protein diet and getting adequate exercise.  We talked at length about my fears, concerns and reservations I had, all rooted in my traumatic experience with Paxton. We felt safe with her wisdom, skills and experience. We laughed. We hugged. We forged a friendship that will forever be near my heart.

Our decision isn't right for everybody, but it was the perfect choice for us. 

----------------------------------------

VBAC information:

1. 13 VBAC myths. Found here. 
2. I'm pregnant and want a VBAC. Now what? Read here.  
3. A women-centered, evidenced based resource on VBAC. Found here. 
4. VBAC support groups. Found here. 
5. ICAN: International Cesarean Awareness Network. Education, Support and Advocacy. Found here.
6. The Unnecesarean: Pulling back the curtain on the unnecessary cesarean epedemic. Here.
7. American College of Obstetrics & Gynecolgoist's stand on VBAC, found here.
1. "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists."- July 2010

 Childbirth Information:

1. Evidenced Based Birth. Get the research evidence on birth into the hands of mothers and families, inspiring them to make more informed decisions about their care during childbirth. Found here.
2. Learn the Cesarean rates in your area, here.
3. Mother's Advocate Blog: Informing women on safe and healthy birth. Here.
4. Science & Sensibility: Research about healthy pregnancy, birth and beyond. Here.
5. The Unnecesarean: Pulling back the curtain on the unnecessary cesarean epedemic. Here.
6. Watch the Business of Being Born trailer here. Or to watch the entire documentary, which I recommend, it can be found here. 

Homebirth Information:

1. Homebirth safety: Critical Appraisal of the Literature found here
2. 24 of the best available studies on planned homebirth and maternal fetal outcomes found here.
3. Why this Yale trained Physician would choose homebirth again, found here. 
4. This study, which examines nearly 17,000 courses of midwife-led care, is the largest analysis of planned home birth in the U.S. ever published. Read here.  
5. Why homebirth: An in-depth discussion, found here. 
6. Journal of Midwifery & Women's Health: Outcomes of care for homebirth, 2004-2009, found here. 
7. Pregnancy outcomes of 1707 women, who enrolled for care between 1971 and 1989 with a home birth service run by lay midwives in rural Tennessee, were compared with outcomes from 14,033 physician-attended hospital deliveries derived from the 1980 US National Natality/National Fetal Mortality Survey. Found here.
8. An honest look at HBAC (Homebirth After Cesarean). Found here.
9. Maternal outcomes of planned homebirth vs. planned hospital birth. Found here. 
10. Outcomes of planned homebirth with certified midwife: large prospective study in North America. Found here.  
11. 2008 homebirth study conclusion: homebirth is an acceptable alternative to hospital for low risk pregnant women and leads to reduced medical intervention. Found here.  
12. Discussion on why Doctors, Nurses and other medical professionals are choosing homebirth. Found here.
13. Watch Why Not Home documentary trailer, here. This is a documentary exploring risk, safety, and the experience of childbirth in America.
14. Watch the Business of Being Born trailer here. Or to watch the entire documentary, which I recommend, it can be found here.