I just read Gloria Lemay’sblog post “Are You A Good Candidate For A Hospital Birth?” and it really got me thinking about how to reach more people to help them understand the range of choices that exist for childbirth. I think if first-time moms really understood the challenges inherent in a hospital birth experience, they might think twice. At least, the idealistic part of me thinks that – the part of me that includes my own personal experiences with giving birth in a hospital, as well as the differences when I later chose to have a child at home.
Some moms are content to not think about the choices. Some moms know both perspectives and choose the path more well-traveled by their peers. Others, like the pre-homebirth me, think that if you want a natural birth at the hospital, you can tell the staff your wishes when you arrive and it will just happen. I get it it: there is immense social pressure to conform, especially when family members or friends say things like, “Choosing homebirth is a selfish choice!” (Yes. Really. People say that.)
So, let’s get real. Let’s drill down and take a look at aspects of hospital births that many women may not have considered. I find Gloria Lemay’s list of questions from her blog post “Are You A Good Candidate For A Hospital Birth?” to be a good place to start:
- Must not be scared of needles.
- Must not be claustrophobic or uncomfortable in confined spaces.
- Must be able to go for long periods of time without eating or drinking.
- Must be happy to share a bathroom with others.
- Must enjoy sleeping on a mattress covered with plastic.
- Must not have a rebellious or questioning nature.
- Must accept the possibility of contracting antibiotic-resistant infections.
- Must be confident with caregivers who are overtired and overworked.
- Must realize that a limited amount of time can be spent in a hospital room before it is needed for the next patient.
- Must like and trust electronic equipment.
- Must be comfortable with a cesarean rate of 30%.
- Must accept that the mood of the nurse on duty will be a large determinant of the birth outcome.
- Must realize that someone you have never met before will likely receive your baby.
- Must realize that the written birth plan will be ignored.
- Must be willing to have fluorescent lights turned on at all hours.
- Must be capable of birthing without making loud noises.
- Must look good in a flimsy blue gown that is open up the back.
- Must be willing to be a teaching subject for student doctors who are learning to do pelvic exams, surgeries, and suturing.
Do women know that this is what they have chosen when they choose to birth at a hospital? Are they so afraid of the process of birth that they’re willing to give up their safety and their preferred birth experience to a system that promises outcomes for them and their babies that are worse than every other industrialized nation? What motivates women to make this choice?
I ask these questions of myself as well. Why did I choose hospital birth for my first three babies? Maybe that’s a good place for me to start as I grapple with ways to address the fundamental differences between hospital births and other birth setting births.
With my first baby, I wanted the best possible care, which, to me at the time, meant the most expensive care: an obstetrician. I thought midwives were somehow “less than” and that homebirth was dangerous. The internet didn’t exist in the average home in 1989, so the ability to make a truly informed choice was limited. My preconceived notions about midwives and uninformed opinions about homebirth and obstetricians drove my decision to seek a hospital birth with an OBGYN. Looking back I can see that I wasn’t informed and armed with facts; rather, I was making decisions based on cultural bias and confusing messages in the media and in books.
In addition, as a headstrong only-child who thought she knew it all, I believed I had fully prepared myself for a natural birth. I thought that if I informed the hospital staff of my plan when I arrived, it would happen the way I wanted. I had read good books about natural birth (Birth Without Violence, Childbirth Without Fear), but “What to Expect When You’re Expecting” had just been published for the first time. It was the new mom book of the day and I practically memorized the book by the end of my pregnancy. I felt like I really knew my stuff going into the birth. In retrospect, it wasn’t really the best choice of reading material, to say the least. Some people joke that it teaches pregnant women how to become “obedient” patients. And that just might be true.
My first birth was anything but natural. There were a lot of medical interventions. Yet active labor was fairly quick. I had a vaginal birth with no episiotomy, so I felt like I’d done pretty well. I hadn’t had an unmedicated birth, but, in the end, I felt like the reasons for that were my own failings, not the failings of the doctor or the hospital, and that they had “given me” as natural of a birth as they could-despite my “inadequate” contractions and “inability to tolerate” the pitocin-augmented labor. What I experienced emotionally was this: feeling a bit deflated, taken down a peg, proven wrong, (See, natural childbirth really is too tough for you) proven to be defective (Your body needed “help” to give birth.) Despite all of these feelings, I convinced myself I’d had a good birth. It was a defense mechanism that helped me deal with the bigger truth. It helped orient me in the cultural norms of childbirth that I butted up against in the hospital. It helped me to let go of my original feelings, preferences, and instincts about how I wanted to birth.
With my second baby, I did as I had done with the first. I told myself I was pretty happy with the first birth experience (I didn’t know anything else), so I went back for more of the same. One big difference this time around was that I was even more financially strapped than with my first; I ended up on Medicaid. I lived in a rural area at the time, and the only obstetric providers who took Medicaid were doctors at a Family Practice clinic. I was served by a large group of residents at the clinic; my birth was attended by a few residents. I felt as if they had no real expertise with childbirth, and that I was just someone for them to practice on. The birth was a tough Pitocin-augmented, persistent posterior birth with no pain relief. I was restricted to lying on my back or my side, which made labor excruciating. I left that birth not ever wanting to go through that kind of pain again.
So, now fearful of birth, for my third birth I chose a birth I felt I could better control-a scheduled induction at 39 weeks with an epidural at 1cm. There wasn’t much pain, but instead of feeling in control, my stated goal, I felt totally OUT of control. I had no physical sensations of birth, which meant no feedback on how the labor was progressing. I felt disconnected from the experience and totally at the mercy of how the doctor felt about my progress. It was horrible.
The turning point for me, and the biggest impact on my decision to choose a homebirth with my 4th baby, was my involvement with La Leche League. I listened to the experiences of other mothers and learned that doctors don’t know everything. I heard other mothers describe the same birth experiences and I finally began to question whether my choice to give birth with an OB in the hospital had really been the best option for me, especially when my stated goal had been natural birth. The stories of these other mothers helped me to see that it was not my body that had failed me, but the obstetrical system that had failed me. The clincher for me was on the day I told my OB that I was interested in taking Bradley Method childbirth classes. She grabbed me by the shoulders and said, “Kim, tell me you are NOT having a natural birth.” I nearly ran away screaming. It was clear that she was not going to support my choice.
I made an appointment with the midwives at BirthCare and Women’s Health in Alexandria. It was life-changing. At the first visit, I knew it would be a totally different journey. Our first visit with the midwife lasted an hour. It was my first experience of a provider actually listening to me and asking questions that other providers had not asked before. When I left that first visit, I felt a peace I had not felt previously about my maternity care. I knew that even though it would probably be out of pocket financially for me to have the baby at home and that the drive for prenatal visits would be over an hour each way, it would be 100% worth it. And I was right.
Charlie’s birth was an incredibly beautiful family event. Birthing at home, connected to my body’s innate wisdom, helped to heal the pain I carried with me from previous births. Finally, I did not feel defective! My body had known all along how to give birth, not unlike it had known how to nourish and nurture my babies through breastfeeding. I’ll never forget that moment when the midwife whispered in my ear after the birth, “See, Kim, your body knows just what to do.”
I’m an intelligent, educated woman. Heck, my great-grandmother was a midwife! I don’t consider myself to be one to bury my head in the sand when it comes to making important decisions. So I ask myself now, what could have helped me to know the truth sooner? To become more aware of the cultural implications of birth? Maybe if I had read Gloria Lemay’s blog back in 1989, or maybe if I had viewed the Business of Being Born, maybe, just maybe, I would have understood the truth about giving birth in the hospital-the limitations, the restrictions, the very philosophy of institutionalized childbirth. I think the best thing we midwives and birth activists can do is to just keep spreading the truth, whether it is in a big way, through documentaries and books or movements, or simply sharing stories and making a difference, one woman at a time.
*Some women require obstetrical interventions in order to have a good outcome. This post is not directed at women who have benefited from necessary intervention-intervention we rely upon obstetricians to provide with their surgical and high-risk skill sets.