Posted by: philosodad | November 7, 2009

in which I muse on babies, birth, and chocolate

We’re having a bit of a kerfuffle in the comments right now, concerning the question of home birth v. hospital birth. And I have to tell you, it’s another time in my life when I realize how amazingly lucky I am to be married to Grrl, and not to any number of previous wives or girlfriends who lack her basic good sense.

When we were preparing to have our first child, there was no debate about a hospital birth. There was no agonizing about the joys and wonders of childbirth. Grrl–rightly in my mind–saw childbirth as a job she had to do, the focus of the job being a healthy, safe baby. Nothing else was particularly interesting to her.

In direct contrast to the picture being painted by the pro-home birth advocates on this site and others, the establishment actually tried to persuade her the other way. The dangers of an epidural were duly explained. The joys of a “natural” childbirth were extolled in our preparatory classes. To all of this, the Grrl simply raised her chin and stuck with her birth plan, as worked out between her and her OB.

The birthing room was quite nice, the bed extremely comfortable, the nurses very pleasant and affable. I had a wifi connection and a bench to sleep on, she was constantly monitored for any signs of danger, helped up if she needed or wanted to walk. We were never treated in any way that was not pleasant and accommodating and respectful.

In other words, the nightmare scenario that some home-birth advocates project, where women are–apparently–strapped down to beds and force fed drugs before being C-sectioned for no reason, is not an accurate portrayal of modern medicine at a decent hospital.

It helps that Grrl works in the NICU (Neonatal Intensive Care Unit). She knows the kinds of things that can go wrong in a birth. She knows what can happen to a baby during a trip to a hospital, how a baby that should be fine can end up on life support, fighting lung infections in it’s first week of life. She swims in that sea.

So there was never any question of where we would be having the baby. Home birth, birthing center… these options were simply ignored. She stayed a focused, dedicated, and fierce advocate for her children.

Grrl worries, now, whether she should have gone natural. She has occasionally admitted to a tinge of regret that she was so businesslike about the whole matter. But we only have the opportunity to have that conversation, and worry about that sort of trivial detail, because we have two beautiful, healthy children. It is a luxury to be able to worry our heads about “fulfillment” or whatever, because the job of bringing the babies into the world is done.

It’s not like we could possibly love them more than we already do!

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Responses

  1. I was so excited to read the kerfuffle that I scrolled right down to the comments. It’s really a very polite kerfuffle. Everyone is being very civil.

    I have to say that I was kinda the same as your wife. I never even considered alternative locations. It was hospital or nothing for me. And no birthing classes. I read a lot of books. Just seemed cheaper than taking classes.

    • I’m curious as to whether you also had a positive experience with the hospital, in terms of treatment, attention, sense of control, and so forth.

  2. I think there’s a lot of guilt wrapped up in parenthood no matter what you do. I admire your wife for being business-like and making sure you ended up with a healthy baby and a healthy wife. That’s nothing to regret.

  3. Well, I guess the hospital I was in was neither modern nor decent. I was one of those strapped-down, drugged (while having a plan that stated I’d rather not be), “sectioned by fear mongering” mommies. I’m a fair skeptic myself, but that experience was so close to what your critics describe that I find it hard to believe it’s not commonplace.

    My only goal was a healthy baby, and we got that, but I don’t think you can discount the emotional trauma of such an experience on the Mom. It makes those first weeks torture, instead of just hard work.

    Contrast that to the excellent state of the art care my son got when he needed heart surgery at the regional children’s hospital, and you realize that there is a real problem in the birthing business.

    • “I’m a fair skeptic myself, but that experience was so close to what your critics describe that I find it hard to believe it’s not commonplace.”

      —————-

      How does that follow? You’re a sample of one. I’m a sample of one. There’s no skeptical reason to conclude that your experience was commonplace and mine was not. There is a reason to conclude that our experiences were different.

      I’m curious, though… were you consulted about the c-section prior to surgery? Were you given a list of options? Were you only drugged because they were about to cut into you and otherwise the shock would probably kill you, or were you drugged without your consent prior to that point?

  4. I find the whole natural/home birth stuff just one more way to get a woman to beat herself up, no different in strategy from women’s magazines and the beauty industry. Your not skinny enough, not made up enough and NOW you didn’t even give birth the right way. It’s so pernicious.

    As someone who had a great hospital and epidural experience, I fully accept that my way is not for everyone. Why don’t the people in the natural birth realm have the imagination to conceive that not everyone is interested in what they’re peddling? We’re not poorly informed, we’re not afraid we’re just not interested. Move along.

    I would also point out that there is a lot of misrepresentation about birth in many books and classes, even mainstream ones seem to have the natural philosophy creeping in. The one that bugs the heck out of me is this 1st stage of labor thing. I was told (and many I know were told) that there’d be this period of up to 24 hours where contractions would be 15-20 apart and very manageable. In this time, I could watch a movie, do some yoga and make a frittata. This was also the time when I guess you can slip into this fabulous mind over matter state where you can cope with the pain. Well guess what? No frittata for me. I went from zero to five minute apart contractions (more like convulsions and vomiting)within the space of about 20 minutes, maybe that 20 minutes was my first stage. Turns out my experience is just as common as the slow labor experience, but somehow no one mentions it as ‘normal’, because it doesn’t fit the narrative we’re supposed to buy into.

    I also don’t do regret and guilt about my parenting, whether it’s birth, feeding, diapering, or sleeping, none of that. I feel bad if I screw up and could have prevented something, opening a car door too fast and accidentally knocking it into her or promising a playdate with a friend without having confirmed that we’re still on. But wondering if I gave birth the right way? no way.

  5. I think you’re engaging in some fallacies here. You seem to draw a false dichotomy between women who do non-hospital birth, and therefore must be doing because of some hippy-dippy “spiritual” beliefs or something, and women who use hospitals, who are “businesslike.”

    I chose a birthing center because the best scientific research supports a low-intervention approach to normal births (and yes, I thank goodness for the medical expertise we have to handle non-normal ones), as the safest and healthiest choice for both mothers and babies. And it is most likely that you will get practitioners who adhere to that approach outside a hospital, though of course it is perfectly possible to get lucky and find them in a hospital setting as well.

    There’s also the old fallacy “at least we have a healthy/alive baby.” I for one was aiming for more than that – I wanted an optimally healthy baby, an optimally healthy mom, and low stress about whether someone would try to sell me (or force me!) into something unnecessary and possibly detrimental at a moment of crisis. So many babies have be “rescued” by heroic OBs doing c-sections, when in fact the interventions ordered by the same OB probably caused the crisis that made the surgery necessary. It’s not as black and white as “the baby survived, therefore it is the best option.”

    • This is just more of the same hospital phobia. The idea that you can’t find a low-intervention OB except “outside of a hospital” is just ludicrous. You don’t have to “get lucky”. The way it works is this: you find an OB you’re comfortable with. Then you give birth at the hospital they hold their privileges at. It isn’t like you get a random stranger for your OB when you go to the hospital.

      Also, what evidence do you have to suggest that the interventions ordered by an OB (whatever those might be) cause any significant number or crises? What is this “so many” number you speak of, and where are you getting it?

      Speaking only of our experience, the only intervention that we were offered was an epidural. And even that won’t be offered past a certain point, certainly not at a moment of ‘crisis’. Past a certain point, you’re going au natural whether you like it or not. Listening to the “natural” childbirth in the next room pretty much settled any doubt about that question in Grrl’s mind.

  6. I’m really glad you had a good hospital experience! Sadly, I have heard plenty of stories from friends on the other side of the coin too. My point was merely that if you want a natural birth, going to an environment designed to support them is a better guarantee than going to a hospital, where epidurals, pitocin, and EFM are standard procedures.

    And yes, you do wind up with random strangers attending your birth in the hospital – you are at the mercy of the nursing shifts, with the doctor typically arriving to catch the baby at the very end, if s/he is avaialable.

    One instance of interventions increasing c-sections and failing to improve outcomes is continuous electronic fetal monitoring. It seems to make sense, but the research shows it results in worse outcomes: http://parenting.ivillage.com/pregnancy/plabor/0,,8wvj-4,00.html

    And yeah, naturally laboring women yell a lot sometimes – how is that an argument for using drugs that carry risks?

    • “One instance of interventions increasing c-sections and failing to improve outcomes is continuous electronic fetal monitoring. It seems to make sense, but the research shows it results in worse outcomes:”

      I checked the research. The article that your source cites (or rather, the article that the review that your source cites reviews) found that there was a decreased risk of infant seizure, but an increased risk of C-section or surgical intervention. So this outcome isn’t “worse” in the unambiguous sense that you suggest. It is possible that some number of c-sections were performed that is higher than needed, and possible that some infant injury was avoided as well. The literature you cite does not support the point you wish to make.

      In fact, the paper you point to seems to directly contradict your earlier point that “natural” childbirth is more healthy for infants.

  7. “And yeah, naturally laboring women yell a lot sometimes – how is that an argument for using drugs that carry risks?”

    There’s a strong social influence that discourages yelling. I was once hit by a car, and while I wasn’t injured in any definable way (no broken bones, just a lot of bruises and this weird weakness that made it hard to cross a room, but cleared up within a few days), it was excruciatingly painful. I yelled and moaned because I felt what I can only describe as a biologic imperative to make noise. I felt bad for the people that saw me get hit, and everyone seemed very shaken. When I got to the hospital, I could tell it bothered people that I was moaning. But I had to. I really wanted to stop, but I had to. It didn’t make me feel better, I just had to make those noises. It was the only thing that made breathing worth it. I felt like I was sub-human, like I wasn’t myself anymore, but instead had been reincarnated as Pain. I was just Pain, and nothing else, and it was horrible.

    At the same time, I was terrified that I was seriously injured. When I got to the hospital, I desperately wanted pain medicine, but I didn’t ask for it, because I didn’t want to distract anyone from finding that my spleen was bleeding (it wasn’t). So I can understand that if you’re afraid enough of the medicine hurting you or the baby, you can forgo it. You just have to be very afraid.

    Pain is a very good reason to take drugs that carry risks. A very good reason. I understand that sometimes labor is too fast, or the anesthesiologist is too unavailable, or your spinal cord is too unusual to get an epidural. And I’ve heard of people undergoing natural childbirth after getting a headache after the epidural. But pain is everything. Just because it ends, doesn’t mean you can forget.

  8. @philososodad

    This study pretty much blows most of your reasoning out of the water. http://www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx

    While we’d have to account for some variations in training of homebirth midwives (in the US some are CNMs while other are not), this really undercuts your 1% argument.

    On a side note, that line of reasoning, is the same as my neighbor’s who makes her kid wear a helmet to the park. If he did fall and fracture his skull, he would be better off wearing helmet. Bravo to you for sounding only slightly less ridculous that her.

    The rancor with which you argue this topic makes me think there is something more personal going on, like you are attempting to make yourself believe you made the right decisions about your wife’s births. Ultimately, these decisions are personal and while a homebirth might be the right choice for one couple, for another it might not. Be comfortable with your decision but don’t demonize those who think differently than you.

    • From your link: “It is important to note that this analysis excluded a large number of women with pregnancy and labour complications, as well as those who had premature onset of labour, required induction or who had additional risk factors such as a previous caesarean or twin pregnancy.”

      ———–

      Step 1: Read the link.
      Step 2: Post the link.

      You’re doing this “research” thing backwards.

      And I’m not employing any rancor, or demonizing anybody. All I said was that if you choose home birth, you are betting on a complication free birth. That’s it. You’re being rancorous and insulting.

  9. Not at all, the part you quoted is saying the study compares apples to apples which proves my point. Those with complications don’t/cannot attempt homebirths in the Netherlands. Try to understand and comprehend the basis for my quotes before becoming unduly pedantic. Take your time. Shooting off like you just did makes you look bad.

    • “Not at all, the part you quoted is saying the study compares apples to apples which proves my point.”

      ———–

      Let’s try this again: my point was that if you choose home birth, you are betting on a lack of complications. The study you quoted excludes all cases where there were complications. So if it proves your point, your point is completely unrelated to my point.

      Step 1: Understand what you are going to criticize.
      Step 2: Understand the research that you are going to use as support for your position.
      Step 3: Use the research to support your critique.

      Your critique is tangential to my point. In addition, even if it were targeted to my point, it would not even apply to US homebirth, which takes place in a completely different health care system with different standards, especially for midwife training and certification.

      In other words, your “torpedo” is so far from blowing my argument out of the water that it would barely register on my arguments sonar.

  10. You are right, I’m giving you way too much credit. Your point is that people who have homebirths don’t plan on complications? When I go to the park I plan on a injury free trip and don’t have my child wear a helmet, this is your line of reasoning? I am capricious because 5 in 1,000 times there will be a head injury and I don’t take precautions. Really?

    Step 1 make a cogent argument that adds to the discussion.

    To review what the study findings: Most of the complications associated with bith can be anticipated and the venue (hospital or home) doesn’t impact the outcome of those that cannot be anticipated, in the Netherlands. This does in fact dispute your point…..again, you’ve aquitted yourself rather poorly except in one area:

    Your main point, really, seems to be justifying why you and your Grrl (wow, won’t even comment on that) decided for a hospital birth. Hope this exercise has been helpful for you in that regard.

    • why you and your Grrl (wow, won’t even comment on that)

      ———–

      So, basically, you’ve reduced yourself to making snide comments about my wife’s nickname.

      Nice argument. I guess it is about as relevant as the study that is completely and totally irrelevant to American home births, so I can see how you would think it was appropriate.

      My main point isn’t justifying our decision. We made the right decision. My main point is that I’m glad I’m married to a woman who views life through reality tinted glasses, rather than someone who sees everything from the narcissistic, reality denying, woo colored glasses I see represented in the pro-home birth literature.

      Your posts are an example of what I’m talking about, by the way. You make totally irrelevant points, coupled with personal attacks, and then get all upset because I point that out, and follow it up with the same irrelevant research and new personal attacks.

      Why don’t you try finding some new, relevant information instead?

    • If I had the choice to take my daughters to an enclosed playground with a foam padded floor or a playground with concrete next to a busy street, I would choose the foam padding. Isn’t that analogy more apt than the free range helmet one that you posit? Meh. They’re probably both false analogies, but whatever.

      Based on the available evidence, I can’t see a good reason to have a home birth, other than monetary. Let’s face it. Most people choose home birth because of their sense of principles, their comfort, their fear of medicine, or their fear of being put through the processes during labor. On the last point, having a midwife or doula advocating on your behalf is sufficient enough to deal with a medical staff on epidural autopilot; the rest of the reasons are selfish in the context of the evidence.

      I still fundamentally agree that expectant parents should just make the decisions that they feel is right for them, as long as the couple is informed and nobody’s life is put in immediate risk (like a home birth far from the hospital). What’s funny is that you both would probably agree on that statement, despite your back and forth. My question is whether home birth parents are well-informed of the risk; if it weren’t for Amy Tuteur, I wonder who would be exposing the cover-up of the evidence.

      And please refrain from begging the ad hominem. It spoils your argument.

  11. Phioloslosdad,

    I did your research for you….looks like Dr. Amy finds the study contextual enought to address here: http://skepticalob.blogspot.com/2009/09/lessons-from-canadian-and-dutch.html

    Her primary problem with the studies and their application to American homebirth is that homebirth midwives in the US are trained differently and the screening precluding expectant mothers from delivering at home is substandard, in the US. Of course both points are dependent upon a specific context and, lots of CNMs in the US are also homebirth midwives…and rule out vbacs, breech, and other risky births.

    With this in mind, if one were to find a CNM to complete a homebirth and not attempt to deliver their 12 pound breech baby at home, it seems the study would be applicable to the United States.

    But to accept this would undermine your personal attacks and ability to feel superior and smug….which seems to be a focus of this blog.

    %30 of Dutch women give birth at home, making sweeping generalizations deriding them as selfish seems unnecessary…and wrong. According to the study, a homebirth in the Netherlands is as safe for the baby as a hospital birth. And it does sorta spoil your argument Ticktock.

    • Good link. Here’s a salient quote:

      Evidently, they have failed to grasp the central lesson of both studies: homebirth can only be safe when practiced by highly educated, highly trained midwives under rigorously controlled conditions. Since this is in direct opposition to the philosophy of American homebirth, it is not clear what advocates are celebrating.

      (Emphasis mine)

      This does not undercut my argument in any way. You seem to think that I’m making the argument that under no circumstances whatsoever in any health care system in the world could you ever possibly even begin to consider the thought of homebirth. But I’m not. I’m actually making a comment about the philosophy of homebirth advocates in America, so this link of yours reinforces my argument.

      I also never derided anyone as selfish for choosing home birth in the netherlands. You are clearly arguing with some other people, on some other blog, and getting them mixed up with me.

    • Which argument is being spoiled, again? I really don’t mind home births if they are safe.

      Please point out any personal attacks when you see them. The focus on this blog is evidence, so we’ve failed if you think we are focused on personal attacks. In fact, the comment preceding yours, we both asked you to refrain from personal attacks.

  12. “She knows the kinds of things that can go wrong in a birth. She knows what can happen to a baby during a trip to a hospital, how a baby that should be fine can end up on life support, fighting lung infections in it’s first week of life. She swims in that sea.”

    Does Grrl know the risks of elective epidurals? It’s not that she didn’t have the right to choose one (I’d go to the mat any day to defend her right to do so), but the risks of epidurals are real and not limited to feeling itchy or spinal headaches. In a small minority of cases, epidurals have been known to contribute to longer labors and could possibly lead to fetal distress. Also, epidurals are directly related to use of pitocin, which is also a dangerous drug that increases the likelihood of fetal distress and emergency c-section. If the only things she considered was the health and safety of the baby, I doubt she would have chosen the epidural.

    Is it not more likely that she weighed her own wishes for a positive birth experience (having been convinced by the screaming unmedicated woman next door that it would be unpleasant without the epidural) with the safety of the baby? This is not a negative choice, but it is a balance that any woman must choose. How much should she prioritize her own comfort against the baby’s safety? In the end, she made a choice that was very likely to be safe (though somewhat less likely to be safe than going unmedicated), and also provided her with a positive birth experience.

    Aren’t homebirthers, unmedicated hospital birthers, and elective c-section mothers trying to do the same? I don’t think any large portion of pregnant women are so lost in some hippy-dippy desire to have a lovely birth experience that they choose something they think is unsafe. They choose a balance between safety and their own personal wishes, just as Grrl did. And more power to her and all the others!

    I think it’s best to look more closely at the example you provided and realize that Grrl prioritized her birth experience as much as the women that you characterize as caring more about the experience than the baby’s safety.

    • You’re right. A woman who chooses a route that ‘might’ possibly lead to some fetal distress in a statistically unmeasurable number of cases is performing the exact same balancing act as a woman who chooses a route that triples the odds of fetal death. But you’re also wrong, because when you’re balancing things against each other, how you balance those things is the measure of how much you care about each.

  13. I wouldn’t so easily refer to the chances of an epidural leading to fetal distress as “statistically unmeasurable”.

    Unfortunately I don’t have numbers about the true incidence of epidural-caused complications because so much of the information I see on this is biased toward the hardline anti- or pro-epidural camps, each one insisting that epidurals are either horribly dangerous or completely safe (neither of which is true).

    It’d be nice to see some good, solid studies that show what the real incidence and severity of complications is. One difficulty in obtaining such studies, of course, is that it would be extremely difficult to randomly assign women to a group that would receive or not receive an epidural (for the woman who feels that she needs it, withholding the epidural would be cruel and very likely traumatic for her). If you don’t randomly assign women to groups, it’s hard to tease out the issues that cause women to choose or not choose them, and how those other factors affect possible complications.

    As far as the argument I made before, I should clarify: of course homebirths and elective c-sections are measurably and clearly more dangerous than epidurals.

    What I mean to indicate is that the mothers who choose those options generally feel that those methods are very likely to lead to a healthy baby as well as a safe and positive birth experience. They make their choices based on what they “know” is safer and healthier for their babies. Of course at times their perceptions are based on faulty or non-existent science, but these mothers do not know that.

    I have trouble believing the idea that very many (if any) of these women are putting an unfair amount of weight on their own experience vs. the baby’s safety – simply because the propaganda they’ve taken in convinces them they’re doing the best for both the baby and themself.

    As for what is safest: when giving birth in a hospital, the safety net to deal with most complications is there. Questions of safety then come down to the seemingly trivial question of whether an epidural is worth the risk. Some women don’t think an epidural is worth the risk, and I sincerely doubt that those women are getting all woo-woo on us.

    • It’s a good point that it is difficult to assign motive to anyone that you don’t know personally. I guess I’m really looking at the literature and the comments and drawing the (possibly unjustified) conclusion that a significant number of women are basing their decision to home birth on subjective measures having more to do with their self-image than with health and safety. I could be wrong.

      What I will say is that I’m still glad that the Grrl is so level headed when it comes to health care decisions, and has a better than average understanding of how to evaluate claims. Our OB basically said that an epidural was a personal choice, that the science was neutral.

  14. I have seen some of the literature and films that promote home birth, and some of that stuff really hard-sells the idea that hospital birth is dangerous and traumatic, while home birth is safe and empowering.

    The Business of Being Born is a great example of this type of media. That film actually makes a few good points, but really strongly advocates for home birth when I think it should be advocating for an increase in evidence-based obstetric care, as opposed to the traditions that some hospitals follow without regard to whether those practices are proven safer for mothers and babies.

    Our midwife (a certified nurse midwife in the hospital) said that she’s comfortable with her patients having epidurals because the risk of complications is low, and because if you feel that you need it, then the pain is severe and it’s not right to force you to suffer in order to avoid a small risk. On the other hand, she said that there is no such thing as a “perfectly safe” epidural, and that she’d be remiss to give us the idea that there was no risk involved in the procedure. She laid out the possible complications and gave us her best assessment of risk, while explaining that solid evidence this subject is hard to come by.

    When I went into labor with our first child, we had two basic assumptions: 1) I probably wouldn’t need an epidural as long as we prepared ourselves thoroughly and I was given the support I needed to manage the pain, and 2) We wouldn’t hesitate to ask for one if I felt I needed it. We didn’t opt for a home birth because though we’d seen plenty of the pro-home birth arguments, we didn’t find them convincing.

    I did have one mother at a playgroup a few months later ask me with all sincerity if I had felt safe in the hospital. I answered that I chose the hospital for safety reasons. She had trouble fathoming why I could possibly think hospitals were safe, after the books she’d read and films she’d seen (she knew I’d seen and read some of the same stuff).

    We had a very interesting discussion, and after hearing about how my hospital birth went she said that she might even consider going to the hospital I went to for her next child – for surely that must be a very unique and progressive hospital, unlike all the others that only wish to make money by forcing unnecessary inductions, c-sections, etc. and endangering babies and mothers.


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