Saturday, September 8, 2007

Confessions of a homebirth supporter

As an avid supporter of homebirth, I rarely speak of it in negative terms. I fear that I am adding to the already powerful cult of misinformation that portrays hospital birth as a life-saving, absolutely necessary occurance in our every day lives. And yet I have a dirty little secret: my homebirth sucked. Not all of it. But much of it.

I had my first child in the hospital 8 years ago. There were some things that I didn't like about the birth: my daughter's cord was cut quickly, and I had a managed 3rd stage. She was taken to the cart to be suctioned and dried off, and I never got to hold her all slimey and wet against my skin. My doctor had broken my water at 8 cm, telling me it might shorten my labour. My nurse kept offering me gas. She also coached me into pushing when I really had no urge whatsoever. At the time, though, these were minor occurances, and I honestly didn't really know anything about active vs. expectant management of 3rd stage, or that I could have waited to push. But my first birth left me feeling powerful and strong. No continuous fetal monitoring, no episiotomy, no drugs. I had waited to go to the hospital, labouring at home overnight and arriving at my doctor's office to find that I was 7 cm dilated and he would follow me to the hospital. I had discussed my wishes, and I trusted that my GP would honour them. He listened, took me seriously, and consistently devoted 30 or more minutes of his time to me at each prenatal appointment. To this day I think that if I saw him in the street I would want to go up and hug him!

For my second birth, I chose to be assisted by a midwife. Things were rocky with my then husband, and we spent the duration of my pregnancy fighting over where the birth would take place. By this time, my GP was no longer practicing family medicine; he had taken a position in our local emergency department. Choosing hospital birth would mean going to several obstetricians, having 10 minute prenatal appointments, and having no idea which doctor would be present for my baby's birth. I had by this time decided that I would practice as a midwife at some time in the future. Despite the fighting, despite the naysayers, I wanted my homebirth, unless something serious came up that I felt warranted intervention.

And so I discussed my opinions, my beliefs, my wishes for my birth with my midwife, who was also a friend of mine. We had met shortly before I became pregnant, united by our wishes for universal midwifery care for women in New Brunswick. In theory we agreed that vaginal exams are rarely necessary, that induction of labour is risky and that the risk of going postdates is often not valid, that cervical "lips" may just be an "old doctor's tale" (as opposed to "an old wives' tale"). We talked and ranted and seemed to agree on all points.

Then my due date came. And went. I was getting anxious, and, thinking I was in labour, called in my birth team, who were driving from 2 hours away....and....contractions stopped. I feared going into labour and having a baby without them around, because I knew I would be promptly encouraged to get in the car and taken to the hospital. I daydreamed about going into labour and having my baby all on my own, and surprising my husband when he got home from work. I fretted and waited, then, thinking all was good to go, called my birth team in again late on a Sunday evening in June. Contractions stopped, and we called a meeting at 2 am, after a walk through the darkened neighbourhood had failed to encourage stronger contractions. I was informed that if I didn't have my baby within the next two days, my midwifery care would be terminated and I would be advised to transfer to obstetric care as I would then be at 42 weeks gestation. I could feel my options slipping through my fingers, and, as I always do when faced with a stressful situation, I became ultra calm.

I agreed to be induced at home. Castor oil and orange juice and baking soda, chugged along with a prayer "Please God let this work". An hour later, an enema gets labour on the fast track. I have pictures of me at 5 and 6 am, sitting through active labour contractions in my grey nightgown, my Siamese cat coming for a cuddle and helping me through another contraction. My house is full of people: a midwife, a friend, a journalist from the local paper, my husband. And I wish that I was alone, in a dark, safe space as the sun comes up and takes away the last feelings of intimacy that I had so looked forward to for my homebirth.

I decide to get into the whirl pool tub. I don't realize it, but I am working through transition, having contractions that I can only deal with one at a time as I descend into a black hole of emptiness. The tub is in a secluded corner, giving me some sense of privacy. My husband presses his forehead to mine, we are both crying quietly, and he is whispering words of encouragement.

Then it happens....I think I need to use the bathroom. All my studying, all my knowledge of birth and I don't recognize this urge to push. It is a huge struggle to get out of the tub, and then I am sitting on the toilet, shivering and bellowing, the pain is killing me as the pressure increases and all I can do is push through it. The atmosphere in the room changes. I am disoriented as I am led to the edge of my bed for a vaginal exam. WHAT?!? WHY DO I NEED THIS? I hear that I have a bit of a lip, and that I need to be kept from pushing. I can't talk, but I am thinking, "FUCK YOU I NEED TO PUSH" and proceed to anyway. The doppler is applied to my stomach, and I can hear it, my baby's heartbeat, marching along at 150 beats a minute. I don't need to see the little screen or use a watch, my music training over the years lets me know the speed instinctively, a little march plays in my head. Then another contraction hits....and the heartrate goes to 30. Something is wrong.

The contraction is done, heartrate jumps right back up to 150, and internally, I am sighing a huge sigh of relief. I am thinking, "My baby will be ok, but he needs to be born NOW!!!" Instead, I am shoved on my side, an oxygen mask put on my face, presumeably to see if that will help my baby's heartrate. I stay there for 3 contractions, feeling like I will die from the pain that this position is causing me. My midwife is holding her hands to her head, saying, "What the fuck am I going to do?" and my husband sends the journalist to call 9-1-1. Crazy words ensue, with the journalist relaying questions from the dispatch center.

Somehow in the middle of all this I have pulled the mask off my face, and I think I have said, in no uncertain terms, that I want OFF the bed. I am standing, pushing...and as three ambulance attendants walk into my bedroom, my son's head is out. Another look of panic, and I am on my back in the bed with my knees to my chest. My midwife's hands are inside me, on either side of my son, maneuvering him out of me. And he is on my stomach, warm towels are on top of us, he is pink and gorgeous and there is a collective sigh of relief. We are healthy, and safe. A knot in his cord is deemed to be the cause of the low heartrate. The youngest ambulance attendant, a trainee, informs us that the time of birth was 9:12 am. I sign some papers to send the ambulance back out to help truly sick people, and the cleanup starts around me.

Today, my son is 4, happy and healthy. I wonder if I had this birth experience so that I could better understand the atmosphere of fear surrounding birth. I used to scoff at women's birth stories that said, "I had no choice...they just did it to me." And now I understand that feeling of powerlessness, when you feel your choices are nonexistent, when your body is working so hard that there is no energy left to formulate arguments.

My son's birth did NOT have to happen the way it did. The induction aside, if I had been able to push the way I wanted to, as soon as I wanted to, I would have felt better about it. If cooler heads had prevailed, then his decelerating heartbeat would have been seen as a possible problem, but the room needed to be filled with support to get him out of me, and a midwife working through in her head what she might need to do to resuscitate a baby if it came down to it, all things she was trained to do. Fear needed to be pushed aside for a moment in order to give us the best care possible.

Two weeks later, my midwife cut off all correspondence. Calls went unanswered, emails weren't returned. It would be over a year until I spoke with her again. We have never processed this birth, and so I am left to wonder about how it affected her, and her perception of birth, and her perception of herself as a midwife. I feel like she abandoned me at a very difficult time in my life, and I can still think back to the emptiness and pain I was feeling, trying to deal with a newborn, a four year old, and a difficult marriage.

I am ready for the barrage of emails I will get about this post. Homebirth supporters, either in sympathy or outrage or just simply defending homebirth and citing my experience as an exception. Hospital birth supporters, chastising me for taking the "risks" that I did, or defending my midwife (a US-trained CPM). This story is an incredibly difficult one to tell, but I have been silent too long. Today I was telling my story to a midwife in California, and realized that I don't want to keep it hidden any more.

I trust birth, totally. I feel that sometimes we need interventions for the safety of both mother and baby, but we need to remove fear from the equation. Until that happens, interventions will be used and abused, women will be left feeling disenchanted and assaulted, and true, loving birth won't happen. We need love to give us courage, and to clarify our decision making. And I join the ranks of women who admit their need for healing and closure, and face mothers with more compassion and understanding than I had just 4 short years ago.

Wednesday, September 5, 2007

...on a journey of love

I started my day today trying to write an article about the safety of homebirth. I have argued and debated the safety of homebirth for so many years now that I was shocked and frustrated when it wouldn’t pour off my fingers and onto the page. I panicked, then went searching for statistics. Surely that would get my juices flowing! But the sentences that were staring back at me were flat and uninteresting. They were cold and clinical.

And so I saved the article for future salvage work, wondering if the world really needs yet another article on the safety of homebirth. Until homebirth is universal, and the normal way of giving birth, the world probably does. But today I am bone weary of the fight: for credibility, for women to take back their power, for people to support women’s birth choices, for birth to be seen as a normal, albeit special, physiological event.

After a cup of tea and a walk around the house, I realized there is a reason that my words this morning came across as cold and clinical. I realized that I could argue until I am blue in the face that women are designed, perfectly, to give birth to their babies. I can scream from the mountaintops that it is the very interference that regular care of birth encourages that causes the myriad of birth problems. But that is not why I am called to serve women in this capacity, and focusing on physiology or statistics doesn’t express the essence of birth as I experience it.

I am called to serve women, and the birth process, in a dance as old as time. Birth is magical. At home, you are in a calm, safe place, an oasis away from the linear, tangible world. As you watch a woman sway to the rhythms her body is directing, a serene energy permeates the air. It is wondrous to watch a baby born into peace, caught by his mother or quietly passed up to her, witnessing the first time they gaze into each other’s eyes. Love flows as strongly as the tears of joy and relief.

There are no needles, no tubes, no hospital gowns, no metal bed, no smell of disinfectant. You are home, your cozy bed ready to envelop you safely as you bask in the glow of your birth. Yummy food is in the fridge, and you have with you those people most special to you, those privileged few who you choose to witness the event. No offers of drugs, no one implying that your body doesn’t work. In its place, there is gentle touch, some birth tea, snacks, your favourite music, freedom to move, candle light, faith and love.

There are many days that I question my calling. I throw up my hands and say to the heavens, “THEY AREN’T GETTING IT! THEY DON’T WANT IT!” And then the phone rings, a breathless woman on the other end of the line searching for alternatives, a little nervous that I will patronize her or laugh at her foolish desire to have her baby at home. My heart sings, a smile breaks, and we start the first steps on a journey of love.