birth research and resources

Planning a home birth

When we were talking about birth last week, Anjali pointed out that information on home birth just wasn’t readily available eight to ten years ago, the way it is now. She’s right, absolutely—and that got me thinking about what led me toward home birth in the first place.

I think it was a combination of circumstances and personality.

I’m a research-happy kind of person. Before making decisions, I have a pathological need to read up on all possible choices first, and talk at length (mostly to my long-suffering husband) about what I’ve learned, and then decide which of my options I think is best. I’m a little nutty that way.

I started out reading books like A Good Birth, A Safe Birth (no longer in print). But I was also just out of college when Abigail was born. My degree had required classes in advanced statistics and research methods and experimental design—so fun! and I’m not even joking!—and I still had access to medical journals through the university’s library system. And I think I mentioned, I love me some research.

I probably didn’t need to look that hard to find information on best practices in maternity care, and certainly no one needs to do that anymore. But once I knew what to ask about, it wasn’t difficult to find out which practitioners and which birth locations followed evidence-based best practices, and also which were able to accommodate the practices that were most important to me.

If I were researching today, I might start with some of these sources:

– Henci Goer’s articles and books. The Thinking Woman’s Guide to a Better Birth is aimed at pregnant women, and Obstetric Myths versus Research Realities is aimed at medical professionals.

– Jennifer Block’s articles and book, Pushed.

– Marsden Wagner’s book, Born in the U.S.A.

– Adrienne Lieberman’s Easing Labor Pain, an overview of all sorts of pain management options.

– Sheila Kitzinger’s Complete Book of Pregnancy and Childbirth, for information on healthy pregnancy and childbirth in any setting.

If I wanted to learn more about out-of-hospital birth choices, I might read these:

– Citizens for Midwifery’s resources page. There are links to news, studies, opinion, and explanation.

– Ina May Gaskin’s Spiritual Midwifery, a classic collection of home birth stories.

Ina May’s Guide to Childbirth, which is all about natural childbirth.

Mothering Magazine, in print or online, which regularly includes out-of-hospital birth stories and articles on natural childbirth.

If I wanted to know more about the midwifery model of care (as opposed to the medical model of care), I would look into these:

North American Registry of Midwives. NARM licenses Certified Professional Midwives. CPMs are direct-entry midwives (midwives who are not also nurses).

– In the U.S., the American College of Nurse-Midwives. CNMs are first trained as nurses, and then receive additional training as midwives. They might attend births in hospitals, freestanding birth centers, or homes.

Midwives Alliance of North America. MANA is an advocacy organization for all types of midwives.

Citizens for Midwifery is a consumer group that advocates for midwifery and midwives in the U.S.

The Big Push for Midwives campaigns for the regulation and licensure of Certified Professional Midwives in all 50 U.S. states.

Heart and Hands: a midwife’s guide to pregnancy & birth, an accessible midwifery textbook that you can probably find at your library.

I would also interview the health care providers I was considering hiring. (I did this when I was pregnant with Abigail. Midwives expected it, and scheduled in-person consultations. Doctors and hospitals, I mostly interviewed over the phone, and sometimes I spoke to an office’s “medical assistant” rather than to the obstetrician.)

I had a long list of questions—among other things, I wanted to know how often they dealt with various complications, how regularly they performed various interventions, and, for out-of-hospital practitioners, how often they transferred care and under what circumstances. Their answers, as well as how comfortable they were being questioned, gave me enough specific information to choose the best health care provider for me. Presumably another woman, interviewing the same practitioners, could come to another conclusion based on what was important to her. And that, I think, is as it should be.

I know that not all options are available to every woman. In the real world, we’re constrained by money (which locations and health care providers will your health care plan pay for, if you have one? can you afford to pay out of pocket for other options?), by location and transportation (can you get to the birth location of your choice? can a health care provider get to you?), and by state and local politics (are midwives legal in your area? if so, are there any? and if they practice out-of-hospital, do they have good working relationships with local obstetricians, allowing for supportive transfer to a hospital in case of complication?). But for women who do have options, I hope resources like these are helpful.

What have I missed? What resources helped you decide where and how to give birth? Are there books and websites available now that you wish you’d had access to years ago?

For more about birth and midwives, check out the birth resources page.

four by four

Audrey turns four today.

She was born just after midnight, a week past her due date. There are so many things I could tell you about that birth—how I didn’t know I was in labor and didn’t believe it when my midwife said I was; what happened when Abigail and Owen woke up for the birth; how Audrey seemed to know all of us, not just me, right from the moment she was born; or… well, there are a lot of good parts to that story, and this is a short blog post, so we’ll save it for another time.

Audrey has big plans for being four. She’s been counting down the days, and talks about all the things she Will Do when she’s four, and all the other things that she Won’t Do Anymore when she’s four. I remember that Abigail fervently believed, when she was three, that four was the age of being allowed to chew gum. No one’s suggested that to Audrey yet, though. Audrey’s list remains entirely her own.

When I was pregnant with her, I was worried that my labor would go so quickly that the baby would arrive before our midwife did. (When Owen was born, I was in labor for all of ninety minutes.) That didn’t happen, not at all, but Audrey had plenty of other surprises in store for us. I’m sure she still does. Let’s see what four brings, shall we?

Happy birthday, girl of mine. May four be everything you imagine, and then some.

home birth stories

Find more of my home birth stories (the very brief versions!) here.

For more on midwifery and birth, check out the birth resources page.

birth philosophy

Planning a home birth

The thing about making unusual choices is, people like to question those choices. Often in a tone best described as mildly accusatory. You know what I’m talking about. You’re doing what? Why would you do that?

So I’m sort of thrilled that home birth is more mainstream now than it was ten years ago, when we were expecting Abigail.

Back then, I fielded all kinds of interesting comments on the topic. More than once, other women told me I was sure to run to the hospital once I went into labor. “You’ll change your mind, you’ll see,” they would say. “Or else we won’t need you to tell us when your baby’s born, we’ll have heard you screaming from here!”

Um. Okay then.

That didn’t happen, obviously. The changing my mind thing, or the screaming thing. And now, having given birth at home once or twice (or four times), I can’t imagine choosing anything else under normal circumstances.

If you were to ask, I would tell you all the things I love about home birth, and about all our different births. I’d tell you how my opting for home over hospital isn’t about avoiding something so much as it’s about preferring something else. I’d tell you about how my experience is normal. Not universal, but normal. Not a fluke. Not just a lucky break. I would talk and talk and talk and talk, if you asked. (If you didn’t ask, I’d mostly leave you alone.) But I don’t really think of myself as a home birth zealot.

Here’s the deal. It’s fine with me if you don’t want to have a home birth. My goal isn’t to convince other people to do what I do. In fact, I think the issue of where and how to give birth is one of reproductive freedom, and thus I’m not interested in telling anyone else what to do.

But what I am in favor is this: I am in favor of all pregnant and birthing women being treated ethically, in any setting. I am in favor of women having access to accurate and complete information. I am in favor of women having the opportunity to use that information to make choices about their care. I am in favor of mothers being valued and respected as autonomous individuals, capable of making good decisions about their bodies and their babies. I am opposed to fear tactics, and to coercion, in any setting, with any care provider.

That all seems pretty reasonable to me. Not even terribly unusual. At least I hope not.

For more about birth and midwives, check out the birth resources page.

in charge

I was washing the dishes at the kitchen sink. Sadie, who is almost two, pushed a kitchen chair up to the stovetop directly behind me, climbed onto it, and began twisting the dials to turn on the burners. She did all this in maybe twenty seconds. Luckily I was right there. Luckily I grabbed her, soapy hands and all, and set her unharmed on the floor. Not one of my older kids has ever tried to mess with the stove. Not one. Not ever. The dials are up high, far out of reach, and mostly out of sight, I thought. Sometimes I think that even if we had twenty kids, every one of them would come up with some new thing to get into, some new way to surprise us. (Um, not that we’re going to have twenty kids. Just to be clear.)

A good friend had a baby this week, had a lovely, normal birth that turned complicated and could have ended very, very badly. The baby is fine—strong and beautiful, I’ve seen her myself—and her mama is recovering quickly. But still, this wasn’t what we expected.

Some days I’m reminded how little we control, even when we spend our days pretending at being in charge, with our childproofed homes and our safe neighborhoods and our reasonable expectations. There is so little, so very little we can really claim to have a handle on. I can accept that for myself, but the thing is: even if I can’t control anything, I’m still responsible for these little people who need me to be in charge of a thing or two.

Or maybe they don’t need that, maybe I just want to give that to them. An orderly world, where if we follow the rules, do the things we’re supposed to do, we’ll all be safe. We like to think we live in a world like that. Most often it works that way. But sometimes not. And there’s not much I can do about that.

Those stove dials, though, they can be removed. I’m keeping them in a locked drawer for now.

happy day

Owen was born six years ago today.

I woke up that day when my water broke, six a.m. the day before he was due. My midwife’s apprentice walked through our front door forty-five minutes later, about the same time we realized my midwife wasn’t going to arrive before the baby did. Also about the time we realized I wasn’t going to be moving, not to the bed, not to the bedroom, not anywhere, not at all. That baby was going to be born where I was at that moment, which happened to be on the floor in the living room. Abigail, almost three years old, woke up just in time to sit in Dane’s lap by my side.

We had several telephones in the room—our house phone, the cell phone and pager of the midwife’s apprentice—and they all kept ringing, our midwife and backup midwife both calling for news, both unanswered while Owen slipped into the world, purple and squalling, healthy and whole.

Reggae music played, drifting in the window from a neighbor’s house. It was 7:33 in the morning. Owen breathed immediately, nursed easily, slept often and with gusto, surprising us on all counts.

When her hands were free again, the midwife’s apprentice answered her phone. “We have a baby!” she said. “It’s a boy.” She held the phone out so we could hear our midwife cheering on the other end. We all laughed, startling Owen. He forgave us.

Every day since has been an adventure. I couldn’t begin to guess what will come next, but I wouldn’t miss it, not for anything.

We love you mr. six, every day and always. Happy birthday.

home birth stories

Find more of my home birth stories (the very brief versions!) here.

For more on midwifery and birth, check out the birth resources page.