Thursday, February 16, 2012

Birth Choices

I have debated with myself about whether I should post this now, or wait until after the baby is born and I have a known outcome...But what the heck, I am posting now.

It is not a secret that Joshua's birth was a planned home birth.  The topic of home birth tends to be a very controversial one.  For most people, you either love the idea or you hate it.  Some people are able to be supportive of others who are planning a home birth, even when they themselves have no desire to have one...  and other people are extremely vocal about what a bad idea it is.  It is not unlike other parenting debates.... breast vs bottle...  cry it out vs not crying it out....  They are hugely emotional topics and the truth is, there is never going to be a winner with these sorts of things..

Joshua's story is one that could easily be taken by those who are against home birth and turned into an example of why you shouldn't try and have a home birth.  Fortunately, I have never been on the receiving end of such judgement, but I have experienced it in more subtle ways.  For example, questions like "Do you regret not being at the hospital from the beginning?".  It is not an unreasonable question, nor is it outright accusatory, but it does carry the suggestion that maybe things would be different, had I planned a hospital birth.  That is honestly something that I will never know.  And I am ok with that.  But I honestly do not believe it to be the case.  Firstly, being in a hospital does not prevent this kind of thing from happening.  The vast majority of HIE babies are born in hospitals.  Some situations are simply unavoidable...  Everybody did everything right and the baby was still compromised.  Many cases can be clearly linked to medical negligence.  Being in a hospital doesn't eliminate human error.
I was quite amused recently, looking at the blog of a Obstetrician who is very ANTI home birth and was tipped off to the birth story of a woman who frequents one of the same forums as I do.  She put her birth story out on a public forum, and this Dr took it and pulled it apart on her blog.  It was titled "You risked your Baby's brain function for this?".  Sadly, this woman's midwife made some very questionable decisions, but eventually a hospital transfer was made and Baby was born in the hospital.  Very traumatic experience for the Mother, but thankfully the baby is ok.  I got to browsing this blog after being made aware of it due to this unfortunate incident, and this is where the amusement comes in.  This very Doctor, who wants to bash women who plan home births (She has another separate blog just for home birth horror stories by the way) has many entries on her blog about the kinds of negligence that takes place in hospitals...  It seemed very unusual to me for someone who is so pro-Hospital, to also be highlighting the sometimes very serious mistakes that take place in a hospital.  Her blog certainly did nothing for me in terms of making the hospital sound like a safer choice!

Home birth can be a hard choice to understand when you don't feel the same way, and I have been asked a few times WHY I want a home birth so much.  This article helps to explain a few things:
Home Birth Mothers still love their Babies

But I will try and explain it in my own words as well.  Despite what happened with Joshua, I still believe all of the things that I believed  about birth before having him.  I still want a natural birth, I still want to avoid common and unnecessary interventions, and I still think I will be happier in an environment that I am comfortable in.  I have seen several of the rooms in the Delivery Suite at the hospital...  Joshua was ultimately born in one, and I still cannot imagine how a woman spends hours in one of those rooms.  I literally turned up and got the baby out....  But having to labour there?
I spent the first part of my labour kneeling on my bedroom floor with my lap top on my bed and chatting with friends on Facebook.  When that got too uncomfortable, I had a few baths, I wandered around the house, used my gym ball, used my heat packs....  Eventually got into my birth pool.  I was comfortable, I had privacy...  my own husband didn't even know I was in labour until several hours had passed...  because I was content just doing my own thing.  And I can't see myself being content in a hospital environment..
That might sound selfish, and I guess it is a bit, because primarily I am thinking about what is going to make a painful experience LESS painful to me.  And to me the answer to that is being at home.  Some people want access to pain relief so a hospital is the clear choice for them...  For me, I don't want it...  I am WAY more scared of having a needle in my spine than I am of the actual pain....   so its important to me that I can be in an environment where I can deal with things the way I feel like it and not be bothered or subjected to hospital policies.
Statistically, a LOW RISK woman having a baby at home, is just as safe, if not safer, than if she was in a hospital.  Of course, the hospital has its place and it would be a very bad idea for ALL women to have their babies at home, because there are times when there is a genuine need for intervention.  Some of these situations are predictable, and women with certain conditions that are either pre-existing or come up during pregnancy would never be eligible to birth at home.  Other times, the need for intervention is not predictable, such as with Joshua, where a problem presents itself during labour and then needs to be acted on.  I am still not happy that I had to go there, but I AM grateful for the hospital and the fact it was there when we needed it.  I just don't want to go there if I don't need it!

So this brings me to planning the birth of our second baby.  The official explanation that I got from the hospital after Joshua was born, was that they didn't know what happened.  That "sometimes these things just happen".  That was not an overly reassuring explanation when thinking about a second baby.  How can you try to avoid a repeat of the situation when you don't know what the situation was?  At first, I thought that I didn't care what the explanation was.  That whatever happened, happened and that we can't change it now so there was no point worrying about it.  But in getting closer to thinking about a second baby, I realised that I needed to know more.  There was never any doubt in my mind after having Joshua, that I wanted my next baby to be born at home.  That I wanted the chance to have the birth that I wanted, but missed out on with Joshua.  But I also needed to know more about what happened to Joshua so that I could be comfortable in making that choice.  I will be the first person to tell you, that I don't wish to do all this again.  That a healthy baby ultimately IS more important than the birth experience.  But, to me, the birth experience is still very, very important.  Not important enough to put a baby at risk, but important enough that I will do everything I can to try and have the experience I want when there is no evidence to suggest that such a choice would be unwise.  So I set out on my quest for information.  I obtained all of our medical records and sent them to a Dr in the US that specialises in HIE.  I blogged about the outcome of that here.  Not long before I had my discussion with this Doctor, I found out that I was pregnant again.  A few months before we were officially planning to try again, and it was hugely stressful for me.  All of a sudden, I was really worried about the outcome for this baby and for the first time, had doubts about my plans to try again for another home birth.  I still didn't want to go to the hospital...  but I wasn't sure if I wanted to be at home either.  Instead of feeling excited, I felt really, really anxious.  Thankfully, I was 4 weeks pregnant when I had my phone call with that Doctor.  I literally felt like a weight had been lifted off my shoulders when he told me that he did not believe me to be at any greater risk than any other woman.  I felt confident again that it was ok to plan a home birth, that this was a choice that I could make safely.  Notice how I use the words "No greater risk than any other woman".  That is because there is always a risk.  ALWAYS.  No matter where you decide to birth your baby, the outcome is not guaranteed.  There is always a risk.  The reality of the situation is though, that the risk of a significant problem is small, and I am happy in knowing that the odds are in my favour that everything will go ok.  Depending on the source, the incidence of HIE is quoted at being anywhere between 1 in 500 to 1 in 1000 births.  If my maths is correct, that is a 0.1 - 0.2% chance of having this happen to your baby.  In other words, you have at least a 99.8% chance of NOT having a baby with HIE.  Joshua quite literally beat the odds to end up in this category.

Understandably, having had a child "beat the odds" like that, many women feel worried about going on to have another baby.  That small risk feels very, very scary the second time around and the majority of women feel safest in making choices very different to mine.  They WANT to be in a hospital.  They WANT extra monitoring.  They WANT an elective C-section.  (Many HIE cases, including Joshua's, are caused by an injury during labour...  so many women wish to avoid labour completely)  I don't judge anybody for feeling that way.  When you have been through a traumatic birth experience, you really need to do whatever feels safest to you, whatever option is going to be the best one for your mental health is the right option.  I just happen to be the opposite to most women in my situation... and feel that the right choice for me is going on to have a "normal" birth.  If you are interested in reading a contrasting opinion to mine, you can check out Claire's recent blog post here, outlining her own choices for birth after HIE.  Completely opposite to mine, and yet, still the right choice for her.

Although many birth choice advocates will tell women that they have the right to choose where they want to give birth, and that NOBODY else can tell them what to do, that is not actually the reality that I have experienced.  (Unless of course, you are planning to give birth at home unassisted..  then you can do what you like!)  Our local home birth service is quite careful in who they accept as clients.  Remember, I said that home birth is only for LOW RISK women.  Midwives in Australia also have guidelines that they need to follow in terms of when they need to seek consultation with a doctor or refer their patients for other care.   This can be related to pre-existing health conditions, previous obstetric history, complications that arise during pregnancy, or complications that arise after birth with either the mother or the baby.  Contrary to what many people think, having a home birth is not just about staying home and "winging it" and hoping for the best.  It is a legitimate mode of care, where precautions are taken when choosing who is eligible to birth at home, and precautions are taken in ensuring the safety of both mother and baby.  Home birth midwives do all of the same things you would expect a Doctor to do during prenatal check ups...  And they come to births equipped to handle a range of outcomes.  Certainly, there is a limit to what they can do in the home environment but they come prepared to deal with many of the common complications that can arise.  Many people don't realise that, and have visions of me giving birth under a tree in my back yard with a hairy legged hippy as my midwife, maybe swaying around a bon fire while I am in labour singing Kumbaya.  It really isn't like that.  (well, unless you want it to be...  but even then, your hairy legged hippy midwife would still have all of the necessary precautions in place!)
So, coming back to what I said about the Midwifery Guidelines.  It wasn't as simple as me just saying that I wanted to try again for a home birth.  The whole situation with Joshua meant that technically, I needed to consult with a Doctor to get clearance to try again for a home birth this time.  My midwife for this pregnancy is the same midwife that I had with Joshua.  And she doesn't want a repeat of that situation any more than I do.  (Yes, its true.  "Crazy" home birth midwives care about the outcomes from their client's births and don't want women to stay home if it is going to put themselves or their baby at risk!)
So, I had to set out on the task of getting "Clearance" for a home birth.
My first point of call was a GP.  Perhaps not unsurprisingly, she was not comfortable in making such a decision and as a result, consulted with an obstetrician at the hospital.  It probably doesn't come as a surprise to know that many Doctors are not Pro-Home Birth.  The GP however told me that this particular obstetrician was not AGAINST home birth and was happy for me and my midwife to come in and discuss my situation with her further.  She told the GP that the "safest" option would be to have a c-section or a hospital birth with continuous monitoring...  but that maybe I might consider choosing the hospital attached birth centre instead, because at least then I would be closer to the hospital.  The GP told me that their discomfort came from the fact that they couldn't be sure that Joshua's problems were not caused by something that happened during the pregnancy rather than a problem during labour.  As far as I am concerned, ALL of the evidence points to the fact that this was a birth injury, so I prepared myself for having to go in and argue that point with the Obstetrician, to "prove" to her that I was not at any greater risk than any other woman.

Prior to seeing the Obstetrician, we had a routine appointment with Joshua's Doctor a few weeks ago (who has been his Doctor since birth), and I decided to take the opportunity to ask him for his opinion.  I posed the question "How concerned do you think we need to be about this happening to another baby?"  And his response to me was "You would have to be VERY unlucky. The risk of having some major wrong with your baby when you take into consideration ALL of the possibilities, is about 3% and I don't think your risk is any greater than that".  Then I told him we were expecting another baby.  He asked me who my Obstetrician was, and I told him that I was currently with the Home Birth Service again, but that we were having an appointment with this Obstetrician to discuss everything.  His response to that was "Well, talk to her for your own peace of mind but I certainly do not think that you are at any greater risk of a problem than any other mother having a baby".  Of course, I already knew this, but it was great to hear it from him too.  And he seemed so sure that the obstetrician's opinion would not be any different to his.  He was also completely unphased by my mention of the words "Home Birth" (which I admit I was scared to mention because I really didn't know how he'd respond)  He said to me "Joshua was born here wasn't he, because you transferred in?" And I said "Yes" and he said "Well, I am sure you will be careful".  No lectures about home birth, just the impression that he had every confidence that we'd act appropriately under any circumstances that might arise.

I was pleased, because now I had two Doctors who had told me that I was not at any higher risk than any other woman.  The Doctor in the US, and now a Doctor within the same hospital.  He made me feel like maybe the Obstetrician appointment wouldn't be that big of a deal.  Because after all, the GP told me that this Obstetrician was not against home birth, and Joshua's Doctor seemed confident that she would share his opinion.  My midwife on the other hand, did not seem to think it was going to be that easy.

We had that appointment yesterday.  And it definitely was not what I was expecting, for two reasons.  The first is that I really thought that the obstetrician was not opposed to home birth.  Well guess what, she WAS.  And secondly, I was expecting to have to argue my case in regards to when Joshua's injury occurred and the fact that the evidence all pointed to the fact that I was at no greater risk than anybody else.  And...  I DIDN'T.

The obstetrician was quite forth coming in saying that she didn't believe I was at any greater risk of a problem.  In contrast to what the GP said, she actually said that she saw no reason to recommend a c-section or even continuous monitoring.  She said there was nothing about my labour with Joshua that would make her think I was likely to have a problem this time.  I went into labour spontaneously at full term, with a good size baby, everything really progressed quite nicely with my labour, with the exception of Joshua and his heart decelerations which led us to transfer to hospital.  And even though his delivery was vacuum assisted, she described it as being easy and straight forward for a vacuum delivery.  She said she saw nothing that concerned her, in terms of a likely problem for this upcoming birth.  Sounds great doesn't it?  Well yeah, that part is great.  The really, super frustrating part, was the fact that she was absolutely 100% opposed to home birth.  And essentially, this meeting for her was basically so that she could attempt to persuade me into making a different choice.  Her main (and pretty much only) argument was that if something goes wrong, it takes longer to access interventions.  I don't deny that as being true.  I readily acknowledge that in some emergency situations, being away from the hospital could make a difference in the outcome.  BUT, I also feel that the chance of things coming to that are really very small and it is a chance that I am comfortable in taking.  I could get into a car accident and die, or be left severely disabled.  That could really happen.  But I still drive my car.  The benefits outweigh the risk.  And I don't feel any differently about home birth.  I acknowledge that there is a risk there, but for me, the benefits outweigh the risk.  And the odds are firmly in my favour that nothing will go wrong.  But despite essentially agreeing with that, we still had to listen to this obstetrician repeat over and over again how much she doesn't like home birth.  She also freely admitted that everything she was saying about home birth had nothing to do with my personal situation, that it was simply her opinion and what she would tell any woman contemplating a home birth, "because I need to know that".  She was also essentially asking if there was anything they could do for me "to make me change my mind".  She wanted to know what was wrong with the birth centre, why didn't I just want to go there?  Well really, there is nothing wrong with the birth centre.  I believe that I could have the kind of birth that I want in the birth centre.  Its just not my first choice.  It's my second choice.  And my very. very distant third choice, is the hospital.  I would quite seriously rank an unassisted home birth as a preferred option before choosing the hospital. And I actually really wouldn't want to do that.  I WANT the midwives there monitoring the baby.  I have my own doppler, but there is no way that I could adequately monitor myself during labour.  And it was their monitoring that alerted us to a problem with Joshua and led us to go to the hospital.  Honestly, if I was on my own, I would have had no clue there was a problem with him.  Some women have this kind of intuition, where they "just know" that something is not right with their baby...  I really don't think I had that...  I've thought back many times wondering if maybe I did get some kind of inkling and I just didn't pay attention to it, but I really don't know that I did.  So, unassisted child birth doesn't feel like a safe option to me.  But I would still prefer that over an unnecessary visit to the hospital.  That probably does make me sound like a crazy person.  But I did say UNNECESSARY visit to the hospital.  You see, this is most likely my last baby.  I won't get another chance to do this birth thing again.  Which is why I refuse to give up fighting for my preferred option.  If I am healthy, and the baby is healthy, then I am not budging on this.

And at the end of the day, this obstetrician was unable to give us any compelling reasons why I shouldn't be at home, and she has accepted that she was unable to persuade me (at least that time, but she was keen to invite me back again for another try, and also called me again later that afternoon to make some more helpful suggestions).  So she made a few recommendations, none of which were evidence based, and all of which are pretty much being disregarded by me.  I never agreed to anything.  I just told her I would "keep them in mind".  We are just happy having the confirmation that there is no need for me to be treated as being at any higher risk of a problem.

So, with that, I am having a home birth.  Of course, this is still dependent on whether or not any complications arise later in the pregnancy or even during labour as they did with Joshua.  There are never any guarantees.  But as long as I am well, and the baby is well, that is the plan.                        

5 comments:

  1. I have to say 'controversial' topics such as this bother me- not because of the topic, because they have to become controversial. Can't people recognize that what works well for them and makes their family happy- doesn't always = what works for others and makes them happy.
    In general we are mothers who love our children. Whether we have our children in a hospital or not, breastfeed or not, choose to circumcise or not, choose to let them cry a little or not, homeschool or not - yadda yadda yadda... we are still looking out for the best interest of OUR child and OUR family.
    Anyway, having said that- I do the hospital thing and my sister in law who I love very much does the home birth thing. I think its awesome that you guys do that. It's not for me- but I think it's great that you can have things the way you desire. She had a difficult first home birth, the baby is fine, but she had a very hard labor, and had an extremely hard time getting the placenta out as well. She tore bad from birth and bled just way too much. She ended up in the hospital and her recovery almost seemed worse than what I dealt with after having a c-section. She got a lot of comments too- mostly people would ask me "She's not going to have another homebirth again is she?"
    People just don't know how to keep their noses out of things!
    Anyway, she went on to have a WONDERFUL 2nd experience. The labor was quick, the birth was easy, and she was back on her feet in no time. A classic easy labor and birth. And go figure the 2nd was bigger than her 1st!
    Thing is, you just don't know what's going to happen- that's part of life.
    No matter how many times I told people that my daughter's condition was random/rare with no known cause and non-genetic, they still wondered if I was happy when I got pregnant the 2nd time- and if I was worried my child would have a condition like my daughter's. Well first of all- I love my daughter and I would do it all over again if I had to... but second of all- no if they didn't hear me the first time, it was random and rare, and chances of me having a child with her condition AGAIN is very slim. So I understand your frustration.
    Go with what is right for you and your family. I truly believe that you will have your heart's desire and have a wonderful home birth the 2nd time around. Keep believing!

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  2. This was really fascinating to read- thanks for sharing your thoughts in such detail. I'm totally with Jessica on this. You know I'm the direct opposite when it comes to my own choices for birth, but that notwithstanding, I think we're on the exact same page in every other respect- you have to do what works for you, and nobody else has the right to make decisions on your behalf.

    You have to weigh the respective risks and choose what makes you comfortable. And as someone who chose the hospital route, I was surprised to find that some of my choices were far higher risk than your home birth is likely to be. I still went ahead with my options and I don't regret them. I really hope that this time is everything you're hoping for it to be, and I know from my own experience that making a determined, considered choice about these things hands you back some of the power you lost the first time. So, more power to you :)

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  3. Well just WOW Karissa. I am really shocked that she is so anti-homebirth! It seems bizarre that your GP would send you to someone that is against homebirth. How incredibly frustrating! I would have thought that she would have been supportive of your decision, of course outlining risks - which you already know anyway.

    I sincerely wish you all the best for a wonderful birth with facebook updates and maybe a blog post between contractions. I will sing Kumbaya and grow my leg hairs on your behalf.

    Sending you lots of healthy birthing vibes.

    x

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  4. I loved this post. It was beautifully written and I enjoyed every bit of it. I am glad that you got the 'clearance' that you needed. I love how strong and motivated you are. You are a very inspiring woman. I really hope that your next homebirth goes well for you. I get visions of Josie with hairy legs and dreadlocks lol :)

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