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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Mother Writes About Her Reasons for Choosing Homebirth

Hi Everyone! I decided it was time that I introduced myself.

My name is [name deleted].I am the mother of a wonderful almost-3 yo daughter, Amy. She is more than I could ever imagine: as you all know for yourselves. I had her at home, in what was and continues to be the absolutely most empowering process that I had ever experienced. I am a completely different person now, as the result of my birth experience.

I am going to start with how I decided to have a homebirth with my first (and only) child. It was a big choice for me, and it is the biggest part of who I am today. I am copying what I wrote for another list, so I hope it all makes sense again! My actual birth story will follow in the next post. It is very long, too [grin].

I support everyone's own process in deciding where to birth. It IS a very personal choice, and ability to relax and trust my team was the deciding factor in my decision. Wherever works is where a woman should be!

I realize that choosing a homebirth is a BIG JUMP in personal orientation for a lot of us. Carroll (my dh) and I made choosing our homebirth our first act as parents, but it was a BIG DECISION for us. We always considered ourselves fairly "mainstream" and it seemed like choosing to be "outside the warm firelight of the medical establishment" (My partner’s metaphor) at the time. Very FRIGHTENING. I, of course, am also very pro-homebirth NOW, but if you had asked me if I was when I was anywhere up to 32 weeks pregnant I would have told you I believed it was ok for some really brave women but I wasn't that brave.

MY first step toward our decision was insisting that we have a doula for my labor, because I wasn't sure that Carroll would be able to "stand up to the dr's when they started pushing interventions". I wanted backup I could trust. I must have had some unconscious leanings toward homebirth, because I insisted that my doula be a DEM midwife. Our doula strongly suggested we take Bradley classes instead of the hospital childbirth classes. It was only when, after being educated to our choices thru LOTS of reading and our first few Bradley classes that we were struck so hard by our next interactions with our "medical team".

Carroll and I really believed that we could work with our OB and our hospital team to have the kind of hospital natural birth we wanted. We really believed that it was just a matter of being informed and assertive. We were not aggressive or hostile. We BELIEVED in the medical model. Our OB was extremely receptive to listening and listening and listening to our concerns and questions. Carroll came to all my prenatals, and we came each month armed with 10-15 typed-out questions to ask our ob, and took notes on everything she answered. She never rushed us or acted irritated at all. We were very happy with her. She even agreed to meet our doula. The fact that ALL my friends that had gone to her had had cesareans bothered me, but I figured it couldn't happen to me because *I* was so informed and committed to a natural birth.

We had planned the conventional hospital birth with our obstetrician with the midwife to "doula" for us and be our labor assistant at the hospital. We knew the baby was "Amy" because we had had an amniocentesis done at 18 weeks (I was 36 and Carroll was 50). After 3 ultrasounds at various points during the pregnancy we also knew that she was basically healthy, with 10 toes anyway.

As my due date grew closer, we began being hit with the realities of the OB practice and hospital that we were required to use. We found out that any one of the 9 OBs in the practice could "deliver" our baby: whoever was on call. About 2 months before I was due we attended the "Meet the Drs" night (since any one of 9 drs could be the one delivering the baby) and were astounded to find that the practice we were obligated to use (thru our insurance company) was extremely interventionist. My obstetrician has a very wonderful bed-side manner, but it turned out that she had a very high caesarean rate, and wanted to induce if I was one day past my due date. All the group drs were in agreement that all first time mothers needed episiotomies, drugs were good, and that constant monitoring (hence no walking around) was essential. No food or drink was allowed and an IV was not really optional. We were astounded, since the propaganda they put out on paper was progressive (birth rooms, etc.).

It was during the "Meet the Dr's Night" (intended to resolve fears by actually meeting the other drs and being able to ask them questions) that MY red flags started waving. I asked about how decisions were made for routine episiotomies (Quote: "Every first time mom needs episiotomies."). Others asked about IVs and moving around during labor and eating/drinking ("IF YOU INSIST, you don't have to do an IV" and "EFM is required, but IF YOU INSIST, you might be able to move around a bit" and "no eating, you can have some ice if you need it"). I was really upset, especially about the episiotomy, which was described by one of the male doctors as "I don't know what the problem is with episiotomies, they don't even hurt". Yeah, I'd like to see someone cut thru the muscle and nerve layers of his scrotum and see if he still feels that way after the drugs wear off! Then we took the Hospital tour. The few LDRP rooms looked nice on the surface, but I was struck by how the bed and room looked still so medical: there were hookups everywhere in the room to every imaginable gadget, the most prominent items in the room was the huge wall clock and the rocking chair sitting right next to the EFM machine. The tournurse explained that usually the LDRP rooms were not available because there were so few of them. During the tour we passed by the nursery where there were 5 or 6 crying babies. They were intubating one of the babies right in front of our eyes while the tournurse chatted to us about visiting hours, etc. When we asked about what we were seeing (not a pretty picture!) we were told that all babies get that treatment, "to clear their breathing passages").

The final straw came after we gave our OB our Birth Plan (standard issues, including what we wanted if our baby was sick, if I ended up with an emergency cesarean, etc. It was not a naive, rosy-picture of a completely complication-free birth). When my OB called us at home to discuss it, she said to us, Quote: "I have read your BP, and I just want you to know that while you seem to have realistic expectations, I won't be able to guarantee that you will get any of what you want, oh and by the way, if you are one day late I want to induce you...").

I was awake late one night about a week later, hearing the male OB's words (about epis. not hurting) and my OB's unsupportive words. They were flashing over and over in my head, and I kept thinking about all the ways the hospital and the drs said "if you insist, you might get this, BUT...." . I realized I just could *not* take the chance that all our wishes would be ignored even tho we would be very assertive and well-educated and non-confrontational about our decisions. I woke Carroll up and told him maybe we should reconsider having a homebirth. After he recovered his breath and heart, we began investigating the safety of homebirth.

To make a long and difficult decision a short story, we interviewed the midwife about emergency situations. Among the many books we studied, "A Good Birth, A Safe Birth" was our leading reference. We discovered that home births have a lower maternal and natal death rate than hospitals for births at all levels of risk. Mine was a low risk birth. After about two weeks of non-stop research and soul-searching, we decided that the only thing holding *us* back was that we would be responsible if something happened to Amy during her birth.

Then I had an insight that made the difference **to me**: that the reason *I* felt safer in the hospital was that if something happened to Amy there, we could blame the hospital or the doctors. We decided, for ourselves, that what was holding us back was simply a mistaken belief that medicine was infallible and at least if something happened *they* would be responsible. When I realized that, I realized that I was willing to let go of the "Doctors as God" complex enough to, GULP, take personal responsibility and realize that sometimes bad things do happen and it isn't *anyone's* fault. It was terrifying.

Carroll was most impressed with the Texas Association of Midwives statistics and those compiled by the Texas Department of Health that showed that homebirth was safer for mom and baby across all risk levels (he's always been a statistics kinda guy). [We lived in Texas then, we live in Minnesota now]. We were both completely satisfied that the midwives we had chosen were well skilled and completely capable of handling emergency situations such as resuscitating Amy if she didn't breath, etc. They had clear protocols for emergencies, and appropriate emergency equipment.

It is an extremely personal and difficult decision to make to be personally responsible for the welfare of your child as it is born. All the research we had done satisfied us that it was more likely that something resulting in Amy's or my death or injury was more likely to happen in our hospital than at our home. And in our situation, Amy's birth experience *would* have been **so** much worse in the hospital.

So we made the decision to have her at home. 5 weeks before Amy was due (4 weeks before she came) we decided to have a home birth. Luckily we already had a midwife, we just had to "up the level of care" expected. We said at the time that the decision to have a home birth was our first major parenting decision, doing something to stand up for the best interests of our child.

We called our "doula/monitrice" and asked her to be our homebirth midwife. She accepted us as homebirth clients. Yeah! Then we began attending Homebirth Classes, in addition to the Bradley childbirth prep classes we were already taking. We were in shock for a couple of weeks after the decision was "made" while our whole world orientation got shifted around. The midwife told us to expect this. I don't know how typical our decision-making process was, since the only other person I know personally who has had a homebirth had always been anti-medical establishment and never had a doubt about having her homebirth. I know when we were accepted as homebirth clients by our midwife, her partner told us that she had thought we were homebirth people from the first time she saw us in the office as a doula client. I never did know what she meant. [smile]

We continued with our obstetrician for prenatal care, and as far as the ob ever knew we would be coming to the hospital to have the baby. This was in case we needed to go to the hospital because our insurance would not pay to change doctors or hospitals and "our" hospital would not have admitted me without an obstetrician from the group. We felt somewhat bad about deceiving our ob, she was a really supportive prenatal obstetrician, but we wanted to have coverage in case something did happen. Our midwives only deal with healthy, normal, births. If anything out of the ordinary happened, they would transport me to the hospital. In that case we would have needed to have our insurance pay for it because we couldn't afford to pay out of our pockets for a hospital birth. (Usually there is plenty of time even in emergency situations to transport safely to a hospital). Also, we wanted to go a hospital where we were registered and with a practice where we were "known" so that we wouldn't be battling the anti-homebirth mentality at the county hospital. We just never would have told them we had been planning a homebirth, we would have just presented ourselves at the hospital as if we got there "a little later than expected". Luckily we could "afford" to pay the cost of the (MUCH LOWER COST) homebirth, cuz it was definitely NOT covered by our insurance.

We spent the next few weeks finalizing our arrangements with the hospital, attending OB and midwife’s prenatals, and getting copies of medical records to give to the midwives. We had already started Bradley childbirth classes, but then we added Home Birth classes, too, taught by our midwife. (Her classes were the BEST! Labor and birth were described infinitely better by the midwife than the childbirth educators. Much more was covered too.) We had bought all the things we needed for the home birth kit, sterilized everything, and put our "kit" together. Ten days before my due date, and We were Ready!

Thanks for listening! My blessings to you! My actual birth story will follow.

[Name deleted]