Over the years I have been on almost all sides of this debate. I had natural/home births...but have also attended women, and have amazing friends, who have had births with varying degrees of intervention. I went back to work after my first, but started my own business after my second, giving me opportunity to stay at home most of the time. I also have been an independent contractor (Doula, Birth Educator, Swim Instructor, PE Teacher, etc) sporadically throughout my mothering tenure. I breast and bottle fed. Co-slept and encouraged nighttime independence. We even walked the line in education, doing some home-school and some public school. I could, at different times and under different circumstances be described as as helicopter parenting, some watered down "love and logic", and some fly by the seat of my pants, intuitive parenting. No one can hit all the dichotomies in mothering, although I think I came pretty close, and with the blessing of time, experience, and distance, I think I can put this whole "Mom Wars" thing to bed, with a your help. Generally speaking, women make decisions about mothering, from beginning to end, with conscious intent, or inherent trust. Let's begin to give each other the benefit of the doubt.
This week there will be an installment every day. I'll cover one topic commonly cited by mothers feeling judged, no matter which side of the fence they're on. Today the subject will be how we birth our babies, and why women may choose what they do. Read on, seek to understand each other, judge less, love more, support more, offer to help more, be kind to each other.
Birthing OUT of Hospital.
Common judgements: Women who birth out of the hospital are careless, unsafe, selfish, stupid. They want a "pretty experience" at the expense of safety and are unrealistic about labor and will probably change their mind.
*I will absolutely go on record here to say that I (personally and professionally) draw the line with unattended home births, if you can't find a midwife in your area to attend you out of hospital, please please please, seek out someone you can trust inside the hospital, or travel to somewhere you can have the birth you want. Our fear of medicine or intervention should never create a greater risk than the intervention itself. Disclaimer covered.
Now let's get to the bottom of the judgment. Most women birthing out of hospital are exceptionally low risk in their pregnancies. Midwives and birthing centers have a very clear limit to the kinds of risk factors they can keep in their practices, and what they have to refer to OB's. Women who have healthy, low risk pregnancies tend to have healthy, low risk births. Most pregnancy complications can be foreseen. If, in the RARE situation, a medical complication comes up that requires immediate attention, birthing centers are required to be within 5 minutes of a hospital that can handle obstetrics. Those who may judge are often under the misapprehension that if there was an emergency, that the operating room is fully staffed and standing there, scrubbed, gloved, and gowned. They're not. A hospital transport (especially from birth centers that are within close proximity) doesn't really look terribly different than a change from the birthing suites to the OR, it takes time to assemble the whole team if an abdominal birth (cesarean) becomes necessary. While a transport is in route, the team is assembling. If we are already at the hospital we just wait in a room for all the players to take their places in the surgical theatre and then move down the hall. Some of the surgical staff may not even be on site since players like anesthesiologists are required to be within a certain distance, much like birthing centers, but are not required to be on site while on call. I have witnessed these scenarios many times, so it is based on my considerable experience in the technologically advanced Pacific Northwest, not on stats or conjecture.
Reasons that I've been given regarding choosing to birth out of hospital:
- Has been previously disrespected by doctors or nurses
- Not being listened to by doctors or nurses/not acknowledging that the patient is an expert on their own body and what is normal
- Doctor not being openminded to alternative medicine or practices
- Traumatic hospital experiences
- Concerned that routine obstetric practices when they are not medically necessary increase risks
- Unnecessary cesarean section rate
- Routine procedures performed on newborns at the doctors (biased) discretion that are unnecessary and unwanted
- Hate the smell of hospitals
- Previous trauma and association with hospitals, previous birth(s)
- traveling during labor sounds awful
- Desire more personalized care, longer prenatal appointments
- Wanting older children to be present and comfortable
- Desire privacy
- Wants to go home as soon as exams are done and mom and baby are deemed safe to do so (usually within 3-5 hours following birth)
- Has personal or family connection to science/medicine and because of experience, is skeptical about the medical system
- Desire water birth (not offered at hospital despite having installed "labor tubs" due to lack of training in safe water birth practices and having jetted tubs which are more likely to harbor blood borne pathogens
- Feel safer
- Desire to labor without unnecessary time limits/constraints
- Has taken childbirth education classes that increased confidence
- Is surrounded by women who have had positive experiences with midwifery
- Prefer NO or at least limited vaginal exams during labor
- Desire a family centered experience, including Dad/Partner catching baby, cutting cord, delayed or no cord clamping/cutting, immediate skin to skin, immediate breastfeeding, delayed examination to determine if stitches are necessary, delayed suturing, family bonding time immediately following birth, no newborn procedures like immunizations, eye ointment, vitamin K injection, examination for an agreed upon time period.
Birthing IN the hospital:
Common judgements: Women who birth at the hospital are naive, too trusting of doctors, want ALL the interventions, are making fear based decisions, are uneducated about the risks of common interventions, want to sign up for a cesarean.
Women generally choose where they birth using relatively simple criteria: Where do they feel safest? We all have fears and concerns about a physical experience the likes of labor and delivery. Women are influenced by a variety of factors, and they must come to their own decision. First and foremost, we have to acknowledge that in-hospital delivery is simply a norm in our culture, and many, many women will make their decision simply assuming that the most common option is the safest, and others are unaware that other options exist. In fact, even having the option to deliver at an OOH (Out Of Hospital) Birthing Center is still rare here in the US. Home birth midwives are available in most states, some more than others, and in some it's still illegal. Limited options may play a huge role in many women decisions. Others are influenced by how birth is portrayed in mainstream media, either ridiculous for comedy or inordinately scary for drama. Seeing normal birth is so uncommon that the media's portrayal has become accepted by many as what labor and birth looks like. Still others choose to birth in hospital because they like the idea of "the best of both worlds", intending to try for an uncomplicated/vaginal/even natural birth, but unsure about what they will ultimately feel about it when in labor, and want to have options immediately accessible. It can also be as simple as what is covered by her insurance. Many women have longstanding relationships with Gynecologist that why have seen for yearly exams and feel a sense of loyalty. Still others know that they have complications, or a family history of possible complications and so feel that it's best to be in controlled environment.
Reasons I've been offered by women choosing hospital births:
- Feel safe there
- Has a long history with their obstetrician
- Wants interventions available as an option
- Partner/extended family may not support OOH birth
- Chose midwives IN hospital for "best of both worlds"
- Has had positive experiences with doctors and nurses
- Has a pregnancy complication that requires hospital delivery
- Had a previous negative experience OOH with prior birth(s)
- Has not known anyone who had a home or birth center birth, no personal experiences to draw on, or has known someone who had a negative experience OOH
- Stories/Family history
- Has not had a comprehensive childbirth education class and is afraid of the unknown
- Has a scientific or medical background and, because of experience, trusts the system
- Likes the idea of having nursing assistance for 24-48 hours following delivery
- Might pursue a birth center birth but none are available in their area
- Doesn't like the idea of a home birth, worried about the mess, doesn't think the space is ideal, etc.
- Has been told that she has to deliver is hospital, even if it's untrue.