I no longer believe

I’m pregnant. This is our third child. With our other children, when I found out, I called up the midwives and we would schedule an appointment somewhere around 8-10 weeks and go from there. This pregnancy, it was a lot more difficult.

Mainly because I no longer believe in natural childbirth and everything surrounding it. With my first two, I only considered natural childbirth outside of a hospital. I used an independent birth center  for my first and was planning a home birth with my second, but ended up going to the birth center anyway. I had only read natural childbirth books, listened to natural childbirth people and all my friends were natural childbirth oriented.

Since I moved away from attachment parenting, I also started questioning natural childbirth. While previously I only read blogs, books and articles with a pro-homebirth/natural childbirth slant, now I read articles from the other side as well. They say that in order to find the truth, it’s important to consider all viewpoints.

I’ve been reading. I like the Navelgazing Midwife. She’s pro-homebirth, but only when it meets certain criteria and acknowledges that homebirth is more risky than hospital births because of the uncertainty you can’t account for. She’s about standards. I read the Skeptical OB. She has a pull-no-punches attitude that makes sure I don’t get complacent and stop thinking critically–like I did after becoming pro-natural childbirth. I’ve also been reading “Brought to bed: Childbearing in America from 1750 to 1950, which has given me a lot of insight into the movement away from natural childbirth to the twilight sleep era, to epidurals and back to natural childbirth.

The only problem is when it came time to decide on a caregiver and type of birth I couldn’t. I could no longer see one type of birth as “better” than the other. Instead, both had their advantages and draw backs. The only thing I was sure about is that I wanted to stay with a CNM, unless I became high risk. I made a list:

Homebirth Pros:

  • Lower cost ($3000)
  • Don’t have to go anywhere during labor (I’ve been in transition in the car with both labors–it sucks!)
  • Know who provider and assistant will be ahead of time
  • Already familiar with the environment and everything in it.

Homebirth Cons:

  • Higher risk (even when attended by a CNM, homebirths have double the risk of a negative outcome over a hospital birth)
  • No access to pain relief (no longer believing in the cascade of interventions has me craving an epidural)
  • Kids might be in the house (I have to make sure I have someone to take them out when I’m in labor. I don’t want them there)
  • No break from home (I don’t want to spend the time immediately after birth looking at all the stuff I didn’t get done before the birth)

Hospital Pros:

  • Access to pain medication
  • Immediate access to specialists in case of emergency
  • Get a balanced perspective (can learn exactly how a hospital birth compares to a homebirth instead of propaganda)
  • Get away from everything that needs to be done at home at least for 24 hours!

Hospital Cons:

  • Higher cost–and I can’t find out exactly how much it will be beforehand. Trust me. I’ve tried. In the US if you go to the hospital and try to find out how much it will cost, everyone will shrug. Accounting and Billing deals with that. Then you’ll have to get the itemized bill and find out they charged you $50 for fucking gauze. We HATE how the US medical system works. Because of this, I’m much more likely to give birth in a hospital in Finland (but the midwives still do home visits!) than in the US.
  • The CNMs who admit to the hospital only attend births during office hours. So if I go into labor outside of those (and I always have!), I get who ever is on call. Normal practice for hospitals, but makes me uncomfortable being used to knowing who’s going to be there.
  • Less autonomy. When I discussed this with my sister, she advised me to get a doula so I would have someone to help me advocate for what I wanted, which immediately made me feel I’d have to. I don’t want to feel like I”m fighting the system when I just want to pop a baby out. Plus, every doula I’ve met (just socially), I have disliked. One of them was discussing how she wanted to become a midwife and I mentioned how great CNMs were and she said, “Oh, I don’t want to be a CNM! I just want to be a direct entry midwife. Becoming a CNM is too much work.” Seriously? Fuck you. If you think becoming a CNM is too much work, what’s your attitude towards attending a long labor going to be like?
  • Less control over the environment. My sister warned me that although I may be able to get out of the house for a while, I wouldn’t necessarily like being in the hospital. Nurses come in and out of the rooms, there’s not a whole lot of privacy.

In the end, I decided my antipathy towards the hospital was too strong. So I chose a CNM who attends homebirths. She’s also a nurse practitioner, which enables her to do a lot more than a CPM or a regular CNM. She also has fairly strict criteria in defining the scope of her practice. When I told her I’d rather have a home birth than a birth center birth because I was closer to the hospital where I lived, she laughed. “Now, I don’t usually do VBACs because it’s out of the scope of my practice, but I had one patient who told me she wanted to try for a VBAC at home or she’d go to the birth center. When I saw she lived across the street from the hospital, I told her I’d attend her homebirth because she was much safer there than at the birth center half an hour from a hospital.” Hearing “out of the scope of my practice” was immensely reassuring. So many midwives doing homebirths and birth center births don’t seem to consider anything out of the scope of their practice, perhaps part of the reason why they are so much higher risk: they’re not just taking on low-risk women.

But my midwife seems to have a good grasp on this. She started out by telling me that it was going to be more of a partnership and there were some things that she insisted on doing and was willing to discuss with me why they needed to be done. These things turned out to be Glucose Screening and at least one ultrasound, both of which I’m totally fine with, but were ‘optional’ at the midwifery practice I had my first two at. So I’ve never been screened for gestational diabetes because I felt I was low-risk, even though my dad has type II diabetes. The midwives didn’t push me. When my sister, Nurse Extraordinaire, found out, she flipped out and informed me exactly why it was so important, etc. I’m now on board with the glucose screening. And I always get ultrasounds around 20 weeks because I like to see the baby. I like to see everything is fine and I like to find out what the gender is. No problem. I may even request another at 36 to make sure everything is still fine.
There are a few things that give me pause about my CNM. Despite her insistence that she is committed to evidence based medicine, she believes in homeopathy. At my first appointment, she compared homeopathy to immunotherapy (I told her I was extremely allergic to dust mites, but was a good candidate for allergy shots and is that safe during pregnancy?). Now, homeopathy is bullshit. Unlike immunotherapy, it has no evidence showing it works and is effective for no body. She also pestered me about the use of my Advair inhaler. My asthma went completely out of control in 2013 (really, started in 2012) and I started getting bronchitis every time I caught a cold, being short of breath while working out and waking up in the night unable to breath. Went and saw the nurse practitioner at my doctor’s office and she got me back on my advair. Went and saw an allergist and learned I’m allergic to dust mites and a few other things, but mainly dust mites. All kinds of dust mites. She advised me to stay on my advair and, if I went off, to come back in for a breathing test.

My midwife listened to all this and asked me if I thought my asthma got worse or better when I was pregnant and if I thought our home construction had slowed down enough to wean me off the inhaler. I looked at her like she was nuts and she backpeddled and said I could stay on the inhaler the whole pregnancy if I want to. Yes, want to. I’ve always been a fan of breathing and I see nothing that says it’s bad for pregnancy. Or at least, worse than having an asthma attack.

Secondly, I’ve developed reflux. It runs in my family. Probably didn’t help that when I started using my Advar, I would rinse out my mouth and then swallow the water. I think that irritated my gut. I stopped when my allergist told me that was a Bad Idea. But I did it for about 5 weeks. And I was drinking 2-3 diet sodas a day. And eating nutella every night before I went to bed. I ended up with bad heartburn that wouldn’t go away even when I cleaned up my diet. So I went to the doctors and they put me on generic Zantac, which is the Best Thing Ever. It got rid of my heartburn! I had no heartburn! It was great.

But my midwife told me I could stop taking that and try papaya enzyme. I hate papaya enzyme. I’ve always had awful heartburn while pregnant and spent most of my first pregnancy munching on papaya enzyme throughout the day. My second I just took tums, which was slightly more effective. Now…I take Zantac and an occasional tums. It’s great! She pointed out that I was just alleviating the symptoms instead of fixing the problem. Then she wondered outloud what herbs she could use to strengthen the sphincter which was causing my heartburn. I felt seriously annoyed because 1) I have reflux and 2) Being pregnant always makes my heartburn worse because all the relaxin is in their loosening everything! I’m not going to trade in my zantac for some damned herbs.

I have, however, cut my soda consumption and nutella out completely. I hope that helps.

Other than that, I like her. I just hope we don’t fight too much over my inhaler and zantac. The reality of the matter is that I no longer care if I have a natural birth or even a homebirth. If any complications arise at all that increase my risk for having a healthy, safe homebirth, I’m going to march my ass up to the hospital and my husband knows this. I just want a safe birth. Maybe I’m just getting older, but my need to be part of a movement or hold to some ideal has withered and died.
Actually that’s one thought that does annoy me: me having a homebirth being heralded by homebirth advocates as proof that more and more women want homebirths and that homebirth is safe if the homebirth rates go up again this year. I don’t want to be used in statistics to support anyone’s agenda. I just want to have a damn baby.
Even worse than that, I see people I know having their first babies and deciding they want to go the “natural childbirth route,” going to the same birth center I went to and raving about the midwives. I worry that like me, they’ve stopped thinking critically. That, like me, they aren’t going to understand the difference between a CPM and a CNM (my first one was delivered by the CNM who has since retired, my second by the CPM who was about the graduate nursing school and working towards becoming a CNM. She’s still getting her master’s and has taken a leave of absence). They only have CPMs at the birth center now. I worry that they’re putting themselves in unnecessary danger and are going to trust too much where they should be more critical.
Granted, of all the women among my acquaintances who have had homebirths, I don’t know of a single one who has had a bad outcome. I know of one midwife who had her license pulled for bad outcomes (two severe birth injuries). But I look at various aspects of their birth stories and realize in some cases it was just luck (in labor at home for three days after membranes ruptured and post dates) or where my friend ended up truly suffering while in labor (severe back labor and pushing against her bag of waters, which the midwives would not strip.)
But I can’t really say anything. No one wants advise, especially the unsolicited kind.







Birth without an Agenda

I’ve been thinking a lot about birth lately. Not that I’m pregnant, but since leaving the attachment parenting movement, I’ve started questioning a lot of the decisions I made under the heading ‘libertarian natural parenting.’ You may be surprised how much the two overlap (or not so much, if you find yourself in the same group), but a lot of libertarians  practice alternative and natural medicines as an outgrowth of their mistrust in conventional (government-approved) medicines.

I decided I would use midwives for childbirth and well-woman care in college, after reading an essay in “Liberty for Women” by Wendy McElroy, which discussed the plot by OB-GYNs to marginalize midwives. I didn’t follow up on any of the sources, but it was enough to convince me. OBs were money grubbers and pushed midwives out in order to make their field more professional for men and so they could charge more. Unlike Europe, American midwives did not move into hospitals when their patients did. I decided I wanted natural births and I had two of them.

It’s embarrassing now to think about how radicalized I when I was pregnant with my first child. I thought it was ridiculous that breech babies had to be automatic c-sections. Indeed, I viewed a c-section as something I wanted to avoid at all costs. My son was born after 12 hours of normal labor with the cord wrapped around his neck, screaming his head off. He was blue, but he quickly pinked up.

When my daughter was born, I was less radical. Having experienced the pain of childbirth, I decided if my baby was anything other than headdown, I wouldn’t mind a c-section. I wanted to tear less, too. But I also was beginning to feel bits of doubt regarding the quality of care I was receiving. The certified nurse midwife who had delivered Alpha had retired, leaving two lay midwives, one of whom was working on getting her nursing degree to become a CNM. The difference between a CNM and a laymidwife is huge. CNMs have masters degrees in nursing and midwifery. Lay midwives in my sate have to be present at 10 births and there may be some other training required, but I’m not sure about that. In other words, it’s a world of difference as far as training and ability is concerned. During my appointments with the lay midwife, she would often leave and go do office work, leaving my prenatal care in the hands of an apprentice midwife, which made me rather uncomfortable. How would they be able to tell if anything unusual came up if the midwife with experience wasn’t even around during appointments?

Later in my pregnancy, I started bleeding a lot. It turned out to be mainly stress due to buying our house, my son being sick and me generally not getting enough rest and being on my feet too much. My sister urged me to call the midwives since it could be premature labor. Since she’s a nurse, I listened and called the midwife on call. She told me to wait a while and call her back if it didn’t stop. It didn’t stop, I called her back. She told me to wait some more and try to get some rest. But I was so worried something was seriously wrong I couldn’t rest. I don’t think she really wanted to come in on her day off, but eventually she agreed to meet at the birth center where she examined me, told me everything was fine and sent me home. Hearing this actually managed to make me relax to where I could get some rest and if I had heard it 3 hours sooner, it would have let me relax that much earlier. When I talked to the lay midwife about that at my next appointment, her only comment was “sounds like your uterus was unhappy and telling you to slowdown!”

The great thing I’ve learned about midwives is that they really trust the process. Since they accept that birth is a normal condition, they can be very calm and help calm the patient down when the when the patient thinks things are not normal. The bad things about midwives is that since they view births as normal, they can be rather slow in recognizing when situations stop being normal. In birth that can happen extremely fast. In those situations, the more information you have, the quicker and easier it is to figure out that something abnormal is happening and get the baby out of there before permanent damage or death occurs. This would be the main benefit of fetal monitoring during labor and other practices that the natural birth community dislikes. Fortunately for my family, my  births went smoothly. But since then I’ve learned that:

* Homebirths and birth center births have three times the mortality of hospital births

*the difference between CNMs and lay midwives

*why constant fetal monitoring is important

* much of the information from the Business of Being Born is factually incorrect

* the only difference between a natural birth and having an epidural is the amount of pain you feel.

You can disagree with these points, there’s nothing wrong about that. But now, having looked at both sides of the issue, I’m beginning to think that the non-natural birth—should I call it mainstream birth?–side has more evidence. NCBers tend to rely on feelings and blow things out of proportion that don’t really matter. Take of example the ‘fact’ that vaginal births are better than c-sections because they expose babies to vaginal flora which helps the baby’s gut. If it really mattered, couldn’t c-sectioned babies just get a swab of their mothers’ vaginal flora in their mouths? It’s not like it’s hard to do. But that’s not the point. Their main goal is to encourage women to give birth vaginally and they are willing to distort data if need be.

Interestingly enough I came across a site called “sisters in chains,” which is all about midwives who are being persecuted for helping women give birth the way they want to give birth. They support letting women have control of their bodies and choose for themselves how they want to be handled and make decisions for themselves and birth how they want to birth. I also support these things. However, birth is one of those situations where you experience asymmetrical information. Just like when you take your car to the mechanics and have no idea if what the mechanic says is wrong with your care is actually wrong with your car or if he’s just making things up to get more money, you have no idea if your care provider is actually telling you accurate information in regards to your birth or pregnancy. In the end, it all comes down to trust. Women, especially women in labor, have to trust that their care providers have their best interests at heart. That they are not working for some larger objective, but specifically to provide the best outcomes for that woman and that baby.

But this is not the case with many midwives. Many of them say that their main objective is to empower women to birth the way they choose, but what if the way I choose isn’t the way they think I should choose? I’ve had two natural births. I’ve been there, done that. What if the next time I give birth, I want to have an epidural? What if I want to experience the other side? People who have had both natural and drugged births have said that the only difference between them was that the latter was painless.

Will women’s advocates support me in this decision? My guess is no, because their vision is one where every woman gives birth naturally, a world in which women are united by the pain of childbirth.