Saturday, August 7, 2010

Should We Home Birth?

The cat's out of the bag. If you don't know us well or you don't read my blog or you don't care to read about my opinions on proposition 8, then you probably don't know that my wife is expecting. Yeah, I buried that announcement at the bottom of my last post about gay marriage. We wanted to have four children, but we didn't want to have a baby around Christmas, so yes, this one was a surprise, but a happy surprise, and yes, my wife is due around the middle part of January. This due date is a guess, we won't officially know until we have an ultra-sound scheduled this week.

But a due date in January, for us, could really mean a delivery around the holidays. Our oldest was induced at 37 weeks. Our second was induced at 36. Our third child's birth is described right here in pretty good detail, but she went a few days past her due date, but we don't know for sure, other than my wife is susceptible to obstetric cholestasis which happened in two of our three births and is likely to happen again. And if you have this condition, you induce.

Well, induction should rule out a home birth right? Well, probably. But we won't know for sure until the pregnancy has progressed a lot further, so we're considering it now.

But why home birth? Well, why home schoo? We would like much more control over both our birth and after our birth.

Plus, we have legitimate concerns about hospital births. We would love our children to be able to come in and witness the birth, something we haven't been able to experience at the hospital. In fact they were not even allowed on the floor. My wife had to come down to talk to them. They didn't get to see the baby at all until a few days later. Why? RSV and hospitals are breeding grounds for disease. So we want to have our child delivered there?

Also, our oldest has type 1 diabetes and she's not quite old enough yet to where she's able to manage it herself independently. And its a lot to ask someone else to manage it for us while we're at the hospital. And all it takes is one low going too low and she's hospitalized (or worse). That's a lot to expect or ask of someone else that's not a close family member and we don't have the family support here that could take care of this for us for this kind of length of time.

But really, we want to home birth for all the reasons that became obvious when we interviewed a midwife last week who has done homebirth for many, many years. She talked to us about how you can prepare for and prevent complications in the pregnancy by dealing with and preparing for it in trimester one and two. Typical preparation involves proper diet and exercise and natural supplements. The whole point of bradley is to educate yourself so deeply in birth and prepare yourself far in advance of the event and then ensure the proper support systems are in place that natural births are more likely. More profoundly, it transforms birth from a clinical experience where all of the control is transfered to a doctor and a hospital to a beautiful, natural experience where the control is shared between father and mother and midwife.

I know, I know, I'm not the one having the baby, but the reason I love Bradley is because I'm involved deeply. I support and sustain my wife through the birthing process. My opinions matter and the way I perform in support of her also matters.

But given our history, I'm not sure a home birth is practical. In all three of our births, we've had messy complications. Our first two were induced. In our first, my wife hemorrhaged. In our third, our baby had extremely low platelet counts, required a transfusion and was in the NYICU for ten solid days.

But my wife really wants a home birth. What do you think?


Rachel said...

First of all, I can't believe you asked that question. This topic just may be more controversial than gay marriage. Seriously.

But, since you asked. If it were me, I would want to take every single preventative step possible to avoid a hospital birth and to give me the best chance possible for a home birth. For me, that would mean planning a home birth and transferring care only if necessary. Honestly, the only drawback I see to that isn't safety like most people would expect. I just trust that qualified midwives would know when to transfer before it was EMERGENCY time, and from my research the very very small percentage of emergencies that WOULD be better handled at a hospital are outweighed by the LARGE percentage of health problems that hospitals provoke. So anyway, the only drawback I see is $$$$$$. Because if you transfer you do still have to pay your midwife full price and the hospital full price. Just one more reason that I wish our nation had better health coverage options, right? :)

NavelgazingMidwife said...

Found this post via Google Alerts. Read your post, then saw you mention Prop 8, so read the last 2 posts re: that subject. So, this will surely amuse you.

I'm a lesbian midwife married to my partner, together for 24 years... we are one of the still legal 16,000 that were not affected by Prop 8. Just thought you'd get a chuckle out of that.

Back to the homebirth question, though. Of course, I don't have your wife's chart in front of me and the midwife you spoke with surely has more info than you were able to share in a blog post, so giving advice (per se) isn't something I'd feel great doing. But, I *can* offer some relevant questions to think about as well as some options that aren't totally either/or.

Even though I am a homebirth midwife, I also assist women wanting to birth in the hospital. I'm sure you already know about doulas -and I do do that, too- but I also monitrice.

A monitrice is a woman (person?) with extra skills beyond a doula. I encourage folks to only hire midwives or nurses for monitrice work because then you know the level of expertise they are using.

As a monitrice, I get to know the couple prenatally, the same as a doula would, but when mom goes into labor, I go to her house and hang out with her, making sure she and the baby are doing well. For a growing number of women, they want to stay home in labor as long as possible, but aren't quite comfortable with having the baby there. The great thing about a monitrice is if something begins happening... the baby's heart tones start going down or mom's blood pressure goes up... then it's a sure-fire reason to get going sooner than later. And some women have a certain dilation number in their heads... say, 7-8 centimeters... before they leave for the hospital. The monitrice is able to do the exam.

So, just a thought about the other option between all home or all hospital. I charge $1600 for my monitrice services, but some charge less. It's half my midwifery fee, but I am still legally responsible for what happens while mom is in labor. Doulas here in San Diego average $800; I charge $1000 for my doula services. Insurance can pay certified doulas now!

Questions to ask yourselves (of course if the cholestasis doesn't show up):

- Was the first birth's hemorrhage random? or was it in conjunction with tugging on the cord. If the placenta's birth was mismanaged, that can cause a hemorrhage all on its own... not something that necessarily repeats.

- How dramatic was the hemorrhage? Did it resolve with pitocin? Or were other medications necessary. The more meds needed to stop the bleeding, the less likely I am to take a client with that history.

- How did the baby's blood issue come to be seen? Were there symptoms? Is that something likely to repeat? (I know nothing about low platelets in a baby.) If the homeborn baby does have the same issue, is it so dangerous an ambulance ride would be too long to be away from the hospital? What blood test would need to be done because in a typical homebirth we do not draw blood on newborns beyond newborn screen. If cord blood is needed to discover the problem, it will still need to be sent to a lab. Will delays cause a problem for the baby?

- The reasons you share about your kids are absolutely valid, but it's important to know you will still need someone there to take care of the kids, homebirth or not. You'll need someone there who can attend to your daughter's diabetes if there is a transfer to the hospital. That part of the equation is pretty moot. But, you are totally right; having kids at birth is always a joy!

These are the main thoughts as I was reading, but if you want to play the "what if" game with me, I'm pretty good at that. :)

Congratulations! Let's hope the cholestasis doesn't come around and that you both have the perfect birth of your dreams... wherever that might be.

tempe turley said...

Rachel, thanks for your comments. I'm not sure at all how the financing works yet.

NavelgazingMidwife, that is amazingly serendipitous and funny that I would write 2 blog posts about prop 8 followed with another about home births. It was almost like I was asking for a comment from a lesbian midwife legally married in California. That's really crazy.

Thanks for all of your valuable insights.

First of all, I've never heard of a monitrice before, but that sounds like a very interesting compromise solution between a homebirth and a hospital birth.

Here are some more details to answer your question:

1) On the hemorrhage. I really can't say what caused it. I do know that hemorrhaging is more likely when a woman has ICP. At the time (it was our first and we were fresh off Bradley classes with all of this anti-hospital paranoia resonating in our brains) I was really paranoid about intervention and when things were happening I was questioning the way our midwife (we had the hospital midwife deliver our baby) had handled the post birth. For example, I felt like she may have pulled the placenta out too early, but it was really hard for me to know. But looking back I'm guessing it was more likely ICP related?

She did take pitocin. At first they tried with a shot and it didn't work, then they gave it to her through an iv and after that they were able to get it under control pretty quickly.

My wife is pretty convince this was ICP related, but it didn't happen with our second and she had ICP again with him (as mentioned in my blog post).

2) Regarding our third baby's platelet issue. About two hours after birth, she started turning blue and had trouble breathing. This happened while nursing (if I remember correctly), and we removed her from the breast and got her back to normal. But then it happened again, we rang for our nurse, and they immediately rushed her out, gave her oxygen and then got her to the NYCU, administering iv's and oxygen. There, she was tested and they discovered the low platelet count.

We have no idea why this happened. I'm guessing if this would have been a home birth, this probably could have been handled with a trip to the hospital (assuming the midwife had oxygen on hand), but it would have been far more stressful.

The problem with this is that we have no idea why it happened. But getting a platelet count right after birth probably would be a good idea assuming we could get the results back quickly enough.

But again, will it happen again? Or was it a fluke? We don't know.

I take your point regarding our diabetic daughter. And we would have to find someone to help either way. But it would be much, much easier if she was just in the next room in proximity where I could help or give advice as needed.

Typically, in a hospital birth, its an overnight stay so it would be asking for a lot. But still even if we did homebirth, we would need to plan for a just in case trip to the hospital, so I agree its probably an equalizer either way.

To me, adding all of this information up seems like a homebirth is out of the question, but my wife really wants the homebirth and the midwife we talked to (this is someone new who does homebirths, the midwife who previously delivered our babies works through the hospital and I strongly believe would be pretty against us having a home birth) seemed open to the idea we could do it despite our history.

Two additional points about both of our ICP births. Even they they were inductions, all that was done was she broke my wife's bag of water. She basically immediately went into labor both times. And she was already dialeted to a 5 (36 weeks with our son 37 weeks with our daughter).

And it was all natural from there on out. So, in theory, this could have been done at home.

Anyway, thanks for the info. Very informative comment.