continuity of care, Doula, home birth, homebirth, hormones, hospital birth, intervention, midwife, oxytocin, partogram
Someone at work asked me how our whole home birth plan is going.
‘Uh, yeah, it’s going, looks like it might be a possibility.’ I smiled.
He asked a few more questions about how I was doing, next scan dates etc. always with the same, unsure grin. In the end I had to say,
‘It’s all ok. It will be ok, I’ll keep you posted.’
I think maybe this whole concept intrigues him. He probably simply wonders why. My answers are simple and complex, straightforward and at the same time impossible to convey. I have often been caught without the words to describe what I believe and feel. I am fighting a learned urge to conform and please people that I look up to. But I do have my reasons. I’ll start with the simple answers, the logical reasoning behind my choice.
Initially I was going to opt for a private hospital birth. I was seeing a private fertility specialist, I had private health cover – I was offered the options of the private obstetricians in my area as the next normal step. Both Todd and I liked the idea of a homebirth and had briefly mentioned it to each other, but being our first baby and that we live 20 minutes out of town, we just pushed it aside as no option. I had seen home birth videos before and the beauty and magic of it had always stuck with me. Late one night I happened to stumble across another one. I watched glued to my tiny phone screen. I was hooked, maybe this was possible after all. I asked Todd the next day and to my delight he jumped at the chance to explore this option further. We searched for and found Lynda our Doula and the rest has been evolving since.
This is not intended as a reference piece. It is more a summary of my information thus far from articles, books, podcasts, DVD’s and my reasoning.
Firstly and most importantly to me: statistically for low-risk pregnancies there is no greater risk of a planned homebirth over hospital birth. I’ll say that again, there is no greater risk for home birth. One of the arguments that is regularly presented to me: why would you risk it? For every horror homebirth story there are hundrends if not thousands of horror hospital stories. These women are left to blame themselves, their bodies and as one beautifully states – no one but them is left to pick up the pieces. Lack of attachment, unsuccessful breastfeeding, post natal depression. The stories are there once you start to open the dialogue. Women are crying out on forums, chat groups, and responding to stories. Soft, immeasurable outcomes – I think not.
One of the first alarming statistics I have seen is the Caesarean rate in our hospitals. Let’s just say it is much higher than recommended. I have no doubt this is any different from most Australian hospitals and the recent release of statistics in WA correlates. The World Health Organisation (WHO) recommends a caesarean rate of 10-15%, and it has been shown that approximately 15% of medical caesareans (those not electively chosen by the Mother) are without reason. So why are our rates so high? There is great debate, but one explanation – the cascade of intervention. One seemingly small intervention, leads to another, leads to another ‘complication’ or measure outside of the set partogram, which leads to another intervention – you see the progression.
Lynda took the time to explain to us, the natural progression of labour and the hormones that are released at each stage which both Mother and baby need for labour to progress. She also explained a few things that might alter this release and enlightened us of things we could do to help keep things on track. It just made so much sense. It is too much to go into and there is a wealth of information available on the subject from reputable sources that a summary here will not do it justice.
On the subject of Lynda, it has been proven that the continuity of care provided by a Doula decreases caesarean rates. Again, it just makes sense to us to have someone experienced, who we know and who knows us, in our corner. To remind us of things we can do, try, to reassure us. To have someone who has been on our journey with us and knows our beliefs and goals. To remind us in the hardest times, why we are here and of course watching the entire progress, to help us achieve a positive birthing experience, however the cards may fall.
In the system we have today, in large public hospitals, the birthing midwife may be someone you have never met before (unless there is midwife/client allocation). Your private obstetrician may not be present in a ‘normally progressing’ labour. There may not be any chance of continuity of care from pre-natal care to labour, or even for the duration of labour depending on shifts. Don’t get me started again on birth plans and the lack of attention or care paid to them. For us, we know that Lynda will be with us for the duration of the journey – feeling reassured by this is an understatement.
I work in a hospital, I nearly wrote live then and sometimes it does feel like it. I am comfortable there and I am probably more equipped than most to deal with going into hospital calmly. But being a patient is different. We/they/the system, takes away most identifiers of yourself, you are in an unfamiliar situation, you have to rely on the information being given to you. Someone tells you all about your mind/body/experiences and what is happening to you. Every aspect of your normal life is altered from diet to toileting.
The very act of admitting to hospital is, in a way giving over of yourself. Still in this day and age we expect paitients to be ‘good’ and compliant, and for many (myself included) there is this desire to please and live up to expectations. Is it any wonder women feel out of control? For me, my house is where I am most comfortable. I am used to making decisions here, I am used to making choices. Again it makes complete sense to me that this is the place I would feel most calm and in control.
Hospitals have bright lights (all the better to see you with my dear), monitors (all the better to hear you with my dear) and swinging open doors (all the better to…. keep an eye on you my dear?). The release of oxytocin needs a calm quiet, preferably dark environment to release and best take effect. Women need to go ‘internal’ as labour progresses. Is the hospital the best environment we can choose to foster this?
To go back in history it wasn’t that long ago that the horror stories of Twilight births were the norm. It wasn’t that long ago that Mother’s were prescribed Thalidamide for morning sickness or recommended routine X-rays to track a babies growth during pregnancy. Do we take too much that is recommended as ‘safe’ for granted? Are the antibiotics/pain relief/ artificial hormones now used routinely in labour affecting our babies in the future? I don’t think anyone knows the answers yet, but for my money it is worth asking the questions and avoiding if possible.
I have been reading the book ‘Gentle Birth, Gentle Mothering’ by Sarah J. Buckley, MD. The section on undisturbed birth and the gammet of hormones, endorphins and adrenalines that circulate and dance together in both mother and baby during childbirth is truly amazing. I don’t want to miss out on this and I certainly don’t want a man-made synthetic version designed to replicate the process. It is seen the world over that man does not imitate nature better than Mother nature herself.
My body was lacking the ability to reproduce naturally. I wonder, but do not know, if in the long term I would have conceived without help. I am incredibly grateful to the medicine that helped me to conceive, and I am not intending to disregard this. My point is this. I need to give my body every possible chance I can to conceive again. I need this hormone surge to perhaps kick-start my system. I need to expose myself to the best of nature if I can and I need to give my family the best chance of having the family we want. It may not be proven that this will work, it may not have been dissected in the research that a natural birth will help, but I have to give it a chance.
During the final stages of birth both Mum and bub share in a huge rush of the ‘love hormone’ oxytocin. This is why the first few moments of bonding and attachment are so prescious. All those love hormones fluttering about making baby wide eyed and looking for Mum and Dad. I have for a while now laughed that the three of us need our alone time straight after birth just to stare at each other for an hour or so, and how true it is. With all the natural highs and love going around, I want to embrace it with my new family. I want to marvel at each of us. I don’t want someone to take my baby away because of schedules and routines. I don’t want to miss out on those prescious moments that can never be replaced. They talk about ‘soft outcomes’ often being ignored in research. The importance of this doesn’t seem very soft to me.
This leads me beautifully into the intangible reasons that are closer to my heart than my head.
Firstly both Todd and I believe women’s bodies are made for this. In Todd’s words ‘I don’t understand why people find it so hard to believe in something that women all over the world have been doing forever.’ As I’ve said time and again, it just makes perfect sense to us. I read a book about birth in other countries and cultures and have been lucky enough to witness birth in Papua New Guinnea. I find it so interesting, the cultural idosyncraies that we in the Western world find strange. Yet when I put some of our customs into the context of a foreigner I can see how bizarre they are as well.
I have been squatting a lot recently with all the cleaning and restorations. I laughed to Todd that I am going to be able to squat this baby out like they do in the fields. Ok, so not so culturally correct, but I know in my mind I like the idea of feeling closer to women of all the world, bonded in this one experience.
On average the Pygmy women stand four foot something and their babies weigh eight pounds. They do not get told they are too small. Their feet are not measured as an indication of their pelvis size (?!). They have their babies naturally, with two women midwives in attendance, by the river. http://primal-page.com/pygmy.htm. I am short by our western standard – apparently this is enough to warrant the ‘inevitable’ Caesar in our society.
Our home is where I feel comfortable. I am supported and it is our place. It is the place that Todd and I have learnt of each other and built love. Part of the home birth magic for me is that we are sharing this with our baby. We are welcoming our baby into our world that we have built and that we love. It is not about us bringing home an addition in a few days time. Our parents and family get to come to our home and meet our new family. Hey, like I said its intangible but very real to me and I make no apologies. This comes from somewhere deep inside and it feels good to recognise it.
This post resonated so much with me Ker. The need to birth in a calm, quiet and dark room us an overwhelming urge for me. In such a vulnerable state it is an string instinct to go into the ‘cave’. I was ridiculed by an obstetrician for insisting the lights be off and only being able to stand the gentle dappled light coming through the curtain. Ridicule away, when he develops the ability to give birth to a human being then we’ll talk.
Sorry for typos on my phone
I love this Krist! You have such a way with words 🙂