By law, women are allowed a two-day hospital stay after giving birth.
Hoping to avoid any hospital stay at all, I decided I wanted a home birth for my third child, which would free me from the hospital constraints of being tethered to an IV, strapped to a fetal heart monitor and confined to a cold, sterile, unfamiliar room. A home birth would mean laboring in the comfort of friendlier confines, with our Jacuzzi tub at the ready whenever I needed relief. It would mean walking or lying wherever I chose, and plenty of options to get comfortable. It would mean all the comforts of home without packing a suitcase — seeking relief by hunkering down in our gliding rocking chair, gripping my favorite pillow. It would mean Ross and Ben, my 3 1/2-year-old twin sons, would get to meet their new sibling minutes after the birth.
Instead, I got a three-day hospital stay.
My experience is a perfect illustration of why home birth is so safe. In a study reported in the January/February 1999 issue of the Journal of Nurse-Midwifery, 2 in every 1,000 home births (with certified nurse midwives) resulted in the death of the baby, either during labor or within a month after birth, compared with 2.2 deaths per 1,000 hospital births. Other studies have confirmed that the home birth and hospital safety rates are not statistically different. Every year, about 1 percent of births in the United States take place at home.
Home birth is so safe because not everyone is eligible.
Including, as it turned out, me.
Granted, anyone could have a home birth if she chose — our foremothers did it all the time. But today, most home-birth midwives or doctors will tell you there are a number of requirements for giving birth safely at home. I planned my home birth with Alivio Medical Center, on the Near Southwest Side of Chicago, which follows these medical guidelines for exclusion from home birth. (There are a handful of Chicago-area practitioners who do home birth, and guidelines may vary somewhat by practice.)
– High-risk pregnancies (multiples, placental problems, etc.).
– Medical complications before delivery (such as diabetes, or severe anemia) or during labor (such as extremely high blood pressure).
– Prematurity–going into labor before 37 weeks gestation, which is generally considered term. A normal pregnancy may last anywhere from 37 to 42 weeks, with 40 weeks being the statistical average for giving birth.
– Baby in the breech, or derriere-down position. Most of those babies are delivered by C-section, which must be done in the hospital.
– Bag of water that has been broken more than 24 to 36 hours. When the bag breaks, the baby is no longer encased in a protective cocoon, and the risk of infection–for baby and mother–increases as time lapses.
My water broke at about 37 weeks. It was a shocker, considering I’d gone 38 weeks with the twins, at which time my labor had to be induced because my blood pressure shot up, causing a life-threatening condition called pre-eclampsia. As it was, it took two days to induce labor.
But in this pregnancy I was far enough along that a home birth was still an option. Assuming I’d actually gone into labor. I tried drinking a castor oil/orange juice slushy, a midwives’ remedy that for generations has been known to get labor going. In my case, though, no go.
I tried walking. I tried visualization–imagining my uterus contracting, or at least, what I thought it would look like contracting. I kept picturing an accordion being squeezed, which planted the tune “Lady of Spain” in my head, but did not deliver a baby.
Nothing helped.
At about the 36-hour mark, my certified nurse midwife and director of midwifery at Alivio, Ceal Bacom, delivered the bad news. Sorry dear, but this will not be a home birth. Pack your things and head to the hospital. A good friend, Ceal sounded as disappointed as I was.
But the one thing they tell you about giving birth is this: Go with the flow. It doesn’t always happen the way you expect and you shouldn’t let a change of plans ruin the birth.
So I didn’t. I had a wonderful birth experience, albeit a prolonged one. I went to the hospital, was given an IV and was put on antibiotics (to combat potential infection because my water had broken more than 24 hours before) and pitocin, a drug that makes the uterus contract and, ideally, prompts labor.
I’ll spare you the details, but I will say it took almost two days.
I finally gave birth to Wilson Paul, our third child. The hospital room was comfy and I used the bed, chair and, finally, a “birthing stool” that looked like a tiny pine bed. Ceal delivered the baby. It was vaguely similar to a home birth–just not at my home. And it really was very nice.
Originally, I really hadn’t considered home birth. Ceal–who has delivered some 50 babies at home and hundreds more in hospitals–suggested it. My husband, Burt, and I gave it a lot of thought and asked a lot of questions.
Burt was particularly concerned about two points:
1. Safety. I nearly passed out due to blood loss immediately after the twins were born. Ceal assured us that she and her assistant always go to births prepared with things needed in certain situations–oxygen for mother or baby, medications to control bleeding after the birth if needed, IV supplies for the mother in case she needs to be transferred to the hospital in an emergency. They also have all basic medical supplies, including surgical thread and needles for suturing the perineum (the skin at the base of the vagina, which sometimes tears during the birth).
In an extreme emergency, it was reassuring to know we were only four blocks from a good hospital. We figured it would probably take us less time to get to the emergency room from home than it would take to get wheeled from my hospital bed to an operating room.
2. The mess. Ceal told us how to prepare for cleanup. We bought a shower curtain and put it under the sheets on our bed. And we were prepared to use (and perhaps toss) a number of our less-than-guest-quality towels.
The list of supplies I needed to have on hand included a supply of disposable pads to place on the bed; a thermometer to take the baby’s temperature as well as the mother’s during labor in the case of a broken water bag (monitoring for infection); sanitary pads for postpartum bleeding; ibuprofen for postpartum pain; a bulb syringe to suction the baby’s nose and mouth; a set of old sheets to cover the bed; blankets; washcloths to soak in hot water and use as heat packs during labor; and plenty of food and drink, not only for the laboring mom, but for the midwives (generally two are present), who may be at the house for a day or more.
Ceal noted that the midwives can do all of the postbirth testing and evaluation of the baby and mother that is done at the hospital (some things are optional). The baby will have a PKU blood test (which tests for a variety of potential metabolism problems), can be given a vitamin K shot to combat potential bleeding, and can be given antibiotic eye drops to prevent infection. The midwives do a complete physical examination of the baby after birth. Before they leave the home, they make sure the baby and mother are stable and that the baby is nursing well. One of the midwives makes a home visit the next day, and three or four more home visits during the next several weeks.
That’s particularly nice in the first few weeks after the birth, so you don’t have to schlep your labor-weary body and a wee tyke to the clinic every few days. I got to take advantage of that, even if I didn’t get the home birth. (A planned home birth also means prenatal visits at home from 37 weeks gestation on.)
I liked the idea that Ceal would monitor the baby’s heart rate every 5 to 15 minutes during labor, and every 5 to 10 minutes while I was pushing, rather than strapping a fetal monitor on me and leaving it there, as is standard in the hospital. Not only is it uncomfortable, but it has to be detached each time you go to the bathroom, which is quite often because of all of the fluids you drink or receive through an IV.
At home, I would be free to eat and drink as much as I liked. In the hospital, laboring women are often limited to ice chips, in case they would have to be sedated in the event of a C-section.
My husband, sentimental guy that he is, was worried that if the baby was born at home we would be compelled to live in the same house the rest of our lives so as not to sever the connection to the birthplace. (Our twins love to point out their birthplace, Rush-Presbyterian-St. Luke’s Medical Center, every time we pass it heading down the Eisenhower.)
My mother, who had agreed to be on hand to watch the twins, was worried that the boys would get upset when they heard me scream during labor (and believe me, people up and down the hallway at the hospital heard me).
You never know when and how fast the birth will happen. Often, the kids are asleep, Ceal noted. Some people even choose to have their older kids attend the birth, although I rejected that notion, mostly because I didn’t want to have to deal with “Mommy, can I have a snack?” in the middle of a contraction.
Ceal always recommends a backup plan for the kids, particularly if they are younger. In the middle of the birthing process, the parents may decide they don’t want the kids in the house, so it’s helpful to have someone who could take them for a walk, or a neighbor who will take them in for a few hours.
It’s nice to have the siblings meet the new little one, whether immediately after the birth, or an hour or so later, once the parents have had some alone-time with the baby.
“In the hospital, so often the baby gets whisked away right after birth, but the baby belongs to the family,” Ceal notes. “In this society, we really underestimate the baby’s bonding with the family. A home birth offers that immediate bonding.”
I was a little worried about insurance coverage. I called my provider–a large insurance company–and was told home birth was not covered. Ceal assured me that, although that was a common response, most claim consultants were unaware that insurance companies most often do pay for it. It would have been billed through the clinic.
After weighing the pros and cons of home birth, we had decided we liked the idea, although I admit I was a little nervous about having no pain medication available (I had an epidural with the twins). But Ceal noted there are several relaxation skills that can help. And hot towels, heating pads and massage can do wonders. Using those techniques with Ceal’s constant encouragement, I was able to give birth “naturally” (if we can forget for a moment about being induced with pitocin) without benefit of any pain medication.
What really sold me on home birth was a story Ceal told about delivering her neighbor’s baby at home. The woman’s mother-in-law was on hand to watch the older kids, and was rather skeptical about the concept of a home birth. After the baby was born, the mother-in-law confided to Ceal that the birth was one of the highlights of her life.
I couldn’t pass up that chance.
At least not if I could help it.
