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home birth

Considering home birth: part 4

What about the pain?

Whether you’re expecting your first baby or your fourth, it’s normal to feel a sense of trepidation when considering the actual birth. I remember very clearly being about seven months pregnant with my first baby and looking down at my belly that I knew would only get bigger and thinking, “this is really going to come out of me somehow?” I wouldn’t say I was in a full-on panic, but I was definitely worried.

Along with the normal maternal worrying is our cultural fear of birth, and we commonly hear expressions that lead us to believe that birth is the most painful thing that a body can experience.

Is it really, though?

I have a problem in my low back that is chronic, expected to get progressively worse as I age, and can sometimes be excruciating. I had one of these acute flare-ups a few years ago just before my daughter graduated from high school, and it was one of the most severe I’ve experienced yet. I cried at the thought of moving, going from sitting to standing, or standing to sitting. Bending down to pick up a dropped item was impossible. Getting in and then out of a car was a ten minute ordeal on each end. Pain was nearly constant, with no promise of an end, and I wasn’t getting a sweet cuddly baby out of it. As a person who normally avoids even common over the counter medications, I was willing to take any pain medications that were offered to me, so that I could begin healing. This experience was decidedly worse than giving birth by a country mile.

I’ve heard people describe other injuries that again make me question our notion that birth is the worst pain of all. My normally mild-mannered brother-in-law was not at all mild-mannered when his shoulder dislocated. The re-location procedure was probably a ten on the ubiquitous pain scale, given the colorful language that ensued during the event. Other medical and dental complications can be incredibly painful, and again, with an uncertain end, with the only reward in the end being going back to normal. A good imagination and a lengthy reading list that includes descriptions of war and violence, could lead any thoughtful person to see that the human body can and regularly does experience much more painful events than normal vaginal birth.

Is pain necessarily a bad thing?

If a friend were to tell you than she is training to run a marathon, you would not likely respond that she shouldn’t try to do it. She will probably experience some pain pushing herself to run farther than maybe she’s gone before. She may become injured training, or during the event, and she will probably be pretty tired after the race. Just the simple fact that she may experience some pain and discomfort would not be a reason to try to dissuade her from her desire to take on a big challenge.

Pain in our bodies is a message:

  • Take your hand out of the fire!
  • Get your shoulder back in its socket!
  • Your teeth need some expert care!
  • Good for you for exercising some unused muscles!
  • Take it easy so your muscles don’t get injured!

After many years of supporting women in pregnancy and birth, it seems true that the pain in their bodies is messages to them. Round ligament spasms, low back pain, and headaches remind us to stretch and exercise, be careful of how much and the manner in which we lift heavy items, and to stay nourished and hydrated. In labor, too, bodies speak and instincts listen. Contractions may make a woman get on her hands and knees and sway during them, which is brilliant for helping the body to open and the baby to descend. The myriad of sensations experienced during birth can help a woman to discern how far along she is in the process. And, sometimes her pain can signal that something is wrong and needs medical attention.

There is so much information in the world right now about the “right” way to be pregnant and give birth, and there’s a lot of moralizing around women’s choices. And, I must admit, at one time I felt pretty militant about un-medicated childbirth, and I was on a crusade of sorts to “save” women from pain medication. The truth of the matter is that on the scale of “Painless Orgasmic Birth” to “Birth Is The Worst Pain Imaginable,” most women’s experiences are somewhere solidly between the two extremes. (By the way, I support Debra Pascali-Bonaro’s work, appreciate her joyful spirit, and think she has a lot of good things to say). So, while I think that planning for a pain medication-free birth is reasonable, and have seen many women birth without pain medications, it’s also reasonable to consider that a positive outcome can be the result of a medicated birth.

In my experience, an un-medicated birth is more likely achieved with some preparation ahead of time. Preparation could include: childbirth classes, engaging the services of a doula, doing some soul searching, keeping yourself healthy, fit and hydrated, and being willing to accept the uncertainty of the process.

Taking a childbirth class, focused on natural birth is a great asset to a family expecting their first baby. It’s great to be in a group with other expectant parents, to hear their questions, and to begin to cultivate community. If you can’t find a local childbirth class, then do read all that you can, and your partner should, too, so that you are both on the same page regarding options and understanding what the process might look like. I still really like The Birth Partner by Penny Simkin. If your partner is only willing to read one book, make it this one.

A doula is a support person who is hired separately from your midwife to provide information and physical and emotional support during labor and birth. There is good evidence supporting the work of a doula, especially if your goal is to have an un-medicated birth with few interventions, and even if you are planning a home birth with a midwife. It is an additional expense, but I’ve not known a person to regret having this helpful and knowledgeable person available at their birth. There are many certifying organizations; take a look and see if any fits your personal philosophy and then see if there is a doula certified in that method in your local area. (Please note: the links provided are not an exhaustive list, only a starting place. I am not affiliated in any way with any of the linked organizations, and this is not necessarily an endorsement of their programs.)

Home birth is not for everyone; a bit of soul searching and understanding yourself might help you to decide if this is the right choice for you. How do you experience pain and sickness? Childbirth isn’t an illness, and it may not be the worst pain you can imagine, but you will likely experience some pain. Even women who describe their births as easy say that they felt pain. Do you have a good support system? Will you be able to relax in your home? Have you experienced past trauma, sexual assault, or abuse that may make pregnancy and childbirth additionally challenging? These are all great topics to take up with your care provider, your partner, and any other support person you will have with you for the birth.

Much has been written about keeping yourself healthy so that you can be as low risk as possible during your pregnancy and birth. I will not expound on that topic here; suffice it to say that nourishing yourself and your baby with good food, plenty of water, fresh air, relaxation, gratitude, and play can go a long way to experiencing your birth positively.

Labor and birth are an unknown, for every woman, every time. It is not a process that is easily controlled. In attempting to control it, we may alter it and create additional problems. While a medicalized birth experience may be right for you for many reasons, it is also worth considering if you want to embrace the untamed delight that can be home birth.

 

~photo credit Fox Valley Birth and Baby

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Considering home birth: Part 3

What about the mess?

This question often comes up in a consultation with families considering home birth, and it’s definitely a legitimate concern. Birth comes accompanied by a variety of bodily fluids, and it’s reasonable to be concerned that your mattress or carpeting won’t be wrecked in the process.

The answer is pretty simple: we clean it up, and we’re pretty practiced at it. We will protect your furniture and flooring with under pads from your birth kit, we will have you supply some old towels, and you will end up with one garbage bag and one bag of kinda yucky laundry. We pre-treat and start the laundry for you before we go, so someone will just need to plunk it into the dryer later. Hydrogen peroxide is a miracle worker when it comes to getting blood out of fabric. There’s a bottle of it in your birth kit, but you may want to have more on hand. If you don’t have your own laundry machines, we can talk in your appointment about how to manage this aspect of a home birth.

Next up: pain

 

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home birth

Considering home birth: Part 2

I know no one wants to think about possible complications, and some people even believe that if we talk about complications we will somehow invite them to happen. It seems reasonable, however, to consider this topic carefully when deciding and planning on a home birth. Preparing for something doesn’t assume it will happen, but it allows us the freedom to relax and release that worry, and also for us to feel confident if something unforeseen does happen. Key concepts here are prevention, management, and transfer.

Prevention: From your first prenatal visit, your midwife is thinking about who you are, what are your particular risk factors, and are you a good candidate for a home birth. We partner with you to have a healthy pregnancy and encourage you to eat well, exercise, relax and get good sleep. While we can’t control some outcomes, even if we “do everything right,” we can lower the chances that something will go wrong in the birth if we are mindful about our self-care. (This goes for pregnancy and all of life, including for midwives!). As a partner in your own care, you can assist this process by being honest with your care provider about your health and reproductive history, your lifestyle, and the things that you feel worried or concerned about. Appointments with home birth providers are typically scheduled for 45 minutes to an hour, so you should have plenty of time to share all of your concerns. It is absolutely to your benefit to learn all you can about natural childbirth, so that you can understand the process, and anticipate a likely course of events. Many families do this by reading books; I think an ideal companion to reading is attending an in-person childbirth class that is specifically focused on preparing for un-medicated births. Ask your midwife for local recommendations.

Midwives and other practitioners who work according to the Midwives Model of Care tend to avoid unnecessary intervention, which is another facet of preventing complications. Consumer Reports has recently done a nice job of summing up some of the biggest interventions that are high risk as well as high cost for mothers and babies. In short, interventions introduce additional risk. Sometimes that risk is warranted, as in the case of a mother or baby in distress, but many times that additional risk could be avoided.

Management: Home birth providers are trained in dealing with the typical complications that could happen during birth, including handling of hemorrhage, resolution of shoulder dystocia (baby being stuck after the birth of the head), stitching up perineal tears, and performing newborn resuscitation. Typically, midwives carry an array of supplies to assist in the management of these possible outcomes, such as anti-hemorrhagic medications, IV supplies, resuscitation equipment, and suturing supplies. Check with your midwife about her personal equipment, skills and supplies.

Transfer: Fully participating in prenatal care, having lab work and necessary ultrasounds performed can help to show that you continue to be a low-risk candidate, and that it is appropriate for you to plan to birth at home. Transfer of care to a higher level provider with more equipment and tools at their disposal may become necessary at any time in your pregnancy, during labor or in the postpartum. Again, your midwife is trained to continue to gather information and assess for potential risks that may be presenting. There may be something that comes up in your care that requires your midwife to consult with a hospital-based provider, or requires you to be seen by that provider. This may impact the decision to birth at home. Ultimately, everyone’s goal is to have a healthy outcome for mother and baby, so even if it has always been your dream to birth at home, a hospital birth may be the most reasonable option for you. Transfer during labor or in the immediate postpartum may also become necessary, and requires safe transport for mother and perhaps baby, if the birth has already been accomplished. Clients should consider this a possible outcome, and participate in the planning of potential transfer by identifying the closest hospital, and finding out what ambulance company serves your area.

What happens if the cord is around the baby’s neck? I really like this article about this topic. Long story short, a cord around the neck is very common, found in about 1/3 of babies. Dr. Rachel Reed has done a thorough review with thoughtful analysis of this topic. It may be that around the neck is a safe place for the cord to be, so that it doesn’t get compressed while the head is coming through the birth canal.

Hopefully, you feel reassured and confident in planning a home birth, as well as managing possible complications. Feel free to post questions in the comments.

Next: What about the mess?

~photo credit Fox Valley Birth & Baby

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home birth

Considering home birth: Part 1

When I was pregnant with my first baby, I was surrounded by family who had already had babies. I’m aware that this could be both a blessing and a curse, especially if all the family members aren’t on the same page as far as their thoughts and opinions on the options for care for mother and baby. Fortunately for me, my family and my husband’s both are full of people who can respectfully agree to disagree, and the issues that created actual tension were pretty few and far between.

An avid reader, my bedside table was stacked with six or more books at all times, and I read them all during the pregnancy. While I was setting my sights on a vaginal birth without pain medications, I definitely wanted to give birth in a hospital. There were many reasons for this, including concern about complications, a fear that perhaps I would need pain medication once the labor was an actuality and not a mental exercise, and, to be honest, a worry that my home (a rental flat) would be a biohazardous mess that would cause us to lose our security deposit.

When newly pregnant families come to me for a consultation, these are often their top three worries. Typically, one partner is more convinced of the idea of a birth in an out of hospital setting, and the other partner thinks perhaps s/he is in an alternate universe because, doesn’t everyone just go to the hospital to have their babies? I will take up these three common concerns in a series of upcoming blog posts. Stay tuned for information about what if something goes wrong.

~photo credit Fox Valley Birth & Baby