As I get closer to giving birth to my daughter (!) I am putting more thought into what that process will be like and how I can best be prepared for it. I am lucky to have a lot of women in my life that have had all kinds of birthing experiences they can share with me. Although I am personally not going to have a home birth, two of my friends have had one and I was curious about the ins and outs of that process, why they chose that route, and what it looked like for them.
My cousin Rebecca was gracious enough to answer some questions for me about her home birth, which was an amazing 50+ hours of labor and also a successful VBAC. She is a true warrior in my eyes and even though a home birth is not for me, I think her outlook and experience with birth is really inspiring so I was excited to read more about it. The more times I read this, the more it inspires and encourages me in doing a natural birth and in what amazing creatures women are! I’d like to make it clear that Rebecca is a cousin and friend of mine and has put herself in an obviously vulnerable place by sharing her experiences on what can be a controversial topic in such detail. Neither of us mean for this to accuse or belittle anyone in their own particular birth choices.
As someone who has never gone through this process yet but has already received criticism or sarcasm for wanting to go naturally, I know it can be scary and sticky to bring up birthing in a public forum (Just talk to my husband Sean, who has a lot of positions on birthing as an internist that aren’t always aligned with mine!) I ask that if you have anything to add or respond to, that you do it respectfully. It’s long, but as someone who is about to go through this process I appreciated her details!
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1. How is a midwife different than a doctor, and what’s a doula?
Many OBGYNs have a heart and desire to help women give birth. They are trained surgeons, so they may often look at a problem as having a surgical answer. Many OBGYNs desire for their clients to experience more positive and normal births. However, hospital protocol and politics, insurance companies, fear and tradition may prevent this from happening.
A nurse midwife works under or alongside physicians in a hospital or birthing center. Nurse midwives may also have independent practices or help women give birth at home, depending on state regulations. A nurse midwife has a degree and her nursing license is regulated through the state. She is able to provide basic gynecological care. When it comes to natural, low risk birthing, midwives often have much better outcomes than physicians.
Lay midwives (or direct entry midwives) have years of experience, wisdom and patience from attending natural births in the home or independent birthing center. They may have been apprenticed by another midwife and/or choose educational certification through specialized schools and organizations. Many continually educate themselves to keep their certifications current, some states also regulate lay midwives. Many states do not have any laws protecting lay midwives, and some states even outlaw them. This may leave them open to prosecution by the state for practicing without a medical license. The U.S. is one of the few places in the modern world to have outlawed midwives. Most women in the world still give birth with an attending midwife.
If you would like to learn more about midwives practicing in the US, here is an excellent article,http://mothering.com To learn more about caregivers and birthing in the US, watch the informative documentaries, The Business of Being Born and More Business of Being Born on netlfix instant or visithttp://www.mybestbirth.com/
The word doula comes from the Greek, for “servant”. A doula is usually a professional who learned her trade through apprenticeship and/or certification through a program. She may work with an established midwife or physician or may work independently. She will attend births in any setting. She is there to serve the family in any way or manner they would be comfortable with. Like a midwife, she may have much experience with natural, normal birth. She helps to ease the mothers discomfort and work with her body toward labor progression. She is knowledgeable and can provide information for parents about birth interventions and support their decisions. She does not take the place of the father, but rather helps and encourages him, so that he may better help the mother. She makes no medical decisions and does not give any medically related care. She is invaluable to the birthing team. To find a doula in your area or to learn more, visit http://www.dona.org
Here is a list of questions to ask a potential caregiver http://mothering.com/ A mother should remember that a caregiver is a person or place HIRED to assist. They are receiving payment to help the mother, the mother is employing THEM. Therefore, a mother has the right to change care providers or place of birth at any time during her pregnancy if she is feeling uncomfortable or just has a gut instinct that the situation may not be right for her.
2. I am interested in “going natural” but don’t feel like I totally know what that entails – can you give some honest feedback on what that was like? How did you cope? Is a midwife a good idea if I do go natural, even in a hospital? Would you do it again? (Sorry, I have lots of questions!)
For me, natural birth meant being drug free (pain medication, epidural, pitocin) and also intervention free (no episiotomy, assisted vaginal birth, cesarean section, etc.)
For me, responsible birth meant Mat and I being proactive, not passive. To prepare for the homebirth, we educated ourselves about options and assembled a birth team that agreed with our birth “philosophy”. We were well-informed when making decisions and we were not coerced or intimidated when making decisions. We were both involved (once again, not passive) with the birth mentally, physically and emotionally.
I coped by changing positions- a LOT! I was walking in the store, in the neighborhood. And later on walking the stairs, sitting on the toilet, floating in the birthing tub, hands and knees, squatting, standing with support… I was also able to cope by use of the water in the birthing tub to relax. And my husband and birth team were AMAZING. I had terrible back labor and each contraction there would be someone to press into my back with their fists. Wonderful, wonderful counterpressure.
The journey of birth is really just one contraction at a time. Each contraction requires a new surrender. I would consciously relax my entire body and clear every thought. And at the beginning of the contraction I would think (because there comes a time when you cannot speak) “God is good. This contraction is good.” Sometimes that’s the only thought my brain could process because I had to keep concentrating on relaxing my entire body. If I got tense or was not mentally prepared to face a contraction it hurt worse. Other times I would visualize my cervix opening in waves, like the rippling of water or baby’s head pressing on my cervix and baby moving down, down, down. Other times I would think about what it would be like to hold baby or I would think about baby’s feet and what it would be like to kiss each tiny toe. These things sound so weird! But they helped! The Bible verse “My grace is sufficient for you, My power is made perfect in weakness” kept moving through my mind. Imagine! My weakness right now was perfecting Christ in me! I did not have to be strong because Christ is strong for me. I would also think of Jesus on the cross-if He could do that for me I could certainly do this for Him! In whatever we do we should give it to the Lord. When we allow Him to carry us, the painful becomes bearable. I think Jesus met most of my needs through my husband. Mat was strong for me when I could not be. I also thought about the heroes of the hall of faith in Hebrews 11. Those were all normal people who God used in amazing ways because of their faith.
The sensation of pushing the baby out is a wonderful relief, it is almost enjoyable. There is a lot of pressure and burning which is completely normal, but you can’t NOT push. It feels good to push! Pushing that baby down is the best high ever. I felt like I was so IN my body but completely absent from my body too. Like I was watching a movie, like someone else was doing this incredible work, but I was so aware of every touch, sound, smell-every sense was heightened. The best moment of my life, better than any drug, better than an orgasm.
I lost sense of time and everything in the world melted away during labor. I had never been so aware of my body EVER. We as women learn to hate and ridicule our bodies, but the way God designed birth, it connects us to our bodies like nothing else. Even with the pain, I wouldn’t trade that journey for anything because it allowed me to love and appreciate my body in a way I never had before. I now feel like I can do anything.
If your question [of going back and choosing how to give birth again] refers to the pain of a natural childbirth, for myself I WOULD CHOOSE NATURAL BIRTH EVERY TIME. The first thing we must understand about pain is that it is related to our emotional and mental state. When I was in the hospital, it was a very fear-based environment, so my pain was very great because I was made to feel afraid. I eventually had an epidural and I was not myself. I was unaware what was happening and I could not move or feel my lower body. It was awful. At the homebirth, I was not screaming or crying in agony or writhing on the bed like I was in the hospital. At home, I was very much in control mentally and emotionally so I was able to manage the pain. I CANNOT EXPRESS ENOUGH THE IMPORTANCE OF HAVING SUPPORTIVE PEOPLE AROUND YOU DURING LABOR. God used my husband and helped me find a birth team who believed in me and were there to help me realize my dream of a satisfying birth, and THAT is how I was able to cope with the pain. Any fear that is present will certainly find its way to the mother to play on her emotions or mental state, this in turn, will create more pain. Fear and anxiety can also stall a labor.
Physicians are trained to care for high-risk clients, and they are incredibly necessary in those situations. However, the majority of women (85%) in the US are not high risk. When it comes to low-risk mothers, trained professional midwives have much better outcomes in morbidity and mortality for mother and baby than physicians. I think it may be because midwives are more experienced and patient when dealing with natural labor and are not quick to use medical interventions. Remember, every medical intervention carries a risk of injury and/or death to mother and baby. Most physicians in the U.S. have not attended a completely intervention-free natural birth. Many new physicians today are also not being taught important skills such as how to attend a breech birth, vaginal twin birth or use forceps. I would recommend to any woman to see a midwife FIRST, and if you are ruled out as being high risk and in need of a physician, THEN look at your other options. Also, if you are serious about natural birth, hire a doula! Mothers who have an attending doula have been shown to have much lower rates of interventions and drug usage. Mothers with doulas also have higher rates of birth satisfaction and a better chance of breastfeeding.
Many mothers today receive the drug Pitocin during labor. Pitocin is the synthetic version of our own hormone, oxytocin. They both contract the uterus. However, Oxytocin is a natural pain killer that builds and builds as it is continually released during labor. Oxytocin is the same hormone that helped to make the baby-it is a hormone that is released during sex, when a mother nurses a baby or any other “feel-good” moment. It is the “love” hormone that helps bond us to other people. So along with the contractions, our body provides its own painkillers. Pitocin cannot provide this, so then we must have some narcotics or an epidural. I think it would be very difficult to receive pitocin and forego an epidural. In my experience pitocin made my contractions much more painful than my own contractions ever were. Pitocin left me unable to cope because the contractions came on so strongly and quickly. At the homebirth I was able to rest and regroup between contractions, I was unable to do that at the hospital when I was given Pitocin. I would describe my own contractions (without pitocin) as painful, but also manageable and predictable.
There is a risk of injury and/or death to the mother or baby with any drug or intervention used during labor. Often one intervention will have a snowball effect, until every intervention is used and the end result is a cesarean section. This is what happened with my first baby, and to several young women I know. If you are a pregnant mother or partner I would highly suggest educating yourself beforehand and then putting into place a game plan and supportive people to help you achieve your best birth.
3. What made you think about doing a home birth vs. just a natural birth in the hospital?
I knew my chance of having a successful VBAC at a hospital was slim to none. I had to think of an atmosphere and an attitude that was supportive of my birth goals. Home was the best choice for us. It may not be right for everyone, and that is okay. But for us, we felt that even if we found a caregiver that would support our decision to have a natural vaginal birth after a cesarean, that physician or midwife would be unable to stay with me during the entire birth. I knew that when our physician or midwife was not around we may have to fight off hospital staff or hospital protocol. Mat and I were not prepared to stand against the insurance companies, the hospital and staff, and the doctors on their turf. Maybe this is why 90% of women today choose repeat cesarean, maybe they too desire peace and not conflict. Only half of the remaining 10% that actually try for a VBAC are successful. I was well informed that less than 1% of VBAC results in uterine rupture. However, only 1 in 2,000 of the uterine ruptures are catastrophic. Compare that to 1 in 200-400 amniocentesis result in death to the infant. I knew that the stakes are higher with a repeat cesarean than a first cesarean. Placental abnormalities, maternal death, infection and hysterectomy are just a few of the risks that are much higher for repeat cesareans than vaginal births. Mat and I and our midwives still considered me low risk because of the type of scar and the reasons for the original cesarean. I also was in excellent health and the best shape of my life. We also knew I would not be receiving Pitocin or Cytotec at home, which increase the risk of uterine rupture. We did not want a defensive birth or a fearful birth, I wanted to have the freedom to have my baby naturally and peacefully without being threatened or coerced because of the fear that pervades the hospital system. The best place to do that was in our home with trained, experienced midwives.
4. How did your friends and family respond to you doing a home birth?
Mat and I didn’t talk about it a lot with others. When it would get brought up I did not feel supported. Mostly, I think people were just uninformed. This was when I had the most growth in my relationship with God and my husband. When I got low I had to remind myself that my feelings weren’t matching my faith. I would talk it over with Mat or look into the Word of God for the truth.
5. What were your fears going into it (a home birth)?
My only real fear was being transferred to the hospital! There was also another fearful time at the end of the pregnancy when I thought the baby was facing the wrong way. My first baby had been facing sunnyside up, too. I called my midwife and she prayed for me and calmed me down. I placed my trust in the Lord that even if baby did not turn I would still be able to have my best birth. Well, guess what? After 50 hours of labor I was still able to push out a baby that was born “sunnyside” up! If I had not dealt with my fear I would have freaked myself out and been unsuccessful. Also, Through the long labor, I learned there is nothing wrong with my body, God’s design is perfect and I am capable of all things when I place my trust in Him.
6. For you, what were the best things about it (a home birth)?
I would say the growth in my relationship with God and my relationship with my husband were the best.
Also…. FOOD! I couldn’t have labored for 50 hours without good nutrition. Between contractions they were feeding me tiny bites of apples with peanut butter or cucumber and hummus or soup. And always always making sure I was hydrated. You can’t starve yourself and then go run a marathon. So it doesn’t make sense to starve a woman and then expect her to labor and push a baby out! She will quickly become exhausted and unable to cope physically and mentally. After the birth I was not exhausted – I felt like I could go run a marathon! I was a little sore, but otherwise my body didn’t feel like I had given birth. It was wonderful.
Another great bonus was I greatly enjoyed my prenatal and postnatal care, and I believe I received the best. My midwives took an assessment and history when we first met to see if I was low risk. They screened me for diabetes and preeclampsia, closely monitored my diet, blood pressure and weight. My midwives were all about nutrition and exercise! At checkups they would listen to the babys heartbeat and feel for the position of the baby. The checkups lasted an hour not 5 minutes and we all really got to know each other and became quite intimate, I knew I could be honest with them and also ask embarrassing questions! There was time for questions to be addressed and always lots of laughter! Postnatally, my midwives did the apgar score and examined baby just like the hospital would. They came back at day 1 and day 3 postpartum, and we talked on the phone several times to check babys weight. They even answered my breastfeeding questions at 10 pm when I had a screaming baby! I also had a 6 week postpartum checkup. To the birth they brought oxygen, suture kit and other sterile supplies and equipment. They closely monitored the babys heartbeat the entire labor. It was all very professional and safe; I knew I was in good care.
Really quick -I liked that there were no strangers present, no strangers touching me, no machines hooked up to me, no people coming in and out, no loud noises or strange smells, no invisible time clock counting down the hours, people actually looking me in the face and caring how I was feeling, I could wear my own clothes, give birth in the position I desired, I wasn’t confined to the bed, I didn’t have to ask permission to use the bathroom, I got to sleep in my own bed, listen to music, turn the lights down, I could go on and on…
7. How did Mat respond to the home birth, and what advice can you (or maybe Mat!) give to husbands to help their wives through any type of birth?
Mat was all about the homebirth, he did not need convincing and he was my number one supporter and encourager. I prayed often beforehand that when the time came Mat would take his position of authority over me and that I would obey. I would encourage husbands to take that position too, don’t just hand over the responsibility of your wife and child to someone else because they are the “professional”. They may have medical knowledge and knowledge of human anatomy, but you know your wife’s heart and soul. You know what is upsetting to her or how to make her laugh. You know what is best for her. God has placed you over your family to protect them and you bear the responsibility of what happens. Sometimes things don’t go the best or the planned way and that is okay because the Lord has a purpose for everything. But that doesn’t mean you can just step back and be a passive observer; be proactive and educated. And do your best to be gentle, serving and loving towards your wife. Mat was all of these things. He was strong for me and also very gentle, just like Jesus Christ.
And wives, allow your husband to live this role. Many times a man will retreat if he feels he is not needed. Men need to be needed by their wives. Most times if they are given half a chance (this is conveyed mostly by our attitude and words, ladies!) they will step up to care for, provide and protect us. This is the way God intended it, it is meant to be an example for us of the way Jesus Christ cares for His church, and an example of how the church is to respond to Jesus. A wise doula, like my doula, Erin, understands this. She knows how to help the father and mother in their roles, thereby helping to unite the entire family. Erin and my midwives were dealing with the extras (food, phone calls, lighting, towels, hydration, etc) so Mat could be a constant presence for me. Often times she was placing counterpressure on my back so I could hold onto Mat. I desperately needed my husband in this time, and Erin displayed the love of Jesus by serving us both so that Mat could meet that need for me.
At our 6 week postpartum visit, my midwife got teary-eyed. She said in 35 years of experience she had not seen a couple that was such a wonderful team. She honored and commended my husband for his role, she was incredibly touched that Mat never left my side. When we obey God by living in the roles he designed for us He greatly blesses us and others around us. It is a wonderful way to birth-and to live.
8. How would you compare your hospital experience to your home experience?
The two experiences were entirely different, but I was grateful in both instances to have a healthy baby.
And Mat and I grew as a couple with both births. Vivian was born via emergency cesarean section for “failure to progress” and “fetal distress”. I will never forget the first time I saw her-she was held up for me to see- she was covered in vernix and crying- already so apart from me and yet always a part of me. They brought her over for Mat to hold and every feature was so incredibly tiny and perfect, and he said to me, “You were right, her name is Vivian”, which means “full of life”.
Vivian was a planned hospital birth with a physician; I had wanted to go natural but had no idea how to go about doing that. I don’t think it was the type of birth that left me feeling upset, I think it was how I was made to feel by the staff and environment that sent me on a journey to have a better experience next time. During labor I was made to feel afraid, that I was incapable of birthing or making decisions and that it was best just to leave it to the “professionals”. I was made to feel that my experience and emotions were not important. There were also things I had discussed with my physician beforehand that were agreed upon but not put into practice. I believe that if I would have had a doula she could have been a mediator to workwith the staff so they could all help us get the positive birth experience we desired. Also, if a doula could have educated Mat and I about decisions at the hospital things may have gone differently. I also believe a doula could have helped me to process my emotions and process what was happening and I would have had a much more positive birth.
Josephine was born at home without any complications or intervention. It is difficult to describe the immense sense of accomplishment being able to give birth vaginally, it was also an emotionally healing experience. Like her sister Vivian, Josie was in the sunnyside up position, and she was also born crying! I will never forget how I was able to hold and nurse her right away. At the homebirth there was no fear. I was encouraged physically and spiritually by my husband’s constant presence and (literal) support. I was encouraged mentally and emotionally by my doula and midwives through the entire labor. They were the perfect team who worked together so well and they were there to cheer me on at times when I wanted to give up. When I said “I can’t do this” they would say “You are doing this, each contraction is bringing you closer to your baby”. When I said “I feel like everyone is watching and waiting” they said “You take all the time you need” When I said “This is taking so long, I don’t know if I am doing this right.” they said “You are laboring exactly right and perfectly” I will forever carry a precious memory of my doula, Erin, praying and singing over me. They all believed in me so I was able to believe in myself.
9. Home birth or not, natural or not, what is some advice that you have for first-time mama’s (and couples) about their birthing experience?
I love being a Christian; all the benefits I receive now are wonderful! As Christians we do not have to dwell on our fears, worries or anxieties. We can take them to the cross and leave them there. “Cast all your cares on Him because He cares for you.” God created all emotions, so even these have their place. But we do not have to live our lives in a state of fear or constant anxiety.
My advice would be to obey the words of Jesus. Time and again the Bible tells us to “fear not” and Jesus said “Do not worry…Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they?….But seek first his kingdom and his righteousness, and all these things will be given to you as well.” If we really believe in Jesus and His promises then lets begin living like it! Do we really believe that God created our bodies and His design for birth is perfect and that it serves a great purpose in our lives? Do we believe Him when He says He will never leave us or forsake us? Our first objective in anything we do should be to bring Jesus glory. Pray that He will give you a safe and satisfying birth, but pray that above all His will would be done and that you would bring Him glory. If any parents are struggling with negative emotions, pray that God would replace your fear with faith. He will do this for you! I am speaking from experience! This is where our baby girl’s name comes from. Josephine Faith means, “God will add faith”.
I challenge first time parents to address their fears before the birth and to find caregivers that are not fearful. This does not mean we are naive or in denial; of course, we must be responsible and educate ourselves and do our part. But ultimately God is sovereign; nothing happens by random chance or accident. Prayer is an immensely helpful tool in fighting fear. Memorizing the word of God will help remind us of His promises when fear comes knocking. And wives, remember what I said before. Give your husband half a chance because many times God uses our husbands to help meet our needs, even our need to overcome fear and worry.