Saturday, September 22, 2012

Freedom For Birth

I had two of my babies at home.  Well, actually, I had one at home.  The other was born in a hotel because we were living in another state, but we wanted to deliver with the healthcare team we knew and trusted. 

Our first baby was born in a hospital.  It was a non-medicated birth with relatively few medical interventions.  It was only as intervention free as it was because I only labored in the hospital for about 2 hours and we fought every step of the way.  When I said I didn't want an epidural, the nurses scoffed and said I would change my mind and I better sign the consent form anyway (then they marked in my chart I wanted an epidural).  As the baby was crowning, we were fighting over whether a local anesthetic was necessary or not.  I could on and on about the delivery.  After delivery, the battles continued. I was brought Celabrex on a regular basis, which I didn't want and refused to take (good for me, it was recalled 2 months later for increasing the risk of cardiovascular events).  I was not brought regular tylenol, which I repeatedly requested.  My baby would be taken to the nursery and not brought back for hours (despite repeated requests) because "the doctor is going to do rounds soon".  All in all, for me and my personality, it was a terrible experience. 

I did some OB shopping at the beginning of my second pregnancy.  While the first pregnancy lasted until 36 weeks, it was filled with preterm labor and treatment to stop the labor.  I was looking for someone who would address this issue and work at preventing it rather than treating it after the symptoms appeared.  I couldn't find that.  Instead, I hired a fabulous direct-entry midwife, also known as a Certified Professional Midwife.  The state of Texas allows these practitioners to attend home births.  For a one time fee of roughly $2,500, which covered every prenatal exam, the delivery, and postpartum care, I was able to visit with my midwife for 30 minutes to an hour at every prenatal exam.  We talked about every aspect of my lifestyle and how it impacted the pregnancy.  I did not go into preterm labor and I delivered at 38 weeks.  My midwife was right next to me for the entire labor, offering support and natural pain relief in addition to regular fetal monitoring and vital sign checks on me.  When a malpositioned baby made pushing difficult, my midwife supplied me with oxygen and guided me into different positions that made it easier to deliver.  Had it become necessary, she had a back up doctor on call to meet us at the hospital.  After delivery, she did a thorough exam of the baby, helped me get cleaned up and stayed until the baby and I had eaten, and baby was maintaining her temperature (of course, she was already breathing well at that point, but the equipment and skills necessary for neonatal resuscitation were available had they been needed earlier).  Postpartum recovery was infinitely easier, even having delivered a significantly bigger baby.  There was no tearing or cutting, there was minimal postpartum bleeding.  We didn't have to leave the house for postpartum checks, the midwife came back to us several times in the first week to be sure baby and I were recovering well. 

On top of the excellent medical care, our entire family was treated with respect.  We opted to hire the same midwife for the next baby.  This time there was no malpositioning and the only difficulty was how fast pushing went.  That meant baby required a little more suctioning and a close watch for a little while.  Things my midwife was perfectly qualified to handle.  Once again she was with us through the entire labor and delivery and until everyone was cleaned up and settled after delivery.  Once again, she came to us for postpartum checks. 

Home birth is not for everyone.  First of all, direct-entry midwifes are only certified to handle low risk pregnancies.  Second of all, a stressed mom is unlikely to relax enough to labor well.  If mom feels comfortable in the hospital, the hospital is where she needs to be.  This second point is exactly why I, personally, do not belong in a hospital.  After my first experience, there is no way I could relax enough to labor effectively in a hospital.  I personally do not support unassisted birth.  I feel home births should be attended by trained midwives with MD back up ready to take over if a hospital transfer is necessary.

But home birth is not legal everywhere.  In fact, there have been court cases in the United States where it has been affirmed that women do not always have the right to refuse to consent to medical procedures.  At any other point in your life, you can refuse surgery, even life saving surgery, but women have been successfully prosecuted for refusing c-sections. They've also had their families scrutinized by CPS because they refused to consent to certain procedures.  This can happen even if baby does completely fine without the intervention. 

Last week, I had the privilege of attending a screening of Freedom for Birth.  This film on the legality of home birth focuses on the case of Agnes Gereb.  Agnes is an obstetrician in Hungary, where home birth was in a gray area of not being specifically allowed.  Agnes was prosecuted after a woman unexpectedly experienced a precipitous (very fast) labor at her birth center.  Agnes (wisely) called for EMT support, but the police came along and arrested her for delivering the baby.  She was sentenced to 2 years in jail and is currently on house arrest while the case is on appeal.  One of her previous patients became pregnant with her 2nd baby while Agnes was in jail.  This woman, Anna Ternovsky, appealed to the European Court of Human Rights.  Her appeal said that she was being denied the right to choose where she delivered her baby because the threat of prosecution kept any healthcare providers from attending her birth at home.  She won. 

Let me clarify that.  The European Court of Human Rights agreed that it is a human rights issue for women to decide the place they give birth.   In European Union countries, if a woman is giving birth at home and the police show up, she can defend her rights, backed by the ECHR, to deliver where she chooses.   In other countries, a pregnant woman who wants to deliver at home and can't because of laws that hinder her ability to obtain a qualified provider, has the option to approach the legal system with the argument that this has already been determined to be a human right in Europe. 

But it's safer to be in the hospital, right?  Can't I and all my home birth friends just get over it and go have our babies where there is a OR down the hall?  All those machines, all those medicines, those are good things, right?  Not exactly.  Despite spending more on maternal hospital care than any other area of health care, our infant and maternal mortality rates are abysmal.  In particular, our maternal mortality rate is actually increasing.  The hospital is the best place for some women to be.  Obstetricians are an incredibly important part of the healthcare team.  But a lot of women are also better off at home with a qualified midwife.  They should have that option available to them.  Thanks to Agnes Gereb and Anna Ternovsky, new doorways are opening for us to assert our rights.

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