From the beginning, I was open to both the idea of giving birth at a hospital or at home. I didn’t know much then about the opinions, risks, and controversies that surround both birthing environments, but I wanted to do my research and make the decision that felt right for me.
I knew of plenty of people who’d had home births, even if only about one percent of people in the U.S. have them, so it didn’t seem like some aberrant extremity like it may to some. If anything, I felt like many in my extended community were biased toward home births, and after reading Ina May’s Guide to Childbirth and watching the documentary The Business of Being Born, I started to feel that way myself.
Yet as far as hospitals go, I’d heard that Group Health (which I belonged to) was one of the best places to be in Seattle if you were hoping for a birth with limited interventions. Their c-section rate was lower, they had birthing rooms with tubs and options to dim the lights and play your own music, they let you move around during labor and labor in different positions, and in general, they did not seem like the “scary hospital environment” that many of the worst-case scenarios suggested. They also had a team of six midwives that you could work with, as well as O.B.s. I gravitated toward midwives because I trusted they would be more knowledgeable about facilitating a natural birth, and might not rush as quickly to the decision to intervene if labor was taking a long time; I trusted they’d understand the importance of a woman being able to control her environment and be an active agent in her birth.
I was born at Group Health, and have gone there my whole life. It was an easy decision to go there for my first prenatal exam. I really liked the midwife I met with; she was warm, compassionate, and pregnant herself. But there was no way of knowing which of the six midwives would be on call when I went into labor. And after the first hour-long appointment, the monthly prenatal exams were only supposed to last 15 minutes. That meant that if I tried to spread out the rest of my visits evenly with all of the midwives, I might only spend half an hour with each of them total. I would barely know the woman who would attend perhaps the most intimate and painful experience of my life. And on top of that, she might have several women in labor at the same time, and only be able to be with me consistently when the baby started to come out. Her twenty-four hour shift might also end mid-labor, and then I’d be with someone else.
At least there would be a nurse who would be assigned to me and me alone, but I would never have met this woman before. And what if she was the type of nurse who would keep offering me an epidural, even if my birth plan stated I wanted to go without medication? Would I accept the pain meds in a moment of weakness and fear (“I give up, I can’t do this!”)? After all, they’d already had me sign a waver okaying an epidural on my very first nurse’s visit. It isn’t that I am absolutely opposed to an epidural. I knew that there is a possibility that I might want one, and that that would be okay if it is what I decided. But somehow the way I was handed the form with no discussion or information felt jarring.
Nevertheless, I was reassured by the presence of the first midwife I met with. She even shared names of a few recommended midwives who did homebirths when I revealed to her that I was still considering that option. She herself was planning to give birth with one of them. (Who do the midwives choose to deliver with? Hmm, let’s take note of this, I thought).
I knew I needed to do more research. I read up on local midwives and home birth options, and I finally scheduled a free consultation visit with a midwife who worked out of the oldest birthing center in Seattle. I suspected that after meeting with her I would know what I wanted. She spent an hour with me and my husband, answering all our questions about home births and their practice. I expressed to her how confused I’d felt when given the information about genetic testing, and the general rushed and indecisive feeling I’d had about giving birth at the hospital. I felt a deep sense of relief as she listened to my concerns. She even offered an ultrasound so we could hear the baby’s heartbeat—I’d seen it on my last visit, but had yet to hear it. I liked this midwife, she felt knowledgeable and steady.
But surprisingly, I left that appointment actually leaning towards going with Group Health. It was one statistic that stuck with me: she told us that about 15-20 percent of first-time moms who plan a home birth end up transferring to a hospital. Only a very small portion of these transfers happen because of an emergency; most of them happen because the labor is taking a long time and the mother is exhausted, and the mother decides that she wants relief in the form of medication.
One in five. I didn’t want to tell my parents this statistic. My mother had freaked out when I told her I was considering a home birth. My mother, like many people in this country, had uninformed ideas of what a modern-day midwife was. She could only picture some woman in a backwards country with limited training who’d learned the trade by default. All kinds of what ifs? were hurled at me. Instead of being open to hearing the information I’d garnered through research (i.e., that home births have been proven to be as safe as hospital births if they are planned and if you are a ‘low-risk’ pregnancy), she just turned the T.V. on and closed down the conversation.
After a couple interactions like this with my mother, I decided to just not talk to her about it anymore, at least not until I’d actually made a decision. What was the point about arguing the merits of a home birth if I hadn’t even decided it was what I wanted? In fact, I didn’t really want to talk to anyone who had a strong opinion either way. I knew I’d be okay at Group Health; I didn’t feel an aversion to it when my husband and I visited the birthing units on a tour, even if the room seemed rather small and still had a hospital-like ambience. Group Health would be cheaper, but our insurance would cover at least 70% of a home birth, which means we’d owe about $1000 plus the deductible. We could afford that, so I didn’t want money to be a deciding factor. But if I chose the hospital, then my mom wouldn’t worry. And her worrying was something I didn’t want to have on my conscience. I wanted to be fully supported in this birth. I didn’t want to feel like I was fighting anyone for my decision, especially not my mother. I decided to go with the path of least resistance and stay with Group Health. After all, if it were my only choice, I would be fine with it. Maybe for my first birth it was a safer choice. Maybe I could have a home birth next time, if there was a next time.
It was a relief to have “made” a decision. I was almost three months along and I longed to settle into the security of knowing who would care for me. I went to my next prenatal exam at Group Health. First a nurse took my weight and blood pressure and asked me if I had any questions, entering them into a computer. Then, finally, the midwife came in half an hour late. I told her I had brought a list of questions. (Last time, the midwife had said to come prepared since the visit would be short.) She glanced at the clock. “Well, just try and prioritize them.” I rattled them off, conscious now of how “important” were they. I told her about how dehydrated I’d been lately and also asked her about appropriate weight gain, and she made a few quick inquiries into my water intake and diet, but otherwise told me I could consult with a nutritionist. I managed to squeeze in all my questions, including asking her about Group Health’s c-section rates. I’d already heard one unofficial answer, but I wanted to see if the information I got was consistent. “About 20%,” she said, “but it’s rising.” Then, a quick assurance, “We’ll only do what’s best for you.”
Perhaps if I hadn’t done all the reading I had already, I could feel relieved by quick reassurances like this, but now her answer felt hurried and dismissive. It was as if I could hear her sighing, “I don’t have time for this.” She gave me a ultrasound so we could hear the heart beat (I didn’t tell her I’d heard it last week with an out-of-hospital midwife; somehow, I didn’t feel like she’d want to hear this), and that was it. We were out of there in about 20 minutes, only making her 5 minutes later for her next appointment. I hoped she wouldn’t be the one on call at my birth.
Over the next couple weeks, I told people I’d decided on Group Health, but I felt myself relaying this choice with a sense of resignation as opposed to relief. And I still hadn’t told my mother. It was as if I didn’t want to give her the satisfaction of that decision, didn’t want her to feel like she was right and I’d “thankfully” seen the light. And I didn’t want to admit to myself how much of my decision was influenced by my fear that if I chose a home birth and ended up transferring to the hospital, that my parents would say, “We told you so.”
How much were my parent’s opinions influencing my decision? Here I was, 34 years old, about to make one of the most important personal choices of my life, and I was still so swayed by what they thought.
I tried to imagine if my parents were completely supportive of a home birth, if it would still be such a hard decision. The answer was no. If they were supportive either way, I realized that I’d probably have chosen a home birth by now. I couldn’t let their fear weigh so heavily on me. But I also had to separate for myself—how much of this was their fear, and how much was my fear? Was there a part of me that secretly welcomed their fear because it gave a voice to my own? Would I feel safer in a hospital, even given everything I’d read about the other set of risks that being in a hospital could bring?
Meanwhile, I kept reading about home births and checking out the websites of midwives, even though I sensed by now that I would not reach my decision by weighing more pros and cons. I’d done my research, satisfied the logical, information-driven part of myself that needs to know the facts. Now it was up to me to reach inside for the right answer. I knew I still felt a wistfulness when I read about home births or heard of others who’d chosen this path. I lay in my bed and tried to imagine going into labor there, as opposed to laboring in the hospital room on the narrow raised bed surrounded by computers and IVs and an unfamiliar staff. I imagined what it would be like to instead have a midwife that I’d spent monthly hour-long prenatal visits with come to my house; to be able to climb into a tub in my living room beneath our A-frame cedar ceiling; to be able to make sure that the refrigerator was stocked with replenishing food for me and my husband, that the music was cued if I should desire it; to ensure that an atmosphere of calm and peace could be created well in advance and that I could go outside and walk circles in my sheltered yard if the labor was taking a long time; that I could lie back in my own bed after the baby was born, and that the midwife and her helpers would stay with us for hours to help us get comfortable caring for our new baby. And that the midwife would then come to my house several times in the coming weeks to offer us support in breastfeeding and answer our concerns. It was about more than just the birth—it was about the whole incredible period leading up to the birth in which I wanted to feel listened to and assured. And it was about the post-partum period too, a period that I knew many of my friends had struggled with, and that was every bit as important to the health of the baby and mother.
But back to the birth itself: more than some idyllic vision of a comfortable, spiritual environment to bring new life into the world through, was the practical knowledge I’d learned that resonated intuitively-- that by being in an environment with familiar trusted people, there was an increased likelihood that I would be able to surrender more easily to the pain and process, that my mind and body would be relaxed enough for my cervix to dilate and open, that I would feel the most trust and safety here in my own home, doing what women have done naturally for centuries. Think about where you feel the most comfortable taking a shit (excuse my crassness)—alone in your own bathroom, or in a public place with strangers watching you? This comparison may seem unwarranted, but I’d read about how the same “sphincter principle” was at play while you gave birth. The mind, your own comfort level, and inhibitions can influence and “hold up” so much. There was plenty of research that corroborated this—the importance of feeling uninhibited and safe in your environment and trusting all the people around you.
More than my fear of the small chance that something could happen that would be better handled in a hospital, weighed my fear that the situation at the hospital would feel outside of my control—the environment, the pressure of decisions made, the increased likelihood of interventions, and the lingering questions I might have of what could have been done differently? Either way, you are taking risks. Which risks weighed heavier for me? Where would I feel most safe? That was the most important question.
I called my husband that night and kept expressing my questions and doubts. He’d been so supportive this whole time of either decision, and hadn’t pressured me one way or the other. “I just don’t know…” I said. Perhaps because of something different he heard in my voice, he said, “I think you do know.” Tears welled in my eyes. I couldn’t say anything.
After we hung up, I cried some more, and whispered aloud for the first time, “I think I want a home birth.” More tears rose in my chest and streamed down my face. The next morning, I wrote the same thing in my journal, and again, more tears. That’s how I knew. I hadn’t had this reaction when I’d “decided” on the hospital birth. Instead, that had felt like I was passively giving in to the path most commonly accepted by others. But now, when I finally uttered the words, “I want a home birth,” a joy and relief resonated through my body, the resounding yes that I’d been hoping for, a clear sign that, for me, this was right.