I believe I've done all the research I can do about my genetic mutations/clotting disorders. I have come to these conclusions:
-The issue raises my risk for miscarriage in the first trimester quite a bit
-Women with this disorder have a notably higher rate of stillbirth after the first trimester, but that risk cannot be quantified. It is a low risk, relatively speaking, but still there.
-Women with this disorder are at notably higher risk for various late pregnancy complications like pre-eclampsia and placental abruption, but these risks cannot be quantified and are quite low.
-The fact that I had three normal, completely uncomplicated pregnancies may or may not have any bearing on my risk factors.
-It is wise for me to be seen every two weeks and watched carefully by a perinatologist (which is what I am doing) for the duration of my pregnancy.
-Most importantly: I do not believe that the MTHFR or PAI gene issues that I have present any specific risks during labor and delivery. However, it would probably make my husband and everyone else I know crazy nervous if I were to give birth at home. Also, dealing with finding a homebirth midwife and arguing with my insurance company over paying for the homebirth midwife seems a bit overwhelming at the moment. Still, giving birth at home would be my first preference and I have not completely ruled it out.
-This leaves me with a couple of options. I could give birth at the freestanding birth center here in town. My perinatologists are longtime supporters of this birth center -staffed by midwives - and would likely be willing to work with the birth center in the last trimester to provide cooperative care and get things ready for a birth there. The birth center is only a few blocks from the hospital where my doctors practice. The birth center has birthing tubs, and I really want to be able to at least labor in warm water, even if I do not give birth there. The down side of the birth center is that they send you home 6 hours after giving birth. I do not want to move after giving birth. I want to stay in one place for at least 24-48 hours. The idea of packing up and going anywhere 6 hours after giving birth sounds very unappealing to me.
-I could give birth at the hospital where my doctors practice. I had one baby there previously and had a very bad experience. It is known as a very medical hospital. They do not even have the LDRP rooms that most hospitals have now, and they certainly do not have birthing tubs. I love my doctors, and I feel certain they would work with me to have the kind of birth I want at this hospital, but I want water. Plus, let's face it, if you go to a hospital with a 90% epidural rate, you are going to have a hard time getting nurse support (and its the nurses who matter while you are laboring) for laboring without a lot of interventions. My husband's preference is that I just go to this hospital and do whatever they tell me. he doesn't see the process of birth as that important - only the outcome. Some days I feel so tired by this decision-making process that I think it would just be easiest to go to this hospital and have a fully medicalized birth there and just not worry about it. Sometimes having an epidural sounds really good - then I remember the back pain I had for several years after the last one.
-I could have the midwives from the birth center attend my birth at my favorite local hospital, where my current doctors do not practice. The midwives have hospital privileges there. This hospital is only a few blocks from our house. They do not have birthing tubs there, but you can bring your own (which is what my sister did). I had great experiences at this hospital with Baby #1 and baby #3 (though these births were medicated and had the full complement of interventions).
-I could wait until near the end of my pregnancy and transfer to my previous regular OB, who delivered both my sons and is a supporter of natural birth. he practices at the hospital near my house, and encourages women to bring birthing tubs to the hospital and labor/deliver in the water.
So there's the deal. It's a lot to think about and I feel really overwhelmed. I believe that if I decide to shoot for an unmedicated birth this time, I will need to make that decision in the next month and start preparing myself mentally, emotionally and logistically. Jon and I will need to take the right childbirth class together and I will need to believe that he is committed to it and supportive of it.
But right now it all just seems like a lot to think about.
I need a nap ;-)
And a taco salad. I could really use a taco salad right about now...
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36 comments:
I am not really sure why anyone would choose to have a baby without an epidural. Birth hurts A LOT! The epidural takes the pain away. It's a no brainer.
Sometimes having an epidural sounds really good - then I remember the back pain I had for several years after the last one.
I have had both kinds of births. I had one in the hospital with an epidural, etc and one at home in a tub of water.
Both have pros and cons. The main pro to the hospital birth is that you avoid pain. But you also avoid experiencing something quite amazing. My homebirth was exhausting and the hardest work I've ever done. It hurt, but not like I was hurting before I got the epidural at the hospital. But I don't regret it for a moment. I wanted to feel birth fully and I am glad I did.
Katie,
Sorry I haven't gotten back to you on this sooner, but there seems to be very little information on the impact of your condition during the actual labor. I'll let you know if anything turns up, but wanted you to know I hadn't forgotten you.
your husband is right: its the outcome that counts. In this country we have come to practically worship something that for most of history you just got thru any way you could to get a live, reasonably healthy baby. Women get depressed if everything doesn't go according to their picture perfect idea of a birth. Personally with a medical issue I wouldn't mess with anything but the safest hospital around. And God forbid something happened during the home birth. You would never forgive yourself, neither would your husband and your kids who would probably have been invited to witness the whole thing would be traumatized for life.
OF COURSE the outcome is what matters most. Those of us who advocate for "natural" (I hate that term. All birth is natural) childbirth want the same thing everyone else wants: healthy babies and mothers. But what women need to understand is that the highly medicalized American way of birth - where women hand all control over to the doctor, the epidural and the hospital - carries risks that can harm babies and mothers. Homebirth is safe for low-risk mothers. Women who have no risk factors that mean they need hospital care have equal or better outcomes (healthy baby, healthy mother) giving birth at home with a trained midwife or doctor as they do in the hospital. In countries with FAR better outcomes for mothers and babies, midwifery care and homebirth are way more common than they are in the U.S.
I chose to give birth without drugs in a hospital. I decided the risks of an epidural outweighed the pain. I prepared myself for the birth with childbirth classes. I had a doula, and perhaps most importantly, my husband was 100 percent behind my decision and took equal responsibility for preparing himself for the kind of birth we wanted.
If my husband didn't care what my birth was like, but only what the "outcome" was, I would not feel that we had shared this important experience or even that he cared about me or my body or my feelings very much.
Sharing an unmedicated birth that we both took equal responsibility for brought my husband and me closer together than I ever could have thought possible. I know now I can trust him with my life.
Having had 4 emergency c-sections, having a vaginal birth AT ALL seems very priviledged.
However it gets here, the most important thing is having a healthy baby.
Katie,
Two years ago, when Lorelei was born, the hospital down the street DID have a tub. Have you checked recently? Were I you, I'd go there. Seems like a good compromise between your wishes and Jon's.
To some of the commenters, the outcome is the MOST important part of the birth, but it's not the ONLY important part. And the way you birth can affect your outcome.
What about hypno-birth?
I had two unmedicated, hospital births, both with a doula. I'm surprised you don't mention finding a doula, particularly for the in hospital options. With a doula who values unmedicated birth you can really avoid worrying about getting a nurse who doesn't support unmedicated labor.
If we lived close to a reputable hospital I would have had a homebirth for my second child. But we don't so we stayed with the hospital an hour away.
Having an unmedicated birth was important to both my dh and myself, and the doula helped us with that, especially the first time. It is possible to birth the way you want in the hospital, you just need a lot of support for it.
"I am not really sure why anyone would choose to have a baby without an epidural."
I'd be a little surprised if a doctor thought an epidural was a good idea for someone (like Katie) who has a clotting disorder. OK, I think I'd be a lot surprised. But IANAD.
I don't think I'll ever understand why so many people think an epidural sounds great. My husband and I took a Lamaze class before our first child was born, and the only thing that bothered us was the episode where you see someone getting an epidural. I think we both turned white.
I've had 2 babies - and yes, labor is hard and painful. It wasn't the worst pain I've ever experienced, though - and it wasn't anywhere CLOSE to painful enough that I'd have considered letting someine STICK A NEEDLE IN MY SPINE.
kate,
i will be sending you good thoughts and prayer...i trust that the universe will send you to the right place, whereever that may be
erika
I don't think I'll ever understand why so many people think an epidural sounds great.
Maybe for the same reason anesthesia sounds great when you're having a limb amputated. Duh.
I delivered at Ft. Sanders with the help of Lisa Ross midwives. It went fine, and the birthing unit there is actually really nice. The benefits of delivering at the Lisa Ross Center are those concerning the freedom to move about and whatnot. Still, as you pointed out, they encourage you to move homeward in a timely manner, and this can be an exhausting proposition right after you have given birth. My midwives encouraged me to exit the hospital ASAP after delivery, but it was much more calming for me to stay for two days and get to know my new kid (they had no problem letting her stay with me) and drink all of the unit's juice (man, I drank sooo much juice) without having to directly transition back into the real world constraints of my household. This is merely anecdotal, but the real problem about modern, medicalized births is that such practices originated in "new" ideals that ignored the time-tested methods employed by midwivery pre-female medicical attention. This is certainly a feminist concern, but hospital birthing centers are starting to incorporate more traditional mthods in their practices. Of course, it is a trade-off; one cannot expect a Doctor or hospital to not take all of the percived precautions available, given the high rates of malpractice insurance. And, of course, this is why midwivery birthing centers usually only accept low risk births, while still maintaining a quick connection with medical expertise in case something goes wrong. The feminist "intuition" about birthing seems to be, at least, a little inconsistent in relation to other medical practices. Yes, we desire the safest practices available, and, by extension, we want those practices to be submitted to scientifically well-founded tests. Still, many "feminists" (not derogatory, I consider myself a 'feminist') wish to relegate their birthing concerns to midwives who espouse doubt about medicalized practices. There's got to be a middle ground here. I worry that birthing itself has become some kind of identity-conferring function in such a way that it distorts the importance of the process. Yes, labor is hard. Yes, carrying a child is uncomfortable, if not very difficult. Yes, yes, yes-but still, the carrying and delivery of a child is one of the very few natural facts in life pertaining exclusively to women. Still, the midwives of yore were probably not too concerned with ideal birthing experiences as much as ensuring that mother and child survive. It seems as if we're in a time now when the "birthing experience" has trancended all of the practical concerns that surrounded midwivery practices in times past. TBC...
Have you considered hiring a doula? That makes the lack of nurse support less of an issue.
Also, I want to note that I agree with the idea of seeking a middle ground.
The Birth Experience is not the point of the exercise here, but that doesn't mean you're being unreasonable to say, "Hey, you know, I don't want to give birth at a hospital where I'm going to be rushed from room to room as I'm starting to push, and pressured to accept medical interventions that I neither want nor need."
I had very positive experiences at two different hospitals in my city. I was treated with respect and consideration, I was not pressured to accept interventions that weren't necessary, people read my birth plan and abided by my wishes (which were things like, "Please don't offer me pain medication; I'll ask for it if I decide I want it"), I was able to eat and drink freely, etc. This should be the norm in childbirth. None of these things impose some major hardship on my caregivers. When all someone wants is the option to be supported in the choice to labor without medication, it appalls me when she gets lectures about how it's really the outcome that counts. The mother's health is part of the outcome that counts.
I work with many women who have birthing center births. All are thrilled with the experience and having that calm atmosphere a birth center. The whole staff is on the same page as you. There is no explaining what you can ease your mind and enjoy the birth without being undermined by staff and enjoy the non-interventionist standard of care.
People hire a postpartum doula to help them so the transition to home immediately after the birth is much smoother and they are taken care of at home.
The doula will also take care of your family (cook, laundry, tidy up, run errands) keep life moving along while you, Jon and the kids are in bed taking care of baby.
You do not need a hospital or a hospital staff; so then there is no reason to go to the hospital, and if you need one the birth center is near one.
Birth center with a postpartum doula for the week you get home is the smart way to go to have a normal birth.
I would suggest that one google "homebirth horror stories" if you would like to see how horribly wrong things can go far from a hospital, things that most likely would have been taken care of immediately if one WERE in a hospital. I also fail to see how "increased risk of stillbirth" is mutually exclusive of "no added risks during birth". Home birth advocates do not tell you this. I gave birth in two different hospitals on two sides of the country and I can assure you that NO ONE was trying to pump me full of as many medications as possible. If anything I remember distinctly BEGGING a doctor for a c section at a moment of pain during my first birth (obviously out of my right mind) and she quickly assured me that it was serious surgery and would only be done if medically neccessary. I remember especially the first time (the second I sort of ignored the input because I had done this before) feeling quite a bit of pressure to NOT use drugs. It was kinda like yeah we have them but you got the idea only a real wimp would actually want them. Now it may be that the south is a totally different animal from the rest of the country. In fact it wouldn't surprise me at all.
I don't think you should judge the South by the comments on this board.
To the anon who said to google "homebirth horror stories"--do you assume there are no hospital birth horror stories? NO provider and NO location can guarantee a great birth experience or a happy outcome. Statistically, out-of-hospital births are safe choices for many women. It is so that hospitals could deal better with some complications that may arise, but it's also true that hospital interventions can themselves cause complications. It's not as simple as the hospital being a safer place for all women.
As far as going home from a birth center: I've worked with a freestanding birth center for five years. I've had four births: one hospital, one homebirth and two in freestanding birth centers. By far the worst, postpartum-wise, was when I went home 30 hours or so after the hospital birth. By that point my adrenaline levels had leveled off and I was exhausted and really hurting. I went home four hours and six hours after my birth center births, when I was still feeling great and riding that post-birth hormone high. It was wonderful to get settled in at home so quickly, and the midwives visited me the next day and two days after that. (and I had plenty of at-home help with the other kids) I understand the reluctance to get up and go somewhere so soon after giving birth, but in my experience it was better than waiting a day and then going home, particularly since my bed was a lot more comfortable than the hospital's. The experience I've had at the freestanding birth center is that most women are eager to go home after a few hours. The only thing I would have liked to have at home is one of those mechanical beds so I didn't have to sit up and lay down on my own!
I can give you a hospital horror story right now. My daughter almost died from the general anesthesia used during my c-section. CPR was performed for a full three minutes before she began to breath.
When I finally saw her, over a day after she was born, she had a scalpel slice on her leg.
IMO, you are more than likely going to end up with some type of intervention (epidural, c-section) if you deliver in a hospital and are not laboring in a very specific way (the best would be to admit at least 4+ cm dilated). I had planned for "natural" and ended up very "un" natural. The epidural was okay (I have a big fear of such procedures) as was the recovery from the c-section. I think that Katie is strong willed enough to deliver naturally in a hospital but for me since this was my first I was very susceptible to the hospital culture of intervention.
After I lost my baby, I went to an infant loss support group & one of mom had lost a baby in a homebirth and the other 20 mothers lost their babies in hospital births. Bad outcomes happen in both places & sometimes there really is no one to blame, not even yourself.
Some of the comments on here are pretty hurtful to moms who did lose babies. If it happens in the hospital, do you just blame the dr? What about blaming yourself for picking an idiot for a doctor?But if it happens at home, you "never forgive yourself?" Doesn't that depend on what happens?
PS to comment above...
And, of course, personal finances (insurance) matter in the US. My anesthesia bill alone (epidural and c-section) was over $3,000! Our insurance covered it but I had a woman in my pre-natal yoga class who is footing her birth bill without insurance and so far I don't want to tell her that my hospital birth bills were around $12K.
If what happened in a homebirth could have been prevented by medical intervention in a hospital you betcha you should be blaming yourself. Better to accept the blame and heal from it rather than spending your whole life in denial and never healing. Sometimes things just happen however its hard to rationalize that in the case of a homebirth where the circumstances were something that would have had at least a fighting chance in a hospital.
I agree, it would be a nightmare to have something happen at home that could be prevented in the hospital. Yet, many disasters are caused by interventions. I can think of 4 women in my support group that had disastrous outcomes due to overzealous medical staff. I'll spare the details so as not to freak out the pregnant people.
There are a few OB emergencies left that are severe and have about the same chances of outcome wherever the birth place is. In my case, the hospital could not help me. So, I feel for homebirthers who feel like its their fault when things go wrong. A mother will usually find a way to blame themselves no matter what.
I can tell some of this flipness is coming from those who haven't been there. None of us have any way of knowing what would have worked in any situation. Maybe a midwife could save the day in a birth where a doctor would have panicked? Or vice versa. Unless it is your birth, you don't know.
I agree, it would be a nightmare to have something happen at home that could be prevented in the hospital. Yet, many disasters are caused by interventions. I can think of 4 women in my support group that had disastrous outcomes due to overzealous medical staff. I'll spare the details so as not to freak out the pregnant people.
There are a few OB emergencies left that are severe and have about the same chances of outcome wherever the birth place is. In my case, the hospital could not help me. So, I feel for homebirthers who feel like its their fault when things go wrong. A mother will usually find a way to blame themselves no matter what.
I can tell some of this flipness is coming from those who haven't been there. None of us have any way of knowing what would have worked in any situation. Maybe a midwife could save the day in a birth where a doctor would have panicked? Or vice versa. Unless it is your birth, you don't know.
and I don't know why that posted twice...:)
In the internet research spawned by this post on my behalf I uncovered a lovely comment by a homebirth midwife that was to the effect of "some women might have died birthing at home but oh well, the number is small so no big". Now that is not the exact quote but thats the general sentiment. I can ONLY imagine the uproar if that statement had come from a male OB instead of a female homebirth midwife. I find it repulsive when, as long as the numbers are low enough, even a few people are considered an OK sacrifice for an ideological cause. And it seems that the data get tweaked around a lot more in some sectors than others.
And I think it is important to separate out those things that were inevitable from things that have a reasonable cause. I realize this may not be something that someone who has had a baby die wants to think about BUT to continue to promote something that played a role in the tragedy is ignorant at best, criminal at worst. True, some things one might never know but others there is a pretty damn good educated guess. It is ALSO important to weed out staff incompetence from the nature of the birth environment itself: things that no matter how skilled the practitioner are still there. I am betting the hospital horror stories are either inevitable no matter what or due to incompetence. Some homebirth horrors probably are simply incompetence which can happen anywhere but some are also no doubt the consequence of not having emergency facilities IMMEDIATELY at hand (and a five minute drive can most definately matter when seconds count) Things can go very wrong very very fast and very very unexpectedly. And if the equipment and facilities are not right there, then you may have lost your window of opportunity.
I think anyone having a homebirth is foolish but someone with medical issues that put them "at risk" even considering it is even MORE foolhardy. I just can't even imagine entertaining that sort of thought for the sake of ideology.
"I am betting the hospital horror stories are either inevitable no matter what or..." same is true for homebirth.
you missed my point. I was saying that if you examine each case I am betting that you would find a good portion of the homebirth deaths are directly related to not being able to IMMEDIATELY get emergency care underway (sometimes even five minutes is the difference between life and death and remember things can happen very fast and very unexpectedly). Whereas you do not have that factor in a hospital birth. With both, yes you can have human error or inevitability which doesnt speak so much for home vs hospital birth as for the individual attendants involved in cases where that would have mattered. BUT in the number of cases where the time, even if short, taken to transfer to the hospital is what made the difference then yes, it IS the fault of homebirth,no matter how good the midwife. And I would also imagine that OBs are more practiced at detected things in need of immediate action whereas I would imagine a common midwife error is trying to "let nature take its course" for too long. I believe that happens more than you think because they are so primed against intervention that they see potentially dangerous situations as no big deal. Of course you would say that a doctor would see danger where a "wait and see" attitude would be better but I think the potential for SERIOUS consequences (not just a "disappointing birth experience") is much greater with the midwives error than the doctors. I don't buy it. It defies common sense. Homebirth advocates with all their "birth is natural, birth is healthy, blah blah blah" seem to forget just how unbelievably high maternal and newborn death rates were prior to the advent of modern obstetrics.
Of course people who have great home births sing their praises. I imagine if all goes well it IS more intimate and cozy and comfortable than a hospital. Most of them do go well. But if you are one of the people for whom immediate access to the latest in technology and medical knowledge matters, that is really scant consolation.
Have you ever tried to have a homebirth, do you know homebirthers or are you speculating? I can tell that there are a lot of assumptions here. The situations where the "experience" comes before safety, thats something you may see with unassisted birth, but not hb thats covered by insurance, with a CPM or CNM.
These types of hb practices have very stringent low risk requirements. The midwives are trained to see problems very early, they can be very conservative. They have physician back up. In reality, unless you are having a sched. c/section, in the hospital you are really being attended by l&d nurses. A midwife has a lot more training than an l&d nurse. You are counting on your nurse to keep your doctor updated. At a homebirth, you have an expert in normal birth with you, she is watching you closely & knows what to look for to help you transfer safely if you need to. At that point, if its necessary, a doctor shows up & meets you.
Can you give an example of a disaster that can happen at home with a CNM that can be avoided in the hospital? I get your point, but I don't think you will know for sure that the hospital could have saved the day. For example, cord prolapse, flipping to breech in labor, preclampsia, all of these have time on their side & are obvious to a trained midwife. That leaves placenta abruption or severe shoulder dystocia, both of which are very rare & especially, s.d., can be equally fatal in hospitals, if its a severe enough case.
don't be ridiculous: I didn't have a c section and my OB was right there both times. Not the whole time obviously because there were other patients but certainly enough and certainly at the birth itself. Yes, I know people who have had home births and are on cloud nine about how great it was. I have heard all their arguments and statistics and I don't buy it. Because I ALSO know a couple of people whose homebirths went wrong and had to transfer who lamented having been talked into this foolishness by the homebirth brigade. One of them came very very close to the death of both her and her baby and just cringes thinking about the whole thing. There are a lot more of those stories out there if you care to listen and not redefine them as insignificant like most homebirth "advocates" do.
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