Birth Business

I used to think pregnant women who wanted to give birth at home were nuts. Now, I'm not so sure.

Over the weekend I watched talk show host Ricki Lake's new documentary, The Business of Being Born, just released by Red Envelope Entertainment and International Film Circuit and getting lots of chatter in newspapers such as the New York Times, The San Francisco Chronicle and the mommy blogosphere.

The film advocates a few extreme views I disagree with. Many ob-gyn doctors, as well as moms who've given birth via Caesarean, are portrayed as uninformed buffoons. Some natural birth proponents argue on-camera that there is a medical conspiracy in our country trying to "cheat" women out of giving birth naturally; that our obstetrics system is in crisis, a category I'd save for places such as east Congo and Iraq; and that women who have babies without "intervention" love their infants more profoundly, a judgment I found not merely untrue, but also insulting to mothers with high risk pregnancies and adoptive parents.

But the movie is mesmerizing, educational, moving, at times funny, and surprisingly convincing -- especially given that all three of my kids were born in hospitals, to my utter satisfaction and joy. As the many on-camera births and interviews with midwives, health care experts, doctors and moms unfolded, I realized that Lake and director Abby Epstein were arguing for empowering pregnant women with choices, period. Nowhere in the film does either woman stridently proclaim that all women must give birth at home without medical or drug interventions. In addition to home births, some on-camera births take place in hospital birthing centers or surgery rooms, including Epstein's first child, born six weeks early in a breech position that necessitated an emergency trip to the hospital and the potentially life-saving medical care we are lucky to have in this country.

Some of the provocative facts I learned include:

* Since 1996 the C-section rate in our country has rised 46 percent; nearly one in three of the 4.1 million annual births are via Caesarean surgery, which is statistically the riskiest way to give birth.

* The United States spends twice as much per birth as other developed countries, where medical intervention in hospitals is usually reserved for high-risk situations.

* The standard reclining or "lithotomy" position required by most U.S. hospitals, in which a laboring woman lies on her back, is less uncomfortable for doctors and nurses but far harder on women. Reclining in a fixed position makes the pelvis smaller and prevents gravity and a woman's uterine muscles from performing at their maximum potential in pushing the baby out (squatting is superior).

* Hospitals, insurance companies and doctors' schedules all discourage natural labor, largely because labors without intervention such as Pitocin, Cervadil or C-section are usually long, hard to predict, and thus disruptive to the way a hospital functions.

But as I explained in "Are You Done?" my views are all hypothetical since I'm not planning to give birth again in this lifetime. But what about you? Have you had your babies at home, in a hospital, or in a birthing center? What's your take on the choices women have in our country today about how, when, and where to have babies? Can women have empowered births in a hospital? How do you measure the pros and cons?

By Leslie Morgan Steiner |  January 14, 2008; 7:00 AM ET  | Category:  Moms in the News
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This topic is near and dear to my heart as I'm staring down the barrel of my last trimester (7 months yesterday!).

In general, I'm supportive of whatever it is the woman wants to do. If a woman wants a natural childbirth experience, I say 'go for it.' If women want to schedule a C-section, again, it's their call. As for myself, I'm Little Miss Epidural all the way - I have NO interest in giving birth naturally. I'm not a fan of pain, thanks, and I just cannot see the connection some woman see of 'natural birth = better mother.'

I'm glad women have a choice in how they want to handle their births, and I'm REALLY glad medical science has made such incredible leaps and bounds that births that would have ended in tragedy (such as a two-month premature baby) is now feasible and viable.

However, for those women who snidely suggest that natural is the only way to go and any women who has 'performed' at a lesser level is a bad mother, here's what I'd like to see as their punishment: They have to go natural with everything - no nitrous oxide or numbing at the dentist, no anesthesiologist at the doctor's, etc. I'm mean, they want to be able to experience the true meaning of it, right? *evil smile*

Posted by: Corvette1975 | January 14, 2008 7:29 AM

While I have friends who have had home births and loved it, I chose not to. I did have a VBAC though and thought it was great!!

Posted by: g8leys | January 14, 2008 7:30 AM

My wife has had 2 c-sections due to medical necessity. I have not seen the film, but to the degree that its intent is to try and "guilt" women into making the choice they see as right (e.g. natural birth not in a hospital) I would be disappointed. All any group should do is provide information to women and allow them in consultation with their partner/spouse/family make an informed decision as to what works best for them. I remember when we had our first child the militancy with which a group such as la leche approached my wife on the issue of breat feeding. it was basically saying breats feed your kid exclusively for as long as possible or you are doing irreprable harm to your baby. Well, their tens of millions of bottle fed babies out there who probably disagree. My wife nursed both our sons for 12 months and still there were certain organizations who made her feel like she was stopping too early.

I genuinely think the only role of these organizations should be to provide information and counsel to women so that they can make the best choice for them. there should never be any sense of judging or guilt involved.

Posted by: happydad | January 14, 2008 7:35 AM

I had a C-section with my daughter due to my pelvis being too small ( I am under 5 feet tall). I actually labored for 31 hours before they determined that the baby's head was never going to fit through the pelvis. I don't know why it took them 31 hours to figure that out. But I am having a planned C-section with the other baby as well. My daughter's head was only in the 10th percentile and did not fit, so we are making the logical assumption that baby #2's head won't fit either. It is also a double plus because I am getting at tubal ligation at the same time. :) But I do think we do a lot of unnecessary C-sections and trust me recovery from C-section is no picnic either. But it is a decision between mother and doctor. It never dawned on me that I was "less" of a mom because I delivered C-section. You do what you need to do to deliver a healthy baby and keep the mother healthy as well. What could be wrong with that? The only bummer is you can't hold your baby right away because they are still stitching you up and I was sort of groggy from the drugs. But I don't think it bothered my daughter. We are very close now and have been since the beginning. I would like to see the movie.

Posted by: foamgnome | January 14, 2008 7:42 AM

The answer is obvious. Rikki Lake and Michael Moore should team up to make and deliver all babies for the U.S.---from Cuba.

Posted by: nonamehere | January 14, 2008 7:58 AM

I come from a long line of women who have LONG gestations. I induced at 41 weeks, but I should have waited. Gestation is 38-42 weeks, after all. The baby was a perfect 7lb 2oz, so there was no risk of her getting too big and me not being able to deliver. I think a major reason for such a massive increase in C-sections is impatience. Hospitals don't allow women to labor very long. If you get to your due date, you're induced, which leads to a long, slow labor that has a high likelihood of ending as a C-section. Childbirth has been "medicalized" to a point where it's basically seen as a disease. So you're stuck. You can deliver in the hospital, where it's safest should something go wrong, but you may be pushed into a C-section or pitocin. Or you can risk a delivery at home or a birth center. Those choices suck.

Posted by: atb2 | January 14, 2008 8:00 AM

The hospital birth experience I had with my two chidren was so unpleasant and discouraging that I'd sooner give birth in a barn than in a hospital again.

My first baby I had at lunch, while the doctors and nurses gave their lunch orders. Fortunately my doctor was pro-natural, though the hotpital staff was more old-fashioned and refused to bring my baby for on-demand nursing during my 3 day stay, saying I didn't have any milk for her. How would they know? The second baby I had at supper, with a doctor who was annoyed that I wasn't moving fast enough so he could get home in time for supper. He used forceps, I've no idea why, and mine was the only baby in the nursery not born by c-section.

I think things have gotten even worse for birthing mothers and their babies. I'd advise my daughter to have a home birth with a midwife for a normal delivery.

Posted by: IslandLady | January 14, 2008 8:13 AM

my first pregnancy, i was VERY pro-water-birth in a birthing center. after I miscarried, though, my views about the fragility of babies and the need to have every possible lifesaving device accessible made me rethink that view. I'm not sure what I'll do next time (assuming i'll get a next time!).

My co-worker just gave birth, and she really wanted to be induced the day before her due date because of the holidays (it would work out better for her leave-wise._ Her doctor told her the baby wasn't ready yet and she ended up delivering a week later. Hooray for doctors who pay attention to what's best for the health of mother and baby, regardless of the convenience!!!

Posted by: newslinks1 | January 14, 2008 8:18 AM

I chose to use midwives because I felt they allowed me to be part of the decisions made during prenatal care, labor and delivery. My son's birth, 11 hours after labor started, was natural (although I'm not against epidurals) and I felt empowered by the midwife and the hospital's nurse all the way. 3 hours of pushing was tough, but I'm glad I was never pressured to give up and do a c-section. I am concerned with the lack of input a lot of parents have in their prenatal care (to do the screening tests or not, etc.) and the labor process. C-sections are done too often. We'll see how labor #2 goes in May, I hope DS#2 doesn't require another 3 hours of pushing!

Posted by: kbkelm | January 14, 2008 8:23 AM

My first labor was very long -- over 16 hours. My second and third were incredibly short and more uncomfortable than painful, making me think I could hypothetically have had baby #2 and baby #3 at home.

But even knowing what I know now, I don't think I would do anything differently. I wanted to have my babies as close as possible to a world class NICU. In case anything went wrong, I'd want them there in seconds, not the 15-20 minutes it would take an ambulance to get them there.

My ideal situation would be to give birth in a hospital, close to medical attention, but with the ability to labor "naturally" for as long as possible. The best of both worlds. Some hospitals, like Roosevelt in NYC and Sibley in DC, are pretty close to that ideal.

Posted by: leslie4 | January 14, 2008 8:28 AM

I pretty much feel that there is way too much focus on "the birth experience." The point is to bring a baby in a way that doesn't in any way harm him or her. The idea of planning some optimal Martha Stewart birth using only guided relaxation and deep breathing to get through it just strikes me as mildly ridiculous. It sets a woman up to feel like a failure if things don't go as planned, and potentially puts the baby in jeopardy if a woman is so hell-bent on sticking to her "plan" that she wants to defy medical advice if it means not being able to experience a vaginal birth.

happydad--I could not agree with you more about the breastfeeding Nazis. My two favorite personal experiences were when the lactation consultant told me that "formula fed babies sometimes sleep so deeply that they never wake up" and when the pediatrician once cooed at my infant son "don't you wish your mom was giving you the best food?" when I brought up a question about how much to formula I should be feeding him.

Posted by: maggielmcg | January 14, 2008 8:37 AM

I am pregnant with my first child. I will be 38 when the baby is born in August and while I realize there are inherent risks involved with a pregnancy at my apparently advanced age, I am hoping to give birth naturally, maybe in water, at a birthing center rather than a hospital.

I was in attendance at my nephew's birth at a local hospital last year and was shocked at the impersonal and uncaring treatment my sister-in-law received. The doctors and nurses were uncommunicative, even when we asked specific questions. They were harsh and unsupportive during the final stages of her labor and made us all feel like the entire event wasn't any more important than changing a tire. While I'm sure there are many doctors, nurses and hospitals out there that could offer a different experience, I have since been determined to have the personal care of someone who will support my choices, answer my questions and understand what a profound and personal moment this will be for me and my family. For these reasons, I believe a midwife is the best option for me. Should my pregnancy become high risk or should I need medical intervention, I will still have the support of my midwife who will assist me with making my choices clear to medical personnel.

To me, this is the most important aspect of all of this, that women get to make their own choices about how they want things to go and are not dicatated to - with any other medical situation doctors offer recommendations and allow patients to make decisions for themselves. I don't understand why it is that with giving birth the patient's wishes are so often not even considered.

Posted by: MrsDre | January 14, 2008 8:46 AM

Our first baby was 2 weeks late. Every time the phone rang at the office during that period, my heart skipped a beat and I got an adrenaline rush. Cool! I was young back then and loved the excitement.

Over a decade later though, I liked the convenience and ease of the planned c-section of our last child much better. it was pleasant, much less painful both before and after the delivery, and my wife didn't cuss me out.

Posted by: DandyLion | January 14, 2008 8:51 AM

For some women, the birth experience IS incredibly important. It seems that it is pretty common for women, especially lower income women or women in more rural areas without as many medical options, to be treated uncaringly. Giving birth can be both terrifying and exhilarating. Frankly, no matter where, when or how you labor, you need A LOT of support and expertise. Sometimes doctors and hospitals are simply not set up to provide that, and it is a shame that such a life-changing and life-giving experience could be treated callously.

Posted by: leslie4 | January 14, 2008 8:54 AM

Good grief, who cares if mom gets to have an "empowering experience" or feel "in control"? Are we American women so spoiled that we can't just be happy to survive childbirth and have a healthy baby?

I'm sure that all those poor women in Afghanistan and Bangladesh feel "empowered" and "in control" when they give birth to 8 kids at home without any "unnecessary medical intervention." They are probably disappointed that they can't have water births, though, due to the lack of potable water.

Posted by: barfster | January 14, 2008 8:56 AM

I really care that women everywhere feel empowered in all aspects of our life, especially in terms of when we get pregnant, how we give birth, and how we raise our children. These are fundamental human rights for women, not to be dismissed lightly in any country, at any time in history.

Posted by: leslie4 | January 14, 2008 9:00 AM

My first child was born in a hospital using midwives, and the experience was, overall, great.

This time around, I have to use an OB because I am technically "high risk" (twins). I am worried about being railroaded by the dr into making decisions based on her convenience rather than what's best for me. My SIL recently gave birth and her OB cut an episotomy for no good reason- he just thought it was taking her too long to push the baby out (a whole hour- egads!).

If I end up needing a c-section, that's totally fine. But I view surgery as something you do because you have to, not because it's easier for the dr or more convenient. I wouldn't have my appendix out for no reason, either.

Leslie, you know that 16 hours is not really long for a first labor, right? 24 is average. I think you may have gotten some bad info somewhere.

Posted by: floof | January 14, 2008 9:01 AM

Mako, are you offering Michael Moore and Ricki Lake a ride on your back to Cuba? It is not that far!

I am not sure about the c-section stat Leslie cited, I thought there was a reversal in the c-section trend a couple years ago, but I could be wrong.

I didn't see Lake's documentary, nor do I particularly care what the NY Times, SF Chronicle or Mommy blogosphere have to say about how I give birth or what people think about my decision. My doctor and I made the decision on what was best for me. The key is finding a good doctor!

Posted by: cmac | January 14, 2008 9:08 AM

I too think the 'birth experience' is overrated and a set-up for feelings of failure. I will add to this that the birth experience is 99% about the mother and 1% about the baby. If giving birth is the start of our motherhood, then we should be most concerned about what is right for the baby, not orchestrating the right ambience for ourselves.

I would question the statement that giving birth by C-section is the riskiest option. The overall data waffle back and forth on this, but the risk difference in any case is extremely small. For both my children, I felt that a C-section birth was actually the safest for them. It was quick (and medically necessary), and I would have done anything to assure their safety. Choosing a C-section was a very easy decision.

Better yet, a planned C-section conserves the new mother's energy for doing what is most important - feeding and caring for her baby round-the-clock. It was a bonus that I didn't have to do that after 24 hours of labor.

As for the bummer of not getting to hold your baby for about 45 minutes while you are stitched up - again, this is mostly for the mother, not the baby. In most cases, there is a perfectly capable parent in the room who can take over that lovely bonding time - the baby's father.

Posted by: violinline | January 14, 2008 9:15 AM

Boo hoo - I don't like all the advanced healthcare I have access to in my country. I want to try to exert control over a situation that is generally uncontrollable.

Puhleeze - only in America would people complain about this kind of stuff. Only in America would people refuse to vaccinate their kids.

As a mom who had two normal, unremarkable pregnancies that turned out much differently than planned, I can't for the life of me imagine forgoing access to a hospital. I'd much rather be seconds from the OR than 20 mins. I also know that much like weddings; it is about the rest of your life NOT that one day or one experience. The narcissism that feeds this idea that MY birth experience is somehow so unique and special that it warrants a soundtrack and scented candles lets me know that this is probaby just the bridezilla in maternity wear.

Posted by: moxiemom1 | January 14, 2008 9:16 AM

Leslie and Floof,

Actually, average first labor is about 12 hours. So 16 hours isn't that long. But 24 certainly isn't average, although perhaps not extremely unusual.

http://www.marchofdimes.com/pnhec/240_1034.asp

Posted by: rockvillemom | January 14, 2008 9:17 AM

Better yet, a planned C-section conserves the new mother's energy for doing what is most important - feeding and caring for her baby round-the-clock. It was a bonus that I didn't have to do that after 24 hours of labor.
Posted by: violinline | January 14, 2008 09:15 AM


I'm incredibly frustrated that people believe that c-sections are EASIER on the mother than labor. There's a SOLID REASON why short-term disability policies allow 6 weeks recovery time for vaginal delivery and 8 weeks recovery time for c-sections!!! c-sections are MUCH harder on the mother physically and take longer to recover from!

sure, everyone has anecdotal evidence about individual cases where a vaginal delivery was terrible or a c-section very easy. On the whole, though, the disability people have very good data about what a reasonable recovery time is. Take a look at that data before you plan on a c-section because it's "easier"!!!

Posted by: newslinks1 | January 14, 2008 9:36 AM

Like a lot of women, in my first pregnancy I read a lot and attended classes and I got the unequivocable message that natural is better, so of course, I decided to go for that.

When we brought up questions around "what if there's a problem," both my husband and I got the spiel that complications are very rare, and if there are any, don't worry, appropriate action will be taken. So, we didn't worry. Later on we found out that's not the case - but people "don't want to upset" a pregnant woman, so that's the story you get. In fact, out of 100 births, only 98-99 people will take a baby home.

But we were sold that "your body knows what to do" and "natural is best," so, I gave birth to my daughter in a birthing centre (in a hospital) that I chose in part for its commitment to natural delivery and low c-section rates.

In one of those twists of irony, the nurse overseeing my labour misread the fetal heart monitor and we continued with a natural delivery (4 hrs of pushing) until my daughter's heart gave out - she had the cord around her neck twice, and although she lived for four days afterwards the damage was too severe for her to survive.

So, you can imagine where I stand on this one.

I think that the proponents of natural delivery have good points and I think it's fine to go for a natural birth - but have a safety net, and don't get so obsessed with "the birth experience" or "bonding" that your child suffers. It's a lot worse than never getting to bond at all, trust me. I think people lose sight of the goal sometimes.

(In my case there was actual malpractice involved and I think probably a midwife would have actually done better. I'm not suggesting my experience is typical. But I still think that right now the culture trend is towards choosing to forget that birth is a risky experience for child and mother.)

I delivered my son in a high-risk L&D ward, naturally, no problems. It was more clinical; the lights weren't dimmed, there were more people around, I wasn't treated like a super-special snowflake.

But he's fine, so.

Posted by: shandra_lemarath | January 14, 2008 9:44 AM

All you granola-crunching natural birth types, call me when the shuttle lands. Oh yes, the 14th century was such a great time to be alive. If only it weren't for that Black Death. Why don't you try to cure that at home.

Posted by: antipATRICK | January 14, 2008 9:44 AM

Right on Moxie Mom.

I think that it's wonderful that (adequately covered) families in America have so many choices when it comes to giving birth. Just remember, though, that this is as privilege for moms with great health insurance or significant resources.

And any woman who does not trust her doctor to manage her delivery the way she wants needs to get a new doc. You need to be able to talk to your OB. Your OB should arrange for you to meet other docs in his/her practice. Check your chart so that you know your wishes have been noted. Make sure your partner knows those wishes and will be outspoken enough to make them known in the delivery room.

But you need to trust your doc, because sometimes your desire for no C-section/episiotomy/epidural etc. needs to be revisited, and you need to be able to trust his/her judgment.

I had a very normal pregnancy. Delivery, however, was another story -- an emergency C-section after it became obvious DD was not going to fit through the birth canal (head=95th percentile) and her heart started going a little crazy. It was scary, but the important thing was that when it was all over, I had a healthy baby.

Posted by: vegasmom89109 | January 14, 2008 9:46 AM

Choice is good. I think the issue is that sometimes hospitals don't give women choices. I delivered my baby last year at a birth center in Bethesda (now closed due to lack of funds)and it was a great experience for me. What was striking to me was how horribly, horribly painful laying down was during labor. I simply couldn't - it was torture. Sitting up, walking, etc. was okay. And I realized then why epidurals are so needed and popular - I couldn't have gotten through labor laying down without an epidural, either. And for some women, that pain must be present no matter what their position. But the birth center gave me options (including going to the hospital for an epidural or emergency) that the hospital alone wouldn't have offered - the option of a tub, of waiting as long as labor took, of walking the stairs, of eating and drinking. I was and continue to be grateful for the experience.

Posted by: lcobb | January 14, 2008 10:01 AM

I am very glad that modern medicine offered me a relatively safe birth. After 3 miscarriages, I did not want to risk losing a baby because of a late-term complication. Plus with my first, I had no idea how bad labor would be, so I wanted ready access to pain medication if I needed it.

That said, even at "mom-friendly" hospitals, the rules suck. I wanted to walk around, to use a birthing ball, etc., and the hospital said they could do that. But they didn't tell me that all that goes out the window when you're induced. 2 hospital, 2 births, 2 inductions -- and 2 times strapped motionless to the dang bed.

What the first hospital also didn't tell me -- and I didn't find out until 2 yrs later -- was that the drug they used in the induction to soften the cervix (cytotec) caused uncontrollable contractions in some women. Which explains why I went from nothing to 2-minute long contractions 30 seconds apart in 45 minutes flat. And after 5 hrs of that (blessedly short, but boy, didn't feel like it!), my daughter's heart rate started dropping precipitously, so they ended up using both vacuum and forceps to get her out ASAP. I was extremely glad to have the NICU there -- she got great care, and despite a tough first few minutes, she's suffered no long-term effects. But I feel very frustrated that the drugs they used probably created a good part of the risk in the first place.

And what's with the no eating thing? How you expect a woman to basically run a marathon with nothing but ice chips is beyond me. With my second, I had gestational diabetes, so no food = blood sugar crash = v. bad for baby and mom. I knew no solid food, so before I went in for the induction, I had a glass of milk. Got to the hospital and they actually sent me home!! Why? Because it was hospital policy. Nothing to do with actual patient care, mind you -- it was to keep their malpractice premiums down. And yes, I do know there is a small risk of (a) needing anasthesia, and (b) throwing up while sedated and choking to death. But to my mind, there was a much, much bigger risk of having my blood sugar drop to a very dangerous level -- practically an inevitability with my disease. But I guess they figured if I passed out, they could "fix" that with more medicine, so that was the "safer" bed from their standpoint -- again, regardless of my own risk/benefit analysis.

Oh, and BTW: a lot of this is not just a matter of finding a good doctor; I had great doctors both times. Most of the time it's the hospital -- and hospital policies are written by lawyers and administrators focused on reducing the hospital's legal risks. Patient comfort and "empowerment" are just not even a consideration. The only thing they care about is that they don't get sued for the 900,000 times women experience extra pain and prolonged labor from lying on their backs in bed -- they get sued that one time out of a million that they let someone disconnect from the equipment and something bad happens.

Posted by: laura33 | January 14, 2008 10:01 AM

And for all you natural birth lovers, go spend a year or two in Africa and watch all the natural births. And deaths. And see the tears in these mothers' eyes as they watch their infants die because they don't have the simple medical care that would have allowed them to live. I am so sickened by some of the statements on this blog today. My God, the lives of your children hang in the balance. We actually, through the luck of OUR birth, have access to the best medical care in the world, and you would turn it down. Give up your developed-world guilt, and allow your child to live!!!

Posted by: antipATRICK | January 14, 2008 10:03 AM

Don't have time to read through all the other comments, but I wanted to point out that the link in the first paragraph is to an article on UNASSISTED CHILDBIRTH, which is NOT the same as "home birth" - it's a tiny subset of all home births. I am planning to give birth (sometime between 1 and 6 weeks from now!!) at home, but I would never DREAM of trying to do so without qualified professional assistance. My midwife will be with me and my husband throughout and we will be relying on her experienced professional judgment to intervene if necessary, up to and including transfer to our excellent local hospital. The "unassisted birth" trend is crazy and dangerous. Home birth doesn't have to be either.

Posted by: gracepritchard | January 14, 2008 10:04 AM

When I was pregnant with No. 1, my OB told me to put together a birth plan, but be realistic. Then she gave me the example of one woman who had in hers about how she wanted one type of music when she was dilated 1-2 cm, another CD when she was 3-4, etc. My OB was trying to tell me not to do that.

My instructions were pretty simple - offer me drugs, do what's right, I *really* don't want a C-Section.

Water broke early with DS 1, so I was in the hospital about 8/9 days before I was induced. The dr's apparently wanted to keep me there, and I heard something in the background about the insurance company wanting me induced. The drs were apparently on my side, and everything worked out fine (DS was over a month early, just tiny, but perfect).

Second kid - I was miserable by the end, went to the dr. and she said it looked like my fluid was low (so maybe my water broke, but she wasn't sure) and she made a comment about how she could convince the ins. Company it was okay (i.e., I was clearly not in labor, they had to induce, etc). - second time I probably shouldn't have gotten an epidural, but that's another story.

Both were vaginal deliveries (oddly enough, my sister had had two csections, my other sister had had one - my MIL had had three - and they were all lobbying and telling me how wonderful c-sections were throughout my pregnancy).

I agree with people who say it should be about getting a healthy baby. The craziness starts much before pregnancy even (when people are nuts about getting pregnant, when they feel they must get pregnant at any cost, that having a baby is the end all and be all of everything). These thoughts then continue after birth (with the helicopter parents ensuring that every moment of their precious child's life is just perfect).

It's creating a bad precedent, with children who feel entitled, with parents who can't say no, etc.

Just let doctors and patients alone. Give us the options, and get out of our lives.

Posted by: atlmom1234 | January 14, 2008 10:06 AM

I think the more choices a woman has, the better. At Anne Arundel MC, there is a natural birthing center that is connected to the hospital by a tunnel, so that in the event that a woman decides she needs an epidural, or in the event that a medical emergency arises, she can be whisked away and given the care that she needs. It would be great to see this type of thing at all hospitals with maternity wards.

Another interesting discussion is on the post-birth experience. Anne Arundel does not have a nursery - which I found to be great, as I didn't have to fight to have my child in the room with me. At the same time, the nurses were more than happy to wheel her around and take her away so I could nap if needed. Again, a great compromise. So, in-room or nursery - which do you all prefer?

Posted by: mdsails | January 14, 2008 10:06 AM

After my daughter was born, I was very much of the opinion that my next kid would be a VBAC. My labor with DD was awful -- a classic case of snowballing intervention and the nurse's hostility to anything resembling natural childbirth principles, culminating in a c-section.

Given all that's come after, I have serious reason to regret that damn c-section. Since DD's birth, I've lost three babies in two pregnancies, have been diagnosed as infertile, and will be starting IVF this week in a last-ditch effort to have a second child. Though I'll never know for sure what happened to turn my uterus and tubes into a mess of scar tissue, at least one doctor thinks it could have been a complication of the c-section.

That all said, I don't care if they take my next kid out with a melon baller, as long as she/he (1) exists, and (2) is healthy. It's not like I'll need my reproductive organs again after that, anyway.

Posted by: newsahm | January 14, 2008 10:09 AM

I'm pregnant with my 2nd child. I had Gestational Diabetes with the 1st and was made to induce in the 40th week because of that. El Kid apparently wasn't ready, however, and after every get-that-labor-moving medical intervention known to man I had a C-section.

I left that experience happy to have a kid, and blessed to have had a caring labor and delivery nurse, but still miffed at how much I ended up feeling like a piece of meat. I was treated well, but as far as experiences go, it was NOT a warm fuzzy memory to write about with gushy saccharine tones in the baby book.

Now, pregnant with the 2nd, I'm already sick of being treated like a sick person. I've got GD *again*... I'm now advanced maternal age... I've got placenta previa at the moment... how many more signs do I need to point to yet another C-section? I'm not adverse to a VBAC at all, but I'm starting to feel, all "why bother" about it.

What makes me even more annoyed is that I doubt I could have used a midwife even if I wanted to, especially this time around. I've got too many complications as it is. The midwife / birth at home option is for healthy women with standard pregnancies. They're the ones who have the real choice to tough it out and go natural or assume the "risk" and birth at home. GD alone kicks me out of the "healthy" group... never mind that my GD is pretty mild and is all diet controlled. Matters not. I've got the diagnosis now... And that affects how I'm treated every *!@# step of the way.

If I could tailor my birth / my experience I'd deliver in a birthing center but WITH an epidural and be right next door to a hospital with a nicu. I'd like to have the chance to NOT be hooked up to an IV and a fetal monitor from the minute I walk in the door, regardless of if anything is looking like it's wrong (last time there were absolutely NO abnormalities in the baby's stats the whole time except during one particularly painful intervention to get the labor moving quicker).

So, the best I can do *personally* is to dump any idea of enjoying my process. I now treat any medical aspect of my pregnancy as a trial I have to get through. I figure I'm doing good if I can keep my annoyances from blowing into full blown anger... and I'm doing excellently if I can hide even the annoyance. Eventually that trial will be over and I can get on with my life. Enjoy it? Bah. That's for somebody else.

Posted by: Juniper311 | January 14, 2008 10:11 AM

As a birth attendant and mother of five (born both in and out of hospitals), I'd say that birthing mothers tend to suffer the same sort of dehumanizing treatment in hospital that most patients go through, no matter what brought them there. What women find so frustrating about this is that having a baby is not like having your appendix out--unless there is a medical emergency, it's not a very medical event. I've been at a lot of births, and the main task of the attendant (aside from providing the mother with as much relief and support as possible) is simply observing the situation closely to determine at every stage that the birth has not devolved into a medical event. I've acted as stirrups while some of the best and brightest OB-GYNs did nothing but what any old granny knew to do--lubricate, watch for rotation, ease out a shoulder.
When their obstetric skills are required, they can save lives. When not, they can be the least pleasant people in the room. Sorry, but it's true. My feeling is, if you can't catch the effluvia of a woman in labor without being human and sympathetic about it, you don't belong in the business.
Problem is, as the hospitals become less positive places to work, the best midwives wind up outside the system. Which leaves those ladies who give birth in hospital to do it with the less empathetic support staff. In a normal birth, the doctor is only going to be there for the very end. Who is really with the woman through her labor? Increasingly frequently, only a loved one or someone she hired.
But for everyone who thinks that the magic of the hospital is the immediate availability of surgical intervention, this is simply untrue. The availability of OR, surgeon, anesthesiologist, support staff, is dependent of factors entirely out of anyone's control: size of facility, number on staff, and least known of all, how many women are lined up for sections at that particular time.
I know a hospital midwife who had an arm up a woman's works for half an hour holding back a descending head from a prolapsed cord while the doctors were assembled. Lady and baby came through okay.

If only we had a more human hospital system altogether, not for those "spoiled" American women who don't know how good they have it (at least that's the implication of so many comments), but for the sake of the good health of all inpatients, and the emotional health of the caregivers.
Hospitals are philanthropic businesses, and the philanthropy will always be in conflict with the business. Hospitals have their timetables, otherwise they couldn't survive. But, as anyone knows who has ever been an inpatient, that timetable is not always to patient's pleasure, convenience, or even benefit. It can even work to the patient's detriment, and that's when the lawyers enter the picture.
If the US would adopt more of the European model of maternity care, society would save itself a lot of money. Midwives for all uncomplicated births, OBGYNs on call for complications. The provision to allow doula trainees to intern in hospital by offering the option of an attendant at intake. Keep the ORs as high-tech as need be, but only use them when necessary. And keep the doctors where they belong--overall supervision and obstetric surgery.

Posted by: yehudisg | January 14, 2008 10:13 AM

oh, and re: advanced maternal age:

I was 35 when pregnant with no. 2. I refused the amnio. Yes I know people who said to me (while they were pregnant): well, I *have* to have an amnio. Well, the first tests they did of the fetus gave me very low odds of anything not 'typical,' so given the risks, I opted out. I guess the insurance company was happy, the dr. who did the ultrasounds didn't try to talk me out of it, it was a non started with the OB, etc.

Posted by: atlmom1234 | January 14, 2008 10:33 AM

I had my first baby in the hospital, and my next two babies at home. I'm very, very thankful that doctors and hospitals and all their life-saving equipment are available when needed.

For a low-risk, healthy pregnancy, however, I think it's actually safer to birth at home or at a birth center rather than a hospital.

Many women find that laboring lying down in bed, or being held relatively immobile by a continuous fetal monitor (belt around the tummy) is not a comfortable or productive way to labor. This inability to work with her body can actually slow down a woman's labor, greatly increase pain and prompt interventions (like pitocin or an epidural) which are often only necessary because of the restrictions on her ability to move.

These interventions, in tandem with the restricted movement, can sometimes lead to stalled labor, fatigue and eventually a C-section. That's part of the reason we have a C-section rate of about 30% in hospitals.

C-sections can be life-saving, but they are major surgery, with all the risks of surgery, and everyone agrees that they're not necessary in nearly 30% of births. It's a risk worth minimizing, if you can.

We live about 25 minutes from the nearest hospital now, and about 50 minutes from the NICU. While I loved my home births, for my upcoming birth I'm considering going to a birth center in the city where I'll be 2 minutes from the NICU - just in case.

Of course there are risks and benefits to each option. It's a matter of getting accurate information about the pros and cons, and weighing those risks and benefits in your particular circumstances.

I haven't seen the movie, but it sounds like a good vehicle to get some information out there for parents to consider - that they generally won't hear from an OB who is only experienced with hospital births.

Posted by: mizhviz | January 14, 2008 10:34 AM

I just realized you linked to an article about unassisted home births. That's quite different than a home birth attended by trained and experienced midwives.

One of the main roles of the midwives is to monitor mom and baby, constantly evaluating whether things are progressing normally - so that you can transport to the hospital in those few cases where it's necessary.

If those were the only two options, I'd definitely choose the hospital birth over an *unassisted* home birth.

Posted by: mizhviz | January 14, 2008 10:55 AM

I'm not sure I buy that 46% increase in c-section rate since 1996 statistic. When I had my first child in 1998, I was told that at that point the c-section rate was one in three births. Unless that 46% increase happened entirely between 1996 and 1998, something's not right (could be me, of course).

I'm really ambivalent on this whole issue. I was raised by a mother who was a big proponent of natural childbirth, but I didn't find out until I had my own children that to her "natural" meant "awake!" She didn't care about getting a few drugs to help manage the pain--she just didn't want to be completely knocked out, as had been the standard when she was first married in the early 1960's. Not knowing this, I figured I'd go with a natural approach as well--an approach I quickly threw out the window when my first labor stretched for 40 hours. I ended up with pitocin to help with the contractions, an epidural to manage the pain, a huge episiotomy to help birth my nearly 10 pound baby, and antibiotics to deal with the mysterious fever I developed during labor (turns out it was just a reaction to the episitomy, but they couldn't take chances with that). It wasn't fun, but what was less fun was the recovery. Weeks and weeks of pain from the stiches and the swelling--bad enough under any circumstances, but who wants to deal with this AND a newborn?

So for baby #2 I vowed to REALLY do it naturally because I had heard that the recovery was easier with fewer interventions. I took Bradley classes (which my sister swore by) and hired a doula, and I don't know if it was these things, or just experience, or just that it was my second baby, but this time the birth was completely different. Still fairly long (19 hours, but that was way better than 40!) but much more manageable, and the pushing was significantly easier without that epidural. This baby was over ten pounds, but the birth was so much simpler and the recover time was about five minutes. I was up and walking around, feeling nearly completely normal, within an hour of birth.

I'm with the people who think that the "experience" of birth is hyped too much and the goal is to just have a healthy baby, but I also think that more parents should spend some time thinking about the recovery from the birth. My own experience seems to bear out the belief that recovery time is faster with fewer interventions. I can't imagine how difficult it must be to be recovering from major abdominal surgery while caring for a newborn! Youd think that alone would be enough to drive parents to do what they can to avoid the c-sections.

Posted by: sarahfran | January 14, 2008 10:56 AM

Choice. A wonderful word. A wonderful concept. But choice does not come without consequences. There are pros and cons to each type of delivery. At home may make sense for one woman and not for another based upon a myriad of factors. There is no one size fits all in pregnancy (or maternity clothing).

Good luck to all the parents making these decision. Please remember, nothing is perfect. Have the baby at home with a midwife and it may be beautiful or the mom or baby may need procedures beyond the midwife's ability to help. You may give birth in a hospital and feel like you are a number at a factory with medical staff that does not care about you as an individual. Or worse yet, you may pick up a MRSA. There is risk and reward with each option.

The wonderful thing about choice is it makes each type of practice - hospital, birthing center, home based midwife - examine their procedures and practices and adopt winning solutions from the other services.


PS - I had a lovely delivery in a DC hospital. It was the best choice for our family - not necessarily the best choice for every family.

Posted by: andrea.kelly | January 14, 2008 10:57 AM

"My ideal situation would be to give birth in a hospital, close to medical attention, but with the ability to labor "naturally" for as long as possible. The best of both worlds. Some hospitals, like Roosevelt in NYC and Sibley in DC, are pretty close to that ideal."

I know nothing about Roosevelt in NY but have known several women who were rushed in ambulance from Sibley to Georgetown do to complications during the birth. While Sibley, is a lovely hospital it does not have a "world class" NICU. If there are serious complications you will be out the door. Now that is unlikely but if you are choosing a hospital based on worst case scenario Sibley is not for you.

Posted by: ChesapeakeBeach | January 14, 2008 11:03 AM

I guess, the most important question regardless of your choice is:

Could you live with your choice if the worst came to pass?

Posted by: moxiemom1 | January 14, 2008 11:06 AM

"Hospitals have their timetables, otherwise they couldn't survive. But, as anyone knows who has ever been an inpatient, that timetable is not always to patient's pleasure, convenience, or even benefit."

Boy, isn't THAT the truth! After my first, I had uncontrolled bleeding and ultimately needed surgery and two transfusions. After all this, you'd think that they'd give me some time to sleep to recover. But no: the doctor had left typical instructions (blood pressure/temperature checks, various medicines, etc), but parts of those instructions went to three separate areas within the hospital -- and God forbid those people coordinate with each other. For the four days I was in the hospital "recovering," I never got more than 4 hrs of sleep at a time -- and was frequently woken up every two hours for another check. I kept thinking, doesn't it occur to you people that what I really need is REST, and that waking me up 4-5 times every night is in fact interfering with my recovery? Who knew that getting home with a newborn would actually be MORE restful?

Posted by: laura33 | January 14, 2008 11:15 AM

moxie - a loaded question you posed. And the one sending moms straight towards medicalization, as if it is some panacea or a talisman against bad things happening. Bad things can happen no matter what decision you make or don't make, no matter what decision your caregiver makes or doesn't make. Bad things can happen to good people. I find your question too loaded, imho...

Posted by: dotted_1 | January 14, 2008 11:15 AM

"I'm incredibly frustrated that people believe that c-sections are EASIER on the mother than labor. There's a SOLID REASON why short-term disability policies allow 6 weeks recovery time for vaginal delivery and 8 weeks recovery time for c-sections!!! c-sections are MUCH harder on the mother physically and take longer to recover from!

sure, everyone has anecdotal evidence about individual cases where a vaginal delivery was terrible or a c-section very easy. On the whole, though, the disability people have very good data about what a reasonable recovery time is. Take a look at that data before you plan on a c-section because it's "easier"!!!"

Having had both and having a much easier time recovering from the c-section than my rather easy undedicated vaginal birth I asked my OB about this. My OB let me drive days after the vaginal birth but was super strict after the C-section. And this she explained was tied to the disability leave. It is all about where the steering will hit you in a collision. And clearly much more dangerous with an abdominal incision than from a vaginal birth.

C-sections are so controlled. There is no tearing things are sewn up so nicely. So much less blood in the weeks after. I loved, loved, loved delivering my daughter it was empowering and incredible. But after having a crazily rare and incredibly serious complication with my son I was nervous about the surgery (but this trouble was so rare I think my docs were nervous too) but the recovery was terrific.

Who I will always feel the worst for are the poor moms who push and push and push. Causing all sorts or swelling and sometimes tearing only to then have the C-section. And then essentially having to recover from both.

Posted by: ChesapeakeBeach | January 14, 2008 11:17 AM

I'm currently 6 months pregnant with my second and am scheduled to have a c-section in April. My first was born after she had been in distress for about an hour at the hospital and the doctor recommended I get a c-section. She had the cord wrapped around her neck 2 times and would not have made it down the birth canal.

When we were planning to have children, my husband (a doctor) started doing research about maternal-fetal outcomes. He quickly narrowed my choice of where to labor and birth to three local hospitals, all of which had NICUs or children's hospitals attached. My daughter ended up going to the NICU for a short period of time and I am still grateful that we had been in the same building, not several blocks or several miles away.

For my second, I wanted a VBAC. My husband helped me sort through the literature and we ended up discovering that planned c-sections for second children are safer than laboring -- on the off chance that something goes wrong (so in other words, if nothing goes wrong, a VBAC is great; but if something does go wrong the odds of it going very wrong can spiral well beyond the risks of the c-section). He begged me to have a c-section (when he was in medical school he attended a VBAC where the mother died and the child lived for three weeks until he died). So that's what we're doing.

He used to joke that "the longer the birth plan, the faster the c-section." I think that's sort of true, in that if you have a "vision" of your birth experience you set yourself up for disappointment more easily than if you don't. And if you're the type of person who plans out each experience (i.e., candles at this point, this type of music here) and it doesn't pan out, your disappointment may end up making you more stressed, adding more complication potential.

As for the PITAness of not being able to eat in labor, don't get me started. I left a delicious dinner sitting on the counter so I could go give birth to my daughter and they had only crap flavored popsicles at the hospital (holiday weekend). But I felt better once my husband explained that because I was getting anesthesia (for the c-section) because I hadn't eaten I was at lower risk for anesthesia complications. What a highlight.

I think for a lot of medical professionals, they have seen a disproportionate share of "bad outcomes" and it affects their advice and their thinking. My husband will not let our daughter be treated by the pre-eminant pediatric group in our town because they don't have privileges at the children's hospital; that was an absolute pre-requisite to whoever we chose. It doesn't make a difference when she has an ear infection, but if something terrible were to happen, he doesn't want the stress of finding new doctors on top of it.

My mother gave birth to my brother in a third-world country. She was in the "best" hospital in the capital city. She hadn't wanted to leave my dad to go to Europe or the US to give birth. She had to contend with dirty water, anesthetics of indeterminate origin, and doctors and nurses who wanted her to pay for her care in advance of birth. When it was time for me to be born, she high-tailed it out of this country to the US, where she knew water was clean and that the doctors would err on the side of her health over the payment plan.

Posted by: anny | January 14, 2008 11:24 AM

laura- OMG yes! I beg, pleaded, and cried to try to get the hospital to release me and the baby, but they weren't doing it. I was up all night for 3 nights, sharing a room in Shady Grove with a LOUD woman and her LOUD baby, and my husband had to go home every night. I knew if I could go home, my mom and husband would actually let me sleep and bring the baby to me for feedings for a day or 2.

We both had elevated temps, we didn't know when my water broke, and there was meconium. We were fine, but they wouldn't let us go until our cultures were back. All they had to do was call me with the results. I would have brought the baby back had there been a problem. In the meantime, I could have gotten some sleep and enjoyed those first few days of motherhood. I was SO hoping to take advantage of a 24 hour stay and an at-home nursing visit.

Posted by: atb2 | January 14, 2008 11:25 AM

Yes, yes, absolutely right -- that first article link is about UNASSISTED home births, the radical end of the spectrum! Sorry for not making that more clear.

Other end of spectrum -- c-sections. Life saving option for moms and babies. But major surgery, involving anesthesia and some pretty serious cutting. Risk of infection. Especially hard on women if they have multiple c-sections. Nothing "wrong" with c-sections. But as one of the experts quoted in Ricki Lake's movie observes, "a lot more serious than cutting your fingernails," which seems to be how doctors treat c-sections.

Posted by: leslie4 | January 14, 2008 11:44 AM

I've been thinking about this one a lot -- I am pregnant with my second and have had several friends with fairly extreme birth stories. I tried to go natural, but got an epidural near the end. It was the best decision I made -- I was better able to focus on the birthing and less focused on the pain (though I still felt some). I tried to "squat", but my legs were shaking so badly by the end that I wasn't able to stand any longer. So I was in bed before the epidural.

I agree with several points, and I think this debate is way to black-and-white: I think C sections are probably more common than they need to be. But I am glad that we can do them when necessary with minimal complications and resulting healthy babies and moms.

I'd like to see some push to lower the C section rate, without making women feel like they are "buffoons" who haven't really considered their options for having one. My friends who had the hardest time with their birth experiences were those who were really hoping to have a natural birth but wound up with C sections. Everyone was healthy -- but they were devastated and felt like they'd failed. This is a sensitive topic for some and that needs to be considered in our national discussion. It reminds me a lot of the breastfeeding conversation -- do what we can to support an environment to bring about a better outcome (less C sections when not necessary in this case). But don't guilt or judge women who have them.

Posted by: skeptic421 | January 14, 2008 12:00 PM

I have given birth five times, four c-sections and one VBAC. Each was its own great and painful experience. In my case the VBAC was the easiest of the birthing experiences to recover from but she was also a small baby and I only pushed for 30 minutes. With my two sets of twins I had scheduled c-sections. Most of that decision is based on the postioning of the baby on the bottom and whether or not it is possible for the babies to come out--but to Floof you can end up having a vaginal delivery with baby #1 and a c-section with baby #2 so that is something to consider with a birthing plan for twins. The idea of recovering from both makes me want to cry.

Posted by: magnificent7mom | January 14, 2008 12:09 PM

We were fine, but they wouldn't let us go until our cultures were back. All they had to do was call me with the results. I would have brought the baby back had there been a problem

_____

Don't blame the hospitals, blame the lawyers. The lawyers are also the reason it is so difficult to find a good OBGYN. Not all lawyers, just the ambulance chasing sleezebags.

Posted by: moxiemom1 | January 14, 2008 12:13 PM

Since I was in the hospital for over a week with DS1 before he was born, yes, they came to take temps/bp/etc every so often (what seemed every 10 mins). The nurses were surprised that they came in one evening at 3 AM and my DH and I were playing games. Of course! We were on such a strange schedule - with them waking me up all the time, I could hardly sleep (and, being 9 mos pregnant and my water broken, it wasn't so comfortable anyway).

As for VBAC. My sister's both had csections for #1. Sister 1 scheduled csection for #2 - reading the research, etc, she felt better doing that. For sister #2, she had a husband who was only concerned that his deductibles would be more expensive if she had another csection, so she had VBACs for the other two - with the second kid she had MAJOR complications, bleeding, etc. Then her third kid came with none. Personally, I would not have taken any of those risks having more kids - knowing there were complications (had vaginal two times, so no discussions for me).

As for csections, after hearing about the terrible labors my mom had with two kids (she did NOT change drs after number 1 as that just wasn't done back then) she would have greatly benefitted from a csection, I suppose. With me, she had me very quickly tho (couldn't wait for my grandmother to get there to watch my sisters, she took them to the neighbor's house and left the door open for my grandma - my dad wasn't even at the hospital yet). *shrug*.

I'm just glad I was in a hospital, with the drs nearby. But others have differing views.

Posted by: atlmom1234 | January 14, 2008 12:18 PM

I agree with the posters who suggest that choice is good. The problem to me is that, like a lot of aspects of motherhood, there is a lot of judgment passed about what "choices" everyone should make. With my son, I had a fantastic experience at Prentice in Chicago - wouldn't have changed a thing about it. Pregnant with number 2, I am anxious about trying a new hospital - but, personally, I would never opt to have a home birth - I found it extremely comforting to have doctors and nurses around who new what was going on, and could confirm that the baby was OK through a long pushing ordeal. With number 2, I will also get my epidural the minute it's offered and don't think that will make the birth any less "natural." All that being said, if other women think that having a home birth or no pain meds will make their experiences better, then that's great for them. Just don't comment on my experience or think me less of a mother because of my choices.

Posted by: runkara2 | January 14, 2008 12:37 PM

shandra_lemarath

Shandra,

I'm so sorry about what happened with your baby girl. I'm glad your son is thriving.

Childbirth is risky business. I opted to be at a hospital and I took the epidural, thanks!

But I did kick up enough of a fuss that I was released before 24 hours with the babies. Hospitals are necessary, but filthy places. I should know, I've slummed around enough of them.

Posted by: maryland_mother | January 14, 2008 12:46 PM

This is a huge issue for me, and something I get really worked up about. I am 7 months pregnant with #2. With my son, I had an emergency c-section as an intervention to save the baby. Did I want a c-section? No. Am I happy I had one? Absolutely!

I had two choices: a vaginal birth and a dead baby or c-section and a live baby. He just turned 2 yesterday, and I've never regretted a moment of the birth experience.

Now I'm in the position of trying to decide if I'm going to have a VBAC or a repeat c-section. There are risks and benefits to both, and I don't mind talking about them with people as long as they are rational. But I have family members who are pushing me *hard* for a VBAC -- and for no other reason than I shouldn't miss out on the "experience." Well, we know a couple whose baby died as a result of a uterine rupture (which is possible during a VBAC). That's an "experience" I'd like to avoid.

I still haven't decided which way to go, since there are risks and benefits to both. My husband and I have to decide what we feel most comfortable with. But I can tell you that the "experience" for me is at the bottom of my list. I'm worried about risks to the baby, recovery time (I have a toddler to care for too!) and risks to me (not risks that I might not enjoy the experience, but risks that might cause death or permanent infertility).

Like a few other people have already said, I'm a little surprised that people focus so much on the "birth experience." My road to parenting was long and bumpy -- we had years of medical assistance to get pregnant (my husband is a cancer survivor), plus a miscarriage and two very, very difficult pregnancies (I've had hyperemesis, gestational diabetes and pre-eclampsia). I'm sure this influences my feelings about birthing babies, but I gave up a long time ago on expecting *anything* to go as planned. What matters most to me is that I have healthy children, and that I'm alive to watch them grow up. Because of my experience, this isn't something I take for granted.

Posted by: sandiego_mama | January 14, 2008 12:52 PM

I want to add that I agree with runkara2 and a couple of other people who support choice! I do too, and I only get upset with people are judgmental about other people's choices.

But I guess it's good practice for the competitive parenting that comes once the baby is born!

Posted by: sandiego_mama | January 14, 2008 12:56 PM

Actually Maryland mother, I had a different experience. With my first baby, born at 1:01 AM, I felt like I had enough time to recover (especially having not gotten out of bed much for so long before the birth) - I was given two full nights AFTER the birth to recover in the hospital.

DS number 2 was born at 9 PM - so that was considered night number one. Which was hardly restful at all, since I got to the room after 2 AM, I believe. So that was one, then I had one more night. I had more experience, so I told the nurses to take the baby away until he needed to be fed so I could nurse, but otherwise, I needed sleep. If that had been my first, I would never have gotten any rest, since with number one, I watched him sleep for something like 24 hours.

Posted by: atlmom1234 | January 14, 2008 12:58 PM

Interesting take by Slate on Ricki's "documentary". Home births have twice the fatality rate as hospital births. Well, my mind is made up...

http://www.slate.com/id/2181860/nav/tap3/

Posted by: dctony | January 14, 2008 12:58 PM

It's funny - when I was pregnant with number 1, I was at a dinner, sitting next to a woman with 5 kids. She was extolling how going natural (which, to her, meant no drugs) was so wonderful, what a great experience, how that's the only way to go, etc (she is toothpick thin, by the way!).

The very next day, I was out and about, and with a woman who has 3 kids. She basically said: take the drugs! You need to be able to recover, there's no trophy for going thru pain, if it's bad, take drugs to help you out.

I thought that was so interesting...

Posted by: atlmom1234 | January 14, 2008 1:02 PM

I almost died giving birth. If I had not been in a hospital... neither my baby nor I would be here. It is incredibly naive and uninformed to try and play doctor at home. If anything goes wrong, they only have ten to 12 minutes to get that baby out via c-section. Romanticize homebirths all you want, but it's not the real world. You are playing with life and that of your baby.

Posted by: bonnieoconnor | January 14, 2008 1:04 PM

I had my twins via Cesarean after the perinatologist saw that the umbilical cord was presenting on ultrasound. I had planned on natural delivery with the midwives, and hope to have a VBAC for my next child (if I'm lucky enough to have another).

However, I saw the ultrasound and have seen the results for natural delivery with the umbilical cord presenting - there are few studies, because the infant mortality rate in small studies of two or three was too high. I also had the midwife I had worked with the most by my side during the surgery. I had a great experience despite needing surgery - my children still nursed within 30 minutes of birth, and they roomed with me as I had wanted them to.

I do wish that hospitals would be more selective about using Cesareans. Childbirth and early parenting is hard enough without women routinely recovering from a major surgery. I wish women felt safe and respected in hospitals, so we wouldn't feel we need to choose between expert monitoring and a good birth experience.

Posted by: ethele | January 14, 2008 1:37 PM

We live in a country that is supposed to have the best medical care in the world, and you note that "Since 1996 the C-section rate in our country has rised 46 percent; nearly one in three of the 4.1 million annual births are via Caesarean surgery" THIS IS NOT A CRISIS?!! Then what is, if the best hospitals and doctors in the world can't prevent C-sections? Perhaps this is due to the fact that everyone BUT the mother and child benefit from a C-section, and clearly they are also the ones controlling the situation.

Thanks anyway...My midwife in Miami (Shari Daniels at Miami Maternity) had a 2% (Yes, that says two percent), c-section rate. She had been present at over 11,000 births (and counting!...) when I last saw her for my now 2YO son. She also was my midwife for my 5YO son. I am SURE that I would have had a C-section with my first had I been in a hospital, but she allowed my to be in control of my birth, so it worked out.

Shari can competently handle ANY situation that arises, and knows when to send a mom to the hospital when necessary. I feel like women today are being fed "information" by biased parties (read:hospitals and doctors) about their "right" to have the perfect birth through modern technology....but who is there to tell them about the feeling of empowerment, connectedness and fulfillment at being awake, whole and aware while nursing your new baby...without painkillers, a moniter, a forced prone position in bed (hot-tub for me, thanks!) while being examined....not to mention eating & drinking during labor and right after.....I cannot even cover all the benefits, these were just a few:)

There is a time and a place for modern medicine in a birth, but I just wish for more women it could be in the truly needful situation, not for ONE in THREE!!!

Posted by: sevadar31855 | January 14, 2008 1:42 PM

I'm in my 6th month of pregnancy, first baby. I'll be giving birth at Prentice in Chicago, which is a wonderful birthing hospital, but I wouldn't venture to criticize someone who wants to have her baby at home. I'm using a midwife because I want someone to help me actively manage my labor (because of a past spinal surgery, I probably can't have an epidural, which I'm not thrilled about, but that's life).

I have to agree with all of those who think there is too much emphasis on the "birth experience." We already put so much pressure on ourselves to have the "right" pregnancy, whatever that means, and now to have the "right" birth. Pregnancy is 9 (10) months; birth is a day or two; having a child is for a lifetime. I really would rather spend my energy on the latter. I agree with Leslie (and most of you) that women should have choices about where and how they give birth, and I think that all too often hospitals "run" birth in a way that is not helpful to the parents or to the child, even if things come out all right in the end. But we are not doing ourselves any favors by thinking of birth as a test, where regret and anger lies ahead if things don't work out a particular way.

Posted by: kakib | January 14, 2008 1:44 PM

"I feel like women today are being fed "information" by biased parties (read:hospitals and doctors) about their "right" to have the perfect birth through modern technology....but who is there to tell them about the feeling of empowerment, connectedness and fulfillment at being awake, whole and aware while nursing your new baby...without painkillers, a moniter, a forced prone position in bed (hot-tub for me, thanks!) while being examined....not to mention eating & drinking during labor and right after.....I cannot even cover all the benefits, these were just a few:)"

Well as I said, my experience was just the opposite - I heard ALL about the benefits and very little about the risks. Trust me that being ready to breastfeed & bond is not much good when your baby is hooked up to a ventilator and having seizures.

I really don't buy the "medical conspiracy" view of obstetrics. Sure, it may be that in some hospitals and some practices people get unnecessary c-sections. But I don't think it's very fair for anyone outside of a situation to try to evaluate those judgment calls.

I'm glad your midwife has such a great rate for c-sections; I would wonder how she pre-screens her clients and also what her complication and death rates are. Those are the questions I now know to ask.

Posted by: shandra_lemarath | January 14, 2008 2:03 PM

Shandra,

I'm so very sorry for your loss. What a horrible tragedy to go through, after trusting your doctors and knowing that the best care was being offered and the fetal monitor was keeping your baby safe...

Knowing that tragedies occur even in the "safest" circumstances will make me a more informed patient in the future. Thank you for sharing your experience, and may it keep future babies safe!

Posted by: newslinks1 | January 14, 2008 2:08 PM

I gave birth to our first child after 15 hours of labor. My son had respiratory distress and was immediately medevacced to a children's hospital over 50 miles away. My husband went with him and I didn't see the baby for 24 hours at which point I didn't recognize him. I was really traumatized by the whole experience.

I was also in some pretty severe pain since I ended up with forceps and no anesthetic. After that, I was seriously pro-drugs during childbirth. I decided that it was basically as if someone had said to me, "You know. There's a bus leaving for Cleveland in half an hour. would you like to get on it?" And I had said, "No. No. I really want to walk eight hundred miles so I can really experience the journey." What kind of logic is that?

Posted by: justlurking | January 14, 2008 2:17 PM

Very funny, justlurking!

Well, since my no 1 son was born early, there were all these 'extra' people in the delivery room. He was whisked away to somewhere, my DH went with him, I was all alone, just sitting there for a while (kept asking the nurses who would come by when I could nurse).

He was fine.

With DS 2, he was all blue when he was delivered - so DH didn't cut the cord, everyone was concerned. Turns out, he was bruised from climbing out of his old 'home.' It was diff. from first experience - so I thought *that* was unusual, when, apparently, they usually give you the baby right after birth.

Posted by: atlmom1234 | January 14, 2008 2:22 PM

For those saying there is too much emphasis on the "experience," if by that you mean the soft-focus birth story, sure. But I think the experience includes a healthy mom and baby at its core, and then as secondary items includes things like how long it takes to recover, the care and nurturing mom and baby recieve during and after birth, and a feeling of respect and trust that you are in good hands.

Many are saying that the health of mom and baby are best ensured at a hospital. For women and babes with any health issue this is beyond dispute. But lots of data show that moms and babies actually do better when attended by midwives through a normal (ie not risky) pregnancy and birth, and that birth centers and even home births can be very healthy options. The data is mostly from the UK and other Northern European countries that have robust midwifery programs, not the US.

I don't think there is going to be some groundswell campaign to take away women' rights to OBs, hospitals, and c-sections. Those things are available to most who need or want them. But a midwife attended birth isn't available to everyone who might want one or benefit from one - there simply aren't that many birth centers and midwives. Can't we suggest that the US might be able to reduce our infant mortality rate with more midwives (since on a population level infant mortality is tied to lack of prenatal care, which midwives provide well)? Why should that be any sort of criticism of those who chose or need other care?

Posted by: lcobb | January 14, 2008 2:26 PM

The birth experience for women IS important. It is not like a "wedding day". It is not a test, but we should set up women to have an experience that respects them and recognizes their efforts. People act like birth is pulling a lever and out comes baby if you are lucky. It's more like climbing Mount Everest. You are DOING SOMETHING, not just lying there while the doctor "delivers" the baby. The doctor isn't the one doing it. The woman is! I think that wording is deceptive.

Our culture does not have respect for the labor process. I felt like I had really accomplished something beautiful with my labor and it all went well. I had a doula and was well-supported during my time in the hospital.

But those of you who say "just be thankful for a healthy baby" minimize the experience. It is one of the most beautiful and challenging experiences of my life. It is sad and insulting that many roll their eyes when we talk about it. My guess is many of those doing so are either male or have not recently given birth.

Posted by: goodhome631 | January 14, 2008 2:28 PM

Or, as my husband once put it: people seem like they would like a medal for performing a basic human function.

Posted by: atlmom1234 | January 14, 2008 2:32 PM

"There is a time and a place for modern medicine in a birth, but I just wish for more women it could be in the truly needful situation, not for ONE in THREE!!! "

Nice anectodal evidence. You are such a loser. Please people, do not listen to losers like this. If you want natural childbirth, fine. Move to Burkina Faso. They have lots of natural childbirth there. And a third of their children die before the age of one. Best of luck on that one. I have a child who has survived until the age of 3 1/2. Why?? Because of the advanced medical techniques of the western world. Gee, yes, I know, I should have exposed him to malaria, HIV, and yellow fever just to be "a cool at-home mother" but, gee, I decided that my child should live.

Posted by: antipATRICK | January 14, 2008 2:33 PM

I had the ideal as leslie4 described. I used CNM's who had admitting privileges at a hospital in Dallas. They were supportive of all my requests ie. getting fluids during labor, no continual IV, etc.

Because they were formerly part of the nursing staff at the Hospital, the nurses respected them and that helped me get what I wanted. I labored for 10 hours w/o an epdidural and 10 hours with. My first pregnancy.

My DD was posterior, so they had a Dr. with whom they practiced on call at the hospital who came to turn the baby, and eventually use forceps to hold her in position while I pushed her out.

I am glad I was in the hospital when DD had to be suctioned to remove meconium and resucitated b/c she wasn't breathing.

I wasn't happy with the NICU who kept her from me for five hours b/c she didn't have a suckling instinct (she's still breastfeeding at 17 mths). My DH had to basically go rescue our daughter from them.

So, in the end, laboring and delivering with Certified Nurse Midwives in hospital setting, Great! My care and baby's care after delivery in hospital, not so much.

Posted by: lovea51 | January 14, 2008 2:38 PM

But those of you who say "just be thankful for a healthy baby" minimize the experience. It is one of the most beautiful and challenging experiences of my life. It is sad and insulting that many roll their eyes when we talk about it. My guess is many of those doing so are either male or have not recently given birth.

Posted by: goodhome631

Hurrah for you. But let's not minimize the fact that dying during childbirth is an all-natural occurence for both mothers and babies. I'm very serious when I say that a healthy baby and mother is something to celebrate. I certainly don't use the process as some sort of test to determine how fit a parent you are, or will be.

Tell a friend with a premature baby in NICU that being thankful for a healthy baby is "minimizing the experience". I doubt she'll miss you, once she's cut you out of her life.

Posted by: maryland_mother | January 14, 2008 2:39 PM

I think a lot of this just depends on dumb luck.

With both of my pregnancies, I aimed for non-medicated childbirth, if possible, but also knew I would not be a martyr for it, either. I opted to give birth both times at big hospitals, with NICUs just down the hall (first time with an OB, second with midwives, both times with doulas). I just so happened to have a textbook first labor/delivery and textbook second labor/delivery. Lucky me, I guess. (And I should note that I am very petite--5'4", 100 lbs--and have tiny hips. Who'd have thunk I'd have a relatively easy time of birthing 6.5# babies?!)

Truth of the matter was that I was scared of having a big needle stuck in my back and did not want a urinary catheter and all the machines hooked up to me. That just seemed too claustrophobic for me. If my labor was hard enough, then OF COURSE I would have opted for these. I'm glad it was available.

Homebirth also scared me, as did a birthing center. In the small chance that there was a serious problem, I did not want to take the risk of losing valuable time in transit to the hospital.

I was just incredibly lucky to be able to give birth the way I had hoped to, have alert healthy babies who nursed right away, and heal relatively quickly from it all. An hour after my second birth, I was chowing down a pizza with my husband, and feeling great. No wooziness or anything.

I would never dream to tell someone else how she should birth her baby. I know plenty of women who've had c-sections (some by choice, most by necessity), and in the end, we're all mothers. I didn't win any medals for having the "best" labor and delivery.

Empowering births for me? Yes, absolutely! But I also realize that it's mostly a condition of LUCK, and I had little to do with it.

Posted by: ravennajen | January 14, 2008 3:29 PM

Wow, why is there so much nastiness in these comments? This is not a black-or-white issue.

I am about to give birth to my first child (due date in 2 weeks) and I am going to try for as "natural" a birth as possible. I'll be doing this in a hospital, attended by midwives, backed up by MDs if it should become necessary.

I made this decision after spending 10 months in rural Nicaragua and seeing what can happen in unattended births. I talked to dozens of poor women about the babies and children they have lost. I went to the funeral of a newborn who died of a problem that would have been easily preventable in a hospital, with one injection during labor.

It is disgusting and immoral that such deaths still occur in today's world. But that doesn't mean that all medical interventions are good or desirable. A statistic frequently attributed to the World Health Organization is that a c-section rate of 5-10% is optimal, and that above 15% is unnecessary. I am profoundly grateful that in the U.S., the 15% of births which should happen by c-section can happen that way. But for the other 85%, why is it so great that we should go through unnecessary major abdominal surgery, which we'll then have to recover from at the same time as we're trying to parent a newborn?

It's really unfortunate that people are being so harshly judgmental on both sides in this forum and elsewhere.

Posted by: skreechdog | January 14, 2008 3:31 PM

Again, trying to present a more balanced view, this time with info taken from the website of Ilana Shemesh, a hospital/homebirth midwife overseas. I especially appreciated her points about the mother's need to feel safe, as well as the very real statistical data from countries like Holland, that have a midwife-assisted homebirth standard. And also, the point about the cascade of worrying signs that tend to indicate that a hospital transfer is necessary.
Of course, there is always risk involved. Just as there is always risk involved in hospital birth. As many have already pointed out.


http://www.birthathome.co.il/

Ilana wrote:

I have been asked to write about the dangers of homebirth, however, I choose to write about the safety of homebirth and the dangers of hospital birth. Basically there is a ton of research all showing without a doubt that planned homebirth is a safe option for low-risk women with a qualified midwife in close proximity to hospital emergency services. All these studies comparing thousands of homebirth women with matched hospital births show that there were either the same amount of complications or less with homebirths. In other words, more babies and mothers did not die, were not brain damaged , or suffered illness as a result of a homebirth, In fact, some of the studies showed better outcomes for homebirthers. It seems that hospital births are more dangerous for low-risk women because of the common routine interventions that can cause complications leading to unnecessary Ceasarians or instrumental delivery, (vacuum and forceps), and the liberal use of pain medication which can have serious side effects for mother and baby. The rare complications of childbirth in low-risk woman would be fetal distress or hemorrhage. This is why a qualified midwife must know the limitations of staying at home and when it is time to transfer to a nearby hospital . She must have necessary equipment such as oxygen, drugs to stop bleeding, and the skill to insert an intravenous line., and be knowledgeable in resuscitation skills. The advantages of homebirth are that there is less interference with the normal physiological birth and there is one-to-one care. The woman is relaxed in her own natural environment and territory, and when a women feels safe and cared for her hormones work better and birth is speedier and more satisfying. The bottom line is, however, that a woman must give birth where she feels safe and secure. If this means a hospital then she should birth there. Birth is a very culture-oriented affair, and all the evidence of safety of homebirth will not matter if deep- down a woman really is fearful of homebirth on an emotional level, as she has been influenced and indoctrinated in this belief. However, likewise for the woman who is mistrustful of hospital and afraid of interventions and views birth as a normal physiological process. She needs to have the option of homebirth available to her so that she can birth feeling safe and secure at home with her midwife. All births have potential for complications, and neither home nor hospital can guarantee l00% success for mother and baby. We do know that most complications do not happen within minutes and there is a sequence of suspicious events that will allow the homebirth client to transfer in time to hospital. Although most people in Israel view homebirth as dangerous, one only has to study the excellent outcomes of birth in Holland, where about 40% of women birth at home with midwives, to see that it is obviously untrue that homebirth is more dangerous. More babies and mothers are ill or die from childbirth in Israel where 99% of births are in hospitals, compared to Holland. The same is true of birth statistics in the United States and other Western countries that have mainly hospital births. Their statistics are much worse than Holland where so many births are at home. The National Health Service in England, after completing an in-depth study on the safety of homebirth versus hospital birth for low-risk women, decided that homebirth is a safe option and is now offered to women by the NHS maternity services. Just as hospital birth is an option, so should homebirth be an available option in Israel too. It should be a matter of choice, and it is time for women to be informed as to the safety of homebirth. Here are some excellent resources for researching and further studying the subject of homebirth.

Websites: www.leida.co.il
www.midwiferytoday.com/homebirth.asp
www.gentlebirth.org
www.homebirth.org.uk
www.mana.org/hbref.html
www.homebirth.org.uk
www.gentlebirth.org/ronnie/homesafe.html#Overview

Books:
Safer Childbirth, Marjorie Tew, Chapman and Hall
Where to be Born, the debate and the evidence, Rona Campbell and Alison Macfarlane,National Perinatal Epidemiology Unit, Oxford
Childbirth at Home, Marion Sousa,Prentice-Hall
Home Birth, Alice Gilgoff, Bergin and Garvey Publishers, Inc.
Homebirth, Sheila Kitzinger, Dorling Kindersley, Inc.
Spiritual Midwifery, Ina May Gaskin, Summertown, Tennessee
Sensitive Midwifery, Caroline Flint, Butterworth-Heinemann Medical
Obstetric Myths Verses Research Realities, Henci Goer, Bergin & Garvey

Posted by: yehudisg | January 14, 2008 3:35 PM

I recently read a very interesting book that goes through how women have given birth through history, and touches on a lot of the issues raised in this discussion. The book is called "Birth: The Surprising History of How We Are Born" by Tina Cassidy. It really gave me an interesting perspective on things- I'm due with my first baby in 10 weeks. I'm planning on having a standard hospital delivery, hopefully a vaginal birth but really I just want a healthy baby so whatever it takes for that, I'll be happy.

Posted by: carifly | January 14, 2008 3:42 PM

"But those of you who say "just be thankful for a healthy baby" minimize the experience. It is one of the most beautiful and challenging experiences of my life. It is sad and insulting that many roll their eyes when we talk about it. My guess is many of those doing so are either male or have not recently given birth."

Well I had a beautiful labour experience - birthing ball, hot tub, nice music, supportive partner, friendly staff that totally supported me in not getting an epidural, pushing in different positions - until all hell broke loose.

So I think I am qualified to say that it really isn't about THE EXPERIENCE. That's the luxury for people who don't have complications. You can have all the wonderful, empowered experience you want, but it really doesn't mean squat if the outcome is lousy.

I really feel like I was sold a ball of goods on the whole natural thing. It all made sense in theory, but I didn't ask about perinatal loss at that facility (higher than average) nor did I look closely enough into questions like how many OBs were on call at any given time (15 people were in labour at the same time I was), etc.

No, I was definitely into how great an experience it would be at this birthing centre.

I don't beat myself up for it too much (although I certainly am vocal about it now) but I really do feel that I was led by the current cultural climate of "birth is natural, don't worry" not to look into these things.

My second L&D was pretty clinical. I was definitely respected but it was more the flurry of med staff coming in and out, machines beeping, bright lights, lying on my back, etc. Healthy baby later, I could care less.

Posted by: shandra_lemarath | January 14, 2008 3:43 PM

shandra_lemarath- I'm horrified by your story, but I'm so glad you're sharing it.

Posted by: atb2 | January 14, 2008 3:48 PM

For those posting information from midwives or birth attendants -- that is NOT an unbiased source of information! There are biases on both sides of this debate -- and we need to find sources that are more neutral.

Second, as a researcher, it makes me crazy when people quote the C section rates at midwivery practices (especially from other countries, which tend to have better regulated midwivery markets). You SIMPLY CANNOT COMPARE those rates to those in the hospital. Those practices can only cater to a small percentage of women who have no risk for anything. So one would expect their c-section rates to be far lower, just based on who uses them.

That's not to say the c-section rate isn't too high. But please don't pretend those sources are unbiased.

Posted by: skeptic421 | January 14, 2008 3:50 PM

i agree that luck (good or bad) plays a role.

but surprisingly, given how "empowered" women are in the US in general, we are pretty uninformed about giving birth. thus luck plays a larger role than it should.

it's kind of like walking into a store and saying, i guess i will take that toaster over there, and then saying you were lucky you got the toaster you wanted. because in our country, we do more research about the toasters and tvs we buy than we do about how, when and where we give birth. in part because it is really hard to get good information from our doctors, in general.

Posted by: leslie4 | January 14, 2008 4:05 PM

but surprisingly, given how "empowered" women are in the US in general, we are pretty uninformed about giving birth. thus luck plays a larger role than it should.

it's kind of like walking into a store and saying, i guess i will take that toaster over there, and then saying you were lucky you got the toaster you wanted. because in our country, we do more research about the toasters and tvs we buy than we do about how, when and where we give birth. in part because it is really hard to get good information from our doctors, in general.

Posted by: leslie4 | January 14, 2008 04:05 PM


My God, Leslie, you just say the most idiotic things!!! There has never been a time in history when patients were able to understand more about their conditions. We have wikipedia, we have WebMD, we have doctors that personally email us, we can go online and look at what textbooks the med students are currently reading and buy them for ourselves!! If some women choose to go into it blindly, that's their (poor!) choice. but to claim it's hard to get good information is just crap. if you have a question, ask your doctor. if he/she doesn't satisfactorily answer, SWITCH doctors, don't whine about how hard it is to get good unbiased information. must we all be victims all the time?!

Posted by: newslinks1 | January 14, 2008 4:19 PM

If you think it is all male doctors wanting to get to the golf course that is pushing C-sections, you are blind to reality. Surely a few lawsuits for every non-section delivery that didn't result in a problem-free birth/baby had something to do with C-sections happening at ever-increasing rates. When we decided that any medical outcome that is not 100% problem free is malpractice we push medical care into the absurd realms of risk-avoidance. By that standard 50% of all legal transactions are malpractice. In addition, there are a few women who want things to happen on a schedule as well -- its not all the male-dominated culture trying to take your womanhood away from you.

Posted by: RBCrook | January 14, 2008 4:26 PM

newslinks, i am sorry if i provoked your outrage! i'm not playing the victim, whining or blaming ANYONE. i'm just puzzled by how uninformed we are (myself definitely included) about something as important as giving birth. it's weird!!!!

Posted by: leslie4 | January 14, 2008 4:28 PM

I have delivered both ways - once in a hospital and once at home. The two experiences were as different as night and day, with my homebirth being far superior to my hospital experience.

The hospital experience was fearful, dramatic, and most of all - traumatic; whereas the homebirth was peaceful, easier, and dare I say it - ordinary. It was beautiful. My husband said we would never give birth in a hospital again!

For a healthy woman who is having a low-risk pregnancy with no complications, homebirth is a very appealing and safe option.

Unfortunately, the medicalized version of birth with its cascade of interventions can oftentimes actually cause a bad outcome in what would have been an otherwise normal, uneventful birth. The medical skills of the OB/GYN should be reserved for the true emergencies in which they are needed - unfortunately, this is not how obstetrics is practiced today in the USA, and the statistics bear out this truth.

I am now pregnant with my third, and hope to deliver at home again. It is wonderful that Ricki Lake has brought attention to the dreadful state of maternity practices in the USA, and shed some light on the beauty of homebirth for those who are good candidates for it.

I also highly recommend reading Dr. Marsden Wagner's book on this topic called "Born In The USA: How A Broken Maternity System Must Be Fixed To Put Women And Children First."

Posted by: stacyphx | January 14, 2008 4:32 PM

stacy -- although i was a total skeptic about homebirth and i don't know if i'd do it( like a lot of supposedly informed women in the US), the hospital "intervention" definitely contributed to an atmosphere of hysteria and panic. i started to labor very quickly with number two. we had to take an ambulance to the hospital and the emt's were very young, inexperienced, and they acted as if i might have the baby in their van (horrors!). then the nurses yelled at me that i was "too dilated" and i'd be lucky if my doctor made it in time. i had been fine before having to deal with the emts and nurses.

however, i still think i'd do it in the hospital, just in case something went wrong with the baby.

Posted by: leslie4 | January 14, 2008 4:37 PM

leslie, your post does NOT sound puzzled. it confidently states that
"in our country, we do more research about the toasters and tvs we buy than we do about how, when and where we give birth. in part because it is really hard to get good information from our doctors, in general."

Perhaps you and those in your close circle chose not to spend hours and hours researching this, but there are certainly many women like myself who do! And to claim that the information is not widely available is to have your head in the sand.

our tax money funds thousands of initiatives designed to educate the public about birth.

http://www.cdc.gov/Reproductivehealth/

http://www.reproline.jhu.edu/

etc, etc, etc...

Posted by: newslinks1 | January 14, 2008 4:38 PM

stacyphx wrote: "My husband said we would never give birth in a hospital again!"

You can't think for yourself?

Posted by: mehitabel | January 14, 2008 4:41 PM

Leslie -- I'm sure there are many women (and men) out there who are "uninformed" about "birthing babies."

However, when you issue blanket statements that "women are uninformed about the birthing process," or "it's hard to get good information about childbirth," well, that's bound to get more than a few women's hackles raised. Some of us have taken the time to do research (both online and in the library); talk to our mothers, sisters, other female family members and friends; talk to our doctors; tour hospitals and birthing centers. I'm sure I'm leaving out some avenue here, LOL.

I suggest you refrain from speaking for "all women," especially when you're accusing us of being uninformed. This may have been how you and your peers approached childbirth, but I can assure you it wasn't mine, nor was it the approach of my sisters, cousins (one of whom has had 4 children at home with a midwife), or friends.

Posted by: vegasmom89109 | January 14, 2008 4:42 PM

For a healthy woman who is having a low-risk pregnancy with no complications, homebirth is a very appealing and safe option.

And for a woman who's child could very easily have died due to the cord being wrapped around the neck twice and the chest once, to the point that the heartrate plummeted whenever I had a contraction--hospital trumps. I was young, healthy, no indications that there would be ANY excitement whatsoever.

You know it's bad when the ob/gyn comes RUNNING into your room with two other doctors and 3 nurses. They almost did "filet-o-maryland-mother" to get the kid out. Luckily not!

I'm glad there was no 15-20 minute ambulance ride, as the kid wouldn't have made it.

Beautiful is all parties alive at the end.

Posted by: maryland_mother | January 14, 2008 4:53 PM

I second vegasmom's comments re becoming well-informed, and can only conclude that Leslie must have willfully chosen to be insufficiently informed.

However, I'd add as a cautionary note the fine comment skeptic421 posted at 3:50 PM re being wary of unbalanced claims (or even downright propaganda) -- not only re pregnancy and childbirth but on all topics, medical and otherwise -- which exist in all sources but seem to abound these days on the Internet, where it can sometimes be harder to differentiate from rigorous scientific research.

Posted by: mehitabel | January 14, 2008 4:55 PM

Damnit.

"whose child".

Posted by: maryland_mother | January 14, 2008 4:55 PM

i certainly never speak for "all women." of course there are many who are very well informed. but i think in general my statement about women, myself included, being uninformed is true -- and not meant to insult anyone, just to raise the question "why?" are so many women, in such an informed age, uninformed about our own bodies.

Posted by: leslie4 | January 14, 2008 4:56 PM

"which exist in all sources"

Oops! I meant "which exist in all genres of sources."

Posted by: mehitabel | January 14, 2008 4:57 PM

Is there anyone else skeptical of the idea that Riki Lake known only because of a lame show that showcased things like "Help me tell my husband that the baby isn't his" and "I'm a Stripper, but I'm not trash", "lesbian love triangles" is now trying to provide guidance on childbirth. I think I'll consult Jerry Springer before my mastectomy! Puhleeze. Just because someone is on t.v. does not mean that they know anything!

It's a pretty simple equation for me. WHich situation is less likely to lead to a dead baby or mother? That's where you'll find me. If I want a good experience, I'll book a vacation to Europe. Its about the baby not the "experience". Stop watching TLC and just have your babies for goodness sake!

Posted by: moxiemom1 | January 14, 2008 5:00 PM

Leslie, just for starters did you never read the classic "Our Bodies, Ourselves," from the Boston Women's Health Book Collective (which I imagine you'd have heard of since you attended college in the Boston area)?

Posted by: mehitabel | January 14, 2008 5:01 PM

Leslie: Other than a documentary you saw, which had a very pointed agenda, what makes you think "women are uninformed?" You keep stating this, but you haven't pegged it to a survey or any research.

FYI, when you say "women are uninformed," one can only assume that you are speaking for all women. You just did it in your response to me. "I think, in general, my statement about women . . . being uninformed is true." You haven't said "some women," "many women," "most women," or even "women I know." Then you say "many" women are informed, but go on say that "women are uninformed," I'm frankly confused.

You also implied that all OBs are performing major surgery with narry a second thought when you said docs treat C-sections as they do trimming their fingernails. I'm sure many OBs would (rightfully) take offense at such a blanket statement.

Regardless, why are you so convinced that women are uninformed? Was it Ricki Lake, your peers, your personal experience, or something else?

Posted by: vegasmom89109 | January 14, 2008 5:05 PM

Well then, God bless you at-home types. Just promise me that if it's good enough for your unborn child, it's good enough for you. When you're diagnosed with breast cancer, colon cancer, lung cancer, etc. you BETTER NOT SEEK PROFESSIONAL MEDICAL HELP you hypocrites. Deal with at home just like people have been doing for the last ten thousand years. 'Cause that worked out so well for them.

Posted by: antipATRICK | January 14, 2008 5:10 PM

vegasmom, Leslie stated at 11:44 AM that the fingernails comment came from an "expert" in the Ricki Lake movie, so therefore it must be true, no? Yeah, right.

Posted by: mehitabel | January 14, 2008 5:19 PM

"The birth experience for women IS important. It is not like a "wedding day". It is not a test, but we should set up women to have an experience that respects them and recognizes their efforts. People act like birth is pulling a lever and out comes baby if you are lucky. It's more like climbing Mount Everest. You are DOING SOMETHING, not just lying there while the doctor "delivers" the baby. The doctor isn't the one doing it. The woman is! I think that wording is deceptive.

Our culture does not have respect for the labor process. I felt like I had really accomplished something beautiful with my labor and it all went well. I had a doula and was well-supported during my time in the hospital.

But those of you who say "just be thankful for a healthy baby" minimize the experience. It is one of the most beautiful and challenging experiences of my life. It is sad and insulting that many roll their eyes when we talk about it. My guess is many of those doing so are either male or have not recently given birth."

Posted by: goodhome631 | January 14, 2008 02:28 PM

I am one of the people who is grateful to have a healthy baby, and I am not very concerned with the experience. I am also grateful that I lived through pregnancy and childbirth (because of a medical condition, a generation ago that might not have been possible). I (somewhat) recently gave birth, and I am about to do it again very soon!

I'm not saying the experience isn't important, but it *is* secondary to a healthy outcome. I don't know anyone who would feel good about laboring without intervention, only to have a death in the process (either mother or child). So, in a true life or death situation, the well-being of mother and child come first -- above anything else.

Since I have many, many medical issuse with pregnancy and childbirth, I see the "experience" as a luxury.

I am thrilled for people who get to have the full experience -- whether it's a home birth, a water birth or an epi at a hospital if that's what they want.

But many of us have real issues that limit our options. It's incredibly hurtful to have people tell us that we're missing out on some kind of "experience." A specific birth is experience is something to be grateful for, not something to expect as a right.

Posted by: sandiego_mama | January 14, 2008 6:36 PM

Come on, back off Leslie on the "information" comments. The fact is, we can do all the research we want, but unless you've been through it before, you still don't know as much as you think you do. I read all the books, had my own birthing plan, etc. etc. etc. But no one ever told me that the drugs they used to induce labor could cause uncontrollable contractions and retained placenta. And why would I even know to ask about that -- until it happened to me? "Excuse me, nurse, but this drug you've decided to use -- might it send me into uncontrollable contractions?" I read the consent forms, I saw the side effects listed, and that sure wasn't there. I knew to ask the docs and the hospitals about being able to be up and moving around, and got assurances from everyone that they encouraged that. But again, no one told me that those rules didn't apply for inductions -- and again, I didn't know to ask, until it happened to me.

And let's not even mention trying to figure out who to trust, when everyone has a different story, there are conflicting studies out there, and it seems everyone is pushing whatever fits with his or her worldview. I'm a lawyer with a reasonable degree of scientific understanding; I know how to do research, and I did a huge amount (when you seem to develop every complication known to man, you tend to spend a LOT of time talking to the doc and finding everything you can on the web). And yet I was still completely unprepared for some of the major stuff that happened to me.

Point is, it's a lot easier to know what questions to ask to be truly informed once it's too late. And it's easy to feel "informed" when you get lucky and the stuff that you didn't know to ask about doesn't happen to you.

Posted by: laura33 | January 14, 2008 6:47 PM

Please remove/ignore "antiPATRICK". Their comments are hateful, and threatening; they've added no helpful information in this important conversation that should be amongst mature people, and not involve name-calling. Thanks.

Posted by: mmaggior | January 14, 2008 7:12 PM

mehitabel wrote:

"stacyphx wrote: "My husband said we would never give birth in a hospital again!"

You can't think for yourself?"

Pardon me?

I am not sure what the nastiness on the part of yours and many of the comments here on this article is striving to achieve, because you are achieving nothing as far as I can tell.

I thought my including my husband's comment was pretty self-explanatory in the context it was used, but since you were not capable of understanding I'll explain it to you like you are a three-year-old: Our homebirth was such an incredibly positive experience for us BOTH - in contrast to our utterly horrific hospital experience - that my husband never wanted for us to birth any of our future children in a hosptial ever again.

That being said, I am certainly quite capable of thinking for myself. In fact, we never would have arrived at the thought of homebirth if it were not for my own thoughts and research on the matter.

For everyone else: here is an interesting comment from my midwife while discussing birth in general. She said most women spend more time doing research on a washer and dryer they are planning to buy, than on researching the present state of childbirth and what their birthing options are. I think that says a lot.

Posted by: stacyphx | January 14, 2008 7:24 PM

She said most women spend more time doing research on a washer and dryer they are planning to buy, than on researching the present state of childbirth and what their birthing options are. I think that says a lot.

Posted by: stacyphx | January 14, 2008 07:24 PM

Sadly, as an anecdotal observation, I think this midwife's comments say more about the women SHE encounters than it does about the population of women, generally. If you disagree, feel free to point me to an objective study that includes more than 1000 women, is not confined to a single state or city, and, most importantly, doesn't involve a self-selected sample of women who have chosen to go down only Path A.

I'm with vegasmom. Most women consider a wealth of information in making their decisions about where and in what manner to give birth. To suggest otherwise based on one's choice to insert one's head in the sand is irresponsible, in my opinion. OTOH, I disagree with vegasmom (this must be a first) on "trusting" any physician. It's your body and your baby. Ask questions. Evaluate risks. Own your decision. Physicians are advisors, not decision makers.

Posted by: mn.188 | January 14, 2008 7:48 PM

Hi MN!

Re: trusting a physician, I didn't mean to advocate trusting a doc just because s/he is a doc.

But I think having a relationship with your OB is important. You need to be honest, and you need to have enough of a history that you trust his/her judgment. I am putting both my life and the life of my child in his/her hands, and I need to know s/he will honor my wishes and, if circumstances dictate a change in plans, that s/he will explain that to me, give me the pros/cons of the decision, etc.

I had an emergency C-section. I probably could have delivered vaginally, after several more hours of labor, significant tearing, and other potential complications. My doc knew I didn't want a C-section. She also explained the potential consequence of waiting a few more hours to see whether DD would cooperate and turn around (she was a posterior [sunny-side-up] birth, 8+ pounds). In the end, the decision was mine and I own that. But I am glad I had a doc I knew and trusted to give me those options and whose opinion I valued. I don't know what I would have chosen if I'd been with a doc I didn't know or for some reason did not trust.

Posted by: vegasmom89109 | January 14, 2008 8:04 PM

stacyphx wrote: "my husband never wanted for us to birth any of our future children in a hosptial ever again."

It's YOUR body out of which the baby is coming. What would you do if you disagreed with him -- obey him, or do what YOU thought was best for yourself and the baby even if it wasn't what HE wanted?

Posted by: mehitabel | January 14, 2008 8:09 PM

On the information side, I think it can be hard to get unbiased information - or at least, the right information. And part of that is just the sheer numbers - what happened to my daughter has about a 1 in 1000 chance of happening, so why would a pre-natal class cover it?

But part of it also really is that childbirth is viewed as part of parenting and it seems to follow a lot of shifts in cultural beliefs. Where I live, there are a lot of midwives and I personally believe that because they are still fighting to be perceived as professional, useful, etc., that they do have a tendency to slant their information. And that's becoming the dominant view - childbirth is no big deal, etc. As a woman in the right category - yuppie, leaning towards crunchy - I did take the information that seemed "more right." I also am in an age category where I don't have memories of cousins and aunts dying in childbirth, etc.

I read the scary books too ("What to expect...") but with the gloss of an easy pregnancy (after 7 miscarriages) I sort of felt like well, that won't happen to me.

And the information wasn't entirely wrong, it just left me without a sense of urgency about what could go wrong. And like Laura said, which questions to ask.

It's also partly because once you're pregnant, there's almost a superstition around telling you anything "bad." After I lost my daughter a few people told me about similar, or stillbirth experiences. I certainly don't share my story with pregnant women unless they ask. But I do steer people I know to practices with low perinatal loss rates.

Posted by: shandra_lemarath | January 14, 2008 8:13 PM

"i agree that luck (good or bad) plays a role.

but surprisingly, given how "empowered" women are in the US in general, we are pretty uninformed about giving birth. thus luck plays a larger role than it should.

it's kind of like walking into a store and saying, i guess i will take that toaster over there, and then saying you were lucky you got the toaster you wanted. because in our country, we do more research about the toasters and tvs we buy than we do about how, when and where we give birth. in part because it is really hard to get good information from our doctors, in general.

Posted by: leslie4 | January 14, 2008 04:05 PM"


OK, I hear your point. And I suppose there's a bit more than luck to explain my good experiences (I did, after all, get the "toaster" I wanted). I did educate myself as much as possible about the process. I selected hospitals and my OB and midwife based on their views about c-sections and medical interventions. I hired a doula. I took prenatal yoga and practiced meditation to take my mind off the pain of labor.

A lot of my friends did the same, and ended up with a less than stellar birth experience. I don't think it was because I wanted a natural childbirth more than they did. That's why I think luck has such a role.

How was I to know that my first labor was going to be a textbook 12-hours? Or that pushing would only take me an hour? Or that I really could handle the pain of labor sans drugs? Or that the cord wouldn't be around my baby's neck? Or my blood pressure wouldn't suddenly go too high? Etc. etc.

As an older (well, mid-30's) mother, I was often treated by the medical establishment as an anomaly. I definitely felt pressure to "medicalize" my pregnancy. I received snickers and rolled eyes from a few who thought I was too naive for attempting natural childbirth.

It's possible, then, that had I not worked so hard to understand the birth process in advance, decided what I wanted, and hired support/medical staff based on my desires, I may have very well have ended up with a typical scenario: enter hospital, be put on pitocin, have an epidural, "fail to progress," and suffer the consequences.

Education is absolutely key. But in the end, I still believe I was truly very lucky.

Posted by: ravennajen | January 14, 2008 8:45 PM

I was very skeptical of anything besides a hospital birth. We compromised and had our first daughter at a birthing center. The experience with the midwives was so wonderful, and so superior to what we received through the standard medical route, I was stunned. Our second child was born at home.

The goal of every pregnancy is a healthy mom and baby more than a good birth experience - but every woman should now about the options that are out there, so she can make the best choice for her.

Posted by: robertlheil | January 14, 2008 9:27 PM

Whew, interesting discussion. Personally, I would prefer to see more hospital-based or hospital-associated certified birthing centers. I gave birth in one, and it was fantastic. I was fortunate and had a great natural childbirth; had I not, it was a matter of being wheeled down the hall.

I changed from my OB/GYN to a practice of midwives about 2/3 of the way through my pregnancy to give birth there, and because I was dissatisfied with the treatment I got from the various OBs in my original practice (though I adored the woman I started with, there were seven doctors who might have ended up attending my birth). My appointments were too short for them to give me real answers to questions, and they didn't even seem to welcome questions.

My midwives were spectacular. They answered all questions, they spent time addressing underlying health issues, they were encouraging but I felt very honest about the risks, particularly as I went past my due date. In the end I had a 10 pound plus baby and received exceptional care through the birth.

I wish that more women could choose something along those lines. I agree that the debate is needlessly pushed into a dichotomy. It shouldn't be necessary to choose between having immediate access to high quality medical care and being able to make the choices that support a natural birth.

Posted by: LizaBean | January 14, 2008 10:25 PM

I keep seeing derogatory remarks regarding the "Birthing Experience" Like it is a vacation plan the mother to be is planning to take...

That birth experience for many, not all is a journey into motherhood, anthropologically it is a rite of passage. Sadly in our culture we have done away with most rites of passages, this one is close to being the next.

Regardless of that, having a natural birth is not all about the womans experience. I have not seen anyone mention the effects of the drugs used with interventions on the baby. Do you all believe they don't effect the baby? Why would you spend your entire pregnancy avoiding drugs and then say, pour them on now that I'm in labor, cause I really don't want to feel pain. Who then is the selfish one... the woman wanting her planned C-section or epidural on arrival, or the woman attempting to have a natural birth and spare her child the drug load, which by the way is usually a large reason for the respiratory depressed babies.

Did you know that one of the most commonly used induction medications, Cytotec is being used off label... meaning it is not FDA approved for such use. It actually has a warning to not use while pregnant. Hmmm Did you all know this and the potential effects it can have on both Mom and Baby...

I am not going to say there is no reason for Doctors and the care they have to give. When needed they are incredible. The thing is they are not needed in their specialized capacity as much as the medical community makes them be needed. Medicalized birth creates problems more times than not.

There is a section in the film where medical students, residents, and interns are asked if they have ever seen a natural birth... They had blank stares upon their faces, and nodded "No". Many Doctors in our country are being trained to believe childbirth is dangerous and woman are primarily defective and unable to birth naturally. This is so not true, unless you psychologically convince a woman it is. Then like a self fulfilled prophecy, the fears will lead to it becoming truth.

No one is asking for a medal here as someone sarcastically noted, just the choices to do what they feel is right. And equating a disease process such as cancer with a natural one like childbirth well, so wrong, I don't really have words.

I have worked as both a Labor & Delivery and Oncology (Cancer) nurse

Posted by: firedakini66 | January 14, 2008 11:01 PM

My wife had our first son at a nearby hospital. She gave birth to our second son at home with the assistance of two midwives, a close friend, and me.

At the hospital birth, there were quite a few buzzers going off with medical personnel coming and going frequently. My wife was in labor for a number of hours without much progress from a dilation perspective. Later on she went from 5 to 10 centimeters quite suddenly. This left the hospital staff in a dilemma because they didn't know what to do since our doctor had not yet arrived at the hospital. We had to get their permission to allow the intern to deliver the baby before the doctor arrived.

At the birth of our second son, the midwives gave my wife their continual attention. We did have a scare when he did not appear to be breathing well, but that cleared up quickly. Aside from the breathing scare, the biggest thing I remember from the home birth was the lead midwife threatening to take my wife to the hospital if she didn't start making some serious progress within the next couple of hours. (The threat worked!)

Our two sons are now 16 and 18. At this point in their lives, I believe it would be pure conjecture to determine if the location and manner of their birth had any impact on their lives today.

As a husband / father, I recommend couples seriously look at both birth situations before making a decision. There is no clearcut answer for anyone. This is a personal decision (to be made by the mother with significant input from the father) that should not be derided by other parties.

Posted by: hpeterschiller | January 16, 2008 10:37 AM

I had my first baby with an OB at Fairfax Hospital. The OB was awful, as were the OBs in training who didn't even introduce themselves before they examined me. I didn't know midwives existed at the time.

I went to the Loudon County midwives for my second child's birth and it was an incredible experience, primarily because these women just listened to what I wanted and were honest about the way they practiced. I had my baby without drugs, but it was an option if I wanted it and I liked knowing I had an option.

I had my third child at The Midwifery Center in Norfolk. We had moved to Williamsburg and the only option in Williamsburg were OBs. I started with them because of their location, but just didn't like it. Having midwives take care of me was like seeing a girlfriend who happens to have more knowledge about birth than I do. I had another natural birth, but still had the option of an epidural if I wanted it.

Amy
www.sofiabean.com

Posted by: amy | January 16, 2008 4:34 PM

My mother gave birth to me and my three brothers at home, unassisted. Among our family friends, home birth was not uncommon, as almost all the children of my generation had been born in the presence of a midwife, at home. When I entered school and came into contact with more mainstream people, I was shocked to see my family's lifestyle not accepted, or not even understood, as many did not know birthing outside of a hospital was even possible. This latter viewpoint is one I still face very often in mainstream society, particularly in the medical community. Thus I am quite shocked to see many commenters acting as if home birth is being forced on them, or at least presented as the best option. Quite to the contrary, hospital birthing is the mainstream birthing practice, and no one is threatening to take that away. The defensiveness can stop.

I believe a woman should birth in the way that feels the most comfortable to them: unassisted (like my mum) if that is what they choose, with a midwife at home, in a birthing center, or in a hospital. Going along with what some previous comments have stated, a lot of women have not been fully informed about out of hospital birthing options, as our culture is steeped in hospital birthing as the only "right" way. Further, many women who would like to give birth with a midwife face legal hurdles, as non-nurse midwifery is actually illegal in some states (especially in the Midwest).

Several comments also reflected similar feelings toward breastfeeding, that some elitist establishment was guilt tripping them about feeding their children formula. While I definitely think making women feel guilty about their personal choices is wrong, and all too typical in our society, we also need to remember that breastfeeding is a practice backed up with scientific evidence, physiology (women having breasts and all), and human history. Just as doctors advise patients who smoke to quit, of course they are going to recommend the healthiest and cheapest food for the baby: breast milk. The medical community has only recently accepted that.

Posted by: gingerakimbo | January 20, 2008 3:41 AM

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