Free Your Mind. The Language and Mindset of Homebirth
Most people view childbirth from a very medical standpoint. Medical language and mentality about birth is so prevalent in society that we can’t even look outside the box…we don’t even know that we’re in one. But is it really so different from a homebirth advocate’s standpoint?
Take everything you know about birth and turn it upside down. The language and mentality of pregnancy, labor, and childbirth is completely different from a homebirth advocate’s viewpoint. If you read about homebirth, you will be seeing these words from the homebirth advocate’s mentality and not the hospital mentality. Hospital language and homebirth language may use the same words, but they have completely different meanings.
Babies are not delivered in a homebirth. The mother delivers, births, or has her baby. She’s the one doing all the work, why should anyone else get the credit?
Anyone who assists in a homebirth is typically referred to as the catcher.
Why? Well, because birthing should be centered on the pregnant woman. The pregnant woman is the one having the baby. The pregnant woman is the one with the front row seat to the entire experience, and her role in it should never be downplayed or brushed aside. Birthing isn’t about babies, because as much as we try and hope and pray, we can’t actually count on a 100% perfect outcome for babies. We can only increase their chances by helping the pregnant woman. The fact is, the baby should always be an afterthought until the mother is done having it and is stable enough to worry about her baby. You can be guaranteed that she will unless something is seriously wrong, and if it is, she’s the one you need to worry about.
This doesn’t mean the baby should be neglected or left unmonitored during labor. This relies on the principle that caring for the mother leads to a better outcome for her and her baby, and that brings me to our next definition: childbirth.
Childbirth is viewed in our culture as an emergency. In fact, 2 lines on a pregnancy test start the freight train of preparation for the catastrophe ahead.
Is that really how we should be looking at birth? Homebirth advocates think that by labeling pregnancy as some sort of a crisis, we’re blinding mothers-to-be to some of the best and safest parts of childbirth and trying to make up for it with an inadequate substitute. In some cases, we’re scaring the wits out of these women.
To homebirth advocates, pregnancy is a natural state for a woman. She’s not going to faint or explode or break out in purple spots just because she’s pregnant. That would be unnatural. Pregnancy, on the other hand, is something that our bodies are designed and prepared for, so what’s the problem?
Sitting around and waiting for complications to arise just because you’re pregnant is like driving around waiting for your car to break down just because you got in it. Sure, cars need regular maintenance (and have similar options to pregnant women actually…you can choose a dealership, a mechanic, or you can maintain your own vehicle), but expecting your car to break down because you’re using it for its intended purpose is silly.
Likewise, birthing babies is what our bodies were meant to do. Now, I don’t mean that in the anti-feminist way. I’m not telling women that they should rip off their shoes and head for the kitchen, but let’s face an obvious truth here. Even in times of war, famine, disease, poverty, disasters both natural and man-made, women have birthed babies at home since the very first human baby was delivered (which was undoubtedly not in a hospital). If it were really all that complicated and dangerous we would have died out long ago. While death rates were rather high in previous centuries, it is not just hospitals that have changed that. In fact, in some cases, hospitals contributed to it. I don’t know what kind of an infection I’d end up with if Doctor So-And-So didn’t wash his hands between dissecting that cadaver and catching my baby, but I can bet that if doctors still didn’t know about sanitation, it probably wouldn’t be a safe and healthy experience. True story, it happened. Often (though hopefully not in this era).
Homebirth advocates face a lot of criticism from women and professionals for taking this stance on birth. They love to point out that in other countries, women die because they were forced to give birth at home. They want people to understand that homebirth isn’t safe. If it was, all those women forced to have a homebirth wouldn’t be dying.
What they don’t want you to realize is that the comparison is flawed. They are comparing healthy, educated women with proper nutrition and health care in first world countries to women in third world countries like Africa. It’s dangerous to drink the water in Africa. I don’t think this is a fair comparison, but it’s all they have because when they compare maternal and fetal outcomes in first world countries and try to line planned, responsible homebirth up against planned, ‘responsible’ hospital birth, it doesn’t pan out. Homebirth is safer when you remove the factors that do not exist in these countries. It is not homebirth that is the problem. It is part of a much bigger problem. Homebirth advocates see this and would like homebirth detractors to be responsible when it comes to quoting statistics. When making an educated argument that holds the future of women’s right to homebirth, it is not responsible to twist facts and omit statistics. That leads to death and injury for women and children, as well as continuing the public perception that homebirth is dangerous. I will get into this more in my homebirth article about safety.
You call it dangerous, I call it freedom.
Many homebirth advocates will talk about the “domino effect” of intervention. Because we understand the domino effect, we advocate against it and all the harm it can bring.
What is the domino effect? It’s rather simple. Monitoring and testing pregnant women who have no complications and are not at-risk for those complications leads to false positives. False positives lead to more intervention which leads to more complications which leads to more intervention which…I think you see where I’m going here.
If we see it in other contexts, we see how harmful it would be. What if every person was required to get mental health screening to ‘rule out’ mental illness? How many false positives would there be? What if one of them was you? What if you were told that you had X or Y disorder and that you had to take medication? What if that medication made you sick so you had to take other medication to combat the side effects and get regular testing to make sure the medication wasn’t killing you?
What if you didn’t have X or Y disorder and you went through all of that, including thinking there was something terribly wrong with you, for nothing?
Do you see the flawed logic? Tests are meant to be used to help diagnose problems. They aren’t designed to screen for problems. Tests are meant to be used as a part of a much bigger picture, which involves a person who knows their body and knows if something is wrong, and a doctor who respects that person and takes the time that they need. Doctors instead rely on tests and machines to tell them if that person is okay. This leads to false positives and unnecessary intervention.
The problem, as homebirth advocates tend to see it, is that doctors (and the hospitals that they practice in) do not center their practice around the pregnant women they profess to serve. They tell us to trust them, and we assume that to mean that they have our best interests at heart, but that illusion quickly dissipates when our needs or desires conflict with the doctor’s or hospital’s policies. This puts the pregnant woman in a position of having to fight an uphill battle for her rights against a practitioner and his staff and superiors.
As much as some doctors try to keep this from happening, as long as prenatal care isn’t centered on the pregnant woman, conflicts will continue to arise. Pregnant women find themselves at the bottom of a long string of people, and most of those people want to do what is best for the hospital because if they don’t, they could lose their job. The hospital bases its policies on what it needs to survive, which includes meeting womens’ needs only as far as keeping them from complaining too much. It does little to address the individual needs of any woman who is a patient there.
A hospital is interested in income, efficiency, and good outcomes. By good outcomes I don’t mean satisfied patients, I mean statistics. Patient survival, babies delivered, money earned, time saved, those kinds of things. The minute your needs or desires conflict with their preset plan for ‘delivering babies’, you are threatening one or more of their statistics.
Hospitals are not the only ones interested in statistics. Homebirth advocates are also armed to the teeth with statistics and personal experience regarding birth. Our voices aren’t as powerful, but we’re making significant headway. This is in part because other societies aren’t as opposed to homebirth and have had some very good success rates.
From the homebirth advocate’s viewpoint, even prenatal care from a practitioner with conflicting motives can be dangerous. There are many stories from some of these women, vividly portraying their ‘negative outcomes’ (as hospitals put it) in the way that only someone who has suffered can. These women are told that they are selfish, that they don’t have their priorities straight, that they should be satisfied because they have a healthy, happy baby. They are told that they should ‘get over it’, but we can’t.
We can’t because we feel that if we don’t speak, then we have somehow failed to empower women to take charge of themselves, their bodies, and their medical care. Empowerment is very important to women, and trusting your body can be a very empowering experience. Homebirth advocates hurt because we have experienced the spirituality and awe of birth and we watch women blinded to the truth and then harmed. Some of us hurt because we feel there is something more that we missed out on and we don’t want anyone else to have to feel that sense of loss. But it is far more than just an intangible sense of loss that drives homebirth advocates to fight the way that we do.
This is a matter of life. Not just the quality of life, but the very right to live it. It has everything to do with positive physical and emotional ‘outcomes’ for mother and baby. It affects the entire family, far into the future. One can’t argue that having a baby doesn’t change everything, so why place so little significance on the opening scene? Accepting what we’ve been told, that a healthy baby is all that matters, doesn’t alleviate our responsibility. That is why homebirth advocates fight for the rights of pregnant women.
I want to share a birth story with you from two angles. Hopefully this will help illustrate the point that I’m trying to make, that homebirth advocates view birth in a completely different light than does the rest of society. Ultimately, it’s really up to you to decide which version you agree with, but I wouldn’t take the decision lightly. How we choose to bring our children into the world says a lot about how we choose to raise them and what we intend to teach them. It’s amazing how many things in life are intertwined.
Story A
Shelly’s water broke at 6am on Tuesday morning. She woke her husband and they headed for the hospital. Once they got there, the hospital did an exam to make sure that her water was broken, checked her cervix, and told her she was at 1cm. She felt some contractions, but they weren’t showing up on the monitor. Baby was doing fine though, so the hospital decided to give her some time to see if they would strengthen on their own. They started her on IV antibiotics, got her a room, had her sign some paperwork, and left. She was feeling some twinges, but nothing that she couldn’t talk through. After about an hour, the monitors still showed no contractions. The doctors started talking to her about induction to speed up her labor. They explained that there is only a 24 hour window after a woman’s water breaks before the risk of infection increases drastically.
Shelly agrees to the pitocin and within 30 minutes the drip is started. Soon the contractions are getting intense but they’re not evenly spaced. It’s starting to wear her out. Though she wanted to try natural childbirth, she started to feel she was getting in over her head. Though she was annoyed with the nurses who were offering her pain medication, she wasn’t sure how much longer this would have to go on.
After 2 hours on the pitocin drip, a doctor checked her cervix and told her that she was only 2.5cm dilated. Meanwhile, the nurse was reading the fetal monitor readout, which had shown a couple of decelerations during the contractions. The doctor explained to her that the baby’s heart rate was dropping, but it was still within the normal range. They would keep an eye on it, but there was nothing to worry about. Shelly starts to feel disheartened and scared. Not only is her body not dilating correctly, but she is worried about her baby. She starts to pay closer attention to the sound of his heartbeat on the monitor.
2 hours later, Shelly and her husband are breathing through the contractions, but she’s starting to say that she can’t do this any more. A doctor comes in to check her again and he frowns as he tells her that she is only 4cm dilated. Since her water wasn’t completely broken, he offers to break it again to speed up labor. Shelly discusses it with her husband and the nurse, who tells her that it will be more painful. Already at wit’s end and still worried about her baby, she agrees to the rupture and intravenous pain relief. The doctor breaks her water the rest of the way and then the nurse injects the pain meds. It does take the edge off for a while, but it starts wearing off after about an hour. The pain is coming back full force and the nurse informs her that she can’t get another dose for 3 more hours. The doctor does another cervical check and finds that she’s 5.5 centimeters dilated. Another contraction hits her as she signs for an epidural.
20 minutes later, the anesthesiologist comes in and puts in her epidural. The relief is evident. She can barely feel the contractions now. She and her husband work on crossword puzzles and talk about their baby, confident that things will start going more smoothly now.
1.5 hours later, the doctor comes in and looks at the fetal monitoring strip. Another doctor comes in and they talk quietly for a minute before her doctor asks to do another internal exam. She is only 6cm. The doctor tells her that the baby’s heart rate is still dropping, and they’d like to put in an internal fetal monitor. He explains the procedure and she agrees. The monitor is placed.
40 minutes later the doctor comes in. Checking her again, he discovers that she is still 6cm but there is a problem. As other people start coming in, he explains to her that the baby’s heart rate is dropping into a range that he is uncomfortable with. If she were closer to delivery, he might hold off but at this point he’s recommending a c-section.
Scared because her baby isn’t doing okay, she discusses her options with the doctors and then her husband. They agree to the c-section.
It was a tense half hour filled with a lot of unknowns. Her husband had to change into scrubs and she was moved to the operating room. Lots of equipment she didn’t understand, lots of terminology that wasn’t sinking in. She was doing the right thing, right? Why was she still scared?
It was going to be okay though. She was in good hands. As they prepared to do the first cut, she tried to get herself in order. She could do this.
A sickening feeling hit her as she felt a tug, and then another. She tried to think of other things, anything besides the clanking of metal and the doctors talking. They saw a head. It’s a boy!
Then silence.
It stretched out forever as she waited for that cry. More tools grabbed, cord cut, baby moved over to the warmer. Dad watched as they rubbed him down and put a mask over his face and they both waited.
There it was. The lusty, angry howl of their baby boy. The nurses cheered as they finished his vitals and wrapped him up to hand to dad. The doctors finished putting mom back together while dad brought over their new son. Mom looked over at him in utter awe as the nurse snapped a picture. It was finally over. He was finally here!
Story B
Shelly’s water broke at 6am on Tuesday morning. She woke her husband and they headed for the hospital. As soon as she hit labor and delivery, the domino effect began. They checked her cervix, and no matter how sterile the gloves they used, chances are that they introduced infection. The 24 hour timer began. To prevent complications, they started IV antibiotics. Unfortunately, this limited her mobility, but not nearly as much as the fetal monitor.
The monitor wasn’t registering her contractions. At this rate, it may take too long for her to deliver if they didn’t intervene. Not only was her water broken, but birth is supposed to take place within a certain amount of time based on statistics. Pitocin was discussed and she eventually agreed.
The contractions with pitocin are unnatural and painful. Shelly was already scared because she was having her first baby and this was the day. Doctors were rushing through the hallways and she was in an unfamiliar place. Nurses didn’t respect her wishes to attempt a natural childbirth and kept offering her medication and she was getting worn down fast. She didn’t know it would be this bad, because it wasn’t supposed to be. The fetal monitor was showing decelerations, she wasn’t dilating fast enough, her body was broken and her baby could be in danger.
Stress worsened the pain of her contractions and made them ineffective. Her body fought the pitocin. She began to fight labor without even knowing it. From her voluntary muscles all the way down to the chemicals streaming through her blood, the adrenaline she was generating was trying to stall out labor until she was in a safe place. Instead of being able to distract herself by walking around or doing something else, she was strapped to a monitor in bed, counting every contraction, worrying about her baby. If she shifted, the monitor could lose the baby’s heart rate and the nurses would come in to adjust it.
They checked her temperature. They checked her blood pressure. They checked her cervix. They kept pulling her out of concentration so that she could assist them, give them permission, help them with this or that. Put this under your tongue, hold your arm still, bring your feet up, bottoms together, under your butt and let your knees fall to the sides so we can check your cervix.
It all interfered. It was all frustrating, painful, and irritating.
She wasn’t dilating so they broke her water. While it may have sped up labor (it didn’t), losing the extra cushioning that the water had provided had placed more stress on the baby and his cord. He could feel the contractions more strongly, and they compressed his cord. The pain relievers running through mom’s system were sedating him. It wouldn’t affect him so much now, but it would later. Mom couldn’t even move to take pressure off of his cord. She couldn’t even feel the urge to do so, particularly once they started the epidural.
The internal fetal monitor confirms what’s going on. The baby’s heart rate is dropping for unknown reasons, and it wasn’t just that it wasn’t picking it up properly on the external monitor. Mom still isn’t dilating. In a classic example of reaping what we sow, the doctor recommends to Shelly that it is time to consider a c-section.
By now all that matters is a healthy baby. It is not at all uncommon for women to need c-sections and it is a small price to pay to protect your baby. She opts for the c-section and in order to get through it, she dissociates and isn’t even all there for the delivery of her baby boy. This is indeed a delivery, because the doctors had to go in there and get him. He didn’t come out on his own because it wouldn’t have been safe.
The baby is groggy and not breathing. Fortunately, vigorous rubbing and a few puffs of air trigger the breathing reflex, but it will take hours or days for the effects of the medication his mother got to wear off.
The mom is okay, the baby is okay, but at what price? Will the mother ever get the chance to try again? Hospitals are starting to refuse VBACs (Vaginal Birth After Cesarean) because of potential risk factors, and Shelly now has no confidence in her body. Never adverse to the position that c-sections are sometimes necessary, Shelly embraces the mentality of those around her…that her baby was in danger, no one knows why, but the doctors and the c-section saved him.
Nothing else matters.
Or does it? Shelly may never know what she missed out on by not being one of those dreaded ‘informed’ parents who think they know everything and have preconceived notions about how they want their birth to be that go far beyond ‘I’d like a natural birth…’. With Shelly’s chances of ever trying again and attempting another natural childbirth dwindling quickly, she may never get a chance to even glimpse what she missed. This isn’t Shelly’s fault. The hospital that introduced Shelly to the domino effect is the one that’s going to tell her that their hospital no longer does VBACs because of the risks to the mother. Shelly will soon find out that no hospital within an hour distance offers VBACs any more due to liability.
The question is, did Shelly see? Does she feel a sense of loss, if only subconsciously? In spite of the fact that her birth was utterly taken over by the hospital and the doctor who attended her, did she catch a glimpse of how it could have been before it slipped through her fingers? If so, she may not be so resigned to the fact that she can’t get a VBAC. She may call hospitals further out or evaluate her other options. If not, then Shelly missed out on what could be one of the most profound experiences of her life and will never know if it could have been so much different.
We will never know whether Shelly’s eyes opened and whether she refused to accept their rules and found her own way because Shelly is merely a fictional character based on not one but thousands of birth stories that I have not only read, but lived.
There may be no Shelly, but the thousands of women who have echoed her story (in whole or in part) have faced or are facing her struggle right now. Thousands more will tomorrow, or the day after, or the year after. Thousands who were afraid to consider homebirth before, or who had never heard of homebirth, are now even too scared to consider talking to a homebirth midwife or advocate because they needed a c-section and now they have to go to a hospital in case they need another one. Scared by statistics that they don’t understand and got second- or third-hand, sure that they understand what was never explained to them, they don’t even know that they could still qualify for a homebirth. Too afraid of what they’ve experienced, without enough knowledge to know how unnatural it was, they consider homebirth dangerous, crazy, and painful. They have no idea what homebirth is and what the benefits are because they’re already opposed to even a discussion of homebirth, much less having one. Scared by the hospital and what they went through, they still run back to it because the hospital put the blame on them. Stifled by fear, they stifle their options, struggling to gain control without knowing how they lost it. Even having the option of homebirth, they will take away their own right to choose one.
If I could choose for Shelly, I would place her in the path of a woman who will change her life. A woman who supports homebirth and doesn’t scare her or make her feel like she and her beliefs are under attack, but helps her understand what’s underneath it all in a loving and empowering way. Though I could choose for Shelly, because she is my creation, that is a different story and doesn’t impact the real lives of Shellys who have faced or will face the topic of homebirth. What I can do is understand that women end up brushing against the homebirth path for many different reasons, and I can try to understand why they feel the way that they do and how they got to where they are.. As varied as the people who come to homebirth, there is just as much variance in homebirth supporters. Some are in your face, armed with facts and statistics. Some are laid back and have an inner peace that draws people. Some are deeply religious and feel that their God feels that homebirth is more acceptable Some talk about the spirituality of homebirth, or how natural homebirth is. Some talk about the raw and real power of woman and the feminine. Some talk about the tangibilities: costs, safety, and convenience. Some are moms, some are dads, some have never had children but hope to someday. Some don’t ever intend to have children but support a woman’s right to make choices that affect her body. Some are doulas, midwives, or even doctors. The message is the same, but the messenger can deliver it in innumerable ways. It’s all about which method speaks to you and makes you think twice about refusing to question.
Homebirth advocates, different as they all are, all have one thing in common. They believe that homebirth should be a woman’s right. They believe that it is safe and offers many advantages that cannot be duplicated anywhere else. They believe in getting the facts and uncovering ulterior motives and hidden agendas, and they believe in things far more powerful and important than the tangibles. Science doesn’t have all the answers. It can’t measure someone’s beliefs or the power of prayer or hope. It can’t measure the determination of a mother or the amount of pain she feels. It can’t tell you when you will die, what could go wrong, or make your decisions for you. It can only give you an educated guess, which, like tests, should be taken in context and handled responsibly as part of a much larger picture. When it comes down to it, each person has the final say in what decisions they make and the best they can do is prepare for it with knowledge and experience.
I’m a homebirth advocate because I believe. I believe in the power of the feminine and in the raw spirituality that I faced, head on, in my own first homebirth after 6 hospital births (when I believed I had nothing else to learn). I believe in my heart and my instincts and I believe that neither will lead my astray. I believe that when I watch my daughter, who is so confident and peaceful and awe-inspiring, that homebirth had something to do with that. I believe that I stumbled onto the right path for me because I never stopped questioning what I was told.
I believe that I experienced something so profound, so life-altering, that I have to share it so that you can too.
That, clearer than anything else that I could say, is the mentality of a homebirth advocate, in my own words.
