My homebirth story
Planning for labor
When I found out I was pregnant with my second child, I decided to be a little more aggressive in my quest for homebirth services in my area. I followed every lead, working with another doula friend of mine who had been at a homebirth in our area a few years ago. Every lead came up empty.
I knew there was a direct entry midwife who was working with a few partners in my area, but I had major reservations about hiring someone for a job I knew they could be imprisoned for. Although my midwife tried to encourage me to call her several times I refused. If she chose to break the law that was her decision, but I would not encourage her to do it. Another consideration was that I could not afford her fee, which could not be covered by my insurance because she was not licensed as a midwife.
How is homebirth legal and homebirth midwifery not? It lies in the definition of the practice of medicine. Attending at labor is considered practicing medicine and most states have regulations about who can and cannot be employed to provide those services. The key is in the employment. It was not illegal for me to give birth at home, it was not even illegal for her to be there helping me. But it was illegal for her to advertise herself as a midwife and receive payment for midwifery services without licensing from the state. The regulations for midwifery licensure vary from state to state, so there is no national standard of what makes someone a midwife and capable of attending labors.
I had a connection to a legally practicing midwife about an hour south of me who was delighted when I called. Unfortunately she was moving across the country a month before my baby would be here. She said if he came early to call her and she would get to me as quickly as possible. The other legally practicing midwives were too far away to consider me as a client.
I had another connection to a woman who was requested at many homebirths after giving birth at home herself. She had taken some childbirth training so she could recognize problems but never considered herself a midwife - she simply was a friend who helped people have home births. A call to her revealed that she was no longer assisting at births because she had decided to become a midwife so she could provide more services to families. She would be in midwifery school when my son was born.
My final attempt at securing home birth services was a doctor who was working at a clinic in my area. He had been a missionary doctor in parts of Africa for a few years, and had experience with assisting at births without standard American medical backup. He had no interest in helping me at all, stating that attending a woman at home in Africa was nothing like attending a woman at home in the United States.
What exactly is that supposed to mean? This was a doctor who had the ability to attend a labor with portable equipment, and was successful at it with women living in poverty. How could it be any more difficult to assist me, an educated, well nourished and healthy woman who had already given birth successfully once? A woman who was not giving birth at home because of a lack of options, but because she understood the options available and felt most safe at home? My assumption was he was not interested in beginning to provide homebirth services for pampered and spoiled American women who would whine and blame him if something went wrong. He did not know me or anything about me, but if word spread he was providing home birth services it might make life harder for him in a number of ways.
So I settled on a midwife group at a local clinic. Settled is not really the right term for it since I fully trusted them and they were my first choice of midwives in the area. They were not able to assist me at home, which meant I would need to go to the hospital. I was fine with this because I trusted the midwives to help me have as natural and unhindered birth as possible, and they caught babies in my favorite local hospital. Exactly what I would have recommended for any of my clients.
A month or two after starting with the practice, one of the midwives went on maternity leave - she would still be on leave when my child was born. I met the replacement midwife and was turned off instantly. She read in my chart a statement that I wanted early discharge from the hospital and began to tell me that decision was not up to me, that it would be the midwives who decided when I could go home. I am sure the look on my face was an interesting mix of stunned and annoyed. I had stayed with a midwife group who did not agree with how I wanted to give birth for my daughter and I was not going to make the same mistake with my son. I left that day and never made another appointment to see her. The midwife I really liked commented about it to me a few appointments later - that she enjoyed visiting with me but I needed to get to know the other midwife. I explained what happened and told her I would rather not come to the hospital than to allow the other midwife to bully me because she was in charge.
I had the opportunity to meet another midwife who was doing some coverage for the group at a labor I attended as a doula. Unimpressed is putting my attitude lightly. I was appalled at her behavior towards the couple. She dismissed everything they said, prescribed a sleeping medication and left the mother alone all night. It took me a few hours to calm the mother down and convince her it was normal for labor to start and stop, that if she felt things were not productive and wanted to go home that was ok. I left the hospital to get some sleep (having had been up for more than 24 hours) expecting her to call and say she went home. Instead I got a call that they had decided to use Pitocin to speed up the labor. I could not believe it, the midwife only spent a few minutes with her on each of her two visits with the mother, but in those few minutes she was able to completely destroy the mother's confidence and start her down the road to a three day Pitocin induction that the other midwives in the group had to manage. I was certainly not going to show up at the hospital if this midwife was on call. The midwife I liked reassured me they were trying to make sure that never happened again.
Even with all I had learned, I was still willing to give birth in the hospital and take my chances with the other midwives in the group. Between myself and one of my doula friends we had seen all of them working at labor and we respected their skills.
My first labor started at 3 in the morning, after three or four days of start and stop contractions. I expected the same thing this time, and I got it. Contractions came and went and came and went and I just ignored them. I thought at one point labor was going to be starting because the contractions were coming every five minutes and it was uncomfortable to sit through them in the car, but they went away after a few hours. I woke up at 4 in the morning two days later to easier contractions, but enough that I did not want to sleep anymore.
At 5:30 I called my doula friends to see what they thought. They both decided they would come just in case labor decided to start. I did not settle into any pattern or even think the contractions warranted being in labor - I am sure the hospital would have sent me home. I did have one good strong contraction around 6:45, but it was the last for a few hours. I had noticed the time and realized my daughter would be waking up soon. So I called another friend to come get her. In the hour it took to get her ready I had no contractions. My doula friends were getting antsy, maybe this was not the day. I decided to take a nap while they visited. My problem was I could not settle down, the contractions were weak but regular and I just wanted to be up and moving. Eventually I decided to take a shower. I stayed in the shower for what felt like a long time, hoping the water would turn the contractions strong (my contractions had turned strong in the shower with my daughter during my first labor).
When the warm water had run out I got out of the shower and decided to get into the hot tub. I was having contractions, but they were not anything that even demanded much attention. I figured we were in for a long start, hoping things would go fast again once labor really started. Three or four contractions into the hot tub they got really strong. One of my friends asked me what was happening, since I suddenly seemed to have a hard time relaxing. I told her I would try to pay attention with the next contraction to see what was going on. The contraction started, began to build and I felt my belly tighten and pressure on my bottom. "I'm pushing!" I said. We could not believe it. I had no't even had any really good contractions, but my body was definitely pushing.
I had no idea what to expect anymore. I had never heard of a baby being born without labor (I know technically the contractions I had were labor, but not anything I would have expected to have been effective). It took me a while to decide what to do, the whole time trying to get used to the idea that I was pushing with contractions and in the back of my head being afraid he might fall out at any contraction since this was my second child. One of my friends called the midwives. Of course it was the midwife I did not like who answered the call, but her advice was good. She told us we had two options. We could either jump in the car right now and hope we make it to the hospital before the baby was born, or we could stay where we are with a phone handy to call emergency services in case of a problem.
Since it was my second child, we decided to wait where we were, expecting the baby to be born any minute. Instead it was two hours of slow progress pushing, the whole time thinking we should stay where we are because this was a second baby and he might come fast. I had some issues that I am sure combined to cause such a slow second stage. First was that I had a strange pain that shot down my left leg anytime I got into any position that bent my hip joint beyond 90 degrees. This prevented me from getting into the most effective pushing position. The second was that I had not really been emotionally ready to push. For a while I kept telling myself I must not be feeling it right, that I should not be pushing yet. It is possible my mind needed to catch up with my body before I could push effectively.
Pushing is effective to get a baby out, even if it happens slowly. Eventually my 8 pound 8 ounce baby boy was coming out. I turned to my husband and asked him to catch the baby, which startled him. I a'm sure he expected me to do it and the truth is I would have except my leg issue made me concerned I would not be able to be close enough to hold the baby securely. I could have asked one of my doula friends, but had enough presence of mind to know catching the baby could put them at risk of being labeled an illegal midwife if anyone got angry when we got to the hospital. So my husband, who gets grossed out at the sight of blood and had told numerous friends that it was ok to be at birth if you do not watch what is happening, reached down and gently caught my son as he emerged.
One of my doula friends called the midwives after the placenta came out to give an update and get further instructions. We were expecting to be told to meet them at their office at the least but knew it would probably be recommended we go to the hospital. To our surprise we were told to make an appointment to come into the office on Monday (I gave birth on a Friday). My husband called the pediatrician to explain what had just happened and was told to make an appointment for the following week. We were dumbstruck. For all the fuss that is made about having to be in the hospital and the safety of having medical personnel, no one seemed to care. It was just as well for us. My daughter came home and met her brother and we all settled in for a relaxing weekend at home.