Midwifery is confusing to many people and in order to somewhat set the stage for this post, I’ll briefly summarize by saying that there are different types of midwives. Midwives who are trained at a graduate nursing level and typically attend births in a hospital are Certified Nurse Midwives (CNMs). There are also midwives who attend home births and earn their education through a midwifery program accredited by the Midwifery Education Accreditation Council. These are known as Certified Professional Midwives (CPMs). There are also Certified Midwives (CMs), as well as birth center deliveries, but for the sake of brevity, I won’t go into either of those now.
When deciding to go back to school, I chose the Certified Nurse
Midwifery route which required me to attend nursing school at the graduate
level, going on to specialize in midwifery. Although I swore I’d never go to
nursing school (or graduate school for that matter), I felt like this route
made the best use of my undergraduate degree, and the work schedule of a Nurse
Midwife seemed more conducive to having a young family.
From the start, I knew that America’s birth system was very
broken. In my application letters to graduate school, I spoke about wanting to be a part of fixing
it. But I had no idea just how broken the birth system was until I entered it
from a provider’s perspective.
The memory I have of stepping foot onto the labor and delivery
unit as a student for the first time is burned into my brain. My very first
thought was that it felt like a factory. The way birth was managed was
completely contrary to my philosophy of it. I felt like hospital policies made
it so that childbirth was approached in a cookie cutter fashion. My perception
was that each woman was to progress through labor in a certain amount of time,
undergoing a systematic set of interventions to keep things “on track.” I did
not see women being offered comfort care in the form of emotional or physical
support. It was very disheartening and I knew that instant that I would
spend my career as a midwife like a fish swimming upstream trying to give women
an empowering and sacred childbirth experience.
I’m sure I had heard about homebirth before 2014, but the first
time I really remember learning about birth outside of the hospital was during
my pregnancy with Dawson. Josh and I watched The Business of Being Born
— a documentary about traditional childbirth in America. The film explores the
maternity care system in the United States. It follows several couples who
decide to give birth “on their own terms,” revealing the distrust that goes on
inside of labor and delivery units. Watching The Business of Being Born
struck a nerve in me. For several reasons, having a homebirth didn’t feel like
the best option for me at the time, but I knew I wanted to take charge of my
birth experience — to really own it. And I did. I sought prenatal care from
nurse-midwives as their approach to pregnancy and birth aligned with my own. I
had a fantastic hospital birth that quite literally changed my life. You can read about it here. It’s the
reason I went back to school to become a midwife.
But because of the clinical experiences I had while pursuing this
career, I knew before I was even pregnant that my next baby would be born at
home. While I love supporting moms in the hospital and doing my best to give
them an experience that goes against the grain of birth in America — the kind
of experience I had with Dawson — I realize that I can only control how I
manage birth as a provider. I can’t control how I’m treated as a patient in the
hospital and this time around I didn’t want to risk being a victim to the
broken system.
On one hand, I don’t want to turn this blog post into a research
paper. Over the last two years I’ve done my fair share of research and writing in school and
this space is an outlet for me to escape that pressure. On the other hand, I
blog to share bits of my experience, and there would be a huge gap in the story
if I passionately shared about my decision making process but left out the
details and the whys. For that reason, I’ve decided to share a bit of the specifics,
hopefully without coming across as though I know it all or am here to provoke
debate.
All that to say, here are some reasons that ultimately
convinced me it was safer for me to give birth at home than in a
hospital. The teal words are hyperlinks to sources.
- According to the American College of Nurse Midwives, "For the essentially well woman experiencing a healthy pregnancy, intrapartum, postpartum, and newborn course, childbirth with qualified providers can be accomplished safely in all birth settings, including home, birth center, and hospital."
- Peer reviewed studies contribute to evidence supporting home birth as a safe option for low-risk women attended by skilled midwives.
- Planned homebirths with skilled providers have lower rates of intervention.
- According to the World Health Organization, the rate of cesarean sections should not exceed 10-15 percent. However, the rate of c-sections in Ohio is 30.3 percent, according to the CDC.
- I was blown away by homebirth statistics regarding the rates of spontaneous vaginal delivery (normal vaginal birth), APGAR scores ≥7 and low cesarean rates, to name a few.
- Additionally, hospital policies routinely go against evidence based practice.
That said, it wasn’t an easy decision and I certainly didn’t take it lightly. A quote in Ina May’s book Spiritual Midwifery summed up my experience deciding to have a homebirth, “...Hasty interventions have their own statistics too. I had never before felt the weight of bearing so much responsibility for one decision. I would have to fully assume the consequences of my ultimate choice. I prayed a lot and cried a lot...”
I researched like my baby and I’s lives depended on it, because
they did. Time and time again during my clinical rotations on labor and delivery, I’ve seen the worst case scenario unfold and so
when I interviewed homebirth midwives, I asked all the hard questions — every
last one — and at the end of the day, Josh and I felt confident in our decision
for me to give birth out of the hospital with our wonderful CPM, Amy. I wholeheartedly believe that
hospital births have an important place, and at the same time, I think it’s a
mistake to say that giving birth in a hospital doesn’t come with its own set of
risks or significant consequences.
Choosing where to give birth is such a personal decision and I’ll
be the first to admit that homebirth isn’t for everyone. It wasn’t for me four
years ago. It’s not a safe or comfortable option for many women and that
is perfectly okay. What’s not okay is that so many women are unaware of their
options and end up getting run through the “factory” without ever knowing that
they missed out on what could be a sacred and empowering experience. Empowerment can be experienced regardless of how or where they
give birth — it’s all in the way their pregnancy and birth are managed and for me that meant being cared for by Amy.
I hope that whatever your story is, you feel empowered and strong and capable. Cheers to taking ownership of our birth experiences, regardless of
what we choose.
You are brave and amazing. And wise and sharp as they come. Love you.
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