[content: infant death and disability]
Overall thoughts
I was able to have the straightforward births I was hoping for; I don’t know how I would feel if I had ended up with interventions I didn’t want.
This is one of those situations where everyone more risk-averse than you seems paranoid, and everyone less risk-averse than you seems reckless.
I’ve previously complained about parts of this interview with obstetrician Amy Tuteur about natural childbirth, but I agree with this part:
“Neo-natal mortality and maternal mortality are now, fortunately, very rare. And so people have gotten the wrong idea – that childbirth is relatively safe. It’s not inherently safe. Obstetrics has made it safe. C-sections have made it safe. Anaesthesia has made it safe. So, you can’t really say what we want to do is go back to unhindered childbirth because it was awesome when it was unhindered childbirth. No: It was horrific when there was unhindered childbirth. And what we’re looking for now is a balance: Are we at the right place?”
Provider type
In most of the US, your option is basically a doctor.
In some areas, you may also have the choice of a midwife. For uncomplicated pregnancies, a midwife is as safe as an obstetrician (higher risk of shoulder dystocia, lower chance of interventions including cesarian – source)
If you want some of the benefits of midwife care, you could consider hiring a doula in addition to standard hospital care. Doula care reduces the rate of preterm birth and cesarean birth (source). If you particularly want a warm, experienced support person with you, doulas are good at providing this.
Personally, I was mostly happy with midwife care in a hospital setting. Eventually I realized they were more anti-intervention than I wanted to be. After I read the ARRIVE study I wanted to be induced sooner than was mandatory (because the study indicates that induction reduces the chance of cesarean, and avoids the risks of going post-term). The midwife’s reaction was basically “I don’t really believe it reduces the risk of interventions” and “midwives like to hold off on interventions” which wasn’t the follow-the-data approach I wanted. But she did schedule the induction like I wanted.
Short- and long-term effects
Labor and birth are likely the most intense experience of your life. But the intense part lasts less than a day in most cases.
Recovery from birth hopefully takes weeks or months. Your child’s life will hopefully last almost a century. I think it’s worth weighting health impacts to the child much more heavily.
The most predictably dangerous day of a person’s life is the day they’re born. The American College of Obstetricians and Gynecologists writes: “although planned home birth is associated with fewer maternal interventions than planned hospital birth, it also is associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000).”
This differs by whether it’s your first baby and what your risk factors are. Based on things like the study above, the NHS says that for second babies and beyond with no risk factors, home birth is as safe as hospital birth.
Personally, I’d choose more medical support for the baby over a more comfortable environment for me.
Transfers
It’s worth thinking about how likely it is that you’ll need to transfer to a hospital anyway.
In the UK where home births are common enough to have decent statistics about, it’s also fairly common that you end up transferred to the hospital at some point in the process (45% of first-time mothers).
When I first chose a birth center, part of what I liked was that it was right across the street from the hospital in case the baby or I needed more care.
“Right across the street” seemed a lot farther at 4 am on an icy night when I was ready to push. The midwife told me she needed to break my water and check for meconium, because if there was meconium I’d need to hold off on pushing and transfer to the hospital. Fortunately, I didn’t need to transfer. But it made me feel I’d rather have just started at the hospital than need to transfer during the last minutes of labor.
A few months later, I was present at a family member’s birth in a hospital. The baby was in the birth canal for a long time, and a pediatric team was quietly assembling in the back of the room. Once the baby was finally out, the midwife focused on the mother while the pediatric team whisked the baby over to the warming table and gave her oxygen. After the baby was doing all right, she was brought back across the room to her mother. It made me appreciate having more staff in one place and medical care right at hand, rather than everything being physically farther apart.
Environment
Part of the appeal of a birth center for some people is that it looks like a house, with normal furniture. It doesn’t look like a hospital. For people with past bad experiences in hospitals, this might be more important. To me it wasn’t. With my first birth, I was in full labor by the time I came in, and after I delivered I looked around and realized there were little electric candles and other warm details. I had been completely unaware of them during the labor.
After the birth
My least favorite part of the hospital environment is when you’ve been up all night giving birth and can’t sleep the next night because they come in every few hours to take your vital signs, and the baby wants to be touching you rather than sleeping in the bassinet. You desperately need sleep, but the baby and the hospital staff keep waking you up.
Options to consider:
- Consider a hospital that will take the baby to the nursery at night rather than requiring that you “room in” – they don’t all do this, so you might ask in advance.
- Take shifts with your partner: one of you is responsible for the baby while the other sleeps.
- Have another person be your overnight support (if no partner, or partner needs to be home with older children.)
- Ask if you can have fewer overnight vitals checks, especially if you’re still there primarily to monitor the baby’s health rather than yours.
Boston-specific recommendations
I did my first two births at the Cambridge Birth Center, which currently does prenatal care but does the actual births at Cambridge Hospital. I did my third birth with the midwives at Mount Auburn Hospital. I’d be happy with either again, but would go for a hospital birth rather than birth center.
Almost everyone I know who’s had a baby around here gave birth at Mount Auburn and was pretty happy with it.
Good advice from one who knows.
One consideration I didn’t see talked about much is the risk of C-section impacting future childbearing. Once one has a C-section, future pregnancies have a very high chance of also requiring a C-section (often due to doctor policy); and C-sections carry a decent risk of emergency hysterectomy over the long term [0] as well as carrying a much higher risk to the infant. As people who hoped to have a large family, we chose to homebirth to reduce the risk of starting off with a C-section and thereby decreasing future childbearing ability. (Of course we would have transferred had a C-section been necessary.)
[0] https://www.hellomotherhood.com/article/31679-multiple-csection-complications/
This was my reasoning as well for trying to avoid C-section, which I eventually had to have with my first after 50 hours of labour. If I had had a homebirth I would have had to have been transferred anyway. And when I tried a VBAC with a second I was diagnosed with malformation of the pelvis (android pelvis). The second C-section was correlated with the first, because a lurking variable caused both C-sections, not because the first C-section caused the second C-section. They were unavoidable for me and in retrospect labouring for 50 hours was pointless and risky for both me and the baby, and I regret it.
I too chose to go with midwives in a hospital setting. While objectively everything went “fine”, I am in therapy to attempt to process my experience and am pretty upset about how a lot of things were handled. Mental health and being treated well is worth some increased risk in other aspects. L & D is so fundamentally different than other medical procedures – I can’t think of much else where you are awake and aware but can’t slow things down or leave.
I regret buying too much into the natural birth movement, and I was very grateful I ended up birthing at a hospital. I had looked into having a home birth – going so far as to interview midwives – and I’m glad I didn’t do it.
I also regret asking them to delay pitocin and C-section in the hospital. Hindsight is 20/20 – it turns out a malformation of the pelvis (android pelvis) means I can’t give birth naturally and I laboured for 50 hours for nothing.
My son also has autism and though I believe it’s overwhelmingly genetic, it’s hard to shake my mother in law’s suggestion (who is a pediatrician specialising in developmental disorders) that the hard labour was a contributory factor. It probably didn’t cause it, but it certainly didn’t help!