I'm writing this note to offer whatever useful information I can to any of you who will ever give birth, or help facilitate someone else's birth, and to anyone who is interested in a very personal take on the ins and outs of homebirth in the modern world.
I had an amazing, well-supported pregnancy and the most ideal birth I could have imagined this past July, followed by easy breastfeeding and a relatively quick postpartum recovery. Some portion of that is certainly luck, but the rest is the result of several years of research, planning, and sticking to my guns. If there's any part of my experience that could help anyone else make the necessary choices to have their version of the same, I want to provide the straight story of the things that worked: good advice I received, my understanding of choices, preparations and outcomes, things to consider, and things to avoid. I discovered a lot during the months of pregnancy that I never found in any book. (There was also a ton of great information in particular books and websites, & I'll name those here as well, as there are countless forums with wildly conflicting opinions and books claiming to be The Book and it can be a loaded and confusing rabbit hole to navigate, so I can at least recommend the ones I found especially great.)
Again: I'm aware of what role good fortune played in my outcomes and certainly don't take any of this for granted, and also must champion the role of preparation to meet and elicit good fortune as much as possible.
Please take this for what it is, which is one person's highly subjective perceptions and opinions. It goes without saying that every birthing woman is completely different, and what worked for me may have nothing to do with what will work for you. My intention is for anyone reading this to please take anything that feels right, and to let go of the rest. Nothing to fight about here.
Also, this contains a lot of information. Among other things, I'm going to be talking about my VAGINA. Because that is where babies - at the time of this writing, the majority of babies - come out, and it is where my baby made her grand exit from my body and into the open air. Dig? If that is TMI for you, don’t read this. You have been warned.
I went into my pregnancy having trained years before as a doula and then having assisted a handful of the births of close friends, all first births, all in hospitals in Los Angeles. Out of those 5, 3 went to an unplanned caesarian section (meaning that those women had not intended and scheduled it, as many do - they had wanted vaginal deliveries), and I think it's fair to say that those 3 women were traumatized to one extent or another by the way they were handled. The 4th went beautifully until a resident (a doctor in training doing his clinical rounds) decided, without the attending midwives' knowledge, to try to dislodge the placenta: he pulled the umbilical cord and prolapsed my friend's uterus (which resulted in her needing to have her second baby as a scheduled caesarian some years later to avoid the risk of another prolapse.) The 5th was the best possible outcome, a beautiful experience with only relatively minor hassling and rushing on the part of the hospital staff: she was given a slowly elevating steady dose of pitocin to move things faster, asked for and got an epidural when the many hours of intensifying labor became overwhelming, and managed to get some sleep; we went through 3 or 4 shifts of nurses during the 24 hours we were there, and most were helpful and sensitive and kind; upon being checked in the morning after some hours of rest, her cervix had dilated beautifully; the doctor showed up in time to suit up and catch the baby. Everyone was healthy.
I learned a great deal from doctor #5 about waiting during pushing, and saw that my friend barely tore at all as a result of not rushing, giving her tissues ample time in between contractions to stretch around her emerging baby. From nearly every other primary caregiver, I learned a great deal about what NOT to do: how not to scare a birthing woman or her family, how not to disappear and reappear with bad news, not to rush the placenta delivery, not to lie, not to refuse to pass a birth on to one's partner despite exhaustion after several deliveries in a row, how not to look at one's watch and push for things to hurry along based on one's own desire to make it to a date that night (and yes, that really happened.) I saw that the culture of each shift of nurses is distinct from the shifts that preceded and followed it, and that the nurses, unless challenged directly by another caregiver, will often make somewhat arbitrary decisions based on what they believe is the best care. Some will lie and be assholes to defend their decisions. My job as a doula with those nurses, who I've found to be a consistent minority, was to run interference and defend the space and agency of the birthing woman. With caregivers who were genuinely supportive of the birthing woman's own process, I helped, watched, and learned a lot as an ally and another set of capable hands. There are plenty of both kinds in the hospitals, as there are good and bad practitioners in any profession. The difference in a hospital setting is that it is completely unpredictable who will show up and when - and when someone unsympathetic to your needs shows up as your nurse in a hospital, it’s can be a hell of a lot of work to move the necessary pieces around to not have to deal with that person, or those who are invested in them.
My conclusion is that, as a doula, I want to support everyone I love who chooses to birth in a hospital. For many of us, it really is the place where we feel safest, especially in as wild a state as one is in going through labor for the first time - it's great to be somewhere that feels so utterly capable of determining normalcy and handling problems. And for those of us with high risk pregnancies and predictably complicated births, those of us who encounter emergencies, and those of us who just want to schedule a caesarian, hospitals are a godsend.
So. I would recommend to anyone reading this who DOES feel the safest in a hospital to BY ALL MEANS PLAN ON A HOSPITAL BIRTH. 100%.
Feeling safe is necessary for feeling relaxed, and relaxing as much as is humanly possible - not having to vigilantly ensure your own safety while trying to birth a baby - is the best way to have an uncomplicated and successful birth. Feeling in control and well taken care of, whatever that means to you, is the golden key to the best possible birth experience.
In no particular order of importance, I passionately recommend the following to anyone who wants a hospital birth:
1) Do proper research into the policies and outcomes at the different hospitals in your area - they vary enormously.
Unless you're planning a caesarian, where do they really work their asses off to ensure vaginal delivery whenever possible? Where do they offer walking epidurals, in which the anaesthesiologists will scale down the intensity of the numbing to let the birthing woman feel her legs and control her own movement, which is essential for moving the baby's head into an engaged position in the pelvis and dilates the cervix? Where do they train their nurses to help position a laboring woman with an epidural to effectively move the baby down into that engaged position in the pelvis? What is their position on routine episiotomy, which should be that they do not perform them unless absolutely necessary? What are their recent statistics on C section outcomes? Will they allow you to eat and drink as much as you wish during labor to keep up your calories and energy, as they should? Be very thorough with your questions, even if you feel like you're being a pain in the ass - please remember that you are considering who to employ to assist you with one of the biggest events of your life. You are beholden to no one.
2) It must be said: births, especially first births, can be scary as fuck. Birth is beyond psychedelics. It is beyond extreme sports. It is the great leveler. So intense is it that, having now done it unmedicated, I have great respect for all of the reasons that that is a rare decision. It is a tectonic rupture in time and space, unprecedented in scope and depth, heralding an entirely new reality, comparable to a one way ride to another planet.
That said, it is COMPLETELY UNDERSTANDABLE that most of us, raised as we are in a medicalized culture - raised to accept the authority and expertise of doctors, and to feel profoundly reassured by it - are much more comfortable having that experience managed for us. A doctor will tell you, from their experience, whether or not everything is normal and healthy, what to do and how to do it, and has in their back pocket a lot of tools for shaping the labor and delivery, including drugs and surgery.
That said, PLEASE: CHOOSE YOUR DOCTOR WISELY. They're really not all the same. They have extremely different opinions on how things should go down. Please put your care into the hands of a person you agree with and trust, preferably someone who's recommended firsthand by someone who has comparable priorities to yours. Don't assume a doctor will rise to the occasion to do something different for you in the moment than they normally would, because they won't. They will do exactly what they have consistently done all along. So find out what that is. Ask around. If you want to work with midwives, ask them which doctors they love and recommend to have as their backup - they'll always know the best ones. You want to know in your gut that whatever interventions are being recommended are actually necessary, not merely convenient.
3) At the risk of repeating myself: if you have never had a baby or seen a birth, you might not really know that it will be the most bonkers experience of your life. We've all seen the movies, but movies are always about something happening to someone else.
So: in all births, but especially in a hospital setting, you want to build in everything you possibly can to ensure that you will have all of the peace and support that you want. You will not be able to keep people out of the room in a hospital, but there are wonderful tricks to making sure it goes as well as possible. Mammals are not built to give birth under observation, so ensuring a maximum of privacy and quiet for your ease in a setting where there is generally very little of either is absolutely key. It is the trick of building a dark cave in the middle of a busy train station.
One such trick which I learned in a birthing class, the best I have ever heard and one I for sure would have used had I ended up in hospital, is to have whoever is filling out the intake paperwork state front and center that the birthing woman has PTSD. Whether she actually does or not (and it's really not for anyone else to say, frankly), saying that she does will ensure that the hospital staff act with much greater care and quiet and respect for space than they ordinarily might: i.e., they will knock before entering, keep voices down, and in general act in a manner that they should be acting anyways, in order to not trigger a freakout. This is a buffer that you want and need. Please don't underestimate the value of this.
4) Get an experienced doula. Seriously. Whether a partner is present or not. Having a seasoned advocate and badass support person whose entire job is to have your back under all circumstances is a tremendous, amazing boon in a situation where the birthing woman is very vulnerable and in a setting where things can happen very quickly. No to mention the arsenal of tricks that doulas have for relieving pain and moving the baby and every other thing one needs in labor. The doula is the person who will stay with you most or all of the time, whereas the doctor and sometimes even the midwife will arrive in time for the pushing and the catch.
5) Birth is a hurricane of raw emotions and huge sensations and high stakes, and success relies upon being able to relax without self-consciousness into the wildness of all of that.
Therefore: Do Not Have ANYONE Present In Whose Company You Will Not Be Comfortable In An Altered State.
What this means in reality is that if your mom, for example, wants to be there, but you know in your heart of hearts that you do not have a relaxed and easy time with your mom, NO MATTER WHAT, EVEN IF IT HURTS HER FEELINGS, DO NOT ALLOW HER TO BE PRESENT DURING YOUR LABOR. If she knows anything about anything, she will support you in whatever you need at this time, even if she doesn't necessarily like it. Because it's YOUR BIRTH, and is therefore about YOU. Please accept this Get Out Of Emotional Jail Free card from me. At no other time are you more wholly allowed to be entirely selfish in your choices, so - i implore you - don't let anybody get away with guilt tripping you about this. I have witnessed firsthand and heard endlessly about this exact dynamic: usually parents (but sometimes partners or siblings or others whose closeness "should" be OK but frankly isn't) in the room or at the hospital somewhere waiting and whose presence creates enough stress that the birthing body cannot relax enough to do its thing. The direct and quantifiable result of this is that the labor will stall. It won't happen to everybody this way, but it is frequent enough that it's a commonly told story.
So: your mom, or whoever fits this description in your world, can come when the baby has been born and bring food and kvell with you. Find a way to say no. Create the buffer. Even if it's your partner. Even if it's your BFF. Examine your heart with great honesty about this, and only allow people to be with you in whose presence you can relax, for real.
6) If you would prefer to not have a C-section, I strongly strongly recommend prepping and birthing with a midwife, as they offer very different care than OBGYNs, and have a skill set that incredibly few doctors in this country are able to match. It was explained to me by an MD while I was pregnant that MDs are trained to intervene in a problematic birth, but not really ever trained in how to facilitate a normal healthy birth without intervening. Many midwives are able to administer drugs (although epidurals are only available in hospitals, as they are delivered by a line into the spinal cord rather than by injection or IV and are therefore more complex to deliver and monitor appropriately.) However: the midwife's expertise is how to employ every trick in the book to get things moving in the right direction without resorting to the surgery and drugs which are the doctor's provenance and are at best never needed, in my opinion. Midwives know how to do a ton of shit most doctors have no idea about and will tell you cannot be done. A perfect example is that it's a rare doctor who will deliver a breech baby - and yet midwives abound who, upon checking and finding out the position of the baby some weeks before the due date, can do a number of things to turn the baby into a more optimal position.
And - you can absolutely have midwives as your primary caregivers in a hospital setting. There are a number of hospitals where that is on offer. So, again: research your options.
7) Routine episiotomies are, in my opinion and in the opinion of the most experienced midwives I've ever met, a bunch of bullshit. They do not prevent tearing and in fact make tearing worse. There are women whose perineums are so godalmighty muscular and gangster that an episiotomy is indicated, but those women are rare. The comparison I was given by my midwife was the notion of trying to tear an intact piece of fabric versus trying to tear a piece of fabric that already has a cut in it - if you've ever tried to rip through something, you know how much easier it is when there is already a cut. Her opinion, as a midwife who's been catching babies since 1975, is that episiotomies performed routinely cause some of the worst damage and the most horrible recovery periods for birthing moms of anything that could happen, including caesarians, and are to be avoided. And, having pushed an average-sized baby out myself now, I concur: I had 2 stitches, was able to have sex after 6 weeks or so, have had minimal scar tissue formation, and my pelvic floor is more or less fully recovered at 4 months out. It is to some extent luck of the draw, but that doesn't make precautions and preparations irrelevant.
Part Two coming soon. Stay tuned, family.