Tuesday, November 29, 2011

Choosing a homebirth: My journey Part 1

I know some people wonder where the decision to birth at home comes from. Other people have moved past the wondering and are debating a homebirth for themselves. And still other have had homebirths in the past and continue to choose it for future births.

I can't give answers to all of the people wondering why except to tell them why I have personally done it. I know the journey of one can help the journey of others. I love to hear experiences, expectations, hopes and questions from other people. (Now I have the Yo Gabba Gabba song about sharing in my head!) I am SO thankful that other people shared with me. These people, unknowingly, gave me options

I was sitting with two other women and we were all nursing our new-ish babies. Two of us had typical hospital births, although mine had not gone as desired. I wasn't telling the story of my birth. I didn't even know enough to know what had happened or why. I couldn't even give a voice to my disappointment - I had a typical hospital birth for my area. The same most women had. How come it wasn't ok for me? One friend talked about her hospital birth. She was satisfied. The other friend talked about her homebirth. (WHAT?!?! People do that? Normal people? People with jobs and houses? WHY?! That's so dangerous and irresponsible!!) She was glowing. She was thrilled. She was happy. And I thought she was crazy!

Maybe a year and a half later I was reading the newspaper when I saw an article about doulas. I still have that article. It spoke to me and called me. I went to the website listed (DONA.org) and happily found out that their current headquarters were near me AND they had regular trainings in my area! I didn't know any other doulas. None of them in my area had websites. There was no facebook or myspace and doulas were still pretty new to the birth scene. Nobody had heard of them and a lot of people thought I was crazy. I bought the books I had to read and I started studying. I went to the training with a handful of other women. I was young, it was new, I had very little birth experience and zero natural birth experience. I had judgments and preconceptions. I was idealistic and there was a right way to do everything. (Time, growth, and experience have definitely tempered that for me!) I finally met other doulas and connected with families and I began to attend births.

I have learned so much. Women are strong. They know what to do. They love their babies. Some care providers are good. Some not so much. I also learned what was important to me for my own future births. These were just basic things. Honesty, dignity, privacy, security, confidence, and support. I watched doctors and midwives. I sat with nurses in the halls. I overheard conversations and saw treatment that bordered on abusive. How was I going to have that natural birth I wanted? It wasn't likely to happen.

Before I found out I was pregnant again I started reading about homebirth. I read articles by Henci Goer about the safety of planned homebirth. I already loved her book The Thinking Woman's Guide to a Better Birth and loaned it to most of my doula clients. I talked to other doulas and got the names of some midwives and started calling around. I read books and copied questions. I'm sure those midwives had heard it all a million times. The list below is a pretty accurate description of what I asked. There are probably a ton of these lists floating around online that are all very similar. This one is from San Diego Birth and Wellness. If you haven't checked it out, I would go read Barbara Herrera's (Navelgazing Midwife) awesome series about interviewing a homebirth midwife here. In part 2 I will talk about what made me personally decide on homebirth for children.

Midwifery Education and Experience
What is your philosophy about pregnancy and birth?
Why did you become a midwife?
How long have you practiced midwifery?
Approximately how many births have you attended?
How many of the births you've attended were homebirths?
How, when and where did you receive your education in midwifery?
Did you attend a formal midwifery education program or did you train by apprenticeship, or both?
Are you also a nurse? Are you a licensed midwife?
Are you a certified professional midwife?
Are you certified in Neonatal Resuscitation?
Would you provide me with the names of a few mothers as references?
Do you maintain statistics from your practice?
Have you had any poor outcomes for mothers or babies? Please explain.

Midwifery Practice
Do you work alone or with other midwives?
What arrangements do you have if you are sick or if two of your clients are in labor at the same time?
Will I be able to meet any other midwives who might be involved in my birth?
Do you participate in regular peer review?
What prenatal care do you provide?
What do your prenatal visits consist of?
Do you provide home visits?
What are your recommendations about my nutrition during pregnancy?
What protocols do you have regarding "going overdue" during the pregnancy?
How do you feel about waterbirth?
How many of your clients deliver in the water?
What are your views on episiotomy?
What is your episiotomy rate?
How often do your clients have an intact perineum after the birth?
Can you suture if a tear occurs?
Up to what degree do you suture?
How many third or fourth degree tears have you had?
Do you assist with cleanup after the birth?
How long do you usually stay after the birth?
How often will I see you after the birth?
What do you do during the postpartum visits?
Do you check the baby at each postpartum visit?

What equipment do you carry?
What neonatal resuscitation equipment do you carry? Do you have oxygen available?
What supplies do I need for a homebirth? Where can I purchase them?
Do you have supplies available in the event of a hemorrhage?
How skilled are you at placing IVs?

Practice Guidelines
Do you have a copy of the rules and regulations that pertain to midwifery practice in this state? Are certain policies and procedures for my care mandated by your licensure?
What prenatal tests do you require or recommend?
What conditions absolutely risk me out for homebirth?
How many weeks along must I be in order to be able to have a homebirth?
Are you willing to use a fetoscope instead of a doppler during my pregnancy?
How often do you listen to fetal heart tones during labor?
What are your standards regarding monitoring of the baby during pregnancy and labor?
How frequently do you do internal exams during labor?
How do you feel about having a doula at a homebirth?
Do you provide newborn metabolic screening after the birth?

Childbirth Education
Do you offer childbirth classes? If you refer out to other childbirth educators, which classes do you recommend and why?

Hospital or Physician Transfer of Care
Under what conditions do you transfer to the hospital setting?
Will you or an associate stay with me if I need to transfer to the hospital?
What is the plan of action if hospital transfer becomes necessary?
What consultation arrangements can be made in advance?
What problems or complications in pregnancy would require that a physician would become my primary caregiver?
What is your rate of hospital transfer?
What are the most common reasons for transfer to the hospital?
What is your cesarean rate?
What are the most common reasons for performing a cesarean section?

Complementary and Alternative Medicine
Do you have training or experience in alternative medicine? How did you obtain it?
Do you carry medications, homeopathic remedies or herbs for use during pregnancy, labor and the postpartum periods?
What do you recommend to deal with the common discomforts of pregnancy? Do you generally recommend alternative therapies before pharmaceutical ones?
Do you refer to other providers who give supportive care such as acupressure, acupuncture, chiropractic care, osteopathic treatment and massage?

Availability and Fees
What vacation plans do you have?
Do you have other mothers booked at the same time I am due?
What are your fees and what is included in your services?
Do you use a professional insurance billing person?
In terms of the midwifery fee, what happens if I have to transfer out of your care?
How do I reach you when I need to speak with you? Are you available at all times?
At what point in my labor will you come to me? How long will it take for you to arrive? How do we obtain a birth certificate?
Is there a fee for the newborn metabolic screen?

And finally, ask yourself ....
Do I want this person with me at this most intimate moment of my life?

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