Some thoughts on Homebirth Safety

It was from my son's birth experience when I began to learn how often needless interventions are pushed in hospitals. I succeeded in a non-medicated, almost intervention free (AROM at 6 cm) birth in a hospital practice of midwives using Hpnobirthing (TM).  However I did not have supportive and respectful staff and ended up essentially fighting for the right to give birth under my own power without the midwives needlessly intervening. 

From this I learned that they are businesses who want to maximize the money that comes in and they do it by rushing women through by speeding up labor and/or cutting babies out which because it requires more equipment, more staff, more procedures bills more. The whole system is set up not to promote health and safety, but to promote efficiency and billable procedures (which includes NICU admissions).

The more I learn about midwifery, the more I see how homebirth midwives understand a great deal more about the physiology of birth than hospital birth attendants. Birth really does work best when its left alone (in 90%-ish of situations). I've lived based on that stat. There's a 90% chance that everything will be just fine at home, transfer services work for the remaining situations (and I always lived 10 minutes from the hospital I would transfer to). Midwives are trained in these situations (and since I'm studying those situations now, I'm impressed with the depth of knowledge expected from then).

One of my favorite ways to think about the safety debate is that the meaning of "as safe as hospital birth" means mortality wise. Women and infants do not have a higher likelihood of dying at a homebirth than at a hospital. Its just as safe in that way. However, homebirth is actually SAFER when taking into account morbidity (other ill health that does not lead to death but might bring a person close...) To women wanting to avoid hysterectomy, abdominal surgery, complications from surgery or anesthesia, PTSD, higher rates of infection, the manual cutting of their vaginal openings or severe lacerations to their perineums, etc: homebirth is considered much safer. Researchers down plays the morbidity thing so much. Its like they don't believe that those experiences aren't bad enough that a woman would go to great lengths to avoid them.

Increasing access to childbirth education

Earlier this week, a Los Angeles Times article condemned women for not educating themselves on childbirth options and therefore being at fault for allowing the Cesarean rate to be so high and for the interventions that happen to them when they trust their providers. 

My reaction to this article when it came out was that 1) expecting families are actively discouraged from being informed about childbirth options (by their care providers) and 2) expecting families see how pointless childbirth education is when it doesn't matter what they learn/want/say, their providers in general aren't respecting their desires and choices and in many cases actively working against the goals of the families. I also see that childbirth education is a costly expense and inconvenience in the lives of pregnant families and many women probably feel their time is better spent resting and taking care of themselves than rushing to another set of appointments.

Childbirth educators are important, don't get me wrong, but their delivery system is lacking and in many cases they are missing the collaborative relationships with care providers.

I think I had a really good idea that could address all of these issues and I'd love to talk about the feasibility of it with others.

Medical groups, doctor's offices, clinics, and insurance companies could hire childbirth educators to work in office. Their job would be to spend 10-15 minutes each appointment with families during prenatal appointments to go over options and to educate women on the process of childbirth. Rather than an additional appointment that takes 1-2 hours, short educational opportunities could be available like many clinics have dieticians and social workers.

I say get the insurers involved and require that these educators are on staff in order to make sure that providers allow them to be there. Some providers will not be difficult to convince on the virtues of this proposal but many others would. Its the ones in private practice that would be the hardest to work with.

This idea came from my midwifery training where I am basically being trained to offer short lessons in childbirth education to clients. I can see how providers themselves don't have the time to do this (and also the will) but they can contract with people who are trained and passionate about informed decision making. This is my vision for how childbirth educators can make it mainstream and break that 30% barrier.

Often that barrier is caused in part to economic factors of the families. Childbirth education is still a privilege available to those who can afford it (mainly middle-to-upper-middle-class white people). The article is flawed in saying that the blame can be put on women by ignoring the institutional and economic factors involved.

What actions would need to be taken to get this happening across the country? Who are the stakeholders who have the clout to make this happen? Grassroots advocates, childbirth educators, policymakers?

Opening the Back

Jamaican midwives having a saying that when the back opens the baby comes. This is referring to the period of time around the fetal ejection reflex where the baby moves down to crowning and birth. Opening the back occurs when the sacrum moves backward to allow more room for the baby to move through the pelvis. Its amazing to learn how much space is gained by this--up to 4 cms in some places! I had never come across it before in any of the other reading I have done on birth. I thought this is so cool, I can share it here. Especially since I can even tell a personal story about it.

I encountered this term in my copy of Holistic Midwifery Volume II written by Anne Frey. It is one of the texts in my midwifery program and covers extensively (its almost 2,000 pages!) the physiology and care of labor and birth.

I remember when this happened during Belle's birth. I even commented on it when I wrote her  birth story. I didn't know the name of it then so I'm pleased to learn about it now. At the time I described it as:

I felt tightness radiating down into my thighs and it felt like the bones of my pelvis and hip were being stretched outwards.

I later thought that this might have something to do with the hip pain that lingered after that pregnancy. I learned that it might be SI dsyfunction (sacroiliac joint) and posted about it here. Finding out that it was an actually physiological process that is part of normal birth helped me feel that the strange sensation wasn't an injury but my body working as it was designed to.

I thought at the time that when I felt my hips spread during Belle's birth that something unnatural had happened. I still think that maybe my SI issues have something to do with this spreading. It happened so quickly--it was like my SI joints abruptly slid out as far as they could like sticky slide locks on a door. Perhaps they slid more forcefully and quickly than is typical when the sacrum moves and the back opens.

This phenomenon is only observed when upright birth is allowed. When a woman in laying on her back in bed, the sacrum is prevented from moving and the pelvis does not expand in conjunction with the fetal ejection reflex.

I don't recall feeling this happen when giving birth to my son. Not surprising, since I felt pressured into birthing on my back. The only way I felt that I had been able to reposition more comfortably as he was descending and crowing was by twisting my hips so that I was more on my side.

Someday I may find more detailed description of this phenomenon. It seems like it hasn't been described or investigated by researchers enough to know what is normal "opening of the back" and what is extreme. As it is, the term is hardly known except in some circles. Hospital birth attendants and medical researchers wouldn't see it because the vast majority of birthing women they see are on their backs. Upright/vertical birth isn't even an option in many hospital birth environments.

Have any of my readers heard of this? Care to theorize with me on the possibility of normal opening of the back and extreme opening on the back?