Empowering Birth Blog

What does a midwife bring to a home birth?

At a dinner party the other night my friend, who recently had her second birth center birth, exclaimed, "Kat, when talking about home birth, you have to clarify that midwives bring the tools available to them at birth centers to a home birth."  Apparently my friend thought that midwives brought little besides their hands to a home birth.  Talking to my mother-in-law last night, it seems she had the same impression as well until a recent conversation clarified things.  I suppose I am so immersed in the midwifery birth world that I forget that what I sometimes view as common knowledge certainly isn't common in our corner of the world.  So here is a picture of some of the equipment a midwife might bring to your house.  As midwife Ronnie Falcao notes in her captions, oxygen tanks are also brought into the house as well.

Don't get me wrong, a midwives hands are VERY important, but she brings a variety of tools to a birth that help her handle emergency situations should the need arise.

You can't Compare Hospital Birth and Home Birth

Thanks to The True Face of Birth for reminding us that there is no comparison between hospital birth and home/birth center birth. I was at my friend's house for a baby shower the other day (our friend is having her second at a birth center and she had her first at a birth center) and she pointed out a picture on her refrigerator of her, her partner and baby just after the birth.  She remarked, whenever I get pictures from my friends who have just had babies, I remark at how sterile they look, the white walls, the tubes running in and out, the hospital gown... we look like we are at home.  And there they were, the three of them snuggled up against a pillow in a room that looked just like home.

When people hear that I decided to have a third baby (my husband ALWAYS wanted three, I always said well maybe we will adopt a third but I am only birthing two) after the birth of my second, they seem surprised.  After my VBAC every fiber of my being proclaimed, I WANT TO DO THAT AGAIN!  Now of course that seems crazy.  The mom in front of me is probably visualizing that picture of the pale exhausted mom with tubes stuck in her holding baby against those sterile hospital walls or maybe they are seeing a picture from a sitcom, mom flat on her back screaming where is that epidural as her husband wrings his hands helplessly.  How can I explain to them that the birth that I know is an experience so primal, so empowering, so full of love and power and strength, that tears well up every time I reflect on its awesomeness? 

Carey's VBAC

Thank's for sharing your story Carey!

Benaiah’s birth

Big Ben was born on Thursday August 2, 2007 at National Naval Medical Center.  That is not how we planned it to happen, but babies have an agenda of their own and the mother has to go along with that. 

Early labor started on Tuesday evening about 10 p.m.  I had experienced labor before so I knew that I had a long way to go so I went to sleep until about 4 a.m. when contractions started to pick up.  I called my midwife, Karen, at 5 a.m. when my contractions were around 5-6 minutes apart.  She called her birth assistant, Nicole who showed up about half an hour later.  She checked my progress and I was 50% effaced, 3 cm dilated at a zero station.  She told me to try to get some rest and to call her when I needed her to come back.  Around 8 a.m. contractions picked up more so I called my doula, Kat.  Both she and Nicole arrived between 8-9 a.m. and we sat around chatting while I crocheted Ben’s baby blanket.  I was having a wonderful time with my friends and enjoyed the conversation.  My mom took two year old Eve to the park to give me a little time to relax and my husband time to set up the labor pool in the living room.  Labor was progressing very slowly and by the noon, Kat had me walking the hallways in my building.  During contractions, she would press a warm, lavender scented rice sock on my lower back that felt wonderful.  I also used the sock on my lower abdomen while we walked.  The walking really seemed to intensify and speed up the contractions, but they were still very manageable.  I sat on the birth ball and circled my hips too, which was a comfortable position.  Nicole checked my progress and this time I was 80% effaced, 4-5 cm dilated at a zero station.  Kat suggested that my husband and I spend some time alone together, which was a great idea.  We talked, kissed, danced, and enjoyed each other’s company and before long labor picked up again.  He did a fantastic job supporting and coaching me and would rub my back through contractions while I stood with my hands on the wall above my head.  We spent about two hours doing this before Kat, Karen, and Nicole showed up together in the early evening.  Thomas needed a little break so I took my birthing ball with me into my closet for some quiet time.  I was able to relax and concentrate only on my contractions and it made me understand how helpful meditation or yoga can be during labor.  From time to time, someone would walk into my closet to check on me and see that I was doing fine.  Everyone seemed pleased with the progress, and I knew the baby would be born that evening. 

Karen and I decided to check my progress and sure enough I was about 7-8 cm dilated, but the baby was still a little high.  She said the baby’s head was slightly to one side so I should do some exercises to open my pelvis so the baby’s could move down.  We set up a chair while I did placed one foot on the chair and did a squat 10 times before switching feet.  We did this exercise for an hour or two and seemed to move the baby to a better position.  I tried the exercise ball again at this point, but the labor was still not moving forward as it should.  There was a bag of water and a cervical lip preventing the baby from dropping further in to my pelvis. Karen decided to break the bag of water that was in front of the baby’s head and as soon as she did, contractions started getting a lot more intense.  The feeling during this time was of helplessness, with contractions on top of each other.  All you can do is try to get through each contraction.  Your body is working so hard and breathing and letting your body relax are about the only things you can do.  I tried every position that was suggested by Kat, Nicole, and Karen and found the best were sitting on the toilet and standing in my bedroom with my hands on the wall above my head.  I couldn’t get on my hands and knees or squat while holding on to anything.  Kat, Nicole, and Thomas took turns supporting me and applying pressure to my hips from both sides.  It was a tremendous relief to have them push on my hips and I know they were all exhausted from the work.  After some time in this phase, Karen decided to check on the cervical lip again and it was still present, but I was 100% effaced, but my cervix was swelling a little bit and I was experiencing some intense back pain.  Everyone was so encouraging telling me that the back pain was normal and it was because the baby was moving down.  Karen suggested I get into the labor pool to try to relax a little.  It was such a relief that my contractions slowed down.  I would fall asleep after a contraction and wake up at the peak of the next grasping for Thomas’ arm.  The girls brought in the birthing stool, but there was too much pain in my back to sit on it and I still didn’t feel like pushing.  After about an hour and a half I got myself out of the tub to get checked again.  I was still not fully dilated and the cervical lip was still there but the baby had moved down some.  It was encouraging and frustrating at the same time.  I tried taking a shower and squatting on the toilet, but the back pain was taking over and I was reaching a point of total exhaustion.  When Karen said there were some heart decelerations I started to worry a little and we decided that I should go in to the hospital.  Nicole drove Thomas and I in and we arrived about 4 a.m. to the Emergency Room at NNMC. 

The drive was long and Thomas rubbed my shoulders while Nicole gave a pep talk.  The doctor checked my progress in the ER and I was fully dilated and the cervical lip had disappeared.  They kept telling me I was ready to push, but I could hardly talk or think, let alone push.  They got me to a room and after much discussion with my doula, we decided to try a local shot to relieve some of the pain in my lower back.  They had me pushing on my back for an hour with three pushes during every contraction and then they brought in the squat bar and I pushed for another hour making very little progress.  I could see the concern on everyone’s face.  The doctor and I decided that I could receive a two-hour spinal and after an hour of rest I would begin pushing again.  Nicole was very hesitant, but knew that I something had to be done.  She told me that if I received the spinal that I had to wake up and push the baby out.  After I received the shot, Nicole and I fell asleep while Thomas went to get some coffee.  Thirty minutes later I woke up and could feel the pressure of the contractions again and felt like pushing.  Nicole, Thomas, and the nurse helped me sit upright in my bed.  The first hour of pushing I didn’t feel much pain, and was making slightly better progress.  When the spinal wore off, the backpressure returned and that is when things actually started happening.  The next hour of pushing was totally different, because I could actually feel the baby moving down and back up with each contraction.  Nicole and Thomas were wonderful coaches and kept telling me that each push was moving the baby a little more.  The nurse essentially stepped aside during contractions and Nicole coached me through them.  When Nicole told me I could touch the baby’s head, everything changed.  Just the soft feel of the baby’s head was what I needed for the extra motivation to get the baby into my arms.  The feeling of the baby’s head crowning was a very sharp burning pain and when I would say it burned, Nicole would nod and say she knew it did.  I felt like screaming but the only way to push was to use a low moan.  The OB arrived ready to catch the baby.  After three more contractions, the baby’s head was out, but the OB wanted me to push between the next contractions because the baby’s shoulders were stuck.  She used her fingers to pull the baby out under his arms and in no time he was crying on my chest.  At that point I was so relieved and totally exhausted that Thomas took the baby to get weighed and measured.  Nicole brought me crackers with peanut butter, Jell-O, cereal, and juice and my lovely husband brought me a mirror.  I had no idea, but my eyes were almost swollen shut and both my eyes were totally bloodshot from all the pushing.  I looked scary, but it made everyone in the room laugh out loud.  My husband told me later on that had Nicole not been in the delivery room, we would have ended up with another cesarean.

Benaiah Maxwell was born at 7:50 a.m. and was 9 pounds, 1 ounce and 21 1/2 inches long. 

Looking back, I realize that I had some issues that weren’t fully resolved from my previous birth experience that ended in a cesarean.  I knew I had to surround myself with people that fully believed in VBAC.  My doula could not have been more perfect having had a HBAC herself and knowing what an empowering experience that is.  My midwife had a VBAC as well and never gave me any doubts as to whether a VBAC was right for me.  My labor stalled at the same point as the first birth, but all it took was the love and support of those around me to move past it.  Although I had planned a home birth, I am extremely pleased with how things turned out.  The 40-minute car ride to the hospital gave me time to clear my head of the frustrations that were present and allowed my body to open up in order to give birth.  It takes absolute concentration to push and because I was so exhausted, there was no way my body was going to cooperate without getting a little rest first.  All it took was a 30-minute nap before I could push my baby out.  There is no way I could have had a VBAC without laboring at home for so long, and there is no way I could have gone through such a long labor without the loving and steady support of Thomas, Kat, Nicole, and Karen.

I was tagged :-)

So Trial of Labor Tagged me and I only just found out!  I am only just starting to catch up in the blogosphere after my sister's wedding and my trip to The Farm.  So here we go:

1. Have you considered homebirth as an option for labor and delivery with a previous/upcoming birth?
2. Why did you (or did you not) consider homebirth?
3. What do you see as the major advantages for homebirth, and what are your justifications?
4. What do you see as the major obstacles for homebirth?
5. Is your (was your) partner “on board”?
6. If not, did discussions (and research on the part of your partner) help?

1. I didn't consider homebirth with my first.  I consider it a lucky mom who does but the reality is that unless you have a bunch of homebirthing friends (I didn't), live in a homebirthing community (I didn't) or had a mom that homebirthed (nope again), your chances of finding out about homebirth are slim to none.  My mom was born at home but had her babies in hospitals and I thought that was what you did.  I did have a deep trust of birth and so never doubted my ability to birth with ease and without the use of drugs, but as my readers know, I ended up with a cesarean.
With my second, I began care with my OB but when I called her at 4 weeks and wanted to schedule an appointment and she was busy for the next month and I said, no thanks, I want someone who can see me soon and get the VBAC ball rolling.  I switched to a midwifery/physician practice, then to a birth center (but had to birth in the hospital with the midwives because you can't VBAC in a birth center) and FINALLY (and very happily) to a CPM and home birth.

2.  My VBAC journey lead me pretty quickly to the realization that my best chances for a VBAC were at home.  VBACers in DC are usually faced with continuous fetal monitoring, something I knew I was not comfortable with.  If you are going to labor drug-free you need to be up and moving, not strapped to a bed.  I also really believe that hospitals are for sick people/babies, NOT for healthy moms and babies and knew that this underlying discomfort with hospitals would not help me get in my groove and really open up and birth.  Once bitten twice shy, right?

3.  The major advantages of home birth?  I could go on and on.  Primarily I think that a mom needs to feel safe and stress-free and needs privacy, freedom of movement, and minimal intervention to birth without complication.  Plenty of things happen in the hospital that stimulate adrenalin which in turn negatively affects moms birthing hormones AND fetal heart-tones.  Labor can take a LONG time and hospitals are always making moms feel rushed.  You are over-due, you need to be induced, your water has already been broken 12 hours and we need to get things moving, you've been in labor for 30 hours and you aren't fully dilated, maybe we need to give you a little something and on and on....  How can you birth in that environment?  VBACers especially need to take their time, feel FULLY supported, and don't need any of that, oh my gosh she is VBACing, why is she off the monitor energy.  I think the stress of being overdue is a reason in itself to have a homebirth.  According to The Mittendorf Study, the average length of human gestation is forty-one weeks plus one day1!  And yet how many doctors start talking induction at 40 weeks!  Moms don't need that kind of stress.  Now for the babies and moms that need hospitals, I have lived several years and traveled in countries that don't have the fantastic medical care that we have and feel very thankful that in the U.S., when needed we are often only a short-drive away from excellent care.

4.  I guess the only downside that I thought of when homebirthing with my second was having to transport.  But on the other hand, that wasn't really a downside because I knew that if my midwife said I needed to transport, I needed to transport.  If I had been in the hospital and a doctor said I needed a cesarean, there would always be the lingering doubt that maybe I had a cesarean due to hospital protocol rather then the fact that I really needed one.  It is horrible to have to think that but the reality is that homebirth midwives have cesarean rates that range from less then 2% and up to 13% for births including vaginal birth after cesarean2 while hospitals have cesarean rates of about 30% (and some close to 40% in our area!) so if you have a cesarean in a hospital, you can't help but wonder if it was necessary.  I guess the other downside is that if you live more then thirty minutes from a hospital then you might have slightly higher risks of complications (and I mean slightly higher because in most cases, birth is pretty straight-forward) but if you plan on having several children I would imagine the increased risks of birth after cesarean (given that your chances of having a cesarean are so much higher in a hospital) probably out-weigh those increased risks.  Too tired to look up stats to back up that theory at the moment please forgive.

5. My partner was not on board with home birth until I was about 7 months.  My friend taught child-birth education classes and suggested we do a trade, I would teach her prenatal yoga and I could enroll in her childbirth class and we would see whether Matt would realize that home birth was the way to go.  After a few of Ginny's classes, walking home one day Matt said to me, you know, you aren't going to be able to have a VBAC in a hospital are you?  And I said, no, I didn't think so.  All of a sudden it wasn't about Matt not wanting me to have a home birth but his realization that he was not really supporting my need to have a VBAC.  He decided very quickly that he would do what he needed to do to support my VBAC goal.  He did the research, read Ina May's Guide to Childbirth etc., and realized that there were some sound reasons that I wanted to birth at home.  We are of course having this next baby at home and it isn't even an issue.  The best part is that we are bringing up our kids in an environment where home birth is an option and so when they grow up, they will have real choice when it comes to childbirth.

6. Yes!  And Matt has helped put other nervous partners at ease as well.  As he says, he is definitely not the home birth fanatic that I am but there is solid research supporting home birth as a safe alternative for most women and potentially a safer alternative for some women (such as in my case where birthing in a hospital, would most likely mean a second cesarean). 

Thanks for the tag! 

1 Elizabeth Davis, Heart and Hands (Berkeley: Celestial Arts, 2004) 19.

2 Kristin Eggleston, Midwives and Uterine Rupture: What We Have to Offer in Midwifery Today, Number 83, 24.

Homebirth is about responsibility

Many people who are turned-off by home birth have heard a scary story about a couple who tried unassisted birth without proper preparation or a couple who had a poor outcome after deciding not to follow her midwife's advice.  The bottom line is that home birth is about responsibility.  If you birth responsibly, home birth is as safe as hospital birth in most cases.  But with home birth, there is no getting off easy, you are in charge. 

When Fenimore was born, he had a very large fontanel.  I questioned my midwife and she said that in most cases a large fontanel was completely normal but it could also (rarely) signal further abnormalities.  She put the ball in my court.  She didn't say go see your pediatrician but she didn't say that I shouldn't go see the pediatrician.  She gave me basic information, stressed that she was not a pediatrician, and that what I did (take Fenimore in or not) was my decision.  This was completely different from my first encounter with a pediatrician.  After examining my day-old daughter, the hospital pediatrician worried about a tiny hip click and informed me that I would probably need to see an orthopedic.  The hip clicks amounted to naught and I had a very confused DC pediatrician wondering why my Chicago hospital pediatrician had recommended an orthopedic surgeon after one hip-click exam on a one day old infant.  After Fenimore's birth I remember immediately thinking, but wait, I want you to tell me what to do, and afterwards, thinking about how many decisions are made for us and feeling uncomfortable with this information.  This from a former Peace Corps volunteer who was responsible for her own health for almost three years!  How quickly we sink back into letting "the experts" handle things.

If you birth at home there will be many decisions that you will have to make on your own.  You can make these decisions in a hospital as well but you are limited by hospital protocol and your freedom of choice is limited by hospital staff who pressure you to make "the right" decision.  What tests will you request/refuse?  Do you want an ultrasound?  Do you want your infant to have a vitamin K shot, an oral dose, or nothing?   Do you want your son circumcised?  All of these decisions tend to be quid pro quo in the hospital but not necessarily so at home.  Fenimore's penis is intact thanks to the fact that midwives do not circumcise little boys after birth.  When my husband informed me that he wanted our child circumcised I said, fine, but you will have to find someone to do it, take him in and clean his wounds afterwards because I do not want to play a role in the circumcision of our son.  All of a sudden Matt had to think.  When circumcision is a routine hospital procedure it is easy to just go ahead and do it.  When you have to make it happen, it is a whole different story.

Speaking of responsibility, I am supposed to be doing my homework for my midwifery study group, not blogging, and so I will sign off!  Happy researching!

Navelgazing Midwife on the homebirth debate blog

So I am comforted to know that I am not the only one who has been frustrated by Dr. Amy, otherwise known as the author of the hombirth debate blog (which is NOT a debate) and recent negative commenter on my blog.  I finally realized commenting was useless and even (the horror) decided to block her comments from my site.  But when I read Navelgazing Midwife's blog entry on Dr. Amy, I felt much better.  I have sadly come to the conclusion that far too many people have trouble agreeing to disagree.  I will chalk this up as a note to self to always be open to comments EVEN (and ESPECIALLY) when I am super passionate about something that I feel is the better way.

The English "get" homebirth

I recently purchased the English Myles Textbook for Midwives for my study group.  This textbook is considered a market-leading textbook for all midwives, nurse midwives AND lay midwives.  Curious about what a standard midwifery textbook had to say about home birth, I looked it up in the glossary.  Here is what I found:

"Home birth will lead to a more profound change from hospital birth than any other change in the organisation of care.  The best evidence on the out-comes of home birth and the experience of home birth for women without complications or real risk factors shows persistently that there is a lower rate of interventions, and that women who ask for a home birth generally enjoy the experience (Page 2000b). Birth at home means that the woman can relax in her own environment, and that she is in a different power relationship with professionals, who are invited into her home.  Although there are exceptions (Edwards 2000), in general the relationship is of higher quality. Home birth brings with it its own pattern of practice, and on the whole it is easier to provide the woman with midwives she can get to know and trust"1

The textbook also discusses at length the problems of centralized birth.  Noteworthy is this quote: "'with the centralization of birth into hierarchically organized and increasingly large hospitals, midwifery increasingly adopted the responses and values of those institutions.'"2

I would be curious to compare the section on home birth in Myles, an English textbook, with a standard U.S. midwifery textbook, but alas, I only have U.S. textbooks that are geared to lay midwives rather then nurse midwives.

1 Diane M. Fraser and Margaret A. Cooper, eds. Myles Textbook for Midwives (London:Churchhill Livingstone, 2003) 36.

2. Ibid.

Safety of Homebirth

I think that by over stressing the hospital/homebirth safety debate people are unable to see the forest they are so focused on the trees.  Looking at the bigger picture, perhaps we should instead be asking ourselves why women started having their babies in the hospitals in the first place?  There were many reasons but a big one was that new research was making it safer to have babies in hospitals.  The germ theory of disease, which gained acceptance at the end of the 19th century, led to the development of antibiotics and hygienic practices that did indeed save lives.  Interestingly enough, instead of sharing these new innovations with midwives, obstetricians launched attacks on midwives, holding them responsible for

"puerperal sepsis (uterine infections) and neonatal ophthalmia (blindness due to parental infection with gonorrhea).  Both conditions were easily preventable by techniques well within the graps of the least literate midwife (hand-washing for puerperal sepsis, and eye drops for the ophthalmia.) So the obvious solution for a truly public-spirited obstetrical profession would have been to make the appropriate preventive techniques known and available to the mass of midwifes.  This is in fact what happened in England, Germany, and most other European nationa: Midwifery was upgraded through training to become an established, independent occupation."1

So why are more and more women now exploring birthing at home or in a birth center?  One might argue (and certainly this drove my choice to birth at home) that given the astounding number of interventions and the rocketing cesarean rate in hospitals, home is becoming the safer choice for many women.

In regards to the research, here are a few of my thoughts on birth research.  There are several routine interventions shown by systematic reviews of controlled trials (the best kind of research) to be ineffective or harmful for mom and baby and yet I see these interventions (including being required to use back-lying positions while giving birth) and hear of their use on a regular basis2.  In addition, there are many more studies (although systematic reviews of controlled trials are not yet available) that show that routine interventions, such using sedatives and tranquilizers to relieve pain during labor, are unlikely to be beneficial to you or baby and should be a cause for concern and yet these interventions are used liberally as well.  There are several studies showing the safety of homebirth.  Some studies have claimed that homebirth is risky but are seriously flawed. Below are a few of Henci Goer's comments on one such study: Pang WY, et al. Outcomes of planned home births in Washington State: 1989-1996. Obstet Gynecol 2002;100:253-9

The Pang et al. study alarmingly concludes that planned home birth confers twice the neonatal death rate of planned hospital birth, but, in fact, the absolute difference amounts to 1 in 1000. It would take only a few mischaracterized births to make the difference disappear altogether or swing the advantage to the home birth side.

If these and other flaws in the Pang et al. study are not enough to condemn it, the conclusion that “planned home birth” imposes greater risk is contradicted by a large body of, in many cases, higher quality studies. This includes a much better done study by the Washington State Department of Health that overlaps much of the data used by Pang et al. Prior to the Pang study we had no study of home birth meeting the criteria for “planned home birth” that showed excess risk in the home birth population. We still don't.

In Holland, where one baby in three is born at home, enjoys a perinatal mortality rate below 10 per 1000 and a maternal mortality rate below 1 per 10,000 (and interestingly enough a cesarean rate around 10 percent, which is a third less then ours)4.   My point?  Just because we have good research on the safety of homebirth does not mean that it will reach the general public nor be put to use by the medical community.

I think the greatest benefit of the existing studies on the Home Birth is to help mom make the decision that is right for her.  All research has some bias but by reading widely and seeking to be informed a mom will make the best decision for her and her birth.  If MANA had the kind of funding and clout that ACOG has, I am sure there would be a plethora of studies proving the safety of homebirth.

Ok, there is a lot more that I could add but I am the mom of two little kids and it is Labor Day weekend, enough said. 

1 Witches, MIdwives and Nurses, A History of Women Healers, Barbara Ehrenreich and Deirdre English (NY:The Feminist Press, 1973) 34.

2 Your Guide to Safe and Effective Care During Labor and Birth, A Series of Topical Guides for Women From the Maternity Center Association, 2000.

3 Ibid

4 Michel Odent, The Cesarean (Great Britain:Free Association Books, 2004)

                       

Top Ten Reasons to Have a Homebirth

I was working on this blog before I received the comments to my dirty hospitals post so I think I will post this and work on a response. 

1. You can labor at home as long as you like and you don't have to ride to the hospital in advanced labor/transition. (If you are not birthing at home, however, riding to the hospital in advanced labor/transition is WELL worth it.  It will save you the interventions that often come with a long labor at the hospital and allow you to labor at home where you have access to food, your own bathtub, the comforts of your own house, etc. etc.)

2. You can create the birthing atmosphere you want; a darkened room with lit candles, the smell of a chocolate cake baking downstairs in the oven, use your imagination....  According to Michel Odent, an atmosphere of privacy and safety where there is little neocortex stimulation facilitates straight-forward labors.1

3.  You can play loud music or sing at the top of your lungs without fear that you will disturb a fellow laboring mom.

4.  If you go past 42 weeks, you won't be automatically induced (the policy in many hospitals/birth centers).

5. If your blood pressure is off or your waters have been broken for 24 hours (to name a few scenarios), your caregiver won't automatically start talking about induction/cesarean.  While your blood pressure might be off from a "normal" blood pressure, the variation might be normal for you and a midwife who has spent hours working with you prenatally will better be able to understand the reason for variation.  The protocols of a Certified Professional Midwife will usually allow more room for variability.

6. No super bugs!

7.  You don't have to sneak food in during labor.  You can sit down and eat a bowl of pasta before you move into active labor if your stomach so desires.

8. Your midwife finds a way to monitor the baby that does not involve remaining fairly immobile while hooked up to a machine for at least twenty minutes.  If you are laboring in water, your midwife will grab her water-proof doppler and check heart-tones on the spot.

9. When the birth is over, you can climb into your own bed and go to sleep.

AND
10. Only the baby wakes you up in the middle of the night!!!!!!!

1. Michel Odent, Birth and Breastfeeding (East Sussex: Clairview Books, 2003)

 

Dirty Hospitals

If I had to do a top ten list of reasons to have a baby at home, dirty hospitals would be near the top of my list.  At my midwifery study group today, a mom from England mentioned that the rise in home-birth is directly related to the desire to avoid the super-bugs that have been bred in hospitals.  When I read this article, I felt a bit germ-phobic for a few months afterwards and made sure my birth bag had plenty of hand-sanitizer. 

And while we are on the subject of germs, whose germs would you like your baby to have anyway?  Hospital super-bugs or your germs?  There has been some interesting research on gut flora.  "Term infants who were born vaginally at home and were breastfed exclusively seemed to have the most "beneficial" gut microbiota (highest numbers of bifidobacteria and lowest numbers of C difficile and E coli)."

And Michel Odent writes:

At birth, a baby is germ-free. An hour later there are millions of germs covering her mucous membranes. To be born is to enter the world of microbes. The question is - which germs will be the first to colonize the baby's body? Bacteriologists know that the winners of the race will be the rulers of the territory. The germ environment of the mother is already familiar and friendly from the perspective of the newborn because mother and baby share the same antibodies (IgG). In other words, from a bacteriological point of view, the newborn human baby urgently needs to be in contact with only one person - her mother. If we add that early consumption of colostrum will help establish an ideal gut flora, there is no doubt that, from a bacteriological point of view, the hour following birth is a critical period with life long consequences. Our gut flora can be presented as an aspect of our personality that cannot be easily modified later on in life.

So it would seem that putting baby skin-to-skin immediately after the birth isn't just about bonding, it is about colonizing baby with your friendlier bacteria.  A good reason to be insistent about baby going skin to skin.   And what about that bath? No thanks!  The vernix on baby's skin helps protect him her from those super-bugs.  Here is one article that should be a must-read for hospital staff.  And I repeat, "Studies confirm that maintaining an intact epidermal barrier by minimizing exposure to soap and by not removing vernix caseosa are simple measures to improve skin barrier function."  Tell your nurse you will bathe baby when you get home!