Wednesday, October 28, 2009

The Business of Being Born

So, I finally got to watch The Business of Being Born, the documentary that Ricki Lake made on home births. I finished watching it with mixed feelings. I do DEFINITELY agree that we intervene way too often. I wish we would stop inducing everyone for no medical reasoning. I know this is what women think they want, but if they were educated on the implications it can have, I don't think it would be what they wanted anymore. It is so funny because I am someone who DID NOT want to be induced and have had to be induced for medical indications both times.

I know complications with home births are rare, but WHAT IF mine was the one birth that went wrong and my baby died. How would I ever get over it when I know had I been at the hospital, it most likely would not have happened. I just could not forgive myself. In a perfect world, I would love to deliver at home, but I just don't think I could take the chance. Not to mention, it happens to be illegal in the state of Alabama. So, in my ideal world, there would be a place where women could go and give birth without intervention, however be next door to a hospital that could take care of the emergencies. I just wish there was a happy medium.

They definitely did make some good points against hospital births in the movie. They talked about the "snowball" effect hospitals have. We have to start and IV, and once we do that and your not progressing quickly enough ...let us just put some pitocin in your IV to speed up your labor. Once women get the pitocin, some find it hard to go unmedicated, so they get their epidural. That slows down there labor, so more pitocin and then eventually our interventions end up stressing the baby out. So, off for a c-section we go. Then we are all so happy we were able to "save" the baby, but would we have had all of these problems without our interventions? I think if we could just let labor occur, then we wouldn't have nearly as many emergencies.

They also brought up some very astonishing statistics. The US has the 2nd worst infant death rate and one of the highest maternal death rates of industrialized countries. They mentioned that in 2005 1 in 3 births was a c-section. Wow...that is unbelievable. What have we come to?

I am so excited about our hospital beginning to offer water births and hopefully we will continue to progress (or regress) back to what birth SHOULD be, but still do it in an environment which has the capabilities to care for those patients who do have true emergencies.


  1. CORRECTION- it is NOT illegal, in Alabama, to do a homebirth. It is illegal to pay a midwife to deliver your baby at home.

    I used to have the same feelings/concerns that you do about "what if" something happened to my baby during a homebirth. I am surprised that the documentary didn't help to show you how experienced CNM's really are. In fact, shortly after that documentary was released a study was done and showed that hospitals and homebirths have almost the exact same fetal death rate..something like .34% (i'll get that link for you and post it back).

    my point is this, I think if you were to talk to a CNM you would see that they do not take high risk patients, and refer them to an OB and therefore they are mostly seeing patients who will most likely have that "textbook" delivery. Im not even a candidate for a homebirth although, if one took me, I would LOVE to do it. There is no more greater risk to having a homebirth than there is a hospital birth. In fact, I would refer you to the book Ina Mays Guide to Childbirth to see her stats on the opposite: a natural home setting or birthing center setting allows less interventions and therefore better outcomes.

    I think you would be suprised to know what all "equipment" a CNM brings to a homebirth and how closely they do monitor mom and baby and WILL MOST DEFINITELY transfer a mom in the case of those rare instances when something goes wrong.. but the key is that.. those rates are no different that if mom was at a hospital.

    Here is a link to a friend of mine who just had a homebirth with a CNM at home (yes, in Alabama) and midwife had to deal with her bleeding afterwards, so she administered pitocin. She was at no greater risk for this to happen BECAUSE she was at home AND it was absolutely something that the CNM could control. Had it not gotten better Im sure she would've transfered her. (she has her other three birth stories on her blog too).

    Anyway.. thanks for posting your thoughts.. I love this discussion. Especially since I used to scoff at homebirth.. ;-P

  2. I loved that documentary! It was very life changing for me to watch. At the time (2 years ago) I remember thinking some of the stuff was a little out there for me, but I wonder if I'd feel the same now? I think when planning your birth, it's all about what you are comfortable with. If I were going to have a homebirth, I'd want someone with lots of experience and good training that I seriously trusted there in case anything did go wrong. Side note: I think it's kinda cool that one of the Duggars from TLC show had a homebirth that went really smoothly.
    After seeing some of the things I've seen, I would not be comfortable with a homebirth for myself, but I'm not ruling it out for others. To each his own...
    Sadly, I do think that the way we do things now in the hospital is so messed up and needs to change drastically! I hope that I am helping in some small way to initiate that change in my city =) Thanks for posting Katie!

  3. Rachel,

    I think maybe you misunderstood my comment. I am not comfortable giving birth in my home at this point, but that doesn't mean I am not in support of other doing that if they desire. I think giving birth at home would be an awesome experience!! I am not saying that being in a home makes you any more likely to have a problem (and I think it may even make you LESS likely to have complications) and I am definitely not saying that a CNM is not skilled enough to handle most, but there are just some things that cannot be done at home.

    I am 100% in favor of women being able to make their own decisions on how/where/with whom they give birth. I CERTAINLY don't scoff at home birth. I just feel as a nurse I have seen what can happen and since I have seen it, I don't think I can do a home birth (if I wasn't high risk also). I feel like whatever decision a woman makes about her birth, whether it be being induced, having a schedule c-section, or giving birth in her living room, she needs to know what she is getting into.

    There are some emergencies that occur without warning and some may be life threatening for the mother, baby, or both. The things I would worry about would be abruption, cord prolapse, and fetal bradycardia. With that said, these are thing that can happen in your home without warning even if you aren't giving birth. A true postpartum hemorrhage wouldn't have been corrected with the administration of pitocin and could potentially be deadly. I am certain the midwife would have realized that and transferred the patient, but things can go SO fast. One of our OBGYNs best friends gave birth at home (not in Alabama). The midwife did not listen to heart tones for the last 30 minutes and the mother gave birth to a baby that was no longer living. I could NOT get over it and could not help but think if I had been in a hospital it probably wouldn't have turned out the same because we would have intervened. Like I said, I know this is rare and it just breaks my heart for that mother. She was only doing what she felt was right for her and her baby. I do not know anything about the midwife and the other circumstances.

    I am also very aware how often a midwife monitors matenal and fetal vital signs. I am on our water birth team at work and I am sure what a midwife does at the home is similar to what we do as far as listening to fetal heart tones and checking the mother's vital signs. I do not doubt a midwife's ability to do safe deliveries. I even have thought about, if things are different here, going back to school to become a CNM. And I am also interested in becoming a doula.

    I do not blame women for not wanting to come to the hospital to have their babies. I think what we do in hospitals is borderline gross. That is why I am trying to do my part to make changes so that women have other options. Anyways, I know this is a very long comment, but I wanted to makes some clarifications. As far as the legality of giving birth at home, you are probably correct. I really do not know the actual laws on it. Sorry for the misinformation :)


  4. so my question would be? how could you safely do a homebirth in alabama if you couldn't pay a midwife to attend??? this seems like a loop hole to me. i have heard moms say that if they wanted a "homebirth" here that they would drive up to "THE FARM" and have their baby there with Ina May and team! =) could be very cool - i would love to visit it sometime

  5. I would love to visit "The Farm." We should make a girls trip. I am sure we could come back with some great ideas for our hospital!! Like I said earlier, I am not really sure on all of the legal issues, but I read it is not the mother, but the midwife they prosecute.

  6. Katie-

    (please hear this entire comment as if I had a huge sad puppy dog face).

    I am soooooo sorry. for the apparent tone of my first comment. I only use ALL CAPS when I mean to use italics.. but this darn blogger doesn't have them. I seriously do not mean to come across as yelling.

    I don't know that it will make much difference but I thought that Abby was the one who posted this particular post, which only would mean that while I know she is sensitive, I knew she had "read" my opinions before and therefore wouldn't be surprised by anything I was saying. So as I was writing, I was thinking as if I was writing to someone I have communicated to before. Had I read the little "posted by Katie" at the bottom, I would have made sure to be extra careful in how my response could be perceived.

    I truly did not intent for any of my points to make you out to be a "scoffer" I was just surprised that "Abby" (who I thought was writing the post) was now not so sure about the safety of homebirth, when we have discussed it before and she was cool with it. So all that to say.. sorry. Will you forgive my inability to process things online or write them in a way that communicates I understand what you are saying?

    I truly did misinterpret your "stance." I thought you thought it was unsafe and not a good option. So I am glad that you set me straight on that.

    I certainly don't want you to think I am a rude person..seeing that you may be helping me deliver in May. Ha! And in the water. I just have such passion about these issues that its hard NOT (there I go again with the caps) to come across and intimidating or rude, when really if you could "hear" my tone it would be a gentle pleading.

    Well I have typed enough already. You and Abby are both precious and I am so thankful that you guys ARE making a difference up there at B and you are helping make a difference one momma at a time. And I think, Katie, you would make an amazing CNM!! Come join us at to make it legal in Alabama again!!

    And as how can you deliver at home safely without paying a midwife to attend? I don't know how they do it.. but there are some midwives who still attend and just take that risk of loosing their license. I have several friends who do homebirth and they all have midwives.. they are comfortable with breaking that law, I guess.

  7. one more "comment" for discussion, if anybody comes back to read...
    Is it wrong/okay to break the law if you don't agree with it?
    If given the opportunity to do a homebirth with a midwife in Alabama, would you do it and feel as though you were right?

  8. Rachel,

    I talked to Abby and she told me that she had talked to you. I understand it is a heated topic and I do understand how passionate you are because I feel the same way about some things too.

    I would LOVE to take care of you! And in the water too!! Can't wait to hear your next birth story (and maybe be a part of it :0) ).

    Apology accepted. And if I offended you, I apologize too! I have just found some new articles and on safety of home birth and will blog on them later.