Home Birth

So I wanted to write this as a separate post from my birth story because I want to give my opinion on home birth separate to my birth story.  Tillman's birth was exactly what I hoped it would be, it was a beautiful experience and I wouldn't change it for the world.  But I also want to share my thoughts on home birth versus hospital birth based on my experiences.  The good, the bad, the ugly and the awesome!

I tell my students that with any birth there are risks.  Hospital, birth center, home birth.  By choosing a hospital birth, you are certainly not choosing the risk-free option, you are simply choosing a different set of risks than if you chose to be at home.

With a hospital birth you may be exposing the baby to viruses, germs and infections that very commonly exist in a hospital.  You are exposing yourself to a significantly higher risk of a c-section and other interventions that can threaten your life, the life of the baby, and your health.  Many hospitals require continuous fetal monitoring which means that the mom is not able to walk around during labor and is confined to a hospital bed.  This slows labor and is not conducive to relaxation.  But you also have the life saving procedure of a truly medically necessary c-section or a state of the art NICU at your fingertips, minutes away if things to go badly unexpectedly.

Most of the time when you see something go wrong quickly during a birth, it's a bi-product of Pitocin or Cervidil or some other synthetic drug that is used to induce labor, but there are no guarantees.

At home your baby would only be exposed to germs that your immune system is used to which decreases the risk of the baby contracting an infection or virus.  You are less likely to have a c-section (3%-4% of home births versus the 38% national average, higher in many major US cities) or interventions that could harm the baby or mother.  You are likely to have a much quicker labor and birth.  At home you are able to labor and/or give birth in the water or in a squatting position, at the hospital moms are often limited to giving birth on their backs lying in a hospital bed.  This obviously works against gravity and can make labor longer and harder.

Enough with the facts, I really just want to share my experiences, opinions, and perspective.

Turner's birth was amazing and perfect.  I was in the hospital but had a completely natural birth with no interventions and the higher level of care of a midwife.  So when deciding what to do the next time around, I didn't choose a home birth because I'd had a bad hospital experience.  I chose to have him at home because I left the hospital exhausted.  Every 2 hours someone is coming in to poke and prod mom or baby.  The beds are so uncomfortable.  The lights are glaring in your face all night.  Other babies on the hall are crying.  And it's just not home.

I also realized that what my birth instructor had said was true.  While my midwife was amazing, I was left in the hands of a hospital for the following two days.  And hospitals have rules and regulations and policies in place, whether the policies make complete sense or not.  Soon after Turner was born I had a slight fever of 99.4 and I was told that if it got up over 100 degrees that the baby would be taken away from me and he would have to be bottle fed formula because I could have an infection.

Of course my temperature is fluctuating, I just had a baby!  My body is designed to warm up and cool off based on what my baby needs, it's an amazing natural process that the hospital was viewing as a danger to my baby.  Nuts!  But because the policy states this, the hospital has all control.  I hated that feeling!  I knew I was fine and this policy could potentially inhibit me bonding with my baby and could have made breastfeeding incredibly difficult completely unnecessarily.  Someone else was making decisions for MY family and there was nothing I could do about it.

So...I took a Tylenol and fortunately that problem went away.  So silly.  But I realized at that moment that I didn't want to put that major of a decision in the hands of a hospital that is really focused on liability and cost (as we know, it's a business and has the pressures of running a business, the liabilities, and the pressures from the insurance companies).  I want to be seen as a person, a family, I want my needs and desires to be considered.  I don't want decisions being made about my health and my baby's health being made with the focus being on the hospital's needs or the doctors needs or out of convenience.

We know that the hospitals are making decisions based on financial gain, fear of the insurance companies, and based on convenience because they are overworked and have too many patience.  The c-section rate is increasing at dinner time when doctors want to go home to their families and in the late evenings when they want to go home and go to bed.  Moms are being induced in the morning completely unnecessarily because they are more likely going to fit in the doctor's schedule.  It's safe to say that when the doctors are focusing THAT much energy on their own priorities that they will not be able to make their patience a priority, even an OBGYN with the best intentions. 

Now to the home birth side of things.

Tillman's birth was also amazing and perfect.  Because it was my second birth and I was in my own home in a familiar environment and my mind was clear the entire time.  I was truly present for the birth.

But in the back of my mind I did have to wonder what if something went wrong.  How long would it take to get the hospital if there were any complications?  What if something happened and for the rest of my life I was that woman who tried to have a home birth?  How irresponsible!  More importantly, I would never forgive myself if something happened at home that could have been detected in the hospital. 

It is very rare for a natural childbirth to have a true emergency, for things to go from great to bad in only a few minutes.  Typically it's a true failure to progress that sends mom to the hospital.  And a good midwife has the ability to take equal care of mom and baby at home that they could do in the hospital.  One of my midwives has attended over 700 births and the other is an R.N. with NICU experience.  I was in good hands and they KNOW birth...OBGYNS know interventions, not birth.  If a baby is going to be okay in the hospital, they'll be fine at home.  If there are complications at home, those same complications would have more than likely happened in the hospital.  But those fears were still in the back of my mind.

As mentioned in my birth story, Tillman had a nuchal cord for about a minute and he had some bruising.  I was nervous that he didn't pink up and cry right away as well (it took about a minute, maybe less).  Neither of these ended up being an issue.  His heart rate stayed perfect the entire labor and after birth and his Apgars were strong.  But it did make me wonder if something had resulted from that if we could do as much for him at home as we could in the hospital.  When it's your baby, your life, you don't want to take any chances whatsoever.  You want to know that you made the very best decision for them.  And ultimately home birth is not accepted in this country and that makes it very difficult to go against the grain.   

Beyond that, I will say that even as second time parents we felt overwhelmed by the fact that we were on our own right off the bat.  Tillman was born at 11:15 and everyone was gone by 1:30 in the morning.  They checked Tillman out, checked me out and left.  Connie walked out the door and said, "Okay, great job, now try to get some sleep."  What?!  I just had a baby!  The greatest high ever!  A life changing, life altering experience!  Adrenaline rush!  Now you want me to sleep?!  But that IS exactly what we had wanted, that's what we asked for.  And eventually my brain shut off and I slept.  I slept great!  And what an advantage to have 5+ hours of sleep under your belt!  I can tell you that I did not get that at the hospital.

The second night, Tillman seemed stuffy and when he got upset he oinked like a pig.  Is this normal?  I think so, my gut says he's fine, but I'm not a trained medical professional by any means!  If I had thought anything was wrong I would have whisked Tillman off to the hospital in a heartbeat.  But I didn't want to overreact and take him into the germ filled hospital and potentially have them overreacting as soon as they heard the term "home birth" either.  So we called Connie and told her what was going on, she told us the symptoms of Respiratory Distress and Tillman clearly did not have that or any kind of infection, so we waited it out until the morning when Connie would come out to check on him.  She got there the next morning, gave him a clean bill of health, and gave him some nasal drops.  That helped tremendously!  Such an easy fix!

We told her we might still go in to see our Pediatrician since he had asked us to come in by day 3 (this was at 36 hours).  She also mentioned that they could run a pulse-ox (to check the level of oxygen in his blood) just so that we would have peace of mind and stop worrying about it.

So we headed in to the Pediatricians office to get him checked out and I thought they might prescribe him something for the stuffiness.

But it was Spring Break weekend, so our Peditrician, Dr. Ho, who we love, was out of the office on vacation.  So we asked for Dr. Oteness who is also great and super laid back...yeah, she was out of town.  So they told us the only doctor who could see us would be (I won't mention a name) their third string doctor (this is the name I gave her).  So we said fine and we went in to the office.

I was a little bit nervous because Dr. Ho knows us, knows that we're responsible parents who care tremendously about the health of our children.  I had told him several times up front that we were having a home birth and he was comfortable with that, he never discouraged it.  But I figured it would be fine.

We decided to give Tillman his nasal drops shortly after we got there so that I could nurse him.  And when the doctor walked in I was trying to nurse Tillman just after he got the nasal drops.  I learned quickly that you have to wait a minute or two before nursing to let the drops clear out of his nose.  Duh.  But of course he was extra oinky and noisy and she immediately said she would like to run a pulse-ox just to be safe.  I was kind of relieved because I really wanted to know that he was okay and that his pulse-ox levels were normal.  So she checked him out and within seconds after she came in the room the nasal drops had cleared and he was breathing like a dream.  She looked him over and noted the bruising on his forehead, but said that he looked great and healthy.  Yea!  She confirmed what we already knew, but it was nice to get a professional opinion on that.

So she sent the nurse back in with the pulse-ox machine just to be safe.  And that's when things went down hill.  When the nurse first placed it on his toe, she couldn't get a reading.  Then when she got a reading it was reading between 88 and 92, they inform us that it should be between 95 and 100.  So within seconds we went from having a perfectly healthy baby to having a baby who could potentially have "brain damage and heart failure and could die at any minute".  My heart sank, I began sweating bullets.  She called an ambulance and they wheeled in an oxygen tank.  It was all happening way too fast!  He's fine.  Everything inside of me is screaming that he's fine.  I couldn't say a word.  Troy was so terrified but so incredibly composed.  He explained that we had gotten him to the doctor's office, she had just given him a clean bill of health, we would go to the hospital, but we were driving ourselves.  We didn't want to overreact and do more harm than good for Tillman.  So we quickly picked up our bags and very quickly walked out of the office while the nurses watched us with glaring eyes (at least that's what I felt...it was very very quiet).  When we walked through the front doors the ambulance was flying through the parking lot and under the porte cochere.  WHAT JUST HAPPENED?!

So we get in the truck and we're flying down the highway to Texas Children's (we agreed a long time ago that if we were ever dealing with something major that we would go there and get some of the best treatment in the world).  On the way there I'm losing it.  I call my mom and tell her to pray.  I call the midwife and she says that if his pulse-ox is low that we need to get him to the hospital quickly and let them run tests, if his pulse-ox is low then there is something wrong.  As we got off the phone she said that they will take him away from me immediately and we will be there at least 48 hours.  She said to request that they start with antibiotics and less invasive testing and then work their way up to a spinal tap.  A spinal tap on my baby?!  My sweet precious tiny baby?!  That did it...

As I was walking into Texas Children's I once again felt the calm assurance of my Lord telling me that everything was going to be okay.  He had told me that during my pregnancy.  He had told me that during my pregnancy when I would worry about having Tillman at home.  He told me it was fine, Tillman was fine, and he was going to be fine.  As I looked in the reflection of the side of the Texas Children's building I prayed to Him, "How is this fine?  How is this going to be fine?  I hear you saying that but I know that they are expecting us, the Pediatrician called ahead.  Now we're not only the home birth people, but we're the people who refused the ambulance.  They're going to whisk him away and do all kinds of crazy tests on him.  Lord, I'm terrified.  Lord, I'm scared.  How is this going to be okay?"

So I walk in the building as scared as I've ever been in my life.  I try to calmly check Tillman in so that they can see the situation is under control and so that they won't overreact.  And a nurse nonchalantly said "Oh okay, come on in and we'll take a look."  So we walked into the preliminary check-in room and the nurse goes to put the pulse-ox on Tillman's toe, but the other nurse quickly corrects her and says "Oh no, you can't put it on a newborn's toe, you have to place it across their foot, you can't get an accurate reading on their toe."

WHAAAAAT?!

At the Pediatrician's office, they put it on his toe...they put it on his toe!!!!!

Immediately his pulse-ox is at 100%...BAM!

I know I had my heart to heart with my Lord, but I may have let a not so nice word or two slip out in relief and anger.  SOaB!  SOaB!  It was the best and worst moment of my life all at the same time. 

So can we leave?

They said that we probably could but that we should get checked out by a doctor just in case.

So now we know that he's fine, but we're going to get some crotchety old doctor who will still want to poke and prod him just to punish us for having a home birth.  Great.  Forget bullets, I'm sweating shot gun shells now.

I'm exhausted.

The cutest nurse walked in and said that everything looks great and we will probably get sent home, but the doctor would be with us shortly.  Sure sure, that probably means sometime within the next 2-3 hours.  I'll be completely dehydrated by then...I just want to get out of here!

I assured Troy I would keep my mouth shut when the doctor came in the room.  You got this, you can handle it, I'm too emotional.  You do all of the talking, let's keep it cool.

But within minutes the cutest young doctor, Dr. Waldrop walked in the room.  I immediately start pouring out my story and trying to explain the misunderstanding before she could tell us all of the tests that would need to be done.  So much for playing it cool....

She threw her hands up and said "Time out."  (Oh here we go....holding my breath).  "This is not a sick baby.  I've been watching his pulse-ox levels for a few minutes and he's fine."

So of course I did the only thing that made sense.  I hugged her while I was crying happy tears, just after nursing with my boob hanging out.  Ha ha!  What else?  The most uncomfortable and fabulous and awkward side hug of my life!

I told her that they ran the pulse-ox on his toe and that they only ran the test for 5 or 10 seconds.  She said "No no no no (with a horrified look on her face), you cannot run it on their toes and you absolutely cannot look at that small of a window of time.  You have to watch a pulse-ox over a period of time, you cannot look at a small window of time and get an accurate picture of what is going on over all."  Hallelujah!  Hallelujah!

She said that it is completely normal for a newborn baby to have dips and then return to normal again.  If they're nursing (which Tillman was when they ran the test at the Ped's office because the nurse told me that would calm him down) because they're having to work hard to eat, if they're crying, really even if they're wiggling, their pulse-ox will dip and then return to normal again once they calm down.  Babies by nature breath mostly through their noses, so when they're expending energy, their pulse-ox naturally dips down.  In the time that we were there at the hospital we saw it dip down as low as 81 and then come back up again.  She explained that was completely normal.  I wish I had known at the time that a baby who is under true respiratory distress would not be able to nurse.  And Tillman had nursed from birth and never had any issues nursing for long stretches at a time.  But...you live and learn!

Wow.  What a whirlwind.

So she looked him over and asked us a million questions that I was happy to answer.  Then she looked at us after reassuring me one thousand times that he was fine and said, "Now you need to get out of here, this is the LAST place a newborn baby needs to be!"

So I pulled that stupid pulse-ox thingy off of Tillman's foot and we skedaddled out of there!

Over the course of 3 hours we went from having a healthy baby with a stuffy nose to having a baby who was on the verge of death, back to having a healthy baby with a stuffy nose again.  I have never felt so drained.  So happy.  So relieved.  So angry.

I was ready to call that Pediatrician and give her a big ole' piece of my mind.  But Troy called and was WAY nicer than I would have been.

We scheduled an appointment with our regular doctor, Dr. Ho for that following Monday.  I wanted closure.  I wanted an apology.  I wanted something from them.

So we went in that morning and coincidentally ran into Dr. Ho getting on to the elevator.  He was getting ready to start his day after being gone for a week.  We said hi and he said hi.  And I thought, "This guy doesn't know us from Adam.  We're just a number."

But he immediately said, "So, I hear we had a little drama with this little fella last week."  Wow.  He not only recognized us but knew our family and was able to put the case he had read before coming into the office together with our faces.  That's pretty impressive for a Ped who sees hundreds of kids each week.  Okay, so he was off to a good start.  I told him that we wouldn't bombard him before he was even able to settle into his office.  But he continued to talk about it and was completely open for discussion before ever even getting to our appointment.

When we got to our appointment we did the usual newborn checkup and discussed the typical topics.  Then we got back into the real issue.  We explained what happened from our perspective.  Though I had been told from both a friend of mine who works as a nurse and from Troy that I should not expect an apology, to anticipate that they will be defensive and that he will have to back up his partner no matter what, I still wanted an apology.  And if I didn't get it, we would leave the practice, simple as that.

But Dr. Ho agreed that our situation would have been traumatic.  He said that if he had been there that probably wouldn't have happened.  Number one, he doesn't like to send patients to the hospital unless absolutely necessary.  Number two, he almost never runs a pulse-ox because sometimes he just doesn't want to know what their pulse-ox is (which shows that it's not the end-all-be-all test).  Number three, he said from all of the pieces he'd gathered, Tillman was just fine that day but had a stuffy nose.  He said he looked like a very healthy baby and gave us the reassurance that he was just fine.  And number four (and my personal favorite), sometimes young doctors just overreact and he said, "That kind of chaos just doesn't happen on my wing of the office."

I was left kind of speechless.  That was about as close to an apology, closure, and admitting that his partner was wrong as I would have ever expected to get!  Even my nurse friend said that was a big deal that he said those things because she would have fully expected him to back her up with no remorse.  Yet he did it professionally and without throwing her completely under the bus.  I was very impressed.  It reaffirmed why we see Dr. Ho in the first place.  He's good.  He's trustworthy.  He's not overly emotional yet he's not cold either.  And he knows what he's doing.  I feel like he's one of the best, that's why I put my kids health in his hands in the first place.

So I left there feeling surprisingly satisfied and ready to move on from this!  I was glad because Turner loves Dr. Ho (and his fish tank) and I would hate to change doctors or practices because of one bad apple.

But...long story longer...my point is that our country is just not set up to accommodate home births.  While I would have rushed to the hospital at any point during the night or day if I had thought anything was wrong with Tillman, I didn't want to have to.  When you've had a home birth hospitals are often very judgmental and will run the gamut of tests on your newborn whether they feel anything is wrong or not, just to rule out anything being wrong.  It's a game of choosing the lesser of the two evils.

I'm not a medical professional so Tillman's health was solely in our hands after the first two hours of birth.  Normally you have at least 24 hours of medical professionals watching over you...even if it is annoying being woken up every 2 hours.  But it is an advantage to be able to ask "Is this normal?" about every little thing that worries you.  And let's face it, having a newborn is a scary thing sometimes and we worry about every little thing.

Another possible con is that Troy had more responsibilities during the birth.  He had to put the plastic down under the sheets, put clean sheets on for after the birth, then another layer of plastic and the sheets that could get dirty in case I ended up giving birth in the bed.  If we'd had a birthing tub, he would have had to take time to set that up and that would have taken even more of his focus.  But I felt like he was rushing around taking care of his responsibilities.  Then he'd FLY over the bed to push on my lower back during a contraction.  And then go back to his duties.  In the hospital all of that would have been done for us and he would have been able to focus just on taking care of me.  So while he gave me all of the attention I needed and he did all of his duties as the coach, I wonder if he was able to slow down and fully appreciate the birth because he was so busy.

And lastly...the cost.  It cost us about $1200 for Turner's birth in the hospital and would have been an out-of-pocket maximum of $2000 no matter what the total charge was.  For a home birth (or birth center birth) we were not able to get in-network coverage, so insurance covers 60% of the cost instead of 90%.  And we figured that was still worth it because it would come out to about the same.  But then as the process unfolds we find out that the insurance company decides what they think is fair to pay and we have to cover the rest.  Okay.  Then we find out that Blue Cross Blue Shield many times doesn't even pay, the battle can be drawn out over YEARS because they're so bad about paying midwives even a dollar of what they owe.  So in the long run we may end up paying more than FOUR TIMES what we would have paid in the hospital. 

So, that's the good the bad and the ugly.

I don't regret Tillman's birth for a second and I know that it happened the way it was supposed to happen.  But I do leave the experience with the realization that there is risk involved with birth any way you choose.  There is NO risk free option.  And that's okay, that's part of it.  So every woman has to make her choice.  But I can say this...GET EDUCATED!  Please please please.  Don't say, "Oh between the epidural, instinct and having watched The Baby Story on tv, I should be fine.  Or "A c-section is the easiest choice, it's 1-2-3 and done."  No.  Get educated and then make informed decisions and give informed consent whatever you choose!  We can no longer afford to accept healthcare ignormantly in the country, particularly when it's related to birth.  We pour hours and hours of energy all of ourselves into our children but we don't take the time to educate ourselves about the beginning of our child's life...BIRTH.  And it's so very very important, we need to wake up and see that!