Friday, 27 January 2012

Home Birth and Home Birth After Cesarean (HBAC)

Ok ok, I've put it off long enough.  I have been avoiding doing this post because I haven't been in the mood to sit and think and write.  But really, I don't think have to think about much for this post if I don't want to.  All I really wanted to do was link up a bunch of information I've come across in my research about home birth and HBAC so that if anyone is so inclined they can have a peek.  That's easy enough to do!!

I guess a little blurb on what home birth means for me is in order though.  The first time home birth may have come up between my husband and I as on option for birth, it was not something we would have considered.  I think I may have read a little about it during my first pregnancy, but did not think I would ever be comfortable with it.  This is probably something that is really common for most first time parents to think.  Childbirth and becoming parents can seem like such an overwhelming experience the first time around.  It's uncharted territory. 

When I was pregnant with our second son, while I did know more about birth and had more confidence in the process, I still would not have considered a home birth, mainly because I was having a VBAC and also it was not given to me as an option by my midwives.  I'm sure I could have pressed for it had it been something I really wanted, but given my births were going to be only 20mos apart, it was not recommended and I was fine with that.  Plus, since I hadn't laboured or given birth naturally with my first, the birth process was still very unknown to me, even though I had taken the time to educate myself a lot more than I had with my previous birth.

My husband likes to remind me of the fact that we had previously decided that home birth was not for us.  I am not so quick to go back to my ways of old thinking.  I know a lot more now, I have been through a lot more.  I would like to consider a home birth this time around.  He on the other hand is not so keen.  Let's just say we have had two arguments about it thus far (months ago already) and have not spoken a word on the topic since.  It is still early, and I have no desire to bring it up again this early in the game.  But trust I am not laying down and giving up on this one.

For me:  I have experienced childbirth in two different ways now, both in hospital settings and both positive experiences.  I have spent the last several years reading and learning about the birth process, and have come to have confidence in this process and in my body.  While I did have a positive hospital birth with my VBAC, in my heart I just want to be at home.  I know it is safe, I know it is where I want to have my child.

For him:  He has not read anything on the safety of home birth (or anything on birth for that matter), and is still following the ignorant point of view that it is best to be in the hospital.  He cannot shake that fear that something could go wrong where we would need instant access to care.  He feels I am putting myself and my baby at risk and am being selfish for wanting to do this.

Well, how much detail do I need to go into here really?  I have been secretly compiling information on home birth (as well as HBAC) for him to read, because the bottom line is he has not read anything and does not have significant information to back up his side of the argument.  Right now what I think would be fair is if this discussion is only brought back to the table once he has read the same amount of material as I have, for only then will he be allowed to have a say in this choice.  He is free to try and dig up as much anti-home birth information as he can find, but I think he will see that what I have researched is accurate and much more compelling. 

The stats and the research is there:  Planned home birth under expert midwife care is just as safe and maybe even safer than hospital birth.

My case was not helped by our first meeting with the midwife, who in her inexperience did not seem nearly as comfortable with an HBAC as I would like.  I made the mistake of having my husband at this appointment, and let's just say he was rather shaken by her lack of confidence in the matter.  This of course was very disappointing to me, because I know a more experienced midwife would have had a calmer manner and more accurate information and experience to share with us.

There are other factors as well that are making it hard for me to really express why this is so important to me.  Most of the time when asked why a woman wants a home birth, her response is so that she can avoid medical intervention.  In my VBAC hospital experience, we arrived and had no issues with doctors or medical staff trying to intervene.  It all went really well.  So my husband might argue that there is nothing to try and avoid, we can have the same birth at the hospital that we could have had at home.  On the other hand, we would be giving birth in an entirely different hospital this time around, so there is no guarantees that I wouldn't still fall prey to a cascade of intervention.  I will admit though, that this is not a concern of mine.  Already having had one fully natural VBAC, I would be confident enough to say that interference from the medical staff or unwanted suggestions of intervention is not one of my concerns.

Our midwife did make a very interesting point though and that is the hospital in this town (unlike the hospitals in the city where we had our other children) is only a class 3 hospital (or was it class 1? I can't remember the order they go in), meaning that obstetricians and anaesthesiologists are not always on the premises, rather they are on call.  So the time it would take to assemble the team in the event of an emergency would be about the same whether I was at home or in the hospital.  Of course my husband's argument to this would be that nevertheless, there would still be staff on hand to get the ball rolling, if let's say I needed blood asap or something along those lines.  I think what he fails to realize is that midwives are professionals equipped to deal with all sorts of emergencies, including hemorrhages, and they carry all the necessary equipment and medications in such an event.  He also fails to realize that incidents of maternal hemorrhaging are actually higher in hospital settings.  All information I plan on relaying to him, in good time.

And of course, there is the little factor of HBAC that I have to contend with.  Perhaps persuading him to go for a home birth would be easier if it weren't for that one little thing - having had a previous cesarean section does put me at a higher risk for complications.  This risk is really so minimal though, and I have information on the safety of VBAC to back it up as well.  Not to mention the fact that I have already had one VBAC already, which significantly increases my chances of another successful one. 

But putting all this information together to support my case is not as easy as it sounds.  I KNOW all this in my head already, I have read it, researched it, and fully believe it.  Getting it across to him is not so easy, as I don't have much of a way with words (or arguments) and really I just come off as a blubbering mess whenever the topic has been brought up.  Which is why it is important he reads it for himself.  Unfortunately he doesn't want to be an active participant in the pregnancy or birth planning process, which makes it hard (and also wants to make me say "Hey, if you don't care to be involved, you have NO say in this matter and I'm giving birth where I want to!").  He is not interested in reading any information or doing his own homework.  It is all up to me.  But don't worry, I have lots for him to read, I'm just waiting for the timing to be right.

We will be attending a home birth information session at the midwives practice in April.  The baby is due in July so there is still time to read and discuss further this matter.

So WHY do I want to give birth at home?  Well, my last birth happened so smoothly, that I look back and think, "Why didn't I just stay home?".  I mean, I could have.  I spent almost my entire labour by myself at home, and not even the slightest bit uncomfortable.  Why would I want to move on to a setting that might change the outcome?  Even while my hospital birth was a positive one, I still can't help but feel I'd be better off at home.  I remember when I got to the hospital, at 9cm and almost ready to push, there was just this feeling of being 'there', and wanting to get on with it.  All I could think was, "Get me on that bed and let me push this baby out".  It's like my mind switched over, and I just stayed there.  I pushed and gave birth on my back, resulting in horrible tearing.  It's almost like from the moment I got there, I gave up my 'natural birth' and succumbed to the 'get on your back and push' mentality.  I feel as though staying at home will help keep me focused, and help me want to stay upright and stay moving, and birth this baby without having to be cut or tear really badly. 

I would also like to consider the possibility of a water birth, something that is not an option in a hospital setting.  Again, maybe the feeling of the water will help me avoid giving in and giving up during that last gruelling stage, so that I can have a less traumatic and more peaceful birth.

And really, who wouldn't want to be in the comfort of their own home?  To avoid having to pack a bag that is usually overpacked because you didn't know what you'd need.  To not have to sit in a car while in the throes of labour, in pain as you go over every bump in the road.  To avoid arriving at the hospital, moaning in pain, and being wheeled to L&D while people watch.  To not have to check out and go home again.  To be able to get up and go take a shower in your own bath tub, and sleep in your own bed.  It's really too appealing to pass up.

He'll ask me "But what if something goes wrong, how could you live with yourself?".  Well, first of all you have to inform yourself and weigh the risks.  Birth is not without risk, where ever you are.  Heck, life is not without risk.  And if you do your homework, you will know the risks are there, but they're small, and the midwives are equipped to handle almost anything that could happen.  Of course I can't say that I'm 100% sure nothing would go wrong, but I am sure enough.

So as promised, before I go on any further with my own dribble, some information I dug up pertaining to home birth and VBAC/HBAC (I've included info that is strictly VBAC because it helps when deciding whether or not to go for HBAC).  This is essentially the same list of links I have saved to send my husband, when I am ready to bring it up again.  (I have more links to news articles about the studies on VBAC safety but have omitted them since I have included the link to the very study that all info in the articles refers too).

Midwifery Today - Home Birth After Cesarean
CMAJ Research on the Safety of Home Birth ***well documented and acknowledged Canadian study on the safety of home birth with midwives vs hospital birth with midwives vs hospital birth with doctors that provides accurate numbers supporting the safety of home birth***note: if you read the whole thing, it does state that once the VBAC subgroup was removed the outcomes were not significantly different
I'm sure this is just the tip of the ice berg.  I'm sure I could find even more compelling information to support home birth.  And I'm also sure than someone who is anti-home birth could find equally as much information supporting the dangers of home birth.  Such is how these things usually are.  Another fantastic resource that I have mentioned, and I will mention it time and time again, is Ina May's Guide to Childbirth.  Her statistics are undeniable proof that home birth under the proper care is safer than hospital birth.  And I would also recommend the documentary, The Business of Being Born (which I was able to get hubby to watch with me, so I'm hoping that has opened his eyes somewhat).

Now, as it is time to get the kiddos up from naps, that will be all from me today (didn't I think this was going to be a quickie just to post some links?).  Maybe someone else might find the information I've dug up helpful as well.

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