Urban Mamas

I've desired a home birth from afar since I was pregnant with my second son, Truman. There was no way I was going to convince anyone of that after I suffered a partial placental abruption in week 23, especially as an attempted VBAC, and sure enough, I ended up with a cesarean, taking home births (at least in my husband's opinion) forever off the table. (Monroe, my third, was a VBAC in the hospital.)

flickr / eyeliam

Whether or not I have another baby and try to convince the interested parties in the sensibility of such a birth, I'm still head over heels in love. I've had several friends who birthed at home; my neighbor did, and so did a friend whose basement birthing room (next to the laundry machine) I ooh-ed and ahh-ed over, wishing. Home births are on the rise in the U.S., up 20% between 2004 and 2008, and not just because of the romance or (as I heard someone say on the radio) the "feminist machoism" -- there are a lot of us without insurance, and home births are just far cheaper. A midwife's services for a home birth are usually around $2,500 to $3,000 for the whole pregnancy and delivery; we all know that hospital births, without private insurance, can top $12,000 for a simple dilate-and-push procedure.

Today on Here & Now, I listened to a midwife whose statistics gave me a thrill. Detractors bring up the scary what-if scenarios, but according to these numbers, of 100 home births 88 were successfully accomplished at home, with 12 going to the hospital; and nine of these only requiring very minor medical intervention once they arrived, with only three of 100 being emergencies. This sounds extremely safe to me; I doubt the statistics of in-hospital births could compare to such a low intervention rate.

I know we have a lot of home birthers here in Portland; does anyone know if there have been statistics kept on such things here? If you've wanted a home birth, how did it go -- both the negotiations and the actual birth?

An urbanMama recently emailed:

I'm having my second child in December at Providence Portland. My OB/GYN recommended I sign up for the hospital's childbirth preparation classes. It turns out these classes run eight hours, which feels like overkill for a second birth. We did Hypnobirthing with my first child and won't be doing that again. So, I have two related questions. First, does anyone have a recommendation for a general refresher course? Second, do other moms really go through childbirth preparation classes the second time?

We delivered a little guy about three weeks ago at Legacy Emanuel Hospital.  The one night we spent at the hospital, we spent in our room along with our two other children to allow our new family of five to begin to get to know one another.  A couple of nights later, another friend of ours delivered their second child at Legacy's Good Samaritan Hospistal.  They, too, spent the night at the hospital as their new family of four.

When visiting together earlier today, my mama friend reported to me that Legacy would have a new rule in effect: no children under 18 may be visitors in the family birth centers because school-aged children have higher rates of exposure to the flu.  In addition, only two immediate family members or support persons could be present at the birth and during the mom's stay.

Apparently, Legacy isn't the only one.  The Providence Health System is also instituting the same policy at all of its establishments, effective October 9, 2009.  An urbanMama recently emailed:

I am heartbroken!
 
I'm due to give birth on October 26th with baby boy #2 at St. Vincent.  I've been so looking forward to my 3 year old son getting to meet his brother for the first time at the hospital.  For the entire 9 months, I've had this vision in my head of my husband bringing my son into the room and being able to show him his brother for the first time.  I want "that picture" of big brother holding little brother at the hospital, like almost every other mother in America has.  Now, because of concerns over the Swine Flu that will not happen.  I'm just sick with disappointment.
 
Don't get me wrong, I don't want to put anyone at risk and I think it important that everyone is kept healthy, especially in the hospital environment.  But I wonder if there is a place on the maternity ward floor where babies could meet their siblings?  I've already called St. Vincent to ask, but so far there is nothing.  I will call and talk with the head nurse on Monday.
 
Are there any other urbanMamas struggling with this new "visitation restriction" policy.  I understand that every hospital in the metro area has adopted it including OHSU.  I would love to hear what others have to say.

In case this topic interests you, OPB's Think Out Loud show on Thursday 5.7.09 is about birth choices.  Here's how they describe the show:

Oregon State University says a new study describes a "pattern of distrust" in the relationship between hospital physicians and midwives who transport their patients to hospitals due to complications during homebirths.

The study (led by OSU assistant professor and midwife Melissa Cheyney) looked at birth records in Oregon's Jackson County from 1998 through 2003 to determine whether a correlation existed between poor health outcomes and homebirths.

While the study didn't find a link between the two factors it did reveal ongoing conflicts between doctors and midwives with physicians asserting that only hospital births were safe. This finding is in line with a 2008 American Medical Association resolution (pdf), which stated:

"The safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex."

Listen up! Call in!  Speak Up! Or join the conversation on the show's active blog.  It's on from 9 to 10 am, then is re-aired again at 9 pm the same night.  And of course podcasted forever.  

If you listened, did you like the show? 

[Photo courtesy of cafemama]

Do you have some recommendations for obstetricians, birthing centers, or hospitals for a twin delivery?  An urbanMama emails:

We recently received an email from a mama, new to Portland, who has a specific request for her natural hospital childbirth experience:

I am looking for a Midwife that delivers in Hospitals that does not require the Glucola drinking for the glucose tolerance test. I am hoping to find one that is open to using the jelly beans or a specific meal instead. I know there are great birth center and homebirth Midwives that do this, but I was hoping someone might be able to reccommend a Hospital Midwife that does also. After 3 horrible experiences with the Glucola, I am hoping to avoid it this time.

Grace is planning a home birth, but would like to rent a birthing tub.  Interesting question, can you help?  She emails:

I was wondering if there is any place in Portland that rents birth tubs for a home birth? I have only heard waterbirth.org but I'm curious if there is a place local so I could avoid paying such a high shipping & handling cost.

After my successful VBAC, Rebecca wondered if Pitocin could possibly be a cause of our country's high c-section rate. That got me thinking, and as I'm doing research for a book I'm pitching on pregnancy, last night I came across two really interesting recent books: Pushed: The Painful Truth about Childbirth and Modern Maternity Care and Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First. Amazon had several pages from Pushed in its little 'inside-the-book' feature and I was struck when reading about one hospital in Florida whose power went out during Hurricane Charley.

The labor & delivery ward changed its policies and cancelled all inductions. Mothers were sent home unless they were in active labor. No one got Pitocin, no one's water was broken, and epidurals were contraindicated. Their c-section rate went down to almost zero, and even first-time mothers had quick and relatively easy labors. What's more (here's a shocker, haha), the births were evenly distributed between day and night, weekday and weekend (did you know that more births happen on Tuesdays than any other day in the U.S.?). Even fetal distress and interventions after birth dropped to almost nothing.

Essentially, the lesson seems to be that induction is the enemy of a relatively easy birth, and what's more: a healthy baby. Most of the nurses who worked the Hurricane Charley shifts at that Florida hospital have quit and a few are campaigning for changes in the 'induction culture' of birth in the U.S. While it's certainly not true that Pitocin causes c-sections, it could be a major contributor to our unusually high c-section rate. It's anecdotally true for me: I had a bunch of Pitocin in each of my two c-sections, but none in my vaginal birth. I'll continue to do research because it interests me (and Rebecca, let me know what you find) -- but in the meantime, I'd love to hear your stories.

Martha needs tips on adjusting her child to the arrival of a new sibling:

I have a delightful little girl who will be two in August and am expecting another child on her birthday. We've done a bit of talking/reading about new babies, but I'm not sure how much she really gets. She has been rather whiny and emotional of late and I'm not sure how much is being a toddler and how much is knowing that something is going on. Any tips for how I can help her adjust to the new screaming addition we are about to welcome into our lives??

Betsy has a question for any mamas who've had VBACs and preparing for the big day:

I'd be interested to know what other second-time (and beyond!) mamas did with regard to childbirth prep the second time around. I'm trying for a VBAC, in-hospital birth with an OB/GYN, but due to the "C" in VBAC, I didn't get a chance to actually use most of the stuff we learned the first time around, so I can't really say I've been through labor and delivery, yet I have. I'd especially like to hear from VBAC mamas. Any advice on prepping for the big day?

I was snuggling 3 and half month old Jack this morning and thinking about the wild day that was his "birth" day. I love birth stories because they are the powerful end of one story and the beginning of another.  Although, I am moved daily in extreme ways by our kids (some wonderful and some frustrating), I find that there are very few moments in life that pack as much love, pain, drama, anticipation, joy, fear than giving birth.  So, in the spirit of sharing, I thought I would share Jack's story as told by my husband (this was an email we sent out to friends and fam after Jack was born - it's a bit long, but most people enjoyed it)...