Wednesday, October 20, 2010

Homebirth Hypocrisy

As I was driving down the road today, I literally had to pull over to change my facebook status after being hit by something so obvious I just had to blurt it out.

After going through the past months with my grandpa, and as I have witnessed a few times in my life, I have come to realize something...

When a person chooses to remain at home to see an end to their days and die at home, they are not only allowed to do so, but are given assistance by a nursing service to maintain their dignity and privacy during this time. Hospice will send nurses or assistants to check in on the person and the family is even given a kit with various 'just in case' items, such as morphine, to ease the transition at the end if necessary. You're given a number to call, and at times a box with a button that will simply connect you directly to a skilled person who can assist you. Everyone speaks so kindly about you being at home, where it's 'comfortable' and you can be 'surrounded by loved ones'. Being put on hospice as opposed to being placed in a nursing home is viewed as a wonderful thing... no need for intervention.. this is a normal part of life.


When a woman announces her decision (whether to family, friends, or the entire free world) to have a home birth, she is instantly met with judgment, disapproval, criticism, and is instantly put on the defense. Even in a more 'accommodating' family/friend circle, she is confronted with 'concerns'.

Photo Courtesy of Jill C.; taken by Patience Salgado

Why is this?

Let's dissect it a bit. What are the 'concerns'? Why the disapproval?

"But, don't you need a doctor?!"
-A hospice patient is typically assisted by a caregiver (typically family members with no training) and has a nurse whose frequency of visits vary from daily to once a week (depending on the individual case). The nurse may work with the patient's regular physician, or hospice may take over those needs-- such as medication refills/prescription-- in lieu of the primary doctor.
Likewise, most mothers opting for a home birth are assisted by their family (spouse/partner, mother or sister, etc) and most opt to have a midwife present. They receive prenatal care from a midwife and sometimes an obstetrician as well.

"But what if something happens?!"
-If the moment of passing comes suddenly and a family member is the only one present, they are able to phone for assistance and will be given instructions for the interim. If the moment comes while a nurse is present, s/he would assist the patient and family member(s) during this time. This is where 'the box' comes into play-- it has items such as morphine which may be administered if necessary.
In a planned home birth, supplies have been gathered well in advance and the midwife typically has some medications on her person in the event they are needed. She will be trained in infant CPR and most importantly, will likely see the problem before it is one. Some midwives have hospital privileges and can have the mother transferred to a local hospital if necessary.

"But isn't it MESSY?!"
-Well, I'm not going too in depth with that aspect of hospice, but sphincters can/do release.
As for home births, it's no more messy than it is at the hospital, the only difference is that you aren't head down/feet up with nurses whisking away your 'used' chux pads. You are in whatever position is comfortable and this may mean that you actually *gasp* see the fluids that naturally come out with any birth regardless of the location. Though, just as things get tidied up by nurses while you're on a birthing table, the midwife or those who were your support will take care of the supplies while you bond with your amazing little one after the birth. And honestly, if blood/guts/& 'icky things' bother you, I'd suggest you take a moment to rethink children. Children are, by nature, icky little things... amazing.. but icky. They pick boogers, eat gum from under the restaurant table, and haven't met a surface that they can resist running their hands along. They fall and get scrapes and bleed-- well, you get my drift.

Does this look messy to you? It certainly isn't the bloody scene Hollywood wants you to expect...

Photo courtesy of Jill C.

Wouldn't you love to come into the world with your brothers waiting anxiously to meet you?

Grandma showing off the newest addition -- Courtesy of Jill C.; taken by Patience Salgado

I have had 3 hospital births, all with interventions of some sort. If I were to have the opportunity to do so, I would actively seek a home birth in the future.

Next week, I will be addressing the increase in state action that is threatening our ability to choose a home birth.

Not only should we have the option of a home birth, we should have peace of mind in the event that we do need assistance we can reach out to physicians without persecution.

Have you had a home birth? Have you had birthing experiences either in or out of a hospital setting which have influenced your preference?


Kacie said... [Reply to comment]

Hmm. I do see your point, but I don't think it's an equal parallel. Birth doesn't equal dying, you know? It's the opposite.

I'm pro-home birth for those who want them. I had a hospital birth with my son and I am having a birth center birth this time.

But, and please forgive me if this sounds rude...but if "something happens" to a hospice patient at home and they die, isn't that what is going to happen anyway?

I think more people probably have experience with hospice care than they do with homebirths. Homebirths seem to be pretty statistically low still. So maybe that's also why people are gasping at homebirths without an OB and anesthesiologist present and whatnot.

Amber said... [Reply to comment]

I have had 2 midwife-attended hospital births, which I was on the whole quite happy with. My first child was born unexpectedly at 34 weeks, so I had no choice of birth locations. With my second, I deliberately chose a small, quiet hospital, and I left within hours of birth.

But that's not really my point.

My point is that I have discussed the same issues with family members, who advocate strongly for end-of-life home care, but have concerns about homebirth. There are differences, I think, in that in hospice care there is not the same kind of urgency or drive to preserve life. But that's why most people who birth at home do so with qualified attendants, and under condition that they are within a certain distance of a hospital. And under these conditions, homebirth is proven safe and should be a viable and protected choice for mothers.

avocadogirl said... [Reply to comment]

Great post! Who isn't more comfortable at home? That's why my husband and I planned a homebirth. Originally we were planning on having it at the birth center, but two weeks before she came we decided to have it at home in our tiny apartment.

I labored for 20+ hours at home when our doctor made the call to head to the hospital. Baby's heartrate kept going down and my blood pressure was rising. I had to stop pushing as my husband drove us (our doc was in the back seat with me monitoring us) to the hospital. We arrived just after 8pm and our little one was born 21 minutes later without any interventions.

At home we were free to get in our own tub, take a shower, lay down on my sheets, throw up in my own toilet, and move wherever my body led me. Furthermore, my support team (husband, doctor, two attendants) were people I trusted to go through the process with. That special time laboring alone with my husband was one of the most beautiful and intimate experiences we've ever had. When we arrived at the hospital, and before I was allowed to begin pushing again, I was strapped up to all these devices, no one asked to touch me or assist me. Strangers shuffled me around and doctors flew in and out faster than I could track. My baby was taken away from me (she had meconium in her and the umbilical cord was wrapped around her neck twice), cleaned and bundled up before I could touch her. We left early the next day after a series of mishaps.

When I look back on the experience, I wouldn't do anything at home differently, but I nearly obsess about each part of the hospital that went wrong. If we have more children we'll plan to birth at home and if we end up at the hospital again, we'll know better what to do.

I would encourage families to consider homebirthing, it's a very special experience.

Little Miss Emmy Lou said... [Reply to comment]

I don't see them as the same.

If something happens when on hospice, that is okay, because they are preparing for death. There will be no heroic actions.

If something happens during a homebirth, there are 2 lives to be saved.

Annie @ Mama Dweeb said... [Reply to comment]

I agree with Kacie. There is still the fear of the unknown with homebirths. Since they happen so infrequently hardly anyone knows someone that has had one and therefore they don't know what to expect or what to think. I agree that homebirths are wonderful and I can't wait until the day they are just as common as hospital or birth center births.

atomic_poppy said... [Reply to comment]

Wonderful post. I understand the fear of "What if something happens?" but it is exceedingly rare for "something" life-threatening to happen with such urgency that a midwife (licensed, experienced, etc) cannot help medically before they are able to get to a hospital or have paramedics arrive. For me, personally, that is a tiny, minute risk that I am willing to take, and I would never presume to tell others that they shouldn't be allowed to do the same, if they choose. Homebirth isn't for everyone, but it should be available to everyone, if they desire.

Carla said... [Reply to comment]

There are some obvious differences - in hospice care death is, I won't say the goal, but it's accepted as the inevitable outcome. In birth, the goal is two living, healthy, happy people - mother and baby. I just happen to also think you have better chances getting that outcome (healthy and happy, not just "not dead") at home than in a hospital.

elise said... [Reply to comment]

Great post. And to answer the question, "What if something happens?"... well the mother nd baby are taken to the hospital... just like if anything bad happens in life.

Anonymous said... [Reply to comment]

I have had 9 children- 6 hospital- 3 unassisted at home. By unassisted, I mean just my husband and myself. I know that my body is made to birth babies- it is when we let the fear enter- usually from someone else's comments- that we begin to doubt that we can do it. We didn't need any help getting the baby in there- we sure didn't need any help when it was born. Birth is a part of life- NOT a medical event- only when the rich started demanding the physician be present- was he allowed into the realm of birth- before that it was "womens' domain" After the doctors stated attending births- that is when childbirth deaths rose- because they didn't know enough to wash their hands after attending to 'sick' people. This is well documented in history- check it out.

Claire said... [Reply to comment]

I think some of the respondants are missing the point, sick at home, healthy in the hospital, how else would you have it?

Gauri said... [Reply to comment]

Money and fear - that is what it all comes down to, imo. I was pregnant and preparing for my homebirth (that did not come to pass - long story) while volunteering at a hospice. The parallels are uncanny, I agree, to the point that there is a movement of hospice caregivers calling themselves death-doulas (eg: But as others have pointed out above the worse case scenarios are generally easy for doctors to shrug off and take no responsibility for - families will not sue for letting them have a 'home death'. Really the worse that can happen is under-medication where the patient is suffering without being able to communicate it. Sad. That or accidentally speeding up death.

At home birth there is more at stake - a life of a young baby (and its mother). The family could get very angry and come after somebody in the medical establishement for 'letting' this happen. Hey, I am not saying I agree, I just think we live in a very sue-scared society. And generally people are just ruled by fear and let their fear that something will happen to an innocent little baby outweight their feelings of loving receiving a new being in a home, surrounded by love.

Good food for thought, though. Thanks!

Olivia said... [Reply to comment]

Thanks for your post! As someone who had two homebirths, one attended by a midwife and one unassisted homebirth, I obviously feel that it is the right of the woman giving birth to decide her birth location. But I do agree with previous commenters that I see a big difference between birth and hospice care. Indeed, the worst that could "happen" is dying at home, which the goal was in the first place.

It also does that, as soon as a woman is pregnant, people feel she is not able or allowed to make her own decisions any more. Why does society at large feel that other people (OBs for example) are more capable of making decisions about a baby than the mother herself? I totally agree that women should be able to reach out to medical professionals to seek the care they need, when they need it, without fear of prosecution or bad treatment.


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