Saturday, November 15, 2008

Baby, You're Home--Great Article on Home Birth in the NYT

There's a long detailed article on home birth in the New York Times "Home and Garden" section. It's really inspiring. We say to all expectant couples -- consider a home birth. They are on the rise, even in New York City, and the people who are having them are onto something: birth doesn't need to be a medicalized and invasive experience.

Even if you have your baby in the hospital, try to stay home as long as you can. Don't go in until your wife literally feels that she cannot bear the pain one more second. That way, they'll be kind and attentive to you in the hospital and they won't try to hurry the labor along.

We have a friend who called her midwife and said her water broke. Her midwife said, "rent two movies, and watch them all the way through, then call me back and we'll see if you're ready to come to the hospital." They did. The laboring wife doesn't remember anything about the movies, but she was so far along when she got to the hospital that she was treated like royalty.

If you want to read more about home birth, here's an article about home birth in western Massachusetts by Jennifer Margulis, first published in Valley Kids:
Pregnant? Consider Having Your Baby at Home

Special to Valley Kids

GREENFIELD — When Florence-resident Kirsten Kowalski-Lane got pregnant with her second child, she decided she wanted to try having a home birth. Her son, William, was born in Cooley-Dickinson Hospital, which is down the street from her house. Her son’s birth went well. “The midwives were lovely,” Kowalski-Lane, who is the Director of the Parenting Center in Northampton—a drop-in center that offers support for children of parents ages 0-5—remembers, “Everything was very normal.”

But, despite the fact that she had no complaints about the hospital or her birth attendants, Kowalski-Lane knew that she wanted to do things differently the second time. “I realized how much of the birth I was in control of,” she explains, “I could have had him anywhere.” This realization, that birth was a normal, natural process that needed no drastic medical intervention, encouraged Kowalski-Lane to consider alternative s to a conventional hospital birth. In addition, she did not like the hit or miss way it was the midwife or doctor on call at the hospital who would deliver her baby. “I wanted to have a different kind of relationship with the person or people who delivered my child,” she continues, “a closer relationship.”

Convincing her husband Jon Lane and her family was not as easy. “It was a good month that Jon needed to think about it,” says Kowalski-Lane, whose baby, Grace Margaret Anne Lane, was born at home on May 17th, 2002. The couple met twice with the River Valley Midwives, a group of home birth midwives that has been delivering babies in the Valley since the late 1970s. Although they initially hid the fact that they had decided to have a home birth from Jon’s family (and from Kirsten’s older sister who is a doctor), Jon’s grandmother was thrilled when she found out her great grand child was born at home. “She told us that she was born at home, and she turned out just fine,” explains Kowalski-Lane. “Now Jon is very proud that we did this. He tells everyone!”

Like Kirsten Kowalski-Lane, many Valley women are deciding to have their babies at home. According to Terri Nash, the River Valley midwife who caught Grace, there are 6 home birth midwives in active practice and approximately 50 babies born at home here in the Valley each year. In Massachusetts 1-2% of all babies born, approximately 800 babies in total, are born at home.

“The number one reason that we get is that it feels right to women,” explains Nash who is a Certified Professional Midwife, or CPM. “It is natural. Women do not menstruate or procreate in the hospital...Why should they have their baby there?”

Home birth midwives, Nash explains, work closely with area hospitals. They exercise great caution and, if anything goes wrong during labor, they accompany their clients to the hospital and stay with them, as their advocates, during the birth. But, although they have a “cooperative relationship with...local nurse midwives and hospitals,” according to Nash, home birth midwives do things differently from obstetric nurses, midwives, and doctors. Prenatal visits are an hour long, some take place in the client’s own home, parents have access to a lending library of books and videos about birth, and the midwives come as soon as the mother starts labor or feels the need to have them there. They stay with the new mother and baby for 3-4 hours after the birth, and they follow up with postpartum visits at the client’s home 1 day and 2 days later and office check-ups 1 week , 3 weeks, and 6 weeks later.

“They lead you through the process,” reiterates Kowalski-Lane, who was impressed by how the River Valley Midwives took their time with her and treated her with interest and respect. “Even though I had already had a baby, I appreciated it. You don’t feel like part of a factory.”

The first time Kowalski-Lane met Terri Nash and Jharna Harvey-Amai, she sensed their approach was different. “I felt so good in their presence,” remembers Kowalski-Lane , “I wasn’t even under their care but I felt cared for.”

During her pre-natal visits the connection Kowalski-Lane felt with her midwives deepened, “They were really interested in who I am. They wanted to really get to know me,” says Kowalski-Lane who remembers one time when she arrived to an appointment late and stressed out. “My blood pressure was high,” she says, “I had been rushing around.” Nash invited her to sit down, made her a cup of tea, and gave her a head and neck massage. When her blood pressure was measured again it was back within normal levels.

Even some Valley health care providers are themselves choosing to have their babies at home. “Up to a third of the people who come to are practice are health care professionals,” says Nash, who remembers one birth that was progressing slowly. The father, a doctor, and the mother, a nurse practitioner, had been laboring for several hours. When Nash checked she realized that the baby’s head was asynclinic, or tilted, and that the position of the head was obstructing labor. She instructed the mother to walk up and down the stairs, which she did, with her husband by her side. The head resolved and the labor progressed quickly after that.

Nash remembers the husband’s surprise that the difficulty could be resolved so easily with so little intervention: “He said, ‘oh my god! Why didn’t I learn this in medical school?!’”

Other techniques that home birth midwives use to avoid medical intervention work just as well. If a woman is 14 days past her due date American doctors will induce labor using potentially harmful drugs or hormones, like pitocin, to get labor started. The River Valley Midwives use a different technique. “We have had 98% success with a combination of herbs and acupuncture,” says Nash, who explains that the first-time mother will go into labor, on average, ten days past her due date, a fact that means that she only has a four-day window before medical procedures are recommended. Instead of sending a client to the hospital, River Valley Midwives refers their clients to local acupuncturists to get labor started. One acupucturist, Amy Mager, has five children, four of whom were born at home. “If those [the herbs and the acupuncture] do not work, then we kick in with castor oil...and we have had a 100% success rate,” says Nash.

The cost of a home birth? Less than half of a typical hospital birth. “More and more insurance companies are covering home births,” says Nash, “because they are realizing how much cheaper it is.” River Valley Midwives charges a universal fee of $2,800 which, if paid by 36 weeks, is reduced to $2,300, and they are willing to make private arrangements with clients who have financial difficulties. A conventional hospital birth costs about $5,000, often more, depending on the interventions.

“I'm saddened by the stories of women who had hospital births and have negative feelings about their birth experience,” says Kirsten Kowalski-Lane. “My advice to women in general is to realize that birth is normal and safe. It's your experience, make it what you want it to be. Home birth is the optimal, it's how we should be treated.”

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