Ah the Roulette… Doctor? Midwife? Birthing Center?

Now that we’ve had four babies in a row, people sometimes ask me: where should I go to have my new baby? Doctor, midwife, birthing center? Or should I have a home birth?

Home birthing is a big deal in the conservative Christian camp. Perhaps because mothers understandably want to stay away from the hustle and bustle of hospitals. And I don’t have a problem with this, per se. But not just anyone should choose home birthing, especially if this is their first child. You just don’t know whether or not you’re going to have a problem that requires more medical attention than is possible in your own four walls. I know a million people who would comment and say I’m wrong, and that’s fine. But home-birthing (attended by a doctor, midwife, etc.) is the riskiest option for childbirth. If you are willing to take the risk, to obtain the philosophical and psychological benefits, that’s fine as long as you know that’s what you are doing.

Next on the list of self-management options comes the birthing center. I had a friend use one here in Boston for her last child. If her experience is representative, it is basically a nice option if you know you have low-risk pregnancies and easy (natural) childbirths. Of course, this is a silly statement since no-one knows IN ADVANCE of having their baby that it will be that way. But my friend had a previous experience where she absolutely cherished her pregnancy and natural childbirth, so she was looking for a non-interventive approach, in faith, for her next baby.

The birthing center was nice because there was a bunch of midwives and doulas who were totally supportive of the way she wanted to birth, which included natural methods, relaxation techniques (including balls, baths, massage, etc), and water birth. The atmosphere was familial, relaxed, with no shots and tests, tags and gowns, lights and brights, etc. Family was welcome and breastfeeding was supported. All the kinds of benefits she wanted from a more natural approach to childbirth were available.

The one thing that was not, was time. Most birthing centers are small and so they have short schedules–moving women in and out is their prerogative. My friend was told to go home when she was found not dilated enough, even though she insisted that she knew she was going to dilate fast. After some arguing, they allowed her to loiter in the lobby, unmonitored, where she progressed to nine centimeters just like she said, within a half hour or so. Somewhat apologetically, they got her in and delivered the baby perfectly soundly, except that the water birth thing didn’t work out the way she wanted because the baby was having some initial breathing problems. That experience over and everything returning to normal, she was out with her baby in six hours. Barely a clean up and new sheets, and she was gone.

I can’t believe this. So many women like it, but I can’t imagine being sent home (especially with other children and toddlers around) in just six hours. I would need at least twelve. And if for some reason there had been a medical emergency in the middle of my labor or delivery, I can’t imagine trying to hold on until I was rushed and transferred into the nearby hospital. When you’re in that much pain and the process is so delicate, it would possibly be one of the worst (or scariest) experiences of my life.

But, like I said, so many people like it. And want to be home… even in the hubbub!… asap. I don’t blame them. Very few people LIKE hospitals. So if you are a naturopath, this is probably a good option for you.

I preferred the midwife option. There are different set-ups across the country, so you have to check out what the labor/delivery path is, but many hospitals have a midwifery associated with them and will take care of you if you have a low risk pregnancy. They may even take care of you if you have a high-risk pregnancy since doctors are associated with them at the top of the hierarchy. I liked the midwives because they were very maternal, hands-off, and supportive of the whole pregnancy/childbirth process. But they are more flexible and safer should there be a change of plans… i.e. you decide you want an epidural or induction, a Caesarean need arises, whatever. They are also equipped to deal with special counsel and will oversee you more closely if you have personal preferences concerning procedures, testing, diet, vitamins, medicine, etc. They will perform the run-of-the-mill tests for your safety (including PAP smears, diabetes, streptococcus). But they will forego sometimes normative but optional things like genetic testing, amniocentesis, extra ultrasounds, inductions, cervical checks, etc., at your request. My midwifery even let me weigh myself, do my own urine test, and handle my own chart each week when I came in. Yay!

For me, the midwifery was the perfect blend of natural and medical care. I gave birth in a hospital. The midwives coached me through the whole process as naturally as possible and delivered my babies, conducted my immediate postpartum routine which included small stitchings. I stayed one and a half days for my last three births, and the hospital nurses largely took over after delivery (although the midwife did check in a day later). I got all the standard stuff done to my babies after they were born (circumcisions, hepatitis vaccines, apgar testing, baths, etc.) And I didn’t like staying overnight much because it was annoying to be interrupted for vital signs and whatnot. But, the nurses were extremely helpful after I was bleeding a lot, and took care of me and my baby when I was exhausted. They were bright, cheerful, and supportive of my desire to breastfeed immediately and often. There was a lactation consultant on staff. The doctor on staff in the nursery caught my fourth baby’s heart murmur when it was very slight. They caught my third baby’s slight jaundice which only showed up on the second day. The nurses took care of me after my first baby when, after a totally normal pregnancy, I contracted Toxemia during the labor and needed to stay in the hospital for a week to get better. And they left me alone during my second baby when he came very naturally and the midwife just wanted to coach me through pushing him. Quiet, serene, totally wonderful.

Not all ladies have this experience, and for those who are mildly concerned about their bodies’ performance in pregnancy or labor for medical reasons, I would recommend the doctoral route. It’s formal and a little more matter-of-fact (read: cold), but it’s very safe. I had a doctor with my first baby, and he was actually a fetal surgeon too, should they have found anything strange during the pregnancy (which can often be fixed these days in utero). That was impressive! I didn’t get many choices concerning tests or how I wanted to conduct my pregnancy or labor (i.e. I had to get induced when I hit my fourteenth day overdue, I got prescription vitamins…), and I honestly didn’t get many of my questions answered (which I had since it was my first pregnancy), but it wasn’t so bad. The doctor just came in at the end of the birth and scooped out the baby. And I turned to the favorite literature–“What to Expect When You’re Expecting”–or the Internet when I had questions.

The main thing I tell new moms who have asked me so far, is to pick the option that you personally feel most comfortable with. Do what your conscience feels good about. If you pick an option because your friend had it and liked it, or because you think you “should” do it, you may feel insecure if things don’t go perfectly. You may even resent your pregnancy or your baby if you had a hard time, and that is what you want to avoid at ALL costs. I firmly believe that sort of thing, coupled with the totally hormonal screw-up of childbirth, accounts for many cases of post-partum depression. If you want to go to a doctor, do it. If you want a home birth, do that. But don’t do anything out of coercion. Do what you feel comfortable with. It will make all the difference when it comes to cherishing your pregnancy and bonding with your baby.

And that goes for breast-feeding or whatever other childbirth options come up after you have your baby. I don’t care whether your mother-in-law was the president of the La Leche League and is going to disown you if you decide to formula-feed, you choose what is going to help you love your baby more. And let your husband be part of the decision-making process, but don’t let him make the decision for you (because he isn’t going to be the one doing most of the work or allowing a little scrunchy newborn to suck on his chest for six hours a day!). Research the options, gather all the information, talk to friends and trusted advisers, and make an informed decision.

And don’t be ashamed to change your mind if you start going down one path and it isn’t what you thought it would be. Change your doctor, change your birthing center, or change to bottle-feed. Your ideals may be damaged, but your relationship with your new precious one will blossom!


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