Monday, August 31, 2009

Long Ass Rant: Homebirth and Quiverfull

For all that I'd just as soon leave the home birth itself out of the discussion, there's no getting around it. In the past year and a half I've come to see my grandmother as a cult leader. What I would like to forget is that she was a homebirth cult leader, and so I think I should clarify my position (as it stands today) here. First, yes - birth is a "miracle". It's also a) gross and b) common. It's a miracle that happens all day every day, and is really only significant to the people involved and their loved ones. (Sorry, I think my kid's special too, but let's not use the word "miracle" lightly, shall we?)

I had these concepts figured out at an early age, because I had such a high exposure to birth - much more than most people. I have to think that the average person really only attends so many births in their life - their own, their children, possibly grandchildren or the children of a very close friend or sibling. I saw strangers give birth, women who I hadn't met till they were already in the active stages of their labor. Birth feels exceptional, because it is really freaking cool to see a new person (or kitten or puppy) come out into the world for the first time ever. But babies somewhere have been born in the time I've been writing this post. (And the time between writing this and posting it. And between when I posted it and you read it.) So I think de-mythologyzing birth might be helpful.

Pregnancy is a medical condition. Stop going on about your "wonderfully made" natural body, okay? God didn't knit your womb together and it might have problems (especially if the other women in your family did).

Obviously a certain level of infant mortality at home and in hospitals is going to happen, especially in cases where a woman chose not to abort a fetus showing signs of developmental problems (which is, and should be, her right) or the child is born preterm (between 24 and 34 weeks gestation). But is home birth just as safe as hospital birth? Well, in large part that can be measured by how closely the homebirth resembles a hospital birth. If the mother receives proper prenatal, ultrasounds, tests for protein in the urine, rh-negative blood type, and every other thing imaginable that they can get from a little blood and urine.

It was at one of these prenatal visits that I found out I'm a carrier for cystic fiborsis (a very not-fun genetic disorder). Because I found out before my son was born, I was able to get my ex-husband's blood tested also, to see what our chances were of having a seriously sick child from Day One. He came back negative, so my son is fine. He might be a carrier like I am - I'll recommend he gets tested before knocking anybody up. The point is, if Little Man had been sick, the prenatal exams would have helped me find out and prepare in advance. In the three days that I waited for the lab results to come back, I learned a lot about CF. If Little Man had been born with that condition, I could have prepared.

Another measure of birth safety is the availability of proper medical equipment. If your midwife doesn't know how to stitch a perinea l tear, you might be SOL. In my personal hierarchy of "awesome" to "deadly" births, I'd rank things thusly:
  1. Hospital birth following extensive prenatal care
  2. Birthing center birth following extensive prenatal care
  3. Hospital birth without extensive prenatal care
  4. At-home birth with medically trained professionals*, following extensive prenatal care
  5. At-home midwife birth without extensive prenatal care
  6. Unassisted childbirth following extensive prenatal care
  7. Unassisted childbirth without extensive prenatal care
*One important note - Your doula is not a midwife. She is a cheerleader, not a medical professional. You can have her there if you want her, by all means, but don't stop at a doula.

The safest birth you can have starts one year before the woman is even pregnant, when she's eating right, sleeping right, and not smoking cigarettes. Then she gets pregnant, and is able to provide good nutrition during pregnancy. The woman in her family have fairly uncomplicated pregnancies and labors. She learns she is pregnant often, goes to all of her prenatal exams, and attends birth and parenting classes with her partner. She suffers few of the side effects most pregnant woman experience, from morning sickness to pre-eclampsia, and continues to exercise and eat well (but more). She writes up a birth plan and discusses with her doctor when certain medical interventions may be used, well in advance of her due date. She goes to the hospital during early labor, and spends active labor and delivery there. She is surrounded by trained medical professionals and top-of-the-line life saving equipment. The baby is born, cleaned, examined for health, and given to the new mommy to hold and nurse.

The closest you can get your birth experience to that one, the fewest complications you'll have.

Now, does someone wanna please fix the Wikipedia article on Home Birth? I can't personally stomach it, but the thing is so damn biased. I'm sorry but the freebirthers are no better than the anti-vax crowd, and they need to have a damn bright spotlight shone on them. I say this with several family members who have chosen unassisted homebirth over the years, including within the last decade. I say this with several family members - both mothers and their children - were in mortal danger or at least appeared to be for some time during their labors. Three of the babies were born in meconium (fetal poop), and since they weren't born in a hospital, nothing was done to expel any meconium the babies may have swallowed in the womb. (Meconium is much more likely to be an issue in a pregnancy that extends past 40 weeks gestation. While I'm not a fan of elective cessarians, most women undergoing prenatal care with the supervision of a licensed OB/GYN will not have this particular threat to their babies' health. At a certain point, around 41 weeks usually, the doctor will recommend inducing labor chemically, using Pitocin.)

These were also days-long labors that had a serious toll on the mothers. My own labor with Little Man was 98 hours (4 days) and I can't even put into words how tired I was, and how unable to care for an infant. I really needed the two days after that I got to spend in the hospital, pushing my Magic Button and saying, "I'd like an apple juice and a Percocet, and can someone change my baby's diaper?" I think every mom deserves that (hell, I think it should've been a week but that time is long gone now). When women birth at home, they don't get the same level of aftercare. The most devoted husband in the world can't compare with a round-the-clock staff of nurses and doctors, as well as a nursery to care for the baby between feedings. Out of the desire for a comfortable birth experience, they have what is, in my opinion, a much less comfortable recovery. (Percocet is seriously great stuff if you've just gone through the trauma and the horror that is live birth.)

So in a nutshell, I think hospital births are safer, for mothers and infants. I think if your mother had a rough labor, you should seriously consider (read: DO) giving birth in a hospital. And if your wife, girlfriend, sister starts telling you that her body was "designed for birth" and that labor and delivery are "totally natural" and that she wants to "trust her body" - tell her to get her ass to a hospital. Or at least to some good skeptical resources.

Like these:

From the CDC - Notes on the Indiana Pre and Peri-natal Mortality

Kathryn Joyce wrote a book on the subject of my grandma's kind of people "Quiverfull: Inside the Christian Patriarchy Movement"

Here's a podcast she did on Brazilian Waxes, Condom Lies, and Quiverfull.

From Newsweek - Extreme Motherhood by Katheryn Joyce.
or you can read a commentary on this article at End Hereditary Religion.

The comments alone make this Feministing post worth checking out.

I highly recomend you read the blog No Longer Qivering (there's no "you" in quivering") especially this post.