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COPYRIGHT 2002 Mothering Magazine
When I tell people I had a VBAC (vaginal Birth after cesarean) and did it at home, they're often incredulous. "Is that safe?" they ask. "Did they know you'd had a cesarean before?" Perhaps in their minds they ask other questions: "What kind of quack let you do that?" "Are you crazy?"
The truth is that many women have had home VBACs. And, although some people believe that we sacrificed safety to have our babies at home, nothing could be further from the truth. In fact, I believe that being at home actually made my VBAC safer.
Five years ago I experienced a classic interventionist birth under the care of a highly respected obstetrician at one of the best hospitals in town, boasting state-of-the-art technology and rooms. As someone who appreciates doctors and their commitment to serving the public, I was confused by the way my labor was handled. No sooner was I admitted to the hospital than I was given a hospital gown, enema, catheter, IV, and internal monitor. To my surprise I was not allowed to eat or drink, and I received frequent internal exams to check my progress. Most of these interventions were administered as a matter of routine within 30 minutes of my arrival. Soon I received an epidural. Though I had written a birth plan, it was ignored ("The doctor's not even going to read that," one of the nurses said.) in favor of standard operating procedure. The hospital norm reigned supreme; resistance was futile.
Thoroughly undignified I lay in my room connected by tubes and wires to various machines, the television blaring Wheel of Fortune, while anyone who wanted to came in and out, including hospital personnel and acquaintances of mine who had heard that I was in labor. Various staff members performed internal exams throughout the day. When I was pain, they turned up my epidural, even though these are known to cause a number of side effects, including an increased incidence of cesarean section.
Indeed, I did end up having a cesarean, although the record Notes no sign of distress or infection in either fetus or mother. The obstetrician's report indicates that my labor was augmented With Pitocin due to "prolonged labor." And cesarean section was performed due to "failure to progress." In fact, the same report indicates that I was in the hospital for fewer than 12 hours and in labor for fewer than 16--not prolonged labor by any accepted definition.
After the birth, my healthy baby was bathed, weighed, held over my head for a moment's viewing while I was stitched, and then carried off to the nursery. There, I later learned, he cried all night and was given two bottles of formula, though I had indicated to staff members that I planned to practice only breastfeeding, while I slept in my room under the influence of intravenous sleep medication I had received without my knowledge. My baby was brought to me in the morning when I "came to."
I was left with a fever, exhaustion, and breastfeeding difficulties that resulted in severe engorgement for myself and jaundice for my son. I spent the next few months recovering from major surgery, and I ultimately suffered postpartum depression--certainly not the idyllic, safe birth I had hoped for. And to add insult to injury, I later discovered that the cesarean and other interventions were very likely unnecessary.
Although not everyone who births in a hospital suffers these extreme circumstances, they are not uncommon. Since my son's birth I have seen the same scenario happen to other women who, like me, obtained the care of respected obstetricians and hospitals, expecting this to increase the safety of the births. My obstetrician was certainly a competent surgeon, and his savvy in selecting a low-transverse (low horizontal) incision allowed me to safely choose a VBAC years later. But I didn't need a surgeon or a hospital; I just needed support in birthing a baby.
A few years later I happily found myself pregnant again. Not wanting a repeat of my first birth experience, I combed the library and the Web for all available information. My research was eye opening, to say the least. I found numerous studies in the medical literature showing that planned homebirth attended by a skilled midwife is as safe or safer than hospital birth, and not a scrap of sound evidence to the contrary.
Research statistician Marjorie Tew, for example, compiled a large amount of evidence regarding the safety of homebirth, expecting to prove that it was unsafe. Instead, she found that prenatal mortality was lower for out-of-hospital births, and for every level of risk but one ("very high risk") the...
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