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Oh Where, Oh Where Shall I Birth Our Babies?

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Tuesday, April 01, 2008

I have never wished harder for the ability to see into the future in all my life. Or yearned more for some sort of guarantee... good or bad. "You will have no complications whatsoever and your babies will be absolutely healthy; go for the home birth," or "There will be trouble; birth in the hospital." Really, either one would be completely fine with me. I just wish there were some way to know, without a doubt, that I am 100% making the right decision either way. Alas, life doesn't come with guarantees.

Why am I considering a home birth? You can read the back-story here, in my personal blog (warning: it's my personal blog, so sometimes I use bad words). The short version is, because there are two in there, I'm automatically "high risk." The fact that I've had three completely healthy, normal, uncomplicated births doesn't figure into the equation. I'm high risk, and therefore there are a whole lot of interventions that are going to be recommended (I use that word lightly) the second I set foot in the hospital.

Quite a few things have happened since I made that post...

First, Lee and I met with Kathy Mitchell, the midwife that was recommended to us by several people. One friend described her perfectly: "She's not crunchy-granola, she's sort of motherly, the kind of person you wish was your mom." That's exactly how I felt as we talked with her. She was very reassuring, and given my health, history, and the fact that both babies are currently head-down, she didn't see any reason that we couldn't try for a home birth. We left feeling really good. Even Lee liked her, and that's saying a lot!

Next up, we had our consultation with the midwives at CHOICE. Lee was supposed to go with me, but Levi altered his nap schedule that day, so we opted for me going on my own, rather than contend with a very crabby boy for the entire appointment. I met with Abby and Kelly, and I adored them both. Abby is older, and very similar to Kathy. I guessed Kelly to be around my age, but she's been practicing since 1987, so she has to be at least a little older. Overall, they were both incredibly realistic. While genuinely supportive of birthing these babies at home, they also carefully outlined the possible risks associated with twins, and how the various scenarios would be handled. At one point Abby said, "I want you to understand that we are NOT 'home birth or bust.' There are times when being in the hospital is the safest option." I found that perspective to be very comforting. While I absolutely believe in my body's ability to birth twins, the bottom line is that there is more potential for risk than with a singleton. If we go with home birth, I would prefer the attendant(s) err on the side of caution. Abby and Kelly felt like a perfect fit. Before I left, I set up the next appointment, where they will do my full history. Lee will come with me to that one, so that he has a chance to get to know them as well.

Finally, I had my appointment with Dr. Jenkins yesterday. Lee was with me, which I think was really good, as we presented a united front. The discussion went... as well as it could, I suppose. I think I offended him a little bit, although I was trying to put things as delicately as possible, while still getting my point across. Going in, what I really wanted was his support of a home birth (even reluctant support would be ok), and his willingness to be a backup should a hospital delivery become necessary. I have a wonderful history with this doctor, and losing him to a home birth would disappoint me greatly.

In response to whether he would be a backup, he said "I won't like it, but I'll certainly do it." I guess I couldn't really ask for more there. We talked about the various things Dr. Ruedrich had said, and he assured me again and again: "This is your picnic... no matter what doctor is on call when you go into labor, no one will do anything to you or the babies that you don't want." He encouraged us to write down the things that are important to us, and bring it to the next appointment. Ultimately, he actually did seem glad that I was open about everything, and that we were having the discussion NOW, as opposed to when we walked into the hospital (or didn't walk into the hospital, because we'd chosen a home birth and didn't tell him). Overall, it appears there is lots of room for negotiation with Dr. Jenkins, and that's encouraging.

So now the questions tumbling around in my brain are...
  • If I stay with Dr. Jenkins, how much do I trust that our wishes will be honored no matter who is on call that day/night? How much do I trust that we won't have to spend my entire labor warding off interventions?
  • If we choose a home birth, will I be confident that the midwives will recognize potential problems early enough to transport safely to the hospital?

And the really big ones...

  • If we birth in the hospital, and something goes horribly wrong, would the the outcome have been different if I were at home?
  • If we birth at home, and something goes horribly wrong, would the outcome have been different if I were at the hospital?

If I had a guarantee that NO interventions would take place, or even be suggested, unless/until there was specific evidence to warrant it, I would absolutely give birth in the hospital.

If I had a guarantee that I would definitely get to the hospital in time if trouble should arise, I would absolutely opt for a home birth.

Unfortunately, no one is going to give me either guarantee, and I'm back to wishing for a crystal ball.


  1. Anonymous Brenda Z. | 7:43 AM |  

    Exactly my thoughts. A crystal ball would be wonderful! It sounds to me like either choice would be safe. Just choose what feels best and then don't 2nd guess after the fact with all the "Oh, would it have been different if we had..." Because that's no way to live. Though I don't think that anything will go horribly wrong. :-)

  2. Blogger Becky | 8:06 AM |  

    Tough decision. When I was 7 or 8 months pregnant with my son (now 19 months and still nursing), the mw told me that he was breech. So I immediately began thinking what I would do if he was still breech when I went into labor. Getting cut open so the doctors could take the baby out was so contrary to everything I worked for. Turned out he was not breech after all. No OB around here (Texas) will touch a first time mom with breech. I was considering The Farm in TN.

    *If* I were pregnant with twins and *if* they were both head down, I would opt for the homebirth. My opinion only. Bonus that you have the proverbial "proven pelvis."

    For inspiration you could search youtube for homebirths of multiples.

    And BTW - I saw vaginal birth of twins on "Baby Story." The Mom didn't have insurance so the hospital did the cheap thing and let her have them vaginally. Makes you think....

    Good luck. It's a tough decision you have to make and you're going to alternate between confidence and questioning in your decision.

  3. Anonymous Robin Elise Weiss, LCCE | 9:17 AM |  

    I couldn't find an easy email to use for you, so forgive me leaving this as a comment. We have 5 yo twins and went through all the same questions that you are going through right now. We kept all of our options open until the very end and had great back up if we needed it. It was so hard to plan so many scenarios! In the end we had a lovely homebirth at 40w2d with good sized babies. The questioning helped us explore so many things. You can find my journal here:
    Journal of our Fifth

    I also have other resources if you're interested! Good luck to you.

  4. Blogger Elizabeth | 9:30 AM |  


    This is quite a big decision you are facing, and it is so neat that you are sharing it with us. Your closing comments seemed reveling to me. You said that if you knew you could avoid interventions, you would go with the hospital, and if you knew you could get to the hospital in time (just in case) you would go with the home birth.

    Now I realize that interventions can lead to all sorts of complications, but you have to admit that a fear of interventions is much less than a fear of having to rush to the hospital. Simply the way you phrased those last two statements makes me think you might be leaning more towards the hospital, even if you don't want to lean towards the hospital.

    Or maybe not. I hope you make a decision you will be content with!

  5. Anonymous Anonymous | 10:22 AM |  

    Any midwife willing to take you on as a client will likely be both experienced in assisting with a twin delivery, and confident in her ability to quickly recognize potential problems. Go ahead and plan a homebirth; don't end up being a surgical extraction statistic just because you are carrying twins. With typically managed OB care, your twins will likely be delivered prematurely, with much greater potential for both short and long-term health risks (see http://www.boston.com/news/nation/articles/2008/03/26/premature_babies_facing_risks_well_into_adulthood/, and the original article, http://jama.ama-assn.org/cgi/content/full/299/12/1429). Despite ACOG's stance, homebirth is a safe option for most women.

  6. Blogger heather | 10:35 AM |  

    Congratulations! Do you know if your babies are sharing an amnion or chorion? If they have separate amnions and chorions you can eliminate some potential concerns like TTTS and cord entanglement. I had my first set of twins at home (a HBAC) in 2006 and am planning a homebirth for my second set now (due in September.) I would highly recommend the book "Having Twins" by Elizabeth Noble. If you are eating well you have a great chance of making it to term and having 2 healthy, good sized babies. Of course there are no guarantees. Carrying twins is a challenge both physically and mentally-because you are treated by the medical community as if you are about to combust at any moment. My mantra last time was "twins are just a variation of normal." Best of luck with whatever your decide and feel free to track me down if you want to chat!

  7. Blogger Renata | 11:00 AM |  

    Hey Anna, it's a tough decision, but is it at all possible to discuss with your OB what types of scenarios would warrant certain types of interventions? Did you have a bad experience with your former births?

  8. Blogger Renata | 11:32 AM |  

    After reading the post on your original blog, I can tell you a compromise for IV that was done when my third was born. Bear with me, as I don't remember the medical terms. They put the port(?) in me, but didn't actually hook me up. It was there just in case it was needed. Of course, I didn't need an IV after all.

  9. Anonymous Anonymous | 12:13 PM |  

    Hello, Anna. My son Xander is 30 months old and still nursing. I'd like to share the condensed version of our birth story. After a textbook pregnancy and delivery with our first son Noah we decided to be cared for by a midwife with Xander. We wanted a birth free from interference so we made the midwife and nursing staff aware of our wishes. The day before going into labor we were assured that he was in perfect position and everything appeared to be normal. My labor progressed quickly, I arrived at the hospital at 7:00am and he was born at 2:38pm. Upon delivery the room became solemly quiet and the team seemed anxious. The umbilical cord was wrapped around my son's neck twice and he was not breathing. The midwife and respiratory therapist tried to revive him with no avail. Thankfully, we were in a hospital and the neonatologist was able to save our son's life. Even with the support of the medical staff, our son almost didn't make it. When we think back to that day we shudder to imagine what could have happened if Xander were born at home. In our situation every second counted. I always considered home birth but ultimately we decided to err on the side of caution. Now we will be eternally glad that we did. I guess what I'm trying to say is this doesn't have to be an all or nothing situation. We had a fabulous delivery with our midwife but we did it in the hospital. The labor went exactly as we wished. The hour following his birth was the most firghtening of my entire life, but atleast I was not panicking waiting for transport to a medical facility. As much as I loved the idea of a home birth I could never bring myself to commit to it. I believe that it was mother's intuition. Listen to your heart and you'll make the right choice for your family. I wish you all the best.

  10. Anonymous Sarah | 12:14 PM |  

    One thing that I have realized while planning for my own homebirth, is that homebirth midwifes are prepared for delivery hiccups that come and usually able to handle them with no medical interventions and just as safe outcomes, than what you might get in a hospital. Hospitals will skip straight to the medical intervention, while the homebirth midwife helps you keep going! I have noticed many people feel that homebirth is only an option in a perfect birth, but in truth something could go wrong, and if you choose a wise and mature midwife she will take care of it! While a Dr will say "well we let you try it your way...now we are going to take matters into our own hands here..." And if there is a serious need to transfer, a midwife is going to get you there pronto cause as much as it is your babies on the line, it is HER life on the line too. How great that you have supportive backup though! That is so great, and you are lucky!

  11. Blogger Jennifer Laycock | 12:19 PM |  

    Hey there "Mother of Xander." (great name, BTW.)

    So glad to hear your son is fine and you were happy with your hospital birth.

    Wanted to point out though that midwives at home births are trained specialists. Part of their job is knowing how to care for and revive a baby that doesn't start breathing on their own. Having a cord wrapped around the neck (even twice, or three times) isn't super uncommon. Midwives will simply slip the cord over the head and continue with delivery. It's often talked about as if it's far more serious than it actually is.

    Also, some babies take some time to pink up. As long as they are still attached to their umbilical cord and the placenta hasn't detached, it's not a big deal if it takes them a few minutes to start breathing. Remember, until the placenta detaches, they're receiving their oxygen through the cord, just as they would in the womb.

    Not saying there aren't times where it is handy to be in the hospital or that things never go wrong at home, but a nuchal cord and a baby that takes time breathing are issues any skilled home birth mdiwife should have no problem dealing with.

    (My daughter was born in the hospital, my son was born at home. We did tons of research on this.)

  12. Blogger Christy | 12:27 PM |  

    I am having the exact same feelings with a VBAC delivery. I have decided to use a midwife that delivers in the hospital. For me that is the best compromise.

  13. Blogger Jennifer Laycock | 12:31 PM |  

    Thought I'd pipe in with my thoughts on your post as well Anna. ;)

    I know exactly where you're coming form. Having birthed Nora at the hospital, I ran through all the same questions for the home birth. We're 20 minutes from a hospital, so that factored in as well.

    Of course I also couldn't find an OB backup, so i would have gone into the hospital with someone I didn't have an established relationship with. Honestly, if I'd had a backup OB, I don't think I would have even questioned it. I would have stayed home unless I needed to go.

    I had Nora in the hospital because of "what ifs." I knew about home birth and liked the sound of it, but I couldn't get past the "what ifs" people throw around. I had quite a few talks with my OB and he assured me over and over everything was my choice and they couldn't force me to do anything.

    That made going to the hospital pretty easy.

    Until I got there. And had an on-call doctor. (Four of them, actually, over a 28 hour labor.) That's when I realized that while they couldn't force me to do anything, they could do everything in their power to convince/coerce me into doing it "their way."

    I had a wonderful L&D nurse who really helped me fight off the docs. To this day, I think she's the only reason I avoided a C/S for FTP, though I did still end up with the pit/epi combo.

    As I see it, there are two factors to consider.

    1.) How confident are you in a hospital staff you don't know? You may know Dr. Jenkins, but do you have other OBs you might be dealing with? How about the nurses? My first L&D nurse chewed me out because she found me drinking gatorade. If she hadn't been going off duty, I would have "fired" her and demanded a new one. But that was in early labor. If I'd dealt with her in transition, I would have lost it.

    The reality is that you'll spend very little time dealing with OBs while you are in labor or at the hospital. It's the nurses and hospital policies you'll have to deal with. Knowing how much battle you might have can go a long way toward helping your decision.

    I will say that if you opt for a hospital birth, I'd hire a doula. I know you have Lee, but I think a third party who isn't as emotionally attached is much better able to keep their wits about them and remind you of your options.

    2.) Where will YOU feel comfortable. I went into the hospital so prepared for battle that I wasn't able to settle down and just labor. I knew I'd have to fight (and I did have to fight) and all that effort kept me from focusing on progressing. I honestly think that's what made my labor last so long and be so difficult.

    When I had Emmitt at home, I was astonished at the difference in the environment. I know you have easy labors, but it was just amazing. I literally woke up, called the midwife, had breakfast, chatted, then got down to work for an hour, pushed out a kid and bam, we were done. So easy and simple. So comfortable. It was just part of our day, it wasn't a "procedure."

    You'll note my two points don't include safety. That's because I am 100% convinced that with a skilled midwife and two head down babies, you're equally safe in either location. Thus, it becomes me about your ability to be comfortable and how much of a battle you think you might face.

  14. Anonymous Anonymous | 12:36 PM |  

    Hi! I have been a lurker for quite a while, and I am glad to see the board back up and running! I was blessed to have a CNM and be able to have a nice hospital birth (NJ). Our hospital offers water births, but my DH is squeamish and I opted for a "normal" dryland birth. However, *next* time, I am not going to consider DH's feelings about it, after all, its my body! I had an epi and IV, but I really didn't consider them interventions- like I would an episiotomy, c-section, forceps, induction, etc. If I were in your shoes, I would go for the hospital birth, with your chosen MWs as support in hospital. Along with your DH, they can head off any interventions that you don't want. Your Dr. was right, they CAN"T give you any intervention you don't want, even if doing so would put your baby at risk, you must give informed consent prior to any procedure. My DH's cousin lost his baby shortly after birth due to complications, and she was born in a hospital (same hospital I birthed my daughter in). So I am a little biased toward hospital births, with the right staff, especially for twins. I wish you luck in whatever you choose!

  15. Blogger Anna | 2:19 PM |  

    Robin: I welcome any resources that you have! You're welcome to post here, or you can email me directly at anna.swank@gmail.com.

    Elizabeth: I suppose the way I worded things does make it sound like I'm leaning more towards the hospital. I think it's simply that I have it ingrained in me that the hospital is the "safe" place to be. It is so easy to believe the OB and everyone else who tells you all the things that could go horribly wrong. Far easier than it is to trust my body and believe the midwives when they tell me just how unlikely it is that anything will go wrong, and even less likely that if something happens and I or the babies do require medical attention beyond their means, there won't be time to get us to the hospital.

    I do want to clarify that this isn't simply a "fear of interventions." Well, I suppose it is, but it's a well-researched, evidence-based fear. Study after study shows that the interventions they'll try to push on me at best don't make any difference in the outcome, and at worst have disastrous results. Are there times when interventions are warranted, and can they save lives? Absolutely. The problem is that interventions are usually applied before there is any evidence at all that they are needed. That's where the trouble begins.

    Jennifer: you worded my feelings on a hospital birth much better than I ever could. I actually just said to Lee last night, "... the OB doesn't show up until it's time to catch." My gut tells me that, no matter how much I love Dr. Jenkins, no matter how many conversations we have, no matter what we’ve agreed to or what’s documented in my chart, it will all fly right out the window when I get to the hospital. Can I still turn the interventions down? Sure. But how easy will it be? How many times will we have to turn them down? How hard will we have to argue? How hard will we WANT to argue? Will we end up with hospital staff that treats us poorly because we don’t do things “their way”?

    Heather: thank you for the mantra! I will definitely be adopting that as my own. In answer to your question, the twins are in completely separate sacs (both amnion and chorion), and actually, they each have their own placenta. So yes, many of the risks associated with twins are lowered.

    Renata: it’s difficult to get answers that go into specific scenarios. Although Dr. Jenkins seems absolutely willing to work with me, he would be much happier if I would go in, get the IV, let them put the internal monitor in, and get the epidural. My gut tells me that even if we negotiate otherwise, whomever attends the birth will be looking for any reason at all to start the intervention train down the tracks. Thankfully, I’ve never had a bad experience with any of my previous births. I am one of those lucky women who progress quickly, and the baby is out in one or two pushes. Of course, I’ve also never tried to fight the routines… I went along with the constant EFM, the IV, the frequent cervical checks, etc. I didn’t know any better, and I was fortunate – none of them had a negative impact on the births. Twins are different, though, and I’ve been reading voraciously since the day I found out there were two in there, when I was 8 weeks along. I now know just how detrimental all of those interventions can be, and that many of them become even riskier with a multiple birth.

    Ok wow… this is getting really long. Thank you everyone for posting and sharing your stories with me! I’ll be sure to update as I read more, think more, and freak out more. :)

  16. Anonymous Jenn | 3:58 PM |  

    All I can do is give my experience. I'll just leave a link to my birth story of my twins. It does have a happy ending, but I believe if I had been anywhere other than the OR when I delivered, I wouldn't have made it and neither would one of my boys. http://www.jennsjournal.net/2006/08/my-medical-mi-1.html

    I'm glad everyone else seems to have had great experiences, but bad things do happen to some of us.

    Also, my OB was the only doctor that was there checking on me and the one that delivered the boys. The nurses were great. I never felt a single intervention was pushed or me or anything like that.

    A lot of my point of view does come from fear. And just wanting live babies after years of infertility. The birth, while important, is just a moment in their lives. The good stuff starts after, no matter where they are born.

  17. Blogger Jennifer Laycock | 4:03 PM |  

    Jenn, I would never diminish your experiences or your feelings, but keep in mind that for pretty much every mom I've ever spoken to, safety comes WAY FAR ABOVE experience when they make their birth decisions.

    Even the ones who have babies at home. In fact, many of us had our babies at home precisely because we believe it's safer. There's quite a fair bit of medical case study to back us up too. It's a little more murkey with twins though.

    I had zero doubts about having my son at home. However, if I was expecting twins, or had a breech baby (or any other variation of normal) I'd be considering my options just as Anna is. I also have no idea what decision I'd make.

    Remember, bad things happen at home and in the hospital. Good things happen at home and in the hospital. Problems can be solved at home and in the hospital.

    It's not as cut and dry as "perfectly normal birth at home = safe" and "any problems at home = dangerous."

  18. Blogger Cagey | 8:30 PM |  

    I think it is great that a thoughtful discussion is taking place here with little infighting or rudeness. Awesome! Obviously, there are no right and wrong answers, but it is great to read all the perspectives.

    I had both of my children in a hospital with an OB I love and implicitly trust. I felt more comfortable in a hospital, but this is a hospital in my home town with which I am VERY familiar.

    My daughter was born with the cord around her neck and yes, it is actually VERY common for that to happen. My OB was not so worried about that, in particular, but was very worried about the fact that her heart tones were so low. I came very close to having a c-section and knew that was what would happen if I did not get her out soon. I pushed even between contractions to avoid that c-section.

  19. Blogger Cagey | 8:38 PM |  

    Oops - hit publish too soon.......

    Meant to add that I think it comes down to comfort level. I would not have felt comfortable in my own home. Pure and simple. However, I am very familiar with my hospital having visited it over the years for various family members. Also, my hospital has really bent over backwards to make mothers comfortable (whirlpool tubs, queen size beds, cozy rooms, etc).

    That said, I have been in some hospitals that are so sterile and cold, I could understand why one would not want to give birth there!

    Again - great discussion.

  20. Blogger Cairo Mama | 4:18 AM |  

    After preparing for natural labor and feeling very confident and ready to birth, I had a scheduled cesarean birth due to breech position (he was breech the last 3 months and never moved).

    I am not pregnant, yet, but I have been thinking about options for the next time.

    I would not want to go into labor prepared to fight. As Jennifer said, it takes away from your focus. Even if you go with a hospital birth, I like the idea of laboring at home as long as possible with midwives and doula.

    As for my situation, we just moved to Korea and our choices are a military hospital or a local hospital. I don't know the rates and philosophies of Korean doctors toward birth so I have a lot of research to do. I also don't know of any homebirth midwives.

    When I was pregnant in Egypt, I went to my parents' house in PA to have my son. It is a small city and very hospital focused, though there is one home birth midwife, but I didn't find her until after he was born. So, it is also a possibility to go back to the States, but then I would be birthing in my parents house.

    I think it is great that your doctor has agreed to be your back-up. If I were you (with 3 previous births), I would plan a homebirth but keep my options open and if, at the last minute, I felt unsafe, I would give myself permission to change my mind. I agree that it is about personal comfort and confidence.

    Good luck with your decision!

  21. Anonymous Anonymous | 6:59 AM |  

    Hi. I can't seem to find a way to post my name instead of anonymous, so I apologize. Anyway, I wanted to ask about the studies that you and Jennifer are talking about. I have heard them mentioned alot, but never anything specific. Not that I don't agree with the idea that there are too many unnecessary interventions, but as a grad student, I am a little curious about the studies themselves. I guess I wonder about the methods- how do you seperate necessary from unnecessary interventions, and account for the difference in numbers between home and hospital births? Plus the fact that moms with issues are going to be refused a home birth anyway. I agree that homebirths are safe for perfectly normal pregnancies with no complications. I had placenta previa, and for the most of my pregnancy, a c-section was a very real possibility. Thank God that it resolved by the 8th month so that I could have the wonderful delivery that I did. But the risk of hemorrhaging was just too high for me to even consider a home birth. Thanks.

  22. Blogger Alexis | 7:02 AM |  

    Hi, Anna ... I don't know where you had your first kiddos, but I want to share my experience with you.

    I really wanted to have our son in the local birth center. Since he's our first, though, my husband was really nervous about it, and it would also have cost us a lot more out of pocket, because our insurance wouldn't cover it. So I rather reluctantly agreed to have a hospital birth, with the stipulation that we hire a doula.

    I was rather nervous. I'm pretty crunchy, and I'd heard SO many things about women being forced to do this or pressured to do that. I didn't want an epidural, I didn't want my son to have the Hep B vaccine, I didn't want to be induced, etc.

    I made a birth plan ahead of time and showed it to my doctor, who signed a copy of it. (We did compromise on a couple of minor things.) I kept a copy and they put one in their files.

    And, almost to my surprise, I was extremely pleased with my hospital birth. One nurse gave me a little bit of attitude, but overall, everything was fabulous! No one tried to get me to do anything I didn't want (except the nurse, who tried to get me to lie on my back, which I refused to do).

    I wasn't induced, I didn't have an epidural, my husband got to cut the umbilical cord, I got to breastfeed right away, etc. At no time was our son ever out of our sight, from the time he was born to the time he left.

    Of course, hospitals and doctors vary widely. But a hospital birth CAN be a very nice thing. :)

  23. Blogger Anna | 9:36 AM |  

    Cairo Mama: My gut seems to be leaning firmly towards a homebirth. I think my head is getting there... slowly.

    One of the first options I considered was laboring at home for as long as possible with a midwife or doula, and then heading to the hospital. For me, there are a couple of problems with that scenario:

    1. Who wants to get in a car and go for a ride in the middle of heavy labor? That just doesn't seem appealing to me at all.

    2. When my babies come, they come quickly. Gracie was 90 minutes from AROM to birth (of course, I was nearly 7cm dilated - but not contracting - when they broke my water). Levi was my longest labor (about 6 hours from the onset of noticeable contractions to birth), but I went from 8cm to pushing him out in pretty much a blink. My doctor actually missed his birth because the nurse didn't believe me when I said I had to push. "One more contraction" she said. Well, the next contraction came and he was out! So... yeah, I guess my fear is that a last-minute trek to the hospital will result in one baby being born in the car, and the other one being born in the hospital lobby. :)

    I love what you said about giving myself permission to change my mind. Knowing how quickly my labors tend to go, I would not feel safe laboring at home with only a doula. If I were to plan for a homebirth, though, I would have midwives with me. However, that doesn't mean I can't change my mind and transport to the hospital for whatever reason... even if nothing is actually "wrong." Thank you for pointing that out!

  24. Anonymous Abby | 9:39 AM |  

    Anna, welcome!
    I want to say that I had a really hard time with the birthplace decision when I was a few months pregnant, so I know what you're going through there as well.
    I opted for the hospital (I'm 38 weeks right now) because of financial issues, but I think if I'd have pushed the issue more and could actually afford it (or saved up in advance), I think I would have been more adamant about a homebirth.
    We're going for a VBAC, and my doctor (I'm in Columbus) is very supportive of it. I personally know a woman who had a VBAC with him over 20 years ago when it wasn't as popular, so I do trust that he is capable of "waiting" through any potential issues without forcing interventions down my throat. That's part of why I feel fairly confident with him.
    I don't know if I'd have been more confident with a "stranger," even though he is the one who did my c/s the first time. Long story short there, he gave me the option to go home after a failed induction, I just didn't take it.
    This probably doesn't help at all with making your decision! But I do have to say go with your gut on this one, because there are way too many "what ifs" on either side of the coin. There's really no way to weigh it out, but if your heart is telling you that a homebirth would be the better option--go for it--and if it's telling you that you should stick to the hospital--do it.
    Congratulations and good luck!

  25. Anonymous Anonymous | 6:33 AM |  

    Oh, all you young moms have brought back so many memories for me. I am a mom of six, 2 hospital births and 4 homebirths (the last one was breech, successfully delivered at home). My oldest is 26 years and my breech baby is almost 9.

    This decision can be so difficult. But each of you seem to have nice store of knowledge. And Jennifer, I can tell that you have been reading for those twins! It is encouraging to me to find young moms actually interested in learning and making informed choices about their births. Home birth is not the best choice for every birth. But is is a wonderful option for many moms.

    If you have a physical complication, we all agree that you should choose the hospital and feel no condemnation for it. The same with your mindset. If you are not convinced that homebirth is safe for you, then you should go to the hospital and feel no condemnation for that choice.

    I believe there are two things needed for a successful homebirth:

    1. A sincere belief that women (yourself in particular) can birth successfully without 'help' or intervention. (Do not confuse my term 'help' with the very real necessity of skilled assistance and support). This can be gained by reading good information and statistics.

    2. A willingness to completely accept responsibility for any problems that might occur. This is probably easier for certain personality types than others.

    Moms that choose a hospital birth and experience complications or tragedy (even if these problems are caused by the medical environment) do not have to shoulder the same responsibility as homebirthing mothers and fathers. Our society places the responsibility on the doctors, nurses, etc. in a hospital or birthing center.

    In the same light, most 'problems' at homebirths are not life-threatening and of the ones that are, many could not have been prevented or foreseen even in the hospital. Sadly, although we want to believe otherwise, there are just some bad outcomes that happen beyond everyone's control.

    Cairo Mom gave some wonderful advice about planning a home birth and giving yourself permission to change your mind when/if you want to.

    My Advice: Be cautious with whom you share the "I am birthing twins at home" excitement. You may have to deal with too much doubt and negativity from others. After all, a tired, emotional pregnant woman should not need to defend her decision daily. And some of your friends and family just don't need to deal with the worry too far in advance.

    Anna, the plan that you have in your recent post is perfect for you and for any mom that is considering a homebirth, but still has a tiny seed of doubt. Give yourself some 'wiggle room' and that can remove a lot of self-imposed pressure. Transport to the hospital 'even when nothing is wrong' is the most common for my midwife. Transport is a reasonable option for a birthing mom that is exhausted, emotionally drained, or filled with last-minute doubts (brought on by transition labor).

    Forgive the lengthy post from an Old Mom and best wishes to all of you smart, young moms for your future births!

  26. Anonymous Karen | 6:53 AM |  

    Anna, I just had to reply to your post. I'm in central Ohio and I've had two babies with Choice. Kelly & Nina. Both were planned to be home birth, but at week 39 of preg #1, Choice said 'you need to be in the hospital for this one'. Pre-eclampsia. The second was born at home after a normal pregnancy. I have deep respect for the way they were firm about having my son in the hospital, and they truly are not 'homebirth or bust' as you say. Kelly and Nina came to the hospital (Grant, I *highly* recommend going there) and it was a good experience. I had a wonderful LD nurse who looked the other way as I drank and ate and escaped to the bathroom too frequently. She did lots of other things to help me avoid interventions too. It became clear though that I needed an internal monitor. I cried, but I looked at Kelly as the nurse was explaining why it was needed. Kelly looked me in the eye and nodded solemnly. They were right, and I could trust them completely.

    I felt very safe trusting my deliveries to Choice. My daughter was born last fall at home, again with Kelly & Nina. She was born underwater with the cord wrapped around her neck, and it was actually the apprentice Jill who delivered her. The cord thing was a complete non-issue.

    My bottom line is that I trust these women to spot danger and handle it appropriately, including insisting on interventions when needed. If I suddenly had to go to a hospital for a birth, it would be Grant, no questions asked. (Their normal clientel is so malleable ;-) and asks few questions. They didn't really know what to do with us so they pretty much did whatever we told them. I have nothing negative to say about a single employee of Grant)

    Also, Dr. Hammett at Grady in Delaware will support home birth. His staff is super-annoying, and not to be told about home birth, but he's supportive.

  27. Blogger rachel | 12:25 PM |  

    I never felt pushed toward anything during my hospital delivery. They just kept asking me what I wanted to do. I asked for a birthing ball and I sat in a whirlpool bath for like 2 hours before I decided I wanted an epidural. I was at the hospital for 10 hours before my daughter was born. Our L/D nurse stayed an hour after her shift was over before leaving since she wanted to stay with us. My only bad experience was with one nurse (one shift) in my following days in the hospital but I asked for a different nurse and our new nurse was fabulous.

  28. Blogger Milk Donor Mama | 6:38 AM |  

    Anna, Take a look at birth statistics in other countries that use midwives as the "normal" birthing attendants. The Netherlands has some good information. Birth has become so medicalized here, that our national numbers are so biased that I wouldn't even bother referring to them, and I'm an epidemiologist. The only thing our numbers are good for is analyzing costs and determining the fact that there are too many unnecessary interventions done to both mothers and babies.

    I only realized a lot of this after my own birth experience at St. Ann's. I thought I had a pretty good one until I was reading about breastfeeding and natural child birth during those long, frequent nursing sessions. The fact that I had procedures and medication administered to me without my permission (and I had an uncomplicated singleton vaginal delivery with no risks whatsoever in my medical history)-- convinced me that I am doing a homebirth for my next pregnancy.

    Unless you yourself are a doctor specializing in obstetrics and neonatal pediatrics, there's going to be no way to tell whether what those in the hospital are saying, are saying it because there truly is a risk to your or your babies' health, or whether the risk is more toward whether they would be sued for medical malpractice.

    I would say you have the best of both worlds here. You are not far from very capable hospitals, should your midwives feel that they cannot control the situation. While your doctor may not personally agree with your choice, his decision to continue as your provider in spite of his disagreement indicates to me that he will still provide you with the same type of care that you could have expected if you were not using midwives for a home birth.

  29. Blogger Amy | 8:12 AM |  

    My vote is still for homebirth. :)

    Like Jen, I've done lots of research on the safety issue. For me, that's not even an issue: study after study after study show that homebirth with a trained caregiver is at least as safe, if not safer, than hospital birth for most moms and babies.

    And, more anecdotally, almost every emergency birth situation I've ever heard or read about in the hospital was in conjunction with other interventions (chemical induction, epidural, etc.). Complications very rarely arise with no warning in a birth that is carefully monitored by a hcp (not a machine!) but otherwise unhindered.

  30. Anonymous Anonymous | 8:17 AM |  

    As Jennifer pointed out, midwives are extensively trained in handling complications that may arise. Unfortunately for us the midwife could not revive Xander and it was her decision to call in the neonatologist to take over. They both agreed that had we needed a transport to the hospital he wouldn't have survived. Although I consider myself a stuanch supporter of every mother's right to choose, I could not in good conscience recommend home birth. I had such a close call and if we were at home and the outcome were different I could never forgive myself. With that said I must add that I rarely disagree with the majority around here so please bear with me ;) I enjoy the fact that we can share our (sometimes opposing) views in a civil manner and many times I have found myself reevaluating my stance on an issue after reading the experiences of others. In my opinion, that's what our dialogue should accomplish!

  31. Blogger Andrea Z | 5:04 PM |  

    I just gave birth to twins, but it was my first pregnancy, so I didn't have a lot of resources to find a midwife who would even touch the twins. Then, we had TTTS and pre-term labor. After my first round of pre-term labor at 27 weeks, they both went breech. This is just to say that I didn't feel that anything extra was done and, in the end, the hospital birth insured that my babies and I were both okay. It was an overwhelming positive experience and I don't regret it. The crystal ball may not be available, but it sounds like you've done all your homework and in the end, that's all we can do. In situations such as these, we only have a small, humbly small, amount of control.

  32. Blogger Amanda | 8:38 PM |  

    Here was my happy medium... a hospital birth attended by a midwife. My Husband and I wrote very specific birth plans, and they were followed to a T. I had my plan on file with the midwife, and took it with me to the hospital. They can not do anything to you or the baby with out your permission. Sometimes you have to be hard headed, but it is true.

  33. Blogger Heather | 9:33 AM |  

    My birth experience is still vivid in my mind; after all, it was only three weeks ago!

    I opted for a hospital birth, not so much because I was concerned for safety, but because quite frankly, I want someone else to clean up after me, and my house isn't what I'd call conducive to childbirth.

    I was forced into taking pitocin, because of the fact my water broke; this resulted in my being chained to monitors, the one thing I didn't want. I gave the nursing staff hell, though; every time I'd move, one of them would come in and tell me to lay back, but I wasn't about to spend my whole labor on my back.

    Some of the decisions I was forced into were absolutely because of hospital-policy, influenced by fear of litigation. Though I was in the hospital for around 30 hours total, I was not allowed to eat anything buy ice chips. Fortunately, I thought ahead, brought snacks, and had my doula and husband bring me pick-me-ups. McDonald's french fries rock. I really don't think I could have done it without that food!

    I was eventually forced to give birth not only laying back, but with my pelvis tilted up... it was so WRONG that I actually had a panic attack and completely lost my grip on my brain. I was screaming at the top of my lungs from the pain and panic. It went against every instinct I had.

    I don't like hospitals. And I don't think I'll be having any more kids because honestly, I can't face another hospital battle, and Georgia is very midwife-unfriendly. And when you're poor like us, you can't afford to hire properly trained staff to help.

  34. Blogger Kimmelin | 12:32 PM |  

    I am so pleased to see so many positive comments regarding your present conundrum. Heather's comment about envisioning a twin pregnancy as a variation of normal is superb! And she's right about the medical community in general...no matter how deep a woman's rapport is with her provider...if you're seeing an allopathic provider, they will be MORE likely to treat your pregnancy as a disease process than a midwife who will treat you as if you are in the heightened/unique state of health that is pregnancy. As a (non-practicing) Physician Assistant, a current Lamaze Childbirth Educator, and mother of three, I have seen this again and again. I encourage you, and any woman grappling with the issue of choosing home vs. hospital birth to:
    1) listen to your INSTINCTS
    2) look at the hard statistics: cultures where home birth and MW attended births prevail, generally result in significantly deacreased infant/maternal morbidity and mortality rates than here in the good ol' high tech. US of A. I am finding that, even with my MOST PREPARED students, that once they step foot through the hospital doors...it becomes extremely hard to avoid the cascade of interventions.

    Best of luck!
    Kimmelin Hull
    author of A Dozen Invisible Pieces and Other Confessions of Motherhood

  35. Anonymous Robyn | 11:10 AM |  

    I read a lot of these comments and am reminded of some of my struggles. I have had two c-sections. That was never my plan. I had always hoped and prayed for natural, vaginal births.

    We did try for a VBAC with our second child and had absolutely no interventions at the hospital besides an IV port and a monitor strapped on my belly. It was completely conducive to moving through pain, breathing, etc. I was in natural (back) labor for 12 hours (staying in transition phase for 2 hours) and I was never pressured. I had a doula (which I think relaxed the hospital staff) as well as a midwife. I was high risk. But I told them what I wanted from the get go and no one forced me at all.

    Good luck making your choice!

  36. Anonymous Robyn | 11:28 AM |  

    I forgot to mention that I understand the crystal ball concept. It's hard to make such important choices when you really don't know the specifics of what will happen. Best of luck. And remember, your job is to raise and love and nurture these children their entire lives. Their birth is important for their health and your health. I hope your experience is wonderful, but I had two not ideal births and my boys are happy and healthy and so am I. I have definitely had to make peace with it and it has not always been easy, but don't fear that your kids won't love you or your bonding will be broken due to whatever happens. I got so tunnel vision the last few months of my second son's pregnancy and I wish I hadn't gotten like that. I had ALWAYS wanted something different than what I had experience-wise, but I had never wanted anything different than my healthy boys. Second guessing stinks and will sap you of the joy of this time with your babies.

    (I realize what I said is probably a lightening rod of people saying they think I'm horrible for trying to accept my c-sections...you don't have to enable this comment!)

  37. Blogger Mommy's Getaway | 11:06 AM |  

    Hi Anna - Welcome!

    I am going through the same type of quandary except with a singleton. I have a great ob who was totally on board with my Hypnobirthing (second child) but because she is in a practice with 4 others, I don't feel comfortable taking a chance on getting her. I know we got extremely lucky with getting for my second chile but I don't think that will happen this time.

    We are looking at a homebirth and in fact, have to decide by Monday what we will do. So far, I am just listing out the pros and cons of each. My heart leans toward homebirth and waterbirth but my mind is a bit scared of the "unknown" (because I haven't ever done either before).

    Best of luck deciding!!

  38. Blogger Health Guru | 11:47 PM |  

    My point is that the birth of a child must be under the supervision of qualified doctors and midwives particularly if its 1st birth.
    Better Information.Better Health

  39. Blogger Jennifer Laycock | 5:31 AM |  

    Health Guru,

    I couldn't agree more that having a qualified midwife as part of your birth team is as great way to dramatically increase the potential for good outcome for a birth.

    That's why I hired a qualified midwife to work with me during my pregnancy and home birth.

  40. Blogger Ahmie | 10:06 AM |  

    I believe in the core of my researcher-being: women should birth where they feel the most confident. If that is home, birth at home. If that is a hospital, birth there.

    The worst intervention of all is undermining the confidence and power of a birthing mother.

    My firstborn was born in a hospital-run birthing center with a CNM who had over a decade of prior experience as a homebirth midwife (before moving to an area unfriendly to homebirths). We taped the birth plan to the door at eye level so that anyone walking into the room had to look at it. My recommendation to ALL pregnant woman, regardless of where they plan to birth, is to gather birth "essentials" into a portable container. My definition of essentials does not include something to cut and tie the cord with (that is not essential and indeed can cause problems being done too hastily - google "lotus birth", no I did not practice lotus birth with either of my sons but we did delay cutting the cord with our second, waiting nearly an hour after his birth to cut it, well after the placenta was delivered, and I believe that in all but the most dire circumstances cutting the cord before the placenta is delivered is cutting the cord too early - placental delivery pushes more of the blood intended for the baby into the baby and waiting until after the placenta has been birthed and rested allows the blood levels in baby and placenta to equalize. Our first had his cord cut before the placenta was delivered and had bad jaundice, our second had normal bili levels tho monitored closely, jaundice being more common in Asians).

    Another non-essential is the nose-suction thingie. Most babies really don't need it from what I've seen and read (and a fool with a bulb WILL want to use it - my firstborn was nursing happily within 5min of birth and some idiot nurse made him delatch so she could suction him... Hello? If he couldn't breathe, he wouldn't be nursing, genius!). If the baby DOES require emergency suctioning, in a pinch mom or dad or midwife can use their own mouth to perform the task - icky, yes, but more efficient (my lovely darling husband does this exclusively for our babies when they have colds, it's much less upsetting to them, and since upsetting them further is conterproductive to minimizing the snot, he logics out that it's a small price to pay for more sleep. My immune system is weak so he doesn't want me risking it).

    What *does* need to be in that container? Some tape and your birth plan, preferably at least 2 copies of it, so you can tape one on the outside of the door to a room you're in and one where you can see it and reread it if you start feeling overwhelmed (and you will feel overwhelmed at least momentarily, no matter where you birth - it's part of the process, these overwhelming feelings. The goal is to channel them instead of allow others to derail their purpose). Also essential are items that bring you back to your "center" when you're pulled astray - these items differ for every individual. I am very touch-texture-movement and socially orientated (i.e. these are my "learning styles") but not very visual or musical. For both of my births I wore a lavender jade Kwan Yin pendant that reminded me of my husband's paternal grandmother, who was well under 5ft tall, maybe 90lbs at her heaviest non-pregnant state, and birthed 10 9+lb singletons at home (she was a Buddhist devote of Kwan Yin, hence the association, lavender because that was the one that happened to feel best in my hand when we were in Chinatown looking for one while I was pregnant the first time). Music doesn't do much for me, I have hearing issues (trouble separating out background noise especially, so playing music means I can't follow what's being said to me), but for my second birth I listed for several hours to the audiobook for Harry Potter & the Half-Blood Prince (I'm a big Potter fan and the 7th book was coming out less than a month later) - this book was my choice particularly because I knew the story well enough to not really listen intently to it, but also because of the mix of tension and humor in it. Pack something in there that consistently makes you smile. Pack a music player if you're moved/focused by music. Massage tools are a good pick for most people (I recommend Nukkles, they're available at Bed Bath & Beyond and stores like that, light-weight and work really well without needing a lot of arm strength) and a tube sock full of uncooked white rice, tied in a knot to hold the rice in (this can be put in a microwave for a hot pack, or in the freezer for a cold pack - make several, heck, make an entire value pack of socks worth of them... doubling up the socks will prevent the rice working its way through the fabric). Pictures of people you love who won't likely be at the birth are also good for this container. A change of clothes for you and the first items you want touching your baby (for me, this wasn't just first clothes and diaper but also a blanket I have made that is the first blanket each of our children is wrapped in, the color matches our wedding colors). And one more essential empowerment item - a doorstop. Having the power to keep people out of the room you're in if you need to, even if you never use it, can give you the confidence in your core that you need when you least expect it.

    Those are the things I really feel are needed for birth, along with supportive and loving hands possessed by people who know how to back off and let your body do what it needs to do unless/until further assistance is needed.

    And, one more thing, if you've got the floorspace for them, the big circular inflatable pools that Target sells work GREAT as birthing pools. Regular price is $40 or less (can't remember), has a seat in it that is a good height for leaning against/using as a pillow, has 3 cup holders (tho the big flip-top straw-inside sports bottles I prefer don't fit in them, think travel-mug or soda can sized). You can get more than 22" of water in them so it will cover the top of your belly, some of those foam mats that puzzle-lock together underneath and it's REALLY comfortable even on a hard-wood floor. My 2nd son was born in one. Lowes Hardware sells kitchen sink adapters to let you hook a regular garden hose to the faucet for filling. I had back labor that I thought was actually re-herniating some weak lumbar discs (had herniated L4-L5 and L5-S1 about 8wks before conceiving my first, hence the research in how to birth without an epidural since that's where they stick the needle and I didn't want to risk re-herniating then). The pain pretty much disappeared when I got into the pool and the baby shifted a bit. Next time we're getting a waterbed heater to go under it tho.

    Hope that helps. Our ancestresses did this, and obviously their bodies worked just fine or else our species wouldn't be covering so much of the planet. Your body is no less capable than your foremothers' were.

  41. Anonymous Amy | 7:16 AM |  

    This is a UK based site but might be helpful.


  42. Anonymous Sugar and Sprouts | 1:39 PM |  

    When I first met my OB (and yep, mine moved right before I found out I was pregnant) I was very blunt as well. I told her my wishes and asked her if she could respect them and support them and if not, that was OK, but that I would find someone else. (Breath hold here because in a small town there aren't a heck of a lot of options). She said she would and we never looked back. Of course, I ended up in an OR with an emergency c-section, but I really believed, knowing that she has actually done a home birth herself, that there was no other way (I later found out by opting for that instead of waiting which I would have preferred, she saved both our lives).
    Short story too long, but I guess what I’m saying is as long as you feel comfortable and respected, you’re OK. I send you good wishes.
    Also, I just linked to your site from my blog"
    because of my entry on breastfeeding. Hope that's OK, but I love reading your stuff! Searched google and you popped right up – congrats on that!!

    Do you twitter?

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