You want to know? I'll tell you!

Homebirth, birth center birth, and really anything other than the all too common hospital with a doctor who totally disregards your wishes birth, is very misunderstood. I've been asked a lot of questions lately, good questions!

What's a birth center?

A birth center is only the most awesome invention since birth itself. It's bears no resemblance to a hospital, and it's perfect for people who, for whatever reason, don't want to birth at home. Technology-wise, it's identical to a homebirth. You will be tended by midwives, never doctors. You will not be bound by any strange hospital policies like a ban on eating, or a requirement to have an IV, or anything like that. You can really do things your way, just like you could at home, but you're at the birth center instead. A lot of them have really nice birth tubs, and cool equipment like birthing stools and squat bars. They have medical equipment, too, but in well over 90% of cases, you'll never see it. It's tucked away in some dresser or cabinet somewhere that you won't have to look at it or think of birth as a medical event.

Birth centers are really cool. They're particularly ideal for people who would love to have a homebirth, but live really far from a hospital, and aren't comfortable with that. Most birth centers are within a reasonable drive of a hospital (half an hour is the farthest I've seen), so they're a really great option for very rural families who aren't comfortable with a homebirth, but don't want a hospital birth either. Oh, and you don't have to stay long after the birth. You know how everyone who births at the hospital ends up staying there for like a whole day after the baby is born? At a birth center, you can go home after as little as 4 hours if that's what you want to do.

What if something goes wrong and you're not in a hospital?

This is the one everyone wants to know. First of all, be assured that all licensed midwives (be they CNM's or CPM's) are highly trained in handling the issues that sometimes occur during births. Baby needs oxygen? Don't worry. The midwife brought some. Mom hemorrhages? Don't worry. The midwife has brought the same drugs they would give in the hospital to control it. Of course, the difference is that in the hospital, these drugs are used as the first line of defense, and in a home or birth center birth, they are a last resort, used after breastfeeding, herbs, fundal massage, and other means to control the hemorrhage, but they are there if they are needed, and sometimes they are. Licensed midwives are required to carry these drugs to every birth they attend. People do not routinely bleed to death if their birth is attended by a licensed midwife. Stitches are also something that basically all licensed midwives are willing to do for their clients, although it's not often they have to do it since the rate of tearing during homebirth, is very low.

Now, if it is something that cannot be remedied at home, then you transfer to the hospital. When it becomes apparent that a transfer is imminent, the midwife will call the hospital and tell them what's going on. Then the client is driven to the hospital. Upon arrival, the people there know what's necessary, and they act accordingly. The drive only gave them time to set up, which would have taken the same amount of time even if the client had been on hospital property the whole time. In the end, there's no difference in how quickly emergency treatment can be given. The exception to this would be very rural families, who may consider a birth center birth instead of a homebirth in order to put them in closer proximity to a hospital just in case of emergency.

What if the baby is premature?

Then you go to the hospital. Every midwife has her own criteria for what she's willing to attend, but I don't know any who will assist births prior to 36 weeks at home. Most birth centers are bound by law to transfer anyone who goes into labor prior to 37 weeks. Nobody is advocating home or birth center birth for premature babies. There are laws in most states about this as well.

What if you don't go into labor on your own?

This is a construct of the modern medical establishment, and those of us within the natural birth community know that every woman will go into labor on her own when it is time. Whether that is 37 weeks or 44 weeks, every mom will cook her baby as long as he/she needs to be cooked, and when that's done, she will go into labor spontaneously. Induction may be discussed if you're doing a birth center birth, or if you live in a state that mandates how far into post-dates midwives are allowed to attend births out of hospital (Florida and Georgia, I'm scowling at you), but in states with good midwifery laws (such as Texas), you can go as long as Mother Nature has for you, and not worry about a thing.

No, it's not bad for the baby to stay in as long as he/she is naturally inclined to do. In fact, it's quite good for the baby because he/she gets to develop fully before joining us earthside. No, the placenta doesn't stop working at 40 weeks. No, the baby won't get too big. Babies are born when they're ready, and every mom can go into labor on her own.

If you don't have cervical checks throughout labor, how do they know how long you have left to go? Similarly, if they don't check you, how do they know when to tell you to push?

First of all, knowing how dilated you are is absolutely no indication of how long there is left to go. Any given woman can take three days to dilate 4 cm, and then go from 4-10 in a matter of minutes, or any other variation of timing. Plus, a good midwife knows about what stage of labor her client is in by the sounds they are making and how they are acting. I did consent to one cervical check during my labor with Orren, but Nancy knew before she did that, what stage I was at. Any experienced midwife would. A client should not feel compelled to request, nor consent to, cervical checks. Most midwives who practice out of hospital make it clear that it is a client's choice whether to be checked or not. Instead of "We're going to check you now.", Nancy asked me, "Can I check your cervix and see how far dilated you are?" I did consent to that. I probably will not request any cervical checks with this birth. They are kind of risky for a Group B Strep positive mom who's going without antibiotics, and they're unnecessary.

As for how you know to push if you don't get checked, if you are unmedicated, and laboring in accordance with what our species has evolved to labor like, you will know when to push. You will do whatever you need to do to get that baby to come down, and to move him/her out into the world. Whether you are in the water, on a bed, on the floor, on a birth stool, hanging from a birth sling, or leaning against a tree in the yard, you will know what you need to do, and you will innately do it. The midwife's job is not to tell you how to push, but to support you as you do what naturally occurs to you. She knows that. By the time you get to that point, you will know it, too.

What happens at an appointment with your midwife?

YES! The million dollar question! Well, they either take place at the birth center she practices at, or at my house. We talk a little while, just catching up on what's new with each other within the past month (I'm still on once a month appointments, but will be on every two weeks after my next one.) She asks me how I'm doing, usually if I've had any more nausea (that's been an issue for me this pregnancy), and how things are going in general. Then she'll take my blood pressure, check the baby's heartbeat, and note that the baby has grown since last time. There are no exact measurements done since that's really unnecessary. Sure, I could be told how far ahead I'm measuring (because I always measure big. I have big babies. Shocking, right?) but there's no point in that. We discuss how the baby seems to be growing, and we find that this baby is following a similar growth pattern to Orren, so we talk about how it may be another one in the 9-10 pound range, but we always talk about how great it is to have big healthy babies, and how they're the best kind. It's all very positive.

Otherwise, we talk about all the other details of the birth, what foods I should make, what things I should get, and really any other details of how I want this birth to go. We even talk about other things, like cloth diapering, the differences in raising boys vs girls (we both had just girls for a long time, and then had a boy!), even intactivism, and what pediatricians in this city support delayed and selective vaccination schedules. Sometimes we talk about the bad side of things, like what happens if I have to transfer, what to expect (they aren't very nice to homebirth transfers here. That's a common phenomenon throughout the nation.) Then we talk about how that's very unlikely to happen, how I'm having this baby at home, just as perfectly and easily as I had Orren in the birth center. On average, our appointments last an hour and a half. We have to know each other well if we're going to work together most effectively. I chose her because I knew that she and I have very compatible views when it comes to this process. Our appointments are to reinforce that just as much as they are to check and make sure the baby and I are doing fine.

What about prenatal testing? Don't you do that?

It's always the client's choice. Homebirth midwives don't offer much in the way of prenatal testing, but they can tell you where to go to get it done, should you want it. They can also discuss with you the risks, benefits, and drawbacks to each test, and even help you make an informed decision on whether or not you need any given one of the common tests. Birth centers do offer most of the same tests as OB's offer. The difference is that it's always put forth as something you can choose to do or not do, rather than "OK, you're X weeks, so now it's time for Y test." If you are a birth center client, just like homebirth midwives, your midwives can discuss with you what tests you are considering, and how they pertain to your individual case, and help you to make an informed decision on what tests, if any, you want to get. I have refused all prenatal testing for my last two pregnancies. Most people do, but if you want it, then that is your choice, and nobody's going to give you a hard time over it.

Similarly, other tests such as Gestational Diabetes and Group B Strep, which are considered standard procedure in OB practices, are considered a choice, or something you must request for yourself, in most birth center and homebirth practices. I have never taken a Gestational Diabetes test. Since I have no risk factors for it, I've never seen it as necessary to be screened, and my midwives have always concurred with that. As for Group B Strep, I was tested for that during my first two pregnancies, and was positive both times. The first time, I had antibiotics during labor, which was a huge mistake. The second time, I didn't. In the two years between then and now, I have researched Group B Strep and treatments thereof, very extensively, and have learned that the Group B Strep test is not essential nor are antibiotics during labor beneficial in any way. I also learned preventative measures. This time, I will not be screened for Group B Strep. If I wanted it, I could request it, but there's really no need. Honestly, most of Europe never tests for it either, and they have better birth outcomes than we do. The bottom line is, it's a choice that each client must make for herself, and that's how it will be put to you.

What about ultrasounds? Do you do those?

Ultrasounds are just like other prenatal tests. You can choose to have them done. Not everyone does, but many do, and if you want one, then just ask. CPM's cannot do diagnostic ultrasounds in most states, but CNM's can in a lot of places. If you want a diagnostic ultrasound, and you are seeing a CPM, then you should ask her for a recommendation for an ultrasound clinic that you can go to for that. If you are seeing a CNM, she can probably take care of that for you. You can have as many or as few ultrasounds as you want. It is up to you.

How did you convince your husband to let you birth out of hospital?

Thak is an interesting case. Sure, his family in the US is hopelessly mainstream, but if you actually hear anything about his mom, as it would seem, she was kind of a major hippie by US standards, only it wasn't called being a hippie. It was called being from a remote village in Thailand, and doing what you consider normal. Basically, even though Thak was born by emergency c-section in a military hospital, and had some pretty mainstream views of birth, he had enough alternative in him to be open minded about things, to read Spiritual Midwifery with me, to watch The Business of Being Born, and ultimately, to go from someone who thought hospital when he thought birth, to a major birth center and homebirth advocate. The thing for him, was to see the difference. He knew what hospital birth was. Then he went to the birth center with me when I was pregnant with Orren. Our midwives involved him in the whole process, showed him that he was an important part of it all, not just some accessory who will be treated as a spare part like in hospital situations. He was so happy to have such a big part in the pregnancy with Orren, and to be so connected to his son even before he was born. Orren's birth was perfect, and he was so proud to be helping with the whole process (he really did everything but catch the baby!), and to this day, he tells everyone about what a great experience it was to help his son come into the world like that. After that, he really understood why I wanted a homebirth this time, and was all for it.

For more resistant dads, I think the best possible thing is for him to talk to a midwife, ask her all the tough questions, and listen to what she has to say. On the rare mainstream ideals that Thak clung to (it was really very small things, just annoying, not major) the thing that got him away from that, was talking with our midwives about that stuff. Hearing it from them went a lot farther than hearing it from me. They do this for a living, most have done so for a very long time, and they know more about birth than he, or I, or any other lay person ever could. Husbands love experts, and midwives are experts. The cure for a resistant husband, is a consult with an experienced midwife. No, she is not in the business of convincing you two to choose homebirth or birth center birth (they only want clients who genuinely want to be there), but she has a wealth of facts to answer the tough questions, and put fear of the unknown to rest.

Aren't you afraid?

I'm realistic. I honestly believe that birth is about as safe as life gets (safer than some of the things I do, actually. Remember, I live in El Paso, home of the worst drivers in the world.) but I also understand that, as with anything else in life, there are inherent risks. I believe that my level of risk during a homebirth is identical to my level of risk during a birth center birth. I know that for me, homebirth is drastically safer than hospital birth. I also understand that sometimes things happen. I know my own history. I know that in homebirthing, things are in my own hands, and that it is up to me to do what is best. I read extensively on issues that pertain to me, and proceed accordingly. I am walking with my eyes open as wide as they can go. With that comes insane power over my own situation, but also total responsibility. I am not afraid of labor pain. I know how to handle it. I am not afraid of birth itself. I've come through that just fine twice. I am not afraid of large babies, as I've been there, done that, and it was easier than I ever imagined birth could be.

Fear is kind of useless at this point. Surely, I know all the things that can go wrong. One thing about homebirthing is that everyone you ever meet tells you every horror story they've ever heard about anyone who ever had anything bad happen during a homebirth. Yup, I'm pretty sure I've heard about every mom in the history of the US who bled to death during a homebirth, or anything else you can imagine. More importantly than that, I have read the statistics on every one of these things. I have read articles from peer reviewed journals from around the world, and countries which have better birth outcomes than we have in the US, many of which have high rates of homebirth as well. My goal was to understand the situation for what it really is, and I think I do. This is where realism comes in. Could something bad happen? Yes. Will it? I don't know. Is it likely? Not at all. In fact, it is far more likely that I will be hit by a speeding car while trying to make a left on Zaragoza tomorrow as I take Erin to dance class, than it is that something will go wrong during my homebirth. Yet somehow, I drive Zaragoza multiple times a week, which is statistically far more dangerous than having a baby at home, and nobody bats an eye. The key is to put things in perspective, and understand them for what they are, not what society wants you to think they are. So no, I am not afraid. When you make the right decision, it isn't scary to follow through.