Q&A: dispute about birth location

I hope this doesn't turn into "I disagree with my partner" week around here, but here's number two. Katie writes:

"I'm hoping you and the readers can shed a little commonsense light on my current *drama*.

I'm 20-ish weeks pregnant with my 2nd child. With my first, I had planned to go natural all the way, but at a hospital; I ended up with an epidural and pitocin. I had really looked forward to trying a home birth with my second. However, my husband is completely opposed to this idea.

He knows the statistics, he respects my desires, and it's not like he's "put his foot down" or anything medieval like that. But over the course of several conversations it's become clear that what he wants (all possible medical options readily available for mother and child) is not going to change. He's all for natural birth, it just has to be at a hospital for him to feel safe. I have extremely ambivalent reactions to this. On the one hand, I am all "womyn power" and wondering what the hell right he has to tell me how to do something that a man has actually never once done -- and what if this is my last child, my last chance to maybe have a birth go maybe sorta kinda the way I want it to? On the other hand, this is his child too, and the lives of two people he loves very dearly are at stake in what can be a pretty dangerous endeavor, and it's not unreasonable for him to want to protect us by having doctors ready and waiting.

I have a feeling we're going to end up with a classic compromise, where nobody involved is happy. I am truly, physically afraid of being in the hospital again, and my biggest fear is that even if we stay home until labor is pretty far along, once we get to the hospital my labor will stop because I am so freaked out, and then it's drugs and numb legs again. But I just don't think a home birth is possible without a partner who is in it a hundred percent. If any of your readers have had a similar situation between two stubborn spouses, I'd love to hear how things turned out."

It would solve everything if there's a true birth center in your area. Then you could have a birth that doesn't terrify you, and he could have a birth that doesn't terrify him.

Because that's what this really boils down to. You are terrified of being in the hospital, afraid of what's going to happen to your body and your autonomy and your child. He's terrified of not being in the hospital, afraid of what could happen to you or your child. And no matter how many stats you can show him (that planned homebirth is at least as safe if not safer for mother and baby than hospital birth, especially for a second baby) he's not going to lose that fear. No matter how many stats you can find about successful outcomes for second babies (and believe me, the second baby is ridiculously easier for almost every woman I've encountered) you're not just going to be able to lose your fear of the hospital.

Now I know there are some of you out there thinking, "What does she have to worry about? All she had was an epidural and pitocin. It's not like she had a c-section/huge episiotomy/horrific induction/preemie in the NICU/etc." Some of you probably deliberately asked for the epi and pit, and really don't get what Katie's worried about.

But this isn't misery poker. If you've read my first post on preventing PPD, you'll know that I think a Good Birth is so important for a mother. And you'll also remember my definition of a Good Birth: A Good birth is one in which you're respected as a person. So the actual details of what happened to Katie during her first birth aren't vital. What matters is that she didn't feel respected throughout the process. It sounds like she felt victimized, and she's really scared that she's just going to end up being shoved into the sausage factory again for this second birth.

Katie, I agree that it sounds like you can't really have a home birth, because it's just going to be too frightening to your husband. It's really, really a shame that you don't have a freestanding birth center near you, because that would absolutely bridge the gap for you and your husband. But since there isn't one and you're probably going to have to have the baby in a hospital, your focus should be on creating a team that will respect you during the entire process of the labor and delivery.

The crucial components you need to look for are:

1. A hospital with good stats for birth without interventions. One of my friends was the only person any of the nurses working that night had ever seen give birth without an epidural. In hindsight, she says she would have picked a different hospital. She knew she could do it, but the nurses were so out of their element without the epidural that they really had no idea how to support her. Birth is really not something you want to be a pioneer in, if you can help it, so find the hospital in your area that has the lowest rates of epidurals and pitocin use. (Since you're a second-timer I wouldn't really worry about c-section rates. Once you've had one vaginal birth your chance of having a c-section is teeny unless something really goes wrong, in which case you'd be happy the technology for the c-section existed.) By the same token, if you know you're going to have a c-section, you want to choose the hospital that does a ton of them, so it's standard procedure for them.

2. A doctor or midwife who really gets what you want and why you want it, and wants that for you, too. A provider who understands why you want an unmedicated birth (and isn't patronizing about it) is going to respect you and your wishes, and use that to help make decisions if things don't go according to plan. (Flip that around to "medicated birth" if that's what you want.) There's no guarantee that you'll have the birth you want, but having a provider who really is on your side means you'll come out of it feeling respected and like everyone did the absolute best they could, including you.

3. A doula. IMO it's absolutely worth it to pay someone to be with you from start to finish and provide a protective layer between the hospital bureaucracy and you. It's just too much of a risk to go into the hospital and take your chances with the nurses on duty if you're feeling that much fear, since the nurses make the whole experience unless you have someone else there advocating and translating for you. It works out if you have a great nurse, but if you have an inept nurse or a distracted nurse or a nurse who thinks the kind of birth you want is ridiculous or a nurse who's just a mean person, you get hung out to dry. Better to bring your own support person who's been at bunches of births and knows how to help you navigate the whole experience. You will probably get lucky, and the doula will spend most of the time helping you through contractions for a few very intense hours until your baby pops out easily with no tears.

So, yeah, this didn't turn into much about how to settle a marital dispute. I lucked out myself, because my own first birth (starting at a birth center and ending up at a hospital) was such an indictment of hospital birth that my husband was convinced easily to do a home birth. (It probably helped that during the interview, one of my midwives looked him straight in the eye and said coolly, "We don't play. If something happens we go to the hospital instantly.") I was happy with my home birth, but then pretty much every woman I know was happy with her second birth, especially compared to the first one, no matter where or how she had it.

Give me what you've got about this. Did any of you have a similar dispute? How did you resolve it?

Also, if anyone knows a good midwife and/or doula who works at Englewood Hospital in Englewood, NJ, will you email me to let me know? It's for a friend. Thanks.

Comments

[Sara]

Well, I didn't homebirth, but I birthed at a *very* natural-birth-friendly community hospital, with midwives. (Very as in, all the nurses very experienced in unmedicated birth, hot tub available, hospital *requests* birth plans rather than lauging at them and actually honors them).

I got the birth I wanted, both times. But even at my NCB-Friendly hospital, I might NOT have gotten it if I hadn't read Henci Goer's "Thinking Woman's Guide to a Better Birth" several times before my first was born. A hospital, even one that isn't a birthing assembly line that starts with "Insert epidural into slot A and Pitocin drip into Slot B," does a lot of stuff not based on any realistic medical evidence.

Having read TWGtaBB, I knew to vehemently refuse having my water broken, which was offered "to speed things up" and which, in my case, probably would have led to a series of interventions I most definitely did not want. I knew that continuous fetal monitoring would not improve my day and might cause my labor to slow and cause scary but meaningless data to be used to justify doing things do me. I was able to accept or turn down interventions based on a base of knowledge that both made sense to me and also was in language the medical personnel understood.

And I agree with all Moxie's points, especially that you *must* find a hospital/practitioner who is *truly* supportive of birth your way, and if you step into a hospital feeling the way you do about them, you need a doula.

[Ann]

My husband and I had the same dispute with our first child. Our compromise was a hospital where I felt more comfortable with the atmosphere (but without the infant intensive care unit that he wanted.) The birth went exactly as I hoped. Two things helped us reach the compromise:

1. Reaching the 38th week. My husband finally relaxed when he heard the doctor say, "Everything is looking perfect."

2. A doula! She was FANTASTIC! And not just for my benefit, but also for my husband! Check out dona.org to find doulas by location.

[k]

First I must admit that I am based in the Netherlands, which is the most home birth friendly country I have come across. But being a foreigner here, I was quite unsure about homebirths and we ended up making the agreement that we would prepare for both! So I packed a hospital bag AND ordered in the homebirth supplies. When the birth began we called the midwife who turned up at our place and once things got going I simply looked her in the eye and asked: how do you think it is going? should we stay here or go? She said that everything looked fine to her and both my husband and me were feeling ok too and we ended up having a homebirth. It wasn’t without drama though – as the midwife after an hour of pushing proposed that if the baby was not born within the next 20 minutes we would decamp to hospital. Now there is a motivator for pushing, right there J. But my point is that if you have the luxury of living close to the hospital it is completely possible to start at home and then move on to the hospital if things get hairy. This happens all the time here [again I am aware that I am lucky with my location]. Either way even if you decide to have a hospital birth – consider staying at home as long as you can or as close to transition as you dare.

[Judith]

I could have written this post four years ago. Here are some thoughts:

1. I met with home birth midwives and midwives who worked exclusively in a hospital and screened them all before I introduced two to my husband. This helped them answer my (generally) emotional-based qs and then when he was with them they could answer his statistic, "what-if" type qs. Both types of qs are very valid, just hard to answer both in the same meeting.

2. I found a passage in a book, (probably Ina May), that described the optimal conditions needed for birth. Here was what confirmed my belief for a home birth -- the book compared how the body prepares to give birth much the same way that, optimally, the body has loving sex. That is, think of the conditions your body and emotions need to have an orgasm. The books asks, could you be that open emotionally and physically in a hospital?

3. A fact that also swayed me about home birth is the "what if" scenario talked about. Assuming that the pregnancy etc. are all in the range of normal, if there was some sort of emergency while you were at the hospital and you needed a C-Section, from what I hear, it doesn't just take two minutes to get the room prepped and ready etc. The usual time is still 30 mins. If you live within 30 mins of a hospital, a midwife with hospital privledges could phone the hospital while you were being transported and when you get to the hospital the room would be ready for you -- same 30 mins. I know this particular aspect will have some readers shouting that their particular birth experience required a must have immediate C-section, but I can say that this particular fact did calm me quite a bit. For those readers, I also have to ask about any birth interventions that happened before a Dr said you needed a C. That is, were you given pitocin or other so-called labor-inducing drug or were you allowed to walk around, in your own clothes, in comfortable lighting, in familiar surroundings, etc? Because all those aspects help you body feel "safe" and ready to give birth.

I know some people may be upset at how I am phrasing this. Again, I'm just saying what worked for me. All bodies and emotions and experiences are different.

A final note for me, personally. I was sexually abused as a child. I knew that having strangers have access to my body at a time when I would need all my emotional and physical strength just wouldn't be optimal. It took almost a year to slowly convince my husband about home birth. We found midwives we loved who also had privledges at a local, good hospital. We also paid for a Doula -- ABSOLUTE BEST $500 or so that I have ever spent in my life. No kidding on that one.

I wouldn't trade my birth experiences for the world.

Of the nitty-gritty details, the only think I would change would be to also hire a post-partum doula for two or three days after simply to clean sheets and carpets. (As my husband euphemistically said the morning after my 24-hour labor and delivery at home, "birth is juicy.")

[Carmen]

Not sure how it works in the states, as I live in Britain, but here you get looked after Community midwives throughout your pregnancy, who also help you through a homebirth if you plan one.

If there is such a thing for you, would it maybe help your husband to speak to them?

I planned a homebirth for my baby, and initially my man wasn't too sure about it for the same reasons as yours, but after talking it through with the midwives, he was very much behind me.

This might sound terribly arrogant, but I do think that your voice counts a bit more in this, because it is your body, and it's going to help you *so much* to be in a place you're comfortable in. And the fact that you're already worried about labour stalling as soon as you get to hospital, is just going to make it more likely to happen, isn't it?

Obviously I realise it's not going to help your hubby to be told to shut up and get on with it, but you've still got a bit of time. Speak to him and/or get a supportive doctor/midwive/nurse to talk to him and make sure he knows why you want a home birth.

And if you don't get your homebirth after all, forgive yourself! Make your husband aware of your wishes and let him deal with annoying nurses. Oh ye - and if you haven't got one yet, write up a birth plan. Not only does it give you a clear idea of what you actually want, it also is something to shove in peoples faces when they try and overrule you just because.

Anyways, good luck with your pregnancy and birth!

[rudyinparis]

What I hear in your post primarily is the anxiety you fear you will feel giving birth in a hospital. As others have pointed out, a doula could be essential for you. Knowing this person is trained to advocate on your behalf could really help you let go of some of the fear (and allow you to focus on more important things!). Scoping out the right hospital (preferably with a midwife service) would also be key. I'd like also to mention the option of hypno-birthing. We used this with unbelievable success. It seems, in particular, that this may be a good fit for you as it focuses on deep relaxation. This would not only help you with the laboring, but also your emotions about being in a hospital. It's also just naturally aligned with the goal of a beautiful, intervention free birth. So this may be worth looking into and finding out more about. Combined with a doula and the right hospital you could have the wonderful birth you hope for. Best of luck!

[Emily]

I just want to be one more woman to agree with the absolute dream your birth can be when you have the right support people. And if/once you have your supportive and attentive midwife/OB and doula in place, write out a birth plan and discuss it with them. In my experience, my birth plan went in my file, which the hospital nurses then had to read or at least acknowledge. The particular night I gave birth, it was a slow night in delivery and there was only a nurse there at the beginning and at the very end; in my friend's situation (same midwife), nurses were there the entire time, and she could tell they'd read her birth plan.

I was really loving the idea of a home birth, but my husband wasn't, either, so we went this midwife/doula/hospital route, and it was a wonderful experience. I think it helped that my midwife has been delivering at that hospital for years, so all the personnel there know the typical "drill" with the midwife clients. If you have a midwife with a similar relationship with a hospital, all the better.

Good luck! You *can* and will have a wonderful birth the second time around!

[Shandra]

Okay I am going to go against the trend here. I am not slamming home births or hospitals; in fact my bad experience was in a (natural friendly, midwife-privileges) hospital.

But, I lost a daughter to a cord accident at birth (she lived four days, during two of which we really had to stare the possibility of a tremendously disabled child down).

I am a little tired of the "birth is a natural process" position... yes, it is. And Nature, red in tooth and claw, is fine with losing a couple of babies out of every one hundred. Infant and maternal mortality rates are low in part because of advances in medical intervention (yes there was a time that it caused more problems than it solved). And when things go wrong, sometimes they go wrong really quickly.

Modern midwives are totally a part of that team; I am not slamming them at all. But I do sometimes think people are going too far the other way here and presuming that their labours are going to be easy. I'm a little concerned by the anecdotal "second babies are easier" thing. Second babies are no less susceptible to birthing accidents like cord problems.

And although I agree that a good birth experience is something everyone should want, the reality in my mind, with my biases due to my experience, is that a good birth is one where everyone comes home alive and with their faculties intact. Period.

Sometimes I think the expectation that we DESERVE a particular kind of labour and delivery can mess us up. Don't get me wrong; I am all about the speak up and get what you want thing, but there ARE things worse than the clinical white glare of paint on concrete block.

Yes, you have a point. Your husband also has a point; we were very glad that our daughter was where she could be revived, because if the damage had been a little less, that would have meant bringing her home.

So... yah. I think there are ways to discuss and negotiate this - find a birthing centre or hospital that will support your goals; if you decide to stay home have a CLEAR and FAST transfer plan. Again, I am not slamming midwives or home births. I am just saying that there is no risk-free labour, and your husband is not crazy for being concerned. Do stay focused here on what you really want and that's a healthy baby.

[Kate]

I just wanted to chime in about Moxie's idea of a Good Birth. I wanted a med-free, intervention-free doula-supported hospital birth.

What I got (both times) was a doula-supported, home-laboring-to-hospital C-section.

BUT! I was the driver.

I decided when to go to the hospital. I decided when to start the chain of interventions (the first time, my doula actually encouraged the Pit drip, because we had tried everything else). With #2, I told the attending OB to step off and leave me alone when he refused to give me pitocin to progress me....and waited until my OB came on service. I decided when to stop pushing and opt for the C-section--I had the option for another hour at least, but based on the nice purple bruise on his head, my son wasn't going to get past my pubic bone in another DAY.

Both times my C-sections were necessary. My intentions were good, but they were not good enough to overcome the laws of physics and my husband's family's enormous heads.

But because I really put myself through a trial of labor [and it was a TRIAL], I wasn't dissatisfied. Either time. I had amazing support--doula, OB, husband.

I hope that Katie is able to find the providers [doula, midwife, etc] she needs to have a satisfying birth...the ultimate thing she needs is a plan that makes everyone comfortable, but SHE needs to be the driver.

You really never know what's going to happen. A friend just delivered her third via hospital-transfer-C-section, after two uncomplicated homebirths....

(Babble much? sorry....)

[MrsHaley]

Shandra, I can't imagine. I'm so sorry you had to go through such horror.

When I hear discussions about this subject, I always think about the 20-30% infant mortality rate of the 17th and 18th centuries when homebirth was the ONLY option ...

Midwives and doulas, etc. are certainly more highly-trained than they were several hundred years ago, but "birth accidents" are no less common -- we just have the medical technology / knowledge to deal with them.

So what I'm saying is, I agree with Katie's husband. Especially with a detailed birth plan and the presence of a doula & midwife, perhaps the only difference between what they each want is the LOCATION of the birth and not its NATURE, you know? I mean, an unmedicated labor with all the freedoms Ina prescribes can occur in a place where all medical interventions necessary can be had at a moment's notice.

So maybe the focus could shift from the building in which the birth takes place to the characteristics of the birth itself, on which the building could have very little impact, as long as everyone involved is well-prepared and well-informed.

Or you could just head on down to The Farm in Tennessee!

[Jan]

We had a sort of similar situation with my second. Not about home birth, because I have never wanted that, but I wanted to try VBAC. My OB was willing to let us make the decision, but advised against it (my first c-section was pretty nasty) and my husband was totally freaked-out against it. I don't know what would have happened if I'd insisted, but I do know it would have created a stress all of its own. In the end it just didn't seem fair to make a potentially-life-threatening decision for all three of us and I opted for a scheduled c-section. A part of me is still a little sad that I did it that way, but I'm not sorry that I made a decision that considered his feelings.

Katie, I think you've got some good advice from Moxie about how to be the driver (I like that analogy, Kate) for your birth. I would also enlist your husband -- mine was my best advocate when I was laboring. He's the one that knows me well enough to see when I'm getting anxious and he knows that I like my water without ice, ya know?

I wonder if if might help you to do some talk therapy counselling before you give birth? Unresolved feelings from your last experience could definitely affect this upcoming one. Maybe your midwife could recommend someone?

This is getting long, but there's one last thing I want to say. I think having an idea of what you want to have happen is great. Ideal. But ideal is often not reality and expecting ideal is likely to lead to disappointment. If we can begin to accept 'everyone is healthy at the end' as the definition for a successful birth, maybe we wouldn't have so many women feeling disappointed and depressed because something didn't go according to plan.

[Mona]

The only suggestion I would add is to do some work at relaxing both before and during the birth so that you are more comfortable in the hospital if that is what you choose. Either Hypnobirth or Bradley or something that appeals to you that can lessen the anxiety both leading up to the birth and during the labor/birth. I think that could be a huge help no matter what you do.

[Katy]

Just wanted to add another encouragement to hire a doula. My husband was actually iffy on the idea during my first pregnancy, but I insisted that we have a doula. She was wonderful, and helped us have a good (hospital/midwife) birth experience.

The second time, he was completely in support of hiring a doula, having seen from the first experience how helpful it was to have her there.

To me, the best thing about having a doula there is that she is someone who is totally looking out for you, but isn't cloudy from being 'in' the experience, the way you and your husband can be. When I was in pain, it was difficult for me or my husband to think clearly - but the doula could remind us of our goal, and offer us suggestions to help the pain in non-medical ways, as well as helping us in our interactions with the medical staff. Having a doula also took the pressure of being a 'labor coach' off of my husband, so he could just support me emotionally.

I hope you are able to find a supportive team of people who can help you feel more in control of your birth experience, however it goes. Good luck!

[AmyinMotown]

The tone of this discussion for the most part, has been really impressive since this is one of the issues where the insults can start flying thick and fast. Yay us!

I know here in MI, some friends have had very positive experiences at a hospital based birth center, where basically you go down one hall and it's a traditional labor and delivery and down the other it looks like hotel rooms. (Providence, just in case you're local to me). So all the emergency stuff is there, but you can avoid the "hospital" feeling. I wonder if something like that exists for you? My crunchiest friends both gave birth there and were happy with it.

This brings up a questions: Where can I find the information you describe in your first point, Moxie? (intervention rates at hospitals).

[Michelle]

I had a very similar story a few months ago. I had every intention to have a natural birth with my first child but ended up with pitocin and an epi. I did have a wonderful doula and felt great about the birth even though it didn't go as "planned".

My second child was due in July of this year and I didn't want a repeat of the pit/epi at a hospital - so I started thinking about a home birth. My doula is also a licensed midwife in my state so it was easy to get more information and I felt very comfortable with her already.

A friend of mine had a wonderful experience at home in May and after that I told my husband I wanted a home birth. At first he was very much opposed, for 3 reasons: 1. Risk of something going wrong, 2. the "ick" factor (let's face it, birth ain't pretty), and 3. the cost - our insurance would not cover the midwifery fee but everything is covered at a hospital.

He was willing to listen though, so we sat down with the midwife, I read parts of the Ina May book to him, and we discussed his fears and hesitations.

Eventually, he did agree to support my decision - saying it was my body and in the end, my birth and if I wanted to do it at home he would support me. He still wasn't 100% with the idea, but he knew I was and he also knew how important a natural birth was to me.

On July 7, 2007 I gave birth at home to a 7lb, 15 oz. baby girl - with no complications whatsoever. For me, home birth was the right choice and I wish this country (the US) was a little more evolved in prenatal and birth care.

Home birth is certainly not the right choice for everyone, but in general women in the US are programmed to think of birth as an "illness" and conditioned to expect the worst. That is frustrating and sad to me, since many women could be having natural births in the setting of their choice if they were better informed.

[Alice]

I labored at home with my DOULA to the point I was pushing. Which meant we got to the birth center (not a hospital) and I was complete and my daughter was halfway out!

So I suggest a FANTASTIC doula. Interview at least 3 like you interview midwives. Maybe a doula who is training to be a midwife. They can make it or break it in my opinion. My goal was to labor at home as long as possible and that I did. But you can only do this if you trust your doula completely, are honest with her (I say her since pretty much all of them are) and are prepared to stay home through the rough patches. Then you show up to the hospital, where there is little time for interference from nurses/doctors etc.

[Elizabeth]

When I had my baby we lived near a true birth center. Honestly, it was sort of like going to someone else's bedroom to have the baby rather than just staying in my own, because the CNMs that ran it would have brought all their equipment with them to our house. But our insurance wouldn't pay for a homebirth and would pay for the birth center, and my husband was more comfortable that way too.

Nevertheless, my husband wasn't totally comfortable with the arrangement at first. We did a "first" prenatal visit with both the midwives and with an OB. He immediately fell in love with the care and time the midwives gave us, and decided he was totally fine with going the birth center route. And then he heard a birth horror story (fourth degree tears, hemmorhage) and starting freaking out. I was getting panicky, worrying that he would "put his foot down" and it would turn into a fight. I told him to discuss it with a midwife at our next visit. So the next time we were at the birth center, for a visit that they probably had planned to take 20 minutes, we sat and talked with the midwife for 90 minutes. My husband told her the story of our friend's birth and she explained to him exactly how they would have handled it, including how they would have tried to prevent what happened and how they would have handled the transfer had it been necessary. He kept coming up with slightly different scenarios and she calmly explained how I would be cared for. Eventually he was reassured.

We also drove the route from the birth center to the two hospitals multiple times. One was for a non-emergency transfer, and one was the nearer hospital where an ambulance would have taken me. He wanted to know that he could get us to the first without having to think, and he wanted to know how long it would take to get to the second even if we didn't have the benefit of sirens (under 5 minutes).

The birth center required that we have a doula with us, and that helped my husband be reassured, too. We also brought our yoga teacher with us to the birth center, and she was able to provide extra support to both of us.

I think it was so important to have my husband comfortable with the idea of the birth center. First he had to be comfortable with the prenatal care I was receiving. That one was easy. Then there was reassuring him that the baby would be okay, and I would be okay. That took more time, but we managed it.

[caramama]

I'm putting in another plug for having a doula, as well as a supportive husband and OB/midwife. Nothing about my birth went according to my "ideal" but I was not disappointed with it--not even the C-section I ended up having. I believe this was in large part due to having a doula who knew what I wanted but also had that outside perspective that Katy talked about. So after I stalled at 8cm for 6 hours with a swollen cervix, even she agreed that it looked like it was time for a C-section.

Having the doula and my husband's support gave me a relaxing environment in the hospital. The hospital, nurses and my OB were totally onboard with my birthing plan and tried to give me the atmosphere and level of intervention I wanted, including the dim lights and relaxing music.

So I guess I'm basically supporting what Moxie said about finding the right hospital and OB/midwife, making sure your husband will be supportive of whatever you decide to do, and having a doula who can help you through it all from her unique perspective.

One last thing to consider: My sister started her labor at a birthing center and ended it with an emergency ambulance ride (30 minutes long) to the hospital! It was the scariest time in my life, her life and our whole family's lives, since I was honestly worried my sister and/or niece was about to die in childbirth. Luckily, everything worked out for her, but I imagine others (like Shandra) have not/would not have been so lucky. It is why my husband and I only considered a hospital.

Sorry that's so long and rambling. I hope that you and your husband are able to work it out.

[Summer]

A few others have mentioned birth hypnosis, but I just have to chime in with my support for hypnobirthing. It was a godsend for me, and I think it would be very, very helpful for the writer.

My story, in a nutshell, is that I lost my first pregnancy in the second trimester, and had an absolutely AWFUL three-day ordeal of an induced delivery. It was alien-abduction-level terrifying (the whole story's on my blog, for anyone interested), so I faced the birth of my son, a mere 11 months later, with far more fears than the average woman. I was scared to birth in the same hospital, but I did; with my history, I wouldn't have been a good risk for a homebirth, and with my level of fear, I needed the reassurance of being at a hospital with a top-level NICU and all the other facilities. Yet I was determined to have as non-medical a birth as possible, and I did, thanks to an understanding OB and hypnobirthing.

The idea behind hypnobirthing is that fear leads to physical tension, which increases pain and the perception of pain. I worked one-on-one with a hypnobirthing instructor who dealt patiently with all my fears, from the fear of losing another child to the basic fear of having a repeat of the awful hospital experience. It worked, and I walked into the hospital calm and collected, even though I was in transition, and I stayed calm and peaceful throughout the birth. I can't say it was pain-free, but it was managable without drugs, and I was free of fear.

The words "fear" and "panic" in the question immediately made me think that hypnobirthing would be very helpful for this expectant mother. I can't recommend it enough. (Moxie, feel free to pass on my email address to her if she'd like to ask me more about birth hypnosis.)

[O]

Two quick thoughts:
1) My friend & neighbor on my street had a home birth, followed by two separate ambulance rides--for no reason except a nervous midwife and overzealous EMT who came to the scene. So keep in mind that many home births don't quite go as planned even if all is ok.
2) GET A DOCTOR YOU LOVE. This made all the difference for me. Note I said doctor; I adore midwives but the MD was critical to the peace of mind factor. But, my OB allowed me to labor for almost 24 hours before even thinking about calling for a c-section (which I did narrowly avoid, though after 10 hours of labor with a 10lb 10.5oz baby, the end of which had no drugs at all, I was ready to sign up for anything that would take consciousness away). I did the tractor pull, the trapeze, you name it. And even with that big a baby, there was no tearing and no episiotomy, because my doctor and I agreed that the episiotomy should be avoided if at all possible. (He had encouraged us to do massage for a few weeks before and certainly all during labor to try to ease things along. Thank whatever mercy there is in the universe that it worked for me.) Have faith that there is a doctor and a hospital somewhere that will agree with you on how much direction you should have on your birth experience. And good luck finding them.
Finally, my OB did all this while reminding me that he needed to ultimately call the shots to keep my life and my baby's life as safe as could be. We trusted each other on this; it was a beautiful thing. I hope sincerely that you find that for this birth!

[hedra]

Great answer, great comments.

I have one nit to pick regarding fears. you CAN release them. Both parties. I highly recommend talking to a) a hypnotherapist who can help you resolve the fear issues - both sides, or b) a counselor (less effective or speedy, IMHO, but helpful still) who can do the same.

The fears are the stumbling block, not the solution. Throwing feelings or stats around will not, as Moxie noted, solve anything. The fears have to be identified and RELEASED, not just hammered at. THEN, problem solving can occur. You can attempt to problem solve past the fears, but it is tricky and IMHO, exhausting work.

The problem-solving portion functions as Moxie described. It is just vastly easier with no fears entangled.

I also ditto heavily the DOULA idea. SERIOUSLY BIG DITTOS. Go to maternitywise.org and print out the entire PDF of the Cochrane Medical Review of birth assitance. While you're there, review the benefits and risks (evidence-based) of every intervention/approach, and review them together. Much of the fear issue also comes from lack of reliable data - better if you have him research this part, and pinpoint the things that are the biggest issues for him, so he can make a plan or learn more about those issues. They won't be what actually comes up, in all likelihood, but a plan helps calm the free-floating anxiety.

I have tried three times for a birth center birth. I'm okay with home birth, I just don't really feel like laboring at home most of the time. I actually prefer to 'come *home* to my nest' rather than 'birth there'. :shrug: It isn't a huge preference, and with the twins, I was edging toward home birth slightly... until I found out it was twins, anyway.

But no go. Three attempts at birth center, three hospital births. One great, supportive, considerate, evidence-based birth experience with fabo support - challenging labor, great birth; one really awful experience in hospital with the most disrespectful unethical backup OB imaginable, but with a fabulous actual labor, supportive doula(s) and DH, and the birth wasn't bad, just would rather have avoided that OB (like the plague); one amazing, near-perfect, easy, powerful, respected, lovely birth (okay, two, since that was the twins).

Doulas, each time, helped dodge the pressures and disrespect, even when offered as the *default expectation* at that second hospital. Doulas, and my DH being REALLY on board (and not prone to fear - well educated in issues and support - I recommend "The Birth Partner" book)... I managed to get 90% of what I asked for with their help.

Hypnobirthing ROCKS for helping with the pain management, fear management, and stress reduction, by the way. I feared that labor would be long (hey, the first one was LOOOOOOONG, even a shorter one might be 'too long'), and that it would be further slowed by the stresses I was under the second time - high risk issue identified just days before the birth, OB was fear-based and fear-mongering, nursing staff 'encouraged fear and pain' by saying things like 'we'll turn up the pitocin until you can't stand the pain anymore' (um, HELLO? TWO nurses said just that, word for word!). BUT - despite the stresses they kept trying to put on us, the hypnotherapy and doula(s) combined to allow me separation from what was essentially THEIR problems, not mine. I was protected, and even when the complete nit of an OB succeeded in scaring me into thinking that my baby might indeed be too big for me to birth safely, a quick script run with the doula (who happened to also be my hypnotherapy instructor) released that fear and I was back on track - and while my first labor was 80 hours long (no foolin'), my second, with the hypnotherapy, was 4.5 hours, and the fastest part was in the hospital, AFTER the nit OB tried to scare me into agreeing to a c-section. 4.5 cm to 10 cm in 40 minutes. WOO! The next hypnotherapy labor was also 4.5 hours, ~30 minutes from 5 cm to 10 cm. So if you can get the fear out of the personal cycle, they cannot force your labor to slow. That part CAN be under your command.

There was plenty to fear that third time, too, though I switched back to the hospital I preferred (better rates of interventions there, more midwifery model). Twins births can be pretty challenging. Mine both flipped to breech juuuust before they were born, so instead of a nice vertex/vertex (both head down) vaginal birth with no meds, I ended up with a breech (single-footling)/breech(double-footling extraction) vaginal birth with no meds. Scared the poor backup OB half to death, though she coped anyway (and again, not a provider I'd ever seen before - my OB missed the birth by 2 minutes, dangit!). Certainly, some fears possible in that scenario! But they didn't throw us - we managed from evidence and current situation, rather than emotion, because I'd already worked through the emotions of being in the hospital, needing meds (bad reactions on first labor), needing surgery, etc., etc. every possible scenario had been run, and all had been converted from fear-based scenarios to positive ones in my psyche - all using hypnotherapy.

It doesn't hurt that hypnotherapy labors tend to be short (not always, but definite tendency). If you think you (and your partner) can practice twice a week, odds are good that it will help no matter how the actual birth proceeds (even if you do have a medically required need for interventions, it helps!). If you can practice more than that, even better.

It only takes one-two sessions to handle most fear issues, even deep fears based on past traumatic experiences. Release those, and then solve the problems creatively. Think about it - your problem isn't that your DH wants you to birth in a fearful place, it is that you fear, and he fears. The solution isn't 'avoid the situation that I fear vs avoid the situation that he fears' but 'avoid trauma all around'. You need the third solution. That's not a compromise (everyone being equally unhappy), that's resolution. My mom taught me that there is always another option, something that hasn't been considered or that wasn't imagined. In your case, you could do many things together that would work, IMHO. Working together I think you CAN find the one that works best for you both.

[Amy]

I totally second (third? fourth?) the idea of someone who is there for the sole purpose of supporting you and your decisions. It doesn't have to be a doula; I had my best friend who helped me labour most of the day with my son (he was born an hour after we got to the hospital after 11 hours labouring at home), and I returned the favour with both of her labours/births. I was her support, her leaning post, her advocate. I shooed them away when they tried to break her water during her natural birth (at 4cms), and allowed her to forgive herself for hitting the wall before getting an epi after 20 hours of excruciating pit-induced labour. Things will not always turn out the exact way that you want, but having people there that respect your wishes and can act as a buffer against anyone (doctors, residents, nurses) that don't, is a godsend.

Good luck!

[amy]

Our insurance would only cover birth in the (reputedly) interventionist research hospital in our city, not the more laid-back hosptal down the street from our house, and definitely not the birthing center. So we hired a doula and it made a huge difference. In the end the OB on call that day was the best of the bunch, but it was the nurse who ran the show, and the nurse was horrible. So having the doula there was essential to negotiating the unpleasantness of an overzealous nurse with (seemingly) little experience seeing a woman through an unmedicated birth.

[Shelby]

I think that getting a doula will achieve your best results. I both agree and disagree with Amy about having a friend there. My best friend and I were at each others' births, but she and I were pregnant together and both attended the same birth class, and were very clear about each other's goals and desires. Not every friendship has this benefit, and a lot of friends have their own agendas, or fears, or beliefs that might interfere with our own in the intense time of childbirth. We both also had doulas, in my case I had two doulas and my BF. And two midwives. And I believe that because of all of this support, I was able to have a vaginal birth. I did end up needing some interventions, but I avoided induction (I had to sign 5 Against Medical Advise waivers, and all the tests to see if the baby was doing OK came back with stellar results the whole time). I firmly believe that I would have ended up with a C-section if they had induced me with Pit. As it was, I pushed for 6 hours and they ended up helping my little girl out with a vacuum. But then, I also believe that if I had chosen a home birth, I would not have been so post-dates (15 days) because I wouldn't have had to go in to the hospital every 3 days for them to scare the crap out of me with every horrible scenario that could happen because I wouldn't let them pump me full of drugs. Next time? Home birth for sure.

[hedra]

Oh, wanted to point out one of the things that often gets missed, that many of us are aiming at in our responses:

The goal of birth is for all to come home healthy and safe, *without undue trauma*

That includes being respected as a human being in the process of labor. Unfortunately, a lot of the traumatic labors I hear about are due to the disrespect factor. I've heard absolutely heart-rending experiences, fetal losses and injuries, etc., but that do not produce trauma beyond the logical outcomes of the experience itself. That is, no UNDUE trauma. Due trauma in traumatic situations, granted. But there is a great deal of trauma that is generated by simple disregard, actions to create submission to authority regardless of need, etc.

Some births will be traumatic - even good, respectful births with healthy outcomes can be traumatic, especially if we expected something different. JUST aiming for healthy, safe, and respected goes a long long way toward a whole, sane, acceptable experience that can be integrated into one's life without psychological damage. My greatest traumas came from being disrespected, NOT from locations or actual interventions. I *agreed* to AROM twice (three times if we count the second amnion with the twins for the extraction), though I don't generally consider it useful. It was once 'something to try' and once 'a way to control the timing so we could spot cord prolapse in a controlled manner' and once for the extraction (technical necessity to avoid a transverse second twin). The agreement is the key. I've used pitocin when I would rather not, I've used an epidural when I'd rather not... 'rather' being absolutes, but in the situation, respectfully discussed, and respectfully decided, and respectfully applied meant no fear, no anger, no resentment.

I think you can get good safe results in a variety of situations, with most conditions. No situation will be utterly safe, but any situation can be respectful. Find the balance point, and aim for safe, healthy, and respectful. No undue trauma that way.

[hedra]

Wait, I think I ended up at 'Safe, Respectful, Kind' again... ;)

[pnuts mama]

i want to preface this statement with the caveat that i in no way mean any disrespect to anyone who is reading this or left comments already. i'm also not trying to start anything, because i do believe that parents who have educated themselves in the wide range of possibilities that the birthing process can bring have the right to choose whatever safe environment they feel comfortable with to bring their child into the world.

ok. i may in the minority here, but i would just like to defend the medical professionals who work in the field of obstetrics and gynecology. both of my parents were registered nurses, and i know plenty of nurses and doctors and technicians who are fantastic and caring and supportive of their patients, and remember why they chose their vocation to begin with. i know that there are bad members of any profession, but i don't think that the medical field has a disproportionate amount of them.

it bothers me very much that for so many of us (and i understand that some experiences warrant this) there is an attitude of "us vs. them" when it comes to medical care, instead of treating all parties as members of the same team with the same goals (whatever they may be). as if every doctor/nurse/PCA has the goal of running your birth like a "factory"- the reality often is that many women whom they work with rely on them completely to be taken through the entire birthing process, or they deal with people who treat them like servants. it's amazing what looking in someone's eyes and talking to them like a person and a professional will do at times.

i also am bothered that so many people i meet don't fully embrace their equal power in the healthcare provider-patient team- if you don't like your doctor, or nurse, or technician, then you have the right (and some would say the responsibility) to speak to that person directly, and if you can't resolve you issues, ask for someone else. or go to a different doctor/midwife practice, and a different hospital. oftentimes the things we dislike the most about our medical care are things that we have the right to change, or have the power to choose different options for ourselves, even if it means signing a waiver or requesting to speak to that persons superior.

this is too long already to share my wonderful and beautiful hospital experience which included cervidil after my water broke at 36 weeks and i never had a contraction and a lovely requested epidural and then magnesium sulfate to reduce my chance of dying from eclampsia. i love my OB and i loved the nurses we had and i was grateful to be in a place that had a top-notch NICU and reputation for obstetric excellence. i wouldn't have gone there otherwise- they took great care of us and i hope no matter what your choice is, you receive the same level of care that i did. good luck!

[Megan]

I would also like to plug Hypnobirthing. Besides the classes my husband and I attended and the practice at home, I had a CD of birth affirmations that I played every day during my work commute. It talked about releasing fear, that I could have a birth free from fear, etc. I really think that CD worked its way into my subconscious like nothing else.

My birth was about 4 hours long (went from 1 cm to 9 in about an hour). My midwife said she had never seen such a rapid first birth in the last 80 births she had attended. It wasn't without pain, but it WAS without fear and anxiety.

No matter what kind of birth experience you have, I truly believe hypnobirthing can make it better. In our hypnobirthing class, many of the women ended up needing to birth in the hospital (not their first choice), and they still said they felt that our classes had helped tremendously.

[Charisse]

I 15th the idea of a doula! I too am scared of hospitals and very scared of anesthesia (yes I'm weird, I have dental work without it, etc.), but growing up as the daughter of an OB also made me lean the hospital direction after knowing plenty about the possible complications. (Ok, these things are probably related.)

Anyway, this was my first birth and I really wanted to avoid epidurals and such if I could. We hired a great doula who was also a hypnobirthing instructor and yoga practitioner, and one of the great things we did was work through the scenarios in advance and think about what I would need if things did go otherwise than planned. We made an agreement that in the event I needed an epidural, for whatever reason, my doula would stay by my side until I could feel my legs again, no matter how long that took. Having that backup allowed me to let go of much of the fear.

In the end, all went more according to plan than not, and I give the doula much of the credit for that as well--she came to my house at 4:30AM and stayed with me until we thought I was entering transition. Then we went to the hospital and (it being a big hospital) with nobody else I knew happening to be on call, having her there was amazing.

[wavybrains]

There's already tons of comments endorsing the doula, but I had to chime in too. I was in the same boat several months ago. My husband and I resolved the hospital/home debate by hiring a trained, experienced Doula. Our doula is certified by Birthing from Within, which also has great tips for making your hospital birth your own, and carries several other certifications as well. In my area (Pacific Northwest), there are many women who call themselves Doulas, but it pays to do a few interviews and learn about their experience/training. By choosing a doula whom our doctors/midwives respect, I 'm hoping that all can work together as a team, rather than doula-against-doctor which I've heard several stories about too. Our doula offered us a payment plan, so be sure to ask about that too!

Also, try to find a practice with certified nurse midwives that allows those midwives some autonomy over the birthing experience. It took some searching, but we found such a practice & hospital, and we're much happier with them than with our first practice/hospital.

After hiring the doula, switching practices and hospitals, and taking additional classes, I feel pretty confident that I'll be getting the best of both worlds when I deliver in the next few weeks. And most importantly, my husband agrees :)

[hedra]

:clap clap clap!:

You are of course totally correct - we DO have the right to address any concerns with the providers in question.

I did address my concerns with the staff I was having trouble with that second time. One of them (the OB) just became uppity (but then, she had no people skills, not sure why she was in the profession!), but the nurse... the nurse did a 180, and advocated for me like crazy. I also always advise treating the staff with the same respect and kindness that one wants. It goes a long way to show your regard for their job (always assume they are doing their best for the best purposes, but may not know how to help YOU best - help them understand if you can!).

We brought a huge basket of treats for the nursing staff, as an advance thank-you for their efforts to help us have a safe and respectful birth experience. It is only a kindness, but kindness helps. My doula spoke to the nurse who was telling me she intended to cause me pain. She really didn't know she said that - it was autopilot phrasing, not intent. She went from being really irritated that we were trying to make them change the usual path of labor (THEIR usual path) to insisting that if I was struggling and asking for an epidural, it MUST be because something had changed drastically - and she was the one to tell me that I was in transition.

OBs may have goals that conflict with yours, regardless - some, and some will say 'many', go into Obstetrics to 'save the lives of babies'. It is a noble goal. It also may be in conflict with the goal of having JUST a safe and respectful birth. If there's no saving required, some OBs *DO* look for a crisis so they can feel they have been of use. (This is from the mouth of a head of Obstetrics at a major hospital - OBs often feel useless when labor progresses normally, and this makes them uncomfortable but they don't know why, so they look for issues, and sometimes find 'something' ... and then they feel relief because they can SAVE THE BABY! ... even if it doesn't need to be saved.) Be clear about your goals, and be clear with them if you see their goals going some other direction.

As much as I detest that one OB, as much as I wonder why she's doing that job, I had no trouble at all forgiving her for her fear. She was fear-based, yes. She BELEIVED she was right. She wasn't being scared on purpose, nor was she being unethical because she felt like it - she was unethical because she was scared for my baby, and felt that being unethical was the lesser of two evils. She was incorrect.

At the time, I did not know that I could ask for a change of OB staff - another doctor would have been much better. And it didn't seem too necessary once she left the room, as my midwife showed up to help support my labor (the OB only showed up again right as it was time to catch - and she did apologize later, though she told the midwife that she did so because she was afraid I'd sue her if she didn't.) So, yeah, one OB sucked.

But the other OB's I've worked with have been excellent. One was the one who as backup to my midwives (in hospital) said to trust me, trust my baby, and follow the evidence - it wasn't necessary to suggest a c-section if we were all doing fine, no matter HOW long labor had been. Fine is fine, and the clock does not apply. WOO! The OB for my twins preg was amazing - respectful, generous, and always a problem-solver... it was he who told me that the anesthesiologist is THE BOSS in the surgical suite, so being respectful of them (when they get very little respect in general) would be my route to possibly allowing my DH and mom and doula to be present in case of a c-section. Useful! The backup OB was scared to death, but she was also willing to trust me on the fly, and work with me, rather than react to her fears without regard to the human patient.

Having dealt with my own issues around hospitals and interventions, getting rid of my OWN fears about the authority/force issues, etc., also helped me really work with the staff. It made it possible for me to really consider their position, and to see how I could make their job easier WHILE making my experience better.

If you know medical staff people personally, and well, you'll likely have an easier time seeing them as human and being able to approach them as an equal. If you don't, and you grew up in the US, odds are good that you were raised to bow to their authority, to fear their power, and to (understandably) resent and rebel against that power when placed in a vulnerable position. We do it all the time - we drag our feet about seeing doctors, and we don't *quite* follow their orders, and all the other typical adolescent ploys we all know for resisting the power of imposed authority.

pnuts mama is correct that by stepping up to the process, by interacting and taking the steps that express our own power, we can work together. We don't have to WIN (meaning they lose), they don't have to WIN (meaning we lose), we can find another path, that third alternative, the no-lose option. A doula is one way to do that, because they are neither in nor out of the power structure - not the patient, not the doctor. Losing the fear is another - by not being afraid of the power of the medical system, I stopped being reactive against it, and was able to be helpful, compassionate, friendly, kind, respectful.

[Linda]

I'm an RN in an adult intensive care unit so I'm obviously comfortable with hospitals and technology. I did, however, have an unmedicated vaginal twin delivery in a hospital setting.

That said, I really wish that I could convey how difficult it is to take care of patients/families who come to the hospital believing that all we want is to hurt them or their family member. When questions or concerns are put forth in an aggressive or accusatory way, when medical opinion is dismissed without any teaching or discussion, when people seem to believe the worst about the hospital and professionals who work there . . . I just want to scream.

We are not perfect. There are some really crappy doctors and nurses and also some crappy decisions made in the heat of the moment. Many of us are tired, have our own issues, we may prioritize other things that you don't know about, our personalities might not mesh with yours, new nurses may lack education in certain areas . . . but we are not out to cause any sort of trauma to our patients. We are sometimes hampered by policies or procedures made by higher-ups with no recent bedside care experience. People threatened to sue us regularly, we are often verbally and physically assaulted, and we deal with overwhelming sorrow on a regular basis. Sometimes these things can diminish our ability for compassion~if I let myself feel deeply for every patient, I would be a wreck. I have to maintain some sort of professionalism. Maybe this would come off as cold to some of you; I don't know.

Most of us enjoy working with patients and families. We want to have a positive experience and the best possible outcome for everyone. When patients enter the hospital with a huge chip on their shoulder, it makes it infinitely harder for that to happen. Thanks to those above who have said positive things about their nurses/midwives/physicians.

That said, I did a lot of education and research with my twin birth and ended up having a good experience in a high-risk setting. I had to give on a few things (continuous monitoring, an IV) and refused a few others (epidural, internal fetal monitor). My OB and I talked about my wishes beforehand and I asked lots of questions, especially if I didn't understand something completely. Like with any relationship, it was give-and-take. We compromised in some areas and I was a hard-ass in others.

[Shandra]

"The goal of birth is for all to come home healthy and safe, *without undue trauma*

That includes being respected as a human being in the process of labor. "

That's true, yes, and part of my remaining issues (including this being a hot-button topic for me) are around how the first hospital where we had my daughter treated me like a pariah after that event.

I did a long and hard search for a hospital for a second birth. And the staff were great - human, of course, but great.

But, and I am totally coming from out out-of-the-norm place on this so feel free to ignore, everyone, but I am still going to stick to my opinion on this one: my priorities since that day will forever be safety first and respect second.

YES you should be able to have both, for sure.

But - and this is very general, not directed at anyone - sometimes I think that there is a kind of anti-medical movement that is choosing to ignore the risks of being a distance from technology, because there might be an asshole doctor there directing its use.

If people want to assume those risks, that's fine. Truly. We all take risks or don't, make calls blindly, and we don't control everything, and that is truly okay.

My experience though was that those risks were NOT discussed in pre-labour classes and that people (including me, offline) do not discuss these things much because they don't want to "upset the pregnant lady." So I just have to say, don't downplay the risks in the name of attaining a "perfect" natural experience. THEN make your decision.

It sucks and the original questioner has all my sympathies.

As a coda, I did deliver vaginally again the second time, and I am really glad to have had that experience.

[liz]

My 97-year-old grandfather died two weeks ago after making the decision to stop dialysis against his doctor's wishes, "I don't want to lose you," his doctor said. But my grandfather had been sent to the hospital 3 times with infections after starting dialysis at the beginning of the summer and wanted to die as he'd lived: independently and in his own home. Just a few days before, he good-naturedly but firmly made sure that a nurse that was about to give him a medication to lower his blood pressure actually CHECKED his blood pressure first - she found (as he knew she would) that it was already dangerously low.

What does this have to do with this thread? My grandfather knew what he wanted and was able to articulate it, insist on it, and get his family to help advocate for it. You need to feel that your birthing team is supportive and respectful. You need to feel that they are not just going to treat you as an incubator that is carrying a baby.

Discuss your fears and desires with your husband, OB, floor nurses, everyone in the world. Make sure that they hear you and are willing to respect you. If having a doula will do that, hire one. If having a written birth plan will do that, write one. If changing OB practices or hospital shopping will do that, go for it.

[Helen]

So you've got two persons with strong feelings about this question, and with valid concerns. But in the end, I have to say your feelings matter more, because your body is the one that will actually be giving birth.

Your body will be strongly affected by what's going on in your mind. If your mind is feeling unsecure, stressed, hassled, distracted, then you are not going to be able to focus on giving birth, and your body won't be able to give its all. You need to feel safe and relaxed and comfortable in order to have a good birth.

Don't make your decision based on whose fears are strongest or who argues better. First, understand both persons' fears, try to resolve them, and then make a decision. As someone(s) suggested earlier, find a good midwife who does home births and go through all your husband's fears with her.

[flea]

Just as an aside, because of my health insurance and finances I had no midwifery options for my second child. There is no 24/7 midwifery delivery in any hospital covered by my insurance. There is a freestanding birth center near me, but I could not manage the $4000 out of pocket expense delivering there would entail, never mind the possible many thousands more if transfer to the out-of-my-network hospital they are affiliated with became necessary. And I have "good" health insurance (at a university with several hospitals) and live in a major metropolitan area, not in the wilderness. Homebirth is illegal in my state (although I know of women who have done it.) I guess I wanted to note that many of the excellent birth options discussed above - including the choice of hiring a doula - are a luxury for many Americans. Oh for midwifery options covered by insurance, doulas covered by insurance - and insurance for all.

The practice of local OBs is to share call with a second practice, so your odds of getting "your" doctor locally when you deliver are about 1 in 5-8 (you generally have a chance to meet all the doctors in your practice; the other practice does alternate weekends. Most practices I looked at had 4-6 doctors.) It is obviously hard to develop a trusting relationship with a medical professional you may never have met until you arrive in labor! Happily my second child was born 45 minutes after our arrival at the hospital - with a doctor "catching" whom I had (of course) never met, but who was very nice indeed. Not that there was much for him to do except the sewing.

[Helen]

It would be fair for the OP's husband to agree to meet with several local homebirth midwives and interview them. That is not saying he has to hire one of them. Just hear them out, for Pete's sake! Reading statistics is great, but it's not the same as meeting the person who might attend your child's birth, hear how she handles challenges, etc. My husband was not thrilled about the idea of homebirth, but he agreed to interview with me, and he was totally sold by the end of the process. You've done your due diligence on what hospital birth can be like by actually having one, so he could at least agree to continue gathering firsthand information. We thought about the freestanding birth center, but the midwives bring all the same equipment to the birth (and he'll probably be impressed once you find out what they bring), so why not have the comfort of home?

Now, here's our kicker. I went into labor, dunked myself in the birth pool, all that jazz. It was great, peaceful. Thennnnnnnn we transferred. I had a c-section. The baby was in distress, due to low fluid from a placenta that stopped functioning and what later turned out to be the craziest cord presentation ever. We still don't know why, but the point was that she caught it correctly. Midwives are NOT in the business of hurting babies or mothers, at least no more than OBs are. My particular midwife has an eeny weeny less than 5% transfer rate, and she knows when to fold 'em. In fact, they got to me earlier in labor than I would have gone to the hospital. If I knew I *had* to have a hospital birth, I probably would have hung out until I could flirt with the idea of birthing on the hospital's front lawn. However, she arrived, detected the distress shortly after arrival, called ahead as calmly as if she was ordering a pizza, and off we went. Everyone safe. Unless you are in the middle of the woods somewhere, you most likely have plenty of time to get to more involved care. I would homebirth again, with the same team, but probably with an extra ultrasound in the third trimester to check placenta function.

Good luck, and if you can't sway him, then don't be afraid to doctor and hospital shop for the best policies on things like induction and pitocin. It's not too late. Also, doula doula doula!

[hedra]

Shandra, you should go check out my 'safe, respectful, kind' approach (moxie linked the post earlier last week, I think). I think you'll find it fits perfectly with yours.

Safe, respectful, kind is not 'all equal' but 'all sequential' - there's not much point for respectful if safe isn't there FIRST. I'm quite firm about the sequence - we needn't even go farther if the item before has not been met.

With my kids, same deal: Safe first. If safe, then Respectful. If Respectful, then Kind. It isn't hard to get to the Kind, once you hit Respectful. BUT, it can be challenging to get Respectful after Safe - it is essential to try, though, because when we stop at Safe we lose the humanity of the situation, and leave wounds that don't need to exist.

It can at times be forgiven if the Respectful isn't handled as well as we'd prefer when the Safe issue is a true crisis. I'm going to forgive myself for screaming and yanking my kid by the arm if she's stepped into the driveway just as an out-of-control vehicle is careening in. NOoooo problemo. She'll even probably thank me. BUT, if I scream and yank her by the arm when she steps onto the driveway when I haven't bothered to look around to see what's happening, or when there's a car about 20 minutes away that MIGHT careen into the driveway, I won't get thanks for the attempt. It might still be safest for her to stay off the driveway - but Safe staying off the driveway when not under immediate threat can be handled in many ways, not all of them involving inducing fear or pain or humiliation or requiring absolute control of her physical position. I think that's fairly obvious, yes?

I forgave that OB for losing her grip, and insisting my baby was high risk for permanent nerve damage due to size... she freaked, to the degree she felt the fear. She wasn't respectful, at all, but I *knew* she was scared. Okay. It also wasn't an iminent threat - I was 3 cm dilated, in early labor. There was time to discuss this, to take a considered and respectful approach, to review my chart again, to make a connection with me at least professionally, if not personally. If she'd looked, she'd have seen more in my chart, and would likely have been able to make a calmer and more respectful approach. Likely, if she had even tried to be respectful, I'd have considered her position rather than just holding her eye as she tried to stare me down and saying (calmly but firmly) that we intended to continue with labor. In that case, I actually *was* more educated than she was... though this won't always be the case. An attempt to be safe (her version) *and* respectful might have won me over, perhaps. I recall saying I was in a sense grateful that she'd been such a jerk, because I immediately rebelled - I knew better. I did *actually* know better, but then I'd spent many years in the health industry and knew my sh*t on this one. Plus, she hadn't even checked my previous birth history, and she was somehow certain that an at-term ultrasound was to be read as a baseline with ONLY upward range of error (she kept saying 'the baby is AT LEAST 10 lbs 10 oz'... um, no, plus/minus means more OR less not just more... he was 9 lbs 6 oz.). The repeated medical management errors... but I digress. SHE was rotten. She's not my only OB experience, and oh, by the way, she's a *huge* advocate for midwifery in hospitals, so don't go hating on her just because she's a poor doctor.

I definitely agree that safe is FIRST, and respect is SECOND, and kind is THIRD. Yet it is very very rare to find a situation in which one cannot reasonably expect all three. Life-and-death emergencies are one place, but most birthing emergencies are not at that level. Some are, most are far more pedestrian 'emergencies'. And when the response cannot be what we want at the time, it only takes a little effort to respond to the human involved after the fact, to say 'we regret that it wasn't possible to ask/inform/respect-that-wish here, I would have liked to have done so and I did not at the time believe it was reasonable to try.'

I do find it uncomfortable myself when people (any people in any situation, it happens a LOT) put kind before respectful, and/or respectful before safe. I've encountered situations... well, I know of a lay midwife who I do NOT trust because she will honor the 'kind/respectful' at the expense of safety, on the grounds that if she insisted that people go to the hospital when SHE thought they should, they'd just go totally unassisted, and that's not good either... um. May be true. Also not rational. Again, there are other alternatives - deal with the fears, find assitance for handling the issues (as with the doula), learn more, look for other birth options... and no, not all of these are available to everyone, and sometimes people are not ready to deal with their fears, either. But at least dealing with the fears, and searching out at least a PRIMARY care provider that can give you what you need in terms of both safety and respect are in the realm of normal possibility.

[r0ckaby3]

I wanted a homebirth, my husband didn't want to clean up the mess with DS; LOL! Thankfully, we have a birth center here in Tucson, AZ and our birth went the way I hoped it would. It definitely made a difference having a doula there! My husband wasn't on the doula wagon at first, but now says he won't do another birth without one. We used a student doula, which was free, because we didn't have a lot of money to hire one at the time. If it was between the hospital and a homebirth in the future, I know that my husband would be supportive of the homebirth now, but with our first child it would've been hard to convince him.

[me]

Wow. This is a hot topic.

Doula Doula Doula!! I would go that route over having a friend be an advocate - an experienced doula has witnessed hundreds of births, and knows so many different ways to help you. Your friend, who may only have a few experiences, may not be as helpful.

I very respectfully, yet very adamantly, disagree with the statement that it's the woman's birth, her body, and therefore everything should be up to her. Hello? Do we all think so little of the individuals that we are married to/partnered with? All this talk of respect, what about the father of the baby for goodness sake??

I think it's too easy to minimize risks and things that can go wrong. I have a niece AND a nephew who both have severe cerebral palsy from birth tramas, and they couldn't get a c-section fast enough. Think running through the hospital to get to the OR. Two different mothers, decades apart. There are lots of risks, everyday, just from being alive, starting from conception. What is wrong with trying to minimize them?

I agree that many people go into a situation with a chip on their shoulder, but I urge people to live up to their part of the bargain of the patient/health-care provider relationship. If you don't *love* your doctor, switch. I am expecting #3, and just changed b/c I met another OB who knocked my socks off within the same practice. If you don't like your nurse, midwife, doula, dentist, whoever, ***ask if you could please see someone else.*** If you are calm and professional, upbeat and optomistic, many times people will reflect that. Not to say that no one can ever encounter a jerk, but for goodness sake just ask for a new person - why give them the satisfaction of becoming angry, hurt, etc? That just gives the jerk power over you. My friend switched practices at 36 weeks because the practice hired an @$$ and she knew there was a chance that he could potentially deliver her... and found a wonderful midwife who worked in the hospital.

A great resource would be to network with people in your geographic area. An experienced doula would know the who's who in your area, and would certainly help you with info, even if you didn't hire her. (Seriously, are there any male doulas out there?!?) Tour the hospital again, and ask to meet with the nurse that coordinates education and training of the other (usually more junior) nurses. Talk to other mothers via playgroups, Yahoo groups, run an "info wanted" on Craig's List... there are bound to be many other women in your area who share your feelings and may have more specific ideas. And I would encourage your husband to talk to other fathers about his feelings too.

[Alice]

I'm about the 40th person to chime in with the doula/hypnobirthing camp. My father-in-law and sister are both OBs, they are both wonderful caring terrific doctors, so I didn't go into the process with negative associations with hospitals/medicine/intervention. I also tend to agree with Shandra, in that there are risks involved with any birth, at home, birth center, or hospital, and it's important to take all the risks into account, and not just be focused on the "ideal" birth experience as the end all goal. The goal is a healthy family.
That said, I did have very strong opinions about what I wanted my labor and birth to be like: as intervention free as possible. So we did our research, had a wonderful OB who I totally trusted to respect my wishes, but also had no problem changing gears if need be. I went to a hypnotherapist who is also a doula, after I went into preterm labor at 28 weeks, and we kept up with the hypnotherapy until it turned into hypnobirthing classes until 39 weeks! We had a terrific intervention free, super fast and stress free experience, and I really feel it was due to the fact I had the tools and the support I needed.
So hypnobirthing is terrific! Especially to help access and release those anxieties related to the original poster's fears, and also to assist in her goal of an intervention free delivery. Also a doula as an advocate could go a really long way in that respect as well.

[pnuts mama]

i'll be honest i was nervous with my earlier comment being too inflammatory as i had to go out for the afternoon- but of course the group here always responds respectfully and with grace.

something i wanted to add was my surprise at how different my actual labor/delivery was from what i expected (and we had done the classes, and i was with my sister when she had her kids)- so i had to chuck my "birth plan" right out the window when my body wasn't doing anything it was supposed to according to plan. this is something that only experience will provide, as i *thought* i was prepared for every option out there. as fearful as i thought i was before labor, when i was actually *in* labor, i entered that zen-mama state of focus and understanding that i think only other mamas know, even though it was potentially scary and different from what i had wanted.

ultimately, being your own advocate or hiring one, no matter what the experience turns out to be, is what will make your birth experience as safe, stress-free and beautiful as possible.

[catherine]

My husband wasn't sure about a doula/midwife but I encouraged him to read The Birth Partner-- which has some great info in it. Through reading that, and listening to my statistics and rattling off info about the good things that happen when you go with a midwife vs. an OB-- he ended up totally on board. I did give birth in a hospital-- naturally but with pitocin-- but with the support of my fabulous midwife and doula who stayed with me the entire labor-- it was a fabulous experience.. who your provider is-- is SO important..

[cass]

Just chiming in to note that a doula can be helpful even if you anticipate a c-section. I delivered (double footling breech) twins by c-section with a (hospital-provided) doula in attendance. The doula was able to come in with me during the surgical prep and be my support when they put in the spinal (one of the things that had most frightened me about the whole experience) and then the agreement was that the doula would stay with me so my husband could go with the babies, especially if they'd needed to leave the room (they didn't until post-surgery, but the plan still held). It really helped me to have even that level of plan in place - to know that DH could go with the babies and not worry that I would be somehow left alone. I think this hospital is working to make doulas a more standard part of their c-section experience - which I think is fantastic!!

[Foster]

Flea, I think I know where you live b/c I live there, too! If, indeed, I am correct, homebirths are not illegal in this state, but the Midwife Center does not have enough staff to cover them. I got this information directly from my midwife b/c I, too, had heard that they were illegal here. I may be incorrect about guessing your whereabouts, but all of that medical info just sounded too dang familiar..

I am in Fleas situation where I am a subscriber of the insurance provider that is generally considered to be the evil empire around here, even by ppl who work for them. Their womens hospital is, litrally, refered to as "the baby factory." We have a lovely free-standing birth center that I have been a patron of for going on 5 years for well-woman care. Unfortunately, my insurance likes to make it a huge pain in the butt to have a baby there, so, due, in part, to insurance complications, I will be having my baby in The Baby Factory. BUT! They do have a midwifery practice, so Ill be going there.

My very biggest concern for birth is that I dont know if I will be able to cope without pain medications. I am absolutely terrified of having a c-section, so that is what makes me not want to go to a hospital. I also dont want to jump through the insurance loops to go to the birth center only to realize that Im not going to be able to take the pain and go to a hospital anyway, and have wasted all that co-pay money (which is a lot). For me, a hospital with their own midwives is a wonderful mid-ground. I can get the midwife care that I love and the pain meds, too :D I think that I may have to pursue this hypno-birthing thing since I really am TERRIFIED of having a c-section. I would not have thought of that if you ladies hadnt suggested it, so thanks.

[Kayq]

I've heard negative things in here about Pitocin...as I had heard before the births of my 3 girls. With my 2nd pregnancy (twins), I had labored for several hours after my 1st water had broken (you can have 2), but had irregular contractions. The Dr. suggested Pitocin. "No way in hell" was my response. I'd heard contractions hurt more, were stronger, and you'd practically HAVE to have an epidural to deal with the pain.

He said, "Ok, we can let you labor for forever, or we can start you on the lowest dosage in a couple of hours & work our way up slowly every half an hour until your contractions mimic the normal progress of labor, at which point we stop."

"Uh...ok. I never knew that" and labor got back on schedule & things went really smoothly. No other medications were required, nor did I have an epidural. If you have a doctor that USES IT WISELY, Pitocin can really help move things along if it's lagged.

I felt more comfortable in a hospital, for safety reasons. Granted, I had my husband prepped to run interference on pressure for unwanted meds & had him sneak water to me rather than those friggin' ice chips; I had to labor on my back since they wanted to monitor the girls' heart rates (I required some O2 towards the end) and they make you piss in a bedpan (one of the STUPIDEST things ever...I am NOT going to give birth in a toilet). The first time I labored as long as possible at home.

Besides all the negatives, I'd still rather be in a hospital. I never had either, but I think the suggestions for doulas & midwives are spot-on.

[Alina]

I agree with the commenter who doesn't understand the us v. them mentality. I think that each of us deserves to have an OB that we love and would trust in a crisis. If you don't have that, I think that you should switch. I don't understand why people even get medical care if they just go into it hating their doctors and other clinicians. I tend to think that it's my responsibility to be in control of my medical care and to keep myself from being pushed around by the system.

To the nurse and the daughter of nurses who posted comments above-- I've just got to say that the nurses in the hospital when I delivered made all the difference in the world to me. I was having terrible back labor and had such a quick labor that I could never get an epidural, and I never would have been able to handle that without the nurses. They were telling funny stories and just generally being calming presences to me. I also had an emergency visit to the OB unit when I was 36 weeks because of decreased fetal movement, and the nurses were so reassuring then. It was midnight and one of them offered to give me a tour of the floor when I was ready to leave. I was so tired that I just wanted to go home and get it bed, but of course I took the tour because it was so nice of her to offer. She pointed out all of the equipment and went through the whole birth process for me and answered all of my questions. This same nurse later knit the most exquisite Irish knit sweater for my son. I was so touched-- just a nice thing totally out of the blue! Another of the OB nurses heard from my husband (who is an anesthesiology resident at the hospital where I gave birth) that I was having a very difficult time breastfeeding. She told my husband that she had had similar problems and she called and emailed me to offer support. These same nurses also told me to feel free to bring my newborn into the hospital on weekend nights when my husband was on call and they knew I was home alone and that they would watch him while I slept in a call room. I never did this, because it would have made me too nervous, but, again, so nice of them to offer. My OB is also truly wonderful and I have enough faith in him that I know he would respect my wishes if possible, but handle a crisis in a manner commensurate with his education and experience.

So, just wanted to put my two cents in that not all hospital births are negative! True, my husband is a medical resident at the hospital where I gave birth, but this could have worked against me, especially with nursing staff who are really the ones who do all the work in a straightforward delivery.

[Hilary]

I didn't read all the replies, sorry. I just wanted to point out that your labor location is merely a philosophical consideration for him. YOU are the one who has to go through the labor. If you are going to endure a natural labor I think it should be completely up to you where you will feel the most comfortable going through it. You saw the limitations of a "natural" hospital birth the last time you attempted it. If you had a successful uncomplicated vaginal birth already, you are an optimal candidate for a home birth, and the risk of complication with an experienced provider are arguably less than you would experience in a typical hospital birth.

I have been to more about 60 births as a doula, a mom, and as a midwife trainee. Now I am a medical student. The homebirths were by far the most peaceful, joyful, and wonderful of the births. The worst birth I ever saw was at a hospital - the doctor finally got there about 1 1/2 hours AFTER the 2 1/2 pound baby was born. (I have been to many hospital births in which the doctor did show up, I am not saying this is common. However, it happens more often than you might think). Safety is relative.

[CJ]

Mom of four here, one awful hospital birth, one lovely midwife-attended hospital birth, two amazing astounding indescribable homebirths. My husband was not on board with the homebirth idea AT ALL after our oldest son's near-disaster birth, but he was willing to go along for a consult with the homebirth doctor. The doctor answered all his what-if questions and was so calm and informed and reasonable that my husband was much more open to the idea after that conversation. It made far more of a difference than many hours of my telling him what I was thinking.

As I was reading the comments, I remembered that a critical part of my husband's willingness to go with this doctor was that he had hospital privileges. We could wait and see, and decide to go to the hospital at any point in the pregnancy or labor. As it worked out, laboring at home just *flowed* so easily that I was in the middle of pushing when I thought, "Oh, yeah, I wasn't sure about this -- glad we're not in the hospital!"

Wishing you a peaceful pregnancy, and clarity about what's best for your family.

[Hayley]

I had my first (and only, so far) birth at home with a midwife. My husband was supportive of it BUT if he hadn't been 100% okay with it, i don't think i could have managed it. he obviously did have some minor questions and concerns, but sitting down to chat with the midwife helped him feel more confident about our decision.

i would suggest you and your husband visit with a midwife and discuss how a homebirth looks. if after this meeting he still doesn't feel comfortable with it, make sure you have those things moxie listed above for your hospital birth.