Monday, February 23, 2015

In defense of home birth

The Sunday before last, a crime occurred at our home. We didn't call the police or file a report of any kind. Nothing was stolen, and nobody was hurt. There was no burglary, no arson, no bodily assault, no disorderly conduct of any kind. In fact, though we didn't ourselves commit the crime, we did everything in our power to aid and abet it, going so far as to pay thousands of dollars for it to occur.

"What was this crime?" you might be asking.

A midwife, duly trained, tested, and certified, with years of experience, safely, calmly and expertly delivered our baby boy with no complications whatsoever in the congenial surroundings of our own home.

"A crime?" you might exclaim, incredulous.

We wouldn't have thought so either, at least we wouldn't have thought so before we moved to North Carolina a year and a half ago.

Our introduction to home birth came during our time in Texas. When we found out that Rosemary was pregnant with Clement, our second child, one of my graduate school classmates referred us their midwife, Molly Germash, an expert midwife who operates her own stand-alone facility, Hearts Desire Midwifery.

We ended up working with Molly's daughter, Emily, who was apprenticing with her mother at the time. Clement was born not at home--we weren't quite ready for that yet--but at the Hearts Desire stand-alone facility in rural Peaster, Texas. Clement's birth was not an easy one for Rosemary, and we were deeply impressed by the attention and care that Emily and Molly lavished upon Rosemary at every step, from their patience as Rosemary labored for nearly two days to the attention she required after Clement's birth due to bleeding complications.

When Rosemary was pregnant with Cletus, our third, there was no doubt in our mind that we wanted to work with a midwife again. Though we're appreciative of the expert care Rosemary received giving birth to Cyprian, our first, in a Wisconsin hospital, there were many things that stood out to us in working with an independent midwife. First, there wasn't the pushiness that we experienced with Cyprian's hospital birth. Nobody was in a hurry at the midwife's facility, and things occurred naturally, and at a pace Rosemary was comfortable with.

At the hospital, on the other hand, there had been numerous tests and procedures that separated mother from child and were simply expected, as if there were no choice or alternative. I remember in particular how they took Cyprian away, ostensibly for a photograph, and never brought him back. I had to go and search the baby out in the nursery, and the nurses seemed incredulous that we wanted him back right away. We have that nursery photo, in fact. Cyprian does not look like a happy baby!

Another big difference with Hearts Desire was the total absence of the clinical, scrubbed atmosphere of a hospital. The Peaster facility has a few well appointed bedrooms and a kitchen. The front office doubles as a living room and child's play area. I am writing this, of course, in the context of the recent outbreak of hospital-contracted, antibiotic-resistant superbugs. For all the efforts at disinfection, hospitals are not healthy places. Yes, hospitals are necessary things. But while we've been conditioned for the last half-century to consider birth one of the times it's necessary to be at the hospital, there's nothing about a normal, uncomplicated birth that necessitates on-site doctors and clinicians. That's not to say that many women shouldn't give birth in a hospital. There are many, many situations that require possible medical intervention. But for a healthy woman thoroughly vetted for possible complications, there is no reason the birth must be at a hospital.

Back in Texas, as Rosemary and I discussed Cletus's birth with each other and then with Emily Germash, by then a Certified Public Midwife, we decided to try home birth. What Rosemary liked best about the stand-alone midwife facility was its home-like atmosphere. It helped her relax, and it made birth seem less clinical and more, well, normal. Home birth would be everything the stand-alone facility was--but better, because it was our home.

By far, Cletus's birth was the easiest, least complicated of Rosemary's first three. Emily showed up quickly, and Rosemary delivered the baby in our own bed. I made her a nice breakfast of bacon and eggs in our own kitchen, and the two older boys came home from a friend's house nearby to greet their new sibling. Not that childbirth is ever easy--I'd get in trouble as a guy implying such--but I think Rosemary is okay with me describing our first home birth as significantly less stressful, less of an illness requiring medical intervention, and more like what it truly is supposed to be: the miracle of welcoming new life into our young family.

So, nine months ago, when we found out that Rosemary was pregnant with Chrysogonus, there was no doubt in our mind that we would again be having a home birth. To our great astonishment, however, we discovered that home birth is practically illegal here in North Carolina. Not illegal, let me emphasize, but practically illegal.

North Carolina, it turns out, is one of 12 states where it is currently illegal to practice midwifery outside of a hospital-affiliated facility unless the midwife is also trained as a nurse. That alone is a significant obstruction, since most states convalidate the national licenses of Certified Practical Midwives, recognizing them as medical practitioners. But until recently, home birth was at least possible since Certified Nurse Midwives were permitted to operate out of stand-alone facilities, even offering home birth as an option, so long as they were under the supervision of a doctor. In the most recent development, however, most stand-alone facilities in the state have been forced to close because the state now requires the doctors to carry medical malpractice insurance for the nurses they supervise. What this means, in short, is that now it's financially impossible for even CNMs to practice midwifery legally outside of one of the major hospital chain-affiliated facilities.

Rosemary and I certainly have nothing against the good work done by the hospital-affiliated facilities any more than we do against the regular hospital neonatal unit where Cyprian was born. But what we were looking for, specifically, was to replicate our experience of home birth in Texas. Again, we have nothing against those who want to have their babies in hospitals or hospital-affiliated facilities, but we were shocked to find that these were the only possible legal options in our newly adopted state.

And why? The medical research certainly doesn't back any such curtailing of birthing options. A 2005 study published in the highly influential British Medical Journal indicated that planned home birth for low risk women utilizing Certified Public Midwives--not even Certified Nurse Midwives, note, but CPMs--was associated with a rate of infant mortality similar to that of hospital births. In other words, it is statistically no more dangerous for a low-risk woman to give birth at home than it is for her to give birth at a hospital. In Great Britain, the government, noting a higher incidence of surgical intervention and a corresponding higher risk of infection, is actually urging low-risk women to consider home birth.

Contrast Great Britain with North Carolina, where home birth is practically illegal.

Related to this frustrating situation, there is a thoroughly interesting article on the website that calls childbirth in the United States a "human rights failure." The author notes that maternal mortality rates in the U.S. have nearly doubled from 1990 to 2008, while the collective rate in most other countries has fallen by more than 30%. For me, the most compelling statistic is the $86 billion spent on childbirth annually in America--more than on any other area of medicine. I don't think I'm going out on too much of a limb to wager that part of the orientation toward medical intervention in a hospital setting is as much profit-driven as it is concern for the health and well-being of the mother and her newborn child. I would also wager that it's in the best financial interests of the big hospital systems here in North Carolina to drive birthing traffic to their facilities.

That's the situation in a nutshell. So, what's a couple expecting a child to do? The Christian tradition's maxim in a situation like this--from St. Augustine, repeated by St. Thomas Aquinas--is lex iniusta non est lex, an unjust law is no law at all. In short, Rosemary and I felt no compunction in flouting the suspect statutes, or at least in paying for their flouting and aiding and abetting it--and, as this current blog post attests, in telling the world that we've done so. In fact, we're proud to be part of an underground movement here in North Carolina, as written about in this article in a Charlotte-area newspaper.

You can read about the birth of Chrysogonus, our fourth child, at our home here in North Carolina in this earlier blog post. Rosemary shared her adventurous take on the day of the birth as well. Everything went smoothly, and we were very satisfied with the experience, and we're grateful for the expert assistance that our veteran North Carolina midwife and her assistant provided throughout the pregnancy, during the birth itself, and now with postpartum care. Obviously we're not publishing the name of our midwife, but do let us--especially Rosemary--know privately if home birth is something you're considering and if you need any advice.

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