When Home Birth Becomes Hospital Birth

I started blogging a few months ago about the process of choosing and preparing for home birth. I had spent over half of my pregnancy overly concerned about preterm labor, having giving birth to my son ten years ago at 27 weeks gestation. When I finally reached the 32 week mark (the point at which *early* preterm labor is no longer the issue), I pretty much stopped worrying and began planning for birth to happen the way I'd hoped it would happen the first time, only this time at home instead of at a birthing center.

Well, my daughter had other plans. Six days before the 36 week cut off (the midwife would not deliver at home before 36 weeks), my water broke as we were heading out the door to church. I had my frustrated, angry, upset cry before we left for the hospital as I was trying to find just one of our birth attendants who wasn't on vacation. My doula was available, and she met us at the hospital. I'm awfully glad she was there, though she told us more than once that she felt her presence was a bit redundant. We asked all the important questions ourselves, and the few times when it was necessary we advocated for ourselves and stated our own desires.

One such time, or rather one such issue (it came up several times) was the doctor's desire to get labor moving with pitocin. They're rather rabid about getting the baby out within 24 of a woman's water breaking, and that was the first thing that happened for me. My water broke at 9:45 AM Sunday morning, and labor hadn't really started in earnest by 9 PM. The nurse came and found us in the hallway where we were walking and reading, trying to encourage contractions by staying on the move. She said the doctor was ready to start pitocin. I said I didn't want to, and that if there was any leeway at all, I intended to take it. If they started pitocin, I was fairly certain I wouldn't make it through the process of labor and delivery without an epidural. She said she could give me an hour before she'd have to insist that we start it. That's a funny way of saying it--if a person refuses a treatment, there's not really much the physician or attending nurses can do about it. However, when a woman is in labor, or at least when *this* woman is in labor, and when she is laboring in a hospital, she automatically feels a bit as if she has to play by their rules. We did our best not to.

The nurse agreed to an hour, and we continued walking. There are, for those who are interested in knowing, a great many things you can do to stimulate labor. There's no need for me to go into detail here, but if you're planning a home birth, or even if you're just desiring to give birth naturally (without pain medications or unnecessary interventions that lead to those medications) do your research and know about those things in advance, so that you can ward off pushy doctors and nurses and get things moving in a natural way.

By 10:30 PM, contractions where coming regularly and intensely. I know I was in the birthing pool not long after that. And yes, they *did* allow me to use the pool, even though my water had broken more than 12 hours previously. Don't let anyone push the assumption upon you that they won't let you, because the pool was my best friend.

I'm fairly certain that transition started while I was in the pool. For me, it lasted a long time (at least an hour), which was discouraging in the midst of the process. But we did it, and the moment she was out, the labor and delivery pain ended and the wonder began.

So we planned a home birth. We *paid* for a home birth. What does one do when home birth is thwarted by pre-term labor? Luckily, our midwife has a method of prorating her services for situations like this, but we never talked about it beforehand. This made for a bit of an awkward situation once we got home from the hospital and knew that the bills were just around the corner. It took a couple of days for me to get around to calling the midwife, and once I did I realized I had nothing to worry about. However, this is a subject that I realized is best handled *before* the situation arises, and it would have been good to include questions about prorating of services in the interview process. Since we have no plans of doing this again, and this information does not serve us, I want to make sure that anyone who ends up using these blog posts as a home birth resource realizes what we didn't.

No one who is planning a home birth wants to assume that it will end up in a hospital--but it may. First of all, talk with your midwife about that possibility, and along with discussing what role she would play in that event, discuss also how she would charge you for her services, since those services will surely change rather drastically.

Also, consider how you would handle advocating for yourself in the event that you give birth in hospital and not at home. Our nurses were wonderfully supportive. Our doctor was amazingly tolerant, and even supportive, of our desires. I didn't push on my back, which I thought for sure would be an issue. I pushed on my side, and in the end, I think that's how I would've chosen to do it at home. My contractions were far too intense for me to want to be upright at all, let alone while pushing. Yet even with how supportive they were, there were still an abundance of opportunities for our desires to be pushed aside. If we had not actively put forward the fact that 1) we did not want an epidural or drugs, 2) I did not want an epidural or drugs offered to me at any point (I would ask if I wanted it), and 3) we did not want any unnecessary interventions, including pitocin-- we would have ended up with induction by pitocin and stripping of membranes (the doc was hot to trot on both of those as soon as she got there), probably an epidural to help me cope with the intensity of induced contractions, and whatever other unnecessary and unpleasant interventions which might have become necessary because of the epidural.

We planned a home birth for lots of reasons, not the least of which was to avoid medical interventions in a non-medical, non-emergency situation. In preparing for home birth, I did a lot of thinking about what I didn't want to have happen to me while I was laboring, and I read a lot about women who advocated for themselves in hospital and achieved the births they desired. I was not completely unprepared, and neither was my husband. But I had the experience of a previous, very early birth under my belt, and that gave me much food for thought as we prepared to give birth. If you are preparing for a home birth, prepare also for what probably won't, but possibly could, come.

Home Birth: Interviewing a Midwife

This should be obvious to anyone in this process, but I didn't think about it until the last minute: Consider carefully what it is that you hope to accomplish as you interview a midwife. About five minutes before she arrived, I realized I had given *no* thought to deliberate organization of my thoughts and questions. This was a rather unfortunate mistake, redeemed only by the presence of my very level-headed husband, who asked all the right questions. I did come up with a few myself, mostly after he got the ball rolling.

Insurance and the Expense of Home Birth

We had read that home birth tends to cost more out of pocket than hospital birth, primarily because a great many insurance companies don't cover midwife services or home birth expenses. There's also the reality that, even if your insurance company *does* cover midwife services, your midwife may not accept your insurance. Insurance aside, we had read that home birth in the United States is *crazy* expensive, and I was gearing up to be disappointed by the reality that we simply couldn't afford to give birth at home.

My fears proved unfounded. There may indeed be places in the U.S. where home birth will cost you your first-born (pardon the expression), but at least in Kentucky, or perhaps just with the midwife we interviewed today, this is not the case. We, at least, will end up paying less out of pocket for a home birth than we would to give birth in a hospital. Unfortunately, we will need to maintain a relationship with our current OB in case I go into labor early again and need to deliver at the hospital (I delivered 12 weeks early with my first pregnancy), and this will mean a bit more expense over all. But if the midwife we choose has a fee as reasonable as the midwife that we interviewed today, this shouldn't be too much of a problem.

Husband as Primary Birthing Partner

My strongest desire regarding labor and delivery is that my husband be allowed to fill as active a roll in the process as we both desire and he can cope with. My husband is my best friend, hands down, and no one knows me as well as he does. Granted, there will be plenty of moments in labor and delivery when a trained professional will know better than my husband what my body needs, but it's not her face I'll be looking for in my moments of distress, and if it's my husband I want (and I foresee that it will be), everyone in the room had darn well be ready to get out of the way and let him through.

Unnecessary Interventions

I want very much to avoid unnecessary interventions--epidural, forceps, suction. This desire is near the top of my list of reasons for wanting a home birth. Specifically, I want to avoid an episiotomy. I'd rather tear naturally. I'd rather not tear at all. I know there are no guarantees, but I've read about (and observed) a great many techniques for avoiding tearing, and I wanted to know that the midwife we choose is versed in these techniques and ready to employ them.

Finding a Relational Fit

The one issue I *had* thought about was how my husband and I would mesh with each of the midwives we interview. What I have been told is that, with a home birth, it is absolutely essential that the midwife and laboring mother have a positive, trusting relationship--not simply a luke warm, I-guess-I-can-live-with-this-person kind of relationship. I assume that it's helpful if the midwife is also a good relational fit with my husband. In this respect, I feel I was very well prepared to interview. It doesn't take long to figure out if I can manage to mesh with someone. We got answers to important questions (most of which were brought up by my husband, God bless him), but I also talked with her about my first experience with labor and delivery, and was able to gauge her responses to my anxieties and desires for my next experience. I felt heard and affirmed, and I think this is one of the most important things (for me, anyway) that came out of the interview.

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These were some of our questions and anxieties--the information we considered key in our process of choosing someone to attend us in the birth of our baby. Your questions and concerns may differ from ours, but thinking through them ahead of time--even writing them down--will help you get the most out of your interviewing process.