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.