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Friday, November 04, 2005

My family ended up with impersonal, candle-free hospital birth instead of a home birth because my logical spouse convinced me that medical professionals would be handy--just in case of emergency. And he was right.

Is a hospital birth safer than a home birth? I can't find any conclusive evidence one way or another--when mom is low-risk and baby is healthy. The problem is that sometimes--as with my situation--you don't know the baby is sick until after it is born. It's those times that doctors and hospitals save lives. "[Ten] of the 20 babies who died (in a home birth) had diagnoses of congenital heart disease or respiratory distress. An additional three babies had major congenital anomalies."

Lamaze International takes issue with that data because some of those babies may have died regardless of where they were born. That is true. But, how many would have lived if they'd been born in a hospital? I guess I'm just baffled by the confidence that it takes to have a baby at home. How can anyone be that certain that everything will be okay?

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You're kidding, right? You have the effrontery, the unmitigated gall to tell me I didn't bother to tour the hospital where my first child might be born?!?

OK, so I didn't.

It wouldn't have mattered, because ESCbC was the only free-standing birth center in Manhattan—until it collapsed when the insurance premium shot through the roof. We loved ESCbC for its outstanding safety record, its low intervention rate, and its skilled, friendly staff. Unfortunately, it came as a matched set with St. Fleabag's, where the midwives went to work after ESCbC foundered. Not surprisingly, all of them quit within six months.

Home births are widely misunderstood, and I know because I was a big misunderstander. I too used to think that women "bleed all over their sheets" and that midwives are helpless if something goes wrong. I know now, from experience, that neither is the case. Our midwife skillfully localized the blood and cleaned every drop. And since she's a CNM, she arrived with a steamer trunk of medical supplies—oxygen, IVs, and medications—that could stabilize just about any baby or mother until the EMTs arrived.

Choosing where to have your baby is a personal choice, and parents need to feel safe. After we did our research (on sites like this and this) and factored in the relative safety rates, the place for us was home. And it worked out wonderfully; my wife and baby bonded and recuperated in our own bed, and I got to tell my buddies how I caught the placenta in a 49-cent roasting pan.

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Wednesday, November 02, 2005

That’s a scary story, and I’m glad TIC is okay. But once you distance yourself from the deep emotional impact of TIC’s surgeries, your argument is a little alarmist. We’re not supposed to do something because something awful can happen? By that logic, no one should drive a car, which is statistically far more likely to kill you.

Hospitals can work life-saving wonders, but they also have many strikes against them. Firstly, they’re bug factories, and death rates due to infection (which are even greater than those of car fatalities) can be under-reported. Secondly, rates of C-sections and episiotomies, which frequently occur at the convenience of harried doctors, are way too high and often unnecessary. And thirdly, the level of care is unreliable (witness the ham-fisted nurses who had to perform our son’s heel stick four times because they kept screwing it up).

We took all of this into account, noted that our hospital (not St. Fleabag’s) was three blocks away if we needed it, and decided that the safest place to have TwoBert was in our bathroom, with a skilled, rested, and undistracted medical professional by our side.

Which makes me curious: I’m sure you’re glad, in retrospect, that TIC was born in a hospital. But if as you say you wanted a birth in your “own bed” and your pregnancy was “low risk,” why did you end up in a maternity ward?

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You can have midwives and doulas at the hospital with you to make childbirth a little less industrial and little more personal. Toddler in Chief's birth started with a midwife, who stayed with us for about 15 hours of the process. She eventually needed to go home for some sleep before her next shift started, but by then I was so far off in Laborland, that I honestly didn't know who was in the room with me.

Even if you choose a home birth, as Laid-Off Dad's family did, you still need a backup plan. And sounds like the "St. Fleabag Medical Center" wasn't a good backup plan. If Laid-Off Dad had toured St. Fleabag's in the spirit of preparedness before No. 1 was due, then he might have opted for an alternate birth center that had a relationship with a nicer hospital, for the what-if scenario. You should always be prepared for the what-ifs. So you don't like hospitals? Well, go check them out anyway. And tour them and interview the staff and talk to the parents who just had their babies there to find out if they were happy with the place. Because you might end up there anyway.

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Monday, October 31, 2005

I could have labored at home. I could have just as easily bled all over our sheets at home as on the ones in the delivery room. There was sweat and blood and swearing and stitches. But none of that mattered. It didn't matter where I was until immediately after Toddler in Chief was born.

My pregnancy was easy. I was young, healthy, low risk. No problems outside of a few varicose veins. I wanted to have the baby without hospitals, monitors, IVs, and drugs. I wanted to do it in my own bed. To leisurely eat my own snacks. To labor in my own tub. To scream so loudly that the neighbors would call the police. But none of that selfish stuff mattered.

My hospital labor was long, painful, and ordinary. It was the minutes after TIC was born that mattered. Doctors whisked him to the NICU before I had a chance to feel his weight from a new perspective or bring him to my breast. Two open-heart surgeries later, I still occasionally wake up sweating, wondering what would have happened if there were no doctors or technology to diagnose and resuscitate him.

If he'd been born at home, he would have died. There were no signs that anything wrong with TIC while I was pregnant. But there's always that teeny chance that something will go wrong with labor. Or that something will be wrong with the baby. My odds: one in 100,000. But it happened.

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When my wife first became pregnant, about all I knew about midwifery was that it was a fun word to say. I was taken with the birth center, with its huge, clean rooms, queen-sized beds, private bathrooms, and hot tubs, but the midwives won me over. All eight of them were smart and professional, and I knew my child’s welfare was safe in their hands.

Unfortunately, when the fetal heartbeat kept decelerating during the pushing stage, we had to go to the center’s affiliated hospital, the St. Fleabag Medical Center. We were given a dirty room with a broken bed and an indifferent, incompetent nursing staff. They wouldn’t discharge us until 12 hours after the birth, and as the time of emancipation arrived we were all lined up like Jesse Friggin’ Owens.

When No. 2 was on the way, the birth center had closed after its insurance premium was raised by 200%. And when my wife suggested a home birth, I think I blacked out. I just couldn’t comprehend it at first. But then I met our new midwife team, read their references, and took note of the facts that 1) all prenatal visits would be house calls and 2) insurance covered everything. So I bought in.

The birth was a bit of an adventure, but I always felt in good hands. Martine examined my wife and child far more thoroughly than anyone at St. Fleabag’s did, and she stayed with us, helping with everything from paperwork to the placenta, for five hours while my wife recuperated. If we’re to become parents a third time while living in the city, I will absolutely agree to another home birth—after I regain consciousness.

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