How Wide is the Birth Spectrum?

Over the past several months I've been learning and only recently blogging about birth. I've learned about something that I've begun to call the "birth spectrum." At one end you have those that forgo all medical care. They are the women and families who choose to have unassisted pregnancies and childbirths. They either do their own prenatal care, or they just trust that their bodies will do what is right when the time comes. At the other end of the spectrum you have the women and families who choose to have every test available and then schedule their c-sections at the desired time. All other kinds of birth seem to fall somewhere in between these two ends of the spectrum.

At the beginning of her pregnancy each woman has an idea of what sort of birth she will have. For the vast majority of women in the United States, it is expected that she will give birth in a hospital. Many plan on having an epidural. One third of these women will end up with a c-section. It is estimated that half of those c-sections will be "unnecessary." A small minority of women choose to give birth in a free-standing birth center. An even smaller minority choose to give birth at home.

Within the rainbow of choices of the birth spectrum there is an ambiguous dividing line. It seems to divide natural birth from unnatural birth. So what is a natural birth? It depends on who you talk to.

I love dictionaries. Even if one doesn't agree with the definition of a word, it gives a person a great jumping off point. This is from Merriam-Webster online:

Main Entry: natural childbirth
Function: noun
Date: 1933

: a system of managing childbirth in which the mother receives preparatory education in order to remain conscious during and assist in delivery with minimal or no use of drugs or anesthetics

For myself, I find this definition to be adequate. Others would argue that any time you intervene with the birth process you remove it out of the realm of "natural." That includes everything from taking blood pressure to having an attendant present. Others feel that out of hospital birth is more natural and that only non-pharmaceutical measures should be taken during birth. This would include using herbs, homeopathics, position changes etc. to alter the course of birth. In our current medicalized culture, a natural childbirth often simply means a vaginal birth.

There seems to be no end to the hairsplitting in the natural childbirth community. Rixa at Stand and Deliver has explored her experience with the various divisions over here. I would encourage you to read the comments. In the post, the woman Rixa quotes says of her move from UC to a midwife:

I find I am getting a lot of crap from my natural childbirth groups, because they all think I've become a "hypocrite" to the cause. That is completely ridiculous. It's not like I'm having a hospital birth with an epidural. It's still a HOME BIRTH! Same team! Same team!

There are two things that really stick out to me in this quote the first is "It's not like I'm having a hospital birth with an epidural." The suggestion here is twofold. First there is the suggestion that a hospital birth with an epidural is inherently unnatural. In the purest sense of the term it is, however, if it results in a vaginal birth, it is certainly more natural than a c-section. The naturalness/unnaturalness of a choice can only be discerned in relation to other choices. The second suggestion is that a hospital birth with an epidural is somehow a less valid choice than a home birth. This leads me to the second thing that sticks out in this quote: The woman feels the need to assert her continued support of the natural birth team, as though birth were a competition.

Now this is no means an attack on the woman who emailed Rixa, but rather an example of how the birth spectrum is fraught with division. Like so many things that women have to deal with, it is based around competition with other women. I think this is bad. And that is the most simple sentence I can compose on the subject.

So what does this birth spectrum have to do with me? Well, I'm trying to figure out where my beliefs lie on the spectrum. I have chosen a home birth. I have done so for many reasons. Most of them due to my belief that women were designed to have babies and that birth is for the most part safe. My goal is to have a vaginal birth with as few medical interventions as possible. There are roughly four paths to childbirth in this country. The most common is a hospital birth. As most women can attest, the chances of getting out of the hospital without at least some medical interventions are slim to none. The second most common choice is a free standing birth center. This likely would have been my choice except for that 1) There aren't any for hundreds of miles and 2) I likely would have been risked out because of my blood pressure and weight. The third most common choice (if you call less than 1% of births common) is a homebirth with a CPM. This is what I have chosen. The least common yet most "natural" is the unassisted birth.

I chose not to have an unassisted birth because its just not for me. I want someone there that has walked the path before. I chose not to give birth in the hospital because I didn't want IVs and continuous fetal monitoring with the accompanied loss of movement and increased risk of having a c-section. I opted for a home birth not because it is the most natural path to giving birth but because I felt that it was right for me. It gives me the chance to birth under my own power while at the same time using the knowledge of an experienced assistant to achieve the best birth possible.

There are many misconceptions about women who choose to give birth at home. The first is that we're all crunchy liberal hippies that want nothing to do with the medical establishment. The second is that we just don't understand how dangerous birth is and if we did we'd have the baby in the hospital. There are those out there who believe any homebirther that allows an intervention isn't staying "true" to the spirit of home birth. There are those who believe that homebirthers that don't utilize the medical system are putting themselves and their babies at risk. For me, choosing a homebirth has been about getting the best of both worlds.

My midwife is a CPM with 20 years of experience. She has 11 children of her own. I am absolutely confident in her judgement and her abilities. Because she allows me to question her every move, I trust her. Because I am not having a freebirth, I have chosen to accept a certain amount of interventions. I don't believe that interventions are inherently bad, but rather their misuse is what renders them undesirable. Each time I go to my midwife she takes my blood pressure, listens to the baby, and measures and palpitates my uterus. All of these things are by nature unnatural because they would not occur without outside interference, however, thats what I'm paying her to do.

One of my midwife's requirements was that I secure a backup OB to be available in case complications arise. Even when one trusts their bodies, unforeseen circumstances can arise and we have decided to add another layer to the birth process by following the midwife's direction to secure a backup. In my adventures with OB's I have written about how they require even more interventions. I have had four sonograms, various blood tests, and a group B strep swab. We agreed to some tests and have refused others. On this blog I've explored our reasoning behind questioning some tests while immediately agreeing to others. Our governing principal has been whether or not a given test or intervention will contribute to the ultimate well being of mother and child. Early on that meant having a sonogram because I had been spotting and it was better for me not to stress over that. Later in the pregnancy that meant agreeing to a biophysical profile to reassure Dr. Dick. We have questioned every motive until we've felt comfortable that what we're doing is the best path for us.

That brings us to our current situation. Do we want to induce labor or not? When I brought up the subject to my father this morning (how many women can talk about their vaginas with their dads?) he reminded me that there is no such thing as a natural induction. He blames the fact that my mother had to transfer during my birth on her use of castor oil. He is very much against hurrying birth. His advice was to leave things as they are. Yesterday at the midwife's we had a long discussion about where I was in my pregnancy and where we were headed. Regardless of my insistence that I have white coat hypertension and my midwife's admonishments not to worry about my blood pressure, realistically we can all see that my BP has crept up in the past few weeks. We've chosen not to be alarmed about it, but we do need to accept that I am showing signs of pregnancy induced hypertension. Ignoring reality does not change it. She asked if I wanted her to do an internal exam and I said "why not." She doesn't normally do internal exams, but in my case, we were staring to wonder if we needed to have the baby sooner rather than later. We found out that I have a favorable Bishop's score and she gave us the option of inducing labor by using Castor Oil this Sunday. She also said that if we choose not to, nothing bad will happen, we'll just check things again at my appointment next Tuesday. Its totally up to us.

Some people would see this situation and think that this is just another example of a first time mom being bullied into something she doesn't need by an intervention happy medical provider. I would like to clearly state, that isn't the case. I have a good midwife. She reserves the more intrusive interventions for those who actually need it. I'm a first time mom who is showing signs of PIH. If I were under the care of an OB I would already have been induced at 37 weeks and likely ended up with a primary c-section for failure to progress. If we choose to induce I will be 39w3d. I am aware that is possibly up to three weeks early if one allows a pregnancy to go to the extreme end of postdates. However, as with all things we need to do a personal risk/benefit analysis.

We have not decided to induce as of yet. It honestly depends on how I feel, what my blood pressure is doing, work schedules, and all sorts of miscellanea that many natural birth advocates cringe at. Would I agree to a c-section tomorrow? No. What about pitocin induction and amniotomy? Not likely. So why consent to castor oil? We're not sure yet. I am not comfortable with inducing just for the sake of having a baby. I can't say I'm not just a little bit impatient, but I need a better reason for inducing than that. Thats why we're reading everything we can, talking to others, and once again going through the decision process we've been perfecting over the entire pregnancy.

We have been preparing my body for labor for nine months. I've been eating well and exercising. A few weeks ago I started taking my evening primrose oil again. I took it while trying to conceive and I know it can help the body do what its already going to do. I don't think I've told my MW that I've been taking it. DH and I have been giggling about our nightly "prostaglandin injections." He's such a good husband, always thinking of his wife. If I'm too tired he'll remind me to think of the baby and then he'll take one for the team. *Please understand this is completely tongue in cheek, our bedroom can get a little silly at times. Its hardly drudgery in there.* I've been playing with the breast pump mainly out of curiosity. I'm totally amazed that I can pump a half ounce of "stuff" prior to even giving birth. Like I've said before I'm a body explorer. I've not found any information that would suggest any of these things are dangerous, though to someone who believes them to be interventions, the thought that I am doing this to alter the birth process would be abhorrent.

What it seems to come down to is that every woman takes her place on the birth spectrum. Some are where they are by choice, others are where they are because they fell out of place and were forced into another. I chose homebirth because it was right for me, not because it was more or less natural than any other choice. I am comfortable in my decisions because they have been well researched. We are taking responsibility for our birth. The main point is that it is our birth. That automatically takes it out of the realm of any one else's philosophy or belief. In the past 24 hours I've been told that it is both irresponsible to forgo interventions as well as irresponsible to consent to them. Those beliefs belong to the people that believe them and thats fine. I absolutely support any woman in her decision to decide for herself. Whether I agree with her decision or she agrees with mine is not part of the equation. We still don't know what we're going to do on Sunday, but either way it will be our decision and we'll cross that bridge when we come to it.