Sylvia was born, but I’m not quite done with this blog yet. This is the first of about four more posts I have planned—although this one was supposed to be posted before the birth.
Families have a lot of options for a birth setting and support team these days. Everything from a completely unmedicated home birth with a team that only supports home births to a planned cesarean section in a hospital. All of these birth choices are valid as long as the mother is educated about the choice she is making mother and her medical provider agree the setting and support matches the mother’s risk profile.
What went into my decision about birth setting and support team?
Interventions
I knew I wanted to try for an unmedicated birth. Part of this was pragmatic. The medical interventions associated with birth are not, despite the rhetoric on both sides, associated with significantly different birth outcomes for the mother or the baby for low risk pregnancies. However, they do tend to be chained to each other. Pitocin induced labor tends to cause more painful contractions which can lead to earlier epidurals which reduces the mother’s ability to move which can prolong labor (but remember these are tendencies, not absolutes). Given how I tend to cope with stress and discomfort, I knew that movement would be important to me during my labor. Thus, my desire to avoid medication. (I didn’t have time for any interventions anyway.)
I also wanted to try to go for an unmedicated birth just to see if I could. While I certainly am not an advocate of pain for its own sake, I also believe that pain is not necessarily bad. It’s part of the experience of an embodied being. The pain of birth has been part of the human experience since before we were human, and I wanted to be a part of that. Obviously, this is a very personal decision. We have the tools to make birth much less painful, and if pain turns to suffering, those tools can be wonderful.
All that said, I was not absolutely committed an unmedicated birth. If an intervention became medically necessary or if I just couldn’t handle the pain, I wanted those interventions to be available.
Support team
I wanted a support team that I felt would not only allow for my preferences but would also help make them a reality. Every provider has different preferences. The more that my preferences were aligned with those of the provider, the less I would need to worry about having to struggle to have things done to my preferences, whether before or during the birth.
I also knew that I wanted my support team to be small. Some people want their birth to be attended by family or friends. I didn’t want that. Birth, to me, is too intensely personal an experience for me to want to share it with anyone other than my husband.
The result
Given these preferences, I knew I wanted to give birth with a midwife. Midwives tend to be more aligned with my preference for minimal interventions. They also tend to be in the room for more of the birth process which was especially important if I wasn’t going to have other family or friends there for additional support.
I had a hard time deciding between a hospital or birth center birth. Some hospitals have default policies that would not align with my preferences (e.g., around insertion of IVs). The nurses may not be as supportive of forgoing interventions. Plus, a hospital has a certain atmosphere that is inherently medical.
On the other hand, birth centers support few to no interventions. If I was having a difficult birth or just wanted an epidural to cope with the pain, I would need to be transferred after I was already in labor. Plus, if I ended up having an unexpected complication, there was a slightly greater chance that the baby or I would end up harmed.
Ultimately, two factors made me decide on a hospital birth at Evergreen Health in Kirkland, WA. First, the birth centers I was considering only transferred to Evergreen for emergency transfers, even though they were right near the hospital. For non-emergency transfers, I would have had to be transported to a hospital in Seattle (and that was even more risky with the 520 bridge closed most weekends around Sylvia’s due date). One source I remember reading indicated that about a third of first time mothers giving birth at a birth center end up transferred at some point, so there was a reasonable risk of having to do an uncomfortable and stressful transfer while I was in labor.
Second, Evergreen is awesome. Evergreen Health Midwifery is a practice of midwives who work exclusively in the hospital and so know the hospital policies and are known by the hospital staff. The labor and delivery nurses are known for their high quality of care and their support for whatever birth preferences a woman may have. The labor nurses work with a single mother at a time, and so are there for support the whole time. Evergreen is also a certified Baby Friendly hospital—in fact, they were the first certified Baby Friendly hospital in the U.S. They are strong advocates of breast feeding and have good support both immediately after birth and after mom and baby go home.
To round out our support team, we decided to hire a doula. Sometimes people wonder if a doula is worth having if you’re working with a midwife. The one-on-one nursing support at Evergreen may make a doula seem even more redundant. But a doula provided us with a number of benefits.
A doula would support us before we went to the hospital, and staying home longer is associated with lower rates of interventions. Another benefit of a doula is they provide support for the partner (or can take on some of the support role of the partner for a woman giving birth without one). The midwife and the nurse would be there to support me. The doula would support Jeff by helping him remember coping and comfort techniques that he could use with me, by providing support to me when he needed a break, and by freeing him from small errands like getting bags from the car or finding snacks.
After looking at the profiles of local DONA certified doulas, we interviewed a couple and chose to work with Tiffany Guenther. We would have felt comfortable with either of the doulas we chose to interview, but we just clicked really well with Tiffany. Plus, in what ended up being a nice benefit given how quickly my birth went, she lives a lot closer to us than the other doula we were considering.
The judgment
So the upside of writing this post late is that I can tell you that I am quite happy with the decisions I made. Of course, I have to add the caveat that a lot of what went into my decision making process was not relevant. There was neither time nor need for interventions (there wasn’t even time to get all of my vital signs). We didn’t have much time with any of the support team. But knowing that I would give birth in a setting that supported my goals with people that supported my goals reduced the stress before hand, and they supported me just as well as I hoped during the birth.