Why Homebirth?

I was perusing the homebirth forum on Mothering.com, where I posted often during my pregnancy and even more often now that Nora is here, and came across this gem.

She said it was ok to repost it, and I'm so glad she is willing to share. If anyone wants to stop by her personal blog, here is a link:

http://raving-liberal.livejournal.com/826262.html

If you have a few minutes, please take the time to read. You may learn something and who knows, you may change your mind and decide to homebirth when/if you have your own babies...

*****

When hearing the news that I had my last baby at home and am planning to have this one at home as well, the first response from most people is, "You're so brave."

This has to be one of the most irritating things that people say to homebirthers. The implication is that birth is dangerous and that we are willing to take on a tremendous risk to do it anywhere but a hospital. It negates the research and planning that we've done to come to this decision. It makes the choice about balls, not brains. After all, homebirth is "dangerous." Hospital birth is "safe." Therefore, it must be bravado alone that would lead a woman to choosing such an option. Right?

In 2003, over 20% of women had their labors induced, with a rate closer to 40% in many hospitals, while that rate should not exceed 10% (and has remained at 10% in most industrialized nations). Inductions are approximately 5 times more likely among planned hospital births than planned homebirths. An 1999 American Journal of Obstetrics and Gynecology "Green Journal" review of 7000 inductions found that 3 out of 4 of the inductions were not medically necessary. Inductions are performed unnecessarily for estimated size of the baby (too large or too small), going past the estimated due date, amniotic fluid levels that are low but not critically low (correctable in nearly all cases by rehydration of the mother), rupture of membranes without immediate start of labor, the mother being dilated/effaced but not in active labor, or scheduling reasons on the part of the mother or care provider. Approximately 40-50% of inductions fail (depending on the induction method used and the mother's Bishop score), and most failed inductions end in cesarean section. Inductions increase labor pain and length, and create, among other problems, an increased risk of fetal distress, uterine rupture, and cesarean section.

But homebirth is "dangerous." Hospital birth is "safe."

Over 30% of women in the US have cesarean sections, while overwhelming research has led the World Health Organization to set an ideal standard rate of cesarean sections at 10-12%, with 15% being the rate where more harm is being done instead of good. Cesareans are performed at a similar rate across all risk groups, low to high. The cesarean rate for planned births at home or in an independent birthing center is approximately 4%. Cesarean sections increase the likelihood of maternal death by as much as 4 times, and have other immediate and long-term heath risks for mothers that include, but are not limited to, infection, bowel or bladder perforation, hysterectomy, future infertility, and increased risk of uterine rupture for future pregnancies. Risks for the baby include respiratory distress, fetal injury, prematurity (if result of schedule section or failed induction), and breastfeeding difficulties. Four of the greatest causes for the increase in cesarean section are overuse of interventions during labor, concern for malpractice/liability on the part of care providers, failed labor inductions, and "failure to progress" (labor not progressing fast enough or regularly enough for care providers).

But homebirth is "dangerous" and hospital birth is "safe."

The ACOG and AMA have both come out against homebirthing, calling it a dangerous trend and referring to it as a "fashionable, trendy, [...] the latest cause célèbre," and they paint a horrible picture of complications arising in low-risk pregnancies with no warning that cannot be handled anywhere but the hospital. Despite that, the most thorough study ever done on homebirth safety, Kenneth C Johnson and Betty-Anne Daviss's Outcomes of planned home births with certified professional midwives: large prospective study in North America, BMJ 2005;330:1416 (18 June), found that the outcomes of planned homebirths for low risk mothers were the same as the outcomes of planned hospital births for low risk mothers, with a significantly lower incident of interventions in the homebirth group. The Lewis Mehl Study of home and hospital births, which matched couples in each group for age, parity, education, race, and pregnancy/birth risk factors, found the hospital group had 9 times the rate of episiotomies and tearing, 3 times the cesarean rate, 6 times the fetal distress, 2 times the use of oxytocin for induction/augmentation, 9 times the use of analgesia/anesthesia, 5 times the rate of maternal blood pressure increase, 3 times the rate of maternal hemorrhage, 4 times the rate of infection, 20 times the rate of forceps use, and 30 times the rate of birth injuries (including skull fractures and nerve damage). Breastfeeding success rates are higher and postpartum depression rates are lower for planned homebirths.

But homebirth is "dangerous" and hospital birth is "safe."

The United States spends more per pregnancy/birth than any other country, the vast majority of women in the US give birth in hospitals, and yet the US's maternal death rate is the worst among 28 industrialized nations and the neonatal mortality rate is the second worst. The Netherlands, where 36% of babies are born at home, has lower maternal and neonatal mortality rates than the US. Denmark, where all women have access to the option for a safe and legal home birth, has one of the lowest maternal and neonatal mortality rates.

But homebirth is "dangerous," hospital birth is "safe," and Brutus is an honorable man.

I didn't choose a homebirth because I am brave. Bravery has little to do with it. If anything, I believe women who choose to give birth in US hospitals are the brave ones, because knowing what I know about our technocratic obstetrical system, I can't imagine voluntarily choosing an obstetrician and a hospital for anything but absolute medical necessity. My decision to homebirth wasn't made in a void, but based upon years of research. I wonder how much research the average woman puts into her hospital birth? Considering how many times I've heard someone say "I'm glad I was in the hospital because..." and then given as her reason a non-emergent situation (such as fetal size or nuchal cords), I'd say not that much.

Call me stubborn, because I wasn't willing to accept out of hand the culturally held belief that hospitals are safer. Call me an idealist, because I believe that birth can be a positive, safe, and empowering experience for child and mother. Call me a nonconformist, because I choose to birth at home in defiance of a powerful technocratic system. Call me outspoken, because I can't keep my mouth shut when I hear about yet another iatrogenic birth calamity. Call me a "birth nazi," because I believe it's the right and responsibility of every woman to educate herself about birth and take ownership of her birth experience.

But brave? Don't call me brave. "Brave" has nothing to do with it.

Rollin'

Well these breakthroughs sure seem to come in bursts. Over the weekend, we noticed Nora intently looking at her fingers and touching them together, then later that day she was throwing her legs up and grabbing them (at least tried to grab them).
Now she's rolling over! Last night we saw her roll from back to belly for the first time, and today over Grandma's house she was rolling back and forth, and even started scooting backwards.

So, it wasn't a tooth...Oops.

So, I feel kind of dumb, but I took Nora to the ped Thursday night for her 3 month checkup. Well, the ped saw what I saw poking through her gums, and said she sees them often - and lots of 1st time parents think it's a tooth - but it's actually some kind of a cyst. It's hard, white and jutting through her gum, but it isn't a tooth. Harmless and very common. It should go away on its own. Oh well! I thought it was REALLY early for her to be cutting teeth anyway. So, I'm kind of embarrassed that I thought it was a tooth, but I chalk it up to never having seen a baby cut a tooth before.

But she is definitely teething. The ped says she sees buds in there ready to come through in another month or so. Yay for fussy babies!

Oh - and she weighs 15 lbs 15 oz and is 26 inches long! My little chunker! 95th percentile, w00t!

Here are some photos to tide you all over!

Gearing up for the cold!



Our big girl - so sleepy!




Beautiful!



Hello!


Happy girl!

We knew it...

After a very fussy day, and a few really hard weeks, Chris and I finally saw a tooth peeking through Nora's bottom gums today! We can't believe she is already cutting a tooth! Our little girl is certainly hitting her milestones quickly!

Silly Giggly Girl!

So, we haven't updated in awhile and I thought I'd just jump on here to say a few words. We had a very happy Christmas with Nora! We hope you all had fun hanging out with us and with her!

Nora is going to be 3 months old on Friday. Where did the time go? Sometimes I feel like I've had no time to spend with her at all, that all of this time so far has been spent struggling to figure her out. Now that she's growing, giggling, and interacting with us more, I feel like she's becoming a little girl instead of a newborn. I want to spend every minute with her!

She's gotten to be an incredibly silly little girl. Her sense of humor and personality are really starting to come through! She often has giggle fits and makes silly faces. Here is one of her favorite faces to make:



We'll update again soon! Promise!

Almost Christmas

It's been quite a while since our last update. Everything's going very well with Nora. She had her first vaccine at her last doctor's appointment, just this past Tuesday. She received only the Daptacel DTaP shot this visit and will probably be getting the RotaTeq rotavirus vaccine next week. We wanted to separate them so if she had any adverse reactions we could isolate the cause to a specific one.

She's up to 12 lbs pound now and is 23" long! This puts her at the 75th percentile for height (is it length until she can walk?) and weight.

Nora has been doing a lot of babble talking lately, she has moods where she'll throw a fit until we put her onto her back and let her just talk to us. She's holding her head up extremely well and has been sucking a lot on her fist, but hasn't yet discovered her thumb.

Aside from that, things are finally starting to settle down around here. After our loss of Leeloo, unfortunately things got worse before getting better. My grandmother (my mother's mother, and the last remaining of my grandparents) passed away a little over two weeks ago. She had been having heart problems for the past year, had a valve ballooning procedure a few months ago, which worked well at first, and actually had seemingly successful open heart surgery about a month ago.

Unfortunately while the surgery and initial recovery went well, she ran into some problems later on. The most significant problem seemed to be excessive fluid retention, which may have been caused by an underlying problem, instead of being related to the heart. She was back in the hospital at least a day before her situation got really bad, so there was at least some time when the doctors had a chance to intervene. While they ultimately not successful, I'm happy she had a chance to fight, both in the months of heart procedures and in the end. She was 90 years old.

We're happy that Nora's Great Grandma had a chance to meet her a few months back. While we're so sad she's no longer with us, back when we announced our pregnancy she was pessimistic about her health and if she'd be around to see Nora at all. It's good that her first heart valve procedure gave her a few extra months of time to meet her first great grandchild.

Thanksgiving was a bust, but we're looking forward to the Christmas holiday now. For a while we were thinking about adopting a dog or a third cat, and now that Cosette is alone we're pretty settled on another cat now. It's at least something new to look forward to.

Goodbye Dear Leeloo

The past week has been a very rough one on us. On Monday, November 3rd, we were forced to say goodbye to our beloved cat Leeloo, after only knowing her for two years. After months of being sick to varying degrees, she developed an infection that her poor little body was unable to fight off. Our hearts are completely shattered. She was a huge part of our lives, she was my best friend, and she is very much missed.

A few months ago, back when we were doing a lot of renovation in the house to prepare for the coming baby, we noticed that Leeloo was occasionally not very hungry. She was still eating during the day but at certain meals she just didn't seem to have a huge appetite. We read a lot about how cats are particularly sensitive to stressing over changes around them, especially with their food dish location, we figured that might have been the problem. We moved the food to a more private location and all seemed fine. She was still acting like herself, begging for food, and usually gobbling it up.

Still, she had lost some weight and continued to do so. She was by no means a skinny kitty, but she used to be massive compared to Cosette, and at this point in time, Cosette was larger than her. We paid particular attention to make sure Leeloo was eating (thinking Cosette was stealing most of the food) but sure enough, she appeared to be eating ok. She was still acting just fine, running around, jumping all over things... just being herself.

A few weeks later, we decided to bring her to the vet because, despite still eating regularly, she was now quite thin. This was on a Monday. The vet drew some blood for tests and gave us the normal "I don't know what it could be therefore it's probably cancer" line.

On Tuesday afternoon we received the blood results, showing she did not have leukemia or anything else identifiable. We were told to bring her into the clinic's hospital for x-rays the following day.

We brought Leeloo in for x-rays on Wednesday, the same day Carrie went into labor. Her labor pains started early that morning but were still latent when it was time to drop Leeloo off, so she came with me to the vet hospital. By the afternoon, she was in active labor so I was fighting through rush-hour traffic to pick up Leeloo while Carrie was at home having contractions and the midwife was en route. I was told that the x-ray showed a mass on Leeloo's liver, potentially cancer, but they needed an ultrasound to get a better look. As luck would have it, the hospital's ultrasound machine and/or person was not around for three weeks, so I was given the option to wait (?!?) or go to another emergency facility for the ultrasound. I chose other facility.

On Thursday, after being up all night for Nora's birth, my mom and brother dropped Leeloo off for her ultrasound. The vet there thought the problem was probably a hairball in her stomach, not cancer! Well, after an ultrasound and subsequent endoscopic surgery, the surgeon actually removed a toy mouse from Leeloo's stomach! She apparently ate one of her $1 toy mice, causing all of this. Leeloo had a feeding tube inserted because she lost so much weight and her liver wasn't functioning properly.

After only a day or two of tube feeding, she was back to eating lots of food on her own. We were incredibly happy that she was making a fast recovery. That Friday, her liver tested ok and the tube was removed (she hated the tube). She was given some antibiotics for an infection she had on the skin near the tube.

It seemed the worst was over. Leeloo was getting back to herself, though still a bit slower she was doing a lot of the same things she always did. She was back to sleeping between my legs at night and laying across Carrie's lap during the day. It seemed all was going well.

Yet October 28th we noticed her appetite was waining again. I tried making her some special food she loves, we gave her some of the left over appetite stimulants we had, and I started giving her Nutrical because I was afraid her liver would get messed up again. She seemed to be eating ok again, but that only lasted a day or two. On Saturday she stopped wanting to eat much food at all, so I ran out to Petco to get a feeding syringe just to force her to eat something. We decided that something more serious was going on and would take her to the vet on Monday.

I fed her and she ate fairly easily from the tube on Saturday evening. But on Sunday morning, she had absolutely no interest in food. It was very difficult to get her to eat. I managed to get a good amount of food down, but when I put her back where she was sleeping I noticed she was breathing funny. I looked up to see if our vet had any Sunday hours. Carrie went over to her and noticed that her ears were really hot, so I took her temperature. 105.5F--way too hot for a cat! I contacted and immediately took her to the vet's off-hours emergency clinic.

The vet was very concerned by Leeloo's breathing and immediately ordered up an xray. It showed fluid in her chest cavity, pushing against her lungs and making it hard to breathe. The did a procedure to remove the fluid, so for a while Leeloo was breathing a bit better. They were pretty certain she had an infection, so they started her on antibiotics. I left her there for them to monitor and care for her and headed home.

If it wasn't bad already, it quickly got worse. The vet called within a hour or so to say that Leeloo had gone into respiratory distress. They had to do another procedure to remove the fluid and had the hard choice of giving her steroids for the breathing troubles (steroids are not good when there's an infection). They ended up also putting her into an oxygen chamber, but her condition wasn't getting much better.

At this point, it really hit us that this might not work out, but we were determined to give Leeloo every chance to pull through. Carrie, Nora, and I headed down to the vet that evening to see Leeloo and to talk to the vet again. We decided that we'd let her trying to get through the night in the oxygen chamber, and in the morning I'd transport her to the Garden State Vet Specialists for some more advanced care. We talked to the vet a bit later and was told that Leeloo got up to drink some water and peed a bit, which was encouraging.

The next morning, I picked up Leeloo around 6:30am. Unfortunately her condition was deteriorating. She had a few bouts of breathing problems overnight, and we had to take her out of the oxygen chamber to transport her. I rushed her down to GSVS, a 25 minute drive down the Parkway, and ran her in, immediately getting her back on oxygen.

A few minutes later, a vet came out to tell me that the prognosis was very bad, and seemed to imply that I should give up. Leeloo had been through so much the past two months, I wasn't going to give up on her. I gave the OK for them to continue to treat her as long as possible and set off for work.

On my way, I got a call saying that Leeloo was in respiratory distress and wanted to know if I wanted them to give her a breathing tube. Of course I did. A few minutes later they called to say she was crashing, and wanted to know if I wanted them to try reviving her. At that point, it really hit me. I debated whether it was worth any more discomfort to Leeloo, whether a bad outcome was already certain, and if dragging this out would only keep her around for a few more minutes of pain. She had been through so much so far, I owed it to her to have every opportunity to pull through, so I OKed resuscitation. I called Carrie to let her know what was going on...

Sitting at my desk, shortly after 9am, I got the call telling me that they were not successful. Our Leeloo wasn't able to be brought back. She was gone. This was the most horrible news I had ever heard.

I came home. It all seemed unreal, yet real enough to be incredibly upsetting. We had thought the worst was over, that she pulled through her toy-swallowing ordeal, but our optimism wasn't enough.

Carrie and I eventually gathered the strength to drive down to GSVS that afternoon to pick up Leeloo's body for burial. The vet told us that the fluid removed from Leeloo showed a septic infection, and was probably from the feeding tube. She said that it wasn't due to any mistakes made in her treatment, but that sometimes they get infections from the tubes. With the loss of bodyweight and the stress of the previous procedures, the infection was pretty well hidden from us, and when it finally started to get the best of Leeloo, it hit her extremely fast and hard. Her little body was simply too tired to fight it off, but she gave it her all.

The drive back home was strange. Carrie and I both felt that Leeloo was there with us, even though she was gone. There was a strange presence we felt with her body in the car with us, even though she was wrapped up and we didn't actually see her yet.

When we got home, I had to do what was necessary. I started digging for her burial. Three feet down, I finally finished and we could continue with saying goodbye.

We opened the box we took her home in and unwrapped her. She looked so sick, yet so peaceful. She was Leeloo but not herself. Our little kitty was just lying there, unable to see us and unable to feel us. We were so unprepared to deal with the reality that she was gone. We always imagined her living with us for 20+ years. She was Carrie's best buddy during the pregnancy and was there when Nora was born. We so expected Nora to grow up knowing Leeloo, and Leeloo knowing Nora. But the cold reality was that simply could not happen any more.

We let Cosette, Leeloo's biological sister, see her body. We don't know what's going on inside her mind, but we knew that she was looking for Leeloo, and we felt that this would help with whatever form of closure she might need. She came over and didn't seem to recognize Leeloo visually. She was sniffing around her feet, which smelled like some sort of sanitizer, but suddenly Cosette smelled near Leeloo's tail and reacted. She took another sniff, dropped her tail, and walked away. She knew. She knew her sister was gone and not coming back to play. We were actually surprised to get such a marked response, but are glad we decided to go that route. I would rather have Cosette need to deal with knowing Leeloo was gone than continue on walking around the house calling for her as she had been.

For her final few weeks, Leeloo loved sleeping inside Nora's stroller covered in a pink fleece blanket. We decided to wrap her in a piece of that blanket. We buried her along with some kibble that I had made (for when she felt better), some straws (that she used to love pulling out of the cabinet and walking around the house with), and a bag of catnip (remembering the time she grabbed and ran off with an open bag of it, getting it everywhere). We put her back into the cardboard carrier we picked her up in and proceeded outside.

There wasn't much to say, other than that we love you Leeloo and we miss you. We're so sorry that you had such a rough two months and we're sorry we weren't able to help you. We placed her in the hole that I dug, a hole placed in a location she used to see when looking out the kitchen window, and Carrie and Nora watched as I refilled the hole. Now she's at rest.

Carrie and I feel absolutely horrible. Not just because we miss her so much, but that we feel like we failed her. It was our responsibility to care for her, and somehow we managed to fail. Looking back, even as I write this, it seems obvious that something was wrong before we realized it, but such is the curse of hindsight. We cared so much for her, and at the time we did everything we possibly could to help her. We don't feel that we made any careless decisions. Any time something like this happens, one always says things like "if only I had done something sooner." But I don't feel that we made any ridiculous mistakes. Yes, we feel that we failed her because she's no longer with us, but we did everything possible to help her at the time. Each decision was made in her best interest at the time, knowing only what we knew then.

I miss Leeloo so much. Almost every night in the winter she used to sleep between my legs at night. In the mornings she used to wake me up with a kiss on my nose, and always used to beg me to feed her before I got into shower. For the two years she was here, I made almost all of her kibble and wet food by hand. I loved the way she'd come up and sit on me on the couch, gracing me with her presence. She'd sit on my lap, and if I had to pick her up to get up, she'd wait a few minutes to see if I'd return before taking the spot for herself. She used to come downstairs and watch me lift weights, just watching that and everything I would do. All that and more will be missed.

During the pregnancy, Leeloo was Carrie's shadow. She seemed incredibly aware of what was going on. She used to lay across her belly when Carrie was on the couch, and used to sleep on her hip at night. Leeloo was there to comfort her when she was feeling sick. We imagined her continuing to grow with Nora, but we're happy that she was able to be there for the birth and to meet Nora, even if only knowing her for a few weeks.

Leeloo's full name was Leeloo Dallas Multipass, named after Milla Jovovich's character in The Fifth Element.

Goodbye Leeloo. We love you. We miss you. We're sorry that we were only able to share two years with you, but we'd do it all over again in a heartbeat.