An article from this weekend's NYTimes chronicles the rising trend in home births in NYC. It partially credits the recent Ricki Lake documentary, The Business of Being Born.
The article does a good job of addressing the different challenges for women giving birth in their NYC apartments. It takes about space concerns, neighbor issues, clean up and hospital transfers. The article is also accompanied by a slideshow of photos from various home births.
What the article doesn't address is the huge class divide in these types of births. I, as a doula and general advocate of midwives and out of hospital births, am a huge supporter of home births. I think they are better for moms and babies who have low-risk pregnancies. I think moms feel more comfortable and are away from the stress and pressure of a hospital. She is on her own time line, no questions asked.
But the huge drawback to promoting home birth is that it is primarily an option for upper middle class women. Not everyone has a home that is safe to birth in. This could be because of family circumstances, overcrowding, lack of support from partners or simply lack of adequate space. There are also obvious financial barriers since most insurance companies won't cover home births.
It's unfortunate that an article about birth in NYC didn't address this issue at all, seeing as it is such a diverse city, in terms of both class and race.
Also, once again an article about women's health is marginalized, this one was placed in the Home and Garden section. At least it wasn't in Fashion and Style this time.
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It's so great to see home births getting positive press coverage. There are so many misconceptions out there, it's amazing.
I had a midwife in-hospital birth (because my insurance wouldn't cover it at home) with my daughter, and so many people were like "Are you crazy? Don't you care about the health of your baby?" when they found out I was having a midwife. When I would tell them some of the stats about what impact all the unecessary interventions of conventional hospital births have on the safety of mother and baby, they would just act like that couldn't possibly be true. Like I was making it all up. You can even show people the medical research on this stuff from Europe and Australia (all published in mainstream medical journals), and they still don't believe it.
i also wonder if some homebirth midwives have had experience with birth in "less than ideal" situations. ive seen "all my babies" (a health department video from the 50s) and read spiritual midwifery and in both cases they dealt with birthing in buses, without indoor plumbing, very very very poor women. would your average "catering to upper mid-class new yorkers" midwives be able to work in those same situations? and are they doing a major disservice to a subset of women who could really use the care. i know that several years ago, the disappearance of black homebirth midwives in the south was causing a dramatic increase of maternal and infant deaths among poor women.
my second birth was at a birth centre, even though i wanted a homebirth, because of issues of space, crowding and comfort. the only bathroom big enough had carpet (who puts carpet in a bathroom!!!??) and had a separate tub and shower stall. the bathroom with a tub and tile was incredibly cramped. we were living with my inlaws, had had a major fight with them the week before and i simply did not want to "perform" for them. i wanted my husband and older son with me. that was it.
I thought the same thing when I looked at the nice homes where the women were able to have their births. Having a home birth shouldn't be a luxury that only some people are able to afford. The birthing process in hospitals and the attitudes of people about pregnancy and birthing need to be changed though.
When my sister-in-law was pregnant, it seemed like every couple weeks, her obgyn would remind her of something that might go wrong and that she would probably need a c-section. Of course, she had a low-risk pregnancy, nothing happened, and she didn't even have to get induced (even though they were going to do it later that day). I think her doctor also told her that if she didn't give birth by her due date (!), she would definitely be induced. There was all sorts of craziness. And she went along with it, because those people have the degrees, not us, so what do we know, right?
Here's the story that first inspired me to start thinking about pregnancy and birth in a whole new way: The Birth of Grey Forest Walt
All I know is that I would not want to give birth in a US hospital. Giving birth on your back is supposedly the most painful way. I also think that the whole scenario is made all the more traumatizing by the bright lights and all those people about you. The baby is always born in such an aggravated situation. Plus, more and more they try to encourage you to take drugs (that you may not want) and get you out of the hospital ASAP. And a lot of hospitals try to push formula on new mothers because they get money from the companies.
I would love to give birth at home or at a specialty birthing clinic. Who knows what I'll be able to afford at that time. But could a midwife at your house compare to the cost of hospital bills?
The reason so many people are against midwives is that when doctors were trying to become established as a respected profession, (I believe this was around the turn of the 19th century) they deemed everything that was older than their new, modern medicine was quackery.
While many, probably most US hospitals do have the practices you mention, I would like to say that if you shop around enough, you can find OB/GYNs and hospitals that will support alternative birthing plans, even in the hospital. My midwives and doulas worked with such OB/GYNs.
These are probably the exception, and not the rule, though.
I know that there are some OB/GYNs who are better than others, but if you're unfortunate enough to live in a smaller city with fewer options, they're pretty hard to find. I would love to have been at a birth center or had a home birth, which is very common where I come from, but those are not options here, and the medical staff at the only hospital here is pretty inflexible. I had to fight them all the way. It was actually the only stressful thing about my birth experience.
a homebirth with a midwife will probably cost you 3,000-4,000 out of pocket and that includes all pre and post natal visits. if you have health insurance, they may be able to cover some or all of the costs.
Where I live, if you don't have insurance through an employer, private insurance has a $5000 co-pay for maternity/birth care (and believe me- I searched around!). The midwives who attend homebirth here charge $1500-2000 total for all care: prenatal, birth, postnatal. Insurance companies won't cover homebirths here- so if you do transfer- you are paying the $1500 for the midwife plus the $5000 copay. It can get costly. Of course medicaid covers expenses of transfers (ambulance, hospital bills) so if you're in the lower class and on Medicaid you're only paying $1500-2000.
This is so common sense: other mammals will refuse to give birth in a brightly lit area with strangers around - they just won't do it. And yet women are supposed to want to lay flat on their backs (the worst way) with bright lights in their faces and strangers milling around either cheerleading them or talking down to them as if they were an uncooperative child... Who came up with this shit?
Not disagreeing with you, just find it interesting the different perspectives. I'm lower class, near the poverty line. I'm also a doula. Most of the people I know that choose homebirth are lower class as well. Often the middle and upper class families give us weird looks for being crazy for birthing at home, often assuming it's just because we can't afford insurance.
I'm also a doula. :)
Thanks for that perspective! If you have any more info about lower income women giving birth at home I would love to see it, because the media seems to focus on the upper middle class women.
Thanks and yay for doulas!
I had my baby in our studio apartment. Sure, I have a bachelor's in math and my husband is working on his Master's in computer science- so we have some advantages such as higher education, but we make less than $25,000/year- not exactly upper middle class either.
Our friends who are self-employed artists (also educated, but not making a lot of money) had their babies at home. They have health insurance, but did not spring for the maternity coverage, so they'd be paying anything themselves. The home birth was a way of saving money (in addition to matching their birthing philosophies.)
I would think hospital births would present more of a financial barrier -- in the USA they're certainly a lot more expensive! I had both my children in a pretty ratty triplex, but germs in your own living space you and your baby already have some tolerance for, unlike all the antibiotic-resistant germs in hospitals.
If you read the research on home births vs. hospital births there's an interesting trend toward home births in countries with state-provided health care. Studies have shown that home births are just as safe, and in some cases safer (fewer interventions and unnecessary procedures), so many European nations encourage midwife home-births for all low-risk pregnancies.
Rachel in WY:
I think you mis-read California's comment. You two are saying the same thing.
Oh yeah, I wasn't arguing with her at all, just noting that in countries where there's an attempt to keep health care costs low while providing the best care, home birth is the best choice for low-risk pregnancies. Of course, in American health care every patient is viewed as a revenue stream, so the medical industry has gone to great lengths to make everyone believe that home births are dangerous.
I disagree about this being an upper-middle class thing. I think home birth is a more natural approach. Don't many/most other cultures do home birth? Or least least they DID until recently.
No birth is w/o risks and I really wish the medical community would get behind it. It's all about money for them.
A woman should have the right to birth her child under her own conditions if they are safe and sanitary. Obviously, some people need to give birth in a hospital (high risk babies and all that), but it just seems wrong to me to take a woman's right away. That is HER experience, HER body, and HER baby. Don't even get me started on unnecessary C-sections. C-section is a MAJOR surgery. I think people forget that because it's done often and it's done to women. But it's a major surgery.
Those pictures were great.
My friend had a home birth. She said it was horrible because of the pain, but she was glad the setting was her own home. It was private, she had a midwife, and she did great. Her HEALTHY, beautiful (and vegan :) daughter is doing well.
It makes me really ill to hear people say that women don't care about their babies if they do home birth. Yeah, asshole, she's carrying it around for almost a YEAR because she doesn't care about it. okay.
I disagree about this being an upper-middle class thing. I think home birth is a more natural approach.
ive noticed "crunchy" stuff makes strange bedfellows. you have uber liberal hippies and super religious people practicing the same things, sometimes for the exact same reasons.
I'm working on my master's degree in medical anthropology and my thesis work is on home birth in the US. Most of the literature supports the idea that home birth parents now (although not prior to the 1960s) tend to be white, middle- or uppper-class, and well-educated. However, not all researchers find this and it varies by region.
My sample skewed middle-class, but annual incomes ranged from $8,000 to $250,000. Probably the single biggest uniting factor of the home birth parents I interviewed are (1) alternative health practices such as massage, naturopathy, chiropractic, etc. and (2) concern with nutrition.
Coverage of home birth often depends on state laws. Many major insurers will cover a home birth, although you may have to spend some phone time to convince them of it. In Colorado, a home birth isn't covered by Medicaid but it is covered by the state's Child Health Plan Plus.
Support your local midwife!
Very interesting stuff, indeed.
I'm pregnant now, and one of my friends plans to have an unassisted birth. This scares the crap out of me, but her body, her life. I'll support her in whatever she decides.
I would have died with both my babies had I not been able to get to a hospital. And this one, I'm not even trying to deliver naturally: c-section it is. My doctor left that up to me entirely, and says I can change my mind at any time. I still may if the conditions are right, but for the time being, c-section is the plan.
What I've found is that as soon as I say I'm having a c-section, some well-meaning, but totally condescending jackass says, "That's major surgery*, you know!" or tries to get me to justify it to their satisfaction, and then try to talk me out of it if I don't convince them. Um, fuck the hell off. My body, my choice.
I had a midwife for my second birth. It was awful. I had a doctor for my first. It was awful, but less so than with the stupid, incompetent (and yes, qualified and certified) midwife. I know most people I've talked to have had great midwives, and I even considered going that way again this time, despite the miserable experience last time. I really wish there were more of them around, and that more people would take advantage of their services.
*not directed at the person above who mentioned that many people don't think of it as major surgery.
Good post. Midwives and home births are wonderful thing, but they aren't for everyone. This is not a one-size-fits-all thing.
No matter how strongly you feel about home birth, always have a backup plan involving a hospital in advance, just in case. And don't judge people who go the traditional hospital route. They may have some pretty strong health reasons for needing a hospital and M.D.s, and besides, it's their own personal choice.
I just wanted to say thanks for your friend who's going unassisted. I mentioned above that I had my baby in our studio- I left off that she was born unassisted because there really isn't a lot of support for that. I had done a lot of research and was very confident in our choice. We did have a back up plan, but it was not needed. Part of me thinks everyone should plan for an unassisted- because you really don't know where you will give birth- on the way to the hospital or if the midwife gets stuck in traffic. That way there is less panic if plans don't go as planned.
But anyway, please continue to give support. It will be so appreciated.
Wow. An entire thread on home birth and not one single "but, but, home birth is so dangerous for all women!" Just a civilized discussion of different birthing choices.
I just jinxed it, didn't I?
I know, isn't it bizarre (and sweet!)?
Well, I'll go there.
It's not dangerous for all women. It's not even dangerous for most women. It's just that for the women who it is dangerous for, they don't always know until until it becomes dangerous. A birth can go from routine to life-threatening very quickly.
I thought there had been a trend towards home-like birthing rooms in hospitals? Whatever happened with that? Everybody has their own risk tolerance, but I'd rather the doctor be down the hall than an ambulance ride way.
I had a professor studying home birthing and midwives in Virginia. Definitely in some cases/areas it was an upper class thing, but for women in rural southern/western Virginia, it could also be an option for those who couldn't afford hospital care, or who lived in areas without immediate hospital access. So, I think it's entirely possible that it's an upper/middle class "phenomenon" in NY, and different in other areas.
I didn't look at the photo show, but the primary article seemed actually quite good (for the NYT, anyway) about considering the needs of lower-income women.
They talked about what happens in small apartments - where do the older kids go? What do you tell the neighbors about the noise through thin walls? How much mess is there really - will you ruin your expensive bed (whatever "expensive" means to that mother)?
The article spoke to all those concerns head on. It didn't directly focus on the needs of poor women, but it wasn't in rich lady la-la land either.
My mother worked as an OB/GYN obstetrics nurse for many, many years, and she said that, even if a pregnancy is "low risk," the damage that can be done to the mother or baby if someone does go wrong was sometimes exacerbated by midwives or doulas who insisted on trying to make the woman deliver naturally or delayed getting her to the hospital. My mom is feminist, an incredible nurse, and cares deeply about the health of mothers and babies. She supports natural childbirth, and the hospital works with midwives and doulas for women who would like to have them there. She has dealt with numerous competent, caring midwives, but also has dealt with midwives who were combative, condescending and unhelpful to the hospital staff, and who provided inaccurate medical information to the women they were supposed to be serving. As a nurse, she felt that it made her job harder when she had to mediate between doctors and midwives, when both should be focused on the patient.
I think that facilitating better communication between midwives and the hospital is very important, and I also think that midwives who think it's some kind of imperative that a woman deliver naturally or reject pain meds do a disservice to women who are unable to, for whatever reason.
I think there's a reason that doctors spend 4 years in medical school and then many, many more years in residency and other training. In childbirth, something can go wrong with short notice and midwives are not necessarily going to be able to address the problem.
I'd also like to point out that many hospitals now have birthing tubs, and let the woman labor in whatever position she feels comfortable (the one exemption being a nurse who let a woman push while sitting on the toilet when she was fully dilated - not a great tactic!). The hospital/midwive dichotomy has begun to lessen, as the two collaborate on helping the woman have the best birthing experience for her.
I'm sure I'll get lots of "You just hate midwives/feminism/nature," and "Hospitals are stressful institutions that impose unnecessary medical procedures all the time," comments. But I don't understand why it's considered "un-feminist" to state that hospitals are better situated to treat medical emergencies than a doula at someone's home. There's nothing wrong with admitting that it is more risky, but that it is nevertheless, for some women, a risk completely worth taking. I think that's fine - it's a totally personal decision, and is different for everyone.
However, I dislike the tendency to categorize obstetrics doctors and nurses, many of whom are also women and feminists, as obsessed with c-sections and opposed to natural childbirth. People work in this field for a reason, and for most people, like my mother, that is to help mothers and babies. This should be the common ground that everyone can agree on.
I think the issue that many of us have is with the western medical model and approach to childbirth itself. When you go to a medical institution and are told to lay passively on the bed so that somebody else (usually a male) can "deliver" your baby, this is a perfect example of a paternalistic approach. I delivered my child. The nurses and doctor (my midwife was out of town) helped me. I had a birth plan full of reasonable things that are well-supported by research, and I had to fight for each and every one of them. I was only pushing for 15 minutes total, but I had to fight to avoid an unecessary episiotomy. I tested negative for gonorrhea and chlamydia, but I had to fight to keep them from giving her the antibiotic eye drops. The list goes on and on. When you speak with most doctors, and many nurses, they are very paternalistic and reluctant to listen. Pregnant women are viewed as sick and in need of treatment. Pregnancy and childbirth are not diseases. I realize that hospitals make more money and manage their time better by putting people on timelines, doing c-sections, performing unecessary procedures that the insurance company will then pay for, etc. I just don't think that any of this is in the best interest of mothers or babies. If more doctors and nurses had a mother-centered rather than doctor-centered approach, I would be much more comfortable with medically-managed child-birth.