Choosing Home Birth

On the morning of August 11, 2009, I was awoken by a slight popping sensation and a trickle between my legs. I didn’t wake my husband because I wanted him well rested. By 6 AM, the trickle had grown along with my excitement, and I roused him. He left a message with work that he wouldn’t be coming in that day. We were still one week away from the ultrasound due date. In the back of my mind, though, I had held onto the date we’d initially calculated using my
cycle, probably because it shortened my pregnancy by a full week, which at 40 weeks felt like a month. Now I felt vindicated that my due date instincts were correct and relieved that my time as a house on stilts would soon be over. The grand plan for my first birth experience was off to a timely start.

We decided to take a walk to Tim Horton’s, a coffee shop half a mile away from the house we were staying in that summer. I’d read that walking precipitates birth, and I hoped, as surely we all do, for a quick and easy birth. By the time we returned, I was down on the sidewalk, floored by the pain. Fear took over. The sensation was so much more than I had anticipated. Moaning on the pavement, I cursed my best friend, Jenny. Her peaceful at-home water birth, which I had witnessed over Skype a month prior revealed nothing of this level of hell. But just as suddenly as the contractions had begun, they miraculously stopped. I left the nightmare on the sidewalk and re-entered the house very relieved that that was over. For now.

As part of our home birth plan, we had temporarily relocated from San Francisco to my hometown of Oakville, Ontario, Canada. A family friend who vacations in Nova Scotia for the summer rented us her house. The walk from the front door of her house to the labor and delivery department at Oakville Trafalgar Memorial Hospital was 45 seconds. My stepfather was chief of staff and chief of emergency at that hospital. My mother, a family physician, had
attended over 2000 births there too. Our plan was a home birth, but, needless to say, we had our bases covered.

Medicine runs deep in my family. In addition to my mother and stepfather, my father is an otorhinolaryngologist. My grandfather was an orthopedic surgeon who built a hospital in Malawi. My uncle Ned is a sports medicine surgeon and the chief medical officer for athletics at Duke University, where he’s known by all the athletes simply as “Doc.” I, too, was being pushed not so subtly towards medicine. As part of my grooming at age 13, I watched my youngest sister’s birth and cut the umbilical cord. Ironically, my 10-year old sister Di, green and cowering in the corner, ended up somewhat following in my mother’s footsteps. She became a midwife.

Di exposed me to alternate philosophies and approaches to birth outside of western medicine. On her advice, I watched “The Business of Being Born” and read Ina May Gaskin’s “Spiritual Midwifery.” I even watched “Orgasmic Birth,” which you have to see to believe. I wasn’t anticipating quite that level of ecstasy from my own childbirth experience. But I did hope to transition my child into the world and into a relationship with me through an experience of empowerment, connection, and health. A natural home birth seemed the best possible recipe for the experience I was determined to have.

In retrospect, I wish I’d chosen a pregnancy test that gave me a moment to translate lines or colors, to gently transition me into the realization that my life as I knew it would be seriously altered forever. Instead, my test screamed “PREGNANT” at me; I’m pretty sure there were neon lights. Once the shock wore off, I organized travel back up to Canada for the birth, planning to stay in San Francisco until it was no longer safe to fly. Luckily, my husband’s law firm had an office in Toronto, and he was able to transfer for the three months around our daughter’s birth. My unique medical family situation made birthing in Canada an obvious choice.

I wanted to birth my baby in a country where home birth didn’t have the stigma it seems to have here in the US. Furthermore, I have never trusted the medical system in the US  like the one I grew up in. Canadian doctors choose the profession primarily to serve. If you are smart and want to make  money, you pursue law or business. Not that people pursuing medicine in the US don’t have the same honorable intentions to serve, but they also have the added incentive of making more money. Doctors in the top earning bracket in Canada can expect to give back over half of their earnings to the government versus only giving back 38% in the US. When in the doctor’s office in the US, I always have the distinct experience of being a customer, given access to certain tests if they were covered by insurance, denied tests for preventive care or to determine baseline health (something that has become exaggeratedly noticeable during perimenopause), and having certain tests or treatments pushed  when they didn’t necessarily align with my personalized healthcare needs or goals. I wonder how the US healthcare system, embedded within the pharmaceutical/medical industrial complex and capitalism, truly prioritizes the health of its mothers and babies. Some of the numbers seem to indicate that it doesn’t.

I first became aware of MMRs (maternal mortality rates or deaths per 100,000 births), during my first  pregnancy. In 2008, the MMR in the US far exceeded that of other high-income countries. Not only has that  number not improved, it has worsened (23.8 from 20.6, see Commonwealth Fund and NIH), landing the US behind Kazakhstan and Saudi Arabia,
especially for women of color (55.3) who are 2.5 times more likely to die in childbirth than their white counterparts. Comparatively, in the Netherlands, which has the highest per capita number of home births and the lowest numbers of epidurals, almost no women die in childbirth (1.2). According to the World Health Organization “Maternal Mortality (MM) is widely acknowledged as a general indicator of the overall health of a population, of the status of women in society, and of the functioning of the health system.” (Journal of Women’s Health 2021.) Why in the United States, a country with so many resources, does this negative indicator of overall health and the status of women continue to climb? Perhaps it shouldn’t be surprising in a country that is slowly stripping away women’s rights to their own bodies. When I looked at the realities of giving birth in the US, including the extremely high C-section rate, it didn’t feel like a safe choice.

We found an obstetrician at California Pacific Medical Center in San Francisco to handle my prenatal care until we transferred to  Canada. I had a lot of nausea and the way I handled it, for better or worse (for worse), was to eat continuously. I didn’t learn until my second pregnancy to avoid foods that spike blood sugar in order to stave off nausea, not to mention the weight gain. My appointments became more and more stressful as the doctor kept insisting on taking my weight that climbed beyond “normal range,” despite that there were no markers of gestational diabetes or any other weight-related complications. I was underweight going into the pregnancy, so it made sense that I was gaining. Di said that there was no reason to keep weighing me and that I could decline to step on the scale. When I declined, the OB was obviously peeved.

My iron levels began to fall during my second trimester and the OB informed me that if they didn’t improve I would not be able to have the homebirth I was planning. I then started cooking everything in an iron skillet including liver, which I could  barely stomach. At the next appointment I asked to have my iron checked. The OB said there was no way that I would have been able to improve my iron levels in such little time. Most appointments would result in me crying on the phone to my sister who was surprised by the OB’s authoritarian approach and the lack of informed choice she offered.

I remember imagining how much worse it must be for those who are not white, upper middle class, and well-educated. Having my sister’s voice in my head encouraging me to be my own advocate, I insisted that we check my iron. She replied, “Well, if you want to get poked…” The results of getting “poked” revealed that I had, in fact, moved my iron levels into the normal range, yet I received no acknowledgment from the OB that what she had stated about my ability to alter my levels was incorrect. I was just happy my iron levels had adjusted and couldn’t wait to get up to Canada. Especially after my final ultrasound when the OB declared that there was no way my baby would be under 8 pounds and predicted something much larger, a prediction that is both unreliably made by ultrasound and that no pregnant woman wants to hear.

I certainly felt very large waddling into my midwifery appointment in Oakville at 2 PM on August 11, 2009, the day my labor had begun and then had stopped. Anita, my midwife, examined me and told me I was already 2 centimeters, which meant I was in early labor. Di and Anita recommended something called a “stretch and sweep,” a manual sweeping by finger of the lip of the cervix to bring on labor. In retrospect, this is one aspect of my care that I might have done differently.

Leaving the midwifery office, I had to face the fact that the baby was coming out. I was hungry, so we picked up some poutine and a chocolate milkshake.  Regrettable food choices, but, as I said, I hadn’t quite figured out  nutrition yet. Growing up with doctors, you learn a lot of science, anatomy, physiology, biology, but oddly, nutrition wasn’t a part of their medical school education.

When we got back to the house, I took a nap. I awoke around 4:30 PM with a contraction that sent me straight to the toilet because I thought I was going to throw up. After a second one of those, I called my sister who was just sitting down for dinner. She sounded quite relaxed and said she’d come by in an hour or two. Then she heard one of my contractions over the phone. “I’ll be there in 30 minutes,” she said. 

Anita and my mother arrived shortly after. Our birthing pool sprung a leak while I was laboring and kept my husband busily searching for towels to mop up and mitigate damage to our friend’s house. It didn’t matter to me what anyone else was doing as long as they didn’t talk or bother me. I felt like I had gone into a tunnel and did not appreciate any reminders that I wasn’t alone. When I began grunting, my sister, who didn’t want me pushing before I was fully dilated, asked me to get out of the pool so she could check. I remember having felt deeply annoyed because the idea of getting out of the tub seemed impossible. Plus, I already knew I was ready. The concept of body-mind unity that I had begun to develop viscerally through my yoga practice became crystallized during the experience of childbirth. Never had it been so clear that my body and mind needed to be entirely the same thing to fulfill the daunting task of childbirth. There could be no separation, no disputes between the two. All focus had to be in one place.

Even though every tiny movement piled more sensation on top of what I believed was my upper limit, I lumbered out of the tub. She checked and, surprised, exclaimed, “You’re fully!” At this point I was preverbal. I remember being enraged at my mother who wouldn’t stop chattering in spite of me shushing her. I had trouble understanding my sister when she said “fully” [dilated]. I needed a number to get the greenlight to push. I managed to string together two words.
“How many?”

“10!” she said. “You’re 10! You can push.”

Getting back into the tub seemed impossible. Having suffered my fair share of constipation, I knew I could push well in a squat. I climbed up onto the birthing stool, which is like a toilet seat on feet, and pushed for a total of 5 minutes. From the beginning of active labor to Charlotte’s birth was only 4 hours and 29 minutes.

My sister who has a knack for guessing birth weight (unlike some OBs we know) took a poll from everyone in the room, which by then was my mother, stepfather, brother, baby sister, Anita, a backup midwife, my friend Jenny (the quiet birther) with her newborn wrapped tightly to her body, Di, my husband Nathaniel, and our French bulldog, Piggy. Di guessed 7 pounds; Charlotte was 7 lbs. 1 ounce.

“I can’t believe I barfed 3 times,” I said to Di.

“3?! Try 30!” she responded.

She likes to say I barf my babies out. She also says that each time a woman in labor vomits it’s the equivalent of 10 contractions. The reverse peristaltic action of retching creates tremendous downward force propelling the baby down the canal. Six years later, I barfed my second baby out, this time in the basement of our home in Oakland, CA.

I couldn’t uproot the family back to Canada like we did for Charlotte’s birth. We decided to give UCSF, a very reputable birthing hospital, a chance. We signed up for their  hospital tour.

As we  entered the lobby we were greeted with friendly staff as all the pregnant moms exchanged nervous smiles and some excited chatter. By the end of the tour though, the smiles had faded. I remember looking around the room and failing to meet anyone’s gaze. So many of the women had  started looking at the cold, hard floor. As we moved through the tour, I began to feel like cattle being herded in and out of shared rooms with horrible lighting and starched sheets on the beds. There was nothing cozy about the  environment. We were told step-by-step what was going to be done to us, who would be handling our care, and what would happen if our assigned doctor finished their shift. While some rooms had decent birthing pools, there was no guarantee about where we’d end up. Most of the rooms had tiny tubs in the
bathrooms and stirrups at the foot of the beds. I couldn’t imagine birthing a baby in this space.

After the tour as we left through the automatic sliding doors of the hospital I looked at my
husband who beat me to it. “You can’t have a baby in there.”

More often than not, the reaction I get when I  mention home birth is a dismissive comment like, “Oh, I’m not that brave.” I always respond, “I think having a baby in the hospital takes much more courage.” Courage to ignore biological urges in order to accommodate doctor’s schedules, bravery to listen to your own inner strength and intuition regardless of what others are telling you is possible, the fortitude to carry on and ignore crucial environmental aspects like lighting and sound that deeply impact your ability to focus, the strength to advocate for important and basic choices such as what and when you consume food and drugs, and how you move or position your body. That’s the kind of bravery I don’t think I have. Childbirth is the most challenging task women face, matched maybe only by  parenting. I wanted to create the
best possible environment for myself to face this tremendous challenge.

In line with creating the best possible situation and due to the negative experience I had had with prenatal care during my first pregnancy, I kind of hoped to avoid it altogether. In The Netherlands, where birth is not considered a medical event, the number of prenatal appointments is two. I would have been happy with that. But upon my sister’s insistence, we found a midwife in our network at Alta Bates in Berkeley who had a terrific reputation and agreed to take me in even though her practice was overbooked. She told me she was going on vacation the week before my due date. If I happened to go early there would be other midwives, none of whom I had met, who would cover the birth. I told her that my sister would also be flying down from Canada and that I felt safe to have the baby at home if it happened to come early and as fast as the last one. She insisted that it would be much better for me and the baby to come to the hospital. I assumed the choice would still be mine.

Luckily, my sister came down a week before my due date because my water broke 5 days early. It took another 24 hours to go into active labor. My mother and sister were anxious because typically a woman goes to the hospital if her water breaks and she doesn’t begin labor within 24 hours. Despite the fact that my sister had been a practicing midwife who had attended hundreds of home births and who had given birth at home herself twice, plus the fact that my mother had been annoyingly present for my first homebirth, she still wasn’t fully onboard with my decision to stay at home. There was a lot of chatter about going to the hospital. Fortunately, just in time, my active labor began at 11 PM the following night. 2.5 hours later Gabriel was born.

I birthed him in an inflatable pool we’d set up in the basement.  During my second pregnancy I had read “Hypnobirthing” and took a class with Rachel Yellin, an amazing hypnobirthing coach in the bay area. She focuses on partner practices to create a beautiful unit that works together to ease the baby into the world. Part of the Hypnobirthing  movement is the idea that a baby does not need to be pushed out but can be breathed down. I was excited to have Nathaniel play more of an active support role this time and to attempt to slow things down to avoid tearing. But as soon as the contractions began, I re-entered the birthing tunnel and wanted nothing to do with him or anyone. When my contractions did finally start it was on like Donkey Kong. Minimal time between contractions and the intensity such that I began retching from pain. Asking my body to get up, squeeze into a moving vehicle, and deal with all the discomfort of transferring to the hospital was unfathomable, and quite honestly, didn’t seem safe. There was no real way of knowing that I wouldn’t deliver in the car.

At one point I turned to my sister and husband sitting side-by-side on the bed, watching me moan and retch in the pool. I said, “I can’t do this anymore.” They looked at each other and shrugged. “I guess she’s close,” Di said. What could they do? So I went back to work. I let out slow, low moans to match the length of each contraction, visualizing an opening getting bigger and bigger as I opened my mouth bigger and bigger and moaned lower and longer. The vibration of the moan helped with the sensation of the contractions, which were right on top of each other with little time in between, the intensity again indescribable. I attempted to breathe my baby down as I had practiced with bowel movements throughout pregnancy so that I wouldn’t tear. It worked. I was in a semi-squat with my left knee down and my right foot on the floor of the tub. My sister helped cradle Gabe’s head and I reached down and caught his tiny body as he squirmed out. Nathaniel cut his cord and we eased into the bed right next to the tub. Just like Charlotte, he was on my breast in moments. 7 pounds, 5 ounces.

The day after Gabe’s birth, the Alta Bates midwife called and very sweetly apologized for missing the birth. She still wanted to follow through with postnatal care and come for a home visit. When she arrived she came up to my dark bedroom, where I was resting with Gabe napping next to me. She barely looked at him before she began berating me for not going to the hospital. She was furious. She told me that she would never have accepted me as a
patient if she had known that I was planning to stay home. I reminded her of my first birth story, which she had heard in her office at our first meeting when she had said that she normally wouldn’t take on extra patients but felt confident that my birth would be an easy one. I assured her that the intensity of my labor prohibited me from transferring and that I felt I had made the best decision for my health and the health of my baby, which I assumed would be her primary
concern. After all, who exactly would benefit from me transferring to the hospital besides the midwife and hospital, financially?

I felt my heart start pounding in my chest as I defended myself in my own bedroom still recovering from a birth that happened less than 24 hours ago to a woman whose job it was to support women through childbirth. More than anyone, she should have been familiar with the process I had just gone through and should have known how important it was that I now rest and recover. It appeared that even within the midwifery model, within a greater capitalist
system, a midwife who is trained to serve women and babies can lose sight of prioritizing the health of mom and baby over profit.

I always jump at any opportunity both to hear a birth story and to share my own. While each one is as unique as the woman telling it, there are aspects of my own story that I wish were more commonplace. In birthing, more than at any other time, I felt my own power and intuition and how intimately they work together. I was left full to the brim with a special confidence. After experiencing birth the way I did, I want that for every woman. I believe it’s her birthright. I think the world would be a better place if more women had that experience versus the trauma I often hear about from women describe an event that was done to them. Lack of privilege, lack of knowledge of the evidence supporting healthy birthing practices, and lack of informed choice, rob women of rights to their own bodies and the potential to experience the most empowering event of their lives. I hope the more we talk about the evidence and realities of childbirth that perhaps the next generation will hear and advocate for better choices for themselves and their babies than the current medical system provides.