Q&A: dispute about birth location

I hope this doesn’t turn into "I disagree with my partner" week around here, but here’s number two. Katie writes:

"I’m hoping you and the readers can shed a little commonsense light on my current *drama*.

I’m
20-ish weeks pregnant with my 2nd child. With my first, I had planned
to go natural all the way, but at a hospital; I ended up with an
epidural and pitocin. I had really looked forward to trying a home
birth with my second. However, my husband is completely opposed to this idea.

He
knows the statistics, he respects my desires, and it’s not like he’s
"put his foot down" or anything medieval like that. But over the course
of several conversations it’s become clear that what he wants (all
possible medical options readily available for mother and child) is
not going to change. He’s all for natural birth, it just has to be at a
hospital for him to feel safe. I have extremely ambivalent reactions
to this. On the one hand, I am all "womyn power" and wondering what the
hell right he has to tell me how to do something that a man has
actually never once done — and what if this is my last child, my last
chance to maybe have a birth go maybe sorta kinda the way I want it
to? On the other hand, this is his child too, and the lives of two
people he loves very dearly are at stake in what can be a pretty dangerous endeavor, and it’s not unreasonable for him to want to protect us by having doctors ready and waiting.

I
have a feeling we’re going to end up with a classic compromise, where
nobody involved is happy. I am truly, physically afraid of being in
the hospital again, and my biggest fear is that even if we stay home
until labor is pretty far along, once we get to the hospital my labor
will stop because I am so freaked out, and then it’s drugs and numb
legs again. But I just don’t think a home birth is possible without
a partner who is in it a hundred percent. If any of your readers have
had a similar situation between two stubborn spouses, I’d love to hear how things turned out."

It
would solve everything if there’s a true birth center in your area.
Then you could have a birth that doesn’t terrify you, and he could have
a birth that doesn’t terrify him.

Because that’s what this
really boils down to. You are terrified of being in the hospital,
afraid of what’s going to happen to your body and your autonomy and
your child. He’s terrified of not being in the hospital, afraid of what
could happen to you or your child. And no matter how many stats you can
show him (that planned homebirth is at least as safe if not safer for
mother and baby than hospital birth, especially for a second baby) he’s
not going to lose that fear. No matter how many stats you can find
about successful outcomes for second babies (and believe me, the second
baby is ridiculously easier for almost every woman I’ve encountered)
you’re not just going to be able to lose your fear of the hospital.

Now I know there are some of you out there thinking, "What does she
have to worry about? All she had was an epidural and pitocin. It’s not
like she had a c-section/huge episiotomy/horrific induction/preemie in
the NICU/etc." Some of you probably deliberately asked for the epi and
pit, and really don’t get what Katie’s worried about.

But this isn’t misery poker. If you’ve read my first post on preventing
PPD
, you’ll know that I think a Good Birth is so important for a
mother. And you’ll also remember my definition of a Good Birth: A Good
birth is one in which you’re respected as a person. So the actual
details of what happened to Katie during her first birth aren’t vital. What matters is that she didn’t feel respected throughout the
process. It sounds like she felt victimized, and she’s really scared
that she’s just going to end up being shoved into the sausage factory
again for this second birth.

Katie, I agree that it sounds like you can’t really have a home birth,
because it’s just going to be too frightening to your husband. It’s
really, really a shame that you don’t have a freestanding birth center
near you, because that would absolutely bridge the gap for you and your
husband. But since there isn’t one and you’re probably going to have to
have the baby in a hospital, your focus should be on creating a team
that will respect you during the entire process of the labor and
delivery.

The crucial components you need to look for are:

1. A hospital with good stats for birth without interventions. One of
my friends was the only person any of the nurses working that night had
ever seen give birth without an epidural. In hindsight, she says she
would have picked a different hospital. She knew she could do it, but
the nurses were so out of their element without the epidural that they
really had no idea how to support her. Birth is really not something
you want to be a pioneer in, if you can help it, so find the hospital
in your area that has the lowest rates of epidurals and pitocin use.
(Since you’re a second-timer I wouldn’t really worry about c-section
rates. Once you’ve had one vaginal birth your chance of having a
c-section is teeny unless something really goes wrong, in which case
you’d be happy the technology for the c-section existed.) By the same
token, if you know you’re going to have a c-section, you want to choose
the hospital that does a ton of them, so it’s standard procedure for
them.

2. A doctor or midwife who really gets what you want and why you want
it, and wants that for you, too. A provider who understands why you
want an unmedicated birth (and isn’t patronizing about it) is going to
respect you and your wishes, and use that to help make decisions if
things don’t go according to plan. (Flip that around to "medicated
birth" if that’s what you want.) There’s no guarantee that you’ll have
the birth you want, but having a provider who really is on your side
means you’ll come out of it feeling respected and like everyone did the
absolute best they could, including you.

3. A doula. IMO it’s absolutely worth it to pay someone to be with you
from start to finish and provide a protective layer between the
hospital bureaucracy and you. It’s just too much of a risk to go into
the hospital and take your chances with the nurses on duty if you’re
feeling that much fear, since the nurses make the whole experience
unless you have someone else there advocating and translating for you.
It works out if you have a great nurse, but if you have an inept nurse
or a distracted nurse or a nurse who thinks the kind of birth you want
is ridiculous or a nurse who’s just a mean person, you get hung out to
dry. Better to bring your own support person who’s been at bunches of
births and knows how to help you navigate the whole experience. You
will probably get lucky, and the doula will spend most of the time
helping you through contractions for a few very intense hours until
your baby pops out easily with no tears.

So, yeah, this didn’t turn into much about how to settle a marital
dispute. I lucked out myself, because my own first birth (starting at a
birth center and ending up at a hospital) was such an indictment of
hospital birth that my husband was convinced easily to do a home birth.
(It probably helped that during the interview, one of my midwives
looked him straight in the eye and said coolly, "We don’t play. If
something happens we go to the hospital instantly.") I was happy with my home
birth, but then pretty much every woman I know was happy with her
second birth, especially compared to the first one, no matter where or
how she had it.

Give me what you’ve got about this. Did any of you have a similar dispute? How did you resolve it?

Also, if anyone knows a good midwife and/or doula who works at Englewood Hospital in Englewood, NJ, will you email me to let me know? It’s for a friend. Thanks.

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