Making the choice -- Are you a good candidate for a hospital birth?

I was just reading Gloria Lemay's blog post "Are You A Good Candidate For A Hospital Birth?" and it really got me thinking about how to reach more people and help them understand what their choices really are. I think if first-time moms really understood what the hospital birth experience is all about, they would think twice. At least, that's the idealistic part of me who thinks that. Some moms are content to not think, and some moms know both perspectives and choose the path more well-traveled by their peers. There is such social pressure to conform, especially when your family says things like "choosing homebirth is a selfish choice" (yes, I just heard that from someone!).

Here's Gloria Lemay's list of questions for her blog post "Are You A Good Candidate For A Hospital Birth?":

• Must not be scared of needles.
• Must not be claustrophobic or uncomfortable in confined spaces.
• Must be able to go for long periods of time without eating or drinking.
• Must be happy to share a bathroom with others.
• Must enjoy sleeping on a mattress covered with plastic.
• Must not have a rebellious or questioning nature.
• Must accept the possibility of contracting antibiotic-resistant infections.
• Must be confident with caregivers who are overtired and overworked.
• Must realize that a limited amount of time can be spent in a hospital room before it is needed for the next patient.
• Must like and trust electronic equipment.
• Must be comfortable with cesarean rate of 30%.
• Must accept that the mood of the nurse on duty will be a large determinant of the birth outcome.
• Must realize that someone you have never met before will likely receive your baby.
• Must realize that the written birth plan will be ignored.
• Must be willing to have fluorescent lights turned on at all hours.
• Must be capable of birthing without making loud noises.
• Must look good in a flimsy blue gown that is open up the back.
• Must be willing to be a teaching subject for student doctors who are learning to do pelvic exams, surgeries, and suturing.

Do women know that this is what they are choosing when they choose hospital birth? Are they so afraid of the process of birth that they're willing to give their safety and their birth experience up to a system that promises the worst outcome for them and their babies than every other industrialized nation? What motivates women to make this choice?

I ask these questions of myself as well. Why did I choose hospital birth for my first three babies? Maybe that's a good place for me to start as I look for answers.

With my first baby, I wanted the best possible care, which to me meant the most expensive care -- an obstetrician. I thought midwives were somehow "less than," and that homebirth was dangerous. The Internet didn't exist for me in 1989, so the ability to make a truly informed choice was very limited. I'd have to say my pre-conceived notions about midwives and my uninfomed opinions about homebirth and about obstetricians drove me to seek a hospital birth with an OBGYN.

With my second baby, I just did as I had done with the first. I thought I had been pretty happy with my first birth experience (since I didn't know any better), so I went back for more of the same. My second birth was a tough Pitocin augmented persistent posterior birth. Being restricted to lying on my back or my side made labor excruciating. I left that birth not ever wanting to go through that kind of pain again.

So, now fearful of birth, I chose a birth I felt I could better control -- scheduled induction at 39 weeks with an epidural at 1cm. Not much pain, but instead of feeling in control, I felt totally out of control. I had no sensation, which meant no feedback on how my labor was progressing. I felt disconnected from the experience. I was totally at the mercy of what the doc felt my progress was. It was horrible.

The turning point for me, the biggest impact on my decision to choose a homebirth with my 4th baby, was my involvement with La Leche League. It was through listening to the experiences of other mothers that I learned doctors don't know everything. Finally hearing that this was the experience of so many other mothers, caused me to question whether my choice to give birth with an OB in the hospital was the best choice for me. They helped me to see that it was not my body that had failed me. The clincher for me was when I told my OB that I was interested in taking Bradley Method childbirth classes. She grabbed me by the shoulders and said, "Kim, tell me you are NOT having a natural birth." I nearly ran away screaming!

I'm an intelligent, educated woman. Heck, my great-grandmother was a midwife! I don't consider myself to be one to bury my head in the sand when it comes to making important decisions. What could have helped me to know the truth sooner? Maybe if I had seen Gloria Lemay's blog back in 1989, or maybe if I had seen the Business of Being Born back then, maybe those things could have helped me to know the truth about giving birth in the hospital.

I think the best thing we midwives and birth activists can do is to just keep spreading the truth, whether it is in a big way or just one woman at a time. Reading Gloria Lemay's blog post has re-energized my determination to keep fighting the good fight. Speaking of which, I sent a copy of The Business of Being Born to my sister-in-law. She's newly pregnant and needs to know the truth. I think I'll send her a link to Gloria Lemay's blog post too.