Saturday, January 14, 2012

A Home Birthing OB Speaks Out-

A short time ago I featured a pretty normal birth story on the blog that became insanely popular.  What made it so special, besides being a home birth?  The birthing mother was none other than an obstetrician. Many people wanted to know more about her.  Here are some questions I had and I hope you enjoy her answers too.  She has a wonderful balance in her perspective and I really appreciate her taking time to answer these when being a mom of a young baby alone is very demanding.  She however is also busy with being a doctor.  So, thank you!  
And enjoy-
So- the first question people asked about this story was, Is it real?
So, is it?  Are you for real?  I admit that I too had my doubts.

I am very real!  I am a chief resident currently and am still searching for a job for after graduation.

Are you willing to share contact information for those of our readers
who are looking for a natural birth friendly OB?

I cannot take private patients as a resident, as I change rotations every couple of weeks, but once I have a job, I'd love the business!

What was it that led you to decide on a home birth?

Ok this is kind of a longish story. So I'll start by saying that my mother is a retired hospital-based midwife who believes in women and their ability to birth.  Long before medical school or OB/GYN or any of that I think I just always knew that I'd aim for a natural birth. Maybe part of the natural birth was the challenge of it -- too hard?? Not for this girl!! Just WATCH ME!

But with all the stuff I've seen after ~500 births, I think I was more afraid of the interventions than the pain.  Deep down, I didn't think I could do it in the hospital.  I would have caved to the epidural and the cascade of interventions with it. I have personal reasons for wanting to avoid an epidural and didn't think I'd have the strength to resist if it was readily available!!

I didn't start out with wanting a home birth.  I planned to go a birth center.  When I was about 20wks, they closed, and when I looked into the newest BC in town I just thought that the woman running it wanted too much money.

Another factor was my classmates in residency.  We're all good friends, and one of them was mentioning my choice of the BC to another and sort of making fun of it.  At that point I realized I'd just have to say what they wanted to hear or I'd get no peace this pregnancy.

So I piped up and said that we'd decided to go with the hospital and my gyn (that they all know and work with) for cost reasons.  And then my friend acted So Relieved that I was choosing a standard medical birth that I then got pissed off and decided to have a home birth.  It just took my husband realizing that we live closer to 2 hospitals than
the BC was and getting more familiar with our midwife.  My husband also did his research and well, just needed some time to warm up to the idea and he eventually came around.  Now he doesn't want to birth any other way!

How did you choose your midwife and what were her qualifications (CNM,
CPM, etc)?

Both midwives at our original birth center had home birth practices as well, and I liked both of them, but felt I clicked just a little more with one than the other. She is a CNM and a former ICU nurse.  I felt like I clicked with her on a personal level, but I also felt she had a sound knowledge base and good experience.  I trust her judgment.

Plus, she has a bit of a therapist quality to her that I definitely needed.  My pregnancy was not planned and I had a lot of mixed emotions about it. Plus, being an OB, I will say that sometimes
ignorance is bliss because I had a LOT of neuroses about the delivery as well, which my midwife was excellent at dealing with.  I didn't really need 'medical' care -- in hindsight, I needed the emotional support and she was excellent at it.

Was there anything in particular that you were worried about having to do with the birth?  I have worked with some medical doctors and they often have lots of fears going into birth because of the things that they have seen happen themselves.  Was this an issue for you?

O.M.G., YES. I had crazy neuroses about the birth.  The one that kept recurring was having a ginormous baby that was OP (sunny-side up) and asynclitic (head a bit crooked in the pelvis) and I'd get to complete and then push forever and then I'd wind up transferring to the hospital and wind up with a c-section, and the uterine incision would then extend down into my bladder and/or they'd have to T the incision and I'd wind up having to have c-sections forever and then wind up with chronic pelvic pain from adenomyosis from the c-sections and have a hysterectomy by the time I was 40.  Then by 60 I'd have horrible
vaginal prolapse and more surgery to fix that.

Plus, that bladder extension would give me urinary problems forever. And then my coworkers would give me so much flack about trying to even have a homebirth and how 'irresponsible and selfish' it was.  And I'd be made fun of for the irony of being so pro-vaginal delivery and then wind up being that person always getting c-sections.

And I'd be used as an example by them forever about what a bad idea home birth is.

[Yes, my midwife had to deal with THAT.  She's a saint.]

Relating to the last question, how did you prepare yourself mentally
and physically for birth?

Well, I have always made it a priority to have some level of physical fitness.  It's how I deal with the stress of my job, and well, overall my mood is just BETTER when I make the time to work out. The day before I found out I was pregnant I signed up to run a half-marathon in Nashville with a bunch of my co-workers. Bought plane tickets and everything.  So I was about 20 wks when I ran that. Training for it, especially in the early weeks, really helped with the small amount of
morning sickness I had (that was actually more like evening sickness).

I bought a prenatal Pilates DVD and did that the whole pregnancy (which really keeps away the back pain! I recommend it!). I worked out with my trainer up until 37wks.  Plus I worked 50-90 hrs a week for most of my pregnancy.

Mentally, well, I stayed away from OB.  All of my rotations during my pregnancy were GYN or GYN-Oncology so I really was just exposed to OB during my calls and even then it wasn't that much.  I read a lot of positive birth stories.  Every bad story I heard at work, I validated how I was different from that patient (ie: well, I'm not diabetic/hypertensive/on drugs, etc).  Sometimes I would freak out, and my midwife was excellent at dissolving my paranoia.  I also had my hypnobirthing instructor do a fear release with me.

I think a big hurdle was just accepting the fact that I only had so much control over the birth.  I had to mentally be OK with a cesarean. I had done what I could to achieve the result I wanted, and the rest was out of my control -- I might still get a cesarean, but at least it would be a Necesarean, and eventually I became OK with that, and just let it go.  I focused on what I could control, and just let go of what I couldn't.

What were the reactions of your colleagues and friends relating to your birth after the fact?

Well, I was pleasantly surprised. Most didn't care -- they were thrilled the baby was here and were happy for me. Others seemed a little irritated with me but overall kept their opinions to themselves.  I've heard stories of some of my attending's reactions – and they were pretty amusing.

I've only been made fun of during rounds once so far, and there's a little light-hearted teasing here and there, but not too bad.  I
think, though, that I've at least opened my colleagues' minds a little more. I think maybe they've dropped some of the 'stigma' with home birth and maybe think that people who choose to birth naturally aren't so crazy after all.  I'm just hoping that if any of them ever get a patient who wants to birth naturally, or a home birth transport in the middle of the night, that they'll think of me and try to be supportive of her wishes and treat her well.

What is your approach to birth with your patients?  Has your birth
experience impacted how you treat them or approach their births?

I try harder to dispel the fear that all new moms have.  Before I didn't have anything to draw from, and well, had those fears myself, so now I emphasize to every FTM that's she's doing well, and try to tell her that labor isn't that bad. If someone is interested in natural birth I really try to be supportive, but I did that before.

I'm definitely pushier with the breastfeeding than before. I remind them as their EDD approaches to give at least some thought to what they want for their birth, and regardless of what they choose, I encourage them to be sure to do their research on the risks and benefits of everything.  I just remind them that being in labor is not the time to think about the experience they want, or hear about the risks of something!  I don't try to talk them out of the epidural – I just try to emphasize that everything has risks & benefits, and I emphasize informed consent more than anything.  I did this somewhat before, but I am much more vigilant about it now.

Just because I chose one route for myself doesn't mean I think it's the best choice for everyone.  Every person is different and has different goals/expectations, and that's ok.  I think epidurals are beautiful things for the right person.  I have my own reasons that made me decide against the epidural, because I wasn't willing to take the risks.  There are many people (and friends of mine) who attribute their wonderful birth experience to having had an epidural, and that's a choice they made, they had a good experience, and that's great.  I want everyone to have an experience that THEY find satisfying.

Do you ever find yourself at odds with limitations within the hospital
you work?  Is there anything that bothers you working as an OB?

I work in a tertiary care center, so some crazy stuff can walk through the doors at any minute, and these hospitals are used to that, so I don't feel like there's many limitations from the hospital standpoint. You know, what gets frustrating is just the politics -- the way malpractice is in this country forces many physicians to have this ongoing underlying fear of litigation.  Care providers are expected to provide everyone with a perfect outcome, which of course is impossible to do -- this litigation fear leads to so many inductions and cesareans.  I also hate how anyone who doesn't want an epidural is 'crazy.'
I wish there was more of an environment of "she'll be fine" than the "she's not fine until proven otherwise" motto.

What do you feel are valid reasons to risk out of home birth?

You know, this is a REALLY broad topic. No patient is the same, and many circumstances can be argued either way.  If I HAD to throw out a few, I'd say fetal anomalies and/or prematurity in the infant – anything you anticipate needing more than standard pediatric attention.  As far as mom goes, I'll just say that if you're not a healthy person pre-pregnancy you should probably deliver in the hospital. Also, if you think that you'll be more comfortable at the hospital because the presence of NICU, the monitors, etc makes you feel safe, then that's where you should deliver.

I'm being intentionally vague -- every situation is different.

And to end- how are you balancing working and being the type of parent
you would like to be?

Wow, well, I guess I'll just say I do what I can one day at a time.  I feel rather deficient in both.  The work distracts me from my baby and the baby distracts me from my work. I don't read or study as much as I should, and I never feel like I have enough time with my baby.  My baby is growing so fast and it brings tears to my eyes to think of how much of it I'm missing.

I'm told the life as an attending is much better than as a resident, so there's light at the end of my tunnel. But I doubt I'll ever feel that I'm spending enough time with him, and I know I'll never feel that I'm as good of a doctor as I could be.

But it's the life I signed up for, and I'm doing the best I can.


Marlene Dotterer said...

This is a wonderful post. Thank you so much for pursuing this amazing story.

Panic Attack said...
This comment has been removed by the author.
Jessie Roberts said...

This was so cool to read. If it makes you feel any better, I'm a stay at home mom -- have been for 9+ months -- and I still wonder where the days have gone, I still feel like she's growing up too fast and I can never spend enough time with her.

All any of us can do is our best. Good luck in Columbia with The Farm -- that is SOO cool. Come back sometime and tell us what it's like working with Ina May! :)

Robin said...

I live in Tennessee and had an AWFUL birth experience. If I ever get past it and want to have another child, I hope to be able to make it to Columbia, to the Farm and this OB. It is about time the medical community sees what they do to women is, dehumanizing, humiliating, demoralizing, disrespectful and abusive. This doctor seems to be on a different and more respectful path.

Robyn said...

I wish there were more docs like her. And I wish she was coming to my hometown!

Write-Word said...
This comment has been removed by the author.
hdcrandall said...

Wonderful.!! I live in Columbia, TN and I am an apprentice midwife working with a CPM also here in Columbia. We need more doctors like you. I am so excited that you're coming to my town and I hope to get the chance to meet and work with you.
Heather Crandall

Kelly said...

I'm a doula in Columbia, TN. I'm thrilled that she has accepted a position with a practice here. She will be a wonderful breath of fresh air here! We have The Farm & The Farm Midwives in our backyard but unfortunately, the OBs & hospital here are not very natural birth friendly.

Laura @ Our Messy Messy Life said...

Love the pro-con list. Thanks!

Chris Jeub said...

This is a fantastic article. Thank you so much for getting this interview, and thank the OB for stepping up and sharing her convictions.

Dr. Eden Fromberg said...

I am an ob/gyn practicing since 1995, now in NYC and Bali, Indonesia (Yayasan Bumi Sehat), supporting midwives and encouraging home birth. I have always planned to have a home birth, if I am ever lucky to have a baby. I refer many of my patients to local home birth midwives. So there are more of us out here! And Ina May Gaskin is my friend and a true inspiration. This OB will be lucky to be a backup for The Farm midwives, and it sounds like they will be lucky to have her! Dr. Eden Fromberg

Liz said...

lovely article it's. I think its great to have an ob in the field who supports homebirth.

justme89 said...

Your amazzing, i complety believe in home births an i believe they are better because in hospitals these days they make u lay on your back Hook u to wires an stay there, (from all the births iv witnessed) but to be at home an in your own relaxing place is healthy an less stressful, u get to move stand how u want! im not saying that hospital births are always the wrong choice everybody is different but i think for someone to say breastfeeding an home births are not safe an just stupid are people uneducated about it!

Robyn said...

I loved her birth story and would love to see how she impacts the world around her for the better. It's exciting to think about just in the lives of the moms, doctors, and nurses she works with. What an amazing opportunity she has! I loved reading this. Thank you. :) I've experienced two hospital births and one home birth and it was a night/day difference. Loved hearing it from a doctor's perspective.

hobbit said...

My mother gave birth to my brother and then me in the early 60's at home, after her first birth at a hospital. I went on to attend several births and had both my daughters at home 20 and 16 years ago. I have since attended births at home and in hospital. In fact my first daughter's birth is the only home birth in Gentle Birth Choices. (That's a whole story itself - it was never supposed to be a nationally distributed video).
Being at the emergence of a new life never fails to stun me with awe. My births were certainly not easy, but oh my, how much better they were for being at home!!
The hospitals births I have attended have always left me a bit sad - watching the constant interference, the inevitable c-section due to induction leading to exhaustion, leading to stress on the baby, leading to .. blah blah ...
I have huge respect for western medicine - I wish western medicine had half as much respect for birthing women.
Thank you for this article - home birthing gave me enormous respect for myself and the sturdiness to face the onslaught of newborn care and birth recovery.
Much love ...
Nicola H

Kelly and Barry said...

I had an out of hospital birth before I started working as a high-risk Labor & Delivery RN. I get those subtle comments too among my co-workers. If I get pregnant again I will plan an out of hospital birth. What a lovely post, thank you!!!

Jennifer Wakefield said...

EXCELLENT!!! One questions I would have liked is: Do you think your views on how the hospital/physicians operate will impact your career? Do you think there will be change to the way hospitals approach births?

mandyjanedesigns said...

This is so amazing! But I have to speak up the T-incision thing! I ended up with a c-section that turned into a T-incision, had a repeat csection with #2 (because I was told I always had to have csections) and with number 3 I did my research and had a VBA2C after an inverted T incision in October at an independent birth center with a midwife. Here's my story

You don't have to have csections after a different scar type. Go to or join our community of Special Scars~ Special Women on facebook. We have had SO many succesful VBACs this year alone, including classical scars, J scars, Inverted T scars and even preterm scars of all of those! And I hope this wonderful OB will also do her research and help deliver Special Scars Mamas too!

Jessica said...

I second the VBAC after Special Scars! I got an Inverted T for my 2nd cesarean - breech turned transverse baby. The vertical extension "extended well into the fundus" and was measured at 8 cm. I've VBAC'd on that scar twice - once in a birth center and once unassisted at home because it was STILL that hard to find a care provider to assist me with my scar. Don't fear the scars! Uteri heal amazingly well. :-)

Jessica Tiderman
Special Scars ~ Special Women

Triumphant Birth Services said...

you are so awesome!! but in regards to that inverted T comment... I also got an inverted T for a footling breech discovered late in transition. then 2 more low transverse sections bc that's what happens after an inverted T, right? not unless you're ok with that! i had a VBA3C with an inverted T in Aug 09 that was absolutely perfect! oh, and an OB attended me, fully supportive of my plans! i hope as an OB you would consider being special scar friendly too!

Amy said...

Another inverted T VBAC here! I had a home birth VBAC with Inverted T supported by an OB and MW team. Forty hours of labor with 24 hours of being dilated to 10cm with a bulging water bag AND four hours of pushing and out came a 9+lb baby with a 39cm head :)

Courtney said...

Awesome!! I love hearing about medical professionals who choose out of the medical mainstream! I think that really speaks to the risks of hospital birth and *unnecessary* medical intervention. However, I also had an unassisted home VBAC with an preterm (29 weeks) inverted-t incision. I was told that *if* I chose to ever have more children (which my ob did not recommend), I would not be "allowed" to go into labour and would need to schedule a section at 37 weeks. I could not find an ob to support me, and knowing the hostility and judgment I'd have to confront in the hospital, I stayed home as long as I could and "accidentally" gave birth to my 8lbs 1oz son (my biggest baby yet) on my own. It was a very easy, uncomplicated delivery, and with my background as a RN in the NICU and along with all the research and preparation I had done during the pregnancy, I was very confident in this decision. It was amazing. I would encourage you, as an ob, to support women with "special scars" in the future. VBAC may not be for every woman for various reasons, but those of us who are searching for a care provider who *will* support us in our determination for a normal birth would greatly appreciate having supportive, understanding women (and men) like yourself in the field of obstetrics. Congratualtions on your awesome birth!!

T said...

This brought tears to my eyes! Thank you for the interview, it brings a bit of comfort to me knowing an undercurrent of change is possibly happening in the hospitals!

PaulaW said...

No! No! No! PLEASE don't move to TN! We need you here in KS! Why don't you move to Manhattan, KS, start a private practice (so we have some competition for the ONE-and-ONLY group of OBs here), and support us homebirthers!

rebekah @ justfordaisy said...

Fabulous post. We are hoping for a homebirth this time around (#2).
We are going to see the short film "Face of Birth" in March which has a broad range of experts on both sides of the 'argument'. Looking forward to it... Have you heard of the film?

Skayea said...

Loved this story! If you have a breech or transverse baby, please consider chiropractic care. A simple adjustment can do wonders for allowing a baby to do the turning on its own. One or two adjustments, and I felt a *flip* a few days later and all was well. I had planned a water birth, but the midwife told me that if I wanted to deliver this baby, I'd have to get out of the water because her shoulder was hung up. It was the toughest of my five, but a great birth nonetheless. I did take her to the chiro a few days after she was born for an adjustment after all she had to go through too.

MeriM said...

I had a 10.5 lbs OP, asynclitic boy as my first baby. I did push for two and a half hours. I did have a CNM that I say saved my life. She never gave up on me and I was able to get that big guy out vaginally. Without a doubt if I had gone with an OB doc I know I would have had a c-section.
I just thought it was hilarious that this was your fear, because I didn't even know it was possible and I got through it.
It was an amazing experience too.

Katherine said...

I would love to know what childbirth education class she took. It sounds like Hypnobabies. :) Regarding her work and mommy balance, I wonder if she's thought of working as an OB at a birth center, or establishing her own Homebirth practice! She could set her own patient load and have baby with her.

S said...

I am a neonatal nurse that attends deliveries (I do the baby stuff in the delivery room) and I am 8 months pregnant with baby #3 (first home birth). I can definitely relate to your story! I want to talk about my birth plans, but I feel like I have to keep it a secret or else be ridiculed or yelled at by my colleagues. I don't want to take on any external fear or negativity from anyone else! It is hard to be a hospital birth worker but planning an out of hospital birth!


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