Missoula Notebook
Natural Childbirth—In a Hospital?
Natural childbirth is possible at Missoula's Community Medical Center. I know. I was there.
By Sutton R. Stokes, 9-28-09
Last December, when I started looking into rumors that the Missoula Birth Center was about to close, I had a personal interest in the story.
My wife and I had just started trying to get pregnant, and Amy was already a patient at the Birth Center. She loved the atmosphere and the staff, and—when we thought ahead to where she would give birth—we always pictured it happening at the Birth Center.
I wasn’t opposed to a hospital delivery, but Amy wanted to deliver in the Birth Center. Since she would be the one doing the work, that was mostly good enough for me. But really, I hadn’t given the matter much thought.
As I backgrounded myself on the subject of birth centers in preparation for writing my first story, however, I became aware of substantive criticisms of hospital deliveries. Many of these criticisms arise from the tendency of obstetricians—like any other medical specialist, or, indeed any human—to find reasons to use the gadgets and tools they have. Give birth in a hospital, statistics show, and you are at increased risk of receiving labor-speeding or painkilling medications and undergoing forceps, vacuum, or c-section deliveries.
Not everyone wants to avoid medications during labor and delivery, of course, but some people feel that these drugs can interfere with the mother’s ability to push safely and can disrupt the natural hormonal release that would otherwise occur during post-birth bonding and nursing. And despite the increasing popularity of c-sections, this is major surgery and far from risk-free, not to mention the fact that many doctors recommend against vaginal deliveries after a c-section, due to the increased risk of injury.
Other problems with hospital deliveries, I learned, include the possibility of staff shift changes mid-labor, policies against fathers spending the night with mom and baby, and the separation of newborns from their mothers for examination and cleaning in the nursery. There are even findings that women who give birth in hospitals are at risk of post-traumatic stress disorder.
I was converted. Clearly, birth centers were the only sensible place for women with low-risk pregnancies to labor and deliver naturally, and—just as clearly—hospital obstetrics departments were dangerous hellholes.
So imagine our disappointment when, a week after Amy showed me those two pink lines, we learned that the Birth Center would close.
We investigated the possibility of a home birth but gave up on the idea when we learned that our insurance not only wouldn’t cover it but might not even cover hospital care if any emergencies arose during one, because—bizarrely—our insurance company classifies home birth as an “experimental medical procedure.”
We would deliver at Community Medical Center, we decided. It wasn’t our first choice; we felt forced into it; we hoped it wouldn’t go too badly.
Then it didn’t go badly at all. In fact, our experience at Community was absolutely wonderful. Looking back on it now, I have difficulty imagining how this birth could have gone better, other than if we’d woken up one morning to find that Coen had quietly slipped out of the womb on his own and was in the kitchen frying us up some eggs and bacon.
After a sleepless night (for Amy; she was good enough not to wake me), we arrived at Community at about seven a.m. Amy started pushing about three hours later, and Coen was born a little after noon. Other than for intermittent monitoring of the baby’s heart rate, Amy was free to move around, leave her bed, assume whatever position felt comfortable, and even labor for a while in a tub. As we’d requested, no one ever offered pain medications.
After the delivery, we moved to a private room where there was a fold-out cot for me to sleep on. In addition to a dedicated lactation nurse, who made several visits to our room, all of the nurses who attended Amy and Coen were supportive of breast feeding and offered useful tips on this and a range of other subjects. Coen did make a few trips to the nursery, but these were optional and I was able to accompany him every time; he never left my sight, and we were always quickly back at mom’s side.
I should point out that at least some of the wonderfulness of this experience resulted from our own actions. Months before Amy’s due date, we toured the obstetrics wing and asked lots of questions. We also researched and wrote a respectful birth plan, went over it ahead of time with our doctor, and not only entered it into Amy’s chart but brought along copies to hand to the nurses. And we took Bradley Method classes, so we had some idea of what to expect during labor and how to get through it without resorting to drugs.
Finally, Amy had a relatively easy labor—words no man should feel comfortable typing, but true nonetheless. If her labor had dragged on, or if there had been problems along the way, our experience, and the actions of hospital staff, might have been very different.
And I should point out that, after the birth, we were very glad to be in a medical environment: Amy’s uterus took its sweet time contracting, which meant she just kept on bleeding and bleeding. If I’d seen that much blood after a home birth, we definitely would have been headed to the hospital anyway, and I suspect that an admission under those circumstances would have been a lot more stressful than Amy’s just being able to lie back with Coen on her chest while a medical team made sure that all of that bleeding didn’t turn into a real emergency.
Obviously, a hospital birth is not for everyone, but I think it’s important for Missoula to know that Community Medical Center has clearly been influenced over the years by the increasingly widespread interest in natural births—probably even more so than a big-city hospital on one of the coasts. Missoula’s just that kind of town.
Community is still a hospital, of course, and different staff members might have different philosophies and bedside manners than the ones we worked with.
Nonetheless, we succeeded in our goal of having a completely natural childbirth, even though we were in a hospital.
It can be done.
Want more Notebook? Read the rest here. I’m also on Twitter and Facebook, and I write a blog.
My wife Barb gave birth to our first child, Rusty, in a pool of warm water. It all went well, but I tell you—it sure cleared out the shallow end.
Comment By Larry,, 9-28-09Sutton,
My wife just had our son at Community and it was a truly wonderful experience. We had no birth plan, watched no movies, basically went in blind and everything turned out well. My wife was scared as hell at having to share a room, as we walked by those rooms with four beds. I wouldn't have been able to stay with her after the baby was born, and we would have gotten the hell out of there were we forced to share a room. How can they get around patient privacy when there are four people crammed in one room? There were only a couple people having babies at the time, so luckily that didn't happen.
As for the natural birth...I've heard all the reasons why one would have one at home and I still can't understand why. My wife is a medical professional and she was adamant about having it in a hospital, even as cold and sterile as everyone makes it sound. God forbid if anything had happened to my wife, the baby or both had died from complications. I'd have felt like a real ass just because we wanted to go natural. I asked my son about his preference, and he didn't mind the hospital.
Oh, let's not forget the drugs. Enjoy the technology. You don't win any awards for suffering, though some of our circle of friends where the no epidural badge like it was a license to lecture. Get over it. We heard the lady with no epidural across the hall. It wasn't pretty.
In essence, do what you're most comfortable doing, but think about the best interest of the mother and child if complications arise.
Thanks for reading and commenting, everyone.
Larry: that sure must be annoying, when people presume to comment on your personal choices about the use of pain medications.
Personally, I could care less what kind of birth someone else chooses to have (well, within reason).
But we were intrigued by the claims of the Bradley Method people that, with the right preparation in relaxation techniques and fore-knowledge of how a typical labor unfolds, medication just isn't necessary. (Human women are evolved to give birth, after all.) Indeed, Amy tells me the possibility of asking for an epidural never once even crossed her mind. So in our case, I'm unclear on what the benefit of "getting over it" and "enjoying the technology" would have been.
And there is evidence that the use of epidural painkillers blocks or interferes with the release of certain hormones and can make it more difficult to breastfeed or bond right after birth. Will that ruin your baby or your relationship with your baby? Hell, no-- adoptive parents bond just fine with two-year-olds. But you know what? The way we did it, Amy sure looked like she was riding a pretty fun natural endorphin wave for that important hour after delivery. For us, it would have been a shame to miss out.
On the other hand, if we're talking about a woman lying there desperately wishing she could just get the drip but unwilling to say so out of principle—well, that sounds pretty dunderheaded. For that matter, it sounds like it would describe your friends with the "badge" mentality, because otherwise, why would you feel like an unmedicated birth was some amazing accomplishment?
Actually, let me soften my last comment. An unmedicated birth—any birth—is an amazing accomplishment. I don't mean to sound like I'm judging anyone who goes through that, in any shape or form. What do I know about it, after all? The only point I really wanted to make was that Amy and I were really happy with the way ours turned out, and it didn't involve anything that Amy now thinks of as suffering or misery. Worked for us, but there was some luck/good fortune involved, and everyone is different, of course.
Comment By Kathy Caudill, 9-28-09Great perspective Sutton. Eons ago (when I gave birth) I managed to have natural childbirth three times in a hospital setting. As you indicated, it helped, even then, to have a written plan with desired outcomes (no meds or monitoring, etc.) and supportive medical personnel. And, easy labors are a distinct advantage. Having had the more recent honor of being present for both my daughters' childbirth experiences has reinforced this belief. As I have shared with Kaytie and Krisi, being present for both grandgirls' arrival was love actualized exponentially and the most joy filled moments of my life.
Comment By Hotspur, 9-28-09I think it is important not to discount the importance of modern medicine in child birth. Before there was access to the skills and technology we have today, 30% of women died and just as many babies during childbirth.
The natural childbirth stuff is great until some complication rears up.
Indeed, Hotspur. But there's a pretty far distance between the kind of modern technology that increases mothers' and infants' survival, and pain medications.
As for your statement that, essentially, intervention-free childbirth is great until interventions become medically necessary for the safety of the mother and child—well, I don't think you'll find anyone arguing with that.
And Hotspur, just so you know: natural childbirth isn't some affectation of selfish hippy parents in which they trade increased risk to their children for bragging rights.
Parents who choose home births and birth center births do so partly because those have LOWER rates of infant mortality, injury to mother and baby, and so on, than births in hospital settings. Look it up.
Yes, in very rare cases, something comes up in a home birth that needs emergency attention from a hospital, which is why, ultimately, we picked a hospital birth over a home birth. But if there'd been a birth center, we'd have chosen that in a New York minute.
Statistically, it's safer.
This is a debate that has raged on for years and will continue for years to come. People just need to respect the decisions of others. If a person decides to have a home birth, so be it. If another person decides to give birth in a hospital, so be it. If one person gives birth without pain medication, great. If someone else chooses an epidural, that's fine, too. None of these choices are superior to any of the others, morally or otherwise. The person making the choice has to do what she feels will work best for her. And if someone else would do it differently, well, that's her choice. As long as the result is a healthy baby, who cares if the birth occurs in a hospital, a bath tub, or the backseat of a VW bug.
My wife had our baby in a hospital with an epidural, which was her intention all along. When the baby was in the birth canal and my wife was making the final pushes, his heartbeat decelerated and did not come back up. Turns out he had a short umbilical cord, so as my wife was pushing, the blood/oxygen supply to the baby was being cut off. Instead of pushing with the contractions at the end, my wife had to push as hard and as long as she could to get him out quickly. She's pretty certain she wouldn't have had the strength to push like that if she hadn't had the epidural. And we're both pretty sure things would have turned out badly had he not been in a hospital on a heart monitor that showed the decelerations. Is it possible things would have turned out okay at a birth center or at home? Sure. But I wouldn't want to make that bet. So the hospital and epidural worked for us. But that's just our story.
Sutton, as for the statistics on home births/birth centers versus hospitals, you know the old saying: there are three kinds of lies: lies, damn lies, and statistics. Birth centers generally accept only low risk pregnancies. Home births are also generally low risk pregnancies. Hospitals, on the other hand, must accept all comers - from low risk to extremely high risk. Thus, by their self-selecting nature, birth centers and home births are likely to have fewer complications. I have not seen the statistics you've referenced, but I'd be interested to know if they are comparing apples to apples, so to speak.
Great article about Community. Our experience there was also excellent. Your article brought back memories of all the great nurses and other staff who helped us while we were there. I'm glad everything went well for you and Amy and that you are now enjoying parenthood. Congratulations.
Travis,
That is true that in America midwifes do only get low risk pregnancies which does skew the statistics. But other countries that have more midwife births and fewer hospital births tend to have less problems with their births than here in the USA.
Sutton,
Great article and congratulations. My wife gave birth to our twin girls naturally in a hospital (while suffering from mild pre-eclampsia) so even with high risk pregnancy it can be done. She even was induced with pit, but like your wife never once asked for the epidural, claims she never thought about it. Damn right she should have a badge!
What enabled us to have the natural birth was:
1. A chiropractor turned the second baby. Or so we think.
2. We live southwest of Bozeman, but chose to drive right by the big fancy Bozeman Deaconess with their 40% C-section rate to tiny old Livingston Memorial Hospital, with their sympathetic OB staff.
3. We picked our battles. We allowed the pit drip and eventually the in utero monitor. But everyone on the staff knew that the section was for emergency only.
4. We had an amazing doula who was able to explain things to me and help me, and was able to calm and focus my wife.
5. She didn't have the epi. They made us give birth in the operating room on the surgery table (The spectacle looked kind of like an obscene beluga on a card table) and I don't think she could have gotten up there with her legs numbed.
Anyways, that was a good article getting a lot of important information out there. Good luck
Travis, thanks for sharing your experience. Again, I totally agree that there is no "right" way to give birth, and I hope I didn't imply that I thought there was.
Meanwhile, thanks for the caveat about statistical evidence. The media in general is terrible about that kind of thing (like how it's always obsessed with crime numbers instead of crime rates, etc.). Just to be clear, there's nothing I hate more than the kind of misuse of statistics you warn against (well, maybe Nazis), so I wouldn't have promoted the claim if I weren't aware of some actual apples-to-apples comparisons, such as one presented in a recent issue of the Canadian Medical Association Journal.
In this study, they controlled for the problem you describe by only using women who fit the same profile of "low-risk pregnancy," whether they chose to deliver in a hospital or at home:
"We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth [i.e., low risk]..."
The comparison found:
"The rate of perinatal death per 1000 births was 0.35... in the group of planned home births; the rate in the group of planned hospital births was 0.57... among women attended by a midwife and 0.64... among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a... hospital birth to have obstetric interventions (e.g., electronic fetal monitoring...; assisted vaginal delivery... or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear...; postpartum hemorrhage...). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife- attended hospital-birth group to require resuscitation at birth... or oxygen therapy beyond 24 hours.... The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration...."
[abstract here: ]http://www.cmaj.ca/cgi/content/short/cmaj.081869v1]
These are interesting results for me, especially because-- even with our "natural" birth at Community, Amy did experience tears and pretty significant postpartum hemorrhage. When the latter was happening, I was glad we were in a hospital, but it's interesting to see statistics suggesting it might have been less likely to happen if we hadn't been.
In all fairness to CMC, though, I can't think of anything the hospital did that could have caused this bleeding--some women just bleed a lot after childbirth, which is partly at the root of the ominous mortality statistics Hotspur mentioned. I'm guessing that the usual way in which a hospital birth might increase the risk of hemorrhage might be when mothers injure themselves by pushing when too numb to be able to monitor what they are doing, or when labor-inducing drugs like pitocin are used to speed things up, though I'm not sure. Maybe someone with a little more knowledge about this stuff will weigh in.
Sutton,
Travis beat me to the punch with his inquiry regarding the stats. I was thinking the same thing. Thanks for citing the study. Interesting.
Sutton, I'm glad you had a good experience. I have several friends that had natural childbirths at Community, which is great. If a pregnant woman's labor goes very smoothly and according to time expectations, then there is no reason for intervention and I have heard the staff at Community do very well with that kind of birth.
The bigger issue is that for people like me- a woman that had a natural childbirth that took a long very time and would not have been permitted to occur in a hospital setting because of liability concerns- having other options are key. Why it took me over 36 hours to have my baby, I don't know. I'd sure rather it went faster! But I do know that with patience and professional monitoring from two midwives, both me and my child were in perfect (if rather tired) shape after the baby was finally born. Had I been at Community, that kind of natural variation in a woman's labor would not have been tolerated, and I would have had a c-section. Which is a shame, because it would not have been necessary, so I would have been in more pain, more risk, and more expense for nothing.
I'm glad that I was able to have my child naturally at the original Birth Center, and I'm really excited that our second kid will (barring an emergency) be born at Jeanne Hebl's new birth center. For situations like mine where everyone stays healthy- birth centers are a great option. And if something seems like a problem, we'll transfer right over to the hospital without another thought. That's the way it should be for the average, healthy, uncomplicated birth.
Community serves many needs, but not all. In the case of births, I'm very glad that Missoulians will have more than just two options (home vs hospital) with the happy medium of a birth center.
Thanks for the comment. I agree, our experience went the way it did largely because of how relatively fast Amy's labor was. And I think you're right that a longer labor definitely has a higher likelihood of the interventions you describe.
Simply for the record, though, I should state that—when we toured CMC—we were *told* that the hospital imposes no limit on how long a woman can labor. Maybe, in the case of a labor as long as yours, that inevitably gets finessed with recourse to "concerns for the health and safety of the mother"; I don't know, and any woman concerned about this possibility should definitely try to pin them down on this. But that is what they claimed.
I'd be curious if any readers had longer labors at CMC, and how that turned out.
My son was born by Cesarean at Community... He was 2 weeks overdue and so I wasn't allowed by Birth Center staff to wait for labor; I was induced with Pitocin. Labored all day and when my midwife (when things were getting pretty intense) broke the waters, she decided to turn off the drip because "things would probably proceed from here." They didn't. Labor stopped, and I was told we needed to "start over."
I was exhausted, both from hard labor all day and from two sleepless, castor-oil takin' nights trying desperately to get labor going so I could avoid the hospital. I was demoralized and felt absolutely unable to start "from scratch" and build back up again. I asked for an epidural. But I wish someone had suggested a meal, a nap, a backrub, a bath, a break. But I was definitely "on the clock." No one suggested those things.
Starting at 7 the next morning (though I could barely feel anything) I pushed for almost four hours before we were told we needed to have a C section.
I didn't hold my son until an hour after he was born. I didn't see him naked for hours after that. We had to stay at the hospital for three days, being woken up every two hours by staff, let alone by our newborn son, who, in spite of being 100% healthy, was treated as a patieint himself, with nurses wanting me to wake him up to eat because it was time for him to eat.
I'm not saying there is for sure any way things could've gone differently. But I wish they had.
Thanks for sharing, Grace. Just out of curiosity, did you take Bradley Method classes before birthing? And did your midwife try any techniques to "restart" labor, like nipple stimulation or having you suck on your finger or anything like that? And when you say that no one suggested those things, was your midwife still present? She didn't suggest those things?
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