My Road to a Home Birth

Bethany with her midwives and baby Eli

by Bethany Hyder, guest blogger

I am a natural childbirth junkie. I LOVE it! I love to learn about it and hear other people’s experiences with it, and I’d REALLY love to educate others about it! I really wish all women could have such a gratifying birth experience. It makes me sad to hear the horror stories of some women’s births. It doesn’t have to be that way! So when I got pregnant at 16, I learned a lot about natural childbirth. My mom had all four of her kids naturally, so why shouldn’t I?!? I read a lot of books, and although I can’t remember all of them, I do remember reading The Bradley Method. I went on to have a (mostly) natural birth with an awesome OB/GYN – Dr. G, at a small hospital (Parkway Medical Center) in Decatur. Anna’s birth is another story though (which I’d love to share, too!).

Fast forward 10 years, and I was 26, married, and had OVER planned for this sweet baby I was pregnant with (seriously…over-planned). At 8 weeks gestation, Christian and I excitedly went to see Dr. G and had an ultrasound – perfect little baby cooking away! Expected due date of January 1^st (but I already knew that, because I had over-planned)! We continued with regularly scheduled prenatal appointments, but I always had a nagging desire for a home birth. It was always just one of those “maybe one day” type things. I had met a mom of a girl in Anna’s girl scout troop that had numerous home births. I wanted to be her. Then my cousin had planned a home birth, and although she did deliver in the hospital, it helped to know more people that actually planned this sort of thing.

Curiosity got the better of me, and I started looking into midwives. In Alabama, it is completely legal to have a baby at home. However, it is ILLEGAL for a midwife to attend a home birth. The state only recognizes Certified Nurse Midwives (CNMs) and they are only authorized to work in hospitals, under an OB/GYN. So basically, you can have your baby at home, but not with anybody that’s trained or skilled in home deliveries! Surrounding states license Certified Professional Midwives (CPMs), but these women would face prosecution if they were caught assisting home births in Alabama. It’s sad, really. I found out that there are some midwives that work “under the radar” in AL and will come to your home for birth. This seemed a little dangerous to me given that 1) I don’t really want to get anybody arrested, and 2) if I did need to transfer to the hospital, the midwife would not be able to come. What if the midwife had important medical information that the doctor needed?

Through a random facebook post, a co-worker recommended his wife’s midwife – Karen Brock. I emailed Karen. I really just wanted to ask questions and figure out how it “worked.” Karen offered to meet with me. So, at about 24 weeks gestation, Christian, my mom, and I drove to Cullman on a Sunday afternoon to meet her. Karen is a CPM, licensed in Tennessee. She does prenatal appointments at her office in Cullman, and has a house just across the TN state line for births. I immediately trusted her. The conversation about birth that we had was SO reassuring. It was nice to talk to somebody that recognized birth as a normal, natural process and not a medical emergency. I was like a giddy school girl leaving her office. I had made up my mind, but I wasn’t too sure about Christian. When I initially told him that I wanted a home birth, before we met with Karen, he said, “Ok…will Dr. G be there too??” HA! No, honey, she won’t. I don’t know if he just trusted that I would make a good decision, or if he didn’t know to be worried, but he agreed to it!

My next appointment with Dr. G would have been my 28 week appointment, before which I was supposed to have the nasty glucose test completed. I never took that test. I faxed Dr. G’s office a medical records release form to have my information sent to Karen, not knowing the can of worms I was opening up. In my mind, I was going to keep going to Dr. G AND go to Karen, and then assuming everything kept going good, I’d just birth with Karen. Good idea, right? WRONG! Later that day, as I was walking out of work, my cell phone rang. It was Dr. G calling to inquire about sending my records to Karen. She was not happy to hear that I was planning a home birth. She made sure I knew that was illegal in AL, and I assured her that I would be birthing in TN. She gave me a few horror stories and tried her best to dissuade me. I was about to get in a van full of coworkers (we have a ride share program) so I told her I’d think about it and let her know. Her scare tactics worked…for a few minutes. I had done enough research and knew enough about childbirth and the midwifery model of care to know I was making the right choice. When I called back, I told her nurse to send the records to Karen. Dr. G had made it clear that she would not be able to continue to provide OB care during this pregnancy knowing that I was going to Karen. She stated that it was a conflict of interest. She would, however, continue to see me as a GYN patient in the future. When I went for my first prenatal with Karen, she told me that Dr. G had called her as well! She quizzed Karen about what she would do if I started to hemorrhage, etc. It turns out that every year when the midwifery bill is presented in Montgomery, Dr. G is one of the opponents there speaking against the bill. It sounded like Karen and Dr. G were going to meet to discuss how both parties could come together for the benefit of mothers and babies (i.e. the midwives and the medical community), but I never heard more about that happening.

I loved so many things about seeing a midwife. Number one was probably the “hands-off” approach. There were no “routine” pelvic exams. Even when I was in labor, she didn’t need to “check my cervix” or see how far along I was. She certainly would, if I wanted her to, but it was not mandatory. Listening to the body is so much more indicative of where you are in labor. Second, the personal relationship we had. Every prenatal appointment was at least an hour long – no rush. Every decision made was ours (mine and Christian’s) to make. We researched, asked questions, and made decisions about how this birth would go and what kinds of things would happen immediately after. We made a transfer plan in case of emergency, and thankfully didn’t have to use it. I felt in control at every point of the pregnancy and birth, and trusted my midwives 100%. I am SO happy I left Dr.G and went to Karen. Best.Decision.Ever!

The Birth Tub felt amazing to Bethany!

Eli’s Birth

Saturday, Dec. 29th

That morning, I woke up and headed straight to the bathroom to pee. I noticed a little bit of blood when wiping. I got excited because SOMETHING was happening! I went on about my day, but made everybody aware that things were slowly getting started, hopefully. Christian went to work, and my sister

Julie, Anna, and I went to walmart to get various things. We drove out to where I work because I had left some information I would need while out on maternity leave. Later in the day, I took a little nap on the couch. All throughout the day, I was aware of very light contractions - nothing worth paying much attention to. Julie made homemade chicken noodle soup (I requested that for while I was in labor), and that evening we went to the mall to “walk the baby out” / get contractions going stronger. That night, I called my midwife, Karen, to let her know that early labor had begun. There was actually a birth going on at that time at the house in Elkton, but she told me to check back in to give her an update before going to bed. Contractions remained fairly mild, so I tried to sleep, knowing my sleeping days were soon to be over!

Sunday, Dec. 30th

Stronger contractions woke me up around 3am, and I lay in bed and timed them with my phone (yes, there’s an app for that). They were around 6 minutes apart. At 4am, I woke Christian up and thought it was time to head to Tennessee. I wanted to go up there with plenty of time to labor in the tub and relax. I called Karen, and she told me to get up and get moving to see if the contractions were going to stall out. Once Christian, Anna, Julie, and my mom had been alerted and the car packed up, I decided it wasn’t time! Contractions had waned again, so Karen suggested trying to get some rest.

Around noon, Karen and Wetawnya (assisting midwife) were ready to leave the house in Elkton after ANOTHER birth (they had 3 that night before me!), so they stopped by my house to check on me. I decided I wanted to know how far along I was, and it turned out to only be about 2cm! Again, rest was prescribed. I took a nap for about an hour before contractions woke me up. I spent the next couple of hours or so walking around, swaying, and finally rocking in the rocker in the nursery while looking out the window. Christian and Anna were so quick to get anything I needed, and they both helped time my contractions. Anna got bored and decided to go to her grandparents’ house, but she wasn’t there long.

Around 4pm we checked in with my mom, and she suggested that we head on to TN so that I could get in the Jacuzzi tub to labor. Christian packed up the car (again) and we headed out. Julie and Nana went to pick up Anna. We called Karen on our way to let her know we were headed there and to see what we needed to know about the tub. She said that she and Wetawnya would head that way too. The drive was about 40 minutes, and contractions were steady at around 4 minutes apart. I wasn’t all that uncomfortable during the drive. I thought it would be hard to sit still for that long, but I made it fine and kept concentrating on the task at hand. We got to the house a little before 6pm, and my mom, Julie, and Anna arrived shortly after.

When my mom got there, I started to cry because I felt like I was nowhere close to having the baby, and I was worn out already. I really felt like I had several more hours of labor left (this was actually most likely transition, but I did not recognize it bc my contractions were not THAT intense yet). She helped me get undressed and into the tub. I tried several different positions until finally settling into a squatting type position. Karen and Wetawnya arrived and I was vaguely aware of them setting up the bedroom. I was very much “within” myself. They periodically checked the baby’s heart rate and encouraged me to eat and drink something. I did not want to eat, but did have a little bit of gatorade to drink, although I really didn’t want to be bothered with that either. Christian sat/squatted (I’m not sure?) next to the tub and kept up with my contractions. I would announce when one started and when it ended, as best I could.

Newborn Eli on Mama's chest

I announced that I felt the need to push, and Julie later told me that Wetawnya had left to get some food, and Karen was eating some of the chicken noodle soup we had brought (remember my request?) so she called Wetawnya to come back! I guess everybody thought we were in for a few more hours of labor. I thought I only wanted to labor in the tub, and would get out of the water when it was time to push, but decided in the moment that I wasn’t going anywhere! We discussed whether or not my water had broken, because I wasn’t sure....but shortly after that it did. I heard/felt something like a rubber band popping, and could somewhat feel the warm liquid, even though I was in a tub full of warm liquid! The contractions quickly became much more intense. My hips and thighs started to ache, and I could feel the baby descending. For the most part, I kept my eyes closed and head down. My mom said that she thought I was going to dunk my head in the water a few times! The urge to push was so pronounced, and it felt so good to do so! I thought I was being quite loud with the guttural/moaning sounds I was making, but I’m told I was actually very quiet.

Crowning took me by surprise...I THOUGHT I had a natural birth with Anna, but apparently I missed a LOT at the end when she was crowning due to the pudendal block I received so that I would be able to stop pushing while Dr. G did some deep suctioning to remove meconium before she inhaled it. The pressure was insane, and I wanted that head OUT! It’s hard to describe, but I started to shift my weight from one foot to the other, while squatting, almost like I was trying to crawl away and “deposit” the baby! At one point, one of my midwives (I can’t even remember which one) got eye level with me and reminded me to breathe and focus. I put my hands between my legs and felt his sweet, soft head FULL of hair. I pushed with all my might to get his head out, and once it was, I SMILED. What a relief! I kept my hand on his head while I waited for the next contraction. I asked Karen how long I had to wait because it seemed like it was taking FOREVER! When his body slid out, I pulled him up to my chest and sat on the seat in the tub. He gurgled and cried, and was just absolutely perfect.

It was ONLY 7:08 pm...just ONE HOUR since we had gotten to the house! I was amazed. I felt like it had been longer, but time seemed to stop once things got more intense in the tub. I really believe that the water worked its magic to help me relax and everything jumped into gear. I wish I had gotten in that water sooner!

It was a bit cold in the water, so after a little bit of time had passed, Karen cut the cord and handed Eli to Christian. They had towels fresh out of the dryer to keep him warm while I delivered the placenta and got out of the tub. I sat on the bed and was able to nurse Eli while we all enjoyed him. He pooped on me while he nursed! Black, tarry meconium all over my tummy!  After we had a while with Eli, Karen and Wetawnya did all the baby checks right next to me on the bed while I ate some chicken noodle soup. He weighed in at 7lbs 9oz. Christian put his diaper on him and got him dressed, and I got in the shower to clean up. Anna, Julie, and my mom got to hold him a little bit too. Karen and Wetawnya left the house, and we were right behind them. We were back at home by 11pm.

I had a 2nd degree tear, and I KNEW I had pushed too hard to get his head out. It took me by such surprise - I was not prepared for the burning and stretching, so I pushed as hard as I could to get it over with! Bad idea...but I chose not to get stitches after discussing it with Karen. I healed just fine :)

Big sister Anna was very emotional, too!

Shortly after the birth, I looked at my sister and said, “THAT HURT”...ha! I told her I’d absolutely do it again, but I would need some time to forget first ;)

Anna has always been very sensitive to my emotions, so when I cried when we first got to the house, she got upset/nervous. Julie took her to the living room to find something on TV, but when I started pushing they came back to the bedroom. I’m sure Anna was nervous, not knowing what to expect, even though I had showed her videos of natural births. She cried and cried once Eli was born. It wasn’t a sad cry, more of a pent-up emotional release. She didn’t want to hold him until he had clothes on since he had pooped on me! Now, Anna says she is going to adopt…no childbirth for her! HA! I sure hope I didn’t scar her for life ;)

Political Tactics Deprive “Home Birth Safety Act” of Promised Vote

Rep. Mike Ball from Madison
has sponsored HB 67.

by Anna Bertone, MPH  Guest Blogger

The Senate Judiciary Committee held a hearing yesterday for House Bill 67, and Senate Bill 99, "The Home Birth Safety Act." The bill, sponsored by Rep. Mike Ball, R-Madison, and Sen. Paul Bussman, R-Cullman would have decriminalized the practice of Certified Professional Midwives (CPMs) in an effort to improve out-of-hospital maternity care in Alabama.

Supporters from across the state filled the room and waited through hours of less popular bills to the last on the agenda – the midwifery bill. The committee allowed three testimonies from the opposition and two from the proponents. Legislators were preparing to vote as planned when Sen. Bryan Taylor, R-Prattville made a late arrival and halted the legislative process by calling for the bill to be tabled. The "no" votes on tabling the bill were Sen. Orr, Sen. Ward and Sen. Williams.

Sen. Bryan Taylor arrived late and
called for SB 99 to be tabled.

The disappointing end to the public hearing came after passionate testimony from both sides of the issue. The opposition cited a not yet published study on national birth certificate data  that found an elevated relative risk of neonatal death for home births. They gave no discussion of absolute risks or the limitations of using administrative records for research purposes. They recounted examples of tragic outcomes from Alabama home births in such detail that many in the audience could identify the cases being described.  

Supporters referenced favorable results from a recent observational study that used “intention to treat” methodology. This study design avoids many of the limitations in using birth records. It involves enrolling women who are planning a home birth early in prenatal care and then following them to document the outcome. They also explained to legislators that credentialed midwives should not be blamed for poor outcomes occurring at unattended home births or births attended by lay midwives (as were the anecdotal scare stories). On the contrary, this legislation seeks to address unsafe out-of-hospital birth practices.

 "Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery."      ACOG 2011 Statement

The Medical Association of the State of Alabama uses powerful political leverage to oppose home birth safety legislation year after year. They acknowledge that parents are choosing home birth in increasing numbers, that it is within their legal right to do so, and that birth carries risk of injury and death to mother and child. Nevertheless, they refuse to come to the table with parents and midwives to discuss safety measures. Medical opponents agree in principal but not practice with the official American College of Obstetricians and Gynecologists 2011 statement on planned home birth, to “respect the right of a woman to make a medically informed decision about delivery.”  We are not respecting women’s choices in childbirth if we strive for standards and quality improvement in the hospital setting but refuse to implement safety measures for alternative choices.

After studying the issue, Dr. Pippa Abston
supports the licensure of CPM's.

According to an Alabama pediatrician:

"I have studied this issue in detail and have learned that the CPM certification process  is rigorous and appropriate.  With well-trained attendants, planned home birth can be a safe option for low risk pregnancies.  Even for higher risk cases, women who decide to give birth at home have significantly better outcomes if they are able to have a well-trained midwife present than if they are not.  Home births without such help, happening now in our state, are dangerous to both mother and newborn.  I support the licensure or at least the decriminalization of CPM practice, to improve the safety of mothers and newborns." -- Pippa Abston, MD, PhD

Women choose to birth outside of the hospital for a variety of cultural, spiritual, economic and personal reasons. For some, a previous negative hospital experience has left them seeking alternative care in a state with no freestanding birth centers. Others hope to avoid the risks associated with routine hospital interventions or hospital-acquired infections. The rising cesarean rate (now 1 in 3 in AL) may be contributing to women choosing a setting more conducive to physiologic birth. Some women who have experienced sexual trauma or forms of discrimination prefer to birth in a familiar setting. There are individuals and communities (Amish, Mennonites) that hold pregnancy and birth to be normal but private life events belonging to the family. Costly hospital services are enough to deter some uninsured or underinsured individuals from utilization.

The 28 states already authorizing the practice of CPMs have come to the common sense

The Alabama Birth Coalition will
keep fighting for the birthing
rights of Alabama mothers.

conclusion that it’s absurd to allow home births but outlaw qualified care providers to attend them. The safest possible course is to license and regulate credentialed midwives while collecting publicly available data on maternal and child outcomes. 

Families choosing home birth are fed up with bullying tactics from powerful special interest groups and want to let the legislative process work to come up with real solutions to real problems. We at the Alabama Birth Coalition agree with the American Public Health Association’s resolution  to increase access to trained out-of-hospital maternity care providers as an important step in improving public health and safety. We support the safest possible care for all Alabama families, regardless of chosen birth setting. 

For more information, visit www.alabamabirthcoalition.org or find the organization on Facebook.

The Alabama Birth Coalition (ABC) is a 501c4 non-profit, grassroots organization.

Will Alabama Actually Make Home Birth Safer?

By Glenni Lorick, IBCLC

For the last several years, the Alabama Birth Coalition has worked tirelessly to pass legislation providing for the licensing and regulation of Certified Professional Midwives. Each year, their efforts have fallen short, as the bill has either not made it out of committee or been terribly altered by unfriendly ammendments. There is good reason to hope that this year will be different!

A New Committee

Instead of presenting a bill to the Health Committee like they have in past years, this year they have taken a different approach: they have provided a bill to the Judiciary committee! The focus of the bill is the decriminalization of home birth. House Bill 67 and Senate Bill 99, "The Home Birth Safety Act," would decriminalize the practice of Certified Professional Midwives (CPM's).  According to the Alabama Department of Public Health, 1,448 women gave birth outside of the hospital from 2005-2012. Many of those mothers had no medical assistance, increasing the risk dramatically. 

While it is not illegal for a mother to give birth in the comfort of her home, it IS illegal for anybody with any medical training to provide assistance to her. This bill provides immunity to midwives and certain healthcare providers who assist in "physiologic childbirth." In other words, specially trained professionals will not be prosecuted for helping a mother give birth at home.

The Debate

Opponents argue that home birth is inherently unsafe. They insist that a woman should only give birth in the safe confines of a hospital. In fact the president of the Medical Association of the State of Alabama weighed in heavily against this bill. Nevertheless, even Governor Bentley recognizes that Alabama mothers ARE having babies at home, and the wisest thing to do is make it as safe as possible for them by allowing trained professionals to attend those births. 

Proponents of the Home Birth Safety Act recognize that the bill on the table actually helps to ensure the safety of mothers by authorizing only "midwives who hold a current midwifery certification from an organization accredited by the Institute for Credentialing Excellence." Certified Professional Midwives are specifically trained in dealing with out-of-hospital births. They are experienced professionals who have undergone thorough testing of their knowledge base.

You Can Help

Tomorrow at 1:00 pm a public hearing is scheduled before the Senate Judiciary Committee followed by a committee vote. Many members of the Alabama Birth Coalition will travel to Montgomery to show their support. Assuming this bill passes the committee tomorrow, you need to contact your state senator, asking him or her to vote in favor of this bill when it comes to a full vote of the senate. Hopefully, the same process will take place in the House.

Eventually the Alabama Birth Coalition would like to see the practice of midwifery licensed and regulated by the state. This would confer even greater protection on childbearing families. Nevertheless, decriminalization is a very important first step!

Whether you personally would be comfortable with a home birth or not, it is time to recognize that every mother has the right to choose how she wants to give birth. Some women just want their epidural in the hospital, and that is their right. Others want a natural birth in a hospital setting. Some even want a Certified Nurse Midwife.  If a woman has the right to choose to end the life of her child, then she should certainly have the right to choose where and under what birthing circumstances her child's life outside of the womb will begin.