A home birth decision: Risk. Worry. Push …

By Mike Hixenbaugh
The Virginian-Pilot

I sat at the edge of my bed and, in the grogginess that accompanies 3 a.m., allowed my mind to drift.

I smiled, thinking of my toddler’s reaction months earlier when my wife pointed at two faint lines on a stick and told him he was going to be a big brother. Poor kid; he cried, somehow aware his little world was about to be rocked.

I started to replay my own bumbling reaction to the news when a hard squeeze on my right hand jerked me back to the moment.

“Here comes another one,” my wife moaned, bracing herself for the next contraction.

After nine months of morning sickness, worrisome ultrasounds and midnight snack runs, the event we had been preparing and praying for was upon us.

“I can’t do this,” she said as the contraction faded. My wife took two deep breaths, relaxed her shoulders then repeated herself in a softer, almost weeping voice.

I wiped a tear from her cheek, leaned in close and tried to whisper something reassuring. “That’s not true, Bethany. You’re doing great. Everything’s perfectly normal.”

That last part was debatable.

Instead of lying on her back in a hospital, surrounded by potentially lifesaving medical equipment, my wife was laboring in our Portsmouth bedroom. Our beagle paced nervously across hardwood floors. Our 2-year-old son slept in a room down the hall.

And again my wife clenched my hand. “Oh, God, I can’t do this.” I watched her breathe through pain, the color fading from her face, her toes curling.

I thought of all the terrible things that could go wrong.

And, for one fleeting moment, I wondered whether we had made a mistake.

***

“Home birth is crazy. It was all my wife’s idea. I don’t even like cooking at home.” – Jim Gaffigan, comedian

Months earlier, we sat at our dining room table, laboring over a decision most expectant parents never consider: living room or hospital room?

The choice should have been easier. Bethany had given birth to our first child, Ezra, in an inflatable tub at our home in Fayetteville, N.C., unwittingly joining a movement of self-empowered mamas who have increasingly shunned medical interference in childbirth.

The philosophy, in short: Birth is a natural function that doesn’t automatically require a doctor’s oversight. Standard hospital interventions intended to speed the process and dull the pain too often lead women down a path toward a Caesarean section. In a sort of rebellion against that system, the number of women choosing to birth at home has increased by a third over the past decade.

Still, the vast majority of mothers prefer the assurance of laboring at a hospital. Less than 1 percent of U.S. births – including about 800 annually in Virginia – happen at home.

In January, we were debating whether we wanted our next child to be counted among them.

A certified nurse-midwife had attended our son’s birth in North Carolina. Her medical schooling meant she was allowed to carry an oxygen tank and drugs into our home, and she had years of training on how to use them in case of an emergency – reassuring facts for an anxious husband.

But there is no such option in Hampton Roads. Here, mothers wishing to give birth at home can choose from a handful of certified professional midwives, of varying reputations. One in Newport News recently offered a discount to expectant mothers who own a gun. A professional midwife must be certified by the North American Registry of Midwives, which requires its members to pass a multiple-choice exam and complete an apprenticeship program.

No matter how much experience they rack up, though, certified professional midwives in Virginia are legally barred from carrying oxygen tanks or painkillers. They can’t stitch up a tear, can’t write a prescription, can’t carry liability insurance and thus can’t be sued for malpractice.

Days earlier, we had met with a pair of Virginia Beach midwives. They briefed us on the differences between nurse-midwives and professional midwives and sent us home with a packet of forms.

The pages were filled with suggestions for prenatal care, information about natural birth – and blunt warnings:

“We are fully aware that in the event of a complication or emergency there are fewer alternatives available at a home birth.”

“In choosing to have a home birth, we knowingly accept responsibility for our labor and birth.”

“Although birth is a natural physiologic process, its outcome is not always favorable.”

I set the papers on the table and took a deep breath. Bethany must have sensed my discomfort.

“Are you sure you want to do this?” she asked.

I wasn’t sure how to answer.

***

“I was my wife’s birth coach, which is a generous title for ‘standing there terrified.’ There was also a midwife there… because we believe in witchcraft.” – Gaffigan

I walked into the chiropractic office that doubles as the home of Seven Cities Midwifery in January with a stack of unsigned papers and some serious questions.

I was greeted with a hug. Two other women embraced me before I plopped down next to my wife in a sunlit room overlooking a lake.

Before I could fire off my first query, the two midwives, Jenny Derugen and Terri Hewitt, and their apprentice, Jennifer Green, began peppering Bethany with questions of their own.

How are you feeling? Have you been nauseous? What are you eating? What prenatals are you on? Are you getting enough sleep?

Soon Jenny – a silver-haired woman who’s been attending home births for three decades – was telling stories about helping the Amish deliver babies by the light of kerosene lamps back in Pennsylvania. Bethany told them about her first birth: four hours in a tub followed by an unparalleled sense of accomplishment and an indescribable hormonal rush. Terri shared her own birth stories. They laughed like old friends.

Suddenly all four women were looking at me. “Mike, do you have any concerns?” Terri asked.

Yep, lots of ’em, I thought. But most boiled down to a single question.

“What if something goes wrong?”

Terri explained that about 15 percent of their mothers transfer to a hospital and that the two midwives err on the side of caution when making that call. They’ve seen it all over the years; combined, they’ve attended more than 1,300 births. Although they’re confident birth is a safe, natural event, Jenny said, there is no guarantee against tragedy.

Their honesty reminded me of the reason I chose to support Bethany’s first home birth: faith.

I have faith in my wife. I have faith in our creator. And now I was starting to gain some faith in the women who would guide us through this.

A moment later, Bethany was on her back with her shirt pulled up, revealing a subtle bump that still seemed so foreign. With a smear of blue gel, a wave of a wand, and a sudden “whoosh, whoosh, whoosh,” reality started to set in.

This kid had a heartbeat.

Before leaving, we wiped away some tears, signed the patient agreements, wrote a check to secure a time slot sometime in the month of June and then hugged our new friends.

I drove away feeling surprisingly confident. But dads are prone to worry.

A few days later, Bethany and I sprawled on the couch for the latest episode of “Downton Abbey,” the salacious PBS drama about British high society in the early 20th century.

One of the lead characters goes into labor at the family estate and is showing some distressing signs.

I shoved popcorn in my mouth and glanced nervously at my pregnant wife.

The Grantham family doctor suggests rushing Lady Sybil to the hospital with a possible case of eclampsia. The revered obstetrician who had come from London for the birth dismisses the dire diagnosis.

Moments later, the baby is born, all seems well, and then… panic. The new mother is having a seizure. Now she’s blue and lifeless on the bed.

Bethany gasped. I set the popcorn bowl aside and shook my head. I should have seen this coming.

The cause of death?

Home birth.

***

“People don’t want to hear about home birth. They’re like, ‘Oh, you had your baby at home? Yeah, we were going to do that, but we wanted our baby to live.’ ” – Gaffigan

Concerns over life and death aside, the idea of home birth appeals to me on a philosophical level.

I’m wary of a medical industry that rewards doctors for procedures, not results. Americans spend more on prenatal care and birth – between $10,000 and $15,000 per pregnancy – than anyone else on Earth, yet the United States has one of the highest rates of infant and maternal death among industrialized nations. Which leads to a peripheral benefit: Even if insurance doesn’t contribute a dime, a home birth typically costs just $3,000 out of pocket.

At dinner parties, I’m the guy bragging about how much he saved by having his wife push at home. And, oh, by the way, I got in the tub with her!

But as I gained trust in our midwives, the objective journalist in me wondered if I was missing part of the story. Home birth is wildly controversial, after all. And so I contacted the nation’s most ardent home birth opponent and asked her for advice.

Amy Tuteur, known simply as Dr. Amy to anyone who’s ever encountered her in an online forum, is a former obstetrician who writes about the dangers of home birth on her blogs, The Skeptical OB and Hurt by Homebirth.

“If given the chance,” I wrote in an email to Tuteur during the final month of Bethany’s pregnancy, “what would you say to persuade us to change our minds?”

She responded that day with several questions of her own.

“Are you and your wife comfortable with the fact that all the existing scientific evidence shows that homebirth has an increased risk of perinatal death?”

“Do you know that CPMs aren’t real midwives?”

“If your baby dies (and your baby really could die) for lack of access to an operating room or an expert in advanced neonatal resuscitation… will you and your wife be able to live with the guilt?”

Tuteur ended the email with one of the horror stories posted on her website, this one by a father whose son died from a preventable bacterial infection hours after being born at home.

I wrote back with some confidence, knowing my wife had been screened to ensure against a similar scenario. I questioned statistics she cited showing significantly higher rates of death during home births – there isn’t enough data to draw solid conclusions – and defended our midwives.

Jenny and Terri didn’t match Tuteur’s description of midwives as unscrupulous and uneducated. When an ultrasound revealed a possible problem with our baby’s kidneys, it was Terri who urged us to seek follow-up screenings and suggested we think about other options if home no longer seemed safe.

I assured Tuteur that we had weighed the risks before making an informed decision. Other parents should be free to do the same.

“I doubt it would make you feel any better if I told you my wife has been drinking unpasteurized milk throughout her pregnancy!” I wrote to end the message, followed by a winking smiley face.

She disregarded that playful reference to another controversial health topic. Home birth, Tuteur wrote in her final response, is akin to driving without putting your baby in a car seat. “Most of the time, it makes no difference, because most of the time you won’t get into an accident.”

“I wish you luck,” she wrote. “But most of all, I wish your baby luck. He or she may pay a terrible price if you have made a mistake.”

He or she?

We were about to find out.

***

“People always assume there was some laziness involved. ‘You didn’t want to go to the hospital?’… ‘It was farrr. I didn’t feel like putting on pants.’ ” – Gaffigan

I was leaving church when I got the call from home: “Babe, I think I’m in labor.”

I strapped Ezra into his car seat – we always strap our son into his car seat! – and tried my best to drive the speed limit.

At home, Bethany sat on an exercise ball, breathing through mild but regular contractions. If her first birth was a guide, we would have a new baby by that evening.

As she labored, I fumbled with a compressor, trying to inflate a birthing tub. A friend knocked on the front door and whisked our son away. Then a homeless man knocked. “Just make him a sandwich,” Bethany said between breaths.

Hours passed.

Terri and her assistant Jennifer arrived around dusk, but the contractions soon faded. A quick check revealed that Bethany was dilated about 5 centimeters – far enough along that many doctors would suggest that we head for a hospital. We continued to prepare as though the baby was coming.

Then, nothing.

We lay awake that night, waiting for the process to pick back up. It didn’t.

Three more days passed, punctuated by occasional contractions and calls from family and friends. Bethany collapsed into bed that evening. “This baby is never going to come,” she said.

Hours later, around 2 a.m., she awoke with a surge of pain.

This time wasn’t a drill.

***

“There was so much screaming, at one point, I actually woke up. ‘Hey, did someone score a touchdown? Oh, you’re having another baby. Can you keep it down?’ ” – Gaffigan

I called Terri, then handed the phone to Bethany. She started to describe how she was feeling but was interrupted by a contraction so intense, she dropped the phone.

I picked it up.

“I’m on my way,” Terri said.

Bethany climbed into a hot shower. I grabbed a garden hose, connected it to our hot water tank and started filling the birthing tub.

Bethany was on our bed, leaning over her exercise ball, when Terri and Jennifer arrived. I rubbed my wife’s back and offered her sips of cold water.

The pain was intense. She had stopped talking between contractions, instead conserving energy and focusing on breathing.

Not long after repeating, “I can’t do this,” and collapsing onto her side, Bethany snapped to life.

“I can feel the head!” she said, sounding almost joyful in the midst of a painful contraction.

Terri soon confirmed it. The baby was crowning. We hadn’t even had time to fill the birth tub. Bethany got up on all fours and moaned through another contraction.

There’s the head! It was covered in thick black hair. Then a tiny arm flung out.

My heart raced. I thought I might faint. God, please don’t let our son wake up!

Terri looked to me: “Do you want to catch the baby?”

I thought, “No, you do it.” Instead my head nodded “Yes.”

I shuffled to the business end of the bed. Terri and Jennifer guided my hands into position. You can do this, Bethany. You’re almost there!

She grunted and pushed. I held my breath.

Suddenly, a child – and a gush of amniotic fluid – landed in my hands. Eyes wide, I looked up at Terri.

She helped me place the baby on Bethany’s chest, now on her back and weeping. After months of careful planning, second guessing and praying, our baby entered the world after two hours of active labor and just six minutes of pushing.

The puffy-eyed infant released a hoarse little cry and soon started rooting for mama’s breast. Minutes passed before I finally lifted the towel and learned that this little person – this new child of mine – was a girl.

My sweet Eleanor Grace.

Our son awoke minutes later, appearing in shock as I carried him to meet his baby sister. As we bonded in bed for the first time as a family of four, Terri and Jennifer continued to work. They recorded notes, placed the placenta into a glass pan, checked Bethany’s vitals and started to tidy up.

Soon sunlight streamed into the bedroom at the start of a new day.

For the next several hours, we cuddled in our house, which suddenly felt much more like home.

Mike Hixenbaugh, 757-446-2949, mike.hixenbaugh@pilotonline.com

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