Thursday, March 14, 2013


We'd like to share a guest post from a home birth mom, and former midwife apprentice: 

One of my friends lost a baby last year. For no explanation. She was healthy, her pregnancy was healthy, she was doing all the right things during her pregnancy.

Her baby just died. Just one day, the baby wasn't there anymore. And two days later, she was induced and she birthed a perfect baby. And no one knows why this baby died.

I cannot imagine the ache and heartbreak of losing one's child. I cannot. I do not think it is imaginable. I know how much I love my children - and the physical yearning I feel for them. I know the impossible and unreasonable love I felt for them when they were born. I cannot imagine birthing a baby who is not alive.

My heart hurts for my friend. I love her. I would never wish this for her, or for anyone. And I want to do something to take away her pain, to lessen her grief, to give her some sort of respite from her terrible reality.

I've spent hours in tears over my friend's loss. What a burden to bear. It seems when there is no explanation, and no answer, it is even worse. There was no negligent provider. No harmful technological intervention. No glaring abnormality or risk factor. There is no culprit; this is the unfairness and cruelty of life. It just happened. Sometimes babies die and we do not know why.

But sometimes, we do know why babies die. Sometimes there are things that surface during pregnancy and birth that risk the lives of babies.

Shoulder dystocia.

Many of these births with these risks are celebrated in home birth circles - it doesn't take much searching online to see a blog post celebrating the "VBAC twin birth at home!" or the "homebirth at 43 weeks, and everyone was just fine!" or the "surprise breech AT HOME!" or any variation of these complications occurring seemingly without a hitch.

My own homebirths occurred with the presence of risk factors. And I do not readily share these details (and I will not now) because I do not want to normalize these risk factors. I do not want to lend credence to the fallacy that since my births with risk factors occurred at home with good outcomes, that all births with risk factors can occur at home with good outcomes. I know better. I understood the risks - and I still understand the risks - and because they were risks, I refuse to publicly celebrate them.

I come back to this -  I believe we must take responsiblity for the realities and myths that we perpetuate by sharing our birth stories.

What if my friend lost her baby to a complication of one of the risk factors I'd had during one of my labors?  What if I'd celebrated my triumphant birth, and touted it as 'proof' that risky birth at home is safe? What if she was influenced or inspired by my birth story? Who isn't inspired by a birth story? Who isn't ecstatic when babies are born living and breathing and crying and kicking and nuzzling and rooting?

But what if our birth stories perpetuate certain myths that birth is safe under circumstances when they are not? Is it worth it to have a homebirth under risky circumstances knowing that not all mothers and babies will be as lucky?

Can the joy of my homebirth be weighted against the pain of another mother's loss? Because I would happily forgo half of my joy to prevent another mother's loss. The loss of a child is too terrible a prospect. I would happily have given birth in a hospital for risk factors only, if I knew that if 1000 women did this, the deaths of one or two of their children would be prevented.

I would do that to prevent the agony of the needless loss of a child.

If we are compassionate beings - and I believe most of us are - we want to do what's best for the most of us and we do not want to do things that cause harm. What is best for most mothers and babies and families in home birth is not promoting her "informed choice" to have a risky birth at home, but to have risky births attended in the safest setting and by the most appropriate providers for that condition. This would mean that many women would have "normal, uncomplicated" births at the hospital. Births that, by the roll of the dice, would probably have ended up "just fine" at home. But, by doing this, the pain of the death of a few of these babies would be prevented.

I cannot do anything to take my friend's pain away. I listen to her express her grief. I replay in my mind her birth - with a live baby - I imagine her with a nursing child. I imagine her mothering her sweet baby. I want it to be different for her. The helplessness I feel makes me think of ways we are not helpless in preventing some newborn deaths. Even one death. Even one would be worth it, wouldn't it?

It's time to move the risky births back to the hospital. This is the most compassionate thing we can do.


  1. This is very compelling. Thank you for posting this.

  2. I think it's really important to not minimize the importance of informed choice (consent or refusal -- see third to last paragraph of post). EVERY care provider must provide and document TRUE informed choice -- not "here's this paperwork we need you to sign about this intervention" or "here's this waiver I need you to sign releasing me from liability based on your choices about your birth" choice. Neither of these is actual informed choice (I do research with human subjects, so I have quite a bit of knowledge regarding what IS and what is NOT informed consent/refusal). When we say that promoting informed choice isn't what's best for mothers and babies, I think we're treading on dangerous ground. If we don't advocate for informed choice (in every birth context), it seems like we're saying that someone else who's "more informed" because of their experience/background/knowledge should be given authority to make decisions for pregnant women based on what's in their best interests and the best interests of their baby. We're asking women to give up their autonomy (and responsibility!) just because they're pregnant. That's not okay.

    I understand that the author feels that telling positive homebirth stories when risk factors were present makes women say to themselves "Well, she had risk factor X and her homebirth went fine, so that means mine will too" but I think that gives women a lot less credit than we deserve. I think most women realize that just because Sally had a positive outcome with risk factor X doesn't mean that Julie will have the same positive outcome with risk factor X. Data/evidence needs to guide the decision-making process, not anecdotes. This data/evidence -- as much as possible -- should be a part of the informed choice procedure both in and out of hospitals.

  3. I agree that informed consent is rather poorly done - among many providers and under many different circumstances - and not just around childbirth.

    My "informed choice" statement may not have come out the way I intended. Those are very purposeful quotation marks, and they are meant to convey that informed choice is not actually what occurred, but some form of persuasion or false-reassurance. A woman's right to making a informed choice is often the reason used to justify poor outcomes in an OOH setting. "But what about a woman's right to informed choice and consent?" "Women have the right to autonomy and to make their own decisions."

    Yes. Yes they do. The most important point is that they deserve the right to factual information - you and I agree on this - and I have witnessed "informed choices" made by women in OOH settings based on anything but a thorough examination of existing data and evidence and the risks of their decisions. (To be fair, I've witnessed this in hospital settings, too, this blog is about OOH midwifery - so we try to keep the discussion focused).

    Midwifery will not have a leg to stand on if they continue to accept/promote risky births OOH. The data will not support these risky births as safe options for women in an OOH setting. But too many of these 'variations of normal' are sold as safe options. Because anecdotally - it usually all works out just fine.

    As far as birth stories go, I have to disagree that they do not influence others' perception of risk. Many people see the positive results of harrowing birth stories and are reassured that these risky situations are or can be safe. This is true not only for mothers, but midwives as well.