bearing blog

Selkie says:

When I spoke to those college students early last month about childbirth, I used an analogy that occurred to me during the Winter Olympics: I said that hospital birth is like ski-jumping and homebirth is like cross-country skiing. Ski-jumping is more dramatic than other events — there are ambulances standing by for a reason. Cross-country skiing has its own risks. It’s unusually hard work, and you could have a heart attack and die on the trail. But out there in the stillness some of us find an extraordinary beauty.

A significant consideration, of course, is that in childbirth you’ve got a passenger along for the ride, dependent on you for protection. Your decisions matter, because we’re talking about the potential for injury to or death of a baby. But I think most people hear "homebirth" and imagine ski-jumping solo, with no helmet and no EMTs, when it simply isn’t like that. In both events you’ve got skis on your feet and you’re heading to the finish line. But when you deliver a baby at home, the spiral of interventions that too frequently culminates in an emergency surgical delivery just doesn’t get started.

I also liked this graf:

So these are my questions, gentle readers: one, should I call my confessor for an appointment tonight or can it wait until morning? Two, should homebirthing women be held to a higher standard with regard to informed consent? (By which I mean, if most women laboring in hospitals don’t know that the shot of Nubain they gratefully accept can impede a baby’s subsequent respiratory effort, should a woman at home be expected to be more conversant with the literature?) Three, Dr. Amy assures me she has a list of references as long as her arm to demonstrate the hazards of planned attended homebirth by low-risk women — does this mean she is an amputee or just a person with unusually short arms?

One of the commenters’ lines got me thinking. He or she wrote,

I agree with your statement that patients should get to make their own choices when each option is equally proven to be safe ….

which made me wonder, in what other "medical" situation are patients only allowed to make choices between options that are proven to have precisely equal safety? 

How ridiculous, how arrogant.   Can you imagine speaking this way (since the writer thinks of pregnant women as "patients") to someone weighing chemotherapy vs. radiation, or surgery for a chronic condition vs. physical therapy?  "I’m sorry, you’re not allowed to opt for the limited radiation course.  Even if all your hair falls out and you can’t taste your food for the rest of your life, you have to take the full chemo course because our studies show that it gives better outcomes." 

And as for the argument that a baby’s health and life are at stake too, which is true of course — isn’t it traditionally the parent who makes medical decisions on behalf of a minor child?  I swear, the hospital maternity department is the last holdout of the women-are-chattel contingent.

But let’s dispense with the medical analogies…  Look, there’s a lot of ways to measure "risk" when it comes to birth choices.  Perhaps it’s true that hospital birth is in certain important senses safer than home birth.   Maybe the risk of death really is several times higher in a planned home birth than in a planned hospital birth.  Before you object, note this:  if it’s not true today, it might be true tomorrow (should hospitals win the battle against staph — it could happen — or should competent homebirth midwives disappear from the earth).

So what if?  What if?  What if hospital birth instead of homebirth were proven to reduce the risk of death?

Look.  So is walking instead of driving.  So is one daily glass of wine instead of zero or three.  So is camping instead of boating.  So is cross-country instead of downhill skiing.

And, since we’re talking about little ones too, so is kids’ soccer instead of kids’ hockey.  So is letting your kid play video games in the basement instead of making your kid go ride his bike around the neighborhood.

Even if hospital birth were proven to be TEN times less likely to end in somebody’s death than homebirth, they’d still be basically low-death-risk activities.   We’re talking small, less than 1 in 1000 risks, maybe even much, much smaller for women who are healthy and strong to begin with and for their babies. 

So, given that the chances of a seriously horrible and tragic outcome are, really, low in both places —- it makes complete sense to respect the right of the individual to make her choice based on the costs and benefits that are much more likely to actually be encountered in the typical situation.   No doctor has the right, moral or otherwise, to tell me I have to drink a glass of wine every night if I don’t like the stuff.    No doctor has the right, moral or otherwise, to tell me to hang up my skis.  And can you imagine if the state medical association (this is Minnesota after all) insisted that parents who let their kids play hockey were criminally negligent and that those whose children were seriously injured ought to be prosecuted?

Look — we know our own family.  Take Selkie’s skiing analogy.  Mark loves downhill skiing.  Is it riskier, on the face of it, than cross-country skiing?  Sure.  Much, much higher chance of striking a tree at great speed if you involve a steep slope than if you don’t.  But — if he weren’t allowed to fly out west for a downhill ski trip several times a year, do you really think he’d replace that time with cross-country schlepping?  Would he be motivated to go to the gym once or twice a week and lift weights all winter to stay in good condition for… shuffling around the (flat) lake path on a snowy evening?  For him, not skiing is probably riskier than skiing, for the simple reason that knowing that ski trip is coming up in a few months keeps him motivated to stay in shape.  Not only that, but he’s planning for the future:  he wants to be in shape to use the senior-citizen lift ticket discount a dozen times a year.

So, throw death out the birth-choice window.  It’s just not very likely to happen — the chances are so small that it counts as "freak occurrence" whether home or hospital, and you can’t live in fear of that kind of thing — it would be like avoiding the hospital solely for fear of accidental baby-switching.  Instead, concentrate on stuff that’s much more likely to be encountered.  Like the chances an unnecessary C-section, with all its complications.   Or the chances that nursing will or won’t get off to a good start.  Or the chances of a medical mistake.  Or the chances of postpartum infection.  Or the chances of more minor birth-related injuries, like pelvic floor dysfunction.   

Or — dare I say it?  — consider personal beliefs about what’s good for human beings to experience!  Safety is one thing; well-being is another.  It’s my right and duty to seek well-being for myself and my children, at all times.  Some minimum standard of safety is part of that, but safety itself is not well-being — elevating absolute safety above all other considerations decreases well-being.

Yesterday evening was lovely and warm, so we took the boys for a walk by the lake after dinner.  The bike paths and walking paths were crowded, and the playground was full of children.  Milo said that the setting sun made the lake look like orange juice.

Mark was helping Milo in the port-a-potty and I was waiting outside with Oscar.  A young mom with one boy joined the line.  She nodded at my pregnant belly and asked, "So how much longer ya got?"

I paused to count, and told her, "About four months."

Then, her jaw went slack with horror and she repeated "Four months…?"

"Um.  Well, with number three, everything happens a lot… sooner."

She nodded, but that look of horror never went out of her eyes…