Homebirth Cesarean

I’m particularly excited about the new (and only) Homebirth Cesarean book and workbook that just came out. I don’t have my copies yet, but I have many dear friends who have experienced homebirth cesareans and I’ve been listening to and learning from them for many years now. My own copies of the books will be arriving shortly, but I wanted to write based on my own experiences and what I’ve learned so far, before I read the books. For a review of the book, I recommend checking out this article: http://commonhealth.wbur.org/2015/03/what-to-expect-when-youre-birthing-at-home-a-c-section-possibly

If you aren’t familiar with the term “homebirth cesarean,” there’s a good, albeit unfortunate, reason for that: the term hasn’t been around for very long, oddly enough. The reality of homebirth cesareans has been around for quite some time, but until recently virtually nobody was talking about them and there certainly wasn’t a specific term for them.

A “homebirth cesarean” is, put quite simply, a homebirth that requires hospital transport and then a subsequent cesarean section. Nobody is actually having cesareans at home (as far as I know).

This special term is necessary because, in our (USA) society, it takes a specific type of commitment and belief in the benefits of out of hospital birth in order to even consider a home birth. Usually the women who plan homebirths are extremely involved in the natural/home birth community and, in the pushback against unnecessary birth interventions, this community has had a tendency to demonize interventive births and hasn’t always managed to differentiate between necessary interventions and routine interventions.

Many natural birth advocates have seemed to forget that — although it’s true that the vast majority of births don’t require much, if any, intervention and it’s also true that it’s better to let things progress naturally when everything is normal and going well — every modern birth intervention has a time and a place when they’re appropriate to use. These birth interventions can be extremely necessary and even life-saving depending on the situation. In the name of “positive thinking” women are often actively discouraged from considering the possibility that there could be complications during their births. Homebirth transports in general tend to be all but a completely taboo topic in many natural birth circles.

Coming from that community it’s easy to see how a very medical birth of any type, let alone the ultimate of interventive births — a cesarean — can be perceived as a failure. The questions about what the mom, midwife, and/or doula “could’ve done differently” to “avoid” or “prevent” a surgical birth are all too common from the natural birth community, as are the well-meaning but ultimately dismissive comments about “well at least you have a healthy baby” from those outside of the natural birth community.

Mothers who experience homebirth cesareans not only have to deal with the loss of their preferred birthplace and type, but often also the loss of the support of the community that had previously encouraged them in their homebirth plans. Instead of feeling supported and validated, they are often viewed as examples of home birth “failures” —  cautionary tales of what “not to do” or instead threats to the viewpoint that birth is overall a safe experience if not interfered with.

The reality, however, is that there are no guarantees in birth. You can do everything “right” and still have an unexpected or undesirable outcome. Planning a home birth doesn’t necessarily mean you will birth at home or avoid a cesarean. Safe hospital transport options and the availability of cesareans when needed are integral to helping home birth remain a safe option.

Unfortunately, the emotional fallout from a home birth transport can be devastating even when the mom and baby are healthy in the end and I believe that the natural and home birth movements are partly to blame for that fallout by not acknowledging and talking with expecting moms about the potential for this to happen.

On the hospital side, respectful reception of moms and babies who transport would go a long way as well. However, as doulas and (student) midwives and natural birth advocates, we have to begin and continue to listen to moms who have transported for cesareans, to talk about the reality of transports, and to talk about the reality that cesareans are life-saving operations when they become necessary.

Cesareans aren’t something to avoid at all costs and they don’t signify a failure of women or of home/natural birth. A cesarean is far from the worst birth outcome and sometimes it’s the best outcome.

New Apprentice

Dear New Apprentice,

The path towards midwifery can be a very long and lonely path. Being a midwifery student/apprentice can isolate you from your family and the friends you used to spend time with. It isn’t easy for someone who has never led an on-call lifestyle to understand how interruptible your life must now be. It isn’t easy for people to understand that you can never fully commit to anything while on-call and that backup plans are a way of life for you now.

Your life is no longer your own. You must come and go based on someone else’s schedule – not only the schedules of the pregnant women who hire your preceptor, but also your preceptor’s schedule and the almost always completely unpredictable schedules of the babies you will help care for. Your schedule and convenience are the least important factors in the equation and, because of this, you cannot simply fit midwifery or an apprenticeship into your life. You must instead fit your life in around your apprenticeship.

In addition to the long hours spent at prenatals, births, and postpartums; you must also somehow fit in your academics. Hours upon hours spent with Helen Varney, Anne Frye, Myles, Ina May Gaskin, Michel Odent, Elizabeth Davis, Oxorn and Foote, and the Practical Skills Guide, among others. Whether you attend an accredited school or choose to pursue a less formal course of study, bookwork is an integral part of your training and has to be squeezed in sometime or other.

It doesn’t matter how little you feel like you “fit in” with the other apprentices in your area. It doesn’t matter how much of a kindred spirit your preceptor is. If you choose to shun the only group of people who are currently experiencing this peculiar lifestyle along with you then you will, almost certainly, be missing out on a huge amount of vital support.

You may be in your early 20’s, just a few weeks into your apprenticeship,  and believe that you know much more than you actually do. You may truly believe that you are set apart and different from all of your peers and colleagues, but when the going gets rough, even you might benefit from a little bit of comfort knowing that you aren’t the only one who is experiencing the intensity of birth from a caregiver’s perspective for the first, or nearly the first, time.

Doubts, even fears, may creep in as you see and assist with potentially life-threatening complications. Questions that you cannot ask your preceptor (as unthinkable as that might seem to some – especially at first) may pop into your head. Maybe you will wonder how the other local preceptors handle certain situations, either with clients or with their apprentices.

But, you may say, I really am different and I really don’t think I need the other apprentices’ support. I just don’t fit in, you continue, and I don’t need any support other than the support I find from my closest friends, family, and my own preceptor.

That’s all well and good and might even possibly be true, but cutting oneself off from the only people who are able to currently and personally understand your situation is not the answer. Refusing to listen to those who have so recently been in your shoes is not a wise path to take. Be open to learning from those who are farther along and traveling the same road you are.

If perhaps, someday, you come across this post and any of it seems to fit, please read it in the loving and concerned tone it was meant to be read in and consider seeking out the support of your peers and colleagues in order to help maximize your chances of success. We would all love to see you succeed.

Whether or not you’re the specific apprentice I was thinking of when I began this post, please – seek out your fellow apprentices for support and don’t burn those bridges without a damn good reason.

~B.

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