Knowing we did not wish for a third child, I grieved the loss of the home birth I would never have and was frustrated with myself for not trusting the birth process until after experiencing unmedicated childbirth the second time. After enduring a long, unsupported, and traumatic induction with my first, along with a faulty epidural, I absolutely knew that I would forgo medication with my second. But after a bad hospital experience, I can't tell you why I went back. Cost? Safety? Distance? Sure, those things were discussed (and debunked). I guess in the end, after such a medical outcome with my first, I didn't yet know the truth about birth. At my core though, I knew my body did not want to be back in a hospital. And it made that perfectly clear when my water broke as I peacefully slept in bed next to my daughter, when contractions started soon after, and when everything stopped entirely once I arrived at the hospital-- for more than 12 hours.
In this post I'd like to explore the ceremonious nature of birth and what is lost when this part of it is not honored. I want to challenge the notion that healthy, normal pregnancies belong in the hands of clinically and medically minded professionals and encourage those who are healthy and low-risk to consider home birth (as well as birth centers) as a safe and rewarding choice for their minds, their babies, and their bodies.
Now would be a good time for a disclaimer. As a birth and postpartum doula, and as a mother who probably very well needed that induction and who likely needed that epidural because I lacked proper support, I am not here to judge one's personal decisions on how to birth. I understand home birth is not for everyone. I merely wish to enlighten women to the many truths about home birth that they may not know. I wish to explore the paramount necessity of listening to our bodies, connecting to our babies, and discovering our strength through the lens of history, ceremony, and traditional support. And I wish to convey an important message- Unless we, as mothers, do not start sharing our birth experiences openly as the pillars of wisdom that we are, women will continue birthing in hospitals out of fear and the high percentage of reported birth trauma (currently 45%) will continue on.
"It seems that in our 21st century modern world, many women have become estranged from their primal brain, and the knowledge that lies within it. Women too often hand their power over to the medical world long before labour and have the idea that someone else is going to do it for them," (Maha Al Musa). This mindset is all too common. When my labor didn't start naturally and I walked into that induction, I felt that not only had my body failed me, but that labor and birth would now be handled for me. Being a patient in a place that intimated me with procedures I hadn't educated myself on, I figured my birth was out of my hands. I didn't truly understand that no one could birth my baby except me. I believe those who have chosen the road of home birth have within them a connection to this truth. For some, they are more in touch with their primal brains and perhaps for others, they've sought out a team who has shared this knowing. But for most of us who have chosen clinical births, we aren't offered this well of wisdom that knows our bodies are capable of natural childbirth. Frankly, most doctors will never see a woman birthing in the comfort and safety of her own home so it's no surprise that our prenatal care is devoid of the discussion. #InaMayGaskin, the pioneer and mothership of home birth midwifery, has been trying to change this discussion since 1970 when she and her partner started a birth center in Tennessee called, The Farm. Although Ina May and her community of midwives were untrained, they used the wisdom and skill they had as childbearing women, as well as the essential help from a few wise physicians, and created the most sought-after birth center in the United States. They helped 186 women birth vaginally at The Farm (without instruments or other interventions) before the first cesarean was ever needed and it was another 138 women before the second. Each baby and mother came out of these divine births unharmed. This degree of success is hard to fathom in a nation where the average cesarean rate is around 33% and where we have the highest infant mortality rate of the developed world. Midwives Alliance of North America reports recent statistics from a large study done on 17,000 home births with an average cesarean rate of 5.2%. While each practice has their own statistics, home birth midwives in San Luis Obispo County are reporting similar cesarean percentages. Their rates are extremely low because they, like Ina May Gaskin, would not assist a home birth that posed any danger to the mother or baby. Complications during pregnancy are found early on and for the 7-20% of first time mothers who need to be transferred to a hospital, it is a result of stalled labor or a need for pain medication. True emergent transfers are extremely rare.
Home birth started to take a plunge in the early 20th century when 100% of births occurred at home in 1900 and then steadily dropped to 50% in 1938 down to 1% in 1955. The rise in hospital births was in large part due to the advancements of pain medications and obstetric care which resulted in the abolition of midwifery care in most states. While the safety of home birth remains a much debated topic, out of hospital births have begun to resurface steadily in 21st century America as midwifery care has made a resurgence as a safe alternative to obstetrics. Although national home birth rates are still currently under 2%, between 2004 and 2009, home birth percentages rose 41%. And now, with the impact Covid-19 has had on hospital births, home birth has a new, desirable face. Between increased Covid cases, limits on visitation, vaccine and testing mandates, to even birthing completely alone, women are weighing their options, beliefs and desires when it comes to birthing in a hospital. And for some, the safer, more desirable place is at home. Home birth midwives in San Luis Obispo County have reported their client inquires increasing 3-4x in a week what they would receive monthly. And now with the Delta variant among our communities, the desire for safer and better supported births won't likely subside. This pandemic has strengthened families and brought them closer in so many ways, and while the pandemic has posed many sacrifices and challenges, I'd be surprised if those returning to the tradition of home birth would say that choice is one of them.
My interest in home birth lies in the truest part of childbirth: that the body takes over in a normal labor. This may sound like common knowledge, but to feel it and to see it offers another kind of knowing-- the knowing to let go and trust the process. The fact that a mother's body demands that she surrender is the reason birth is safe. There is nothing more normal and physiological than this course her body takes, because in the end, the body labors for her. And while it is true that complications, at times, arise and while it is life saving in some situations to have obstetric care, the fact is, most bodies are going to expel its baby with this natural force regardless if you are in a hospital or not. When I realized I was on a ride I could not get off of, I understood the incredible value of environment. I understood the incredible value of support. And the incredible value of privacy. The tools that were meant to "help" my labor clashed sharply against my instincts to be left alone and the desire to be back in my warm bed cradled against the back of my daughter was profound. It is no wonder that a birthing person is often compared to the likes of a monkey or something wild as it is a feral event that occurs during childbirth. My primal sounds could have been shouted to the stars, to the knowing cows, to the purple mountains beyond. Instead, they were shouted at the monitors that continued to malfunction.
As I grow as a mother and birth worker, I am continuously reminded that childbirth is safe. I wish to help women believe this the first time around and a part of sharing that wisdom is embedded in the exploration of home birth. If home birth is safe, that means birth is safe. And what a profound realization for a first time mother! If we can trust in the process of childbirth, that means we can do it our way. And once we agree to that, we accept and insist that a birthing person not only has autonomy, but that her birth matters. BIRTH MATTERS. There is nothing more intimate and significant than birth. We will always remember the birth of our babies, particularly how we were treated and how we felt about the outcome. When doctors and nurses undermine our abilities to birth naturally and when their treatment of our experience is, at times, physically and emotionally abusive,* we enter motherhood under the notion that we weren't strong enough. Having disbelief in our capabilities is a profoundly heartbreaking introduction to motherhood when insecurity already plagues the new roles of mothers. We need to spend the majority of our pregnancies reflecting deeply on the transformation happening to our bodies and our identities. We must stop relying entirely on new information, technologies, and interventions, and connect to the wisdom of the lineage that came before us. We must speak to women about our experiences, our traumas and our success stories and seek out these stories. I spent a long time feeling bitter- not at the interventions I endured with my first born- but, surprisingly, at the natural childbirth movement I felt had let me down. Nowhere in Ina May's Guide to Childbirth was my experience of birth. There wasn't any wisdom for the bad epidural, the poor bedside manner, the violent emergence of my daughter or why she ended up in a NICU her first week of life. I figured my story was real birth and what I had read were fairy tales. But when the answers to her birth continued to surface over time, I realized two important truths: I had never actually prepared my mind for natural childbirth and once in the hospital, I had decided I was a sick patient like the one they treated me to be. It was this realization that, at the very least, helped me achieve an unmedicated hospital birth with my second because I entered that hospital as a mother, not as a patient. We need to stop laboring as patients and start laboring as mothers. The first time around.
For this to happen, we need to refocus our intentions and realize that family, home, love and companionship are at the core of becoming a mother because soon, nothing will matter more than these values. Our introduction into motherhood need not be tests, blood work, pain medications and monitors. All too often these things lead to cascading side effects, surgeries, NICU visits, and nursing problems. Transitioning to motherhood is hard enough. Imagine your rebirth starting and ending with merely the birth of your baby. That's it. It can be so uncomplicated. The journey from there could then focus on rest, nutrition and healing. There is a wonderful sense of euphoria when we are able to ease into parenthood following a simple birth. When we accomplish childbirth without the added stress of interventions, and when we do this in a place of comfort and support, we realize something profound-- birth is normal. This is the truth behind childbirth. We can birth our babies ourselves and we are as strong as the lineage that came before us. Birth does not have to be a fearful event. It can happen where it all began- with your partner, in your home. We can give birth the ceremony that it deserves-- a sacred, intimate celebration that is honored and respected.
To the mothers of San Luis Obispo County and beyond- if home birth is something you're eager to know more about, please look into the the wonderful and skilled licensed midwives in your community. A healthy pregnancy does not need a clinical outcome. Please read on to learn more about the midwifery model of home birth care.
*A 2014 survey of over 2,000 doulas, childbirth educators, and labor and delivery nurses in the US and Canada found that almost 90 percent had witnessed a care provider engage in procedures “without giving a woman a choice or time to consider,” and nearly 60 percent had observed providers perform procedures “explicitly against the wishes of the woman.” (Passage taken from Birth Monopoly) #birthmonopoly

The Midwife Model of Care
(referenced from Midwives Alliance North America)
•Monitoring the physical, psychological and social well-being of the mother/birthing parent throughout the childbearing cycle
•Providing the mother/birthing parent with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
•Minimizing technological interventions and
•Identifying and referring women/birthing people who require obstetrical attention.

(Parts of the following were sourced from BayAreaHomeBirth.org)
Who Can Have a Home Birth?
Women in good health with a low risk pregnancy. This means no evidence of chronic disease like heart disease or hypertension or pregnancy complications like preeclampsyia, placenta previa or gestational diabetes. Also women with preterm labor before 36 weeks and those with twins or breeched babies are advised against planned home birth.

The Benefits of Home Birth
-Fewer maternal infections
-Decreased risk of third-degree or fourth-degree vaginal or perineal tears
-Ability to be surrounded by any number of support people
-Freedom to do anything you want including movement, dance, ceremonies, showers, bath, eating, drinking, and laboring/pushing in a variety of positions
-Absolute control of birth decisions
-Lower cost or the same as a standard out of pocket expense for hospital birth
-Increased bonding with baby including a twice as likely outcome of breastfeeding compared to hospital births and more time to bond as a family without the interruption of newborn routines
-More privacy
-Option to have a water birth
-Higher success rates of VBAC (Vaginal Birth after Cesarean)
-Your team believes in your capabilities to birth your baby naturally
-Very little chance of obstetric bullying or violence
-Continuous companionship. Aside from your support team, your midwife will be with you much more during labor than an obstetrician or nurse midwife at a hospital.
-Availability. You need not wait for your next prenatal appointment to voice your questions and concerns. Your midwife is likely always available through text and email.

Is Home Birth Safe?
In a normal pregnancy and labor, home birth is absolutely safe. Midwives in California are legally licensed to carry equipment and medications to safely manage normal deliveries at home. Some of this equipment includes:
-Resuscitation equipment for mother and baby with oxygen
-Antihemorrhagic drugs to stop excessive bleeding
-Monitoring equipment for mother and baby such as a doppler, stethoscope, blood pressure cuff and stethoscope
-Supplies for newborn exam and procedures such as a scale, measuring tape, erythromycin ointment and vitamin K
-Suturing equipment should the mother tear and lidocaine to numb suturing
For more information, read this article by Midwives Alliance of North America on the safety of home birth including the overwhelming positive health benefits for low risk mothers.

How Much Does it Cost?
Home birth fees are usually around $4,000-$6,000 and usually include prenatal care, birth work and postpartum care. In fact, home birth midwives typically visit their patients multiple times following birth as opposed to the one scheduled appointment with your provider at six weeks postpartum. Also keep in mind that most hospital births average $30,000 with a typical out of pocket expense around $3,000-$5,000 and can exceed upwards of $10,000.

Is Home Birth Covered by Insurance?
Most PPO insurance companies will accept a Superbill provided by your midwife at the out-of-network rate. However, each midwifery practice has different approaches to insurance billing so be sure to inquire with her as well as your insurance company ahead of time.

Is it Worth the Money?
I love this comparison of childbirth to getting married- The average cost of a wedding is $24,000. Like a wedding, birth is a very important and emotional day. It has become very clear that birth creates a lasting impression on women greater than their wedding day. Women remember their births with deep feelings for their entire lives, and most clearly remember how their care providers treated them. Knowing this, it is clear that home birth is worth even the full amount of an out of pocket home birth expense.

What About the Mess?
Your midwife will likely advise you to order a "birth kit" online which includes all disposable supplies for your birth. She will also likely advise you how to best prepare your home for labor. While you and your family are bonding after the birth of baby, your midwife and team will quietly clean up for you.

San Luis Obispo County has become a flourishing birth community with all the valuable resources you need to have your desired home birth. While this list deserves every potential pregnancy, labor and postpartum resource our county provides, please take note of these wonderful licensed midwives and stay tuned for a more in depth resource list as well as my next blog post, "Why San Luis Obispo is a Great Place to Have a Baby."

Licensed Home Birth Midwives and Birth Centers:

Pure Birth, Justine Waldram
Kindship Midwifery, Alia Clark 
Intimate Journey Birth Center, Erin Ashley (enrolled MediCal provider)
Nature's Way Midwifery, Tanya Walker
Santa Lucia Birth Center, Tiffany Dietrich and Mishell Whitaker
Pacific Midwifery, Megan Bochum
Cyprus Midwifery, Natalie McCluskey
​Manzanita Midwifery, Jennier Oquendo
Alexis Starting, LM CPM

Hello! In this post I wanted to address that common question these days-- What is a doula? And why do I need one? I want to answer this for those birthing in one type of birth setting: The hospital. Pam England, author of Birthing from Within, explains what she believes women ought to know before going into labor in a hospital and this description, to me, outlines exactly why a woman should consider working with a doula. She writes, "Contemporary women who are birthing in a hospital need two kinds of knowing. The first, and most basic, is primordial knowing, that innate capability which modern women have but must rediscover (and trust). The second kind is modern knowing: being savvy about the medical and hospital culture and how to give birth within it. Birthing from within requires both these kinds of knowing."Studies have shown that 45% of new mothers have reported experiencing birth trauma. I think a big reason women have unsatisfied births is both that they have not connected with their pregnancy and that 'primordial knowing' that their bodies understand how to birth and also their lack of 'modern knowing' of how hospital births often times go. For the many couples who do end up taking a Lamaze, Hypnobirthing, or Birthing from Within class and even a childbirth education class provided by their hospital, still, I feel, may lack the knowledge and innate understanding of what their birth experience may entail if they go into it with the support of their partner only. I love the metaphor that says, "Would you willingly hike the top of Mount Kilimanjaro with just your partner and not a guide?" This really is, in so many ways, the same thing. I always tell my clients, "The hospital has their birth team. You should have one too." And while I think a tribe of women present at your birth (mom, sister, aunt, grandma, best friend) can be wonderful, that team may lack the skills of modern knowing on top of primordial knowing. "Well, aren't the nurses and my midwife (or OB) my birth team?" You may ask. Yes and no. They're busy! They typically have multiple patients at the same time and while they care a great deal about your health and safety, more often than not, the decisions that they make in regards to your care come from what is in the hospital's best interest. This is a topic I could elaborate on but I want to keep this post specific to doula support.

The term doula is a historic Greek word meaning "a woman who serves." While some mothers will chose to traverse ahead with solely their partner, the many that choose to also include a doula have with them a piece of wisdom, knowledge, and history. If you hire a doula early on in your pregnancy, the primordial knowing that England refers to is the starting point. This wisdom that both you and your doula possess should be discussed at length during your prenatal visits so that you feel emotionally and mentally prepared to trust your body and your instincts. It is so important to go into labor with the understanding that birth is normal and that all of your fears and anxieties have been discussed. These visits also help prepare the partner to also trust you and trust in the process. While labor classes and breath work will prepare you for the rigorous workout of birth, they may not prepare you for the time to let go and let your body take over. This is the only way birth not only happens naturally but is the gateway to a satisfying experience. During labor you will try to overthink the experience, doubt your capabilities, and try to escape from it entirely. Losing yourself in 'labor land,' however, is what gets you to the end and is most successfully achieved when you have the right support team.

The 'modern knowing' that Simkin refers to in hospital birth is the tool box. If you participate in a childbirth education class offered by your hospital, many of the routines and potential interventions used will be discussed. Induction, vacuum extraction, and hep-lock are a few of the many clinical terms used to prepare a patient for the protocols and potential outcomes of their birth. But there is a multitude of things to consider when birthing in a hospital such as pain management, medication side effects, Covid-19 protocols, newborn routines, cesarean rate, how to have an unmedicated birth, etc. Because birth is so unpredictable and different for everyone, the list is so extensive, it would be impossible for a first time mother to educate herself on them all. And why should she?! Pregnancy should be a time of connection, postpartum preparation and meditation on having a satisfying birth. But so often, when a new mom has her baby in a hospital, with the sole support of her partner, there are things that happen that she may not understand or may resent later. When a doula is not present, the other unfortunate outcome may be violation of the birthing person's human rights. There is a common term used by hospitals called implied consent. This means that the hospital may assume a specific procedure or decision for care has your consent since you signed a piece of paper upon admittance stating that you give the hospital your consent to care for you the way they see fit. While this may not sound terribly wrong or threatening, it has problems for two main reasons. One-- you are not a sick person. You are a mother doing something incredibly natural and (more often than not) safe. Unless under general anesthesia, you are capable of understanding and consenting verbally to any procedure involved in giving birth. The other problem is this-- Giving birth is the absolute most intimate thing you will ever do. While it's unfortunate that most of us will not birth in a dark and quiet den of our choice (as most animals and mammals do), it is even more unfortunate that the act of giving birth often lacks respect, privacy and at the very least, proper bedside manner. This is where the value of a doula continues. Your interests are incredibly important to your doula. She is the one person who not only likely knows every possible hospital intervention and protocol, but cares deeply about how those things affect your birth experience. If there is a term, tool, touch, or technique that you don't understand, your doula will hold your hand, explain it to you, and ensure that you feel safe, respected, and in control of your birth. Advocacy and the discussion of informed consent are terms discussed and explored prenatally and an incredibly important aspect of doula support.

And now, to finish this post off, I'll address the fun little details of doula support and how these tips and tricks can turn a hospital room into a cozy, home-like den. My personal approach to labor support stems from my own experiences giving birth-- both what I lacked the first time and what I cherished the next. I've found that to attempt a natural, unmedicated childbirth relies on a safe and calm environment. Renown midwife, Ina May Gaskin, calls this the "Sphincter Law," which essentially states that the sphincter will not relax and open unless it feels safe. Imagine someone walking in on you in the bathroom during that, ahem...very private time. You'd close up immediately and wait until you had your privacy back. Well, it is my theory that this is why so many hospital births are prolonged, induced, and full of interventions to get things moving. So, the hope is that if we can transform the environment, birth will continue naturally. As your doula, and with your permission of course, I will alter the room in the following ways: Lower the blinds, turn off the lights, put a sheet over the monitor, set up the LED candles, turn on the twinkly lights and essential oil diffuser, and either offer you ear plugs, a sound machine or music. You will also take comfort in the small but necessary details of doula support such as water, chapstick, hair ties, a cold washcloth, a comforting touch, and giving your partner a break. I find it important to "find your den" before labor becomes difficult. As labor progresses and you feel the need for physical support, I will revert to either water therapy like a tub or shower, use the Rebozo to relieve weight from your belly and hips, offer you a birth ball, or exercise a few of your preferred labor positions. I, along with your partner, will use massage, pressure and verbal affirmations to help you through transition (the final stage of laboring before the pushing stage). I will make every effort to limit interruptions, lower voices, and maintain a comfortable environment. During the pushing stage, your partner and I will ensure you are in an optimal position to bear down and welcome your baby into your arms.

Support, of course, does not end there. A doula's contribution continues well into newborn care, lactation, mental health, physical healing, home visits, nutrition, gifts, doting, the list goes on and on ;) I hope this has given you a little insight into the importance of doula support for a hospital birth! Stay tuned for my next post, "Why hire a Doula for Home Birth?"

Have a great week!