I am a birth photographer. So after watching various births I felt I knew which type I wanted. A home birth. With my own midwife.

No blinking hospital lights for me, the clatter of people passing outside the room or a succession of staff coming and going. Instead of lying flat out on a strange bed, I wanted to walk and crouch and yell and scream and for it to all be okay; with my husband, Pete, a home birth midwife and support people around me.  My own furniture, cushions, towels and food around me in a happy mess.

I especially wanted the little bundle of baby to enter a world of quiet and peace. So when I became pregnant, I put together a birth plan for home, hired a comfortable padded tub for a water birth and prepared for the wonder of home birthing. The Plan had a little clause regarding hospital procedures I wanted followed IF I had to go to hospital — which I never thought I would. Without thought I included an independent midwife to accompany me because that is what ‘you have when you have a home birth.’ I never realized the importance of this last bit.

Australia is one of the safest places in the world in which to be born, according to a Medical Journal of Australia 2004 article. But the authors, Professor De Costa and Dr Robson, say that “while Australian women are now 40 times less likely to die during pregnancy or childbirth than they were immediately before the Second World War, the ‘medicalisation’ of birth has tended to diminish women’s satisfaction with their experience of childbirth.”

With surveys of Australian women finding that their main sources of dissatisfaction with birth are ‘lack of involvement in decision-making, having obstetric interventions, and unhelpful caregivers…’ many women, their families, midwives and some doctors are understandably seeking a more natural environment for uncomplicated births. Increasingly, emphasis has been placed on the quality of a woman’s birth experience. It has been shown that women are most satisfied by care from a single practitioner, and when they themselves have input into decision-making.

It used to be that only the most ‘disadvantaged’ had to make childbirth a hospital event. Now one in four births in Australia are caesarean section, an unprecedented intervention rate at a time when our population has never been so healthy. As a reaction to such ‘medicalisation’ of a natural phenomena, increasingly women and their families are looking to ‘naturalize’ and ‘humanize’ the birth process.

This does not mean that there is no place for hospitals. Medical intervention has saved many lives of both women and babies. Including my own. For after two days of labouring at home my cervix had not opened. My midwife sat with me on our couch, looked me straight in the eye and suggested my ‘back up’ birth plan — the hospital. Nine hours of excruciating oxytocin later the cervix had still only dilated 2 cm. My independent midwife, the only person who heard me say that ‘I felt like my insides were about to explode,’ dragged in a doctor to check me.

The hospital doctor immediately recommended an emergency caesarean. It had been three days since my waters broke and there seemed no point in trying further for a vaginal birth. The doctors, used to quick compliance, were shocked therefore, when I asked everyone to leave the room and let Peter and I alone to discuss it. What was there to think about?  Why was I hesitating?

I hesitated because I had to let go of my dream to birth naturally or at least vaginally. Strangers were going to take over the most profound experience of my life and I needed to regroup, to spend a moment coming to terms with the shifts that had occurred in the past three days, before handing myself over to machines and strangers.

This was what I had wanted to avoid but this is where my ‘hospital clause’ came into it’s own. In preparation for my home birth, I did a huge amount of research and found information and statistics for and against both home birth and hospital birth. I had been heartened by the usually conservative World Health Organisation publishing a report, which concluded, "Home is the most appropriate birth setting for most childbearing women…”

In preparing for home birth there is a lot of support and information available. We went to home birth preparation seminars and classes; I read all I could about home birthing and tried to ignore the constant murmuring and gasping of well-meaning people whose responses to my home birthing plans ranged from disapproving silence to dire warnings.
The medical profession generally is not happy about a woman wanting one of their ‘medical procedures’ in her own home and I met several GP’s who warned me that I may haemorrhage to death, that it’s not safe to have a first baby at home and that I was being `selfish'.
Asking why I was being selfish in not taking up scant hospital resources and using tax payers’ funds by paying for my baby’s birth at home, I was told that my ‘private’ midwife could be simultaneously seeing several births all at once in a hospital. We subsequently found a warm, caring GP, Peter Lucas, who works with a couple of independent midwives, Jan Ireland and Jennie Teskey.
There are not many independent midwives around and according to Jennie Teskey an independent midwife for the past seventeen years, it’s partly due to the demanding work involved as you are on call 24 hours a day, seven days a week. There is however another factor. Three years ago indemnity insurance was withdrawn for all independent midwives in Australia fuelling a crisis in that field. “It was not due to any event or midwife being sued,” Jennie explained, “yet there was suddenly no way to insure yourself in this country.”

Jennie now works without insurance, relying on ‘evidence-based’ care and taking on only families with whom she feels she can trust to share responsibility. She finds that most people who want a home birth take responsibility for their own lives and what happens to them and will not sue others for what is their own responsibility. Suing often occurs when people are not given information, are told what to do and feel upset that they lacked choice.

I felt deeply concerned hearing this. It reveals the deep crisis that this field is in. Without independent midwives, as well as the power of choice being taken away from women, home birth is in jeopardy as only independent midwives can attend women in their own homes.

Leslie Arnott, a state president of the Maternity Coalition, a national birth advocacy and resource organisation, agrees that having your own midwife creates a better caring environment. She is a goldmine of figures and statistics including the compelling change in our neighbouring country’s model of care. When New Zealand home births became publicly funded it saved the country millions of dollars and helped put the health minister, into the current Prime Minister’s position.

“The reason for the drop in health spending across the Tasman,” Leslie explained, “is that it costs around $4,000 for each woman to have a hospital birth while a home birth only costs $3,000.” The New Zealand system also allows some midwives to work part-time with only four cases a month, easing the 24/7 problem that confronts people like Jennie.

Much research points out the lower levels of intervention, foetal distress, monitoring, ruptures, episiotomies and post birth infections at home births. Artificial pain relief and drugs are also used less at home as most women choose water, massage and emotional support to deal with the pain.

Having a home birth does not mean there is no benefit from modern medicine however and my midwife arrived at 3am on the night my waters broke, with oxygen, intravenous equipment and other reassuring gadgets. I was immensely glad to see her. More then I would have believed. Many mothers had pointed out to me the importance of ‘continuity of care.’ This surprised me. Why do I need the same people throughout my pregnancy and at the birth I wondered. I will be focussed on the growing baby and birth not on whoever is there. Anyway my husband will be there with me.

I had not accounted for the emotional changes that hit me during pregnancy and the altered states of consciousness during birth. Unable to explain what I wanted, it required people to be present who knew me and with whom I had developed a relationship. I had also not realized that husbands go through their own upheavals and are in a sea of emotional and mental confusion in a hospital when the woman they love is in pain and the mysterious child is about to appear. When I checked this point with Peter during the writing of this story, asking him if he was confused with the birth procedure, he took a deep breath and said, “I was confused from the moment you told me you were pregnant.”  Pause.  “I am still confused.”

My independent midwife travelled with me to the hospital. She slept on the floor of my hospital room along with my ‘support’ people and husband, a loving mass of bodies near me, a sea of love in that swirl of hospital chaos, as we waited for a labour room to vacate. Jan Ireland was with me during the next nine hours of induction and, helped by visits from Peter Lucas, constantly supporting, encouraging and advocating. It was eminently reassuring and helpful having professionals who were known by the hospital and knew how to ‘work’ the system to my advantage. It also helped to have someone there who had been with me through the entire pregnancy as an antidote to the stream of strange faces briskly appearing in and out of the room.

I didn’t get the home birth I had planned but it went as well as it could, due to the continuity of care from Jan and Peter who gave me the information I needed and allowed me to choose. Even at the point of being told I had to have a caesarean by the hospital doctors, I could consult Jan and Peter who told me that I didn’t actually have to, that we could wait until morning and have another shot at the induction, something I would never have known from the well meaning hospital staff. I chose the c-section and the apprehension of major surgery was softened by the power of choice.

The wonderful support I was having hit home to me as the hospital staff wheeled me (alone for the first and only time during the whole birth) to the door of the operating theatre. Stopping just outside the theatre door so I could glimpse glaring lights, strange impressive equipment and costumed strangers doing strange things inside, one of the trolley pushers turned to me lying on the trolley.

He proceeded to list all the things that could go wrong during the caesarean including hysterectomy, disability and death, then went on to the spinal anaesthetic which included lifelong pain, paralysis, disability and of course, death.

It would have been great to have had my midwife whispering in my ear at that point that it was only routine and the hospital had to do this to cover themselves. Instead alone, vulnerable, apprehensive and naked under a shift, I nodded stupidly. Even had I wanted to, I am unsure I could have gotten my head together enough to say…NO! Stop proceedings, I want to get off the train.
However expert the medical staff are, in the physical procedures there lacks a holistic approach in hospital, which takes in the mental, emotional and spiritual, dimensions of the pregnancy and birth process. It was Jan who covered the clock in the hospital room so I wouldn’t be distraught by how long things were taking. Jan who made sure I was not offered drugs for pain relief during the induction, knowing I was dealing with it through other means. She had also shocked the entire hospital floor by wheeling the monitoring unit out of the birthing room, down the corridor and into the bathroom so I would not have to get out from under the blissful shower.

When the time came for the emergency caesarean Jan met me in the operating theatre and held my hand.  When the pink, blue-eyed creature was finally plucked out and held aloft, it was that familiar voice in my ear who encouraged me to look at my son for the first time. Jan it was who organised for me to breastfeed in the recovery room and who later put a sign on the baby’s crib in my ward to stop nurses coming in and taking the baby away without asking me first.   A hospital midwife would not have been able to care for me in these ways.

Trent is 18 months old now and a constant source of delight and wonder. I touch my caesarean scar and dream of my next child being born naturally...at home surrounded by loved ones. I was glad that medicine could help me, but I still prefer home birth and this time I hope I can try out that gorgeous birthing tub in my loungeroom.

And one of the first things I will do when I am pregnant again, is tell my independent midwife; my friend, and my birthing confidante.

 

Phoenix Arrien is a professional photographer, writer and trainer published in over 200 articles, who lives in Melbourne with her husband and children. She has qualifications in photography, writing, training, counselling, family education, massage and complementary therapies, but the greatest training has been the double PHD of motherhood.
Contact details PArrien@hotmail.com