Monday, December 24, 2007

The Politics of Birth

It's such an interesting experience to be planning a home birth for our baby and to be working in a job that is directly linked to Obstetrics and a population that typically chooses a type of birth that is generally in direct opposition to that. Every time an associate (not in my direct work group, but outside educators, etc) asks where we are going to have the baby, I make a funny little smile with my eyebrows up, nod my head a few times and say "a home birth" in a tone that says "can you believe it"? They usually grimace involuntarily (I work with a lot of nurses) and say, "REALLY? WHY!?!". I had a very sweet L&D nurse literally beg me to have us do it in the hospital, promising that it would be just like home and she'd take care of everything.

I really think birth is one of the most polarized topics in America. When I try to explain to our friends who aren't familiar with this issue why we've had so much trouble with reactions (from our former Ob staff who stalled getting our charts to the midwives, from colleagues, etc) I explain that it's almost like the tension between Anti-Choice and Pro-Choice camps. It's a lot less visible but when you scratch the surface it feels like that kind of intensity.

The other funny part is that most of the nurse-midwives I know would choose a homebirth for themselves but L&D nurses and Obs are generally horrified. I think this goes to the fundamental difference in Obstetrics versus Midwifery (and L&D nurses are trained in the Obstetric model). Midwifery assumes that birth is a normal proces and all things will proceed normally unless shown otherwise. In contrast, Obstetrics (a specialty really for high risk births) assumes that something can go wrong at any minute and probably will. Obstetrics is a critical field and god knows I'd want an obstetrician (and we'll have one in reserve at the hospital) in case there are any complications. However, I just don't think normal births need to be monitored and attended by Obs.

When people ask me how I could take the chance that something could go wrong I just want to whip out all the statistics on the mortality and morbidity statistics on home v hospital births. The mortality rates are the same but the morbidity rates (injuries and complications) are significantly higher for hospital births. I'm WAY more afraid of birth in a hospital given all the unnecessary interventions that lead to more interventions that lead to complications.

Enough of that. Off to my job that I really love despite the apparent philosophical conflicts!