Home birth vs. hospital birth: The debate rages on

I had planned for a natural birth when I was pregnant with my first child. "Crunchy granola," my friends called it. My parents were alarmed (they pictured me laboring outdoors under a tree wearing beads and doused with patchouli, I think) but I was certain that my body already "knew" how to give birth-that's what it was designed to do, right?-and that all would be fine.

Still, I'm a pragmatic, don't-believe-everything-you-hear journalist who's always looking for the other side of the story, and so is my husband. And so we picked a birthing center that partnered with a well-equipped hospital right across the street. Just in case.

I practiced my breathing and attended the prenatal classes and wrote out my birthing plan and got ready for what I was sure would be a wonderful, albeit painful, life-affirming experience. I brushed off the uneasy feeling I got when the prenatal instructor chirped, "That rarely happens!" after I asked her about danger signs and complications. I'd soak in a tub and listen to inspirational music and labor in whatever position felt best, without restrictive monitors and invasive tests. I reserved the right to ask for pain medication if I wanted it, was sure that I wouldn't want it, and would refuse pitocin, no matter what. I worked right up until my due date, not realizing that the days of increasing crabbiness and discomfort meant that I was in the early stages of labor. And everything was fine... until, all of a sudden, it wasn't.

My story isn't uncommon; women the world over experience complications in pregnancy and labor. What makes each story different is in the details, and in the decision women in the U.S. make between going to the hospital to deliver in the presence of doctors, going to a birthing center to have the birth attended by midwives, or giving birth at home, with a midwife or without.

In her groundbreaking 2008 documentary "The Business of Being Born," Ricki Lake explores the political, personal, and medical history of childbirth and asks, "Should most births be viewed as a natural life process, or should every delivery be treated as a potentially catastrophic medical emergency?" The movie changed the way many people view hospital births, and launched a renewed interest in home birthing.

Dr. Amy Tuteur, an obstetrician-gynecologist and former instructor at Harvard Medical School who writes at The Skeptical OB, contends that women don't really understand the risks of home birth, and says that "home birth advocates aren't about to tell them." What's worse, Tuteur writes at her new blog, Hurt by Homebirth, "when a bereaved mother attempts to share her baby's story with other home birth advocates, the baby is figuratively erased out of existence. Home birth websites delete home birth tragedies. They don't want women to know the truth."

As always, the truth may really be somewhere in the middle. Horrible birth experiences can happen anywhere-it has less to do with the location than it does with the skills of the doctors or midwives and their willingness to admit when there's a problem. "We bring up our daughter's breathing and are told it's just mucus," one mother writes at Hurt by Homebirth, describing the newborn evaluation given by her midwife. "The odd bluish purple coloring around her nose is just bruising. Her sleepiness was due to the long (18 hour) labor. Her floppiness was due to just being a tad early." While the misdiagnosis is tragic, it's not really about home birthing, it is about blatant incompetence, deception, and misplaced trust.

For every story about "birth rape" in hospitals you're likely to find one that chalks up a baby's survival to timely medical intervention-and many more that had perfectly wonderful experiences in either location, in spite of complications.

I think everyone can agree that the ultimate goal is to end up with a healthy baby and a Mama who is well enough to take care of him or her. What makes the home birth vs. hospital birth debate so complicated is that we want birth to be an experience. As with marriage, when considering our birthing options we're often focused on the event and what we'll remember about it, instead of the end result.

In my case, after more than 30 hours of active labor I was still barely dilated, my blood pressure had skyrocketed, and the baby's heart rate had plummeted. My midwife sent us across the street, to the hospital. Yes, I was upset-I felt like I had failed at something I was "supposed" to be able to do easily. Yes, I ended up with the monitors and the IVs and the meds that I really, really didn't want to take. But hours later my daughter was born, tiny and loud and perfect, via an emergency C-section. And, even though it was nothing like I'd hoped, and too much like I feared, I consider myself very lucky.

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