Homebirth

HOMEBIRTH / Sharman Apt Russell FOR MOST AMERICAN WOMEN, the question of where to have their first chUd is easUy answered. Either they would never dream of having it in a hospital or they would never dream of not. For these women, there is no decision to make, no research, no latenight reversals. Intuitively they have determined the relationship between birth and technology. Most accept pregnancy as a medical "event," belonging to the realm of doctors, pharmacology, and electronic equipment. A few reject that model as undesirable and unsafe. Right or wrong, pro-homebirth or pro-hospital, these women feel secure. They have made their judgment. I envied this security—this intuition—when I became pregnant with my own first child. Traditionally, cultures surround the uncertainty of birth with protective ritual. From the funny sayings on maternity clothes to deciding who to aUow in the deUvery room, we erect a bulwark of standardized, moraUy required routine. Yet for various reasons, at the age of thirty, in the year 1984, I did not possess that sense of what was "routine" or moraUy required. Like other questions related to society and self, the concept of birth seemed to require painful and ludicrous analysis—ludicrous because, for this particular mystery, analysis is Uke using a hammer to peel a banana. In this case, the hammer was statistics. A game of roulette was wheeling in my stomach and I wanted to know the odds, the specific odds of what could go wrong in the day-to-day growth of an embryo into a human being. I wanted to know what could go wrong in utero. I wanted to know what could go wrong in labor. I wanted to know what the doctor could do wrong. I wanted to know what the midwife could do wrong. I wanted to know what I could do wrong. This was a new dimension in negativity. Did I dare to eat a peach? Nosedrops could contract the blood vessels in the placenta; too much Vitamin A might cause cleft palate. Three out of one hundred babies wiU have a major congenital defect. Five in a thousand wiU have abnormaUties of the heart. Another two in a thousand wUl be missing an arm or leg. The Ust goes on. In 78 · The Missouri Review twenty-five percent of births the cord is wrapped casuaUy about the baby's neck. In a much smaUer percentage, it tightens like a hangman's noose. Confronted with the range of potential disaster, it seems any mother would demand having her chUd near, if not in, an intensive care unit. Surprisingly, statistics do not necessarily confirm that the hospital is safer. Ninety-nine percent of babies in the United States are deUvered in a hospital. Yet countries Uke the Netherlands, where forty percent of women give birth at home and midwives actuaUy outnumber physicians, consistently have a lower infant mortality rate. Other studies within the United States—in Marin County and urban Chicago—show homebirth to be as safe, if not safer, than a hospital birth. The obvious question is why, and I spent a fair amount of time during my first pregnancy examining that question in unrelenting detaU. One answer has to do with the screening out of high-risk patients. In most areas only the very healthy are permitted the luxury, or the risk, depending on one's viewpoint, of a non-hospital birth. Another, more compUcated reason, involves modern obstetrics and the indiscriminate breaking of the mother's membranes, the use of synthetic hormones to stimulate contractions, the use of pain-reUeving drugs and fetal monitors, and the sometimes overly hasty resorting to forceps or to Caesarean. When it comes to tracing the history of my decision to have a homebirth, however, most of this information—the length of time that Demerol is stored in an infant's brain, or the high blood pressure caused by a spinal block—is supplemental. It is important, but it is not the heart of the matter. In truth, I would not have had a homebirth if most of my friends had not. More bluntly, I did it because they did. Peer pressure may not seem a...