This weekend Jessica and I had the privilege of attending the Blissdom conference. We got to hear amazing speakers and meet some awesome bloggers. The best workshop was given by Jeff Goins. He was challenging and inspirational. However, his final challenge left me with a cotton mouth: write what you are most afraid to write about….. and then publish it. Gulp. Here goes, Jeff.
The first time I was ever involved in a home birth gone bad was two weeks into my OB/GYN rotation as a medical student.
A screaming woman came in by ambulance. Her stretcher sheet appeared to be painted brown from her waist down. The trail of red behind the front tire and the salty smell of fresh blood revealed the source of the sheet stain. The team frantically evaluated the patient and attempted to stabilize her. She had been laboring at home for 3 days and had begun to hemorrhage. An emergency cesarean section was ordered.
The women began to cry.
”I don’t want a c-section,” she was in hysterics between the pain and blood.
The jaded resident just glared at her and responded rather harshly, “Shut up, I’m trying to save your life.”
A scurry of activity ensued. Minutes later the baby was born. As a newbie med student, I was stunned as I watched the chaos of the delivery suite.
The baby did not come out screaming and pink, like all the others I had seen. The nurses used two fingers to rhythmically push down on the limp infant’s chest in an attempt to circulate its blood. After several tense minutes, a heart beat was detected. We had hope. The mom received several units of blood and spent a week in the ICU. Sadly, the baby passed away a few days later.
My young mind could not comprehend the tragedy.
That experience has left me biased.
When I became a OB/GYN resident myself, I treated high risk obstetrical patients. Everyday I saw how quickly a normal labor could develop into a life threatening emergency.
Over the years of training, I saw many other home birth hospital transfers. Luckily, none with such a severe outcome – but with each encounter I had to fight my emotions. I always remained professional toward the patient, but internally my anger and frustration were often not proportional to the situation.
Why did these women value the birth experience itself over the health of the baby? I would often think.
Why did their choice make me so angry? Was it the memory of tragedy? Was it resentment for having to help someone who had initially ignored medical advice? Was it the fact that their decision also affected the life of their child?
The longer I was in private practice, the more I began to understand the home birth proponents’ point of view. In the real world, emergencies are rare and most deliveries are uncomplicated. Our national cesarean delivery rate is soaring to unacceptable levels. I read reports of doctors doing unnecessary CDs, not caring that by scaring a woman’s uterus, they are at that moment limiting the number of children she can bare.
I’m saddened by my fellow doctors who make decisions out of fear of lawsuits, rather than choosing what is in the best interest of their patients.
The longer I practice the more I have become an advocate for those women who desire natural childbirth and VBAC. I try to avoid interventions and work with women to reduce their risk of cesarean section.
Why does home birth still bother me? After much soul searching, I believe it’s because I take it too personally.
I sacrificed years of my life in training to be a doctor. The sleepless nights, 100 hour work weeks and hours of study. I saw horrific tragedies that my heart could barely process.
I missed kissing my own kids goodnight too many times.
I did not do it for money.
My passion is for helping women have the healthiest most peaceful pregnancy they can. I want to lay vigorous pink babies on their mom’s chest and watch beautiful tears of joy roll down the fathers face. I want to save lives. I don’t want another mother to ever have to bury her baby on my watch.
I feel like an engineer who worked for years to build a state of the art bridge across a river, only to discover that people were crossing the river on a rope swing because they don’t trust the engineers. Most of them make it across just fine, but every once in while someone will needlessly slip into the water.
I’ve read the studies. I know statistically that the risks of home birth are low. But they are still there. I understand the reasons that women feel that home birth is the best option for them. But the idea still makes me cringe.
When thinking about pregnancy and childbirth, what words or ideas make you cringe? C-section? Epidural? Pitocin? Vagina?
Hi Dr. Rupe! As a local Nashville doula, I REALLY appreciate hearing about OBs that TRULY believe in and support natural birth and VBACs. Also in my line of work I have met many, many women who felt they were wronged by their care providers…often receiving an unnecessary c-section and 5:30pm, or right before a major holiday, conveniently. Or being told they are VBAC supportive, but at around 36/37 weeks they perform an ultrasound and determine the baby is “too big” so a c-section is called and they aren’t even given the chance to labor (for example, my sister was told her baby would be 10lbs at 40 weeks so she was induced…she ended up with a c/s and had a 7.5 lb baby). When there seem to be so many providers out there that are practicing this type of medicine due I think mostly to legal and malpractice insurance restraints or fear, these women often feel like their only choice for a truly natural birth with no interventions is to do a home birth. For these women, yes, I think it is extremely important to choose a very experienced CNM with an OB backup. Trained and professional home birth midwives should be able to know when a transfer is necessary and not hesitate to make that call. But what about the fact that places like The Farm in Summertown have a less than 2% c-section rate? Yes they only take low-risk moms, but they also take VBAC clients. It seems that a low risk mom with no prior complications so often ends up with interventions and a c-section in a hospital setting…at home or in a birth center, there are no interventions (like pit and epidural) that can be done so that takes away a huge reason so many births end up in emergencies. I think if there were more OBs like you out there then women would feel much more safe about delivering in a hospital.
Amen. I love the idea of home birth, but in reality? No, thanks. Especially after my first pregnancy ended in a stillbirth at 31 weeks fom unknown causes. I never, ever want to hold the dead body of my child, and home birth just presents too many risks. Why gamble with the life of your precious child? I have no idea why so many women chose this when a normal, healthy labor can go south so FAST. Home birth makes me mad, too. Thanks for writing this. <3
Thank you so much for sharing this, right now I am a year 10 student from Australia and our English assignment is to write a persuasive speech. I wanted to do my topic on home births, and this story has given me a lot of insight to how medical staff “experience” home births. I was just wondering whether or not I could use this story (obviously not all of it) to help support my argument, that home births are not the safest option for both mother and child.
Thanks.
Yes, please feel free to use it!
I’m curious what you think, Dr. Rube, about free-standing birth centers staffed by CNMs? The midwife practice I am currently with is operating out of a hospital, but they are making plans to open a birth center next year, five minutes from the hospital. That will happen after this baby is born, but God willing this will not be my last baby.
I had a really wonderful midwife-attended hospital birth with my daughter, and anticipate a similar experience this time. I would love to stay with them even after they open the birth center, but I don’t want to endanger my children.
Sorry, Dr Rupe. >_< First post on this site and I misspell your name…
I think a birth center 5 min. from a hospital staffed by CNMs seems the perfect answer to those who desire a HB experience.
I find it interesting that the majority of people that are against home births are those who have never experienced it. To have the experience of allowing your body to bring a baby into the world, without medication, in the privacy of your own home is a beautiful experience. There really are healthy women are in the world having uncomplicated pregnancies without the need for medical intervention. I am thankful for hospitals when there is a need for them. And a good midwife knows when it is time to transport. But let’s face it. Doctors see the worst case scenarios, and rarely if ever have the opportunity to see the other side. Home birth mamas are not all “kooks”. Just sayin.
This is a great topic. Thanks for posting. There is often a lot of emotion and passion when talking about home birth. I have never had a home birth myself (but 4 babies), but I have had quite a number of friends who have home birthed (either planned or accidently :). I now see home birth as a very healthy option.
I can see how your extreme experiences have shaped your emotional response to home birth and I am really glad you were able to share this. It really does help to understand where many care providers are coming from.
It is disappointing that while, as you said in the real world most births are uncomplicated, most of what many doctors see are the complicated or traumatic births. Leading to a pervasive belief that birth is like an illness seeing women as ‘patients’ to be ‘fixed’ or ‘saved’ instead of the belief that pregnancy and birth is a healthy and natural part of life that goes way beyond just physical processes but includes the whole person, body, mind and spirit.
In reading your story I can’t help but wonder what experience or information would have driven that mum to be so fearful of cesearean or the hospital in the first place. No mother purposefully choses the most dangerous route to have their baby, but based on the information that they have or are given or are lead to believe, Mum’s make decisions on what is the best for them and their babies. I wonder what she learned and how she feels about that decision now and what would she do differently next time? I wonder how that has affected her and her family over the years, like it has you.
My hope is that mothers and care providers would be able to have open, honest and informative communication so that mothers can make the best choices for their own individual set of circumstances. And by the sounds of it you are the type of care provider who loves to do just that! I wish there were more of you
I think your engineer analogy is interesting and I do see your perspective and thank you for all your years of study and hard work, but I do balk at the rope swing idea. I doubt they are using a rope swing, but more like individual water craft, some are built with good engineering principles, but most don’t want to go where the bridge is heading. They don’t want to be on that road heading that way. Yes they want to get to the other side but in a different way. Some people who are on that amazingly engineered beautiful bridge find that it’s crowded and they are lost in the crowd, they are treated as a group and not an individual, some are pushed around and jostled, some have been pushed off the bridge and are left to deal with consequences to things they never even knew were on that road.
Whose responsibility is it to make birth the safest, most significant, precious and deeply life changing moment of life??
Have a great day and thanks again for opening this up for discussion and giving me the courage to write too.
Mel
Hi Mel, Thank you for sharing your thoughts. I agree that patients need to find a doctor they trust. As Dr. Rupe pointed out (and she should know, she works with and went to school with several) there are a lot of wonderful physicians out there. In response to whose responsibility it is to make birth the safest. . .Obviously there are things a physician knows and understands that I do not so I personally put a lot of that responsibility on them. But as I’ve said before, I believe it’s a partnership. We need to be able to trust our doctors and we need to be able to trust ourselves. . .that we’ve educated ourselves to know what to expect. Thanks again for joining the conversation!
Partnership is the best way!
I think your example of the watercraft fits for a HB performed by a CNM who allows only proper candidates a trial of labor at home.
The rope swing would apply to lay midwives or those who choose unattended births.
Since there is so many fields of steliacpies that I have a choice of, I still really can’t choose one. So I am going base on my personal experiences. My original goal back in high school and maybe even before that, was to work in a Neonatal ICU! I had a brother that passed before he had his first birthday from heart complications, and that year I spent a lot of time at hospitals with my parents. My goal the first couple of years was to work with babies just like him. That was until I had my own children, I would of still loved to have worked in that career field but the heart ache I would most likely endure when one of those babies did not make it home. I could not have handled!On to more positive experiences, I have worked with the elderly and Geriatrics interests me very much. Being surrounded with people that have lived a fulfilled life is so much more rewarding. Even though at times it is the ending stages of their lives, and it is sad when someone does pass. It’s less of a heartache to know that most of the time they are ready to move on. They are still very dependent on you and when you are able to help them with their needs that’s the most rewarding of all, plus you form a special relationship with the patients and their families.
I just stumbled upon your blog as I was googling around for something else. I am 8 weeks pregnant, and just moved away from water birth, which was my original plan. My husband just couldn’t get comfortable with birthing even at a birthing center, and while I was looking forward to some of the benefits of water birth, I came around to fully get where he was at and realized that I had been a bit brainwashed by some well-meaning women. It came down to stepping back, seeing the whole picture and talking to my OB (who I trust completely) and realizing that we care way more about what is best for our little one than anything else.
I appreciate you sharing your thoughts – as it continues to solidify my feelings on the issue. It can be scary how many decisions you have to make as a new mom! And with lots of prayer, this is where we’ve landed for our family.
I really appreciate a doctor’s perspective on this issue. I’ve never comtemplated a home birth myself mainly because it just didn’t seem to be an option, plus I’ve been considered high risk with all 3 births, due to my age (37, 39 and 42).
On another note, something Jessica W. said resonated with me …”I think one of the main reasons women are looking to alternative options is that they cannot find physicians they trust to make the best choices for them”. In my experiences, it sometimes felt like I was having to “debate” or ‘haggle’ with my physicians for the births I wanted…natural, unmedicated vaginal delivery. Even my midwife wasn’t as keen on a completely natural birth as I was. Having said that, I’m so appreciative for the educated, experienced midwife (#1 in the US) and ob/gyn (#s 2 and 3 in the Philippines) I had for each birth. Each birth turned out well. But you can be assured, if something had gone wrong I wanted to be where I and my baby could get help immediately.
The issue that ocncerns me when I talk to friends and acquaintances, or watch A Baby Story 🙂 is that it seems often women are content to go into childbirth practically ignorant of what is going to happen to their bodies. I felt so empowered and prepared by the Bradley method classes I took, and I’m so grateful to have known as much as I could about the birth process. Why do we inform ourselves about soooo many issues in our lives, but leave this one out? It’s puzzling to me and something I hope will change in the future.
Thanks for this blog. I’m always interested in anything to do with childbirth and babies!
Hi Joy. Thanks so much for posting your thoughts. I did want to clarify that I didn’t mean for my comment to sound like it’s so hard to find trusting doctors. I believe most doctors have their patients’ best interest in mind. But you do hear women talk about having doctor’s they don’t trust. I say often if you don’t trust your doctor then find another one quick! But you have to let yourself trust your doctor as well. You are so right…we need to be educated on important health issues (not just birth, but everything and especially for our kids). If we educate ourselves and remain open minded with a doctor we trust, it creates a life-giving partnership. I trust Dr. Rupe completely. And I am an information junkie. So when we discuss my issues I feel very sure that I know what’s going on. If I’m unsure of her recommended course of action we discuss it and find a solution together. The keys are trust and partnership. Our part of the partnership is educating ourselves just like you said. Thanks for sharing this valuable point!
See, I knew I’d hit a nerve when me and my big fat mouth started talking about the mid-wife issue in my state when we chatted at Blissdom. Please disregard my pregnancy-induced verbal diarrhea. I really appreciate your honesty on this post. Experience shapes who we are and your experience with both a terrible transfer situation and thousands of happy births is valuable. And I think your conclusions and your goals ARE admirable. All I really wanted to say the other night was there was so much I didn’t know in the beginning and now that I’ve had all my various birth experiences (and one still to come), I’m grateful for the people who patiently educated me and the doctors who respected me and the lives of my babies. Thanks for bravely posting!! Well said!
I happened to stumble across your blog today and wanted to say thank you for sharing your perspective. I’ve had two hospital births, one with epidural, pitocin, & episiotomy (that’s the word that scares me!) and the other completely natural without meds or other interventions. Both of my boys were healthy at birth, thankfully. I am preparing for birth #3 and have decided to do another hospital birth with a midwife, but have to confess that home birth has been something I’ve seriously considered. What you say in this identifies the tension I think exists for many women:
“I feel like an engineer who worked for years to build a state of the art bridge across a river, only to discover that people were crossing the river on a rope swing because they don’t trust the engineers. Most of them make it across just fine, but every once in while someone will needlessly slip into the water.”
I struggle with trusting (and paying) the “engineers” who don’t always seem to have my and my baby’s best interests at heart but rather expediency and convenience. This was the case with my first OB. Add to that my total lack of knowledge the first time giving birth and I feel very fortunate to have everything end up the way it did!
I applaud your commitment to safe, natural child birth and wish that there were more OB’s like you in our communities. I cried as I read this:
“My passion is for helping women have the healthiest most peaceful pregnancy they can. I want to lay vigorous pink babies on their mom’s chest and watch beautiful tears of joy roll down the fathers face. I want to save lives. I don’t want another mother to ever have to bury her baby on my watch.”
Thank you for all that you do!
Lacy, Thank you so much for sharing your perspective. I think one of the main reasons women are looking to alternative options is that they cannot find physicians they trust to make the best choices for them. I am fortunate to have Dr. Rupe who I trust implicitly but that relationship is rare. I pray often that pregnant women everywhere would find a doctor they can trust as much as I trust her. So good to have you join the conversation. All the best to you with this pregnancy!
Jessica, I disagree. I don’t think I’m any kind of rare breed of a doctor and I do think think that most women do (and should) trust their providers. I think the majority of doctors DO put their patient’s best interests first.
I didn’t mean for that to sound like it’s rare to find a doctor you can trust. Some women just have a hard time with that trust. They also have to let themselves trust their physician. But I’m still very fortunate to have you!
Lacy, Thank you! Congrats on your upcoming new addition.
In my training, I worked with some awesome group of hospital based midwives who taught me a lot about labor and natural childbirth. I was in awe of the patience and care that these ladies provided their moms.
I am a home birther, but I’ve had hospital births as well. All were definitely the right decisions for me. I am glad you make a point to say that emergencies are rare. There’s a certain perspective for medical professionals to think home birth is so dangerous because they don’t see all the successes- they are there for the emergencies or the traumas, so of course they probably are only exposed to the negative parts of it. No matter what, these days it’s hard to be open about what you truly feel because someone might choose to take it personally. I’m glad you were able to share!
Steph
Yes, I would think it’s difficult for a doctor to be supportive of home births considering the side of it (births-turned-emergencies) that they would see. I–too–loved that Dr. Rupe made it a point to say that the emergencies are rare. That lends some balance to the post.
I’m glad you wrote this post to get the conversation going Dr. Rupe.
Personally, I wish every woman would give natural birth a try. I understand it doesn’t always end up that way (I had an EMCS with my first child and a VBAC with my second), and I have absolutely nothing against “interventions” when they are necessary. The main thing is that I support women’s right to make their own decisions (as do you, Dr. Rupe). I suppose I just wish more women took the time to be a little more informed about the process of birth and what our bodies are made for. I’m glad there are doctors out there like you who are willing to help and who are proactively seeking to educate us.
I’ve had some home birthing friends and I think it’s amazing. I don’t think I’m comfortable with it for myself (I want to know that a doctor is on hand STAT should I need it in case of emergency) but I think it can be a good option if the attending midwife is experienced and wise. I much prefer the birthing center (or hospital) route where possible.
Kuddos to you for writing this important and personal post. I’m so sorry that you had to experience that trauma early on in your career, but it’s obviously something that’s shaped you and given you even more compassion for the birthing mum… so that’s wonderful.
Well done for putting your heart on the line here.
Thanks for your thoughts Adriel. I think you hit the target when you talked about being informed and making the decision that’s right for you! Always love having your input here!!
Hi Steph, Thanks so much for visiting and sharing your perspective. Most of all we want this to be a grace-based community where moms and moms-to-be can interact and encourage one another. It’s been very encouraging to read all of the comments and hear each other’s heart and experience. You are so right about people taking it personally. That can be tough when talking about such personal issues. So glad to have you join the conversation!
Steph, I think I accidentally posted my first response to you under Adriel’s comment. : ) Just wanted to make sure you saw it…see below. : ) Thanks again for joining the conversation!
I agree! I’m an L&D nurse, and given birth in the hospital, at a birthcenter, and at home. I (and most homebirthers) have a back-up plan for long labors and complcations. While desiring natural birth, we are flexible enough to accept medical care when necessary. The majority of transfers from home to hospital are not due to emergencies, but to maternal exhaustion. While MDs may see the occasional homebirth that goes wrong, they don’t see the thousands that go right. I’m glad the author of this article works toward least intervention, but in my experience, that is rare in the hospital setting.
Heather –
Thank you for having the courage to write this. While I didn’t want a home birth, I desperately wanted to have a natural birth. Partly because of my fear of the side effects of the drugs (due in part to my “granola” upbringing). Well, I ended up having an emergency C-section and cried my eyes out. But I knew that the health of myself and my baby was most important. And in the midst, it was a tremendous lesson in learning to let go and trust that God knew best. And He did 🙂
There is a genuine sense of loss that women feel when their birth doesn’t go the way they had hoped. I ‘m glad you were able to find good in the situation, and more importantly that you have a healthy baby.
Dr. Rupe! It was so great to meet you on Saturday at Jeff’s talk. I look forward to meeting you at the office soon and getting to know you better. Like Jeff said, we are looking forward to diving into your book, especially me who has had friends recommend it to me prior to you giving it to me! I was so thrilled to receive it from your personally. And reading your post only makes me more eager to read the book. Your post also makes me even more grateful that I have found a place like WGF and to know that there isn’t just my primary doctor looking out for me and baby, but others like you too!
Thank you for your kind comments. I hope you find the book helpful and entertaining. I am so glad you feel comfortable with our practice! I look forward to meeting with you again and serving you anyway I can in your pregnancy.
Way to go, Dr. Rupe! Thanks so much for coming to the session and for being courageous in writing (and publishing) something dangerous. Thanks for the book, as well. My wife and I can’t wait to dig in and prepare for our first child!
Your welcome. Thanks for the inspiration and encouragement. Best wishes on your journey to fatherhood.
I couldn’t agree more about giatrerics. I miss sitting with some of the elderly individuals I used to help and they would tell me stories for hours about the things that they witness when they were younger, and the lives that they lived up to the point that they needed care. I have always felt that the elderly know how to live their lives better than anyone, and they for sure never take it for granted! Sometimes the people taking care of them are not good people though, and it always breaks my heart to see someone talking badly to an elderly man or woman.I like how you made a switch from little tiny babies that have no real experience with life, to elderly men and women who have lived life to its fullest and still have more life to share with others. Such opposites!
Great post, Heather!
Thank you for writing this post. I think it will help many people to look at all angles before making a decision. I appreciate your candidness and transparency.
I LOVE your perspective here. I love your honesty and openness about your true feelings behind it all. I would need several pages to describe my most recent birth experience. A failed VBAC that I still mourn to this day (baby is fine, thank God), but I so badly wanted a s,ooh, healthy natural delivery like my first. Instead my last 2 were both emergency sections. But, because of that, I am firmly in agreement with your perspective b/c twice I was one of those that “fell off the rope swing.”
So sorry you had a failed VBAC Jennifer. That must have been so hard. One of my favorite things about Dr. Rupe is how she is so supportive of women who want the most natural childbirth possible. But she is wise and professional and balanced enough to know when it’s time to intervene. I pray all women can connect with a doctor they trust as much as I trust her.
I stood in line behind you with the book @Sticky Jesus. We shared our dangerous post ideas there, and you sweetly pulled me to the side and prayed for me and my husband. Thank you so much! I want you to know how deeply you touched my heart that day, and how amazing you are for writing this dangerous post. Well done!
Jen, I was praying for you again this morning. So glad our paths crossed. Thank you for your kind comments.
Jen, I told Heather when we left that our time with you was one of the best moments at Blissdom for me. I love that you felt you could share your heart with us. I love how brave you were to come to Blssdom in the midst of a hard season of life. And i love that we could all forget for 5 minutes all the other reasons we were there to gather together to pray. I will continue to be praying for you friend.
For me, choosing a mcdieal specialty is easy. I was lucky enough to have the opportunity to work as a Dermatologist Tech prior to moving to Alaska. What an amazing field! No two cases are the same and more than one type of procedure can be performed in a day. Working for a dermatologist provides the benefits of both a private office setting and hours along with the experience of surgeries and unique treatments. Cyst removals and cancer treatments became the most interesting procedures to me and I can not wait to get back into the field!There are not many positions or specialties I would turn down when it comes to the mcdieal field. If I had to pick one, however, it would have to be gynecology. Why would this be the field I turn down? I am honestly not sure. I must be lacking the gene the would cause me to be interested in the subject! For whatever reason I would choose to work anywhere else before choosing gynecology. Specialty clinics are like sushi I guess. How do you know you don’t like it if you’ve never tried it?!
I have to confess that home birth makes me nervous too. I was a young, healthy 22 year old when my son was born. If I had not been in the hospital, I would have died from hemorrhaging. As it was, it was a miracle that I did survive. My sister-in-law, who has 6 children, had her last 3 at home. Although everything went fine, it still made me nervous. And if I were a doctor, it would definitely be difficult for me to accept. Great post! I loved Jeff’s session too!
Alicia, I’m so sorry you had a difficult birth but glad everyone ended up healthy. Thanks for joining us here.
I applaud you for being honest about your feelings. I hope you get supportive comments here. What words make me cringe? Blood transfusion. I haven’t had to have one, but I’ve had to sign the paper allowing it, if necessary, for my last two births and that is sobering. And a big reason why for now, I won’t be having any more children.
Nicole, I understand that. I had to have a blood transfusion after Dr. Rupe removed my ruptured tube from an ectopic pregnancy. That was actually two years ago today…day after the Oscars. It was unnerving but I knew it was necessary. Great to have you join us here to share your thoughts!
Brava! Love this post, and it crystallizes so much of how I feel, as well. I hope your words are able to reach those that may not otherwise be inclined to think twice about risking their babies’ lives out of fear of what could happen in the hospital. Keep fighting the good fight!
Thanks, Dr. Whoo. I find we are often on the same page. If you ever get tired of the sunshine and want to move to music city let me know.