LITTLE ROCK — Most women call a doctor’s office the minute they test positive for pregnancy. Most women faithfully go into that doctor’s office for all their appointments, carefully follow that doctor’s advice and at the end of their pregnancy go to a hospital and let that doctor dictate how they give birth.
Most - but not all.
The documentary, The Business of Being Born, released in 2008, opened many people’s eyes to the idea that although one in three American women have Caesarean sections, and induction of labor is even more common than that, they have other options, such as whether to have pain medication via an epidural, or pitocin-induced labors that often lead to surgical births. And they can choose whether to have their babies with all, some or none of those things in the hospital or naturally, with little or no intervention at home.
Long before that film was made and well before its sequel, More Business of Being Born, was released in November, women gave birth without doctors. Even after doctors became the norm, some women decided that they wanted a different kind of birth experience than any physician was likely to give them.
Home births increased by 29 percent between 2004 and 2009 - from 0.56 percent to 0.72 percent of births - according to the Centers for Disease Control and Prevention.
That followed a decline in home births between 1990 and 2004.
The number of home births remains small in comparison with births in hospitals, but a substantially larger group of women are taking charge of their situations by presenting their doctors with detailed plans outlining how they would like their births to go.
About one in every 90births for non-Hispanic white women is now a home birth, according to CDC statistics, which also note that home births are less common among women of other racial or ethnic groups.
MAKING A PLAN
“The trend for birthing plans that outline a family’s wishes for their hospital birthing experience is a good thing and has gained momentum,” says Dr. Kevin Breniman, an obstetrician with Cornerstone Clinic for Women in Little Rock. “It helps the patient think through and delineate her wishes for the delivery process, and when these wishes are written it helps the delivery staff know what to expect, which is always a good thing.”
Breniman says the use of doulas, advocates for mothersto-be, is up, as well.
“The doulas that I haveworked with are very professional and an asset to have in the birthing event,” he says. “It is a great thing to be able to facilitate a team approach that benefits the mother and the baby.”
Doulas are especially valuable when things don’t go as planned, he says, because they can help focus mothers faced with options that are different from what they originally wanted.
Jody Hefner of Little Rock found a doula soon after she got pregnant with her first child, Levi, now 2.
When it was discovered after three hours of labor in the hospital that Levi was in breech (presenting himself feet first), Hefner’s doula asked the doctor if the baby could be turned in utero, which might have allowed Hefner to have the kind of birth she wanted. The doctor, reluctant because amniotic fluid was low and Leviwas in distress, insisted a Csection was necessary.
TRY, TRY AGAIN
When Hefner got pregnant with her second child, Aria, born in January, she again hired a doula. She found a clinic and a doctor who were open to allowing her to try for a vaginal birth after having a Caesarean, and she did have a successful natural birth after three days of labor.
Under Arkansas Department of Health regulations, midwife-assisted home births aren’t allowed in Arkansas for women who have had previous C-sections, but if the rules change before she has another child Hefner says she and her husband will consider havingthat baby at home.
Doulas aren’t allowed to do medical checks - even for dilation, blood pressure or heart rate. Midwives, licensed by the Health Department, can perform routine assessments and lab work, essentially complete obstetrical care for low-risk mothers-to-be and on the same schedule as most obstetricians. Appointments with midwives typically last an hour, compared with 10 to 15 minutes with medical doctors, and cover issues like nutrition, exercise and whole body prenatal care.
Ed Barham, public information officer with the Health Department, says there are 26 licensed midwives in the state.
One of them, Mary Alexander, opened Birth Works30 years ago, during a time when certified nurse midwives - registered nurses with master’s degrees in midwifery - were allowed to deliver babies in hospitals. Hospital privileges for midwives were revoked in the 1980s by Arkansas Code Annotated 25-15-201 and 17-85-101, which was last updated in 2008.
Alexander, not a nurse, went through an apprenticeship training program, her own experience leading her to a career in midwifery.
She saw a doctor most of the way through her pregnancy back in 1970, but she made the decision at 33 weeks’ gestation to have her baby at home.
She couldn’t find a midwife, but a friend who had given birth at home offeredto help her.
“My child is 42 years old now but I can still remember everything about that 3-hour labor,” Alexander says. “The head came out and everybody in the room - my husband, and my friend and I - just looked at that baby’s head and we were all just mesmerized and we were just holding our breaths in total amazement. Here is this little human being, right there. And when you’re that silent, and there’s not even a breath to be heard … there’s just this moment of timebefore the next contraction that I could hear a teeny tiny little sound coming from the baby - that sound is the sound that is in my heart every second.”
She couldn’t have heard that sound or had that experience in a hospital with doctors and nurses, she says, and over the years she realized she wanted to give other women a chance to feel what she had.
SUPPORT STAFF
Amy Cefalo, who has worked as a doula through Birth Works and recently became a midwife in central Arkansas, pursued her path for much the same reason.
Cefalo has used midwives for all six of her children’s births, the first two in birth centers in Georgia and the last four in her home.
Her older children were invited to be at the later births, and they chose to be there.
“I remember the three oldest children just coming through the living room and sitting quietly on the couch, and I was in the middle of a contraction and I was working hard to cope with the contraction. And I remember as soon as the contraction ended, looking at my three sweet babies sitting on the couch and saying, you guys remember this is just helping the baby to come out, right, and they all said, oh, yeah, yeah,” Cefalo says. “I think she was born in the contraction after that in our birth pool, in our living room, with our childrenright there.”
More than anything, Cefalo says, doulas and midwives want women to do their homework and find out what’s best for them and for their babies.
“The truth of the matter is that our clients come in and they will make a birth plan and have an idea of how their birth is going to be and no birth ever goes exactly the way that you think it’s going to. You have to be prepared for all of those things. As a consumer, you have to know your options,” she says.
“Obviously that’s where we think doulas come in because doulas list all the options and are able in the moment to say OK, things have changed, they’re presenting one option to you but you actually have four options. We’re not there to give advice, we’re there to support the client in the choices that they make.”
Family, Pages 36 on 03/28/2012