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At home from the beginning: Emily Marynczak and her son Arlo.

photo:Shannon DeCelle

Born in the Living Room—and Under the Radar
By Miriam Axel-Lute

To many familes, giving birth at home feels safer and more comfortable than the hospital. But to do that in the Capital Region, they need to look underground for a midwife

 

Emily Marynczak’s second child came at “banker’s hours.” Her labor started around 3 PM, and Arlo was born just a few hours later, an uncomplicated “VBAC” (vaginal birth after Caesarean section). Wendy Kelly gave birth to her second child in a tub, called a “water birth,” after about six hours of labor, half the time of her first child’s birth. Caroline Sharkey labored for 37 hours before giving birth to her son. After the birth, her placenta wouldn’t deliver, and she needed surgery to remove it. Phaedra Zoe Stasyshyn spent the whole afternoon she was in labor in a rocking chair, and was so mellow that her mother didn’t hurry to the birth, and arrived as it was much farther along than she’d expected. Carolyn Keefe was hoping to have a VBAC with her second daughter, but the baby kept shifting into awkward positions, and eventually she needed another c-section. Mara Afzali is pregnant with her fourth child. Her first one came nearly two weeks late, but the birth went smoothly.

Each birth is completely unique. But these six births do have some things in common: They were all planned as home births, their labors happened at home, and, except for Keefe’s, the babies were all born at home.

There’s something else they have in common: If you ran into one of these mothers or their partners on the street and asked them who their midwives were, they wouldn’t tell you. In order to have their babies at home in the Capital Region, these families had to go underground for their health care.

Home birth is not illegal in New York state. However, to attend home births legally, a licensed midwife needs to have a supervisory agreement with a doctor’s practice or hospital that explicitly allows her to do so. While there are a lot of midwives practicing in the Capital Region, not a single doctor or hospital they work for will allow them to catch babies at home. In Ithaca, New York City or Rochester, families can find a few home-birth midwives in the yellow pages. In Vermont, Massachusetts, or Pennsylvania, home-birth midwives are easily available. But here in the Capital Region, women who want to give birth at home find their options very limited.

But they seek it out anyway. The most common themes in their lists of reasons are the comfort of familiar surroundings, control over the process and who is present, and freedom from the restrictive rules and invasive practices of hospitals that are often based more on liability and doctors’ convenience that the realities of birth.

“The free movement,” is the first benefit that Afzali (who has had all of her children at home, but has attended hospital births) thinks of. “You watch someone at the hospital being strapped down, which to the hospital is no intervention. . . . What I do in all of my labors is much more constant movement, much more range—up, down, in the tub, out. That’s my coping mechanism. For me, movement is imperative.”

“To be able to walk, squat, and stretch my arms up and hang on the shower curtain so I could feel my back and all the vertebrae separate,” lists Sharkey. “To lay on my bed on my side when I needed to, to lay on the floor, to get in the pool, to take a walk outside, to strip all my clothes off.”

There are other benefits to the atmosphere of home. “No monitors, no nurses, no noises,” says Sharkey, adding that that was essential to allowing her to take the little cat naps that let her pace herself through her long labor. “I can’t imagine being in a hospital and having a bunch of people I don’t know around, a bunch of distractions,” agrees Kelly.

Hospitals also make a practice of restricting food and drink during labor, something several women said they wouldn’t have had the energy to make it through their labors without. “I can’t even imagine being deprived of liquid and only being offered chipped ice,” remembers Sharkey. “We had two cases of water and I drank a case and a half in the 37 hours that I labored at home.”

“The other huge difference is you’re the one calling the shots,” says Afzali. “You go to the hospital, and the doctor says ‘Now this is what we’re going to do’ . . . and at home, you’re the one. The midwife makes suggestions, and it’s not that they can’t take control if they need to, but they’re not going to need to most of the time.”

“The best thing I love about home birth is after the baby’s born,” says Kelly. “Being home, not having to come home.” Her husband Sean adds that not having to leave home and go to a hospital in the first place is a major plus as well. “I couldn’t imagine getting into a car [while in labor],” agrees Kelly.

The integration into the rest of their life was important to Marynczak. Her 6-year-old was present for the birth, and by 7:30 PM, “here we were all sitting around on the floor, eating pizza, and he was playing with his new brother, and then he went upstairs and we tucked him in.”

Several of these families value the opportunity to have older siblings, even fairly young ones, present for the birth itself. “It really gave her a connection to him, and she’s very protective of him and very in awe of him,” says Kelly of her daughter, who was two and a half when her son was born.

Marynczak’s older son was given the job of taking pictures—he would wander around the rest of the house when things got a little intense for him, but he was thrilled to be helpful, and she says it created a very strong bond between him and his brother.

“I’ve never had any ‘When do we take it back?’ or ‘Where does it belong?’ or ‘Who’s its mommy?’ or all the things you hear that kids say,” says Afzali about her older children. “They get it, that [the new baby] is definitely part of the family.”

Although home-birth midwives are careful to make sure that expecting parents really want a home birth, and are not just afraid of hospitals, the fact that hospitals don’t do so well with normal birth is an undercurrent through every discussion on the subject. Everyone involved in home birth recognizes that hospitals and their technology are an essential backup for complications. They are also careful to acknowledge that women are going to have a better outcome wherever they feel safer—and for many that’s a hospital.

But that fact remains that many women are concerned that American hospitals tend to intervene at rates far higher than recommended by the World Health Organization or justified by medical evidence. For example, WHO recommends a c-section rate of 10 to 15 percent. The United States rate was 28 percent in 2003. Planned home birth rates are about 4 percent. The WHO says that drugs and electronic fetal monitoring should not be routine during labor. In 2000, the U.S. rate of use of drugs in labor was 80 to 98 percent and the rate of fetal monitoring was 83.5 percent. Planned home-birth rates were less than 10 percent each.

Advocates of more natural birth point out that we’re not getting anything for all these extra interventions—the infant mortality rate in the United States is nearly twice that of other developed nations, and rates of preterm and low-birth-weight babies have actually been rising.

Women who want to make sure they have a c-section only if it’s necessary, or who want to keep their systems from being pumped full of drugs, often decide that rather than fighting for a natural birth in a hospital setting (which is possible, but difficult, and only for short labors), they will have their children at home.

Sometimes the smaller indignities and biases of the conventional medical system also rankle enough to incline families toward other options. In Marynczak’s first pregnancy, she recalls, the OB’s nurse would make a distressed noise “every time I’d get on the scale. They made me feel incredibly fat and like things were going wrong and when finally I couldn’t take it anymore and said ‘What’s the big concern, yeah I’m huge, but what’s the big concern,’ they said, ‘You might be left with some extra weight after the pregnancy.’ I was horrified.”

A more common scenario, say local midwives, is that doctors and nurses will start telling a woman that her baby is too big for a natural birth—which is almost never true.

Marynczak’s first baby was born by c-section because he flipped to a breech (feet first) position at the last minute. Although midwives are trained to deliver breech babies, medical students are no longer taught how, and many hospitals insist that all breeches be delivered surgically anyway. But one of the things that sticks with her beyond having to make the decision, was how she was left completely alone and shivering in the recovery room because her husband needed to follow the baby to an x-ray the hospital staff had deemed necessary.

Keefe says she and her husband were traumatized by her first c-section because they were deprived of decision-making power and respect. The doctors waited until her husband was out of the room to tell her they’d decided on a c-section, cutting him out of the loop. Her daughter was taken for 45 minutes after the birth for routine procedures, “screaming the whole time,” never held or comforted. She had been given drugs to induce her labor, and had a slow and painful recovery. Many women choose home birth because they are traumatized in a similar way, she says.

We did it our way: Corey McQuinn (l), Caroline Sharkey (r) and their son Remember.

photo:Shannon DeCelle

When Marynczak started shopping around for practices when she was pregnant with her second child, she knew much better what to look for. But she couldn’t find it. “I kept coming across, ‘Well it’s a VBAC so you have to have continuous fetal monitoring and you’ll have to have an IV,’ ” she recalls. “And the conversation would kind of stop right there because those are both things that lead to increases in Caesarean sections, and I’ve been there, done that. . . . There was no indication that my uterus wasn’t functioning properly, any structural abnormality. So why would you now strap me in bed and give me an IV and really reduce my chances of having this baby?”

But what if you are in that small percentage of mothers where a c-section or other intervention is really medically necessary? That is perhaps the most common question women choosing home birth face from their families, friends, and other pregnant women.

Since every birth is an unknown, and carries some risk, this is a scary thing for any expectant parents to face. “If something goes wrong in a hospital, here’s a sense of ‘Oh, it’s so tragic, we did everything we could,’” explains Marynczak. “If something goes wrong at home, there’s a sense of ‘Oh you selfish person. Look what you did.’ ”

But the fact of the matter is that home birth is just as safe as hospital birth. A large study of midwife-attended home births released this June in the British Medical Journal found that mortality rates were equivalent to that of low-risk hospital births.

Home-birth midwives, including underground ones in the Capital Region, are not slow to transport to the hospital if it looks warranted. “We don’t play ‘You must stay home,’ ” says a local midwife. “We don’t wait. We go when it’s safe.” She says her practice has a hospital transport rate of about 12 to 17 percent. “Neither of us are afraid of hospitals. If the baby’s saying ‘I’m not happy’, then OK, let’s get help.”

These midwives encourage their clients to also get prenatal care at a hospital-based nurse-midwife or obstetrician practice, so that if they need to transport to the hospital, they will have a relationship with someone there and not be appearing out of the blue.

But it is perhaps the stories of the women where something did go wrong that answer this charge most completely. “I’m certain that my second Caesarean saved my daughter’s life and my life,” says Keefe. “But it shouldn’t be the first place you go.” Although she is disappointed that she ended up needing a second c-section, Keefe is glad she planned the birth the way she did, and got to have labor at home, which she found immensely more pleasant than a “dark little room” in a hospital where she had to be “disconnected from all these wires just to go to the bathroom.” But after a few days of on-and-off labor, she and the midwives decided at the same time that something was wrong. They went to the hospital well before there was any crisis.

When, at the hospital, the midwives told her they thought surgery was needed, they gave her a few minutes to bawl and “get it out of my system.” Because they had chosen a hospital and doctor supportive of their approach, she was respected the whole way through, and even allowed to be the one to apply pressure on the upper abdominal muscles after the incision to actually push the baby out. The baby was held the whole time it was being checked out, and the far shorter time that Keefe had drugs in her system made recovery much faster. “Overall it was much more positive,” she says.

Sharkey, also, says having a major complication has done nothing to diminish her enthusiasm for home birth. She delivered her son at home, but then the placenta refused to deliver. “My cervix clamped down, my uterus refused to contract. . . . It’s a rare condition. The midwives were by no means shy in telling us, ‘It usually takes such and such time and we think something’s up.’ . . . Finally, they very sweetly explained that we know that you want to stay at home, but we think you should consider transport because we think surgery might be necessary.” Though she was disappointed, “I was thrilled with their honesty.” The surgery was successful, and she was released the next day. “The experience at home had left me feeling so comfortable and empowered that at no point did my confidence falter,” she recalls.

Another unusual thing about Sharkey’s experience is that her midwives helped arrange for a group of friends to bring her family dinners every day for a month after the birth. While it doesn’t always take that form, six weeks of postpartum care—at the house—is the norm for a home-birth midwife. This is one of the many ways that the care from home-birth midwives differs from standard perinatal care. Their prenatal visits are often one to two hours long, and involve the whole family. They may incorporate anything from support in grieving previous miscarriages, preparation for parenting challenges, referrals to family counseling, and even help with budgeting for families where one parent has decided to stay home with the child.

This kind of close relationship adds to the feeling of safety for clients—“I felt that she knew me so well, that if I looked odd she was going to get it almost as quickly as my husband,” says Marynczak. “She was getting to know us as a family. How we functioned, what the dynamic is. It just became amazing in terms of comfort.”

Comfortable and empowering and safe as it may be, home birth in the Capital Region still means going underground for a health-care provider, something that, while it doesn’t dominate the pregnancy experience, is still a weird and sometimes awkward thing for expecting families.

Finding a home-birth midwife in the first place isn’t always easy in such a climate, unless you happen to already be in the loop. Home-birth midwives in the area certainly can’t advertise, nor can they tell just anyone who approaches them what they do; though it’s rare, midwives have been arrested in sting operations by state enforcers posing as a pregnant couple [“The Midwives’ Tale,” March 7, 2002].

Stasyshyn traveled to several different practices in Amsterdam and Saratoga Springs before someone suggested that she talk to some people who turned out to be home-birth midwives. The process took long enough that she had given up hope and was considering living with her father in New Jersey for the end of her pregnancy or traveling to a birthing center in Rochester. “It was like chaos,” she says. “I had been so discouraged about home birth at that point. When I came to talk to them they were speaking on the level of just a doula [labor assistant], until I went through the whole story and I said my brother was born at home and it’s what I always imagined. Then they said ‘Well, is that something you want to do?’ I was blown out of the water.”

Wendy and Sean Kelly had a similarly hard time. Their first daughter was born at home in Boulder, Colo., where home-birth midwives were common and legal. But here they found themselves going down one dead end after another in their search. Eventually they called their midwife from Colorado, who was able to connect them with someone locally. Without that connection, they might not have been able to make it happen here, they say.

Then there’s making sure you don’t let the midwives’ names or other identifying information slip in front of the wrong company. Practicing midwifery without a New York-sanctioned license and written practice agreement is a felony, punishable by four years in jail, so their clients take discretion very seriously. “It wraps [the pregnancy] in a cloak of secrecy,” says Tisha Graham of New York Friends of Midwives, who had her fifth child at home in the Capital Region about 10 years ago. “It makes some women feel very duplicitous.” Graham would tell people that she was having her baby “in Saratoga, with midwives.” “People would assume, I didn’t say it, I’m having my baby at Saratoga Hospital with the midwives [on staff]. And I would never clarify that one way or the other.”

The climate has gotten a little less hostile than it was in the mid-’90s, and many families are opting to talk about their decision and just leave out names or identifying information. But even then they talk about “living in fear that her name will slip from my lips,” as Marynczak puts it.

“I still feel like that, if I go to the park and my kids are playing and someone asks me how far along I am and then asks me where I’m having the baby, should I just say I’m having it at the hospital?” recounts Afzali. “Makes it easy. But you want to stand up for what you believe in and make it a normal choice for people. I generally say ‘I’ve had all my kids at home, I’m having this one at home, I use midwives.’ . . . There’s definitely been times where I’ve had to lie. It depends.”

And then there’s the negotiations after the birth. Marynczak’s pediatrician wanted her to get a newborn infant screening work-up, something usually done right after a hospital birth. “The amount of phone calls and work it took . . . was hilarious,” she recalls, “because everybody I would talk to said, ‘Oh no, no, your baby had that done at the hospital.’ ‘Well, no, my baby wasn’t at the hospital.’ It wouldn’t even compute. ‘No, your baby’s already had the newborn infant screening.’ ‘No, we need to come in.’ ”

Sharkey recalls with a grimace having to tell hospital staff after her surgery that the baby had come so fast there was no time to get the hospital for the birth itself. After 37 hours of labor, she says, that was a really tough thing to say. “I definitely wanted the credit!”

When Sean Kelly went to get a birth certificate for his son, he had to come back when the one person in the Saratoga Springs Town Hall who knew how to issue one was in. “I said ‘Here’s this part about witnesses, what do I do about that?’ They’re like, ‘Well, who attended the birth?’ and I was like ‘Well, umm. . .’ The other woman told them ‘If they had a home birth, they might have had a midwife, but they’re not going to want to talk about it, so just have him sign it as the witness.’ ”

Returning to a backup prenatal care practice, or to an unsupportive pediatrician’s office, can also be awkward. When the Kellys called to schedule their first postnatal checkup, their usual pediatrician (who had said they could schedule their first appointment when they were ready) was on vacation, and the receptionist and the nurse read them the riot act for waiting more than 48 hours to come in. They held firm. “The whole reason I have a home birth is to be home,” says Wendy.

Stasyshyn isn’t sure if the practice she visited will take her back for her second pregnancy, knowing that she had her baby at home the first time. She also feels bad that her midwife there couldn’t be a part of her birth. “There’s pictures all over the wall of babies she’s helped deliver, and I always felt she went through this whole thing with me and she never had a part of [the birth] because she couldn’t,” she sighs. “I called her. She was very nice about it.”

But these concerns fade away when it comes to how excited these women are about their birth experience. In fact many say they’ve faced some social awkwardness in having enjoyed something that is “supposed” to be an ordeal. As Stasyshyn puts it, “No one ever says about a birth that it was perfect. [They say to me], ‘Oh, you don’t remember.’ But yes, it was.”

Quietly, these women are spreading their stories to those who are ready to hear. “I never wanted to play the role of recruiter,” says Sharkey, but she says women are not getting to make fair choices if they don’t have all the information, and she had has taken it upon herself to help people know what their options are. “Options are all I ever asked for,” she says.

maxel-lute@metroland.net

For more information on home birth and midwifery in the state of New York, visit www.birthnewyork.org.


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