12 October 2011

Birth Story: The Difference

Monday: why we chose to plan a home birth. Yesterday: the birth story.

Peanut was born in Haarlem, in the Netherlands; Pumpkin in Chicago, in the United States. Both have dual citizenship. He's kind of fair, like his father. She's kind of dark, like her mother. We're all perfectly balanced out in a silly story book kind of way. I love that our dual-nationality family has one child born in each country. We didn't plan it that way, but it happened and it's nifty.

It means that we did a pregnancy in the Netherlands and one in the United States. Can two countries be much farther apart? The US has a C-Section rate approaching 35%. In the Netherlands, most women go to a midwife unless they have a high-risk pregnancy. Perhaps most importantly, these countries see each other as opposite ends of the spectrum. In the US, a number of natural birth advocates were thrilled to hear I had given birth in the Netherlands. This is in part due to the fact that people like Ina May Gaskin often refer to the Netherlands as the golden land of natural child birth. In the Netherlands, people assume that birth in the US is all epidurals and scheduled C-sections. Neither is entirely true, and neither is entirely wrong. But the differences are far more nuanced

When I was pregnant with Peanut, I went to the local midwives. They took good care of me. It was a practice with six ladies and they were all nice to talk to. My visits were brief – they checked my blood pressure, felt the baby, measured my belly, listened for a heart tone, asked me how things were going, and sent me on my way. I met all but one of the women in the practice. They were patient with my questions and concerns concerning the birth. It was nice.

We elected to have a midwife assisted hospital birth (in the Netherlands, if you are low risk, you can choose whether you want a home birth or a hospital birth) and it was fine. We had a large, well furnished room to ourselves. Everything was there for the baby and husband to stay in the room. The room has double doors (a door, a hall, a second door) for privacy. The lighting was adjustable from low to operating room bright. There was even a refrigerator (for champagne, of course).

During the birth, we were assigned one nurse. She was the only person aside from our midwife who came into the room. When her shift ended, the next nurse took over. We ended up seeing an OB/Gyn at the very end because Peanut ended up being a vacuum-assisted birth, but they way they transformed the room was amazing – apparatus and people rolled in, Peanut was born, and everything went away – all within about half an hour. We ended up staying for 24 hours as a result, but we could all stay and sleep in the room together.

All of this sounds and was lovely, but I'm one of those women who want a natural birth. I was in the hospital, so when we needed the doctor, it was easy. But it's not all beautiful bellies and happy mamas over here. For instance, about half of all home births (for first time mothers) end up in the hospital. That usually means a transport to the hospital in a later stage of labor. If you haven't been in a Dutch house lately – the stairs are often as steep as ladders. Sometimes people are lowered out of windows because a stretcher can't go up and down the stairs. Imagine that.

Up until about three years ago, pain relief in the form of an epidural was not guaranteed. If a laboring woman requested pain relief outside of office hours (Monday through Friday, 9-5), it was at the anesthesiologist's discretion. Why interrupt a family meal or a good night sleep because some woman can't manage her birth pain? This has changed, thank goodness. But back when Peanut was born, I knew one woman who went home to Germany for her birth because she was afraid of not being able to get pain relief. There is a lot of support here for breastfeeding moms, but I've also heard women refer to the breastfeeding mafia – the pressure to breastfeed, whether you want to or not. Most women start, but not many keep it up.

There's also an ongoing debate between midwives and gynecologists over who should be in charge. Midwives aren't always eager to take their laboring mothers to the hospital and I've heard such transfers referred to as regrettable as opposed to necessary. I think it has to do with payments and power, but I'm not sure about the details there.

On the other hand, in the United States, pregnancy and birth are basically in the hands of doctors. This thanks in part to the insurance companies for reasons maybe someone can explain to me because it makes no sense. There's a clear (statistical) tendency towards more intervention and more pain treatment. Women are the objects of a birth, not necessarily the actors. In other words, birth is seen as something that happens to women, not something that women do. Instead of a process, it is an inconvenience between the rose-colored pregnancy and baby shower stage and the rose-colored new mother stage (neither of which are rose-colored, but the cupcakes might be).

If you decide that you do want a midwife or a birth center, the resources are out there. It takes more work on the mother-to-be's part (and partner), but it is possible. If you decide on a home birth, you may have your fair share of “what on earth are you thinking” conversations, as well. It's making a statement to choose for a home birth. The advantage here is that midwives who choose to offer their services to support home births (at least the ones I met) are very dedicated to their work, in part because their work is part cause.

So there are some of my thoughts. I'm curious to know about what birth is like in other countries or cultures. And how closely my observations match the experiences of other mamas. Do tell!

1 comment:

  1. Thanks for your balance, I usually stay out of birth discussions as both sides can get so militant. My three experiences in Australia have been really positive and I guess pretty broad. With one epidural delivery, one breech c-section and one all a bit too natural and rapid with no time for anything but a shower.

    In Aust we have a good public (free system) that offer birth centers through to c- sections. We also have a user pay private health insurance where you end up paying half and the insurance (which you also pay for) covers the rest. When you go privately you choose your Dr and see the same Dr once a month and weekly in the last month. In that time you have the opportunity to build a relationship and have lots of discussion. I used private with my first which was a great birth experience for a first baby and my Dr was a great non interventionalist. My second baby I had really wanted a mid wife delivery but when it showed baby was a footling breech and I would need a c - section I changed to private so I could plan it well in advance with a Dr who had a great C - section record. Third baby I also went private as I wanted a V-back with a really experienced, confident Dr.

    In my experience the private system worked nest for me. I felt that we had a Dr who owned me and took responsibility for getting us the best possible outcome. My half a pregnancy, reltionshipless experience in the public system, seeing a different person every time was disappointing and made me feel like a number.

    Gosh can't believe I had a birth rant, hope I made sence. For me I feel it's about choice - I feel we were able to make informed choices that best suited our needs and had a great people around us to make our choices happen so we are happy with our outcomes and wouldn't change a thing. (I do acknowledge that we were in a finacial potion to have so much choice. It is sad for birthing mums if choice is only for those who can pay.)

    Thanks for the bought provoking post x.


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