Perceptions of Home Birth After a Previous Hospital Birth
Tuesday, April 12, 2011 at 12:02PM
Guest post by Andrea Laurel Merg
During my first attempt at graduate school, I became pregnant with identical twins. I was in a PhD program in clinical psychology with an emphasis on violence prevention. I took a leave of absence after I had my daughters. I tried to go back and felt I could not do both: be a grad student and be a mother as well as I wanted to simultaneously.
The irony that words from my violence prevention program applied so easily and appropriately to my experience of pre-natal care and birth was not lost on me. Coercion, lies, manipulation, bullying, intimidation, threats, anger, submission, compliance… I knew someday I wanted to go back to graduate school. I also knew that I was still deeply interested in violence prevention while becoming increasingly interested in the role birth experiences play in shaping families.
After essentially re-doing my master’s level coursework (non-terminal master’s degree in the beginning of PhD school, could only use so many transfer credits, blah, blah, blah…don’t get me started), I submitted a proposal. I was granted the privilege of interviewing 11 women who had homebirths after previous hospital births. My aim was to capture the essence of their collected comparisons reflecting the midwifery model against the hospital model. Hospital births were classified as hospital model regardless of who attended the births. The midwives who attended a couple of the hospital births still had to operate under the policies of those institutions. The midwifery model included only homebirths.
I analyzed the data consisting of verbatim transcriptions of the 1 to 2 hour taped interviews using Moustakas’ method. The major themes that emerged across all participants were: a) respect/autonomy vs. disrespect/coercion, b) trust vs. distrust, c) accomplishment vs. failure, d) empowerment vs. power struggle/powerless, e) allies vs. adversaries, and f) satisfaction vs. dissatisfaction. Additional major themes, which were reported by four or more participants, in addition to myself, were: a) avoiding probable interventions, and b) healing vs. broken.
Respect/Autonomy vs. Disrespect/Coercion
Every participant felt they had the freedom to act and make decisions of their own volition during their homebirths. Only three women did not specifically feel disrespected or coerced by the hospitals, the doctors, or other staff at the birth of their first children in the hospital. Athena subsequently felt disrespected and coerced by the postpartum nurses, particularly as it pertained to the handling of her newborn baby. Demeter and Artemis went on to have second hospital births filled with disrespect and coercion from hospital staff, and in Artemis’ case, the doctor.
Allies vs. Adversaries
Without exception, each participant relayed feeling that her homebirth care providers wanted for her what she wanted for herself. Five of the twelve of us felt the hospital staff and doctors were our adversaries, showing little if any regard for our wishes and preferences, and working against us when our wishes and preferences interfered with their agendas.
Avoiding Probable Interventions
Fifty percent of us experienced specific circumstances at home, which we feel would likely have resulted in unwanted and unnecessary interventions at a hospital. Those included position changes to handle shoulder dystocias. Gaia also said of her second homebirth, “I would have been sectioned several times over.” She explained she had an intact amniotic sac and was 8 centimeters dilated for 12 hours. She did not have any temperature problems, or anything else that indicated trouble, but she feels a hospital would not have waited.
I had a VBAC and believe I would have had a real fight on my hands to prevent most hospitals from trying to give me a repeat cesarean, or interfere in any number of other ways.
Healing vs. Broken
Five of us experienced psychological healing as a result of our homebirths. Artemis went through tremendous physical trauma, with a urethral tear during the birth of her second child. Her doctor bullied her into pushing her baby out “as hard as she could.” Artemis was only in the labor and delivery room 1 hour and 44 minutes when her daughter was born. Her doctor was only there when Artemis began to push.
Artemis came to view her daughter as “intense…needy…and crying all the time.” She felt she did not get to fully experience her daughter as an infant. At times, she feels she is still making up for that. Speaking about her homebirth, Artemis said, “[The baby] launched me into a wonderful place. Actually she…her birth was very consoling for me.”
Following the hospital birth of her first child, Aphrodite was left with a great deal of residual physical and emotional trauma. Aphrodite explained that her homebirth was a way of “solidifying” the mother she was already becoming. Aphrodite said, “I think it was a really healing experience. I felt like it really helped heal all the pain that was left from the last time.” Describing her body helping to push her second baby out: “…just experiencing that moment sort of washed it all away.”
Arianrhod described being changed by her hospital birth. She said, “I thought I was strong, I thought I was brave, and after that I wasn’t anymore…I walked into the hospital elated and I walked out…broken…” despite leaving the hospital with a “healthy baby.” Arianrhod described that near the end of her homebirth she started making a noise. She said she was unaware of her ability to make such a sound. She said, “It was this song…it came from deep inside me…And there was no way that I could have released that song without being free…And from that moment, I’ve been free.”
Hemera initially had difficulty emotionally connecting with her daughter. She attributes that to the trauma they shared during birth and postpartum. For her second hospital birth she labored at home and was actually at the hospital only nine minutes before she delivered. The postpartum experience for her second hospital birth was still not nurturing. She left with frustration, anger, and resentment.
Hemera described her homebirth as a spiritual experience. She said that though her second hospital birth helped her heal from the first, her homebirth did more still.
When I became pregnant with my twins, it did not occur to me that I would be treated like a medical disaster waiting to happen. I felt healthy. Blood tests and ultrasounds confirmed that we were all healthy. I carried the girls for 38 ½ weeks.
I progressed, effaced, and dilated to seven centimeters before all the interventions arrested my labor. I ended up with a cesarean section and, with a lovely smile on my face I deeply hated everyone there except my doula and my husband. I cried and smiled and told people not to feel sorry for me.
I felt broken. Every challenge of being a new mother to infant twins felt like further confirmation that I was not equipped. I decided I could not handle my PhD program and be a good mother. Leaving the program did not make me feel any better about my mothering ability. It just made me feel more a failure.
For my second pregnancy, I found a midwife to whom I will forever be grateful. She supported me, and I came out of that birth a relatively whole person. If she had fears, she never showed them to me. She showed me trust and respect. She gave me information, and I made decisions.
I believe my study demonstrates understanding of the ways the midwifery model of care contributed to and even restored well-being in the women studied. In future, I hope to see research further examine whether women who have been cared for under the midwifery model of care have fewer difficulties adjusting to their role as mothers.
In seeking publication for this study, I have presented it to an interdisciplinary journal. It is one thing for advocates to stand around agreeing with each other. My hope is to get people who may have never thought much about maternity care to consider the effects. Whatever happens, I am trying to do my part to influence the way women, their support systems, the community, and society at large view and approach prenatal care and childbirth.
Reader Comments (22)
Thank you for doing this work...hopefully having a "study" on paper will lend credibility to the midwifery model for those who still see birth through a medical lens.
what an amazing study thank you so much for sharing this with all of us.
Andrea, do you have a link to the study itself, and transcripts of the interviews? They sound fascinating. (and I like the use of goddess names).
Did you include your experience in the study you submitted? Can you tell us a little more about how studies like this are received and used in your field? Thanks.
Thanks so much for sharing your research and your experience. This is important work for all of us. I also love that you used goddess names. Best wishes!
Thank you so much for sharing your work with us. I do hope you totally crush your goals someday.
I have ID twin girls, too - they had TTTS and I was induced at 34w because of it. During the pregnancy I'd switched care providers to folks I felt more comfortable with (from the guy who wanted to be a hero) and used nutritional therapy in an effort to switch things up. My OB at the birth was absolutely fantastic - I know that I was spared a c/s because of him. But the interventions, the residents, the NICU nurses - in retrospect, I'm really shocked at how powerless I felt. How small. How not the mother. The smaller twin had some growth questions around a year old or so, and there were specialists and the pediatrician and whatnot. I recently had the opportunity to read all our medical records from that time, and in reading them was transported right back to what those feelings were like.
I totally forget where I was going with this because a cage match broke out between a twin and the three year old and I have to marshall the 9yo into a karate uniform and pretend to care about dinner, but I'll go ahead and post this anyway, because it at least says, "thanks" and that was the most important part!
Do we ever need a study to quantify what supports women in what is possibly the most empowering and almost certainly most miraculous event fo their lives. The cynic in me thinks that even with a study group of thousands and irrefutable data the 'medical system' will move at glacial speed to make any changes.
The Amazonian in me thinks there is no more important issue and wish you every success in continuing this critical work.
Thank you for doing this study ... any supporting information that is in some scientific format will help home birth advocates defend their choice! I would love to read the transcripts and the whole study too!
Thank you!!!!
What would ACTUALLY be interesting would be to also interview a group of women who had homebirths first and then chose hospital births for their next child and then compare and contrast results.
Also women who had hospital births and chose hospital birth again.
I don't think that this study has a lot of meaning as it stands.
@Ellie: Considering how Andrea is coming from a clinical psychology background and writing a study on psychology, there would be no point in interviewing women in all of these other categories, because the goal was not to quantify all variations of experience. This isn't a study on outcomes of homebirth vs. hospital, but a study on the psychological themes that emerged from these 11 women based upon the birth experiences they had. I imagine a study of 11 different women could have had entirely different emergent themes for Andrea to write about.
Telling 11 individual stories and studying the psychological themes that emerge? IN ALL ACTUALITY - that's pretty interesting.
I can't even begin to describe how many things are wrong with this post. And I am deeply offended as a hospital providor.
It's perfectly reasonable to express some misgivings about a study of this sort. No, of course it need not encompass every facet of birth experience, but it seems obvious that a study designed by someone who had a personal stake in the outcome might be less than objective. The way the study is structured, participants chosen, how data is collected, organized, and then interpreted-- what is included and what is not-- all these things matter. Is it really necessary to point out the limitations of interviewing a few people who were unhappy with one experience and then subsequently chose something else and were happier?
Like Ellie, I'd find a study like this much more interesting and meaningful if it attempted to incorporate any experiences outside of the pre-scripted hospital birth (bad) vs. homebirth (good).
As a thesis/dissertation, I totally get it and appreciate it. My own dissertation (molecular biology) explored the role of one specific gene product in specific tissues. As a manuscript for publication, this one provides interesting food for thought but is obviously intended to delve into the psychology of women in one very specific situation, not to be all-encompassing or to compare experiences across different scenarios (e.g. women with only hospital births or women with unpleasant homebirths followed by pleasant hospital births).
I don't know why anyone would be offended, honestly. I've only seen two hospital births (one was my own) and I can see these themes as very valid. I was only in the hospital for 20 minutes before my daughter was born and even for that amount of time felt like I was disempowered and coerced into things that I didn't want. My beautiful perfect newborn daughter was separated from me just because she was "too cold"...blah blah blah.
I look forward to a homebirth with the next baby, and I will also enjoy comparing the two experiences. Thanks for this post; I think it was interesting :)
I want to thank those of you who took the time to read and respond to this, and in between managing a sick 4-yr-old and her older sisters I will try to address any specific questions and concerns.
emjaybee & Andrea von Schoening : I am finally going through channels of traditional academic publishing for the thesis itself. As soon as it is available, I promise to post the link. I am in a little bit of a sticky situation as far as posting anything else right this second as my thesis chair and I co-authored an article based on the study and I don't have full permission to post anything until the journal decides whether it will publish the article. This post would probably have been frowned on - please no body turn me in ;) I may be able to put the transcripts up - I'll get back to you on that.
ellie: please see Caitlin's response and perhaps may I suggest Creswell's (2007) Qualitative Inquiry & Research Design: Choosing Among Five Approaches (2nd ed) for a fuller discourse on the value of the phenomenological approach, narrowing one's topic, etc. Furthermore, I think it is actually interesting to give women a voice and most usefully - so did my committee.
Caitlin: Blessings.
More later - my daughter needs our only computer.
The more I read on these NCB sites, the more I realize how many women seem to go into labor with an emotional "glass jaw" or are just bare of emotional resources to begin with.
I find the promotion of the next birth as being "healing" to be dangerous in so many ways.
I am a L&D nurse and, as much as I hate to admit it, I have seen some of the ugliness this study addresses. Too many HCPs use scare tactics and a God-complex to coerce women in to things they don't want. It really is sad. I will also add that I'm fortunate enough to work in a facility that employs 2 CNMs (the only ones in the area) and they are phenomenal. They catch more babies then any of our MDs, have a 8% C/S rate and absolutely empower women to have the type of birth they want. I definitely am a proponent of women doing their homework before choosing a HCP while pregnant.
As a side note, we attempted a home birth with our first child and ended up transferring to the hospital. Luckily it was still a good experience. I am currently pregnant with our second and we will be planning another home birth. When an OB nurse doesn't even want to deliver in a hospital, I think that says a lot about the current system.
anon, I can't even begin to describe how many things are wrong with this post. And I am deeply offended as a hospital providor. This thesis was a description of the lived experiences of individuals. I really can't apologize for helping other women tell their stories, giving them my ear and a voice. Neither can I apologize for letting other women know that they are not alone.
Yttrbia & others, You wouldn't find a study like this that does not include the author's personal experience as that is part of this particular type of study design. The methods include describing one's own experience in order to first set it aside, then compare it to other experiences. The rich detail of subjective experiences is the domain of phenomenological research. Identifying themes can establish foundations for further research - it's about contributing to the existing body of knowledge on psychological outcomes of childbearing. It wasn't about hospital is bad vs. homebirth is good. Ultimately, it is about laying a foundation that may bring to light what may improve maternity care and childbearing experiences for all women, which may percolate up to the overall well-being of mothers, babies, fathers, other offspring, etc. Just imagine the ripple effect of increasing the probability of psychologically healthy birth events. Or don't if that is not of interest to you.
Ellie, I think you may be enjoying your virtual position. You'd be hard pressed to get away with saying these women were lacking in emotional resources to any of their faces.
Meredith, thank you for your voice. Congratulations and very best wishes.
Andrea, I appreciate your response. I absolutely am interested in improving psychological health in relation to the birth experience; however, my concern is that a certain type of birth experience is being promoted as being universally beneficial when that may not be (and in my personal experience, is not) the case.
Please do me the favor of not suggesting that my criticism stems from a lack of knowledge about the research process. As someone with training in research methods, I'm sure you understand the role that discussion, analysis, and inquiry play in determining how a given piece of work fits into the existing body of knowledge. I'm sure you're also aware that writing about your personal experience and conducting a very small, completely non-random interview survey of people that reinforces your pre-existing beliefs is of limited utility. I'm not saying there's no place for such a thing-- I thought it was an interesting read, and I'm always happy to hear of women having positive experiences-- but a study of this sort does not rise above the level of anecdotal evidence. Further, I think it's a theme that has already been identified... to the exclusion of almost any other viewpoint.
I'm being completely genuine when I say that I would have appreciated a study that was more than just a narrative supporting an a priori conclusion. There's more to maternal psychological health than the themes identified here. I'm not saying it's your job in any one study to identify or elucidate ever factor, but there's tons of stuff out there supporting this particular view. I don't think it's the whole story, and I think it leaves a lot of women out.