Ghostbelly by Elizabeth Heineman

GhostBelly_stroke_400px Ghostbelly: a memoir
by Elizabeth Heineman

Every once in a while, a book falls into my hands that rips my heart out a little, and keeps me awake at night.

“I think we ought to read only the kind of books that wound or stab us. If the book we’re reading doesn’t wake us up with a blow to the head, what are we reading for? So that it will make us happy, as you write? Good Lord, we would be happy precisely if we had no books, and the kind of books that make us happy are the kind we could write ourselves if we had to. But we need books that affect us like a disaster, that grieve us deeply, like the death of someone we loved more than ourselves, like being banished into forests far from everyone, like a suicide. A book must be the axe for the frozen sea within us. That is my belief.” – Franz Kafka

Ghostbelly is one such book.

Elizabeth Heineman, or Lisa to her friends, has lived an unconventional life, making unconventional choices.  So, it’s not surprising to those who know her when she falls in love anew in her mid-forties and decides to get pregnant at the age of 45.  What might be surprising, however, is that she chooses to have a home birth, eschewing the barrage of unneccessary medical interventions routinely present in the medical model of maternity care and childbirth.  It is not a decision Lisa makes lightly; she agonizes over it, researches it, and ultimately chooses a home birth attended by a certified nurse midwife because Lisa believes in evidence-based practices, and nobody she consults with can offer her any concrete medical reason that she would not be a good candidate for an out-of-hospital birth.  Indeed, regardless of her “advanced age,” she’s extremely healthy and fit and is deemed “low risk” by the hospital midwives she sees through a good part of her pregnancy, as well as her family practice doctor.

After an easy, happy, uneventful pregnancy that continues past her due date, Lisa goes into labor one November evening in 2008.  Something goes terribly wrong during her labor, however, and her longed-for baby, nicknamed Thor, is stillborn.

What ensues is the story of a woman  whose love for the child she never saw draw breath is inseparable from the gut-wrenching grief she inhabits over her loss of Thor.  Making yet more unconventional choices, Lisa demands more than the half-hour allotted time with her dead baby’s body that the medical examiner’s arbitrary protocol allows; she and her partner, Glenn, instead spend six hours with Thor that first morning in the hospital, cradling him, lovingly examining him from head to toe, rocking him, singing to him, and talking to him – as loving parents do with their new babies.

“I see Thor.  I feel him.  I smell him.  They have handed him to me in a blanket, and he is heavy in my arms.  I rock him and smile at him and sing to him and kiss him and inhale him.

“Glenn watches me and cannot understand: I seem happy.

“He is right.  I am happy, because in this strange new life I have just begun, the life of the mother of a dead child, this is what counts as happiness: I have my baby, I am cradling him and talking to him, and they will not take him away in half an hour, and so I am happy.”

***

“This is what I want to do in those six hours.  To take that moment, in which Thor will not grow six hours older, and inhabit it fully.  To fully absorb Thor, because it will be our only chance.

“And because this is so important, other things can wait.  Like crying.  Like thinking about Thor’s absence.  I will have a lifetime to explore Thor’s absence, every inch of it; to acquaint all my senses with it, to inhabit it.  Any time we spend crying now, bewailing his death, will be time lost to things like singing to him, touching him, things we only have a few hours to do.  Thor’s absence will not last just a moment, not even a stretched-out moment.  It will occupy time.  First he will be dead a day, then a week, then a month, then a year.  I will have the rest of my life to explore it, and its exploration will require the rest of my life.  But the time to explore Thor’s absence is not now.  Now is the time to explore Thor’s presence.”

The next day, after an autopsy is performed, Lisa and Glenn visit the funeral home where Thor rests until his burial is carried out.  They are surprised when the funeral director talks about Thor as if he matters, as if he were a person, a real baby, and not just a corpse.  “Uncle Mike” as he becomes known to them, encourages them to visit Thor whenever they want, and even to take him home for visits, which they do.

Lisa, of course, agonizes over what went wrong after such a wonderful, low-risk pregnancy.  Why did Thor die?  She unflinchingly analyzes her choices and the events that led to Thor’s death.  While she came to believe that Thor might not have died had she planned a hospital birth rather than a home birth, she does not condemn home birth or midwifery care as one might expect after such a catastrophic loss; rather, she condemns the alienation and isolation of home birth midwives in the U.S.; if home birth and home birth midwives were not placed on the fringe by society and the medical community, if midwives were treated as colleagues and invited to collaborate with doctors, it is likely that situations like Lisa’s wouldn’t arise.

“I believe Thor is the statistic for unnecessary death in an out-of-hospital setting.

“I believe someone else’s child is the statistic for unnecessary death in a hospital setting.

“I believe that a single unnecessary death during home birth prompts calls for abolition of out-of-hospital midwifery.  I believe that hundreds of thousands of unnecessary deaths in hospitals prompt suggestions for voluntary reform.  I believe the difference lies in the imbalance of power between hospitals and midwives, not the comparative level of risk of home birth versus hospital care.”

Lisa contacted me a few months ago and asked me to read and review her book (I have to say, I am so incredibly fortunate to have the opportunity to “meet” some wonderful authors this way; Theresa Shea and George Estreich also come to mind), and gave me a synopsis, so I knew going in what the gist of her memoir was.  To be honest, I was a little scared to read it; I expected it to be morbid and maybe even macabre.  It is decidedly neither morbid nor macabre, although it surely takes the reader out of a comfort zone.  On a personal level, this book moved me in so many ways: aside from sharing a name with the author, we share religious views, and I, too, chose home birth (three times) and gave birth to a baby at an advanced age (44).  I can’t help but feel a connection to Lisa and her story, though I’ve never lost a child.

Searingly honest, gripping, and articulately emotional, this is a story that needs to be told – and a story that needs to be read.

For more information about this author and her stunning memoir, check out ghostbelly.com.

31 thoughts on “Ghostbelly by Elizabeth Heineman

  1. This review made me think of a documentary I heard on the CBC — Buried So Deep. It tells the story of the infant memorial garden in Vancouver where upwards of 11,000 babies were buried without ceremony, often in an open grave. My husband’s mother lost a child and never got to hold it or see it. So many people lost their children — and the documentary tells the tale of how 5 years ago, an infant garden was created to recognize the deaths. Family members could come and place a stone or pebble into a a creek bed. In any event, here is the link: it’s extremely moving. Years after the deaths, the parents finally have the opportunity to grieve.

    http://www.cbc.ca/thesundayedition/documentaries/2011/10/18/buried-so-deep/

    I also agonized over the decision to have home births. How medicalized birth has become.

    I’ll look for Ghostbelly. It sounds fantastic.

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    • My grandmother had a stillborn baby boy in the 1940s, sometime between the time my mother was born and her youngest sister. He apparently died in utero and she carried him for several days until she went into labor. I remember her telling me the story just a few years ago when I was pregnant with one of mine, and all those decades later, the memories were still very much with her. After he was born, the doctor whisked him away, and she never got to see or hold him. It’s difficult to fathom.

      Thanks for sharing that link, Theresa.

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  2. The reason doctors don’t like to collaborate with homebirth midwives is they do crazy stupid reckless things, teach their clients to distrust us, and fill their heads with nutty ideas (‘cascade of interventions’, ‘birth rape’), AND THEN expect us to fix the mess they bring in after waiting way too long to transport.

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    • What sort of crazy, reckless things do home birth midwives do, exactly? I’m curious. I take it you’re a hospital-based medical professional? You must be a joy to have as a care provider.

      Listen, I’ve had three hospital births (four if you count my twins’ birth as two), and three home births. You need to back your assertions up with facts. What are the facts? The facts are that home birth is just as safe for low-risk women/pregnancies as hospital births are. In many ways, a hospital is, in fact, a dangerous place to be. A typical hospital birth is teeming with unnecessary interventions and protocols that are utilized mainly to protect the hospitals and medical staff from liability – not for the mothers’ or babies’ well-being (let’s see . . . continuous fetal monitoring, withholding food and drink during labor, mandatory IV “just in case,” routinely augmenting labor to ensure it follows the strict timetable set by medical personnel (which timetable is completely arbitrary and has nothing at all to do with anyone’s medical well-being), limiting a laboring woman’s ability to move around at will or to give birth in whatever position feels appropriate to her – these are just a few. So are you saying that the “cascade of interventions” is bullshit? What about the FACT that there is roughly a 33% c-section rate in hospitals across the U.S.? That means that roughly one out of every three women who is admitted to a hospital in labor will end up with a c-section. That’s astounding. You know, I presume, that even the World Health Organization supports the midwifery model of maternity care for low-risk women over the medical model of care?

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      • The WHO may support a midwifery model of care, I’m not sure, but what I do know is they are not speaking of CPMs and lay midwives, the type that most commonly attends homebirth in the US and which no other industrialized country allows.

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      • Oh and what basis do you have for making the snarky comment about the person you’re replying to? None that I can see. I’ve seen a homebirth midwife say chewing up a cinnamon candy and blowing it across a pph mom’s face is a legitimate treatment. I’ve seen midwives rail against regulation and oversight, which would bring their horrific stats up somewhat. Having an actual education would also help, as would hospital privileges and accountability. I’ve recently seen a midwife ask another midwife to crowd source an emergency…and the baby died. Yes, babies die in hospitals but are far more likely to die at home, actually. MANAs own stats support this conclusion, as does the study from Cornell and the study comparing homebirth apgars and hospital apgars. I’ve seen a midwife tell a couple that the average length of time between twin births was 47 days (after a quick Google of course) . I’ve seen midwives insist that their job is to simply ‘hold the space’ and not intervene at all. I’ve seen multiple midwives tell moms that they are experienced with breech birth simply because they want the experience and have read a book or attended a work shop. I’ve seen those babies end up dead or severely injured. I’ve seen midwives suggest splenda to ‘refill’ amniotic fluid when their was none on a post dates mother over the emergency c section she needed and the baby died. I’ve seen many midwives suggest checking a piece of placenta or even dates for postpartum hemorrhage instead of the active management necessary. Heck, most of them couldn’t tell the difference between heavy bleeding and pph. I’ve seen midwives say you can do NSTs with a handheld doppler. I’ve seen midwives take classical incision vbacs, twin births, breech babies and others that should have been risked out. I’ve seen babies die due to those choices. And all of this was blandly or even excitedly self reported by the midwife herself.

        So pp has a point, and you really had no reason to get snarky with her. If you support women and choice in birth, you cannot in good conscience support the current model of care or the CPM and lay midwives. I’ve also laid out more reasons in a response below.

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      • The basis for my snarky response what the snarkiness of that commenters comment. Frankly, I would like specifics about all the “messes” she and her colleagues are expected to “clean up” after midwives that “waited too long to transport.”

        As for this comment of yours, I find it curious that you say you’ve “seen” this and “seen” that. Is that just a figure of speech, or have you actually witness midwives doing all these things firsthand? And if so, how did you come to be present in so many of those situations? Do you attend home births regularly? I’m curious.

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  3. Hospitals across the country are trying to accommodate women who desire a less medicalized birth through both OBGYNs and CNMs and providing things like birthing tubs, hemlock instead of IV, intermittent monitoring, no pain meds and heavy breastfeeding support. While, yes, more babies have died in the hospital overall, you are 3-5x more likely to lose a child homebirthing than you are to lose a child in the hospital. But since hospitals deal with 99.5% of all births you would expect the overall number to be higher. They also take very high risk pregnancies. Pregnancies that homebirth midwives should, but don’t always, risk out. Another good option is an accredited attached birth center. You’re 2-3x more likely to lose a child at a homebirth than at an accredited attached birth center.

    The problem is that in the US we have CPMs and lay midwives being allowed to practice. No other industrialized country does. Their midwives are university educated, as our CNMs are. OBGYNs and CNMS have oversight, accountability, education, and medmal insurance. CPMs and lay midwives have none of these things. You are also able to see an OBGYN or CNM’s statistics and record, and cannot with a CPM or lay midwife. That puts women choosing them at a huge disadvantage, because there is no way to tell the difference between the excellent ones and the quacks responsible for the death or dire injury of a child or even many children. One famous midwife told a family that the average length of time between twins being born is 47 days! Another recently asked another midwife to help her crowd source an emergency on Facebook. The baby died.

    So yes I want women to have access to a good care provider. Abolish the CPM and only allow the CNM or CM to act as a midwife in homebirth or birth center settings. Because why should so many babies be dying PREVENTABLE deaths in the name of choice? That is like supporting back alley abortion in the name of choice; it makes no sense at all.

    Thanks for this review, there is a great website where you can learn more about homebirth loss (Hurt By Homebirth). I believe women should be able to make an informed decision to birth safely at home if they choose to. With the current state midwifery and homebirth in this country it’s simply not possible.

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    • Hmm. Well, I’m certainly not an expert, so maybe not in a position to argue with the points you make, but as a woman who has been pregnant six times and who has given birth in both a hospital attended by OBs and at home attended by a midwife, it seems a tragedy to me that the medical community views pregnancy and birth as inherently pathological – and treats it as such. My midwife – I had the same one for all three of my home births – is a “lay midwife,” or direct entry midwife. That doesn’t mean she’s some schmoe off the street who goes in and pulls people’s babies out. She had to undergo a rigorous education, apprenticeship and examinations in order to become licensed by the state of California. Does she have an OB backup? Does she have malpractice insurance? No. Because there is such animosity from the medical community towards out-of-hospital births and midwives that they can’t obtain those things. There should be more collaboration. It’s terribly unfortunate that hospital doctors and nurses generally have such hostility about out-of-hospital birthing; as this memoir, Ghostbelly, points out, if there were less of an imbalance in power, if there was less hostility from the medical community and less resulting defensiveness from the midwifery community, if there were true acceptance of one for the other and a collaborative attitude, whatever bad outcomes that arise in a home birth setting DUE TO MIDWIFE MISTAKE OR POOR JUDGMENT (I want to emphasize that, as there are certainly bad outcomes that will not be avoided regardless of birth setting/care providers) would be much, much less likely to occur.

      It’s certainly ridiculous for anyone to say that the average time between twins being born is 47 days (are you sure whomever said that didn’t say “47 minutes”? That would be more likely in a vaginal twin birth that was allowed to progress naturally. The vast majority of hospital twin births, however, are c-section, and so the twins are usually born approximately ONE minute apart. My own twins were born in a hospital, but I spent my entire labor fighting with the doctors who were trying to bully me into a c-section for no good medical reason – just protocol!! – they ended up being born vaginally, 18 minutes apart. And frankly, over nine years later, I still have so much anger when I look back on that experience and remember how I was treated by the medical staff), but I seriously doubt that’s conventional thinking among midwives. Further, a university education, etc. etc. certainly doesn’t preclude doctors from making crackpot claims. My own pediatrician tried to convince me that NOT vaccinating causes autism. He also told me that my son’s eyes crossing was all in my imagination, even though everyone else could see it and a visit to a pediatric opthalmologist confirmed that he has strabismus.

      As I said, my own midwife is a direct entry midwife, and I think it’s a mistake to think that just because she doesn’t have some sort of medical degree that she doesn’t know what she’s doing.

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      • No I’m 100% sure she said 47 days. There’s a lot of asinine things being said and done by lay midwives. I have a friend who recently delivered twins vaginally in the hospital. If you look at the MANA stats there’s a very good reason twin births are highly managed and that’s because they are far more complicated and more likely to result in death due to things like cord prolapse.

        My problem isn’t that she doesn’t have a medical degree per se, but I do think that without a university degree she’s at a distinct disadvantage. She learned whatever the midwife who taught her knew. Why do you think no other Country follows this model for homebirth? It’s because the outcomes are so poor. A 450% increased risk of death isn’t something we should ignore. That’s with a non controlled survey with only 30% responding and ignores negative outcomes aside from death like brain damage. So the stats could actually be much worse. Your experience with your midwife was good…but you have no way of knowing if she’s ever killed a baby through negligence or stupidity before. Without insurance it’s unlikely a civil suit would be brought against her, so if no criminal action has been taken there is no record of any bad outcomes from her. I have friends whose midwives killed their baby and the midwives still practice and have clients who say the same thing. That’s horrifying.

        I can tell that you very much support women and choice and I’m hoping that with enough information you will realize what an unfortunate crap shoot homebirthing with a cpm or lay midwife is.

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  4. I’m sorry for the author’s loss. I’d like to make one comment- she was not “low risk.” She was 45, a first-time mother, and post-dates. Those are three risk factors.

    You talk about the isolation of the home birth community in the US, but in a country with an integrated midwifery system (Canada or the UK, for example), she would have been risked out of home birth.

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    • Nowhere did I say that the author was a first time mother. She did in fact have an existing child already, one who was also born in an out-of-hospital setting.

      Why does age, all by itself, constitute “high risk”? She was thoroughly checked out by her family practice doctor and a group of hospital-based CNMs and deemed utterly fit and healthy despite her age. She was told by them that her age was secondary, that it would only make her “high risk” if her age, in fact, was causing specific medical issues or problems, which it was not.

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      • Actually, after age 40, even otherwise healthy women have more stillbirths, more premature labor, more pre-eclampsia, and more dysfunctional labors. Nobody is sure why, but it may have something to do with the aging of the vascular system and the very extreme demands placed on the body by pregnancy. Now, I don’t LIKE that this is so, but it IS so, and is a fairly robust finding in research on pregnancy after 40. To say that it is so is not to imply that this mom did anything wrong or that she doesn’t have good health habits. It’s just a fact. To ignore that fact is perilous, as she found to her sorrow.

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  5. The WHO doesn’t support un/under-educated “apprenticed” lay midwives. They support midwives with the equivalent of university degrees. In the U.S. that should be CNM’s. We shouldn’t have a second, lower level of midwives and maternity care. Lay midwives in my community cannot, nor do they know how to read and interpret the results of U.S., Blood Panels and more. They don’t have more than a pocket doppler to monitor babies, so they truly don’t have a clue when things are going poorly and a dead or dying baby is born. It’s then explained away as one of life’s mysteries and that baby “wasn’t meant to live”. It’s horrible care, one step above a random cab-driver delivering your baby. Good prenatal care isn’t talking about your feelings over tea. That’s what friends, sisters and mothers are for. Good prenatal care means utilizing technology and modern medicine at our disposal to ensure the healthy arrival of our most precious babies. I KNOW this is the case ^ all I have written above, because I used to be one of those lay-midwife students and I lived it. They DO NOT have enough training, equipment or experience. Some “midwives” are such after just a few assists at another midwife’s client’s births. They are often shoved into the role of primary midwife for less desirable clients of the lead midwife, when she is too busy/overbooked. They have NOTHING in the way of experience, backup or skill as compared to an OB or even a Family Practice doc. And I’ve had 5 children, homebirths and hospital. The homebirth midwives couldn’t manage to show up for my homebirth until an HOUR after my baby was born. Thankfully things were fine and I was too ignorant to understand what a grievous breach of trust and responsibility that was, until much later. Neither midwife ever apologized for being late or took any responsibility for not being there! The hospital births were in a range, from very invasive to completely hands off. It depends on your provider, the hospital, their policies, and also YOU the consumer, knowing what you want, understanding why they want to do certain things, and understanding the risk of not complying with what they want. Yes, some things in the hospital are more routine and just protocol, and not necessarily specifically for your benefit, but just what they do for every patient, but sometimes, even those routine things, like IV’s can be lifesavers, if they cut down the time to intervene when there really is a life-threatening event. Constantly judging the hospital to be an evil place teeming with germs is ridiculous. There are so many good-hearted people who are dedicated to helping others that it is truly insulting to them. To the amount of time and MONEY they spent on school and certifications and constant updating of their training JUST so they can take care of you! Compared to what homebirth midwives do in the way of “training” it simply does not compare. A coffee-klatch whereupon tincture of Valerian is discussed and the wonders of black and blue cohosh is admired is not the same as a group of dedicated professionals reviewing intubation skills for neonates, to save LIVES.

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    • Well, it sounds like you have hard feelings about home birth and midwives based on your own personal experience, which was negative. My own home births were extremely positive, my midwife was completely dedicated, knowledgeable, and capable, and thus, my feelings are quite different from yours.

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      • Lisa, did you just “skim” my comment? I know it was lengthy, but had you read THIS part “I KNOW this is the case ^ all I have written above, because I used to be one of those lay-midwife students and I lived it.” you would see that I, myself have attended many many homebirths as a doula, as an assistant and student CPM/Lay Midwife. I chose NOT to become a CPM. NOT because the path was hard, but because it was SO EASY and there was almost NO accountability and almost no medical knowledge needed. This is the case throughout the country, as I had my homebirth with irresponsible midwives in California, LICENSED midwives, btw, and worked with and was taught by midwives in my new homestate of Michigan. Midwives all over the country are practicing with limited or no medical skills or knowledge. Their response? “Birth is not a medical event.” <— That is irresponsible. I want to use some choice expletives here, but I will just leave them to the imagination. That is a ridiculous back-pedal to try and avoid responsibility. I don't have "hard feelings". I have years of experiences with midwives who were supposed to be teaching me, but had to borrow money from me for gas, to get to and from appointments, because they were broke/mismanaged their finances. I dealt with midwives who came to prenatal appointments late, constantly, and actually had me park and wait outside, so that we could "arrive" together, so as not to make her look bad. Midwives who didn't have batteries that worked, in various equipment. Who forgot their stethoscopes and borrowed mine for appointments as well as births. Who let mothers labor for 4 days and kept me there as well, when the mother really should have been transferred, to be on the safe side, and then dealt with PPH with expired medications. Midwives who "hated" transfers and would bemoan having to ever transfer patients because the hospital personnel were so "meeeen". What about the safety of the mothers who desperately needed help? YOU may have gotten lucky and had an uneventful birth, whereupon your midwife looks like a guiding angel. BUT had something gone wrong, you may well have been in the other camp, with loss mothers, some of whom STILL can't cope with life and the overwhelming grief and guilt that comes from finally realizing that THEIR own choices contributed to the death or injury of their child.
        THANK you for posting my comments. I appreciate the honest discourse. I didn't think you would actually allow my comment, but I do appreciate it. There are more former midwife apprentices and doulas and midwives and assistants and many others who have worked in the crunchy cult of NCB and recognize how dangerous and deceptive the group-think of "Trust Birth" can be.

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  6. Yes, I work in a hospital, and no we don’t have routine IVs or restrict food or activity. We don’t follow a strict timetable for labor. So there’s that.

    And before you judge me you should have to sit and cry with as many women as I have who have lost their lovely perfect babies to undertrained homebirth providers because somebody told them we were mean and rigid at the hospital. What crazy things do they do? Deliver a teenage girl’s breech baby at home. Let somebody go to 43 weeks. Ignore a developing uterine infection. Ignore meconium. Let someone push for 24 hours (I wish I were kidding, but I’ve seen that). Treat Group B Strep with a garlic clove. Let somebody VBAC at home.

    I even know a woman who’s tears were repaired by a midwife who wore no gloves. Since the midwife was colonized with flesh-eating bacteria this meant the poor mom got infected ON HER PERINEUM and wound up having most of her vulva removed. Oh and with a colostomy.

    Home birth is NOT as safe as hospital birth in the US. MANA’s own data shows a 4 times increase in the risk of death during labor.

    And you don’t know me. I’m actually as sweet and kind and patient as anyone could wish. I just don’t let bullshit fly past me unchallenged.

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    • You work in a hospital that doesn’t have routine IVs and doesn’t restrict food or activity for laboring women, and doesn’t follow a strict timetable for labor? That’s a true rarity here in the U.S. You realize that, right?

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  7. I find it mildly amusing that of all the things I said, my first paragraph is all you reply to. To respond to what you asked, it’s actually not such a rarity. The three hospitals in my area I’ve work in have the same policies. Perhaps things have changed since you had a hospital birth?

    I should add that of all the (real) cases I’ve mentioned resulted in death of the baby…except for the one with the colostomy, which is horrific enough.

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    • See, now it just feels like you’re taunting me. At the very least, you’re being extremely condescending. I’m glad I’ve “amused” you.

      Perhaps birth practices in hospitals have changed since I last had a hospital birth.

      Stillbirths happen in hospitals, too. Women die in hospitals. C-sections alone present HUGE risks (and women do, in fact, die from complications from c-sections). But nobody really talks about that, because hospitals are, apparently, above reproach because they utilize all the technology available.

      No, I guess I didn’t address every point you made. I may not be qualified to. I do know, however, that as much as the midwifery/home birth culture vilifies the medical model of pregnancy/birth care, so the medical community vilifies midwifery and out-of-hospital births. Pregnancy and birth are not inherently pathological; they are not intrinsically events to be feared and managed; they are not catastrophes waiting to happen. On occasion, things go wrong – sometimes because of poor judgment calls on the part of care providers (both medical and midwife), sometimes directly due to unnecessary interventions, sometimes directly due to absence of necessary intervention.

      I would absolutely choose home birth all over again.

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      • I don’t think you’re reading her tone the way I am at least. I appreciate you had a good experience but other women may not have. Anyone can deliver a baby during a normal labor. It’s that when things go bad they can go very bad very fast. You’re like most women who don’t really have the means or knowledge to really research the issue…and you shouldn’t have to be a statistics professor to pick out your midwife. That’s why a educational, licensing and oversight requirements are so desperately needed. Women shouldn’t have to settle for a provider because they’ve been fed a load of hooey by the birth junkies who get a rush delivering babies…especially in high risk situations. And yes, that’s what they call themselves.

        Do you know the author personally?

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      • “Stillbirths happen in hospitals, too. Women die in hospitals. C-sections alone present HUGE risks (and women do, in fact, die from complications from c-sections). But nobody really talks about that, because hospitals are, apparently, above reproach because they utilize all the technology available”

        Lisa, it’s very very clear from your statement, which I’ve quoted above, that you have “swallowed the hook” as it were. There is very little evidence of stillbirth in hospitals for healthy full-term babies. This is something you’ve read and “researched” directly from the homebirth community. It’s really really despicable, because you and many other intelligent and educated people have fallen for this line. It is NOT true that any signifigant percentage of healthy, full-term babies die in hospitals. If and when a baby dies, there had better be an extremely good damn reason, in hospital. There are boards of review. There is quality control to determine if someone screwed up somewhere along the line. And it is found out and it is investigated and it is sometimes something the parents can and will, often, sue over. BUT it is very rare. MOST babies who die in hospitals were simply beyond saving. Their (usually genetic) abnormalities are so incompatible with life that the only options are to either terminate the pregnancy, which many women choose, or birth the baby, and give palliative care until the baby passes. This is to give the parents time to grieve and adjust to their circumstances. Most women in the U.S. today who die in childbirth die of other causes, most often of heart disease, and other risks. NOT because of bleeding out or of stroke, which can and has happened in home birth. C-section presents a risk, to be sure, but most women are completely willing to undergo the risk to keep their baby safe. C-sections SAVE LIVES. It is simply UNtrue that most women “suffer” during or after a c-section. There is a lot of hand-wringing and angst in the ICAN community about how horrible a section is, but the (first world problems, people) issue is not too many c-sections, it’s NOT ENOUGH in developing countries.
        In Africa, in MOST countries there, women DIE because of lack of access to health-care including lack of access to hospitals, OR’s and c-sections. Women die the most horrific deaths you could possibly imagine, their babies stuck inside them. Their dead and decaying babies poisoning them from the inside because the baby passed and labor was not induced. They die on the way to the hospital, which is a two hour drive on a dirt bike or other wildly unsafe contraption because this is the only way to get there. Do you find this unpalatable? Difficult to believe? Here are some links to blogs about midwives and doctors who live this, all the time. One is a “lay” midwife, apparently a CPM, and she is better than nothing, but as you read her blog you will find that there is often little to NOTHING she can do to save these women or their babies. AND she works, occasionally, with an M.D., so, that is sometimes helpful, but only when there is an M.D. available. The other IS a doctor and there still, is often NOTHING he can do to save these women and babies. That we eschew modern medical care is absolutely a first world privilege and it is arrogant beyond belief to think that we are entitled to avoid the completely normal biological processes and expect that OUR births will be perfect, candle-lit orgasmic experiences just because we read a few books, watched a few movies, joined a few babycenter groups and FB pages and then ran out and hired the local lay/crunch-mistress/midwife. It’s WRONG that most women assume that these lay midwives have much more training and knowledge than they actually have. It’s a cult, a mind set, a pervasive way of looking at things through our first world, middle class mostly white privilege that says, THIS is the way I want something, so just by virtue of being ME, I shall make it so.
        This weird, strange, feel-good cult of personalities has grown up around that self-actualization ideal that one can simply make something so, by thinking or wishing it to be. I KNOW what it’s like. It feels good. It makes you feel wise, powerful, empowered, as if you have magical powers or those others who are leaders in your local community have those magical powers. It feels good to be included in that “special group” of people who are wise, smarter than the “mainstream sheeple, so natural, so organic, so back to nature, so down to earth, and yet hip and “with it” at the same time. I totally “get” it. It’s a deception
        I hope you will take time to think about WHY on earth I’d spend all this time writing to you and about this particular issue. Why bother? I’m a mother of 5, I work full time and am in school full time to become a paramedic. Why would I reverse course, as it were, and stop trying to become a CPM and decide that I needed more training? More knowledge? I would have been an established midwife by now, for sure, and taking my own clients at $2,000 a pop, more than my Family Practice doc makes attending births! I would not have had to undergo ANY more college courses. I wouldn’t have had to take chemistry, anatomy, physiology…. nothing! A cpr card was all that was required, and to have my preceptors sign off on a few pages of paperwork. Take one test, the cost of which is utterly outrageous at $700 or more per pop! I can tell you that THIS course I am on is infinitely harder and more expensive. That is as it should be, as I will have people’s lives in my hands. Student loans, difficult courses, changing work schedules to continue with school… it’s all very difficult and very very worth it.

        I hope you’ll take time to think about this and everything all your commenters say. It’s too easy to fall into the snark trap and not really HEAR what they’re saying. I CARE about mothers and babies. I am a mother. I have 5 babies. Those babies will have their own babies someday, hopefully, and I may have the honor of becoming a grandmother. I want my kids and my grandkids to be safe. Everyone, in this modern age, absent serious medical conditions, really ought to come out of birth ALIVE. When a perfectly healthy full-term baby DOESNT, people naturally want to know WHY. And the answer, in homebirth, so very often is a complete lack of understanding about the medical side of birth, of what’s really going on and the physiology of birth. When a baby drops from a mother, mostly dead, dying, completely cut off from O2 for hours during labor and the midwife had no idea, that is a HUGE problem, This simply doesn’t happen in hospitals. But it happens ALL THE TIME in home birth. Please, please, as a rational person, ask yourself WHY.

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  8. I’m sorry you feel that way. It was not my intent.

    You don’t have to apologize for your good birth experiences. I have met some really good midwives and you obviously either had one, or were lucky to have uncomplicated deliveries.

    Yes stillbirths happen in hospitals. It’s just that they happen at 1/4 the rate they do at home. Based on what you describe of this poor mother’s experience, I’d wager Thor’s was a preventable death and would not have happened in the hospital. You see, the opposite of the ‘cascade of intervention’ resulting in a c-section is the cascade of non-intervention resulting in a very bad outcome indeed. Personally, I’d take the interventions as needed, even if they resulted in a c-section. (I birthed vaginally, by the way). Anyway, no need to reply. I’m not sure why I offended you, but I am sorry.

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  9. I just wanted to say that I appreciate you allowing this dialogue to take place. It’s nice to see someone allowing opposing comments and not just deleting them!

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  10. Hi friends, book author here! Thanks, Lisa, for the sensitive review; and thanks, Theresa, for the tip about the documentary about Vancouver! What a moving story. For me, the emotional heart of the memoir is the grieving process, and I’m very glad to see that there’s increasing awareness of parents’ need to grieve pregnancy and neo-natal loss.

    Passions run high on the subject of homebirth, and one thing that emerged from my experience is that the matter is more complicated than the highly polarized ways we usually discuss homebirth – whether pro or con. In my book I discuss many of the issues that have come up in this thread, including CNMs versus CPMs, the gap between the factors many people assume are high-risk and the factors identified as high-risk by the American Congress of Obstetricians and Gynecologists, the ways homebirth is handled in different countries (and for that matter in different states) – as well as other variables that matter a great deal but haven’t appeared on this thread. There’s plenty to discuss when it comes to homebirth, just as there’s plenty to discuss when it comes to hospital practice (which, like homebirth, can vary greatly according to state, city, hospital, or even individual practitioner). One of my hopes is that my book will contribute to a productive dialogue.

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  11. Thanks, Lisa, for chiming in here; your thoughts are most appreciated since the memoir is your own experience, and you have courageously put it out there for the public.

    I want to offer a couple of final thoughts here:

    Yes, the topic of home birth is very much a hot-button issue. For that matter, the topic of birth in any context is. People – especially women, understandably – have very passionate feelings about birth, and home birth in particular is an extremely polarized issue. Likening home birth to back alley abortions, I think, is horribly biased and inflammatory, and hearkens back to the time when midwives were the targets of witch hunts. What would be a fair comparison to back alley abortions would be if home birth were outlawed, because the fact of the matter is – whether people like it or not – women WILL continue to seek out home birth, so outlawing it would only force it underground and make it very unsafe indeed. Women SHOULD have choices when it comes to giving birth, when it comes to who their care providers are during pregnancy. Midwives who practice legally have undergone whatever education, hands-on apprenticeship, and practical examinations that their states require. It is my belief that the vast majority of home birth midwives are extremely knowledgeable, capable, professional, dedicated, and passionate about their profession (and no, I do not believe that I was just lucky in my home births; I was cared for a very capable, devoted midwife). Are their crackpots? Yes. There are also bad doctors. Midwives and doctors alike can make poor judgment calls. Why is it that if a baby or mother dies when under the care of a midwife, all midwives are deemed “killers”? But when a baby or mother dies under the care of a doctor, it’s merely a terribly unfortunate fluke.

    I would strongly suggest to those who are so opposed to home birth, those who believe it is unsafe, to invest their energies into lobbying to make it safer, then; work to eliminate the polarization of birth options, lobby for obstetricians to not be allowed to refuse to be backup for midwives; lobby for home birth midwives to have hospital privileges; lobby for home birth to be viewed as a valid option so that midwives can actually collaborate and consult with obstetricians. Vilifying midwives and home birth accomplishes exactly nothing productive.

    I am saddened and disappointed that the comments to this post took such a hostile, negative turn and quickly became a heated debate about home birth. I am generally opposed to censoring comments on principle, because I do believe very much in honest, open discourse. However, I feel that the discussion here got way off track, and in order to prevent it from devolving further, I am closing the comments to this post at this time.

    The post I wrote is about a profoundly deep and beautiful book about one woman’s experience with loss and grief and love for her child. It is a book that I hope many, many, many people will read.

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