"You don't need to fill the creche, honey"

Just a quick note to let anybody know that blogging will be thin for the next month. I mean, if I get an energy spurt and a piece of note paper I might go on a real tear (my next target is the banking industry), but the fact is I've got a sizeable wriggling watermelon in my abdomen that pretty much dictates what I get to do with my day. Basically, when the kids are down, I sit. I sit and knit, or sit and talk on the phone and knit, or sit in front of the Internet (if only I could knit).

My midwife says I need to take walks. I try to stifle my incredulous laughter. Even after walking the short distance to the mailbox, this baby feels like it's about to drop out. The due date--Jan 6--approaches. But it feels too far away.

Preparing for a third baby is a lot different than the first one. Where to put the baby is a principal concern. This child will be lodging in our (pretty big) walk-in closet for a time, until I can get the boys to share a room (Tom doesn't always sleep for his nap, while Carl does). I cleared off the changing table, weeded out some ragged diapers, and rounded up enough plastic pants to last me several months (thank you, Rachel!). The dresser had to be cleared off, the birth kit refurbished. I need to stop by medical supply and pick up a few things. Then the birth tub will be paid for and picked up.

This is going to be a home birth.

While this idea has become comfortable for me, it scares a lot of people. So I don't mean to advocate it unconditionally. My experience with Tom in the hospital has given me a lot of faith in conventional medical care, and were I to need their services, I wouldn't get a spike in my blood pressure about it. However, the road less traveled in birth--at least by most Americans--deserves a look. It offers advantages that some women might prefer:

1. You're in control.

2. You can avoid unnecessary medical intervention.

3. You can avoid unnecessary and inflated expenses.

I don't know how it happened, but there's a subtle conditioning at play that says, you're not safe giving birth anywhere except in a hospital bed with a doctor catching the baby and the OR and neonatal unit located just down the hall. When I was about three months from giving birth to my first, somebody asked me whether I'd ever considered home birth, and I was stunned. "You mean, people still do that?" was my reaction. But then I went home and Googled "home birth" and my education began.

Not only do a substantial number of moms give birth at home, but they enjoy lower mortality rates and much lower Cesarean section rates than the rest of the population. Outside the US, where midwives and birth centers (not hospitals) are the norm, outcomes for moms and babies are even better (we're talking industrialized nations here, not the third world).

Not only do home birth moms enjoy better outcomes, they reap incredible savings. While the average vaginal birth in hospital can cost upwards of $8-$10,000 (and you meet parents of toddlers who are still "paying on the birth") a home birth can be as cheap as free. Not that midwives don't request compensation--fees vary considerably--but our first two births were covered completely by insurance.

How's that again?

The typical medical codes and charges submitted by our midwife were reimbursed as if we had given birth in a hospital--which we hadn't--so our midwife's very reasonable fee was fully covered from what they reimbursed us, and she returned to us all that we had paid her on deposit. It doesn't always work out so well. Now we are on a cheap insurance plan with a high deductible. But here again--thank the Lord for home birth! Because the premiums on our current insurance are super-low, we can afford to pay the midwife out-of-pocket and not pay any more than what the premiums under the old plan would have been.

Of course, you must do your homework if you plan to pursue a home birth. I interviewed four midwives with a two-page questionnaire before I found my midwife, the one that seemed more friend than anything and inspired my confidence. I am not suggesting that any mom take risks with her health or her baby. High-risk pregnancies are why we have hospitals. But I do believe that many risks are exaggerated, and pregnancies which would have turned out just fine if left alone are turned into medically-managed "conditions" that scare the crap out of the parents and cost them thousands. Even if I had a so-called "high risk" pregnancy, I think I would consult an experienced midwife before I sought conventional medical help. I've spoken to midwives who've caught 3,000 kids apiece and believe me, they've seen it all.

But how do you get through a labor without pain management? Hmmm. While I am not the be-all, end-all expert on pain (and I hope never to be!), I can offer a few thoughts from my own experience. After having read Dr. Dick-Read's Childbirth Without Fear and a LaMaze manual, I thought I was prepared for the birth of my first. "I've been through boot camp," I thought. "This'll be no sweat." Whoa, was I wrong. Not only was the labor really long (36 hours by my count--Mary's was somewhat less), but the pushing was very hard and I was exhausted by the time the kid came out, bloody wet mess everywhere--about as medieval as you can get. Sounds terrible, right?

But here's the silver lining. Despite the endurance test and mess of that first birth, I may have avoided a host of medical interventions that could have left me with a Cesarean scar and an admonishment about future births. I would have left the hospital with a baby, for sure, but also with a lot of trauma and trepidation about the birth process (not to mention a huge bill). This experience is all-too-common for first time moms, unfortunately. No wonder they swear they'll stop at two.

The funny thing is that after that birth, I felt empowered. I was thrilled with my baby, amazed at my own accomplishment, and (I confess) a bit proud for having done it "my way" (my midwife thinks I was nuts for not using a birth tub). I recovered quickly and was so thrilled about being a mom that we voluntarily got pregnant again nine months later! I just don't think I would have felt the same way about it had the whole thing gone down in a hospital.

But we were talking about pain...I think contractions are more painful when the mom is tense, or afraid. It's not like breaking an arm. There is sensation, pressure...you breathe through it as long as you can. Then you start moaning. Your brain squirms around in your head trying to make sense of everything, and distractions become incredibly irritating. Then you can't think in words at all. Time sort of stops. It's just you and that massive force building up inside you. You moan louder. A weak, downward pushing seems to help. For me, sitting on the toilet seemed to help. Most women feel pain because they tighten up in fear, in fear that the contractions will just get stronger and stronger until they can't handle them anymore. But Dr. Dick-Read was right: they reach a peak of strength and just kind of stay there awhile. But if you can work with them up to that point, slowly, you can manage them (not having nurses running in and out of the room sticking their hands in your vagina is also nice).

Hot water helps.

The second time we used a birthing tub. This is simply a portable hot tub that was set up in the guest room after the labor started. We were caught a bit off guard by Thomas, since I hadn't had a period and we didn't have a sure way to set the due date. But everything came together quickly and the labor was obviously going to be much shorter. Instead of 36 hours this time, the whole thing was done in about 6.

You float in the warm water, and breathe. The midwife shouts into your tin ear, "The baby is moving down! Everything's normal!" You feel the urge to panic a little bit, then someone suggests you change position, grunt a little more. Surprisingly, it works. You can feel that baby moving down. But the contractions are oh-so-powerful. Something else is taking over your body. You have to give in to it. You have to give yourself over to God. This, I think, is the secret to natural childbirth. You gotta have faith in the process, that it is a process that was created by God, and it's natural and normal. Just a few more pushes and--amazingly, incredibly, with a thubbity-bubbity-whoosh--deliverance. Then I brought the baby--still underwater, and whisper-soft--up into my arms, where he immediately drew his first breath, turned pink, and opened his eyes for the first time. Everyone was laughing and crying and we were singing hymns.

As wonderful as my births were, I have to recommend home birth for the aftermath, as well. Instead of a cold tile hospital room with paper sheets, I was wrapped in a warm blanket fresh from the dryer, tucked into my own bed, and brought a cup of strong, sweet tea while the midwife examined the baby and my husband cut the cord. The baby was placed in my arms, where he was urged to nurse immediately. The placenta came out when it was ready, and I was packed into a diaper, on top of a waterproof pad. After I urinated (this part is important to make sure there's no damage to the bladder or urethra), the midwife left for the night with a promise to be back tomorrow. Then...sleep...oh wonderful sleep, that terrible pressure gone, gazing on the face of my new little one, who was allowed to sleep as well (no force-feeding all night).

So there's my apologetic on home birth. Is it for everybody? Probably not. If a mom (or her husband, for that matter) are simply too nervous, then don't bother with it. It's something you have to look into and decide about for yourselves. And I don't advise a woman to go against her husband's feelings on it. Birth is a really touchy-feely thing and everybody needs to be on the same wavelength in order to support the mom. But it can be a true liberation, if learned about and pursued with a proper perspective--in Dr. Dick-Read's words: "a monument of joy."