Self-Test: Which birth location is right for you?

Not sure which birth location is right for you? Take this completely unscientific and grossly overgeneralized survey to see if your personality is best suited for a hospital, birth center, or home birth.  If you’re on the cusp, you could go either way, so be sure to read all the results.

1.       Your idea of a heavenly day is:

a.       Hiking in the mountains

b.      Getting pampered at a spa

c.       Dinner and a movie

2.       Your office is holding a potluck. You:

a.       Create the sign-up list, organize RSVPs, and cook two healthy homemade meals – just in case someone forgets their dish

b.      Whip up some of your famous gluten-free oatmeal cookies

c.       Pick up a store-bought lasagna

3.       You find a strange mole on your shoulder. You:

a.       Research skin conditions on the Internet, then apply a homemade salve

b.      Keep an eye on it, vowing to see your doctor if it gets worse

c.       Call your dermatologist – he’s on speed dial

4.       At the grocery store, you:

a.       Always buy organic fruits and grass-fed beef even if it costs more – you’ll just cut back in other areas

b.      Always buy organic fruits but sometimes buy conventional beef (let’s be honest, the grass-fed stuff can get expensive!)

c.       Buy mostly conventional products with a smattering of organic goods ever mindful of the cost

5.       Which television show best represents your personality?

a.       Little House on the Prairie

b.      Buffy the Vampire Slayer

c.       Sex and the City

6.       A friend makes a snide comment about your new haircut. You:

a.       Think: “Who cares? What does she know?”

b.      Wonder if maybe you went a little too dark but decide to stick with it

c.       Feel awful – next time you won’t let your stylist talk you into a new ‘do

7.       You hear a strange noise in the middle of the night. You:

a.       Ignore it and go back to sleep

b.      Think it’s probably nothing but get up to investigate

c.       Call the police

8.       You and your partner/husband get into a fender-bender on the way to the store. Your husband:

a.       Makes sure you’re okay, then gets out to survey the damage, exchange contact information with the other driver, and call your insurance company

b.      Calls a friend to take you to your doctor for a quick once-over

c.       Calls the paramedics – you can never be too sure

9.       When you had to do group projects in school, you were generally:

a.       The self-appointed leader

b.      One of the key team members doing much of the work

c.       A contributor, but you let others take the lead – they probably know more than you do anyway

10.   Which extreme sport would you be willing to do?

a.       Skydiving

b.      Bungee-jumping

c.       Uh, no thanks, I don’t do extreme sports.

Scoring

Give yourself 1 point for every “A” answer, 2 points for every “B” answer, and 3 points for every “C” answer.

Results

10-16 points:  Homebirthing Hero

You’ve got that do-it-yourself, self-confident spirit that’s just right for homebirth. You’re comfortable going against the grain – less than 1% of births take place at home, so you’d better get used to being an oddball - and you can handle a little criticism from friends without questioning your ideals. You favor a natural birth experience, and you’re suspicious of modern medicine’s approach to many ailments. You’re not easily alarmed by the unexpected. You're okay with "roughing it." You like to be in control, and you don’t mind putting in the research and legwork to ensure success. You also recognize that your ideal birth experience may cost more out-of-pocket than the other options, but you’re willing to sacrifice for it. Your husband/partner is calm and collected under pressure with a similar non-alarmist approach and an ability to focus on practical logistics, which is vital when birthing at home. You understand that homebirth involves some risks, but you believe the outcome is well worth it.

17-23:  Birth Center Bound

You want a natural unmedicalized birth experience with a strong support team, and you want the freedom to move around, to labor in the water, and to avoid unnecessary interventions. You’re open to new ideas but cautious, willing to take some risks, but nothing crazy. A hospital feels wrong but a homebirth is a little too kooky for your taste – maybe next time. A birth center provides a calm, nurturing environment for unmedicated birth without having to do all the prep work. It’s that happy space between homebirth and hospital, and since you need to drive there, it feels a little more normal than just plopping out a kid in your living room. You’re also cost-conscious, and there’s a far better chance of getting insurance reimbursement for an accredited birth center than a homebirth, which is nothing to sneeze at. Your partner has the same cautiously optimistic approach to birth – he’ll thrive in a birth center where he can support you emotionally without having to worry about logistics.

24-30:  Happy in the Hospital

When it comes to your birth, you’re not taking any chances. So many things could go wrong, and you don’t want to lose any precious seconds on a transfer from home or birth center to the emergency room. You’ve read tons of pregnancy books and can rattle off dozens of potentially harrowing birth calamities – shoulder dystocia, failure to progress, postpartum hemorrhage, cord prolapse….why take the chance?  You may or may not want a natural birth but you think you can achieve your ideal experience in the hospital where at least you’ll have all the latest high-tech gadgets within grabbing distance if things don’t go as planned. You have a lot of faith in the medical establishment, and you’re not apt to question authority. You might be really, really nervous about the pain of childbirth and not sure you can handle it. During labor you want to be able to sleep, chat with friends, post Facebook updates, and not stress. You care about delivering a healthy baby, that's it. The birth experience is secondary.

Why not have an epidural?



Epidural - yikes!


What I love about my friends is that they're not crunchy granola types who easily embrace things like "perineal massage" or "eating your placenta" or "natural birth." Which means I get a lot of practice justifying my own perspectives on epidurals, hospital births, and cesarean sections while trying not to come across like a condescending know-it-all. And the truth is, sometimes I totally lose the argument.

Take for instance a recent exchange with a good friend who had a c-section with her first birth and made it clear that under no circumstances would she ever attempt a drug-free labor. Her point: If labor is painful (yes) and there are strategies available to eliminate the pain (yes) and those strategies are not excessively harmful to mother or baby (yes), why on earth wouldn't I take advantage of it?

In other words, why not have an epidural?

Natural birthers cringe at such a proposition, but it's a legitimate question. These days, we just don't tolerate discomfort anymore.  When I have a headache, I take Excedrin. If my muscles are sore, I pop Advil. I wouldn't dream of having a cavity filled without novocaine. Modern medicine has given us women amazing ways to reduce pain, and we've readily taken advantage of them. Why suffer? (Unfortunately, this same logic doesn't apply to high heels - why do I still wear them? Why?!)

My instinctual response was to tell my friend that epidurals have awful side effects - that's why you shouldn't have one. But the reality is, if you look at the medical literature, epidurals aren't that bad. There's a chance you'll get a monster headache from leaking spinal fluid, but that only occurs in about 1% of women. There's a very good chance the epidural will slow your labor, especially the pushing stage - lots of studies showing this trend (read here and here) - and that a prolonged labor could lead to other interventions, like vacuum extraction, Pitocin, and forceps, which can result in poor outcomes.  But a major review of medical literature in 2011 found no difference in overall c-section rates or baby's health with or without epidural. It may cause some problems, but overall, you won't be unduly harmed. So if it makes you feel better, why not go for it?

(On a side note, I find it funny that women who won’t eat brie cheese, ingest a sip of wine, or take Advil during pregnancy are often the first ones to have analgesics shoved into their spinal column as soon as the first contraction hits.)

I couldn’t win the argument with my friend, because in the end, my reasons for going natural didn’t have anything to do with side effects, statistics, or medical studies.

We women who choose natural birth do so because we have infinite faith in our bodies to birth. Because we recognize that it’s about more than us.  Because we want to give our babies the best start in life, and we don’t need a long list of scientifically verified side effects to know that sticking a catheter in your spine absent medical necessity is probably not the best start. 

Yes, I take pain killers when I have a headache. But when it comes to birth, I’m willing to tough it out and have trust that my body and baby are working in awesome harmony. I may have to sacrifice a little bit of personal comfort to get that benefit, but that’s okay. Isn't that what motherhood is all about?

Great home birth - now what?

You've had your beautiful home birth, your midwife has wished you well and taken off, and now you're left alone. How should you spend the next few hours?

 

1.  Eat.

Especially if you've had a long labor (and even if you haven't), eat something. You'll be shocked by how hungry you are.  That's why they call it labor!  Have your partner, doula, or any random companion fix you something healthy and nutritious with lots of protein because if you've lost blood, you'll need to replenish your iron stores.

 

2.  Rest.

Don't rush to get up.  Your body has been through a lot, and if you get up too fast, you’ll feel woozy and could pass out.  Just take it easy, let your body adjust.

 

3.  Sleep.

Your newborn likely will take a nice long slumber after birth - take advantage of this rare stretch and catch some z's yourself.  You'll be excited and hopped up on the miracle of home birth, probably wanting to post a zillion Facebook status updates and get some pictures on the family blog, but all of that can wait. You won't have another shot at hours of uninterrupted sleep for a few weeks so enjoy.

 

4.  Don't be afraid to call the midwife.

If you think something's wrong (for example, you start bleeding heavily) or you just don't feel right, call your midwife right away.  She may be able to assess your situation over the phone, or she'll take another trip out to see you.  Either way, she'll want to know if something isn't right.  And if things take a major turn for the worse, dial 9-1-1.

 

5.  Bask.

Congratulate yourself on a job well done. Feel proud of your accomplishment.  You're in the 1% of women who birth at home, and you've given your baby the best start in life you possibly could.

Things they didn't tell me about home birth

If you read the usual blogs, articles, and Facebook lovefests about home birth, you'll start to believe that birthing your baby at home is about the easiest thing you'll ever do. In fact, if you're like me, you'll actually start to look forward to the experience because everyone makes it seem so incredibly awesome.  Even up until the moment I went into labor, I thought my home birth would be kind of like a day at Burke Williams - you know, a mildly uncomfortable deep-tissue massage followed by lots of relaxing teas, cleansing breaths, and Zen-like escape.

Let me dispel you of that notion right now.

Home birth is a great alternative to a hospital birth for low-risk women, and if I had to do it all over again, I'd do another home birth, no question about it. But it ain't no day at the spa.

Here are some things the books don't tell you about natural birth and home birth and that many mamas conveniently omit from their awe-inspiring birth stories.

1.  "Early labor" still sucks.

My HypnoBirthing instructor made it sound like early labor (up until around 5 cm) was just a walk in the park. Oh, just keep yourself distracted when your contractions first start, she said - take a walk, run some errands, watch a movie, catch up with old friends, ha, ha, ha... maybe I have a lower pain tolerance than other women, but for me, “early labor” was still pretty rough. When your previously compact cervix is cranking wide open, it’s kind of tough to fold laundry or take a stroll around the mall. Use the skills you learned in natural childbirth class to get through it.  

  

2. You might have diarrhea.

Seriously. I could not stop shitting. Of the 27 hours I was in labor, I probably spent 20 of them on the toilet as my bowels released every shred of anything I'd ever eaten in the previous 30 years. When the midwife arrived for my first pelvic exam, I emerged from the fetid bathroom and the first thing I said to her - even before “hello, it's good to see you” - was “I have diarrhea.” Diarrhea is extremely common in labor so be prepared. And you might want to give your significant other a heads up while you’re at it.

3. You might bleed a lot.

I’m not talking about a hemorrhage, just a slow and steady drip throughout the labor, like the worst period you’ve ever had. Stock up on maxi pads and congratulations if you’re one of the lucky ones, like me, who had fluids coming out of both ends throughout your labor.

4. You more than likely won't go into labor at 9 a.m. and have everything wrapped up by lunch.

I prayed that my labor would begin at a reasonable morning hour after a good night’s rest and finish in a matter of hours. So naturally, my labor started at 8 p.m. and stretched into the next night. Labors tend to be very inconvenient, and they don’t always obey normal business hours. Think of it as your baby’s way of preparing you for motherhood.

5. You could find all of your comfort aids useless.

I had everything ready to go – the birth ball, aromatherapy oils, a playlist of relaxing music, massage tools. In the end, all I wanted to do was lay in bed on my back without anyone touching me or talking to me. The only thing that really helped was soaking in the tub. Everything else was a waste of money. No big deal, you just need to be flexible and realize that in the end, the best comfort aid is your breath and support team.

6. You'll realize your HypnoBirthing/Bradley Method/Lamaze instructor lied to you.

No, that can't be right, I remember thinking when the contractions first hit.  That felt like pain. But my HypnoBirthing teacher said I'd just feel some pressure, maybe some "sensations." Could she have been…gulp…wrong?  Okay mamas - let’s be honest about labor. Sure, there are some freakishly superhuman moms who manage to get through it pain-free (I’m suspicious of those women) but most of us won’t. Childbirth is not pleasant, and it hurts. There, I’ve said it. So don’t think there’s something wrong with you because you’re feeling pain. We’ve all been there. We got through it, and so can you. Labor pains aren’t going to kill you, and they’re not going to last forever. After a few months, you won’t even remember it.

Don't think you need a birth plan? Think again.

Women having natural births in a hospital often draft birth plans - sort of like a childbirth wish list - to formulate their decisions ahead of time so they can clearly articulate them to the hospital staff.  You might think it’s unnecessary to draft a birth plan for a home birth because you won’t need to fend off an epidural or argue with a nurse over whether you need Pitocin to speed your contractions.  These interventions simply won’t be available to you.  But having a birth plan, even at home, is crucial.

Here’s why:

1. A plan helps everyone get on the same page.

A birth plan documents your preferences: Do you want a water birth? Do you want to eat and drink during labor? What interventions, if any, are you comfortable with? Who will attend your birth? By working with your partner and midwife to develop the plan, you can assure that everyone will have similar expectations going into the birth. Sure, things may change, but at least you have an agreed-upon starting point. It’s far better to work out any differences beforehand.  You can also include instructions for after the birth, such as who’ll be there to help out with the baby and when.

2. Writing a plan helps you visualize your ideal birth.

By thinking about these decisions before labor, you implicitly commit to following through with them. For some reason, when you write your preferences down, they suddenly become more real, and it gives you an opportunity to picture your ideal birth experience. Even if  things don’t turn out the way you imagined, the act of documenting your preferences reinforces your desires and empowers you to make them reality.

3.  It forces you to think about post-natal treatments in advance.

After labor, you’ll be in no condition to decide whether or not you want that Vitamin K injection for your newborn, and your brain may be too foggy to sign an exemption form for antibiotic eye drops. So think about what treatments you may want in advance, research the alternatives, and document your decision in your birth plan. Your can spell out your preferences for the Vitamin K injection, antibiotic eye treatment, the newborn screening blood test, vaccines, and circumcision. 

4.  If you need to transfer to a hospital, a birth plan will help you advocate for your preferences.

Depending on the circumstances of your transfer, you still may want to pursue a natural birth.  And don’t think just because you’re going to the hospital, you’re doomed to a c-section.  You don’t lose all control.  You don’t check your rights at the door. Your birth plan can include preferences about Pitocin administration, epidurals, fetal heart monitoring, and episiotomies.  And you should make clear to the hospital staff that you want to be able to approve all interventions, from inserting an IV line to upping the Pitocin dose. 

5.   A birth plan has all the important information in one place.

You don’t want to be scrambling for the midwife’s phone number or frantically Googling the nearest hospital in the throes of labor. Your birth plan should contain all the critical pieces of information:  names and phone numbers for your midwife, doula, back-up obstetrician, pediatrician, and emergency contact. You can also include phone numbers, addresses, and maps to the nearest emergency room and your back-up hospital (which may be different).

For tips on putting together a birth plan, click here.

For all the multi-tasking mamas out there

Between a full-time job, raising a 3-year-old, taking care of the house and writing, I'm wiped out on most nights. Lately, it's been even more exhausting with all of the (wonderful!) new exposure for How Big is a Placenta Bowl?

It's reminded me of a column I wrote on the 50th anniversary of the birth control bill, sort of an homage to all the multi-tasking we women have to do. Enjoy!

Me multi-tasking: soothing the baby while writing

Want to do it all - and not get pregnant? There's a pill for that

Daily Breeze (Torrance, CA) - Saturday, June 26, 2010

On the 50th anniversary of the birth control pill , as experts expound on its feminist virtues and larger sociocultural impacts, I find myself captivated by this observation from an Associated Press story:

"A world without 'the pill ' is unimaginable to many young women who now use it to treat acne, skip periods, improve mood and, of course, prevent pregnancy."

That a single pill meant to prevent pregnancy now solves all of these problems says a lot about women. Leave it to us to multi-task our birth control.

I mean, who has the time to just prevent pregnancy? If you're going to spend half a millisecond staving off ovulation, you may as well knock out a couple of other errands, too. And so we pop the Pill to treat acne, reverse anemia, manage endometriosis, reduce cramps and cut out menstruation entirely.

Some birth control manufacturers even tout these secondary effects.

Before the federal government slapped them down for misleading advertisements, the makers of Yaz claimed their little pill improved your skin, reduced headaches, curtailed irritability, lessened anxiety, cleaned the bathrooms, cooked dinner and picked up the kids from soccer practice.

OK, maybe I'm exaggerating. But it's no wonder drug companies try to capitalize on the female quest to have it all.

I didn't really get the whole multi-tasking thing until I started juggling motherhood, a full-time job and a husband who'd rather eat three bowls of cereal for dinner than turn on the stove. Now I know why a whole industry exists to help women jam-pack every second of their day with activity.

The other day, while flipping through a women's fitness magazine, I came across an article devoted to "taskercise," which basically entails transforming mind-numbing tasks into mini-workouts. Like doing tricep dips on the edge of the tub while waiting for my kid's bath to fill. Or squats with the laundry basket as I transfer clothes from the washer to dryer. And lunges across the kitchen while preparing dinner.

I guess I should be grateful for the advice. But the whole concept just saddens me. When did I become the kind of person who can't take 30 minutes out of her day to get some exercise? Am I really destined for a life of half-hearted workouts and mediocre dinners?

The picture isn't the same for men. Compared with the 1960s, men today help out more with the housework and child care, but strangely, they also have more leisure time, according to 2005 research out of the University of Maryland.

As for women, now that many of us work outside the home, we've lost that "me" time. Instead, we're heating up food while emptying the dishwasher and catching up with the husband as we sweep the floors.

We turn laundry into sock puppet theater and call it playtime with the kid (I'm grateful my son is still young enough to be fascinated by me folding pajamas).

Almost three-quarters of us women think we have too little time for ourselves, compared with 57 percent of men, and 39 percent of us "always feel rushed." At the end of the day, when I'm reading my son "Goodnight Moon" before bedtime and wondering where the time went, I count myself in that category.

So I don't much fault the makers of Yaz - or any other birth control pill manufacturer - for playing into the hearts of time-strapped women. Promise us a magic multi-tasking pill , and we're happy to indulge.

I'm sure if women stopped to really think about it, we'd laugh it off as the cheap marketing scheme it is, a half-baked attempt to profit off the frantic pace of our lives and our desire to have it all.

But unfortunately, we don't have the time.

Home birth isn't for everyone and that's okay

Every once in awhile, I find myself on a home birth blog or Facebook group where someone posts a question like this one:*

"Looking for some advice from my fellow HB mamas - I'm 34 weeks pregnant with breech twins. Recently I started bleeding, and a trip to the back-up OB confirmed that I have a slight placental abruption. Also, I tested positive for GBS (did I mention I have gestational diabetes?)  I really, really wanted my VBAC home birth, but now I'm not so sure. What do you guys think? Has anyone ever had a successful VBAC/twin/breech/GBS positive/gestational diabetes home birth with placental abruption?"

Posts like this one frighten me on so many levels. First, why are you trying to get medical advice from a blog?  Second, why are you even considering a home birth? Even more appalling are the responses, which can often be downright encouraging of home births in high-risk situations. Just because one person had a successful VBAC-twin-breech home birth doesn't mean that you should.

Let me be clear. I'm not saying that a VBAC automatically disqualifies you from a home birth. Or twins. Or any one of those risk factors on their own. What I'm trying to confront is this increasingly narrow definition of "high risk" that leads many otherwise poor candidates for home birth to believe that home birth would be safe for them. Yes, you might have a perfectly fine birth in your living room. But if you have risk factors, why take the chance?

The research shows that home birth is as safe as a hospital birth only in low-risk situations. We should be grateful that we live in a society with state-of-the-art hospitals that enable high-risk women to deliver healthy babies. As much as I love home birth - and I firmly and strongly believe that women should have unlimited support and access to home birth - I wouldn't chance a risky labor in my house. There's just too much riding on it.

And here's why I worry. The American Medical Association and the American  College of Obstetricians and Gynecologists are just itching to give a big "I told you so" every time a home birth goes wrong. If more and more high-risk women choose home birth and those births result in disastrous outcomes, there could be a serious push against home birth. And that's going to ruin it for everyone.

This is why we need qualified and licensed midwives, why these midwives need to be conservative in their approach, and why home birthers need to trust in their midwives - even if they recommend a hospital birth - and ignore Facebook comments.

Because in the end, it's not just about a single birth. It's about all of us finding support for home birth from a society generally hostile to the idea, and we need all the help we can get.

*It has to be said that this is not an actual post, just a spoof - thank goodness!

Stuff Homebirthers Like #5: Ina May Gaskin

Every good cause needs an inspirational icon - that all-knowing, omnipresent figurehead with just the right amount of elevated expertise and popular appeal. For homebirthers, that icon is Ina May Gaskin.

Don't worry if you've never heard of her. Most people outside the natural birth world aren't aware of the Farm midwife and original homebirth crusader. But to homebirthers, Ina May as we call her (as though we know her personally) has reached goddess-like proportions. When she speaks, we hang on every perfectly uttered word. When she writes, we buy multiple copies of Spiritual Midwifery so we can give them to expectant friends, keep one for ourselves, have another in our lending library...

When she makes appearances, we flock to meet her so she can bestow upon us encouragement and empowerment in peppery aphorisms like "Your body is not a lemon" and “Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.”  Who can't get jazzed up about natural birth after reading affirmations like that?

She's completely likable with her fluffy gray hair and frumpy dresses, sort of like your grandma if your grandma were a tough-as-nails ex-hippie willing to talk shit about the medical industry while empowering generations of women to take back control of their bodies.

So yeah, we worship Ina May. We buy her books. We post her quotes on our Facebook pages and create whole Web sites dedicated to her words. And we pay homage in cheesy photo collages. Ina May - we heart you.

Tip #3: Recruiting your care team

Home birth may seem like an intimate and solitary experience - at least compared to the hustle and bustle of a hospital ward - but you'll need a lot of people behind the scenes to make sure your birth is a success. One of your most critical tasks will be lining up this all-important care team. You'll want these folks on your side.

Midwife

Your midwife is the No. 1 key player on the care team. She's the medical authority. She'll conduct your prenatal visits, refer you for prenatal testing if desired, monitor your health and the baby's health during labor, and give your newborn a quick check-up after birth. Referrals are the best way to find a midwife, but you can also try the search features at Mothers Naturally (affiliated with the Midwives Alliance of North America) or Midwife.org (affiliated with the American College of Nurse-Midwives).

Midwife’s Assistant

Your midwife should have an assistant she brings to the birth to help set up the room and act as a second set of hands.

Back-Up Obstetrician

Yes, even in a home birth, you need an obstetrician in case something goes wrong or you decide to pack it in and go to a hospital.  In a true emergency during labor, you’re going to head to the nearest emergency room and see whomever’s on call.  But sometimes, an issue emerges before labor, such as a breech presentation or a baby that’s gone past its due date.  In these unexpected circumstances, you’ll need to work with an ob/gyn to assess your options.  Your midwife probably has an ob/gyn with whom she works.  Set up at least one meeting with the ob/gyn in your last trimester. 

Back-Up Midwife
Every home birther dreads the thought of her midwife being sick or away on vacation when she goes into labor.  But your midwife should have another midwife who backs her up under these circumstances.  Meet with the back-up midwife in advance just in case she arrives for your birth.

Pediatrician

You'll need to take your newborn to the pediatrician within 24 hours of the birth just to make sure everything's okay. Meet with the pediatrician in advance and let him/her know of your home birth plans. 

Releasing fear (with no help from society)

Take a look at this trailer for the movie "What to Expect When You're Expecting:"

This shit just drives me batty. Overblown characterizations of labor are why women are afraid to give birth naturally. Look at these women - screaming, sweating, cursing, yelling at their husbands. No wonder why many moms go into childbirth thinking there's no way they can withstand it.

When I was giving birth, the scene was totally different. No screaming, no panting, no swearing, no demanding an epidural (okay, there was a little of that toward the end). Maybe some quiet moans or grunts, a few long sighs. But I never felt the urge to scream at the top of my lungs because it wasn't that kind of pain. Good grief, these woman act as though they've severed a finger.

Which brings me to the notion of fear in pregnancy and childbirth. Our culture is very good at making pregnant women totally paranoid. At the outset, you're given a list of things you shouldn't do. Don't eat deli meats or soft cheeses. Don't even look at sushi. Don't let your heartbeat exceed 140 beats per minute. Don't lay on your back.  Don't have so much as a sip of wine. Don't take Tylenol or Advil or anything remotely linked to a pharmaceutical company (until, of course, you go into labor - then have at it!). 

You're made to feel as though pregnancy is a disorder rather than a fleeting condition. And you're made to feel - at every turn - that you're just one brie slice away from hurting your baby.

Which is probably why many women turn to hospitals and surgeons and high-tech medical interventions to manage their pregnancies and births. We've been told for nine months about everything that could go wrong rather than the reality, which is that - statistically speaking - you are overwhelmingly fine and your baby will be fine.

That bit about not eating certain foods, like cheeses or meats, because of the possibility of listeriosis? Your chances of contracting listeriosis are 3.4 in 1 million. In other words, infinitesmal. On the other hand, your chances of dying in a car accident on the way to a prenatal appointment are 1 in 20,000.

Still, our culture focuses on the fear. It perpetuates the myth of the fragile expectant mother and obsesses over the slim risk of harm. It features women screaming in labor, completely alienated from their own bodies. It subtly and insidiously tells us what we can't do instead of rejoicing in what we can do.

Forget about "What to Expect When You're Expecting" - you don't need to expect fear, pain, and disconnection from your pregnant body.

Expect that you can do it. Because more than likely, you can.

Stuff Homebirthers Like #4: YouTube birth videos

When’s the last time one of your friends shared a video of her baby emerging from a caesarean incision? Probably never. But you’re almost guaranteed to get a video from your homebirthing pal. In fact, she posted her birth on YouTube and made it public so complete strangers can marvel at her expanding vagina.

Homebirthers love sharing videos of their births. Often these videos contain photo montages of moms slumped over birth pools as new age music plays in the background. Sometimes the videos have captions cut in – “almost there!” or “1 centimeter to go!” – sort of like a football play-by-play but with more sweat.

Put “birth video” into the search field on YouTube and the whole first page of results gives you homebirthers in action (okay, there are also some animal births and a Monty Python sketch). But what you won’t see, until you dig into the depths of YouTube, is video of a hospital-gowned woman delivering her baby with the aid of an epidural, a fetal heart monitor, and a small army of medical personnel. It's not that hospital-birthers don't film their births. I'm sure they do. They just don't broadcast them to the world.

So why do homebirthers feel compelled to publicize their births? Well, for one, home births are pretty fucking cool. If you've never seen a natural labor, watch a video. It's an amazing sight, sort of Marcus Welby meets Little House on the Prairie but with way more tarp. You can't help but feel impressed by the miracle of birth and how fabulous women can look even in the throes of labor.

And lest you think these videos are intended to educate close-minded rubes about the benefits of homebirth, let's clarify the second reason homebirthers post to YouTube - because other homebirthers consume homebirth videos like encapsulated placentas. Homebirthers watch birth videos so we can say, "Holy shit, I did that?" and then, "Holy shit, I did that!"

Three prenatal tests every homebirther should get

(and others to consider)

Some homebirthers are wary of prenatal testing, but for others, a quick lab test or ultrasound peek offers some peace of mind. Regardless of where you stand on the more invasive tests like amniocentesis or ultrasound there are three prenatal tests that every pregnant mom should get, even those planning to birth in the most natural umedicalized way possible. I've also included some other tests you should consider - and how to get them if you're planning a homebirth.

1.  Urine tests. Your midwife should perform urine tests several times during your pregnancy; at every prenatal visit is best.  Usually, the urine test involves peeing in a cup, dipping a strip into the urine, and observing any color changes. This non-invasive test is essential for detecting sugars - which could be an early warning sign of gestational diabetes, proteins - which could signal preeclampsia, and bacteria - which could point to a kidney or urinary tract infection. It can be performed in your own home or your midwife's office.

2.  Glucose tolerance test. In your third trimester, you should undergo a glucose tolerance test to rule out gestational diabetes. This test involves fasting for a few hours, then drinking a high sugar drink (your midwife will give you the glucose liquid) or consuming a dose of high sugar foods/drinks like honey and apple juice.  Within an hour of consuming the sugar, your midwife will draw blood, which she'll send to a lab for analysis. If your midwife is not able (or doesn't want) to draw blood, she can refer you to a lab where you can have the test completed.  If it turns out you have gestational diabetes, your midwife can prescribe dietary or activity changes to manage it.

3.  Group B Streptococcus (GBS) test.  GBS can cause urinary tract and bladder infections in pregnant moms, and in more serious cases, meningitis and stillbirths.  The risk of GBS is that you'll pass it to your unborn baby during labor.  A newborn with GBS may have breathing problems, meningitis, or gastrointestinal problems. The test involves swabbing your rectum and vagina, then sending it off to a lab for a culture. If you test positive for GBS, you may want to consider antibiotics administered intravenously during labor or homeopathic remedies 2-3 weeks prior to delivery.

Other tests:

If you're like me, you're all for a natural unmedicalized birth, but you also don't want any surprises. Here are some other tests I would strongly recommend. Your midwife will not be able to perform these tests in her office or your home, but she can write you a prescription or a referral to another office that can perform them.

First trimester screen.  This is a two-part test in the first trimester to rule out chromosomal abnormalities including Down Syndrome and Trisomy-18. First, you'll need to get an ultrasound that observes fluid in the nuchal folds behind the baby's neck. Second, you get a blood test measuring pregnancy-related hormones. Taken together, they give you the risk of your baby having an abnormality. You may think: Why do I need to know? I don't plan to terminate the pregnancy either way. True, but knowing gives you time to prepare and to seek out possible medical interventions, such as fetal surgery for spina bifida.

Ultrasound. Aside from learning the baby's gender, an ultrasound provides a reassuring picture inside the womb. I had one done late in the pregnancy to confirm the baby was head down. The ultrasound also allows you to rule out placental abnormalities.

For more on prenatal testing, go to the American Pregnancy Association.

Stuff Homebirthers Like #3: Placentas

Most people consider it a bloody uteral organ that goes straight into a biohazard bin. Homebirthers call it a lifeforce, the tree of life, or an all nourishing source of energy and are more likely to stick it in a blender.

Homebirthers adore their placentas maybe even more than the babies themselves. We wouldn’t dream of throwing it out with the rest of the birth detritus. Homebirthers spend months thinking about what they’ll do with their placenta once it’s out. Freeze it? Encapsulate it? Slice it up and put it in a lasagna? Bury it beneath a tree? The possibilities are endless and include everything but throwing it in a dumpster, which is illegal in most states anyway.

We swap placenta recipes. We share referrals for people who dry it up so we can pop placenta pills for months after its emergence. Sometimes we take the bloody mass and make art prints from it. Then, when someone asks about the Jackson Pollock-esque painting on our living room wall, it gives us another chance to talk about our homebirth (see #2).

Stuff Homebirthers Like #2: Talking about homebirth

Homebirthers will never miss an opportunity to mention their homebirth. It will come up in a conversation like this: “Oh you need help lifting that box? Well if I birthed my baby at home I can certainly lift a silly old box…”

Or “Sure I can run a marathon, I had a homebirth, didn’t I?”

Or “Excuse me, sir, where can I find the organic granola? My homebirthed child is hungry.”

Look, we plugged through months of childbirth training, hours of natural labor and incessant amounts of fluid discharge to have that baby at home and we’re damn proud of it. Statistically speaking, in a roomful of 100 women, we’ll be the only one who had a homebirth. We plan to make sure the other 99 women know it.

If you find yourself confronted by a homebirther, you must indulge her. Ask questions about how she endured labor for 30 hours without an epidural. Marvel at her ability to withstand pushing for two hours. Prod her with questions like "Isn't it messy?" so she can laugh in a silly-you kind of way and prattle on for another 20 minutes about the amazingly empowering experience that she went through and chronicled in graphic detail on her blog, "[Insert name here]'s Amazing Home Birth."

If you're lucky, another homebirther will come along to rescue you because the only people who can stand to listen to yet another birth story are other homebirthers. Your best bet to avoid the sheer boredom of hearing another labor play-by-play is to avoid eye contact with a homebirther or better yet have a homebirth yourself.

Stuff Homebirthers Like #1: Affirmations

Homebirthers have never seen an inspirational quote or positive affirmation they didn’t like. The most popular inspirations describe motherhood and the act of natural childbirth as expressions of female empowerment, manifestations of pure feminine beauty, and sacred blessings/ birth rites/ treasures. We also love any words uttered by Ina May Gaskin. Affirmations remind us that we’re not crazy for birthing at home. In fact, we’re way more enlightened than you are. We’re strong and powerful, but you know, in a totally feminine way, not like sweaty truck drivers.

Sometimes homebirthers write positive affirmations on flashcards to review while we’re laboring. Other times, we listen to CDs that ply us with encouraging words. The inspirations keep us positive while our cervixes are contorting to inhuman proportions and our uteruses are swelling like balloons (sorry, think positive  – “blooming roses”). But mostly, these little nuggets of encouragement appear as Facebook posts so we can share them with friends and make comments like “so true!” and “brought tears to my eyes.”

It’s a bonus if the affirmation comes with an image, preferably a baby – or baby hand/baby foot – or a woman lightly resting her hands across her protruding belly. Black and white images are especially heartwarming as is anything that depicts a man supporting his homebirthing wife. That shit just makes us melt.

The v-word (vaccinations)

I recognize that many homebirthers choose not to vaccinate their children. But many of us do. For those of us who choose to immunize, what do we need to know?

First, allow me to get on my soapbox for a bit about why I vaccinated my son and why I think it's a good idea.

A large population of immunized individuals provides what's called "herd immunity," which dramatically reduces the chance of a disease outbreak - that's good news for everyone, especially since vaccines aren't 100% effective at an individual level.

In the last couple of years, as the rate of unvaccinated children has increased to as high as 12% in some communities, we've seen outbreaks of diseases that were once largely eradicated in the U.S., including measles outbreaks in California and Minnesota and a whooping cough resurgence in California in which many children got sick and some died. Personally, I can't stand to watch my child in pain or discomfort even from a run-of-the-mill flu, so the thought of my kid getting measles or whooping cough is too much for me to bear.

I know a lot of parents worry about the harmful effects of vaccines. I do, too. But so many studies have discredited the link between vaccines and autism (in fact, the original study that started it all was not only a bad study - it was an outright fraud and the doctor has subsequently had his license revoked). Bottom line is, the risk of not vaccinating is far worse than the risk of doing it. At minimum, I'd encourage you to vaccinate on a non-traditional schedule at least for the most harmful diseases (for example, get MMR but skip chicken pox or spread the shots over a longer period).

I know my pro-vaccine stance is controversial, especially among homebirthers, but as our ranks become increasingly diverse, the homebirth community will need to be inclusive of those who want to immunize their children. We homebirthers love to do our research, and we're good at being skeptical - please, please, please scrutinize the claims on both sides of the vaccination debate and come to your own decision about what's best for your child and our society.

If you're birthing at home, keep these tips in mind:

1. Tell your midwife your plans.
If you plan to vaccinate your child, it's a good idea to give your midwife a heads up. She may not agree with you. That's okay. But she shouldn't make you feel bad about your decision or try to dissuade you in any way. It's your decision.

2. Plan ahead on the Vitamin K shot.
Most states require newborns to get a Vitamin K injection within a few hours after birth. Although I don't consider this shot a vaccine, Vitamin K prevents a rare but serious bleeding problem called hemorrhagic disease of the newborn (HDN), which stems from a baby's naturally low levels of Vitamin K at birth. You can choose to have Vitamin K administered as an injection, orally, or not at all. If you don't want the shot, you'll likely need to fill out an exemption form, which your midwife can provide. Think about what you want to do well in advance of the birth and include your decision in your birth plan.

3. Don't fret about Hep B.
The first dose of the three-dose series of the Hepatitis B vaccine is usually given to newborns in the hospital. Obviously, if you birth at home, your baby will miss it. Not a big deal. Hep B is spread through bodily fluids - blood, semen, saliva - so your baby isn't likely to be exposed so early in life. Your pediatrician can administer the first dose at your first immunization visit and get you back on track fairly quickly.

4. Find a like-minded pediatrician in advance.
Before you even give birth, you should have your baby's pediatrician lined up. Talk to the doctor about vaccines. If you want a non-traditional schedule, find out what your pediatrician would recommend. Most doctors today are willing to work with parents who want less traditional immunization schedules, but you'd be hard-pressed to find a pediatrician unsupportive of vaccines entirely. The Centers for Disease Control has information about the "traditional" schedule. Go over it with your doctor. What can you put off? Which ones can you spread out?

If you're interested in exempting your child from immunizations all together, you'll probably need to file paperwork with the state. Talk to your midwife or pediatrician about the details.

Top 10 reasons to hire a doula

If you're having a home birth, you may not think you need a doula. After all, when you're laboring at home, you won't be fretting over epidurals or arguing with nurses over your kooky HypnoBirthing birth plan. But in some ways, doulas are even more important during a homebirth. And because I didn't have a doula for my homebirth, I learned this lesson the hard way.

Here are 10 reasons to hire a doula for your homebirth.

1.  Doulas understand the birth process.
A certified doula receives formal training in childbirth and hands-on experience as a labor assistant.  They learn ways to support natural birth - everything from calming affirmations to different positions to enhance your comfort. Your well-meaning friends can boil you some tea during labor and offer reassuring words, but they likely won't understand the birth process the way your doula will. And having that professional experience - especially if this is your first experience with natural childbirth (see #7) - is invaluable.

2.  They'll be there whenever you need them.
Most of us aren't lucky enough to go into labor at 9 o'clock in the morning and have it all wrapped up by lunch.  On the contrary, labor can be awfully inconvenient, and when you're laboring at home, you don't have the luxury of a 24-7 nursing staff.  Friends and family who volunteer for labor support are great, but they may not be thrilled about having to drag themselves out of bed at 2 o'clock in the morning. Your doula, on the other hand, will show up whenever you need her, even if it's at the crack of dawn, in the middle of the night, on Christmas Eve or during her cousin's wedding. She's paid to be on call, and that's good to know.

3. They're in it for the long haul.
There was a moment during my 27-hour labor when I looked around the room and realized I was alone. My mother was sleeping. My husband had crashed. And there I was, breathing through each contraction, desperately craving a glass of water and wondering whether someone - anyone - could please, please, please turn down the heat. With a doula, someone will always be there with you. If your doula can't swing a 30-hour all-nighter, she'll at least help manage the shifts so your partner can get some rest while she's on watch and vice-versa.

4. They take the pressure off your birth partner.
This one goes along with #3, but I'll take it even further. Aside from being there to physically relieve your partner, the doula is an emotional relief. Just knowing someone else is there - and someone with far more experience - is reassuring to others in the room. Your doula can answer questions, offer advice, and make suggestions, empowering your partner to be the best support he can be.

5.  Your midwife will appreciate it.
Your midwife is the medical authority during labor. Her job is to focus on your health and the baby's health, which means she'll be checking your vital signs, giving you pelvic exams, and monitoring the baby's heartbeat. Although your midwife is likely to be nurturing and supportive, that's not her primary responsibility. She's not going to sit at your side for 15 hours as you limp along toward 10 centimeters - she's there to deliver your baby. So your midwife will probably appreciate that you have someone knowledgeable about the birth process to be at your side for comfort and support. It takes the pressure off of her to fulfill that role and enables her to concentrate on what she does best: delivering healthy babies to healthy moms.

6.  They've been there, done that.
By the time your doula attends your birth, she's probably seen a lot of other labors. Which means you don't have to worry about your labor being weird or unusual - your doula can reassure you that everything's normal or suggest you call your midwife if something warrants attention. 

7.  First-time mothers need more support.
First-time mothers are overwhelmingly more likely to transfer to a hospital during a home birth - up to 40% of first-time moms compared to 10% for those who've previously had children, according to some studies. At least one midwife I know requires first-time mothers to have a doula in attendance. Bottom line, doulas provide outstanding birth support. The 2006 Listening to Mothers II survey found that 88% of women ranked their doula support as "excellent" compared to their partner/husband at 72%. So if this is your first time around, a doula can be a wise bet for you and your first-time partner.

8.  Doulas won't take it personally.
You may not know how you're going to react during labor. You might make weird noises. You might scream or moan. You might snap at your well-meaning birth partner when he tries to massage your back or sponge sweat off your forehead. But while your husband might get offended, your doula won't take your emotional outbursts personally. And she can help put your crabbiness in perspective for your bent-out-of-shape hubby.

9.  Doulas are a great resource for other assistance you might need.
Many doulas are also lactation specialists, childbirth educators, or prenatal yoga teachers. But even if they don't have specific outside expertise, most doulas at least know where to find it. Since doulas are well tapped into the natural childbirth community, they can refer you to breastfeeding specialists, babywearing experts, like-minded pediatricians, natural parenting stores, and anything else you might need. They're a good source of advice and can also put you in touch with other homebirthing mommies.

10. You might have a better outcome.
This is probably the best reason to hire a doula. Numerous studies show that a doula's continuous presence, hands-on support, and encouragement can improve your labor and increase your success at breastfeeding. One study found that women who received doula support in a hospital were more likely to have a shorter labor and fewer interventions, and my favorite study (which was randomized and controlled - hello, gold standard of research!) showed that women with a doula were much less likely to end up with a caesarean section - 13.4% versus 25% - and less likely to get an epidural - 64.7% versus 76%.  Although these studies took place in a hospital, I have to imagine the results would hold for a homebirth.

Bottom line: I've never met a woman who regretted getting a doula. To find out more, go to DONA International, CAPPA, or ICEA.