Guest Blog by Tamara Tarasova

Safe and happy birth is a beginning of a new life for your baby and also for the whole family. That's why creating a birth plan may be one of the most important decisions in your life. Fortunately, the Washington DC area offers many varied options. In this article I explore some of them and share my story of how I ended up with a planned homebirth.

From the very beginning I would like to say that this article does not advocate a home birth, nor does it promote any specific services. My personal and professional interests are far from the area of medical care. However, I wanted to share my experience with those who may consider this as an option, because this experience was extremely beneficial for our family.

I first learned about home birth nine years ago when I was in Ukraine, pregnant with my first child. I read the Baby Book by Dr. Sears, an American pediatrician describing home labor of his wife Martha in a birth pool. To me it all sounded like another planet – a stress-free birth in the home, a mother surrounded by beloved and trusted people rather than technical devices, and a birth pool instead of drugs for pain relief. At that time and in that place, it was unrealistic to think of it as a real option. So like most women I knew, I had a hospital birth -- which could have been better-- however, my daughter was born healthy and that was what was most important.

Several years later I was pregnant again, this time in the U.S. And I immediately started to look for a ‘good’ doctor and a ‘good’ hospital. Good in my terms was the one that would favor my inclination towards a natural birth and provide a reliable back-up in an emergency.

At first I chose Inova Fairfax Hospital – one of the hospitals closest to me. I found out that they specialize in risky pregnancies, which I considered to be a great plus and requested names of doctors having a privilege there. I was not a risky patient, but what if…?

My doctor was a highly experienced professional, however, as my pregnancy progressed I increasingly felt that my smooth pregnancy was being treated more as a medical condition, rather than a natural process. When I was asked: ‘Who will deliver your baby?’ my “pregnant brain” was shocked by the literal and implied meanings of this question. Deep inside me I wanted to reply: ‘Who’s going to deliver my baby? Of course it’s gonna be me!’ At that moment I realized how important it was for me to take full charge of my pregnancy and delivery. But how?

When searching for alternatives I found an article at the Washingtonian very helpful. Among the alternative options I learned about were birth centers. There, the least possible interventions are made during birth and women are assisted by Certified Nurse Midwives (CNMs). CNMs are certified professionals who provide prenatal care, birth assistance, and help with newborn care. However, if a c-section is required or other emergency occurs, a woman is transported to a hospital. The downside of this option, besides a double transportation in a worst-case scenario, was their long waiting list. However, I still got a call from them lately while being 8^th in the waiting list initially, thus, if you find this option appealing don’t be discouraged by the waiting list.

By this time I also discovered that Virginia Hospital Center in Arlington and Fair Oaks hospital welcome natural births. Much later I also came to know that the George Washington Hospital in DC offers the option of a water birth with a midwife and the security of having a doctor on call in an emergency.

The more I learned about alternatives, the more dissatisfied I became with my own doctor’s approach. Finally, I had an incident that made me very reluctant to continue with a traditional doctor and hospital approach. I had a very painful examination ‘to be sure that I was at no risk’ after which I had some issues, though minor. But when I was told that this examination had to be repeated every 2 weeks till the end of the pregnancy (I was in the middle of the term) I got scared that my quite smooth pregnancy would end up with a risky one solely due to this regular intervention. A specialization in risky pregnancies--something that I found appealing in the beginning—now turned out to be a negative factor. I had no doubts that no matter how healthy I was, I would be treated as a sick patient.

Around this time, a friend in New York City called me to share her happy home birthing experience with a doula (woman specially trained to assist moms using breath techniques and other natural pain relief methods). ‘I am not calling you to have a home birth, just don’t go to the hospital you don’t like…’ She broadly supported my search for local options but her positive experience with home birth was compelling. Home birth… hmm… The more I thought of this idea, the more I liked it: I would not have to travel while in labor, I would not risk in having any unnecessary medical intervention, I would not live through a stress of being in a hospital which was a very important factor for me. And finally, haven’t women delivered babies for centuries in this way?

But is it safe? What if something goes wrong? What about the mess? I began asking these questions of a Certified Professional Midwife (CPM) – a person specifically trained and licensed to assist home births. Her name was kindly provided by the BirthCare center in Alexandria.  This is what I learned:

Prenatal care. CPMs monitor pregnancy on a regular basis following the same schedule as doctors. CPMs widely use natural means and work in cooperation with natural medicine specialists, including acupunctures and chiropractics. Whenever a risk arises for the mommy or the baby that could not be handled in such a way, a midwife refers a client to a back-up doctor. It is important to find a back-up doctor in advance and to find about his/her membership in your insurance network.

Birth. Midwifes provide a list of things that would be necessary for the birth and they come over a few weeks before to make sure that everything is in place. All of the birth details are discussed with a midwife in advance, including time for calls and any of your special requests. Throughout labor the midwife regularly checks baby’s heartbeat and monitors mother’s blood pressure. After birth they provide full examination of the mommy and the baby and issue official papers to be presented to pediatric practices and authorities to obtain the birth certificate. They also do all of the cleaning and you don’t have to deal with any mess. Nice surprise!

Birth pool. Even if a woman decides not to deliver in water, this pool could be used as effective pain relief at any stage of labor. Specially designed birth pools could be rented from midwifes. They are spacious and keep the water warm (great for a spa day too).

Emergencies. Midwifes are trained medical professionals and they know how to provide help to a baby and mom in difficult situations. There is always a contingency plan including transportation to the nearest hospital by a midwife. In case of emergency the midwife accompanies the patient throughout the whole process of check-in.

Postpartum care. The midwife visits mom and the newborn on the next day after labor, a week after and about a month later. However, she is always available for any extra visits and advice as for lactation, health and emotional issues.

Pediatric care.  Before delivery a mother chooses a pediatrician.  Most practices require the first check-in within 1-2 days after a homebirth, though some may allow a longer period to stay at home.  In this way the newborn benefits from both the natural approach of your midwife and the medical care of a pediatrician during the first days of her life.

Finances and contracts. Finances and obligations of the parties are regulated by a contract signed between a midwife and a mom at the beginning of cooperation. Prenatal care and labor coverage vary a lot in different insurance companies and plans. Although home birth itself is usually not covered, the midwife services often are, which is often the most substantial cost of a home birth. In and out of network coverage policy would also affect your amount paid out of pocket.

Having been reassured by the contingency planning and quality of the care provided by midwives, I made the decision to leave my doctor and plan for a home birth. And our family had a wonderful experience! My son was born healthy and my labor was easy and even kind of fun. Throughout pregnancy, labor, and the postpartum period I was supported by my midwife’s professional skills and emotional encouragement. As for pain management, the stress-free environment helped lessen the tension of my muscles and made labor much easier to bear.

Finally, there are some of the lessons learned from a home birth that I would like to share:

Lesson 1. Trust yourself! I learned to trust my intuition, my body and the boy gently kicking inside me. Those who advocate for a natural birth often refer to the innate wisdom of a woman, and I could not get the point until I experience the home birth myself. I learned to distinguish between real concerns and fears, with the last often exaggerated.

Lesson 2. Homebirth requires responsibility. Unlike a hospital, where everything is prepared for you, you take care of all of preparations and make important decisions. You need to know a lot more about birth and pregnancy if you want to experience birth at home. And, if you have a pre-existing condition that requires special care, you are the one to make the decisions on the scope of additional medical care.

Lesson 3. Homebirth is legal but is contrary to mainstream. For instance, not all of the pediatricians deal with home born babies and your pre-delivery gynecologist may exclude you from the practice after home birth. However, overall, it is no more challenging than finding a doctor you can count on in any other situation.

Homebirth is not for everyone, especially those with complicating medical conditions or risk factors. However, for women with normal pregnancies and who favor a non-medicated approach, it is an option that I encourage you to research. Although it requires more planning on your part, the reward can be a more relaxing birth experience for you and your baby.

Acknowledgments: I am very grateful to my husband, my friends Maria and Eun Joo for encouraging me in pursuing my decision. I am thankful to my midwife and her assistant for their generous support and professional advice. I am also grateful to my mom, who, being extremely worried and initially opposing this option, believed in my intuition and granted me with all her love and support. I am thankful to my daughter for her courage, support and deep wisdom.

Tamara Tarasova is a Life Style Coach and mother to a nine-year old daughter and toddler son.  She blogs to reveal her professional insights and also to share some of her personal stories with other moms.  To learn more about Tamara and her coaching services please visit her website at www.highheelcoaching.com.  To find local birth centers, hospitals, OB/GYNs, midwives, doulas and more, see DC Metro Mom's Health & Parenting Support Guide.

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