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January 06, 2011

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Oh DEAR!!!! That was a near-miss or close-call or whatever you call-'em wasn't it? I'm so glad you scheduled the appointment, PHEW! I hope the poor furnace can last a few more good years (did they say it should be fine for a while now?).

And, anyhow, I haven't made it public yet (i.e. blogged about it), but it looks like we're embarking on our second fixer-upper journey. Just in case, we're going to inspect it BEFORE we make the offer (there was a fire in the kitchen 3 years ago and the whole upstairs was redone -- there's a basement). And we just found out that here in Virginia the thorough and lengthy questionnaire-type disclosure we were accustomed to in MA and PA is NOT required. :( BLAH

Are these types of disclosures not used in TN too? I bet it's a Southern thing. And the bad thing is that home inspectors don't catch LOTS of things (we had a thorough inspector in PA and he didn't catch some things) and, of course, they don't want to scare us from buying, right?

From what I've been reading here for the past year, it looks like your inspector missed tons of things too! :(

Good call on the furnace checkup. I lived in fear of The Furnace Death after Freya was born and one day, tiny newborn in arms, there was no heat. On the freezing-est day ever. Furnace Maintenance is good! If spendy! Ugh.

Funny story— the house I passed on buying had listed (as a selling feature) "two year old gas pack!" When I crawled under the house with the home inspector we had a good chuckle— bastard thing was twenty years old if it was a day— date was stamped on it and everything. Apparently the slumlord bought a *used* gas pack and installed two years previous. Talk about semantics.

Hi, Jo, after reading your birth stories, I became curious as to why you chose to rely on midwives and avoid drugs as much as possible during labor and delivery.

I came across some information on the internet indicating that some mothers and health care providers believe that pain medication and other medical intervention during labor can have a negative impact on neonateal health.

I wasn't able to find any references to studies published in peer-reviewed journals, however. Are there statistically sound studies, whose results have been independently reproduced, that show that children have long-term health consequences as a result of the type of care the mother received during labor and delivery?

I found one obstetrician who maintains a (surprisingly passionate) website insisting that homebirth is dangerous and midwives are all lying about how many babies die at their hands (she didn't seem to have any statistics to back this up, just a strong hunch, as far as I could tell), but I wasn't able to find what I would consider verifiable research supporting the idea that children whose mothers received epidurals during childbirth performed worse (or better) by any sort of cognitive or other standards at any given point in childhood.

Am I asking the wrong question? Are persons who choose homebirth, or who choose to avoid epidurals or other drug-based pain management during labor, motivated by OTHER considerations?

I assumed the motivation had to be a consideration for the long-term impact on child health (like the impact of nicotine or alcohol use during pregnancy), but then I realized that I didn't have any basis for that assumption.

I understand you're not setting out to be the spokesperson for midwives, I was just curious about what motivated your choices, thanks.

-victoria

Oh, I'll bite. Hi victoria. Background: I had a hospital birth.

I wanted a drug-free birth because I wanted a drug-free birth. I had been drug-free my whole pregnancy to avoid exposing my baby to anything so I was still pregnant while in labor and the same instinct to protect my baby kicked in.

Also, I didn't want any complications or side effects. Pain passes so I wasn't worried about the pain. Epidurals can have side effects like headches, fever, etc. I didn't want that for me.

Narcotics can make you vomit. I can't imagine how horrible it would be to be in pain and vomiting instead of just in pain. Also: constipation. Not fun.


So, different strokes for different folks, but for low complication singleton pregnancies, Europe generally uses midwives. Often studies comparing midwifery care to ob care do a comparison of Europe to the US (since the percentage in the US is low). It's sort of apples to grapes because Europe has a different demographic than the US, but you get the idea.

So, the studies comparing low complication European-widwife attended births to US hospital births show little risk to mother/child when approrpiate back-up plans for transfer exist in the homebirth. The same infrastructure for homebirth may or may not be present in the US (I don't know), and I think a lot depends on whether you are using a CNM versus a direct-entry midwife.

I'm certain you could get a book on homebirth, flip to the back and find a list of websites, technical papers, etc for reference.

And Jo: I ended up getting a twitter account so I could be cool just like everyone else, so if you're going to tweet, let us know and I will follow you. 'Cuz I know you're waiting for my permission.

Last winter my gas dryer (the one I bought used 6 years before and never did any maintenance to) had a part start to fall apart that clothes were getting snagged on. I, being the handy(wo)man in the family, took it upon myself to fix it. So I bought a replacement part online, read up on how my dryer is assembled, and dismantled it almost completely. The bottom section, where OPEN FLAME shoots through a tube that directs the heat into the drum, was completely filled with lint. I almost had a heart attack when I realized how easily all that lint could have caught fire. It was completely terrifying. Moral of the story: CLEAN OUT YOUR DRYERS!

Also, Victoria, I chose a drug-free homebirth because I figured if natural events in my bedroom could make the baby, natural events in my bedroom could birth the baby too. Humans have been doing just fine (most of the time) with birthing their babies without medical professionals for thousands of years. If I'm not sick I don't need a doctor.

Good questions Victoria. I'm sure Jo can give you references to studies, but another mother (of five) and blogger has also written passionately about the subject of home birth. If you contact here I'm sure she could email you tons of links/info. She's Jamie: http://www.mostgladly.net/cj/
(I think you can click on the "birth" category on her sidebar and also send her an email).

I had an unmedicated hospital birth because that was what I wanted. I didn't know much about midwives vs. doctors back then and apparently my insurance wouldn't have covered midwives, so I had a doctor. Today I would have preferred midwives. 5 minute long impersonal prenatal appointments just don't cut it for me.

Victoria, there are in fact TONS of studies, some older, some brand spankin' new.

I direct you to http://www.hencigoer.com/. Her book, Obstetric Myths vs. Research Realities, is an incredible resource -- citations, discussions. Beautiful. And I am happy to see that the updated version is now in press! Anyway, enjoy! Goer is a treasure.

I know the physician to whom you are referring. She's...not my favorite person. ;)

Regarding motivations, I think it's safe to say that given the appropriate situation (health of mother, baby, no underlying problems) the less interference in birth, the better, both for maternal outcome and neonatal, both short-term and long-term.

omg you wrote niggling? racist.

oh, and to Victoria: I won't even pretend to touch the knowledge my sister and other commenters on this blog have regarding midwifery, hospital births, medication during labor, etc., but I will relate this: I ended up with an epidural, which gave me severe convulsions (yes, convulsions: my husband had to hold my jaw shut during my C-section in order to keep me from biting my tongue off) and the worst headache I've ever had. That and the pain of surgery greatly complicated my ability to experience my son's first day or so of existence. I was, in some ways, numb to the joy and, in others, suffering from the enormous discomfort of medication. Not of labor. Not of delivery. Of medication.

My decision to have an unmedicated homebirth had a lot to do with being a wimp. I really, really, really did not want a C-section. My best odds to avoid one were to have the kid at home. Also, there was never a point in labor where I was really keen to get in the car. Add to that that I have never been in enough pain in my life to want a needle in my spine.

It's interesting to read mothers' explanations for choosing midwives. Thank you.

I was intrigued not because I have an opinion on childbirth (never having participated in the experience) but because I once opted for local not general anaesthesia during oral surgery, thinking local was safer and general not worth the risk.

The (routine, low risk) surgery was so horribly painful that I still (30 years later) have PTSD from the experience.

I cry, shake, and perspire even while having my teeth cleaed -- indeed on any occasion when I have to lie down and have someone in a white coat do anything to me. I have nightmares in advance of every dental visit.

Laughing gas and Valium don't help. Nothing helps. My body sometimes shakes so violently that (even during painless teeth cleaning) they have to hold me down, or give me frequent breaks to cry.

Since then I've become convinced that (for some, at least) the experience of short-term pain can carry long term risk, which turned out to be, for me at least, avoiding the dentist completely for years because I would rather lose my teeth than put myself in the hands of anyone who could do that to me again.

I appreciate learning why people would elect not to have pain meds, thank you.

Victoria - If you're not a candidate for a drug-free birth, that's OK. You might not be a candidate for a drug-free birth. You'll get no judgements from me.

As it turns out, I wanted a drug-free birth (both times), but for the second time, I definitely was not a candidate for it. I had a serious pregnancy complication that necessitated a c-section. Even your strongest vaginal birth advocates do not want a woman with placenta previa to deliver vaginally. So, I had a c-section, and obviously, for surgery, you need anesthesia. I had the spinal (with long-acting duramorph). It wasn't awesome. But it didn't hurt. I had a few side effects (low blood pressure and nausea), but those were quickly handled by competent medical staff (and continuous monitoring by a nurse anesthetist). I would say it was about as good of a surgical birth as you can have.

Victoria, that sounds awful! I'm so sorry you had to go through that!

It's important to note that labor pain is profoundly different from the pain of surgery, or of injury in general. Labor is not the pain of injured tissue, and the body has a lot of mechanisms in place for dealing with it.

For example: I had a terrible experience with an HSG once, that caused a traumatic amount of gynecological pain. It was horrible. But labor was a profoundly different experience -- not that it didn't hurt, especially toward the end, but my brain responded in a really different way. (Although having a cervical check during labor is really painful and unpleasant for me.)

There is just such a wide range of experience with labor. It's almost impossible to compare with injury or surgery.

What a witty story about band-aid. Somehow it is useful indeed.

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