Q&A: dispute about birth location

I hope this doesn't turn into "I disagree with my partner" week around here, but here's number two. Katie writes:

"I'm hoping you and the readers can shed a little commonsense light on my current *drama*.

I'm 20-ish weeks pregnant with my 2nd child. With my first, I had planned to go natural all the way, but at a hospital; I ended up with an epidural and pitocin. I had really looked forward to trying a home birth with my second. However, my husband is completely opposed to this idea.

He knows the statistics, he respects my desires, and it's not like he's "put his foot down" or anything medieval like that. But over the course of several conversations it's become clear that what he wants (all possible medical options readily available for mother and child) is not going to change. He's all for natural birth, it just has to be at a hospital for him to feel safe. I have extremely ambivalent reactions to this. On the one hand, I am all "womyn power" and wondering what the hell right he has to tell me how to do something that a man has actually never once done -- and what if this is my last child, my last chance to maybe have a birth go maybe sorta kinda the way I want it to? On the other hand, this is his child too, and the lives of two people he loves very dearly are at stake in what can be a pretty dangerous endeavor, and it's not unreasonable for him to want to protect us by having doctors ready and waiting.

I have a feeling we're going to end up with a classic compromise, where nobody involved is happy. I am truly, physically afraid of being in the hospital again, and my biggest fear is that even if we stay home until labor is pretty far along, once we get to the hospital my labor will stop because I am so freaked out, and then it's drugs and numb legs again. But I just don't think a home birth is possible without a partner who is in it a hundred percent. If any of your readers have had a similar situation between two stubborn spouses, I'd love to hear how things turned out."

It would solve everything if there's a true birth center in your area. Then you could have a birth that doesn't terrify you, and he could have a birth that doesn't terrify him.

Because that's what this really boils down to. You are terrified of being in the hospital, afraid of what's going to happen to your body and your autonomy and your child. He's terrified of not being in the hospital, afraid of what could happen to you or your child. And no matter how many stats you can show him (that planned homebirth is at least as safe if not safer for mother and baby than hospital birth, especially for a second baby) he's not going to lose that fear. No matter how many stats you can find about successful outcomes for second babies (and believe me, the second baby is ridiculously easier for almost every woman I've encountered) you're not just going to be able to lose your fear of the hospital.

Now I know there are some of you out there thinking, "What does she have to worry about? All she had was an epidural and pitocin. It's not like she had a c-section/huge episiotomy/horrific induction/preemie in the NICU/etc." Some of you probably deliberately asked for the epi and pit, and really don't get what Katie's worried about.

But this isn't misery poker. If you've read my first post on preventing PPD, you'll know that I think a Good Birth is so important for a mother. And you'll also remember my definition of a Good Birth: A Good birth is one in which you're respected as a person. So the actual details of what happened to Katie during her first birth aren't vital. What matters is that she didn't feel respected throughout the process. It sounds like she felt victimized, and she's really scared that she's just going to end up being shoved into the sausage factory again for this second birth.

Katie, I agree that it sounds like you can't really have a home birth, because it's just going to be too frightening to your husband. It's really, really a shame that you don't have a freestanding birth center near you, because that would absolutely bridge the gap for you and your husband. But since there isn't one and you're probably going to have to have the baby in a hospital, your focus should be on creating a team that will respect you during the entire process of the labor and delivery.

The crucial components you need to look for are:

1. A hospital with good stats for birth without interventions. One of my friends was the only person any of the nurses working that night had ever seen give birth without an epidural. In hindsight, she says she would have picked a different hospital. She knew she could do it, but the nurses were so out of their element without the epidural that they really had no idea how to support her. Birth is really not something you want to be a pioneer in, if you can help it, so find the hospital in your area that has the lowest rates of epidurals and pitocin use. (Since you're a second-timer I wouldn't really worry about c-section rates. Once you've had one vaginal birth your chance of having a c-section is teeny unless something really goes wrong, in which case you'd be happy the technology for the c-section existed.) By the same token, if you know you're going to have a c-section, you want to choose the hospital that does a ton of them, so it's standard procedure for them.

2. A doctor or midwife who really gets what you want and why you want it, and wants that for you, too. A provider who understands why you want an unmedicated birth (and isn't patronizing about it) is going to respect you and your wishes, and use that to help make decisions if things don't go according to plan. (Flip that around to "medicated birth" if that's what you want.) There's no guarantee that you'll have the birth you want, but having a provider who really is on your side means you'll come out of it feeling respected and like everyone did the absolute best they could, including you.

3. A doula. IMO it's absolutely worth it to pay someone to be with you from start to finish and provide a protective layer between the hospital bureaucracy and you. It's just too much of a risk to go into the hospital and take your chances with the nurses on duty if you're feeling that much fear, since the nurses make the whole experience unless you have someone else there advocating and translating for you. It works out if you have a great nurse, but if you have an inept nurse or a distracted nurse or a nurse who thinks the kind of birth you want is ridiculous or a nurse who's just a mean person, you get hung out to dry. Better to bring your own support person who's been at bunches of births and knows how to help you navigate the whole experience. You will probably get lucky, and the doula will spend most of the time helping you through contractions for a few very intense hours until your baby pops out easily with no tears.

So, yeah, this didn't turn into much about how to settle a marital dispute. I lucked out myself, because my own first birth (starting at a birth center and ending up at a hospital) was such an indictment of hospital birth that my husband was convinced easily to do a home birth. (It probably helped that during the interview, one of my midwives looked him straight in the eye and said coolly, "We don't play. If something happens we go to the hospital instantly.") I was happy with my home birth, but then pretty much every woman I know was happy with her second birth, especially compared to the first one, no matter where or how she had it.

Give me what you've got about this. Did any of you have a similar dispute? How did you resolve it?

Also, if anyone knows a good midwife and/or doula who works at Englewood Hospital in Englewood, NJ, will you email me to let me know? It's for a friend. Thanks.