Abby Phillip: How I wound up giving birth at home

CNN

Opinion by Abby Phillip

(CNN) — It was a little after 6 p.m. on Sunday, August 15, 2021, and things were about to get real. The mild discomfort I had been feeling for days was suddenly noticeable enough to stop me in my tracks: I was in labor.

My husband, mother and I jumped into action. I insisted on cooking a meal — I had to keep busy, and I refused to be hungry while giving birth. As I stirred a pot of pasta and chopped up vegetables, I fell into a routine. Every 7 or 8 minutes, I stepped away from the kitchen and found a quiet place to breathe through the contractions.

Within a few hours, I was in my bedroom, lights dimmed. I sat on a birthing ball, swayed through the pain and pressure as each contraction gripped my body and prepared to give birth at home.

If this were a movie, it would be the moment the record scratches, and I look straight to camera, saying, “You’re probably wondering how I ended up here.” Never in a million years would I have thought that I — a huge believer in modern medicine and someone who takes no unnecessary risks with my health — would end up giving birth at home.

So, what happened? Let me explain.

I became pregnant with my first child in late 2020, as a global pandemic was raging. It was a scary time to be pregnant, or anywhere near a hospital. Layered on top of all that was my fear that I would not make it out of childbirth alive. I had somehow come to view childbirth, something as old as humankind, as a life-threatening event.

I can’t tell you exactly when this became such a deep-seated fear for me, but my anxiety would ratchet up dramatically at the thought of being in a hospital, unable to advocate for myself. That fear was compounded early on in my pregnancy, when I was ignored and dismissed by my doctor’s office — so much so that I left that practice and went searching for better care.

Even when I found another doctor, those visits felt perfunctory and isolating. I was repeatedly asked whether I had any questions during the brief 30-minute visits. And I did. But I would realize later, as a first-time mother, I often didn’t know what I didn’t know. I hesitated to bring up my experiences and discomfort, unsure whether they were worth mentioning or indicative of more serious problems.

To allay my fears, I dove deep, spending months researching the quality of hospitals, different birthing practices and studies about the pros and cons of various medical interventions. I studied C-section rates and induction rates, and found that many of the most sought out hospitals where I lived had some of the highest rates of medical interventions. Ultimately, I was trying to find evidence that I would be safe somewhere or that I would be supported in making the choices that were best for me.

Without question, part of my fear about being pregnant stemmed from statistics that I was all too familiar with as a journalist: Black women are 2 to 3 times more likely to die in childbirth than White women in America, regardless of socioeconomic status.

And while modern medicine has decreased maternal mortality around the world, the numbers are moving in the wrong direction here in the United States. I couldn’t understand how, in one of the most developed nations in the world, women like me are dying more frequently.

The situation worsened during the pandemic, when there were many stories about how Covid-19 had adversely impacted the health care system. One horror story stuck in my mind: A 26-year old Bronx woman died during childbirth just days after tweeting about concerns she had with the hospital where she was receiving care.

A toxic mix of Covid-era health care breakdowns and the longstanding disparities in care for Black women apparently combined to create a horror story for her family — and there are countless stories like hers. Stories like April Valentine’s.

April was a 31-year-old, college-educated Black woman in Los Angeles who knew the statistics and thought she had done all she could to keep herself alive. I spent time with her partner Nigha and her daughter Aniya in Los Angeles recently.

Her family told me that when April was admitted to the hospital, she was denied access to her doula and ignored when she complained of pain in her leg throughout labor. That pain ultimately was a sign of deadly blood clots that eventually took her life.

Every woman has a different set of priorities when thinking about the experience of giving birth. Some want an epidural as soon as possible, others want a spa-like environment and still others need C-sections and the benefits of modern medicine. Those choices, no matter what they are, deserve to be respected.

I wanted a childbirth experience as free from unnecessary medical intervention as possible. I believed, and a good deal of medical evidence suggests, that it would be the safest thing for me and my child. But I came to believe that it would be too difficult to achieve that in a hospital.

I quickly reached a conclusion that increasing numbers of Black women are coming to: Finding safety in childbirth in America is not as simple as going to a hospital.

Midwife-attended births in the US have been on the rise, going from about 1% of births in 1980 to around 12% in 2020. Midwives are trained to deliver babies and can provide care both in and outside a hospital setting. But as many of them have told me, their model of care is centered on minimizing intervention for most mothers who have low risk pregnancies and providing more holistic support to women during pregnancy and childbirth.

Something else happened during the pandemic. The number of Black women opting out of hospital births surged. From 2019 to 2020, it increased by 36%. The following year, it went up by another 21%.

It turns out, I was part of that statistic.

What I learned was that my home birth wouldn’t be just about where I gave birth, but about how. It was about a model of care centered around the full picture of my life and health.

My midwife, Aza Nedhari, came to my home for examinations that lasted an hour or more. I sat comfortably on my couch while she asked questions about every facet of my life: from how much water I was drinking to how much stress I was experiencing.

I realized quickly that she wasn’t just checking that my baby’s heartbeat was still present. Her job was to ensure that I stayed on a path to a healthy pregnancy. I felt seen, heard and more empowered. Eventually, my fear began to subside. It was replaced by excitement and joy for the arrival of my daughter — emotions that I had struggled to access earlier because of how worried I had been about surviving pregnancy and childbirth.

My labor, all 12 hours of it, went by quickly. And yes, there was pain. I was free to move around my home, free to use water, nature’s pain relief, to help manage the discomfort. No one told me when to push or how quickly. I could eat and drink freely, small comforts denied to many women in a hospital setting.

There were no beeping monitors or parades of strangers walking in and out of the room. And perhaps best of all, I was in my own home — literally in my own bed — surrounded by a team of people, including my midwife, my mom, my husband and my wonderful doula, all focused intently on helping me and my body do what it knows how to do — on my terms and at my pace.

After my daughter was born, I experienced excessive bleeding, known as a postpartum hemorrhage. Aza and her team, trained in managing these complications, quickly stopped the bleeding. It happened so quickly, I barely noticed it. I felt confident that we had a plan to manage challenges like those. I joke now that those first hours after childbirth were the best I had felt in nine months.

So many moms I know felt left to their own devices after delivering their child. It was the opposite for me. In the days after I gave birth, my midwife returned to our home multiple times to check on our family. She provided breastfeeding support and evaluated me for any post-partum complications, which account for 60% of deaths related to childbirth in the United States. Even when she wasn’t there, she was a phone call or a text away.

By the end of my journey, I was a different person than the woman who had that first, nervous meeting with her midwife just a few weeks earlier. I realized that the core of the midwifery model of care is that I am not a passive actor in my health, but an active participant. I learned how to listen to my body, in part because my midwife asked probing questions and took the time to listen to my pregnancy experience every time she visited. I learned to listen for my baby’s heartbeat and identify her position in my belly. With my doula, I practiced body positions that would help me manage the pain during labor and make the labor process more efficient, without the help of drugs.

I couldn’t help but imagine what it could be like if more women had access to care like this. But even though giving birth at home or at a birth center is less expensive than a three-day hospital stay or a surgery, insurance typically doesn’t cover it – leaving families to cover the cost themselves.

Organizations like Kindred Space LA, a Black-owned birthing center and midwifery practice in Los Angeles, are trying to find more ways to bring holistic, community-centered care to more patients through small group care, grants and subsidies for families that need it.

This model of care is not for everyone, of course. It would not have been possible for me if I had a higher-risk pregnancy. But it was an option that suddenly I wished more people knew was available to them.

Ultimately, what led me to give birth to my daughter at home was my determination to move beyond my fear. I emerged hopeful that there were solutions out there that can save lives. What would happen if women were allowed to truly embrace choice in their care? What would happen if midwives, doulas and doctors worked in concert to keep more women and babies alive without the stigma? What would happen if Black women’s birth stories were not tales of trauma but of joy?

The cause of this deadly racial disparity in maternal health is complicated. Health disparities, racism and lack of access to high quality care all contribute, experts say. The solution must be multi-faceted and centered on care — not just medicine.

The women who I met as I explored this maternal health crisis in America come from all different backgrounds. But they’re fighting to be heard. They’re fighting for their health. They’re fighting to reclaim childbirth as a moment that should be accompanied by the joy of bringing new life into the world, not the fear of what could be if the worst happens.

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