Birth information photo by subewl

My first two children were born at hospitals and it seemed like the children’s birth certificates magically showed up for me to sign sometime before we left the hospital. When Nicole was born at home, I had to go through a bunch of legwork to get her birth certificate. On the morning of Nicole’s birth, the midwife carefully explained to me what I would need to do: make an appointment with the county and take this letter and this form and a copy of a utility bill to establish residency. Click my heels three times and repeat, “There’s no place like home (for a birth).” (Just kidding). I nodded my head, yes, I will remember all of this stuff, but really I was lost in a haze of post-birth natural high, consumed by baby love, and I had no room for details in my brain. So about six weeks later when I went to the county, not only did I first go to the Office of Vital Records instead of the Health Department, I then dragged my three-year-old and newborn a few blocks more to the Health Department without an appointment, and I didn’t take a copy of the utility bill. Now I can look back and laugh, but at the time I was not amused about having made mistakes that meant yet more half-hour car rides with a 6-week-old who didn’t like the car seat.

When I think back to all the paperwork I had to fill out to get the birth certificate, I cannot recall having to answer any questions about breastfeeding. So I was surprised to read “Breastfeeding Status on U.S. Birth Certificates: Where Do We Go from Here?” Pediatrics, Vol. 122 No. 6 December 2008, pp. e1159-e1163. It explains that 79 percent of U.S. states collect breastfeeding data for birth certificates, or expect to do so within two years. According to this interesting United States map, California is not yet collecting breastfeeding data on birth certificates (so no, my memory isn’t quite that bad!) Researchers contacted the vital statistics registrars in each of the 50 states, as well as New York City, Washington, DC, and Puerto Rico. Nearly 57 percent of the registrars were already reporting breastfeeding status on state birth certificates, although the questions used to collect the information were not standardized. Most states use the Standard Certificate of Live Birth (SCLB) questionnaire (PDF), which asks, “Is the infant being breastfed at discharge?” Six states, New York City, and Washington, DC, developed their own questions. The study authors concluded:

Within the next 2 years, nearly 80% of US states are expected to be collecting breastfeeding data on their birth certificate. This represents a significant contribution to our national breastfeeding surveillance efforts, because data should be collected for every newborn in every participating state, thereby avoiding the potential for sampling bias. Because birth certificates also collect data on several relevant variables that are known to affect breastfeeding outcomes, the inclusion of a breastfeeding question on birth certificates has a strong potential to improve breastfeeding surveillance in the United States. Consistent with the Healthy People 2010 guidelines, we strongly encourage all states and US territories to collect exclusive breastfeeding data on their birth certificates and to monitor this outcome closely. Standardization of the breastfeeding question that is used on state birth certificates should be a priority so that breastfeeding outcomes can be compared across states. The revision of this question should involve a process that includes feedback from health professionals who collect these data, pretesting of the revised question for feasibility, and training of professionals who collect these data.

Were you asked about breastfeeding when you applied for your child’s birth certificate? Do you think the information provided at that time is valuable? I agree that the pertinent question is whether or not the baby is being exclusively breastfed. It would be helpful to see which states are breastfeeding-friendly and which hospitals need to improve exclusive breastfeeding rates and reduce any unnecessary introduction of sugar water or formula.

One study published in the Journal of Nurse Midwifery found:

The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery.

“The Cost-Effectiveness of Home Birth.” J Nurse Midwifery. 1999 Jan-Feb;44(1):30-5. Gee, what a novel concept — care that costs less but has a better outcome!

I did an informal survey of sources online to determine that the average hospital birth costs around $8,000 in the United States, depending on exactly where the mother lives. That does not include the additional costs of an epidural or cesarean section, nor does it include the prenatal care from a physician, which costs anywhere from $1,500 to $3,000. For the sake of discussion, let’s say the total cost of prenatal care and physician-assisted hospital birth is approximately $10,000. Compare that to my prenatal care and home birth with a midwife, which cost a total of $4,300. That’s $5,700 — nearly 60% — less! And I was far happier with my home birth experience than my two hospital birth experiences.

Guess how much of that $4,300 my insurance company covered? $2,947.08. Compare that to what the insurance company theoretically would have paid for physician-assisted hospital birth: $8,000! By that token, the insurance company should have been paying ME to have a home birth. My choice of home birth saved the company over $5,000. And the irony is, I had to fight to get the company to cover a home birth at all. Because there were in-network midwives who could attend births at a hospital, the insurance company initially denied my request for a homebirth. I had to have my midwife write a letter to the company stating that I had a “medical need” for a homebirth (basically we argued that I had had such bad hospital experiences — with a fourth-degree tear and a failed epidural — that for my mental health I needed a home birth!) Luckily, the company agreed to pay, although I had to pay 25% co-insurance, rather than 20% co-insurance for an in-network provider. In the end, I wound up paying about $450 less out of pocket for a homebirth, and had a safe and satisfying birth.

My three-year-old and I recently spent an entire morning playing the “midwife” game. This involves variations of going for a check up (she calls it a “check out”), having the baby (laundry basket as birth tub, naked child, teddy bear as newborn) and getting married. She insists on getting married before having the baby, but I’m pretty sure the baby was conceived out of wedlock.

The Labor Day holiday presents a fitting day to discuss labor — the birthing kind! Here are my answers to the Labor Day meme. You can play along with Rocks In My Dryer too, but be sure to leave a comment here with your link (or just your answers if you don’t have a blog) so I know to go read your answers!

How long were your labors?

Kid #1, 22 hours.
Kid #2, 5 hours.
Kid #3, 11 hours.

See a pattern there? Nope, me neither.

How did you know you were in labor?

Kid #1, contractions that woke me up at 3 a.m. I tried to go back to sleep but (a) I had to focus on breathing through the contractions, and (b) I was too excited!
Kid #2, water breaking.
Kid #3, water breaking.

Where did you deliver?

Kid #1, hospital.
Kid #2, hospital.
Kid #3, at home, in the birth tub.

Drugs?

Kid #1, spinal/epidural combination after 16 hours of labor. At the time I was very grateful for the relief, but with my second labor I realized that when the pain got bad enough that I wanted relief, I was getting close to delivering! For me, that’s when the really good progress is being made, and if I could just keep that in mind, I could go without pain medication. With kid #1, the epidural slowed down labor for two hours, and the nurse was about to suggest pitocin when she rolled me on my side and my water broke, speeding things along.
Kid #2, a failed epidural. I asked for the epidural, had trouble sitting still for the necessary IV (duh, because I was ready to push! No one checked me for dilation!) So five minutes after I got the epidural, the OB/GYN showed up and said, “You’re ready to have a baby!” I growled back, “I know!” Three pushes and an episiotomy later, my daughter was born, and I happened to look on the floor and see the tube for the epidural, disconnected and dripping on the floor. So I’m calling that an unmedicated birth, even though I caved and asked for the drugs
Kid #3, no drugs.

C-section?

Thankfully no. With #2 and #3, I was diagnosed with placenta previa. Fortunately, both times subsequent ultrasounds revealed that the placenta had moved away from the cervix as my uterus expanded.

Who delivered?

#1 Three teaching hospital residents I had never met. They threatened to give me an episiotomy and told me to push like I was having a bowel movement, resulting in a fourth degree tear. Luckily one of them felt so bad about that that she spent an hour stitchin’ me up!
#2 A doctor who was so embarrassed about being late to the delivery that he refused to see me for my 6-week follow-up appointment. He sent in another doctor even though I had made the appointment with him. Chicken.
#3 A midwife and her assistant, both of whom I knew and trusted.

Your turn

Play along and leave a comment!

Please do not take this list of advantages of a home birth to mean that I think every woman ought to give birth at home. Each woman should choose as she pleases and as is appropriate for her situation, and I know there are advantages to a birth center birth or a hospital birth (room service comes to mind!) These are just some advantages of a home birth that I appreciated.

1. Never having to get in the car during labor or soon after the birth.

2. Getting to (being encouraged to!) eat and drink during labor.

3. Being able to open the windows for fresh air.

4. Resting completely undisturbed after the birth. No one woke me or the baby to check vital signs or for any other reason.

5. The baby was never separated from me (as my other children had been for a bath, a blood test, or a hearing screen).

6. No one ever tried to offer my baby a pacifier, glucose water, or formula.

7. My baby did not get dehydrated from the dry hospital air, and in fact she regained her birth weight in 3.5 days rather than the typical 10-14 days.

8. My older children got to participate in the birth and never had to be separated from me or my husband.

9. No one questioned my choices about vitamin K injections, antibiotic eye ointment, vaccinations, or co-sleeping.

10. I knew every person who interacted with me and the baby during labor, delivery, and the post-delivery period. I felt comfortable (and, well, at home!) throughout the entire experience!

For those who have had a home birth, what do you see as the advantages? Were you happy with your experience?

On Wednesday July 16 I was 38 weeks and 1 day into the pregnancy. The midwife had just finished her pre-birth home visit at 3:15 that afternoon. At 4 p.m. I was resting in bed and reading stories to my girls. Over the next hour I had some contractions, but no more and no stronger than I’d been having over the previous several days, so I didn’t pay much attention. Until I felt a little “pffzt” in my belly and I wondered whether that could possibly be my water breaking. Read more

Nicole Marie White
7 pounds, 2 ounces
19.5 inches

Born Thursday, July 17, 2008
at 2:51 a.m.

At home, in the water.

Our first nursing session lasted a blissful hour. I am happy and feeling well! More details later!

That’s right folks, at 38 weeks 1 day, my bag of waters has broken! It’s been about two hours and all I feel is some pressure, back pain, and the occasional mild contraction. I’ll update when I can (hopefully with good news and even a baby name!)

I thoroughly enjoyed reading your comments and watching the poll results on what I should name Baby Egg White, III. Thank you! While you all had clear favorites in Camille and Rebecca, discussions continue between my husband and me, and we are not that much closer to figuring out the name. Tick tock, tick tock . . . .

Today marks 38 weeks of pregnancy. My thoughts at this point:

1. Husband home from Ireland [check]. Birth supplies bought [check]. Birth tub set up [check]. A million nesting tasks accomplished [meals in freezer - check; air vent dusted - check]. Group B Strep test negative [check].

2. Call them Braxton-Hicks, call them pre-labor, I call them “hinting at painful.”

3. Perhaps I ought to work on positive thinking and consider them not so much painful as powerful.

4. Why, when a woman is preparing to give birth and needs all the rest she can get, does she find herself with insomnia that has her awake from 2:30 a.m. to 4:30 a.m.?

5. When I finally fell back asleep, I dreamed I was Jessica Simpson (I think my brain confused her with Britney Spears and Jamie Lynn Spears) and I was in high school and I had gotten pregnant by Mario Lopez (I always did think he’s cute) and I was going to track him down and hold him responsible. Gee, do you think I have any last-minute anxiety about giving birth and caring for a new baby?