The Beginning of Home Birth with Kaitlyn Fusco

(Derived from Episode 142 of the Birth Lounge Podcast)

Today, we are chatting with Katelyn Fusco, Host of Happy Home Birth Podcast. We are covering home birth and how birth has transformed over the years. Katelyn is sharing who is right for home birth and the top home birth myths. We are also diving into stickier topics like the business side of birth and how legislation can impact women’s health. We shine a spotlight on consent and continuity of care as well. I'll hand it over now for Katelyn's thoughts!

We are so ingrained now, especially in the United States, to think that birth is a medical event that just has to take place in the hospital. I mean, that's just in our minds. I know growing up, that's how it was for me. My mom had all three of her children as C-sections. So when I was growing up, I thought, 'Okay, well, I'll have C-sections for my babies. Birth is surgery the end'. I don't think I'm alone in that whether, you know, you were born from a cesarean section or however you got here, it's very likely that you grew up thinking that birth was a medical event. It's kind of crazy because we haven't even had hospitals for that long. So the fact that birth has transitioned from something that was just a it's kind of like the extraordinary normal, you know, like birth is extraordinary, but it is normal. It's transitioned from that to something that we have to have like flashing lights and warning signs.

Let's go ahead and start back. I mean, biblically look in Genesis, midwives are mentioned in Genesis. Like this is from the very beginning we have been giving birth and women have been supporting other women in birth. So this is not new. Midwifery is not some new age woo-woo thing. This is literally from the beginning. So I love to start there. I also like to talk about the fact that when in the past we were giving birth, it was not so isolated. So now, even if you have a doula, even if you have your partner with you, you are going into a hospital typically where you're giving birth. And it is a teeny, teeny, tiny little group, maybe, maybe a threesome. You, your partner, your doula- it's a small group that we're giving birth with. Back before the hospital and before this became the norm birth was a community event. We were growing up seeing women give birth hundreds of times before we gave birth. Seeing, 'Oh, wow, this, this works. Of course, this is what we do'. Moms, sisters, aunts- were at the birth together- we were all there and we were all supporting the person giving birth. So birth wasn't this crazy shocking thing and we knew our bodies were made to do this. We knew that we were created, we were designed to be able to give birth.

That doesn't mean that every single time it goes perfectly, of course birth is wild. It is a wild event, but it is something that is not supposed to be just deeply in our bones that we're fearful of. I think that that is the biggest issue is there's just become this shift, especially in the United States. If you compare our maternity system to other places, you know, it is so different. Home birth is, is highly more common in other countries. The way that The American Medical Association formed, it was a business. One of the things that they did was instead of working with midwives, it was, 'These people are not educated. We are educated'. So they realized that they could trash these midwives who had decades and centuries of knowledge passed down one to the other one to the other, you know, these amazing established communities. There were smear campaigns and they talk about this in the 'Business of Being Born', which is a great documentary. I actually spoke to a midwife, my friend Janell, about this and about how there were actually transcripts in Varney's midwifery book from the AMA where they were talking about how they were going to convince the public, that midwives were not quality even though they knew and acknowledged that their outcomes were worse than those of midwife attended births.

How did we get from a primarily home birth to hospital?

It started off where doctors had become prevalent as a career, but birth was left untouched there for a minute because that was, that was woman's work. Then they realized, 'Wait, hold on a second- we could make money out of this'. So that is what happened. It did start at home. Doctors did begin attending births at home, but the shift to the hospital was massive. It revolutionized everything, because it turned into, 'Why would you have your baby in your home? It's dirty, it's unclean. It's unsterile.' It began like, 'Oh, I'm going to be fancy. I'm going to go to the hospital to have my baby.' Then it filtered down throughout society and became the norm. like, Oh, well, you go to the hospital.

It was not like the hospital today, like women were going into the hospital, but their partners were not with them. They were going into these back rooms. We don't know what happened. The partner has no idea what's going on. They would use like sheepskin wraps around their arms so that when they were held down with all of these drugs, they wouldn't leave marks. The drugs that they were giving them actually didn't help with pain management at all. It was knocking them out. They're basically in and out of consciousness this entire time. Do you think it's easy to have a baby that way? It is not my friend. It's just disturbing to think how behind the times they were with their practices, as opposed to what was going on in the community beforehand, when using midwives, you know? The hospital was seen as the safe option, but in reality, if you looked at what was going on it was the last place you would want to be.

Understanding Your Home Birth Options

So many people have no idea that home birth is an option. Hw can you have informed consent when you don't know all of the options? When it comes to home birth, it's not talked about a lot. 1% of the population gives birth at home right now in the United States. 1% that's, that's teeny. But my thought, and the reason that I created the Happy Home Birth Podcast is it would be a lot higher if people knew that it was an option and that it was safe.

That's where we need to be going. No home birth is not for everybody. Home birth is for low risk mothers. The majority of people do fall into that category over 90%. So 90% of people would be safe to have a home birth. That doesn't mean that they would be comfortable. That doesn't mean that I'm saying, well, you, if you're low risk, you just should, but that the safety factor is there. The great news is that midwives, you know, if, if you're choosing to use a midwife, they are trained in low-risk birth. There they are so competent at assessing what is and is not low risk. If you ever crossed that threshold of safety they will go ahead and transfer your care over. This would be the appropriate time to transfer care.

Also, it's important to note that though, there are different types of midwives and they do practice in different ways. Typically there is an overseeing type of provider that will also be able to check off and say like, 'Yes, you are low risk. You are qualified for a home birth.'

But your house is so...germy.

As the research with the micro-biome has just taken off in the last few years. We are realizing that theory of all germs being bad and scary and dangerous, it's just not accurate. The other neat thing that's going on with the micro-biome is that we're learning a lot of people have always assumed the placenta, the amniotic sac is sterile, but it is not. We are finding there is bacteria already there. So when the baby's not in this sterile vacuum, they're already being exposed to your microbes, to the microorganisms inside of your body. So they are already attuned to the environment. So it's kind of cool to think about the fact that, 'Okay, we are giving birth in the place that we created the baby- the place that we have grown and nurtured this life- we're giving birth to that new life in this atmosphere.' Is that not actually the safest place t be? We're not exposing them to something new, we're exposing them to the friendly things that they've already grown accustomed to.

Let's talk about the business of being born. What do pregnant people need to know to be informed?

The first thing I think is the most surface and the easiest for us to wrap our minds around. So 99% of people are giving birth in the hospital? A large percentage. It's busy, OBGYNs are busy. So the first issue is that the way that this system has been created. You go in for your prenatal care and the majority of your appointment is not with your doctor. The majority of your appointment is sitting in the waiting room. Is there a lot of education going on between you and your provider? Not often.

The other question is, is how often are you seeing the same person? How often are we having continuity of care? We don't know who the heck is going to show up when we're having our baby. So there's overcrowding of practices. There are so many patients coming in. There are so many doctors to take care of all of those patients. And of course they want to grow a business. They want to be able to add more doctors to generate more money. So these practices are getting larger, larger, larger.

There's no time for connection. It's not even that it's this evil situation or intentionally evil. It's that it's just a busy place. So we're going to get in, we're going to do what we got to do and we're going to get out.

The second issue that we could discuss is the fact that these obstetricians are well-versed in surgery, right? That's what they went to school for. However, do we need to be looking for pathology in every single birth? No, we don't because like I said, 90% of us are low risk. And then of those 10%, how many actually need a c-section? It's a very small percentage of the 10%. Which is not what we're seeing across the country.

We're putting these people who are trained to see pathology and who are trained in surgery in a situation where they're not really needed. It doesn't make sense that their job is to care for all pregnancies. And, if you look at other places, that's not how they divvy up the responsibilities. Midwives are taking care of the majority of low risk clients.

We've got another situation to consider: How are we looking at birth? Are we looking at it as a normal event? Or are we looking at it as a pathology?

When it comes to laws, most doctors, have a three year period where somebody could sue them. When it comes to OBGYNs it's 21 years. because they can look back and say, 'Oh, well, they're having this issue that's related back to birth.' So obstetricians are legally in a tough place. They can get in a lot of trouble. And so it's a lot of money to cover them insurance wise. They really want to prove that they did every single thing that they could do to get that baby out safely. So if there is even the slightest of like, 'Oh, well the heart rate went down for just a dip- take her to surgery.' Let's do, do, do to prove that we did everything, everything that we could to make sure that this baby came out safely the end. What that leads to, is it way more intervention than is actually necessary.

We add these three pieces up and it's kind of scary if we're not super confident in our care provider. If we don't feel that we are completely aligned with them and that they totally understand where we are and see our pregnancy as an individual and unique pregnancy.

I think that it's so easy for us to say, 'Oh yeah, OBs are the worst. Doctors are just awful.' And that's of course that's not true. It's just like any other profession, we've got great ones. We've got ones that are in it for the right reasons. And then we've got trash. Some humans just don't care as much. That's the reality. It's important for us to remember that. These people, these people are people and they are doing their best even if it is misguided.

The other issue that I didn't touch on is the fact that the information that they are working on is outdated. It takes so long for information to be trickled down to practice. So ACOG might come out with a statement about episiotomies. It'll take 25 years for a episiotomies to not be done. It takes that long for things to go down into practice. These doctors are so busy. They went to medical school 25 years ago. They learned the stuff in medical school. And now they're in the trenches. Their head is down. They're working on these massive patient loads. They're in the hospital, they're in their clinic. It's busy. Do they have time to sit down and read like the evidence based birth website all the time? No. So we are there, they're practicing on with, with standards that are just outdated.

That's one of the most frustrating parts to me. If you are going to be dealing with people's lives and the lives of their babies, you just have to care, there's no other way around it. You're going to have to find the time you said you would. You promised. You took an oath to take care of people- to give them the best care. And that's truly how I feel. I hold myself, my doulas and, my team to that same standard. We're not medical professionals. And I get that. They are 1000% busier than we are, but you promised as an OB to take care of people and you've got to do that. It's one of the priorities.

We are consumers of this broken system. We have to start saying, 'Listen, I'm not going to accept this.' That's a lot easier said than done, but I will give a great recommendation- 'Shared Decision Making: Bring Birth Back Into The Hands Of Mothers' by Dr. Brad Bootstaylor. He talks about the fact that you've got to hold your care provider accountable. To be upfront about the the things that you are looking for in your care provider. So you can see if you are an ideal fit. Now, the important thing for us to remember is, like I said, a lot of these practices have how many providers? We need to make sure that all of these providers are fitting. If they're not, then we're saying, 'Okay, I'm going to go look for someone else who closely aligns with me.'

A lot of times I think that we just go with what's easiest. We need to be very serious about this. This is the birth of our child and this is our birth into motherhood. This is a day that will be remembered forever. So we need to have the right people supporting us. We need to be asking them questions on all of the things that are important to us and make sure we're getting the straight answers.

And then of course, from, from my perspective, we need to be considering other care providers. We need to be considering care providers who are trained in physiological childbirth like midwives. They're trained in the fact that birth is an, a beautiful ordinary, extraordinary event.

So really considering if a midwife is an option for you. When you go to see your OB, how often, like how long do you talk to your OB? When you go to see a midwife, I'm just letting you know, your appointments are usually 30 minutes to an hour and only a brief period of that time. It is so holistically focused on you and the baby and all of this hands on care and attention during the prenatal period so that they can be hands off during the birth. The more positive birthing experiences that we have and that we share with others and tell them of their experiences, the more people are going to feel empowered to do the exact same thing. And that's how a revolution has started.

How do you know if you're right for home birth and then also, how do you go about finding a midwife?

We do know that 90% of moms are low risk. So if you do not have anything that's labeled high risk, you are more than likely a great candidate for home birth. As for hiring a midwife, I would recommend going to https://mana.org/.You can get a breakdown of your state and what the regulations are, what is, and is not considered legal from a care provider standpoint. Then you can start to search for your midwife.

BOOKS MENTIONED:

Dr. Brad Bootstaylor —book: Shared Decision Making

Tina Cassidy— book: Birth, The Surprising History of How We are Born

PODCAST MENTIONED:

Ep 64: How Did We Get Here?! The History of U.S. Maternity Car‪e‬

Ep 59: "But What if Something Goes Wrong?"- How Midwives Handle Emergencies at Hom‪e‬

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