Happy Fall everyone!  I’m getting back into it…  Here is a question from a mother who is dealing with a complication in pregnancy:

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I am 31 weeks along and my midwife just dumped me today because of suspected cholestasis. We have refused testing so the diagnosis is not confirmed. She is not comfortable with the stillbirth risk. My husband and I are well-informed and comfortable with the risk.

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I am 24, in perfect health, and otherwise low-risk. Hospital birth is not an option and early induction (“natural” or otherwise) is not an option. I am/We are willing to accept the outcome of our pregnancy, positive or negative.

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I am considering freebirth. I have complete faith in my body and in my baby. I am willing to do the preventative care (nutrition, exercise, meditation, etc.) and research.

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I’m afraid my husband will not support me in this decision. How do I handle that? My worry is when labor gets difficult he will chicken out and call an ambulance. I also fear I will not get the encouragement I need as our doula is reluctant to attend a freebirth as well. How do I prepare my husband to be a good, even if reluctant, free birth partner? What resources are there for helping him come to terms with my decision?

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Hello,

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And thank you so much for your message.  First of all, congratulations on your pregnancy.  What a magical, transformative time for you.

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Although I am in no way a medically-trained person, or a midwife, (nor can I offer you any medical advice), I am absolutely honoured to be able to give you my opinion on what you have expressed in your message.

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From your letter, I understand how much you love your baby, and that your primary concern is that you bring your child earth-side in the most gentle and loving and wholesome way possible.  I also hear that you are strong, and very independent. And yet, it sounds like you are feeling conflicted, and let down. Fundamentally, you are dealing with the multiplicities and vulnerabilites that every mother feels when it comes to birth, and our imperative to protect our children.

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I genuinely believe that pregnancy and childbirth are normal, biological life events– like elimination, conception, menstruation, etc. For the vast majority of women, birth is totally unmedical–like a [wild, beautiful, excruciating, glorious] walk in the park.  But just as a walk in the park can sometimes become a medical event, so can birth. I believe very strongly that most women and babies are much safer giving birth at home than in the hospital.  So much of what is standard in the way of hospital care for mothers and babies is not only counter-productive and counter-intuitive, but also dangerous.  However I do I also recognize that in a very small number of cases, the services offered at the hospital can be life-saving for mums and their babies.  If I were ever pregnant or giving birth and I felt that my life or the life of my child was truly at risk, I would go to the hospital.  And I don’t know any independent, autonomous or indie-birthing mother who feels differently.

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From what I understand, Cholestasis is a condition that involves liver function, and specifically, a problem with the flow of bile which causes a buildup of bile salts in the liver which can then enter the bloodstream.  It is thought that cholestasis is linked with the hormones the body produces during pregnancy, but the fundamental causes are unknown.  This condition, like so many others during pregnancy, exists on a wide spectrum–some women suffer from severe cholestasis, and in other cases it can be quite mild, and less problematic.  Unfortunately (also like so many other conditions) the conventional approach to treatment involves frequent ultrasounds, sometimes drugs, and often induction.  There is actually no firm evidence that shows that cholestasis has a specific effect or outcome on the growing baby, although many believe that babies born to mothers with cholestasis are more likely to be born still, and cholestasis does seem to be linked to earlier births, or premature birth.  Women of South American descent are more prone to suffer from cholestasis, and there seems to be a strong genetic factor.

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When it comes to my own perspective on pregnancy and birth, I have to acknowledge my own immense privilege:  I have been able to choose free birth for myself, in the context of being in very good health, and of having a robust support system.  Of course, the terms “complication” and ” high risk”, in the context of pregnancy and birth encompass a huge range of conditions and realities.  These terms are also highly symbolic, cultural, and subjective.  My own pregnancies have been, by my own assessment, perfect and normal. But from a medical perspective, I probably would have been considered “complicated” or high risk in some instances, by some people.  All of my babies come at around 43 weeks, and I have had other small issues which I felt entirely comfortable dealing with on my own, outside of the system–variations of normal, in my personal (yet highly educated) view.

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You mention that you have declined the testing required to actually diagnose Cholestasis one way or another.  While our cultural climate is highly intolerant of the decision to remove oneself from the diagnostic circuit–especially mothers–I can definitely relate to your desire not to partake, I respect it, and I believe it should be respected by others, including your partner.  Despite the fact that the blood tests for liver function are relatively non-invasive, a positive result, even if mild, would certainly make it more difficult to decline further interventions, and could result in conflict with doctors.  Then again, knowing the actual status of your liver function could possibly help you to make a clearer choice as to how to proceed.  If you received confirmation that your liver is functioning relatively well, this could be a strong case for convincing a midwife to help you find alternative treatments in order to stay out of the hospital system.

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I think it is safe to say that most midwives or birth attendants with clients who present with symptoms of possible Cholestasis would highly encourage testing, simply to find out the status of the liver, so as to have a better idea as to the risks, and the potential for treating holistically.

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But I feel very strongly that no adult should ever have to justify his or her reasons for the decisions they about their health care.  And I feel strongly that we all (including mothers) have a right to our bodily integrity.  I absolutely reject the widespread infantilization of pregnant mothers, and the fact that our rights are negated, and ignored and violated throughout pregnancy and birth.  But unfortunately, paternalism towards mothers is the standard, and it is widely accepted and employed.

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There it is:  fundamentally, I am not the kind of person who could ever tolerate being in a position of having to justify my choices  (when it comes to my body) to a partner or someone whose services I have employed.  I could never tolerate being in the position of having to convince a midwife or birth attendant, that my choices are legitimate.  And so, (as is the case whenever I talk about birth), we come back to the issue of rights, liability, legalities, and so on.  When midwives work for the state, they are accountable to the state, rather than individual women who have widely different needs, desires, philosophies, world views, and bodies.

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And yet, despite my supposedly high standards, I have absolutely tolerated a great many experiences with the medical community which I now perceive as being transgressive.  Some of these occurred because I was afraid, and some because I was coerced, and some I submitted to because I was worried about political or legal ramifications. Throughout my life, I have been wholly unable to live up to my own extremely high standards.  And, looking back, it’s ok.  I am ok with all of it.

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Declining treatments, and even testing, should be your choice.  But the reality is that this choice may have consequences that could prove to be more invasive, painful and destructive than that which you are attempting to avoid.  Especially when it comes to the potential that your husband, your child’s father, might withdraw his support.

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The decision to give birth at home, without the presence of a midwife or a birth attendant (even with a midwife!) requires the assumption of a huge amount of responsibility, which clearly you understand.  During my first pregnancy, I felt mostly prepared to have an unassisted birth. But I ended up choosing to invite an independent birth attendant to be there with me.  And in retrospect, I think I made the right decision, a decision which prepared me to go on to have 3 subsequent family-only births.

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In your situation, my primary concern would be the possible legal ramifications of going into a solo birth situation without the support of your significant other, especially as it is now on your medical chart, that you refused even preliminary testing.  It seems to me that the work you need to do over the next few weeks is to connect with your husband.  Explain to him why you have made the choices you have, and try to understand his perspective.  It seems to me that you are both coming from the position of great love and concern for your baby and your relationship.  Try to help him understand that you strongly feel that you are making the safest and most reasonable choice, and gather resources that could help to make that choice understood.  Again, in my fantasy of how the world should be, women should have fully autonomy over their bodies.  We don’t.  We all have to play the game to one degree or another.  Connecting with your partner, and cultivating softness and grace in the face of this conundrum will be a balancing act.  In my view, your partner does not have a right to your body, or a right to any authority around your birth experience.  But I hope, for the sake of your family, that you will grant him the privilege of your honest heart, and of your reaching out to him to make a connection as you all prepare for the arrival of your baby.

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Consider seeking help outside the registered or direct-entry midwifery community.  There are several midwives and birth attendants who, thanks to technology, are able to offer assistance from afar. I highly recommend connecting with Maryn Green, author of the website ‘IndieBirth”.  She is an independent birth-worker with lots of experience, and she would be a great person to consult with along with your husband.

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I do know that many of the independent, unregistered midwives I know end up taking on many clients who have been deemed “high risk” by the system, and who may have been dropped by registered midwives due to issues similar to yours.  Most of these women end up having beautiful, safe home births.  I also know other women with risk factors who have chosen unassisted or family birth and whose babies have been stillborn at home.  Some of these women were able to integrate the death of their babies and the pain they felt and will always feel, in a holistic and beautiful way.  Some of these mothers deeply regret their choice to withdraw from the medical system, and have ended up feeling angry with themselves for refusing medical treatment that may have saved their children.

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In the end, if your husband is adamantly opposed to supporting you in a home birth or solo birth, perhaps there is another family member or friend who could be a birth support for you, or provide you with a space to give birth?  In every community, there are at least a handful of women who choose home birth.  Maybe you could reach out to another mother who could act as a doula.

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I am so sorry I can’t offer you more help or specific advice.  Ultimately, you are growing this baby.  You are the mother, and it is your intuition that you must follow.  At the same time, all of our decisions are influenced by our partners, our families, the political climate and social milieu we found ourselves in.

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I wish you the very best.

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Sincerely,

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Yolande