| Week of December 15 |
Episode 6 |
the UK vs the US
Karen Shopoff-Rooff, a mother of two
who chose a homebirth with her second child after giving birth to her
first child with midwives in London, discusses her
experiences with the differences between the UK and US maternity
as well as switching providers late in pregnancy. She also
discusses how common complications can be successfully handled during a
transcript of the interview appears below:
CATHERINE: First of all, welcome Karen; it's a
pleasure to have you with us.
KAREN: Thanks very much.
us a little bit about yourself. What's it like to give birth in the UK?
What are the primary differences between the two systems?
in the UK, midwifery is the standard of care. A pregnant woman would
not go and even see an obstetrician unless he was high risk to begin
with, or having some sort of complication later in the pregnancy that
the midwives identified and then felt that you needed to be seen by a
specialist. The obstetrician is really seen as a specialist rather than
as the primary caregiver for that pregnant woman.
CATHERINE: Now, what were the ultimate reasons
you chose to give birth at home with your second child?
we had such a positive experience with the midwives, and well then our
first son was born at a free standing birth centre with a private group
of midwives, and we were really seeking the same type of experience
that we had with the very personal, very peaceful and very calm. Trying
to seek out the normal in birth rather than the, I don't know, exciting
or perverse drama that pervades so much of American culture.
know exactly what you mean. Now when you were pursuing this decision,
what role did your husband play? Was he immediately supportive?
absolutely supportive of thinking of using midwives; there was no
question that we would use midwives with our second pregnancy. He was
less quick to come to the idea of a home birth I think, mostly because
our first experience within a free standing birth centre, that facility
was located immediately in the basement to a hospital there by making
transfer very, very easy. However, the options for doing that in our
new home in Austin, to transfer from a birth centre would have really
been a more difficult transfer than from home, and so the appeal of
having it at a birth centre was really just vanished – it wasn't an
option. And at the time, there was no midwifery option in hospital, so
that really left us with the idea of home birth. We did our research,
and just decided that that was really the best thing for our baby, for
me, and then ultimately for him as well, because he was concerned about
us. He's very supportive the entire way; the entire pregnancy and in
the end, he's spoken to more than one of my friends husbands in the two
and a half years since, and has become a complete home birth advocate.
[He] really recognises now, having seen first hand the benefits, why it
can work really well for other people.
CATHERINE: It's amazing how they have started on
the fence and then…
KAREN: Oh yes.
CATHERINE: Once they've had that experience,
they just can't compare.
no. The other thing from the husband's point of view is with respect to
midwifery. Very strongly in home birth, because the child's also being
born in the husband's home as well is that they're centrally involved.
They're not a cast aside role player; they're, they're very much a
strongly supporting figure. I think that really begins their
relationship with their child on a much stronger base than the old
model of dad wandering the hallway.
CATHERINE: I absolutely agree. They sometimes
feel like an accessory.
the hospital or birth centre. There are so many other people that walk
over them. In home, it is definitely more of a central role.
you were preparing for your home birth, you and he had previously said
that although you had found midwifery care here in the States, you
ended up switching to a different midwife; relatively late in the
KAREN: Yes, about thirty four weeks.
CATHERINE: What were the primary reasons you
felt the need to switch?
just had a personality conflict with the midwife. It was something
that, very early on, well part of it was that we weren't both on board
with the home birth to begin with, and that sort of left us looking at
what were the birth centre options in town? That really narrowed down
our choices, and so we selected a midwife who we felt really
comfortable with on a professional level; have absolutely no question
about her professional competency, but didn't really click with her
personally. And as the pregnancy progressed and it became
and more clear that we really wanted to do a home birth, it sort of
became that question of, “if this isn't somebody that we'd be really
excited about inviting over to our home for dinner, do we really want
that person in our home for the birth of our child?” It's hard to say
because. It was very, very difficult to phone her and tell
particularly at thirty four weeks, that we felt that we needed to make
a change. Because midwifery is a very personal profession as well, but
I honestly think it was just the most difficult thing that I've ever
had to do in my life, but really probably one of my best decisions as
well. It was one of those things that, particularly because early in
pregnancy, you only see your care provider every four weeks. Then we'd
talk about different things. I think, oh well, that's not really what I
am thinking; that's not really what I'm envisioning, but I'd let it
role off my back. But then you start seeing them every two weeks, and
those things were happening more frequently. And then it just got to
the point where I was like, wait a minute, is this still my birth, is
this still my experience to have? It's up to me to step up to the plate
and take control of the situation.
CATHERINE: Right. I think you have an excellent
point; that you're your child's first advocate.
you're advocating for who will be present and making sure that your
wishes for that child will be respected, and if you don't have that
kind of relationship with your care provider, you have to make that
tough decision of this is just not best for our family.
and then I also went through the ideas in my head of if I'm not
completely relaxed and allowed to do what I need to do during the
labour, this could wind up being the bad home birth story.
of a good one. I think that; I think it would have been very different
had it been my first child and not my second, but again, because I had
such a positive experience; I had such a clear vision in my head of
what I wanted, what I was aiming for, and as it became more clear to me
that I didn't feel like that's what I was going to have as an option, I
just needed to, get out.
hear all too often women saying, well, I didn't want to step on toes,
or I didn't know how that would work, I didn't want to hurt feelings.
CATHERINE: But ultimately, you recognized that…
CATHERINE: Tension and stress can really impact
and I have no ill will at all towards this midwife. It's just part of
midwifery, such a strong part of midwifery and why I think it works so
well is the personal connection.
CATHERINE: Yes, it's ongoing relationship.
and if that's not there, then in many ways to me, that's just as
important as whether they take insurance or not.
CATHERINE: Right, absolutely, you need to form
CATHERINE: If not there, it might be with
KAREN: Most midwives do recognise that.
CATHERINE: Right. I hear it a lot from people
as well; that if you don't click with a client – that's okay.
KAREN: Yes, yes.
CATHERINE: Because you might know someone else
that would be perfect for them.
exactly. I mean, I'm glad that I did; I still have a relationship now
with the midwife who I switched to; that's been very positive. So
definitely in the long run, it was very difficult, but very worth
what other types of challenges did you face as you started preparing
for your home birth? Did you have any other obstacles to work through
like insurance coverage?
absolutely. Insurance is always a nightmare when dealing with
midwifery, unfortunately. That's a whole other hot button issue though.
Here I was, I had two care providers with two completely different
payment structures. In the end, I wound up paying hugely out of pocket
for my home birth because of my split. But in the long run of my
child's existence, how much it costs to get them into this world is
just a drop in the bucket.
KAREN: I can't, I can't lose too much sleep
over it; I consider it a really good investment.
CATHERINE: So if you had stayed with the first
midwife, would care have been covered?
yes. A higher level of care would have been covered because she was a
certified nurse midwife as opposed to the midwife who actually attended
the labour and delivery is a lay midwife.
KAREN: And my insurance coverage is slightly
that and then my; the first midwife that I used had built into her
contract administrative fees, based on how long you were with practice
that were non-refundable; a hundred dollars a month a bed with her so
it was seven hundred, eight hundred dollars.
CATHERINE: Um hum.
thank God I'm in a position to say it's only money, but I truly believe
that you just have to say, there are some things in life that are worth
CATHERINE: Right, money can be replaced.
exactly, you know we will cut back in other places, but you know good
health, good health care is really not negotiable as far as I'm
CATHERINE: I completely agree. Now, in terms of
preparing for both births, how did the systems compare between the UK
and the US?
honestly, our prenatal preparation for our first child in London was
part of what made our experience so fantastic. There is a group in
England called The National Child Birth Trust and they run fantastic
anti natal courses. At eight weeks you meet one hour or two hours once
a week for eight weeks with a group; you go through all this sort of
basics of pregnancy, child birth, what to expect post partum, how much
your lives are going to change with this, but what's so amazing about
the NCB classes is that the instructors are really charged in a very
positive way with creating community out of the classes. Our group is
built so strongly from the classes that we actually went back to London
this summer, and had a joint fifth birthday party with the nine other
kids that were born with my first one.
CATHERINE: That's incredible.
incredible, and I can honestly say that the midwife who ran those
classes was the head of the midwifery consortium we used; she wasn't at
my son's birth, but it was her other midwives were there. But the power
that they instil in the process of giving birth and having support and
creating a community out of all these other new parents is really
unparalleled. And for us, I mean its very cliché and cheesy to say, but
It was absolutely life changing. So in that way, we felt extremely well
prepared for our second son's birth – for the home birth, because what
she had taught in our first set of classes in London, just was so
meaningful and has stuck with us so well that we; I think a lot about
how my life would be different had we not been living in London, and
had my first child not been born there, and we hadn't ever used
midwives and have never found this NCT class, because it's really been
life changing for us.
I think one of the things you hit on there too is how much preparation
is a part of how your birth experiences goes and how your views are on
how everything went.
CATHERINE: It's completely common for women to
just skip classes.
CATHERINE: That's just mind boggling to me.
They definitely don't come out with the story that you have.
right. They allow it to happen to them rather than being an active
participant. Really, frankly, what is the most important thing you're
ever going to do in life?
CATHERINE: I completely agree, yes.
KAREN: I don't understand.
that we've talked a little bit about your preparation and care options,
did you take any other courses or preparation for your second birth, or
did you feel that you had such a wonderful training from your
experience in London that you were well prepared for a home birth as
Well, I didn't take any special courses, but really, once you have one
great birth experience, you really become kind of like a birth junky
and you read all the birth stories. You can, and you quit watching all
those birth stories on television because they're just frightening and
scary and so far out of the realm of normal that they make me irritated
to even know they're on. If I have surrounded myself; you know, I can't
say completely unknowingly because it's self selection in finding your
group of friends that - my group of my closest friends are all home
birthers, which I think is a very strong statement that something that,
even though we're very different politically, we're very different
social economically that I guess the bond or the shared experience we
have had by doing a home birth has really brought us together on other
levels as well.
completely see exactly what you're talking about; that child birth
choices are such a basic part of who you are, that they do in a sense,
KAREN: Um hum.
though you can be so different in other arenas, it's just a common
thread that can take over a relationship. Like you said, even though
it's maybe not intentional, those are the people that you're
CATHERINE: Because it is such an important part
of your life.
And I find it very interesting as well, because of the necessity of the
father being on board with the whole idea of a home birth, that we get
along very well with the couples as well. You know how difficult it is
to like meet couples where all four people get along? We don't have
that problem with one of our friends who have home birth. And I don't
know, I'm not a psychologist, I can't explain why
happens, but I do think that there is some sort of like base
understanding that goes on. It allows you to relate
Now, you've indicated that you do have a pretty wide group of friends
that are home birthers. When you were first planning your home birth,
did you encounter any resistance from other friends or family members?
had a lot of concerns from family members who I think, understood that
while we chose to have midwives in the UK because that's the way that
it's done there. They didn't really understand why we didn't do it in a
hospital here, because that's the way it's done here. And basically,
what we did is I went through and from all the research that I've done
online; collected a whole list of links, and articles, and put them in
a big Word document and just sent them to people. Partly, in a
defensive stance to say you know we didn't just chose to do this to
tick you off, but we actually researched it and thought about it, and
think it's a really good idea. But also because rather than just being
defensive and saying, hey, we researched it, to really try to educate
them as well. And as I had friends in the last few years, sort of turn
to me to say, hey, you had a home birth; I'm kind of thinking about it,
but you know my husbands not really sure. It's been often, someone will
say, hey, I have this Word document with all these internet links on
it; everything from like Web MD, to the British Journal of Medicine,
to, you know, this and that, that says home birth is an incredibly safe
option. Home birth is aimed to be the standard of care in many
countries around the world. This is it you know, people out in the
woods, beating on drums, and we're going to send you a carrier pigeon;
the baby is born. So it's been an ongoing type of education. I think in
a lot of ways, that's been the most exciting part to me, is that we
didn't just have a good experience, but maybe some other people have
learned from it as well. Who knows what kind of experience they're
going to have now that they wouldn't even have considered before.
CATHERINE: You never know how many lives that
will touch when you share that story with others.
commonality in this country is home birth before the experience.
They're not realising that this decision is based on what the research
is really saying; that home birth is a safe option.
yes, well in fact now, if you are a pregnant woman in the UK, and
you're on the National Health Service, your having a home birth has to
be presented to you as a viable option. And, if you have no risk
factors, it has to be presented to you as the preferred option. It's
not about saving money, because it's a lot more expensive for people to
go to your house than for you to come to them.
CATHERINE: Right. In the long run, it might save
money in, at least in this country, in terms of the number of
well, absolutely. The reason that a midwife in Austin can charge
nineteen hundred dollars for every single prenatal visit, six postnatal
visits, and the labour and delivery, is that's like the price of an
aspirin in the hospital; you know, even with you the entire time.
KAREN: Yes, like I said, that's another option
tell us a little bit about how you prepared in the event an emergency
did arise. What steps did you take to prepare in case something were to
happen? You've already indicated that transfer wasn't as easy of an
option if it would have been in London.
we know that we are about two and a half miles from our closest
hospital and honestly, to call 911 and get an ambulance transfer to a
hospital two and a half miles away, I figure is very, very close to the
same amount of time it would take you to be transferred within the
hospital up to an emergency situation, and have the team ready and
everybody there. So it really became almost a wash in terms of timing.
I had a friend who came over and spent the night with my older
son. She knew that she was going to be able to be there for
duration of the delivery. Honestly, I've had complete faith in my
midwife to do what needed to be done and to do; make the appropriate
decisions at the appropriate times. One of the things that I think that
people don't understand about midwifery, because there's so much talk
about emergencies, is the greatest benefit in my mind to having a
midwife, is that you have somebody with whom you've established a
relationship; who understands behaviour and your type of thinking. And
she is with you from very, very early on in labour and as such can
identify any potential problems very early on; before they become an
emergency. That, I think, is priceless.
is as rates in an insurance policy that many of the complications that
can arise and that are dangerous, can only be identified by physically
being with the woman.
KAREN: Um hum, yes.
CATHERINE: The nurse just down the hall.
I think that that's really something I tried to tell people a
lot. If you are considering midwifery, but for focusing more
the emergency aspect, is that the reason that midwifery is this
successful and that home birth have such positive outcomes is because
if problems arise, the midwife is there to take care of them and either
deal with them in an appropriate way and stop the problem from
escalating or, is there to take appropriate action; transfer you before
the situation becomes an emergency.
CATHERINE: Absolutely. It's not "uh oh, here's
an emergency on our hands", it's "let's prevent, prevent, prevent".
CATHERINE: But we have nothing left to treat.
CATHERINE: Yes. Now, tell us a little bit about
your birth. Did an emergency arise?
was – I don't know if I'd call it an emergency, I'd definitely call it
a complication in that my labour was incredibly, incredibly, fast.
Which people think is fantastic; however, I'm not really an advocate of
a crazy fast labour. It's kind of like trying to hop on a freight train
while it's already moving. However, my; I, I was contracting quite
regularly and was obviously, I was going through a transition. It
became, as I was pushing and the midwife was monitoring my baby's heart
rate, there were some pretty significant decelerations in my baby's
heart rate for two straight contractions. And pushing. Her incredible
calm through the situation was so confidence inspiring in me. Even as
we were going through it, he – my husband, I was birthing in a water
pool in my living room and my husband was in the pool behind me, and I
could see after the first time that she took the reading, she turned to
her apprentice and no noted that that was a significant acceleration,
we'll need to monitor again on the next contraction. She did and she
looked and told the apprentice what the reading was, and then she took
my hands in her hands and she looked at me and she said, I need you to
take deep breaths and a lot of love and a cry down to your baby and
then push your baby out; time for your baby to be born. And, she
motioned to the apprentice to get the neonatal oxygen, and I looked at
her and my husband was supporting me from behind, and my son was born
on the next contraction. And it was; it was incredibly peaceful. She
gave him oxygen; didn't really need it as it turns out, but I was glad
it was there. She was prepared, he took it, and he cried within ten
seconds; it always seems like forever, but I had another friend who was
there, a photographer, and she was taking pictures. In hind sight, it
was really interesting because my friend who I know very well – home
birther herself, said that it was one of the most amazing things that
she's ever seen because the midwife was so calm and so peaceful and
there was never a sense of, oh my God, what are we going to do. You
know, there was no scary music playing in the background; none of that.
She looked at me, she told me what needed to happen, I believed in my
ability to birth my baby, and he came out, and he's perfectly fine. In
fact, he's a little bit crazy; he's two now, he's everywhere. But I
really am afraid to think of what would have happened had I been in a
hospital. It's opposite situation with my first son at a birth centre;
I pushed him for very close – just under three hours, which never would
have been allowed in a US hospital. And so look at my two situations;
one where I had really long pushing stage, and one where I had a very,
very short pushing stage, and I think neither of them would; I would
not have been allowed to birth my child in either of those situations,
in a hospital, I don't think. However, they're both perfectly normal,
I'm perfectly fine, I didn't tear with either of them, I can't think of
a better outcome.
absolutely not. Now, the first thing that came to my mind was that in a
hospital, if we're looking at late decals like that, you're almost
certainly going to get either forceps or episiotomy, extraction,
something to make sure that we get that baby out right away.
KAREN: Right now, right.
CATHERINE: Your midwife was able to tell you
what needed to happen; that factor wasn't there.
not at all. It's hard, it's hard to say what would have happened had it
gone on another three minutes, or another two sets of contractions if I
hadn't been able to do it, but you know he was there, he was ready to
be born. And frankly, this is also another funny thing that I sort of
just, in hind sight, – that's who he is, he's a drama kid. He's all
about causing a ruckus. Where my first child, he didn't you know it
took nearly three hours just about and that was the most calm, peaceful
birth, where I'm like laughing and making jokes through the whole
thing. It was just really like sensitive, calm, quietness. And you
know, I don't want to read too much into it, but it is very
CATHERINE: Interesting; how they let us know
who they are.
KAREN: Oh my gosh.
CATHERINE: From the very beginning.
KAREN: Oh yes.
now in retrospect, you have that experience of having a home birth
versus that birthing centre, what were the foremost benefits in your
mind of birthing from home?
of it. I mean, it's hard to say because it's so inter connected. I
think, the foremost benefit would be that I was able to birth in my own
home, be very relaxed and have somebody attending to the birth who
believed in my ability to birth my child. I would say another huge
benefit is even though my older son was not quite three years old; he's
grown up with the idea that having a baby at home is normal and that's
how babies are born. And part of why I think that God gave me boys, is
that I can do a lot of work for the feminist movement. Like between
them; about things that women need and women want and you know having
them see that as men, they get very involved. They can get very
involved in the birth of their children, become very close to their
children – if they're included.
you've raised another important issue; that by raising boys so that
they're accustomed to birth, they realise what their role is.
and you know the birthing with - my home birth baby was born overnight.
I had said that I had my friend who was staying with my son, first time
in his life, he slept all night Long. He would simply try at three
years old, it was a monumental night. he clearly new that something was
going on and he needed to sleep, but he woke up at his regular six
o'clock in the morning or whatever. And he woke up and said to the
midwife, baby is here, and it was as if he just got this present over
night. There was no - the baby was born into the home, into the family,
it was seamless.
CATHERINE: Um hum.
it's hard telling what he'll remember about that. He thinks he has a
lot of memories; we look at the pictures a lot, but growing up with
that as an idea of normal I think is going to be incredibly powerful
Now if you were to have another child, would you make different
decisions the next time? Would you choose a home birth?
Oh, no, absolutely I would have another home birth. You know the only
way I wouldn't is if I had some real medical need that would put me or
my child at risk. Honestly, and I tell people this all the time, I
can't imagine having to go through labour and delivering a child and
not being in a nice warm tub of water, because both of my kids have
been water birth.
CATHERINE: Um hum.
KAREN: And I just can't imagine knowing, having
somebody tell me to lie down.
CATHERINE: Or someone to tell you what to do.
KAREN: Right, or when I have to push. Because
frankly, it was rather clear.
And I think that if it comes - the really good midwives have; they know
how to dance and they know when to talk it they know when to sit there.
CATHERINE: Um hum, and they know that mostly
it's a job of watching and waiting.
yes, now I'd have to say that, but absolutely. Not planning to have
another child, but if it would happen, it would be born at home.
Although, my husband says he's going to be devastated when he has to
sell our house. You know, in three years. It'd be hard to leave a place
a child's been born in.
What is the one piece of take away advice that you'd like to share with
other women who are considering home birth, who might be on the fence,
or just exploring their options during their pregnancies; what would
you say to them?
would tell them to do their research, to find a care provider that they
feel comfortable with on a personal and professional level, and then
you just, you make the decision the little voice in your head tells you
to make, and I believe in that. I believe everybody has a conscience
and if there's one point in your life to listen to your conscience,
this is a really good time. And that it's hard because our society does
not embrace this option, our society does not make it very easy to do
home birth, but if that's what you believe is the best choice for you,
there are people out there who will support you, and it's not too hard
to find them once you go to start looking.
CATHERINE: There's always a way.
There is always a way. Like I said, this is going to be one of the most
important days of your life; both for you and your child. And to give
it less attention than it deserves is really selling a whole lot of you
short – your whole family.
Thank you so much Karen for being with us today. Is there anything else
you'd like to say before we go? Appreciate the time you've taken away
from your boys to be with us.
I just hope that more people understand that home birth is a safe and
viable option, and that it's been incredibly peaceful and powerful way
to grow your family.
CATHERINE: Well I hope that they will. Thank
you so much Karen for being with us today.