Home-birth Transfer Mirrors Life Sometimes

After a fitful night of pesky dreams - the kind that mirror things going on in your life but are just a tad bizarre, as dreams are - I woke up with some insight. Funny.

It starts with the home-birth *transfer*.

It's safe to say none of us who are advocates - obsessive junkies, really - for home birth like it when a client has to transfer. Oh, of course we all give a lot of authentic lip service to being grateful we have the option when necessary and all that. But we really don't like it.

First, if a client must transfer from the pleasant tranquility of a home birth to the tubes-and-monitors-and-needles environment of a hospital to have a baby, then it's likely something's wrong. Maybe not always *wrong* - we use kinder words like "variation" - but it could be mom or baby is struggling in some way. (In fact, in my classes, I tell clients, "If you have to transfer from home-birth midwifery care to a hospital, it's because there's something at the hospital you *need*.")

Second, it's not always clear *what*, exactly, is wrong or what the client will need. And that is a bit unsettling. Most times the midwives will have their own suggestions: "Let's see if we can get you an epidural to relax your pelvis and get this (posterior) baby to turn so you can push him out." Other times they're not sure themselves exactly what will help, as it's not always clear if there's a true physical problem or if mom's just too exhausted or discouraged to go on. (The latter doesn't happen a whole lot at home, by the way.)

Third, we're not sure how things will go once we get to the hospital. It depends on the doctor who's there, the nurses, hospital protocol, how the staff views home-birth midwifery, the client and her desires, our own preparation and reactions and, of course, how the baby's doing. I've been to three transfers as a doula or birth assistant. Two of three were great. One, it was clear the doctor thought we were back-woods practitioners - and she treated the midwife as such.

Fourth, there's this more intangible overall *feeling* we all have in various ways on various levels. It has to do with *failure*. For the mom, often she's struggling, feeling like she "failed" the natural childbirth experience test and let not only herself but also everyone else down. After my own home-birth transfer in 2003 that resulted in a cesarean for a surprise breech baby (and other factors), I told my childbirth educator and doula, "I'm so sorry I messed up your statistics." While she was, of course, quick to assure me I was worrying needlessly about that, it was a very real feeling for me. I know other moms who transfer feel the same way. And so do the birth team members, I'm sure of it. We all ask, in various ways, "Why didn't it work?" Or "Was there something I didn't see, something I could have done better?"

See home birth - natural birth - is serious business. For many of us, it becomes our *cause* or our *passion* and we're so convinced that almost all women - given the chance - can do it. When it doesn't work, it feels like we're eating our words. I had a lot of words to eat after my cesarean. Like any medicine, they were bitter but provided some necessary healing for later. (Oh, and my VBAC at home three years later erased a lot of those feelings of failure.)

ANYWAY, whew. Where I'm going is that, this morning, it struck me that many things in life are like the home-birth transfer. We do our homework, do our research, do our meticulous preparation. We're active, vocal and confident about what we're doing - not shamelessly careless. (You should see how professional and awesome my midwife friends are who do this.) We get to the big event - the birth, but for you maybe it's a new job, a lifestyle, school, a relationship, whatever - and then things aren't going quite right. If you're like me and have done what I teach in childbirth classes, you've done what you can to first *prevent* problems. And when you *detect* them, you aim to *treat* them, using the least-invasive and most natural techniques first.

But.

Then you find things just are not improving. Maybe it's the - metaphorical, here - mom. Maybe it's the baby. Maybe it's neither. Either way, it's not getting better, and it's time to transfer. Apparently, you need something somewhere else that you just don't have at home.

My husband and I are in that position right now. We've forged ahead for a few years with a definite ideal. And it is - ideal. But here we are, things not going so great. Our course corrections - least invasive and some more drastic - haven't worked well. Maybe it's the mom. (Um, in this case, that'd be me, and it probably is.) It's time for the transfer.

And just like at a birth, I don't like it. I may understand it's necessary, but I still don't like it. And I think, when we get there, it likely will be clear what was wrong and how to fix it. But those measures probably won't be so fun either.

I was at a transfer once where mom did *everything* she could, holding off a cesarean until she had labored herself completely out and pushed for three hours with nothing but some caput (essentially baby's scalp) even *peeking* out under the pubic bone. She had her cesarean and discovered a most bizarre anomaly in the baby's presentation. It was "Aha!" for all of us. We were exhausted and emotional. (She was just happy to see her beautiful baby.) This mom is so inspiring because she - still very vocal - has not given up on the idea that home birth, natural birth, works. But for her, transfer was necessary.

I don't like the transfer - uh, I think I've said that - but sometimes it's necessary, and you're not sure why until much later. I'm hopeful that's my case, and I still won't say ideals aren't worth pursuing.