“Rethinking my Attempted Home Birth” – with Athena Antal CNM

In this episode of High Risk Birth Stories, Athena Antal, a certified nurse-midwife, tells the story of delivering her first baby. Athena decided to have a home birth even though she was a labor nurse at the time, but after some difficulties, while laboring at home, her midwife drove her to the hospital for an epidural where she ultimately had a forceps delivery. She explains what this experience was like and how it changed her plan for her following pregnancies.

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Dr. Fox: Welcome to “High Risk Birth Stories,” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High Risk Birth Stories” is a podcast designed to give you the listener a window into life-changing experiences of pregnancy, fertility, and childbirth. All right. Athena, welcome to the podcast. Thank you so much for coming on.

Athena: Thanks for having me.

Dr. Fox: Athena, as you know, but our listeners might not, you were a labor nurse at Mount Sinai, right?

Athena: Yes.

Dr. Fox: And then you subsequently went on to continue your education and training and now you’re a certified nurse-midwife.

Athena: Yes.

Dr. Fox: We’re gonna be talking about the birth of your oldest, Lyndon, in 2015, your oldest of three children.

Athena: Yup.

Dr. Fox: Fantastic. So tell us a little bit about yourself, just, you know, who you are, where you’re from all, prior to your first birth.

Athena: Okay. So I’m from Boston. Came to nursing kind of late in the game. My undergrad degree is in something completely different. I ended up volunteering at Lutheran Medical Center in Brooklyn out of college and decided that I wanted to do that more than what I got my degree in. So I went back to nursing school. I was the only person in my graduating class who wanted to do labor and delivery. It was a…

Dr. Fox: Who wants to do that? Yeah.

Athena: Who wants to do that?

Dr. Fox: How’d you find yourself in Brooklyn?

Athena: For a boyfriend. [Crosstalk 00:01:31]

Dr. Fox: Wow. Okay. Got it. And you said you studied something different undergraduate. What was that?

Athena: So I have a degree in peace and justice studies from Tufts University.

Dr. Fox: What does that even mean?

Athena: It means sort of an intersection between political science and conflict resolution and negotiation history. Like kind of looking at social justice movements and activism.

Dr. Fox: People who majored in that other than labor and delivery nursing, which is definitely conflict resolution and justice and all that, what do they normally go into? I’m just curious.

Athena: Lot of friends who work for NGOs. I had a friend actually who worked for the State Department who went on to do research or work overseas, humanitarian work, all kinds of stuff.

Dr. Fox: That’s really cool. And what was it about labor nursing, labor, and delivery that attracted you to it?

Athena: That is… I don’t have a good answer for that. We did a lot of different rotations in school. You know, I tried med surg, I tried ICU, I tried rehab, oncology, and when I tried labor and delivery, it just clicked. I knew that this was where I was supposed to be, that I was supposed to be working with moms and babies and I never looked back.

Dr. Fox: So cool. Was Mount Sinai your first labor and delivery position or had you come from somewhere else? I don’t recall.

Athena: No. It was my first. That’s where I was raised as a baby. Baby nurse.

Dr. Fox: Who raised you? Who was, I guess supervisor or whatever it would be called?

Athena: Fortune, you know?

Dr. Fox: Oh, my God. You’re in the Fortune School of Nursing. That’s awesome.

Athena: Fortune School of Nursing, you know, you’re thrown right into the fire. I mean, I’m so grateful that I got my start at Mount Sinai because they really got me up to speed quickly and made sure that I knew my stuff.

Dr. Fox: Yeah. And were you doing mostly night shifts?

Athena: Yes. Night shift.

Dr. Fox: Is that typical for people to come out of school, that they start with night shifts?

Athena: Yes. You know, historically, traditionally, it is the, you know, “less desirable shift.” I ended up being a hardcore night shifter, really enjoyed it. Even when I had the option to go to day shift, I declined. I just, you know, I’m an owl nurse.

Dr. Fox: It’s a different culture, nights and days. I love the night shift also. I just think there’s something about it because, you know, it’s just, first of all, it’s a lot of people in spontaneous labor. Like if they’re getting induced, it’s just starting, but it’s a lot of labors, not a lot of scheduled things at night. And I don’t know, something about people who stay up at night just clicks with me. I’m not sure why. It’s an interesting breed. And, of course, if you’re at night, you’re with Fortune, she runs the night at Mount Sinai. That’s awesome. And how long were you doing labor nursing at Mount Sinai?

Athena: So I was there for a little bit over two years, almost three years. And then I did basically travel nursing. From there, I took travel contracts. My husband’s job kind of hopped around a lot. I was in Stanford, Connecticut. I was outside of Seattle, Washington doing travel nursing. And that is when I got pregnant.

Dr. Fox: When you got pregnant, you’re working as a labor nurse, obviously, you’re intimately involved, like you know the field, you know the topic. What were your thoughts about it going into pregnancy? Was it something that made you, you know, excited? Because you sort of knew a lot about it or were you maybe potentially more afraid because you saw all the crazy things that can happen or how did you process, you know, entering that world yourself as the pregnant woman as opposed to the professional?

Athena: In the beginning, when I was a labor nurse and I was learning the ropes, I remember thinking to myself, “Oh, my goodness, how am I going to be able to handle pregnancy and delivery?” Like I was terrified of all things that could happen, but kind of as the years went on and I knew more, the knowledge made me less scared. Let’s put it that way.

Dr. Fox: Okay. I think that’s fair. And then at the time, at least the beginning of your pregnancy, did you spend the whole pregnancy in the same place? I know you’re doing travel nursing or once you got pregnant, were you in the same location?

Athena: So I moved back midway through my pregnancy to Boston because we decided that we wanted to be close to family. And when we got pregnant, I was 29 and I don’t know why, but I thought that it was going to take a long time and we’d be trying for months and it wasn’t gonna happen immediately and then it happened on the first try, which was shocking. And it was really scary because we didn’t have a good sort of exit plan. We had to kind of scramble and we moved back to Boston when I was, I think, 23 weeks pregnant, 24 weeks.

Dr. Fox: Okay. Were there any concerns you had specifically like medically or in terms of anything that’s going on with symptoms at the beginning of pregnancy or was it pretty straightforward for you?

Athena: I had and have the most benign pregnancies.

Dr. Fox: That’s a blessing.

Athena: It is. I have kind of your run-of-the-mill morning sickness in the first trimester. I have, you know, your usual kind of aches and pains, but never anything concerning.

Dr. Fox: Were you still working when you moved back to Boston or did you take time off once you’re in the third trimester?

Athena: I took time off after we moved. And I was at school at this point. I was in school, you know, remotely. So, you know, I was taking classes and all that. Yeah.

Dr. Fox: Remote school. You were ahead of your time. Pre-COVID.

Athena: Pre-COVID. OG. Right.

Dr. Fox: Yep. I’m curious, at the time when you were seeking out whether a doctor or a midwife, you know, a prenatal provider, who did you look for is gonna be my first question? Like what kind of provider? And the second is why? Like what was it about your experience as a labor nurse that led you one direction versus another? Because people go in different directions with this. Some people see what happens in a hospital and like, “Oh, I wanna go much more low intervention.” And other people see it and go, “Oh, my God, I wanna go to like the high-risk doctor even though there’s nothing wrong with me.” Where did your experiences take you for your own pregnancy?

Athena: So for that pregnancy, it was the former. So for that pregnancy, I was young, and healthy, and low risk and I knew that I wanted to be in as low intervention setting as was appropriate for me and I knew I wanted to be with a midwife and preferably have a delivery at home.

Dr. Fox: All right. Here we go. Game on. Home birth.

Athena: Here we go, right?

Dr. Fox: So I’m really curious, I wanna talk about this a little bit. So you’re working, you know, on labor floors and you’re working, you know, with doctors, with midwives, with both, but all of them are in a hospital. Was there something that you said, “I don’t like the hospital for me,” or was there sort of, did you have any negative experience? I’m just curious, you know, how you came to that conclusion that you wanted to have a home birth after working in a hospital.

Athena: Right. A lot of people, when they seek out a hospital birth, they’re saying, “Oh, you know, I had my first birth in a hospital and it was horrible and I want a different experience.” That wasn’t my story. You know, I didn’t have some kind of past bad experience of the healthcare system or anything that. I just kinda, you know, I want it to be, if I could, I want it to be, you know, at home with my husband and my cat.

Dr. Fox: Your cat, because does it have a crucial role, like to cut the cord or something?

Athena: Yeah, yeah. That was the, you know, that was gonna be the plan, which got disrupted.

Dr. Fox: “Here, Fluffy. Gnaw on the cord.”

Athena: But, you know, at that time, it was a little bit… You know, I didn’t know as much as I know now, and I was kind of seduced, you know, by the idea of home birth and by kind of the analogness, if you will, of it. And the comfort, you know, being in your own home. It was appealing to me.

Dr. Fox: Had you ever been a part of a home birth before?

Athena: I had not. I had gone to at like friend’s birth at a birth center but until that point, did not have any firsthand experience with home birth. And, of course, I had colleagues like other nurses who left nursing for midwifery and became, you know, out-of-hospital midwives. And so I kind of knew people in the field.

Dr. Fox: What did Luke think about this? Was he like, “This is awesome?” Or was he… Did he have some trepidation about this?

Athena: He was very trusting. He’s like, you know, “You are… This is kind of your purview and if you think this is what is best for us to do then we’ll do it.” He was on board.

Dr. Fox: Cool. And what about your family and friends? Did they know this was the plan, like, were you born at home or any other family members? Like was this something that people had done in your, you know, in your circles?

Athena: No.

Dr. Fox: Got it. Okay. How did you find your midwives to do this?

Athena: I think just through contacts in the community, or maybe my midwife in Seattle also kind of gave me a list of her sort of colleagues back in Boston and that’s how I found them. Yeah.

Dr. Fox: Okay. So you made that decision and you’re following with them. And how did the rest of prenatal care go until you went into labor, I guess?

Athena: Very benign. Very nice. They came to my house. The two prenatal visits was luxurious. It was no waiting around at a doctor’s office. I did go to a hospital-based clinic for, you know, ultrasounds and my glucose test and a couple of other things, you know, make sure that my placenta was in the right, you know, not blocking anything, not blocking the exit, you know, other things like that.

Dr. Fox: Right. And so tell me about your labor when that happened.

Athena: Well, the whole home birth aside, this is where it also kind of turns into a cautionary tale. Now, remember this was pre-arrive trial. This was pre, you know, say prevention of a cesarean. When I went into labor, [Inaudible 00:11:41]. Okay. I was 41 and change.

Dr. Fox: Forty-one weeks.

Athena: So I was 41 weeks and change and I had an induction scheduled for 41 and 5.

Dr. Fox: And were they planning… I’m just curious. I don’t know how it works. Were they planning on inducing you at home or for an induction, do you have to be in a hospital or birthing center?

Athena: I had a working relationship with a midwife at Mount Auburn Hospital, so they knew…and I was registered with them. So they knew that they were going to take me if I didn’t go into labor by, you know, 41 and 5.

Dr. Fox: Okay. So the induction would have been at the hospital with the midwives there. And was that also sort of like the backup plan in case the home birth wasn’t working out, you would go there?

Athena: Yes.

Dr. Fox: Okay. And they have a relationship that, that’s sort of, you know, set and established and, you know, they work together?

Athena: Yeah. I think it’s kind of more mutual respect than a formal, you know, any kind of a formal arrangement.

Dr. Fox: Got it. Okay. Got it. So you went into labor though.

Athena: I did go into labor. So I was like, I was staring down the barrel of induction and, you know, I did all the things the night before, I ate spicy food, I ate Italian food. Oh, we got acupuncture. Right. We called somebody, somebody said, “Oh, try acupuncture.” And, of course, you know, I didn’t know as much about alternative medicine then as I do now. I don’t know if I would be down with acupuncture now, but, you know, I was a little more open to it back then. We did the, you know, went and drove to somebody’s house in Cambridge and did the acupuncture. And, you know, she told me, “Oh, you’re gonna go into labor tonight.” And I was like, “Oh, I hope so.” And I did. You know, I don’t think it wasbecause of the acupuncture or because I was, you know, 41 and 4, but I did go into labor.

Dr. Fox: You never know.

Athena: Or the Italian food could’ve been a, you know, it could have been the chicken parm.

Dr. Fox: Could’ve been any.

Athena: Could’ve been. So I did go into labor that night. I had a contraction so bad that it made me throw up all that Italian food and I was like, “This is it.” They were labor starting. So I labored, you know, all morning. I completely forgot about the appointment for my induction. They’re calling me at like 9:00, 10:00 and I’m like, “Hey.”

Dr. Fox: Where are?

Athena: Where are you? And I said like, “No. I’m good. I didn’t labor. You know, I’ll be in touch if we need you.”

Dr. Fox: Right. And how was it with your midwives?” Are they coming and going? Are they with you? Do they wait until you’re a certain stage of labor? How does that work logistically?

Athena: The way it worked for us is that they kind of waited until things became…things ramped up. So when it was no longer early labor, when things sort of changed. So I think when they arrived, it was mid-afternoon at that point and I was six and we had a tub set up. You know, we had set up a tub previously in our apartment and that was kind of like in and out of our bathtub. But when we started filling up the big tub, then we knew it was time. So it was time to call them.

Dr. Fox: Like one of those like inflatable labor tub type thing?

Athena: Yes.

Dr. Fox: Got it. Okay. And during this time, do they monitor the baby’s heart rate or they do it intermittently or not at all until they get there? What happens? I’m asking because I’m curious not because I know what happened. I’m just wondering what they did.

Athena: There wasn’t any monitoring when I was in early labor. You know, I had precautions to call if, you know, X, Y, and Z happened, you know, I didn’t feel the baby move, yada, yada. So they came, you know, they came like mid-afternoon, definitely and I was six and then they started there, then they were, you know, hands-on so the whole time and started there. They did intermittent monitoring of the Doppler.

Dr. Fox: You mean six centimeters dilated, right?

Athena: Yes.

Dr. Fox: Yeah, yeah. Okay. And so they do the intermittent monitoring with the Doppler to check the heart rate. Okay. I’m presuming that they do it pretty expectant, right? Are they breaking your water? Are they doing any like nipple stimulation to get more contractions? Are they just sort of, you know, watching and waiting and helping you through the pain?

Athena: You know, were watching [Inaudible 00:15:56]

Dr. Fox: Okay. Good. So how’d it go?

Athena: So it went well initially but I couldn’t keep down any food or fluid and I was vomiting, vomiting, vomiting. I had an IV and they gave me fluids, was vomiting up fluids, and all this was making my heart rate rise. So I had a high heart rate and I was in the tub and the tub itself was hot. You know, I liked my bath, you know, like a hot tub. And so my temperature, I think, was rising also slightly. And so the midwives said, you know, your heart rate is elevated and your temperature is a little high. I need you to get out of the tub and we need to kind of start talking about a plan. And before we even started talking about a plan, I got out of the tub and I was like, “I cannot cope without being in the tub. I need an epidural. This is game over.” So we went.

Dr. Fox: So you went from there to the hospital?

Athena: We did, and it was the most horrible car ride of my life. And I remember it like it just happened.

Dr. Fox: Who drove?

Athena: My midwife. One of my midwives.

Dr. Fox: Okay. Is that… I’m just curious, is that the plan? Like if there’s a transport to the hospital, that’s the expectation that she will take you to the hospital in her car?

Athena: It’s a transfer for pain management. If it were any other kind of transport, like a medical transport, then we obviously would have called in an ambulance.

Dr. Fox: Ah, okay. So you go in her car, how long is the ride to the hospital?

Athena: A grueling nine minutes, eight minutes.

Dr. Fox: Okay. Okay. And so when you come to the hospital, how does that work? Is your midwife still with you or they don’t have privileges in the hospital?

Athena: No. They don’t have privileges at the hospital. So I’m handed off to the in-house team.

Dr. Fox: Okay. So you’re handed off, did you have time to get an epidural?

Athena: I did.

Dr. Fox: Okay. And then…

Athena: Oh, yeah. Had a lot of time.

Dr. Fox: How long was there between getting there and the delivering?

Athena: Twelve hours. Thirteen hours.

Dr. Fox: And how long were you laboring at home before you went?

Athena: So let’s say labor started at like 8:00 in the morning, 7:00, 6:00. So it was a good 24-plus, a little over 24 hours that I was in labor. So we were at home from, you know, 8:00 a.m. until 8:00 p.m. I think I transferred.

Dr. Fox: So about half and half. Okay. And so how did the birth go ultimately in the hospital?

Athena: So it was interesting. This is kind of where… You know, this whole experience is worth to say that if I hadn’t been in the business, if I had been, you know, like a layperson, what happened in transferring and everything would have been more traumatic, but at the hospital, you know, we got there it’s where…it’s what used to. You know, I know what’s going on, I have my wits about me. So when we got there, I was a little more relaxed. You know, I’m glad that I was because things got a little bit iffy. My water broke spontaneously. So I was, you know, this whole time I was kind of in labor, I didn’t, you know, stall, there wasn’t any talk about [Inaudible 00:19:39] or anything. So I got there, got the epidural and my water broke, I think like as they were laying me down after the epidural. And I had meconium, which, you know, at 41 and 4 isn’t, you know, uncommon, you know, there’s that. And I got to fully. And at this point, you know, I had a bunch of vaginal exams and it was pretty and, you know, by my contraction pattern, you know, you can sometimes tell it was pretty clear at this point that Lyndon was direct OP. That he was, you know…

Dr. Fox: Sunny side up as we would say.

Athena: Sunny side up. Yes. My treating was good. It was fine. But when I… I remember when I started pushing there did start to be some befalls and attendings came in and they started talking to me about potentially a C-section if, you know, baby’s heart rate continued to drop with contractions or while I was pushing. And, you know, I think they kind of first offered it to me around maybe 2:00 or 3:00 in the morning and they said, you know, “Like it’s not an emergency, but, you know, we don’t think this is kind of…” I don’t know quite the words they use, but, you know, “We don’t think this is kind of happening.”

Dr. Fox: Did they know you were a labor nurse?

Athena: Yes.

Dr. Fox: Okay. So they were talking to you maybe in a higher level potentially because like, you know, colleague to colleague.

Athena: Yeah.

Dr. Fox: Okay. I got it.

Athena: It’s hard because I wanna be the patient. I wanna be in that. I wanna be able to have that space where I can, you know, not know things and ask dumb questions and not try to be my own provider because that never turns out well. You know, and I was also under the care of midwives at that point who were pushing with me, you know, in hospital-based midwives and we kind of made the decision to take a pause from pushing and just give the baby a little time to rest and then kind of restart and if it keeps happening, then, you know, I [inaudible 00:21:56] So we did. And I kept pushing him and the baby looks much better and I pushed, and I pushed and I pushed. So let’s see, I started pushing what, at 2:00 a.m, right? So 3:00, 4:00, 5:00, 6:00. So now we’re, you know, baby did come down, I’ve made some progress, but we’re still really not…we’re not getting there.

Dr. Fox: So the attending came in and it was a situation where a reasonable choice at that moment would have been to proceed with C-section. I think that… And it’s, you know, and if you kind of talk about risk-benefit decision-making, it’s hard because every person and every provider is gonna have their own sort of risk tolerance and their own sort of preference for how they… Some people really don’t care. How they wanna deliver their baby. And I didn’t know how many children I wanted to have and I really like I wanted to have a vaginal delivery if I could have one. I’d rather not be cut open and have a major surgery if I didn’t need to. Of course, we don’t need is subjective. So what happened, you know, like around 6:00 or 7:00 is, you know, the timing was basically like I’m out of, you know, I’ve kind of done like all I can, I’m out of options, baby isn’t well enough to vacuum, you know, C-section is all I can offer you. And I asked about forceps because I kinda knew where this was going and I knew… I’m very fortunate to have worked in a place… Now forceps is something that’s like, “Oh, wow. Are those still used anymore?” Well, I happened to be trained at a place where people use them when they’re appropriate. But if they did not know how to use them. And she said, “But the doctor coming on, [Inaudible 00:24:02] he teaches all the residents at Harvard how to use them and, you know, if your baby can hold out for an hour, he can come and assess and see if you’re a candidate. And so by the grace of God, if somebody else had been the oncoming attending then I would have happily had a section.

Dr. Fox: So it’s six hours of pushing or in between pushing with six hours, what we call the second stage, the new attending comes on, does the forceps, it was pretty straightforward, the birth was okay?

Athena: Yes. Yep. There were like 100 people in the room.

Dr. Fox: Put you in the big viewing gallery taking pictures. Come a little closer, everyone.

Athena: Viewing gallery with 100 people in the room. I was naked.

Dr. Fox: Yeah. Whatever. Here we go.

Athena: I don’t know how that, at some point, you know, the gown got discarded. My husband was topless and was so shirtless because he thought that, you know, the baby would not be able to go to me after delivery. He would do skin-to-skin with the baby. So I’m naked, he’s shirtless. There are, you know, 50 people in the room, you know, anesthesia is like… [Inaudible 00:25:20] was a epidural but the top off wasn’t…like the top off wasn’t working. And so, you know, I was like, I hadn’t been turned down and had like a non, you know, halfway not functioning epidural and, you know, for forceps delivery which was great. And I kind of knew the benefits and the risks and I was comfortable with that. And yeah.

Dr. Fox: How was how was your recovery after the forceps? I mean, it’s a long labor, that’s a long time and you definitely gonna be pretty exhausted afterwards, but how did it go over the first few days and then the next few weeks?

Athena: So it was not great. So…

Dr. Fox: It’s hard.

Athena: It is hard and kind of, you know, it gives you a lot of thoughts about like, “Oh, in hindsight, should I have made a different choice?” And, you know, it’s hard to say because, you know, I have gone on to have two more, very easy vaginal deliveries. So after the forceps, you know, there was internal bruising and pain and I had incontinence that lasted quite a while, which was not fine. And because of the pain, I had difficulty initiating breastfeeding. So that kind of got off to a slow start and we had to supplement my son with some formula, but, you know, we’ve kind of gotten through that eventually. But it was a little bit more, you know, a little bit more involved than your regular vaginal delivery for sure.

Dr. Fox: Yeah. I mean, you know, if I’m on the other end of that and I’m the obstetrician, I have someone who’s pushing for a long time and… Yeah. We do forceps for two reasons. One is, you know, the heart rate’s dropping, we need to deliver the baby quickly and it’s just quicker than a C-section. But the other is like someone like you, you’re pushing for very long time, it’s just not happening. And, you know, in those situations, like you said, that’s healthy. We could do forceps or we could do cesarean. And a forceps is not a walk in the park. I mean, it’s a tough recovery. It hurts, you know, frequent, especially on a first baby and whether it’s gonna hurt more or less than a cesarean, I would say usually it’s an easier recovery than cesarian, but not always. Sometimes a cesarean is an easier recovery than a difficult vaginal birth. It’s hard to know that in the front-end, but that’s sort of how it is. One of the advantages, it does make it easier to deliver vaginally the next time around, but at that time, you don’t always know what the “best thing is.” And all that’s a conversation. It’s hard to have the conversation sometimes in an emergency, but typically someone’s pushing for hours and hours, you do have time to sort of talk through it. For your next pregnancies, did you try to do home birth again or did you say hospital, or midwives, doctors, what’d you decide to do for the second and third?

Athena: For a second and third, I decided to go to the hospital and I found midwives, certified nurse-midwives affiliated with hospital practices both times. I showed up, you know, went into the ER, as I’m getting walked up. I’m like, “This is my name. This my date of birth, this is my blood type. My platelets are great. I want an epidural. Like anesthesia now. Have them ready before I get up there.” What I thought I wanted was not what I wanted. You know, I tried the home birth and it’s not for me. And kind of, as I learn more, you know, in school and kind of, you know, I don’t know if this… It definitely wasn’t appropriate for me and there is controversy as to whether it’s appropriate for anybody, really. And that’s kind of a…I feel like I’m a traitor to my colleagues by saying that, but that’s kind of where I’ve ended up. So I think that if I, you know, if I were pregnant now, if I had to have my first pregnancy now, I would’ve made some different choices. I wouldn’t have gone for home birth, couldn’t have stayed pregnant until 41 and 5, you know, that kind of thing.

Dr. Fox: Yeah. I mean, it’s interesting that, you know, home births, and we’re not gonna settle the debate about home births in this podcast, but, you know, one of the ideas is, you know, they are done around the world in certain parts, but in the places that have a successful sort of home birth program, it’s because it’s very organized. You know, it’s robust, there’s a lot of people that do it, there’s systems in place, there’s transport to every, you know, the hospitals, everything is sort of set up. And then in that setting, the risk is not very high because you can get from your home to, you know, a more acute care setting, you know, sort of expeditiously, you could do that. And, in fact, if you know, if someone did not know your feelings about this, right, but just looked at your story would say, it’s an attempted home birth, right? But it’s not like a failure in a sense, meaning you tried a home birth and there was something that went different and you’re in a lot of pain and so, okay, you went to the hospital, the plan changed, and you had healthy delivery and they would say good outcome, right? They’d say, “Everything was great. Tried your home birth, didn’t work, get a healthy hospital delivery,” but it’s not just that. It’s what you’re talking about. It’s also the experience of the woman going through it. And for some people, having the attempted home birth and then it not happening going to the hospital, they’re like, “Okay. I tried it. I feel good about it. It’s a good, you know, it’s all good.” And for other people, they sort of look back on it and they say, “I wish I hadn’t done that.” And it’s hard to know that before you start, what it’s gonna be like, if that were to happen, there’s a real chance when you try home birth, the baby’s not gonna be delivered at home. It happens a lot. And people don’t know that. I mean, you must obviously have women who come to you who ask about home birth, I assume.

Athena: Yes. Yes. After I graduated, I did practice in a birth center. So it was an out-of-hospital setting. And I didn’t personally do any home births, but, you know, it’s, I mean, it’s similar, you know, the resources are similar, kind of the access is similar. You know, there’s no OR in the back. And, you know, people do ask about, you know, a hospital birth or home birth and the risks. And, you know, it’s hard to be honest and say, you know, there’s no OR in the back where we can take you, you know, if you start a booking. If your baby needs rapid like fluid expansion, we can’t, you know, after delivery, something wacky happens, like we can’t do that. You know, there are limitations, you know, based on the environment. In a place like America where we have such a disjointed system, it doesn’t make as much sense.

Dr. Fox: Yeah. I mean, I don’t have a lot of people ask me about home birth. I mean, just because the nature of my practice, it’s not really on the table for people. But, you know, every now and again, friends or family, it comes up in conversation. And I’m not negative about home birth per se. I think it’s fine. I just don’t know of a really good system locally that has that all set up. I mean, I would be personally afraid, you know, of my family members on having a home birth. They’re “Oh. Like what’s your plan if things go crazy?” Right? And I mean, you can imagine you’re, you know, you’re in Brooklyn, you’re laboring in your third-floor walkup and an emergency happens, you call 911. Okay. How soon are they gonna get there? How can they get up there, how are they gonna get you down the stairs? Where are they gonna take you? When you get to the hospital, they’re not gonna know you from holding the wall, right? So, you know, who are you, what’s going on this? And then the people taking over your care potentially, unless they’re, you know, the best providers on earth, are gonna be a little bit irritated that this is happening. And it’s just, you know, there’s a setup for potential problems and unlikely for something horrible happening is, of course, low. Most people, it’s gonna be fine, but it’s not set up at least where I practice to have a, you know, home births in an organized fashion. And I think that’s people’s hesitation locally, at least.

Athena: Kind of, you have to look at why are people…why has home birth that sort of exploded in popularity and why, despite all the evidence, you know, all the evidence that the hospital is the safest place, do people still seek out home births. And I think that’s a question that we, you know, sort of the global we, need to answer because I think that there are two things that can be true at the same time. So I think that so on the one hand, you know, the hospital is the safest place to give birth for mom or a baby. And the other part that is also true is that the hospital can… There’s something that’s not going right. That’s something that hospital-based care is falling short on that’s causing people to forego it. So what is that and what can be done to sort of keep people? What’s so bad what’s happening that it’s making people say, “Oh, no, I don’t wanna be in the place where I’m gonna be most safe. I would like to take a risk of a preventable death?” So I think that’s a big question.

Dr. Fox: Yeah. I think hospitals are very uncomfortable with everything not being, you know, all the T’s crossed and the I’s dotted and everything. So it’s understandable why they feel that way because hospitals are big systems and if bad things happen, you know, they get bad press and they get blamed or they get sued, or they just don’t want bad things to happen. So for them, it’s like, you gotta put, you know, safety measure, upon safety measure, upon safety measure, upon safety measure. And they view that as a very good thing because they’re keeping people safe and it is a good thing. But for the woman going through that, that one safety measure could be annoying. I don’t want this oxygen mask on my face when I’m in labor. I don’t want this intravenous line in my arm. I don’t wanna be attached to a monitor. It’s a balance trying to, you know, put safety on one side but not, you know, ruining or I don’t know, changing the experience that someone’s looking for on the other side. And we try to navigate that all the time. And there are some things that just aren’t an option because the hospital makes rules. You’re right. There is something that’s lacking that is driving people out of the hospitals. And I don’t know the solution to that. It’s more complicated than I can figure out, but it’s real.

Athena: Yeah. Unfortunately, COVID has sort of exposed the sordid underbelly of the Venn diagram overlap. There’s a lot of science denialism, there’s a lot of skepticism and, you know, it flows through the home birth community. It’s all, you know, all can come from the same place.

Dr. Fox: On the one hand, you know, if you wanna think of it like…I agree like a Venn diagram or a spectrum, on the one hand, there’s definitely people who just don’t trust the system, right? They don’t trust science, they don’t trust the government, they don’t trust the hospitals, they don’t trust the system. And I get it. And that’s sort of, you know, some might look at that as paranoia. But in on the other hand, we definitely also see that there’s people in those positions that maybe do go overboard with recommendations and being too strict and too aggressive. And there is a balance between those two, but it’s trying to find that balance and that balance is complicated because it needs to be nuanced. It’s gonna be different for each person based on her own risk factors, based on her own situation, and that’s very hard to do. It’s much easier to just draw a line in the sand and say to the left is bad to the right is good, you know, acceptable, not acceptable versus for each person modifying it. That’s just very difficult to do on a practical level or on a large scale at least.

Athena: Yeah. And communication has a lot to do with it. You know, I think people occasionally just want to be communicated with, they want to feel like they know why things are happening. If we’re gonna, you know, why you’re doing what you’re doing or why I’m making this recommendation or that, and they wanna be part of the process. And, you know, I think they feel…people feel as if they’ll get to be more part of the process, you know, when in out of hospital setting, it’s also…unfortunately, it’s a little bit of propaganda also as far as, you know, this kind of belief or default that natural is better or not having an IV is better. Why? Or not being attached to a monitor is better. Why? I think that there are some sort of truths…things that people think are truths that, you know, we can question.

Dr. Fox: Fascinating. Wow. Athena, I love this conversation, hearing your story. We touched on so much. It’s awesome.

Athena: There’s a lot there. I was a little sheepish-ed, honestly, when I first emailed and I said, “Oh, God. I attempted a home birth is, you know, is this off limit?

Dr. Fox: No. But it’s an honest story. Yeah. Listen, you’re not eligible. Obviously, you made a choice that was clearly…you thought about it and it was informed and it’s what you wanted to do and you’re looking back on that and it’s not, you know, you’re, you’re telling your story. And it’s interesting for people to hear all, you know, perspectives on these. And I think that yours is a really good one. And I know I loved hearing it. I’m sure our listeners will. And no, absolutely reach out. Everyone listening, reach out, tell your story. It’s good stuff. It’s very cathartic. You feel better telling your story?

Athena: Yes.

Dr. Fox: Excellent. Well, thank you so much for coming on and, you know, it’s great to hear from you. Your kids, Lyndon, Logan, and Gunnison, your youngest was just born a year ago, midst of the pandemic. Where are you guys now?

Athena: So we’re in New Hampshire. We’re in a building in New Hampshire.

Dr. Fox: Wonderful. All right. And I’m looking forward to hearing more from you and yeah, thanks for coming on.

Athena: Thanks for having me.

Dr. Fox: Thank you for listening to “High Risk Birth Stories,” brought to you by the creators of the “Healthful Woman” podcast. If you’re interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at hrbs@ighriskbirthstories.com. If you liked today’s podcast, please be sure to check out our “Healthful Woman” podcast as well where I speak with the leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Have a great day.

The information discussed in “High Risk Birth Stories” is attended for information and entertainment only and does not replace medical care from your physician. The stories and experiences discussed in our podcasts are unique to each guest and are not intended to be representative of any standard of care or expected outcomes. As always, we encourage you to speak with your own doctor about specific diagnoses and treatment options for an effective treatment plan. Guests on “High Risk Birth Stories” have given their permission for us to share their personal health information.