Book Review/Commentary: Homebirth in the Hospital (Kerr, 2008)
I just got my hands on this book last week–the BPL took awhile to get a copy in, apparently–and I’d had very high hopes for it. It’s a great title, first of all–I think something about that concept (comforts of home, plus the just-in-case feel of a hospital) appeals to a wide range of women who would not consider a homebirth. I had also read a little about the author’s background, and I was eager to read anything by a woman who had lived at The Farm for years, had a baby there, worked under Ina May, and then became a family-practice physician who delivers babies in standard hospital settings. Unfortunately, the book doesn’t quite live up to these expectations; it generally presents a watered-down view of the standard medical party line on childbirth, with a few bones thrown out for women along the way.
Kerr’s whole point here is that she–and other doctors inspired by her–can provide care for a woman, her child, and indeed her whole family in what Kerr calls an “integrative model” (15) of care:
I resolved to provide hospital care that was as close to midwifery as possible. I vowed to trust Mother Nature, watch with vigilance for signs of distress, and respect each mother who honored me with her trust. I worked to integrate the midwifery model and the medical model into each birth I attended. (13)
The problem here, of course, is that if Kerr sets out to combine the midwifery model of care with something else, she is implying that it is insufficient on its own, and I wager most (all?) practicing midwives would disagree here. There is no midwife on the planet, after all, who will tell you that there is absolutely no place for a c-section: midwives acknowledge that medical technology has life-saving benefits to offer, when truly needed. Kerr therefore seems to overly simplify the midwifery model and depict midwives (even though she apprenticed with them) as Luddites.
The book is set up with an introduction by Kerr explaining her philosophy, a first chapter aimed at expecting parents to convince them of the value of integrative childbirth, a final chapter aimed at OBs and family doctors to convince them of the value of integrative childbirth, and fifteen chapters in the middle containing women’s birth stories (most in the words of the women themselves). All of the births profiled here (except Kerr’s own) are indeed hospital births, some with absolutely no interventions and some with quite a few. The birth stories are not nearly as spiritual or inspiring or positive as many of those featured in Ina May’s books, however, and plowing through all fifteen of these stories became slow-going indeed. I can see how a woman who is absolutely set on a hospital birth might like to read more hospital birth stories rather than homebirth stories, but there have to be more inspiring hospital birth stories out there than this set Kerr has chosen.
Kerr herself offers side-notes to the birth stories, clarifying some points and offering “tips”: “Looking forward to pushing your baby with excited anticipation makes it easier to accept and push through the pain” (61); “Allowing the provider to rupture the membranes is a relatively natural way of inducing labor without the side effects of medication. But . . . once the membranes are ruptured, the baby must be born within twenty-four hours” (66). Probably because these sidebars need to be quite so condensed (they look like those mini-blurbs magazines pull out from the main article and reprint in larger font), they alternate between pleasant, empty drivel and aggravatingly medically-minded statements with no elaboration.
Furthermore, the birth stories themselves tend to be upsetting on an emotional level, since many of the women profiled here display a passivity and lack of agency about their own care and their own births:
When I arrived at the hospital, I kept thinking, “Well, soon we’ll have a baby.” Whatever that means. During the whole birth process I just kind of disconnected myself from the whole thing. I just kept thinking of the following day. (66)
I wasn’t afraid of childbirth at all. And that doesn’t make an ounce of sense at all. It’s just something that you have to tough out. . . I’d just think of the horizon and what lay ahead, and I didn’t dwell on what was going on at the moment. I wasn’t excited about it. I was just really indifferent to the whole experience. (71)
Typically the midwifery model of care values the process of childbirth (the experience for the mother) as well as the product (a healthy baby), so I’m unclear why Kerr presents a woman’s dismal views of childbirth above without commentary on them.
Elsewhere in the book, there are frequent derisive references to birth plans, as though women are not capable of making informed decisions about their birth preferences; birth plans are trivialized, and both Kerr herself and some of the women she quotes suggest throwing them away:
We have a saying in my practice: “Burn the birth plan!” My patients were the one who coined this phrase. . . (29)
The quote above is from Kerr, and while she may have a point about women who attempt to rigidly adhere to birth plans, the quote below–from one of the women she profiles–is more troubling:
I had already learned from my first pregnancy that birth plans don’t work because everything you write down that you don’t want in your birth plan is pretty much what you will end up needing. So in my second birth plan, I didn’t write things like “I don’t want a C-section.” (80).
Of course I understand that birth is a natural process and as such doesn’t necessarily run according to “plan”; it would clearly be absurd to write in a birth plan, for example, that you want to be in labor no longer than X number of hours, etc. But the derision shown to birth plans–and the suggestion that there’s no point in listing the interventions you don’t want because “you will end up needing” them anyway suggests that this supposedly integrative model of birth is far more on the medical side of the spectrum than I had anticipated. Unfortunately, I think it’s too far toward the medical side to truly be of value to women who value the process of birth, desire a low-intervention birth, and trust themselves and their bodies to birth their babies.