Book Review/Commentary: Homebirth in the Hospital (Kerr, 2008)

29 June 2009 at 5:15 pm 3 comments

Homebirth in the Hospital: Integrating Natural Childbirth with Modern Medicine, by Stacey Marie Kerr (Sentient Publications, 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.



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3 Comments Add your own

  • 1. mfomcontributor  |  30 June 2009 at 10:34 pm

    Hi Christina: I read this book, too, and I found the introduction and author’s history fascinating. I did think that some of the interventions were aggressive, even for a hospital! But I think that the book could be helpful to those women who would never, ever consider homebirth or a birth center birth, but they are still seeking an experience that is not disempowering or like a factory conveyer belt.

  • 2. nursingbirth  |  1 July 2009 at 4:06 pm

    I once was a woman who would NEVER EVER EVER EVER have considered a home birth. But movies like Business of Being Born, and books like Spiritual Midwifery, The Thinking Woman’s Guide to a Better Birth, Born in the USA among others really opened my eyes to the possibility. So I dont necesarrily think that women who “would never ever” consider a home birth do not still benefit from home birth stories and generally other media that talk out against our over medicalized model of maternity care. I am pretty upset that a book with such an enticing title as “Homebirth in the Hospital: Integrating Natural Childbirth with Modern Medicine” is filled with statements that: undermine a woman’s right to be an active participant in her plan of care (i.e. writing birth plans), includes stories where women comment that felt “disconnected” and “indifferent” to the process of labor and birth, encourage “goal oriented” as opposed to “mindful” thinking during labor and birth, and overall give women the impression that they should just expect to agree to everything the hospital system tells them they need (ie the birth plan comment again) is HURTFUL, RIDICULOUS, AND SHAMEFUL! I mean there are other authors that are against birth plans for a variety of reasons (Pam England CNM for example). But unlike Pam England, Dr. Kerr’s reasons for discouraging birth plans isnt because she wants women to surrender to the unpredictability of birth, but because “everything you write down that you don’t want in your birth plan is pretty much what you will end up needing” That is PROPOSTEROUS! I am upset this book came up so short, especially since this author not ony collected statstics for Ina May on home birth, but HAD a home birth on The Farm. This book could have been a great tool for many mothers. From the small amount I have read about it (reviews, summaries, as well as the official website etc) I am thoroughly disappointed.

    • 3. christinamichaud  |  1 July 2009 at 4:12 pm

      Oh, just to clarify–that quote about “everything you write down that you don’t want in your birth plan is pretty much what you will end up needing” is from one of the women (Kerr’s patients) reflecting on her own birth stories, not from Kerr herself. Kerr does seem to be implicitly agreeing with England–surrender to the unpredictability of birth, etc.–but doesn’t state it in such a clear-cut way. Sorry for the confusion!


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