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Doula Dani believes there can be no informed consent without information. She shares her thoughts on post-cesarean birth choices with SteadyHealth.

Giving birth is, no doubt, among the most profound and life-changing experiences any woman can ever have — it marks the start of new life, after all. It's hardly surprising that modern women and their partners frequently turn to the internet in search of answers to questions such as "Where can I have the safest, most comfortable birth?". 

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Over recent years, women have started to exercise more control over their birth choices — and the natural childbirth movement has gained popularity. Increasing numbers of expectant moms are aware they have many possibilities, including homebirth, vaginal birth after c-section, and even homebirth after a prior cesarean. Natural birth and homebirth websites can quickly give the impression that these choices are perfectly safe. Are they, though?

SteadyHealth spoke to Danielle Repp, AKA Doula Dani, a former homebirth advocate who doesn't gloss over the possible consequences of choosing homebirth in high-risk situations. Her blog, "What Ifs And Fears Are Welcome", does not shy away from tough topics. Homebirth advocates may not like her conclusions, but she speaks out because she believes women deserve to see the less idyllic side of the natural birth movement. Danielle shared her thoughts on vaginal birth after c-section, homebirth after c-section, supporting women, and the natural birth movement with us. 

'Concern, dissent and stories of home birth loss or injury are too frequently not "acceptable"'

Your recent commentary on the safety of vaginal birth after c-section, and vaginal homebirth after c-section (HBAC) in particular, has caused some controversy in the homebirth world. Why do you think that is?
 

What I wrote about VBAC (vaginal birth after cesarean), and in particular what I wrote about HBAC (home birth after cesarean), goes against what the home birth movement promotes. It threatens what they believe, threatens choices they have made, and threatens their livelihood. At this point, I am not really shocked anymore by anything from home birth advocates.

I have been deleted, banned, censored, attacked. I am certainly not the first. And I won’t be the last.

In ways, it is cult-like. There’s a tendency to create echo chambers isolated from any counter opinions. Concern, dissent and stories of home birth loss or injury are too frequently not "acceptable" in home birth circles and forums. They will call it fear mongering or hide behind the guise of "we allow support only" when the reality is, they don’t want people to question the safety of home birth and they don’t want people to share information or stories that make people question the safety of home birth.

I think there are a lot of well-meaning midwives and home birth advocates out there who put their trust in the leaders of the home birth movement. I think those at the "top" – the leaders and more outspoken advocates – know the deliberate lies and misinformation they are spreading… and it just trickles down through the home birth community, shared as the truth.

For those that don’t know who or what is censored, they are left in the dark.

The midwife/client relationship is another aspect that makes it hard for women who choose home birth to see what is and is not acceptable/ethical care, what is and is not true informed consent. It can easily become an us (home birthers) versus them (the hospital/doctors/medical world) situation – which makes collaborative care very difficult and makes it hard for home birth mothers to know who to trust.

'I Realized I was Duped By All Of The Home Birth Propaganda'

You were once a homebirth advocate yourself. Can you describe what led you to change your mind? 

It was a combination of factors. It started with being involved in an emergency home birth transfer as a doula. From there, it just took off into several different avenues, searching for answers to the mounting questions and concerns I had. The process and the aftermath have made me a much more skeptical person. In the end, I realized I was duped by all of the home birth propaganda. I realized I only had part of the story when we were hoping/planning for our home birth.

Using infant mortality [as a yardstick by which to measure the safety of home birth], for example, is a deliberate attempt to fool someone about our maternity care here, to scare women away from hospitals and obstetrics in the USA. You see, infant mortality is live birth through the entire first year of life. Perinatal mortality is a much more accurate measure for maternity care. It includes prematurity, antepartum mortality, intrapartum mortality and neonatal mortality. That is obstetrics. That is maternity care. So why don’t the leaders of the home birth movement discuss perinatal mortality? Because the United States does very well with perinatal mortality, tied with countries like France and Japan, and actually better than countries like the Netherlands and the UK. It doesn’t help the home birth agenda to share that information, though.

That is one example of many. Lies, cherry-picked information, misinformation, and happy anecdotes are really what home birth in America is built on.

We took into account every logical and emotional argument we could. The last piece was just me being brutally honest with myself, which was the hardest piece of all. But our bottom line was safety. I knew the hospital was the safest place. It’s a matter of fact, not opinion. It’s a greater risk of (potentially unnecessary) intervention in the hospital but a greater risk of death when not in a hospital. I felt my chances of avoiding unnecessary intervention in a hospital would be greater with a support system, having a good "birth team".

The process taught me so much about home birth in our country. I don’t have respect for the home birth movement here. I can’t support it because I feel I am trading in a piece of my integrity by doing so. I support a woman’s right to have a home birth. But I have lost so much respect for our home birth "system".

It became clear that the home birth movement in our country isn’t based on empowering women. It is based on deceiving women. And I could not be a part of that.

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