This is very interesting. The fact that there are only 700 babies born in the PAUSD catchment area shows no sense for the prospective kindergarten figures 5 years down the road. It is very worrying knowing that the only demographical way of assessing the number of potential kindergartners for the next school year is by looking at the birth rate for the PA zip codes (as per Santa Clara County records) for 5 years previously.

According to this article, the kindergartners for 08/09 should be around 700. We all know that this will not be the case!!

Pal Alto zip code birth records are an inaccurate predictor of kindergarteners. People DO move to Palo Alto after their children are born, when they must actually seriously contemplate where they will plan to send existing children to school.

Another

I agree with you entirely, but the birth records are the only predictor the school board has. Everyone, including the school board, know that this is a flawed system, but there is no other way.

I would say that at least 50% of my friends moved to PA when their oldest was in the 2-4 year old range, specifically for the schools. (my kids are 3rd grade, 6th and 10th)

What a fantastic article! I expecially appreciate the last sentance:

"...And an area where women know their options, and demand excellence from their physicians, is a great place to give birth, Rydfors said"

This was a very thoughtful article, and much needed. I've spent much time talking to moms about birth experiences and have been really saddened by how fear of birth seems to have pushed people to over-rely on technology and medicine for what should be a normal process.

In that vein, I wanted to shed a little more light on the philosophy behind birthing "naturally" (by that I mean without drugs), because as the article mentions, it's not about braving the pain for the sake of it. It's about going through a normal birth to have the best possible chance of an ideal outcome: a healthy, nursing baby.

It's often not clear to new moms and dad that drug interventions of any kind, including an epidural, can change the body's physiology so that it no longer works in a "normal" way to birth a baby. Once you've altered body chemistry, you're more likely to have fetal distress, which then can result in further interventions, and before you know it, you're in the "emergency c-section" camp. Of course, all of these drugs and interventions have their place and can be important, but many people simply don't understand that they can have real repercussions. And, many people also do not know that epidurals given during labor and birth are associated with decreased rates of breastfeeding, both in the short and long term. I've seen so many moms struggling with breastfeeding and the guilt that goes along with failing to get it right, and yet people give birth without understanding how to best improve their chances of success.

And therefore, the reason that homebirths are a nice option if you don't want to step on the ladder of interventions is that an intervention is less likely to occur at home. Homebirth excludes drug painkillers - you must be transferred to a hospital. However, as a mother of two children born at home in Palo Alto, I can say that birthing at home provided me with all the tools I needed to deal with the intensity of labor - on my own terms. Being in control of my experience was key to dealing with pain.

Nearly all studies on homebirth in healthy women show that it is at least as safe - both in terms of maternal death and infant death - as birthing in a hospital setting. Obviously, to have a successful homebirth, however, you must feel safe at home, and therefore it's not for everyone; most people these days seem to feel safer in a hospital. I only came to the conclusion that home would be safest for me after extensive research - I'd not planned a homebirth until I met a midwife I loved that only delivered at home.

So, I guess my point is simply to say that I'm pleased to see more information about birthing choices out there, especially in such a balanced article. I just wanted to add a little more depth to the side of things I've spent a lot of time thinking about.

P.S. I just wanted to add that Blossom Birth, mentioned in the article, provides the most outstanding childbirth prep classes ever. I credit them for providing me with nearly all of the successful pain management strategies I used during my girls' births.

We have had two home births and they both have been perfect -- with no problems whatsoever. The midwives in this area are superb and very professional (We used Faith Ginson & Donna Driscoll).

The experience is amazing and it really wonderfully magical to have your newborn with you right after the birth.

Also, I have met at least 2 mothers who had awful bacterial infections from having birth at the hospitial, which caused them to have to actually have long hospital stays later.

After what was apparent normal pregnancies, I have had 2 deliveries, both of which would have caused my death and the death of my babies had I not been in a hospital.

I am not taking away the experience from those who have had home deliveries, but being surrounded by technology if it is needed is something I would recommend to any prospective parents. To a large extent many of the birthing rooms in hospitals are non-intrusive if things are going well and they still give you your newborn into your arms right after birth. Knowing that they have checked the baby first (it takes practically no time) before putting him in your arms is very reassuring.

Good article, but I often get the sense that this community places too much emphasis on having babies. Conceiving them, delivering them, being parents. I would like to see more coverage on adopting children or the choice of some couples not to have children. There are so many little ones out there in thread-bare orphanages around the world, why bring more new babies into this world, where our global resources are growing more limited every day?

Kudos to the Palo Alto Weekly for running a story about natural childbirth in the area. I do, however, have a bone to pick with you about offering only part of the story, leaving your otherwise uninformed readers with the feeling that hospitals really are the best way to go, without just coming out and saying so.

As stated by Rollin at Blossom Birth (a fantastic local resource for families), birth really is a very personal experience and it is up to the comfort of mother to choose what is best for her and her baby. What we also have to remember is that birth is largely a cultural experience, as well as a physical, emotional, and spiritual one.

What our culture teaches us about birth is that it is painful and traumatic and that most of us aren't capable of doing it on our own naturally. Women NEED to educate themselves about their bodies and why they should trust the birth process, but they also need to learn how to train for birth, by whatever method they choose.

A large point of your story focuses on a couple who entered in with the best of intentions for a natural birth only to be defeated, but who were saved by a hospital, doctors, and medications. They were described as having "researched doulas and practiced breathing.... even painted puffy clouds on the ceiling of the baby's room."

For a truly informative piece about the choices that go with natural childbirth, how about listing more of the options available to women, such as more well-rounded information on midwives, home births (and state regulations surrounding this choice), birthing centers, or hospitals that offer midwives?

You could print a Birth by the Numbers chart detailing things like a woman's age, the birth method chosen, classes utilized by the mothers, and interventions necessitated for each method, rather than an entirely uninformative chart on age and zip codes. It would also interest a lot of women to know that natural childbirth with midwives is the norm in a lot of developed countries and that the U.S. is the black sheep of the world using doctors as primary caregivers as well as having some of the worst cesearean, complication, and mortality rates in the world. The Netherlands, for example, has the highest rates of midwife attended births, and the lowest rates of complications.

What women need to know the most is that childbirth is inherently a natural, normal, healthy, and safe process, however they choose to go about doing it. To learn more about the process of birth, as well as about how natural childbirth works (not just a grit your teeth and deal with it method), they can start with Ina May's Guide to Natural Childbirth, by Ina May Gaskin, an internationally renowned, and doctor respected midwife. It is filled with personal stories, by women who gave birth in hospitals and naturally, as well as scientifically sound information that is written in an entirely relatable and understandable way.

It provides a strong foundation upon which women can build their childbirth education and preparation.

Something else that needs to be pointed out is how hard it is in this area to plan for a home birth and yet also work with an OB in case you need a hospital delivery. For that you need an OB willing to work with a midwife over the course of a pregnancy and, to my knowledge, there is preceisely one in our area: the wonderful Dr. Jan Rydfors.

My wife and I were lucky enough to work with Dr. Rydfors and the equally wonderful local midwife, Donna Driscoll, for the birth of our second child. As it happened, our home birth plan was scotched by our son's last-minute gymnastic flipping in utero. We ended up with Rydfors, Driscoll and Julie Debrouillet, a good friend and fabulous doula, in the delivery room at Stanford, all working together with great skill to make our boy's birth a very happy event.

Being able to work with an OB and midwife over the course of the pregnancy and having that OB available for hospital delivery makes planning for a home birth much less of a scary option.

I wish more local OBs were as enlightened as Dr. Rydfors. Until they are, I would say that home birth is not as much of an option for local parents as it could be.

I have had three babies delivered at Kaiser in Redwood City. Kaiser's normal practice is for a midwife to deliver each birth unless there were complications. My first and third babies were delivered by midwives, but the second, as complications arose, the midwife called in a doctor who delivered by emergency c section. Even with a c section, I was able to deliver vaginally the last time. Kaiser also have some of the lowest rates of c sections for any hospitals.

[Post removed by Palo Alto Online staff].

[Post removed by Palo Alto Online staff].

Thank you for a great article! I agree with others - Blossom Birth is great - they are really there to help families.

I'm confused about the stats people refer to, some of which I've read myself but I don't know exactly how they do this. Apparently complications and mortality rates are similar in hospitals and at home. Okay, but aren't the most risky births, and the least planned ones, happening in the hospital? So, suppose you have 1 in 500 deaths in a hospital, and 1 in 500 at home. Nice, except, aren't the hospitals' set of 500 more risky/complicated to start with? Are we comparing the same kinds of pregnancies and pre-natal care situations? Wouldn't homebirth stats be skewed by the set of hospital births that started out planned for home and had to go hospital? So dealing only with the healthiest group, homebirths match the rate for hospitals dealing with all types? Maybe I'm wrong, if anyone knows, enlighten me.

I've heard too many stories, and have one in my family, like the one above.... everything was going fine until the baby's heart rate plunged.... going fine until mom passed out after delivery... I honestly don't understand people who want to take the chances at home when there's a perfectly good hospital. For the sake of their 24-48 hours of emotional preference they pass up on the best chances if something goes wrong. Labor is really quick, compared to a lifetime of good things or a lifetime of regrets. My cousin is starting high school now. He'd have died in a home birth. Should the years of his life be measured against how his mom would have felt more comfortable at home?

Instead of overall odds, just answer the question of where you'd like to be at the moment when the cord chokes the baby and it needs to get out NOW.

Why do people think it won't happen to them? I mean, I've driven my car for thousands upon thousands of days without a car accident, so the odds of me being in a fatal car accident seem very very very low. Should I drive without my seatbelt?

I had 2 babies in a hospital. Then, a third in Menlo Park's Birth Center where I had 2 M.D's, a nurse and a doula present as I gave birth.

I would never have had a hospital birth if I knew what a natural birth could be like. I have tried to describe the difference, but I can't find the words.

I am delighted to hear that people are talking about a new Birth Center. It is exactly what is needed in order to say, "We have choices."

Both my children were midwife-deliveries; the first as a natural unmedicated birth in a hospital with a RN-midwife (where everything that I disliked about the experience was standard-hospital-related) and the second in the cleaner and much less stressful atmosphere of my own home with an MD midwife and with my family in attendance. I have no plans to have any more, but if I did, I'd definitely plan another homebirth (given optimal conditions again.)

My experience with various midwives (the RN was part of a revolving group of three) has been extremely positive, and they all gave me much more time, patience, respect, insight and good advice at regular checkups than any of the OBs I ever dealt with.

In response to "stats" appropriate concern about whether the studies on homebirth v hospital birth have different underlying populations, there are good studies on thousands of births in the US, UK, and Australia that closely pair the underlying health of home v hospital births, and find same mortality (deaths) and lower morbidity (disease) among home births. There are deaths of moms and babies in hospital births at the same (very low) rate as home births, again paired with the same low-risk moms. What's different is that at home there are many fewer respiratory illnesses among babies (no hospital germs and no compromised breathing from drugs) and complications from Cesareans (less likely to be needed). Birth is a physiological process that typically proceeds best in surroundings that are quiet, low-light, and perceived as safe. This is our mammalian heritage. Unless the woman feels safer in a hospital, conditions at home are more conducive to the innate physiology of birth.

Am I the only one who find the number of births to kids under 20 - over 100 - in a single zip code - a concern? What kind of a contribution does teenage pregnancy make to the much discussed "achievement gap"? The fact that in 4 zip codes combined there were just a few birth to kids under 20 vs over one hundred in a single zip code is a great cause for concern.

PA Mom

What you are looking at is obviously the 94303 zip code. That zip code includes East Palo Alto as well as parts of south Palo Alto (the Palo Verde and Duvenick neighborhoods, I think). The different demographics in these two areas are the reason why the comparison of zip code v zip code makes these numbers so different from the rest of Palo Alto.

Thanks for the thoughtful reply. I understand your very well-presented points and explanations.

I still don't really have (or understand) the answer to the ultimate question: when everything goes very wrong very suddenly, where would you rather be? Why would you assume that sudden and devastating complications can't happen to you?

I know the odds are very low, but I can't see myself putting all of the minor and short term benefits of homebirth ahead of the minor and short-term disadvantages of hospital birth; the deciding factor for me is which facility could save a life, and how quickly I'd have access to that kind of help. Homebirth seems much more about mom/family emotions than about taking best precautions in a situation that carries some risk of a catastrophic outcome. I know I'm talking about a tiny percentage of cases, but like I said above, I'm related to one of those kids. I can't imagine his mom living with the lifetime of sadness if he'd died in a home birth due to a complication that arose suddenly and was solved surgically using every precious minute they had.

(I know that sometimes babies and moms die in childbirth in hospitals too, but what are the odds that a case that bad would have been better off at home?)

What if there were a hypothetical vaccine that carries a 1-in-10 chance of up to 24 hrs. pain and fever, a 1-in-100 chance of bacterial infection or respiratory complications, but prevents a 1-in-10,000 chance of death? Seems to me that home-birth is like skipping the vaccine. Works out fine most of the time, but.......

Novice questions - is the midwife trained to the APGAR score on the new born?

What about the placenta, other human body material - how does that get disposed?

I had a beautiful painful spiritual loud messy homebirth. My first born baby was born in a tub of water with absolutely no interventions. No pains medications, no IVs, no fetal monitor, NOTHING. My lovely midwife, Rosanna Davis, was low-key and soft-spoken during it. I wouldn't have changed a single thing about it.

And I am medical practitioner. In a large hospital.

We are in a culture and time that doesn't trust women to know instinctively what is the right choice for their lives and their bodies. The patriarchy and our consumerist culture forces them to rely on technology and their reassuring mechanical beeps. Because expensive medical equipment can't be wrong, right?

Let's remember though that the choices these women are making are a privilege that many other women in this area cannot make. The majority of homebirthers are well-educated, and of a high SES level. A homebirth is expensive and the fees are up-front. Poor women, undocumented women, teenage women, women of color are not gaining access to these amazing services and they do have a right to. Instead they are put through the mill, where they are prodded, their sacred spaces are invaded and "delivered" by an MD or resident, they have never even met. I don't want us to forget these women.

Also Jan Rydfors is an amazing gynecologist and I respect him immensely.

Let us remember that 100 years and more ago, there were no contraceptives and women gave birth with no medical help, just an older woman who had gone through it herself, hence the term midwife, being the only help available. All four of my grandparents were born about this time. They were survivors of many births to their mothers, of which most did not make it beyond the first few days, let alone the first five years. My grandfather was brought up by his step mother because his mother died in one of these births.

Now this was a time where natural births were the norm and granted things were different back then, but anyone saying that this is the ideal way of giving birth because women instinctively know what to do, is very wrong. Yes, there is a lot more knowledge for women to research and there is training for midwives, but do we really want to return to the way it used to be. Yes, if some women really want this "ideal" birth at home, fine for them. But, please do not make the rest of the population who want to take no chances, feel that what they are doing is second best.

I had my babies in France but would not dare have them in a hospital here in this country, the 27th best in the world for medical care. Infant mortality is the highest here than in any other industrialized country.

This does not say too much about safety of hospitalized births here, since 97% of babies of babies are born in the hospital.

I'm sure there's room for improvement in the quality of hospital care, but I'm also sure that our overall infant mortality rate, relative to other industrialized nations, has much more to do with our overall poverty rates, drug abuse, and especially our lack of access to healthcare, moreso than hospital shortcomings.

As for the post above about trusting technology and things that go beep, well, yes - if the baby is about to d i e , I want to be in the place with the equipment and the doctors capable of providing an emergency c-section within minutes, rather than spend precious minutes getting in the car, driving, arriving at the ER, waiting for them to get things started, and then heading up to surgery. So, gosh, it's not the beeps themselves that are reassuring, actually. That dismissive response kind of missed the point.

So far, everyone responding to my points cites statistics and personal success, and believe me, I'm thrilled that there are so many good outcomes. But no one answers the question - IF things go horribly wrong, where do you want to be? YES, I know that things usually don't go wrong, but my hypothetical question is assuming they do, because, sometimes... they do. Like, I know I probably won't be hit by a car crossing a busy street, but IF I were hit by a car, I'd want to be... next to the hospital. And if I only had to cross the busy street a few times in life and could choose where to do it, I'd choose... by the hospital, even it were a more unpleasant place to cross. And in this case, it's not just a matter of my risks. There's a child involved. So, have the baby in water if you like, spare it a minute of discomfort and crying, out of the thousands of hours it will spend crying in coming years... I just don't get it. I want to be open-minded about this, but everyone just keeps telling me "odds are..." and I just want to know about what happens in those rare cases. So if we have more kids, my wife and I are on the same page with this - we'll put up with the resident we never met and the supposedly higher risk of infection in exchange for the surgeon standing by. And we're not even complaining about the residents, by the way. Our two experiences at Stanford were fine and dandy, thank you very much.

A choice made by fear alone, is not an informed choice.

Do the research, read the literature, don't make a gut reaction ...homebirth is as safe, if not safer than hospital births.

I am mystified at the obsession with pregnancy and birth by today's young women. Is it disillusionment and retreat from the work world? It seems they believe they are inventing childbirth. Previous generations didn't really appreciate their new babies? What nonsense.
Maybe it is just the extension of narcissism. That seems more like it, and unfortunately that unpleasant quality is being extended to their offspring.
The conversations here are the same we had 30 and 40 years ago-- the different opinions about home birth, the so called spirituality of this very physical event.
Has anyone read anything to explain this phenomenon?

"Novice questions - is the midwife trained to the APGAR score on the new born?
What about the placenta, other human body material - how does that get disposed?"
Posted by Mom, a resident of the Crescent Park neighborhood, on Jan 14, 2008 at 9:23 am

Yes, midwives do APGAR scores, and enter them on their paperwork. They're very well trained professionals here, not "village healers".

Placenta - for a homebirth, same as in a hospital; you can have them take it away for standard medical disposal, or choose to keep it and plant it under a tree for symbolic/spiritual reasons, or whatever. You can keep the umbilical cord segment too if you like and let it dry out as a souvenir.

I don't know if midwives today do cord blood collection for stem cells; it wasn't something being done even in the hospital when my kids were born.

just as I thought - no one could answer my question. "Fearless" - I'm not asking out of fear. I'm asking because, as rare as it may be, things can turn bad quickly for anyone, anywhere. Just curious if the homebirth crowd is really indifferent on my question. No one seems to want to answer it directly. They like to say that both places have similar risks of complications. I'm wondering if both places have similar ability and options to save a life within minutes. Rhetorical question, right - of course they don't. So what kind of odds are people considering when they take a chance on mother and baby?

And when you weigh the slim odds against the severe consequences, is it worth mom's happy spiritual home experience?

If I offered you a nice, free car, but told you it had a 1 in 10,000 chance of exploding without warning, would you take it? After all, 1 in 10,000 is exceedingly rare, right? But for that 1 in 10,000 the outcome couldn't be more serious.

and I have to agree that much of the childbirth industry that has sprung up in reaction to the medical/industrial industry seems to rely on their own brand of arrogance/superiority, mixed with a healthy dose of narcissism. No angels on either side of this. But look, I'm not denying that birth is a spiritual and emotional event - I know the intensity of that experience. And in the first case, no, hospital care wasn't everything we could have hoped for. But after the baby is born, all that other stuff fades from consciousness pretty fast.

2008 movie, The Business of Being Born

http://www.thebusinessofbeingborn.com website and trailer

"Footage of women having babies punctuates THE BUSINESS OF BEING BORN. Each experience is unique; all are equally beautiful and equally surprising. Giving birth is clearly the most physically challenging event these women have ever gone through, but it is also the most emotionally rewarding.

Along the way, filmmaker Abby Epstein conducts interviews with a number of obstetricians, experts and advocates about the history, culture and economics of childbirth. The film’s fundamental question: should most births be viewed as a natural life process, or should every delivery be treated as a potential medical emergency?

As Epstein uncovers some surprising answers, her own pregnancy adds a very personal dimension to THE BUSINESS OF BEING BORN, a must-see movie for anyone even thinking about having a baby! This film premiered at New York’s Tribeca Film Festival and is due to be released in theaters in January 2008."