Written by Alex Louise

I don’t know why women choose to write the birth stories of their children. Perhaps to keep the memories close, in order to share them one day with anyone who might ask. Perhaps to digest and process an event that could be anything from transformative to traumatic. The first time I wrote a story like this, the title was followed by at home. But that was that story and this is this story, and as many know, no two stories or births are ever the same. 

I have thought about this story often over the past 11 years: Why I chose to have a hospital birth after having a home birth, how a nurse named Mahalia will forever be etched into my brain and how it felt to be in the cocoon of a hospital recovery room where the only thing that mattered was me and him and literally nothing else. 

In my experience, moms never forget birth stories. 

I cannot tell the story of the birth of our second son without telling the story of the birth of our first.  At the time of our first son’s birth 3 years earlier, I was a trained postpartum doula. I was a vocal (and adamant) believer in home birth. I had trained with midwives, attended international birthing conferences and worked at a local center for expectant parents who wanted a natural birth. In fact, when my husband and I were only dating, I made sure he knew, “If we ever have kids they will be born at home.” 

Two years after that date, my husband would become home birth’s biggest advocate and cheerleader.

The birth of our first son happened at home, just as we had planned  - with a positive outcome, on paper:  mom and baby were healthy. The home birth skeptics in our family and friend circles could exhale. We had proven to them that home birth can, in fact, be safe. For many in our support circle, the story of our first son’s birth was the first and perhaps only story of home birth they knew personally. For us to share the news that all went according to plan (meaning there was no emergency hospital transfer) meant they now had a story of home birth they could share with confidence and conviction. As could we. And we did. For our story of a boy being born, in a condo, in a tub in the living room, in the middle of San Francisco, was too good not to tell. If you are interested in the first story, click here



Three years later, I became pregnant for the second time. Though I started prenatal care with the same midwife who had assisted us with my first pregnancy, it became very clear to me early in the process that something was different this time. I was different. My thoughts were different. My fears were bigger. My anxiety was louder. My trust in the process had been shaken and I unexpectedly found myself floundering in a new sea of overwhelm, decision fatigue and total confusion. This was not the confident young woman who explained home birth to a wide-eyed young man on date #8, five years earlier. Not the same woman at all. 

No one understood me. No one understood how I could possibly be questioning having another home birth. I didn’t understand me. I had somehow swallowed the assumptions about home birth that for years I had tried to detangle for the people who thought home birth happened on hippy communes with some hot water and lots of howling at the moon. I used to believe: once a home birth, always a home birth. 

Not having a reason why and not having a rational explanation for my new thoughts and desires was excruciating, so I delayed making a decision for as long as I could. I did prenatal care with both our midwife and a nurse-practitioner at Kaiser.  I somehow danced between taking the tests that one vehemently opposed and the other required. I tiptoed around decisions and delayed some appointments - wondering what would happen if they each found out about the other. They kind of knew because I wear my heart on my sleeve and my indecision was hard to hide but neither pushed or poked. I knew both had an agenda, though it was softened with love, gentleness and understanding. Perhaps they were both wise enough in their craft to know that I needed to come to the decision on my own and that any kind of persuasive rhetoric on their parts would have not landed well. 

Being indecisive feels unnerving to me. I tried to steady myself on the shaky ground of not knowing but I have never liked that feeling - I suppose not many people do. Ultimately, I had a finite amount of time to make a decision - this baby would come whether I found blissful clarity or not. Without any reason that seemed valid at the time, I knowingly and proactively chose to have a hospital birth after having a home birth for one reason: because at the time, that is what a voice deep within me I knew I needed. 

My choice didn't make sense to most, especially those involved in the home birth community. It didn’t make sense to my husband who literally had educated himself about everything about home birth so that he could say without a doubt that he was onboard the first time around. But the worst was that it didn’t make sense to me—because of everything I had studied, learned, experienced, and, prior to that moment, believed. 


Hindsight is 20/20. Looking back, I can now see that I had assumed I would be the same person with baby #2. But I wasn’t. 

For one, I was now someone's mother and my thoughts and energy were no longer just my own. All the internal preparation I had done for the first birth was not accessible to me the second time around because I was distracted with being the mom of a now toddler.  I wondered how I would turn off my vigilance for our son in order to be fully present to this upcoming second birth experience and baby. I convinced myself I couldn’t have a home birth if our older son was at home, and not having family in the area meant I didn’t have an easy solution for a place for him to go. The idea of him being in the home for the birth of his brother, was something I knew I didn’t want. 

Second, we now lived somewhere different. The concept of “home” was in flux because we were in a rental home looking for a house to buy. During nap times on the weekends we feverishly rushed from one realtor’s open house to another, all in the final months of this second pregnancy, leaving me feeling disconnected to my sense of home and place. I couldn’t plan for a home birth if I didn’t know where home was going to be. 

But perhaps most impactful was that I now had an actual visceral experience of birth. I had body sensations and memories. In hindsight, I can clearly remember moments during our first son’s home birth where I felt devastatingly alone and afraid. Because, for a short while, at the most pivotal time, I was completely alone, lying on the floor of our San Francisco condo, on cold black bathroom floor tile. It was 2am. My husband had fallen asleep briefly. Our midwife wasn’t there yet because we told her we had it under control and we would call if something changed. I knew enough, I had thought. I could do this. But I had underestimated how quickly birth can change and how it  would feel to go through that moment of transition when labor moves from progressing to active. And at that moment, women don’t look for a phone to call for back-up.

Some part of me now wondered if those feelings of being so alone wouldn’t have happened if I had been in a hospital for that first birth.


At one point, I could no longer be straddling two options. Choosing a hospital birth meant choosing to go back to the city to the Kaiser location with labor/delivery. Knowing we had to cross the Golden Gate Bridge to have a baby, we had a plan, with padding for traffic and a deep desire to avoid any kind of gridlock.  It also meant being very aware that I would know none of the names or faces of the staff on the maternity floor. They would be perfect strangers to me. They wouldn’t know my history, my fear, my triumphs. They wouldn’t know how much I knew about birth. So when my membranes ruptured before any contractions started (which I was expecting because it happened the first time that way) - I had some time in the car (30 minutes to be exact) to figure out how I would approach the medical staff at the hospital.

In a home birth, in this scenario, midwives tend to wait. They monitor, they avoid internal exams to reduce chance of infection and they let the contractions come. In a hospital, doctors tend to intervene. Fearful of infection and then complications and more susceptible to the constraints of schedules and shift changes, women whose membranes rupture before contractions start will usually be given medication to induce labor and to expedite the contractions, whether they want it or not. It’s just protocol and it makes sense why in a hospital following protocol is important. I knew the protocol.

I had this knowledge, but I also had my own experience.

I just needed the right nurse.  



I knew enough to not come barging in with a complicated birth plan or aggressive pushback. “Please let me wait.” I asked, hoping that this nurse would be the one nurse who would hear me and see me as an individual and not a protocol to follow.

I didn’t give her time to say no but instead proposed my case with kind conviction because I had practiced it in advance, knowing this moment would come. “This happened with our first baby. The contractions will come.”

I barely took a breath and didn’t avert my gaze, staying confident, but soft. “I know what my body is capable of, I know what pain I can withstand without medication, I know how to do this if it follows the timing and rhythm of my body.”

I couldn’t read her facial expression—it was distant, but I just kept my words calm. In my memory, me pleading my case had no real beginning or end.  I started to feel as though a no was forming on her lips so I added my well rehearsed closing line…“If you give me Pitocin it will create a rhythm that is not my own or my baby’s and I won’t know how to sustain it. And if then the pain gets to be too much I will say I can’t do it and you will give me something else and that will lead to….”

The nurse stopped me there. I have no idea what she looked like or what her name was. I had never met any of these caretakers before. 

“I see you know how this can go,” she said with a tone that felt more like one reserved for colleagues than for the formal dynamic between nurse and caregiver who are complete strangers. “I will try and slow things down. There is a shift change coming up. We will “skip” your room. If you need something, buzz.” 

Several shift changes later, an emergency c-section that called away the on-call doctor from regular rounds and a bit of luck, and I managed to stay under the radar for most of the day.

We walked the halls. I didn’t see many other women, but I knew they were there. Names on doors, occasional sounds. Weird to know you are alone and yet so not alone. I remember the white hall walls and stark floors. As we were making another round on our floor in the building on Geary Blvd, I looked at my husband as we walked this eerily quiet  floor of the maternity ward and said, “I am really glad we did this baby thing at home first where everything was familiar. The sounds, the furniture, the smells, the letting things happen all felt very normal at home. These machines and weird contraptions parked in the halls aren’t scaring me now but I wonder how it would feel to see them the first time you have a baby. They would freak me out, I think.” 

In that moment I think what I was trying to say was that I wasn’t afraid of the process because I had experienced the process at home first, with a midwife who had helped to normalize every single moment of it.


Evening came and rules are rules and I was given a dose of Pitocin. The contractions came on like a semi-truck with failing breaks  – fast, big, intense, unrelenting. My mindfulness birthing tool of remembering to rest in the space in between was utterly useless because the space in between barely existed. A doctor, some doctor, came to check on me. I was tired, in pain and absolutely certain that this baby was coming any minute. She checked me out, looked up at me and said, “It’s going to be a few more hours. I’ll come back then.” Then she walked out the door.


I was crushed. I was devastated. I was defeated. And I was starting to get scared. Not the alone scared I had felt during the home birth but the animalistic fear of the unknown where you think your life is at stake. I couldn’t do this intensity for a few more hours. I could feel panic, I could feel fear, I could feel myself giving up. I don’t know if I voiced all these intense feelings in the matter of seconds that followed the doctor’s abrupt exit or if the nurse in the room, who I hadn’t noticed before this moment just knew, but she came to me and said something that landed in my heart, head and body like this: “The doctor is wrong. This baby is coming any minute. You can do this. My name is Mahalia. I won’t leave. We got you.” I am fairly certain these weren’t her exact words but it was the fight song I needed to hear. 


30 minutes later he was born, like a rocket. A doctor, maybe the same one or maybe not, literally rushed in to catch him. 

I don’t know the doctor’s name who caught our baby or who tended to my body as I held our boy.  I wouldn’t recognize her on the street. But I will always remember the name Mahalia. Maybe because my dad had Mahalia Jackson records when I was a kid and I had never met anyone with that exquisite name before. Maybe because the nurse with this name changed the course of that birth for me without knowing it. Maybe because she was that person for me, that person that every woman needs at the time of birth who reminds her that she can do it and that she is not alone. 

Here’s the thing: Birthing women need advocacy not agenda. That is what Mahalia did for me. That is what the no-name nurse who let my room get lost between shifts did for me. That is what I did for myself when I asked for them to wait on the interventions. That is what I did for myself when I said I needed to have this baby in a hospital even though I couldn’t yet explain why.