Where are the "normal" births?

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Armygirl7

188 Posts

Specializes in ED.

what2donow--

I am so glad to see this post today. Just finished a 6 week rotation in L&D and it was a c-section factory. So depressing.

Normal birth is all around - but you have to look for it!

Can you assist a CNM who does homebirth? I have assisted at 7 home births and it is a whole different event than hospital birth. Like, you wouldn't recognize any similarities except the presence of a pregnant woman and eventually a newborn! The prenatal care is markedly different as well. Much more education going on at the midwife's office. Naturally, because she is a nurse!

The women I took care of in the hospital often were bewildered by what happened to them. Upon gentle questioning I would discover how little they had been told about what was actually going to happen to them, how little they understood about the cascade of interventions awaiting them at the hospital, and how much unaddressed fear they had about the birth process. They had put themselves completely in the hands of their doctor (OB's are surgeons, surgeons dig surgery!)

I did not see a single laboring woman on her feet in 6 weeks at the hospital, not even to urinate, foleys for everybody, yipppeeee!

And I agree with ruralnurs, people have to take personal responsibility for their choices - but the machine that is for-profit healthcare has a much more powerful voice than the one we can muster to broadcast correct information into the community. It is very hard to be heard especially if you are not using fear as a marketing tool.

This country runs on the almighty dollar - if they reversed the compensation - if NSVD was reimbursed at a rate twice that of c-section you would see a transformation in the statistics OVERNIGHT! This hospital I was at is making a FORTUNE on all the crap they sling at these women, usually ending with the cherry on the reimbursement cake: c-section. So there is no incentive certainly for hospitals to be educating women, or employing people (including supportive RNs) who could educate women, about options that veer them away from expensive interventions.

I like the Dutch model - all low-risk pregnant women (90%) deliver at home with a midwife, all high risk women deliver with an OB at the hospital. Outcomes are among the best in the world. The Dutch don't do this so that women have some kind of "natural experience," they have developed this system because it is the SAFEST way to give birth, it results in the fewest DEATHS and bad outcomes for moms and babies, it is backed up by SCIENCE! But people in the US flipped their lids at the mere mention of a single payer healthcare system... So we get the care that is driven by the dollar and not by evidenced based practice, common sense, or health! It's embarrassing.

Some of the women I cared for were in so much pain & discomfort and so wiped out from major abd surgery they couldn't even hold their babies hours after the birth. First time moms. Sad. Sad. Sad.

Is a revolution in L & D even a possibility?

LoveANurse09

394 Posts

Specializes in Cardiac.

Armygirl- You said it all! Maybe an army of aspiring midwives like myself can revolt. I too agree, that women need to develop a voice and make their caregivers aware of their needs/wants, but like you said an 18 year old first time mom ( like me), who got pretty much NO prenatal,breastfeeding, postpartum teaching (despite CB classes) who didnt know any better than what the DR told me to do is helpless.

Not to mention growing up with the knowlegde that women go to hospitals to have babies and epidurals are normal, I had NO idea of midwifery and real SAFE labor.

ErinS, BSN, RN

347 Posts

Specializes in Hospice.

I am just lurking, but I wanted to put out there my wish. I wish women could deliver in hospitals, but in a natural (less intervention) way. I am a hospice nurse, and have cared for four babies with complications following a home birth that have resulted in terminal conditions (at least two of which could have been avoided with immediate intervention in the hospital). While this is not a large number, it is devastating to those four families. It would be great to combine natural birthing with the fast access to emergency care if needed in a hospital setting. It really is a broken system.

JenniferSews

658 Posts

Specializes in Professional Development Specialist.
I am just lurking, but I wanted to put out there my wish. I wish women could deliver in hospitals, but in a natural (less intervention) way. I am a hospice nurse, and have cared for four babies with complications following a home birth that have resulted in terminal conditions (at least two of which could have been avoided with immediate intervention in the hospital). While this is not a large number, it is devastating to those four families. It would be great to combine natural birthing with the fast access to emergency care if needed in a hospital setting. It really is a broken system.

In my own small experience, my decision to homebirth was cemented by a friend's hospital birth. Her "uncomplicated induction" labor and delivery ended in a baby born still who was alive during an intensively monitored labor. Whether the birth was mismanaged or not is up for debate. But the end result was the same, a birth that was in theory safe with a healthy fetus ended in the ultimate tragedy. Being in the hospital isn't always the answer. "Could have been avoided" is Monday morning quarterbacking. Maybe it could have been prevented, or maybe not. But having actual hard science to back those decisions up instead of provider preference and superstition is a worthy goal. Too many birthing decisions are based on maternal fear and lack of knowledge, provider threats, and the worry of a lawsuit on the part of the clinician.

Armygirl7

188 Posts

Specializes in ED.

Wow ErinS that must have been very hard. Did the babies spend time in hospice care before they passed? Is there a neonatal hospice in your hospital or is it freestanding? Were the births planned homebirths attended by a CNM? What were the preventable complications that could have been prevented at the hospital but not at home?

Things can go wrong for babies and moms at births, even when they are right there in the hospital. Just being in the hospital is no guarantee because birth is in some ways unpredictable even though, if left alone, 95% of births happen spontaneously and without adverse events.

I find many Americans want some kind of guarantee of perfection and safety. And whether you are in the hospital or at home that is simply not a possibility. And the statistics bear out that the hospital, as it is run right now, is the more dangerous place for a laboring mom and newborn.

BabyLady, BSN, RN

2,300 Posts

Specializes in NICU, Post-partum.

I am a NICU nurse but also work shifts in L&D...mostly PP, but they know I am willing to assist with laboring a patient, so I help out when I can, because I enjoy it.

To me, there doesn't seem to be a happy medium.

I personally do not believe in home births, because home births are only good in hindsight...if they turn out ok, then everyone attributes the success to a home birth, but if they turn out bad, I could not live with myself if I was the mother and knowing that had I been closer to the hosptial, things may turn out differently.

I also agree with fetal monitoring..you have to know what is going on. I have seen one very tragic outcome of a patient that demanded removal of the fetal monitoring and the nurses had no idea that her baby was in trouble....she was laboring and NOT on pit...baby had been previously doing well.

I am a firm believer in letting nature take its course...the baby will come when it is ready and letting a woman labor and then 5 hours later, a physician coming in and saying, "Well, you are not progressing...."

Well, I call BS b/c we have all SEEN woman stay at a certain cm and then just expand...as long as everyone is medically stable, I see no problem with this.

...an the placenta? Don't get me started...yanking it out by the cord with a pit bolus is not the way to deliver it. To me, there is a reason that this process is delayed as well...yes, I understand that if it is not out in a certain amount of time that the Mom can bleed out...but it doesn't HAVE to be out..two minutes after the birth.

LoveANurse09

394 Posts

Specializes in Cardiac.

I think the biggest thing here is there is not ENOUGH research in this area. I'm not an L&D RN, but I 've read EFM has no greater effect on neonatal outcomes or Apgar scores than intermittent monitoring q 15mins (as in a homebirth)

does.

http://www.ncbi.nlm.nih.gov/pubmed/17150066 I've read this in other books, but here is a little something i just found.

If that pt refused EFM, the nurses still should have been monitoring that baby with a fetoscope! But, I bet that equipment wasn't available in the hospital! Every other hospital unit bases their policies on evidence-based practice why doesn't L&D??

disclaimer: there is not directed at anyone person, just venting my opinions. I think we have a pretty good discussion here!

CEG

862 Posts

I think the biggest thing here is there is not ENOUGH research in this area. I'm not an L&D RN, but I 've read EFM has no greater effect on neonatal outcomes or Apgar scores than intermittent monitoring q 15mins (as in a homebirth)

does.

http://www.ncbi.nlm.nih.gov/pubmed/17150066 I've read this in other books, but here is a little something i just found.

If that pt refused EFM, the nurses still should have been monitoring that baby with a fetoscope! But, I bet that equipment wasn't available in the hospital! Every other hospital unit bases their policies on evidence-based practice why doesn't L&D??

disclaimer: there is not directed at anyone person, just venting my opinions. I think we have a pretty good discussion here!

Sadly there is plenty of research to support lower intervention birth, it just gets ignored in favor of high cost high intervention procedures. The hospital certainly has a doppler available to perform intermittent auscultation-- fetoscopes can be difficult to use in labor, but a doppler is more than adequate. Every hospital should have one for those patients who come in who are too early in pregnancy for EFM or surgical pts who require intermittent monitoring.

LoveANurse09

394 Posts

Specializes in Cardiac.

Of course, I forgot about dopplers :o. That would be wayy more accurate!

tablefor9, RN

299 Posts

Specializes in ICU, Home Health, Camp, Travel, L&D.

EFM hasn't decreased infant mortality, nor has it dropped rates of CP. It has, however, increased CS rates.

Studies show planned homebirth with a qualified practitioner is as safe for low risk families as hospital birth.

These are facts, so belief really isn't an issue.

Here's another fact: Of the industrialized nations, ours isn't doing birth best. Not. Even. Close. Why? Multiple factors, but one can't deny that the countries doing birth better are birthing at home, with MW attending low risk women, and in hospitals with OBs for higher risk clients.

A lot of the new L&D RNs I have oriented, and sadly, many of my fellow "old timers" (more than 10yrs in specialty), have somehow bought into the notion that women's bodies have become lemons. I think I'll hold my money, because I'm not buying it. Families have the right to choose where, and with whom, they will birth their babies, and every laboring woman has come from a long line of women able to bear children by virtue of her existence. For every story about the women that died years ago at home, there's a story of a wounded (or worse) woman today.

Do bad things happen in some home births? Yep. Cord prolapse and transport, PPH and transport, abruption and transport, list not exclusive. Do bad things happen in *many* hospital births? Yep. Sometimes, it's just because we can't keep our hands to ourselves. IV and EFM, next stop AROM and PIT, next stop failure to progress, next stop CSection, next stop wound infection/hematoma/nicked bowel or bladder, next stop baby won't latch, mom too tired, next stop baby with bili lights, list not exclusive.

Let's educate our populace, and put choices back where they belong: with the families.

SaraStrong

105 Posts

Anyone interested in this issue should see the documentary 'The business of being born.' It touches on many of the things mentioned in this thread. A must see, IMO.

CnmAshley

39 Posts

Hospital=interventions=problems. Nuff said!

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