Where are the "normal" births? - page 2

I am just starting in out in a much sought-after, much anticipated job as an L and D nurse, where I hoped to gain the foundations of a potential future career as a CNM. And..... I am way... Read More

  1. by   LoveANurse09
    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.
  2. by   ErinS
    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.
  3. by   JenniferSews
    Quote from ErinS
    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.
  4. by   Armygirl7
    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.
  5. by   BabyLady
    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.
  6. by   LoveANurse09
    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!
  7. by   CEG
    Quote from LoveANurse09
    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.
  8. by   LoveANurse09
    Of course, I forgot about dopplers . That would be wayy more accurate!
  9. by   tablefor9
    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.
  10. by   SaraStrong
    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.
  11. by   CnmAshley
    Hospital=interventions=problems. Nuff said!
  12. by   TLAandy
    Quote from blueindigo79
    I can totally understand. I worked l&d at a baby factory in nyc and was horrified. I started wrking there versus other hospitals bc there were midwives but only medicaid pts saw the midwives. How are birhs at home or at a bithing center safe? Bc moms are allowed to walk, fewer unnecessary interventions, no inductions, intermittent monitoring etc. They have better outcomes (csection,'episiotomies) than the hospitals. Look at the stats at The Farm in kentucky'amazing. Hang in there!!

    "The Farm" is in Tennessee, that is where you will find Ina May Gaskin. In Kentucky if where you will Find the Frontier School of Midwifery and Family Nursing. But wow, wouldn't it be great if they were in the same place??

    What you are saying about interventions is spot on, the more interventions the more the risk of complication go up. OB/GYN's love to augment labor with Pitocin, which causes the pain to be worse (not to mention being unable to move, flat on your back) the worsening pain causes the mom to ask for an epidural, which causes the labor to slow down, which causes the OB to once again increase the Pitocin, which decreases the amount of O2 the fetus receives, TADA=Fetal distress>>>>>>>OR=C-section.

    I work in a Birth Center in Florida with two CNM's, as a Birth Assistant for Births and Medical Assistant in the office. I am an RN and currently a Student Nurse Midwife at Frontier. Complications like the one described above are rare at the birth center. There are no pitocin inductions or epidurals. Our client population is the same as the local hospital, yet we don't have the same kind of complications they do. It basically comes down to something I very wise Professional Midwife told me, "If you don't break the Mom and baby, you don't have to fix the Mom and baby." It is sooooo true. Some of the countries with the lowest infant/maternal mortality statistics primarily use Midwifes for most uncomplicated pregnancies. We might get there some day, I sure hope so.
  13. by   enchantmentdis
    It's all about money, lawsuits, and OBGyns not wanting midwives to do their job.

Must Read Topics


close