Home birth vs. hospital - page 11

I belong to another parenting board & one of the debates that surfaces every so often is home birth vs. hospital birth. There are so many pro-home birthers that talk about how natural home birth is.... Read More

  1. by   SmilingBluEyes
    I am from a medium-sized city in Washington State and practice in a smallish community hospital that sees about 800-850 births/year (and rising as this is a growing area). As liberal as WA State tends to be, I am sad to say, homebirthing practices are in some cases, pretty limited by some of what I call short-sighted laws (for example, NO VBAC allowed in midwife-run birthing centers). Also very few hospitals even allow TOLAC/VBAC at all. Again, lawyers and insurance companies have so much say in these matters.

    And I have a problem STILL with the statistics. I realize they can be used/manipulated to prove any point anyone chooses to posit. From all I know, most OB units are a money-drain, not money-maker in most places. And while I can see where people might believe c/sections are revenue-raising enterprises, rather than medical necessities, I simply have not found that attitude to be prevalent among the OBs with whom I have practiced. They still very much prefer to avoid (especially) primary c/section without sound medical reasoning. I do, however, see many, many repeats----often I am aware, the doctors REALLY encourage these and do downplay the positive aspects of TOLAC/VBAC. But again, risk management

    And I just really want to say, I support 100% the right for families to choose to birth wherever they choose. I just hope they realize and accept the responsibilities that always run concomittant with such rights. And I know, not all DO!

    Respectfully, my observations, of course.
    Last edit by SmilingBluEyes on Mar 8, '07
  2. by   BreckH
    Quote from crysobrn
    I as an Ob nurse do see a lot of intervention that I don't agree with. But women often ask for intervention. I have women that come in that "think" they're in labor for weeks. And eventually they are close to 40 weeks and the dr suggests that they start pit and the patient not only agrees they are exctited. The dr thinks that a c-section is best for whatever reason and many moms are happy about it. I get dissapointed at the rate at which we intervene but I'm the nurse NOT the one writing the order. I can only butt heads with the dr's so many times

    We've had many deliveries when the women bring in a birthing plan and have taken classes (hypno birthing or otherwise) and I think that most of the nurses that I work with are not only open to these plans but are actually excited to learn something. We try to educate ourselves as well as share information with our patients. I'm sure that there are more than one that I can think of that would have had issues with breastfeeding if not for a nurse standing there reassuring and lending advice and assistance as necessary. I've never had one of my patients that wanted a home birth but ended up at the hospital tell me that she regretted it. They have always said that they were suprised by the attention and cooperation they've received.

    My grandmother had 10 children the first 9 were healthy normal deliveries. Her last was a c-section. She was told that he was presenting chin first and that if she would have begun pushing at home she would have broken his neck and she would no doubt have bled out. Yes this is a horror story but I thank God everyday that my Gramma is around!

    Is it possible for a baby to be born at home. Well sure. But knowing everything that I know I personally would not take that risk. A woman that I work with told me that in her grandmothers generation a woman that was near the end of her pregnancy she would "pick the dress she wanted to be buried in" just in case. So, she says "if you're gonna deliver at home, you better pick the dress that you wanna be buried in"
    And back in her grandmothers day maybe that was true but not anymore. Statistics show home and clinic births have a much better outcome, IF the woman has prenatal care, has a good diet, has a good birth team, has an uneventful pregnancy and is willing to enter into labor prepared. NO ONE without any of these things should consider birthing outside the hospital. Birthing at home is not something to do because you dont' want to hassle with the hospital, it is something you do because you want to have the best possible outcome for your baby, you want control of how your baby will come into the world with your choices of who will attend your birth. (the provider you want, the midwives and doulas you want, the family you want to have with you) You want a drug free environment and the ability to move around in surroundings that you are familiar with.

    Studies have shown that animals that are moved during labor either stop their labor or deliver their young dead. Women who come into the hospital and are sent home with "false labor" would most likely have continued with their labor and had their babies if they had stayed at home. More babies would be born at night like nature intended but birth certificates across the states show that more babies are born between 8-5pm Mon. thru Friday then any other time. Pit, inductions, cesareans and impatient providers have contributed to this.

    There are some amazing OB nurses out there I have met many in the different hospitals that I have worked for, but the OB nurses that are working in the hospital here in SD love the epidurals, they want their moms asleep during the night and monitor them from the nurses station. It seems gone are the days (here at least) when they would get them up, get them into the shower, birth ball, walking the halls all of that. The new policy nation wide, in order to get federally funded, is that a patient has to be assessed every 30 minutes for pain management. You ask a laboring mother if she is painful every 30 minutes and eventually she will believe she should be. Then the epidural is offered, and she is bedriddened and inteventions begin.

    Women without prenatal care, drug mom's and there are many, difficult pregnancies, pretermers, women who don't have the desire to be totally involved in their pregnancy should have their babies at home, but moms that are not wanting an out of hospital birth should be given every oportunity with midwives in every state, birth clinics in every town and doulas allowed in evey hospital to have the birth they want and to bring their children into the world as natural as possible.

    Did you know that 90% of babies born today have some type of drug in their system and I'm not talking about street drugs?.
  3. by   SmilingBluEyes
    Ok, this is way too long, but obviously, I am impassioned, so please bear with me.

    Sadly, my hospital has a HUGE epidural rate, somewhere about 85%. HOWEVER the c/section rate is nowhere NEAR 85%. (!!!) More near 25% was the last quote I heard from the manager. Yes, nationwide (in the USA anyhow), the primary c/s rate is rising at an alarming pace. Perhaps we need to look at the various reasons why:

    *physician reasons/medical justification---there are justifiable reasons for c/section, although the true percentage, I am unsure.

    *patient desire for yes, I will say it---convenience and easy birthing (so they perceive). Yes, I have talked to MANY a poorly-informed patient who wanted to forgo labor altogether and just "have it cut out". Sad but true. Britney Spears, anyone? She is not alone in her views. People want things neatly-packaged and easy these days, from meals to birthing. Fact, not fiction.

    *The very HIGH number of hospitals that disallow TOLAC/VBAC. Again, doctors themselves do not always set such policies. They come from much higher places-----adminstrations and risk managers are the ones responsible, as well as hospital insurance companies that out and out disallow them to do this.

    *The increasing number of clinically and morbidly obese women we have---and increasingly large for dates (LGA) babies that result. I don't know about you, but I have looked around and taken care of a lot of very obese women---young ones, mind you----who already are developing co-morbidities such as diabetes, high blood pressure, renal problems and yes, even arthritis, in their 20s and 30s!!!! And we all know, women who are very obese also tend to have a lot of problems giving birth vaginally. Where I work they get a trial of labor, of course, but fail at an alarming rate. The babies are too big, and pelvises, tend to be too narrow often. And on a related subject, babies of unfit moms tend to be medically-challenged, at least in the first days after birth, too; hence, the increase in NICU/Nursery Special care admissions (in certain cases).

    These are just a couple reasons I see that come off the top of my head. I know there are more, but this post is long and you, I am sure, get my point.

    I just want to reiterate what a couple of other OB nurses said. We don't tend to look at our patients and push epidurals, and other interventions. Patients CHOOSE these things---particularly epidural. I wish I had a dollar for every pregnant lady who walked through the door demanding an epidural in prodromal labor. They won't take me up on my offer of a shower, massage, ambulating, or other comfort measures to help them cope. NO, they want drugs and they want them NOW!

    Personally, I LOVE natural labor experiences, crave them, yet don't see them enough. Also, please understand: our choices as labor nurses are FEW and getting even narrower due to increasingly draconian policies set forth from many administrations and JCAHO-----the changes I have seen in just 10 years sometimes make me really desire to go back to school and get out nursing altogether. I am depressed and down some days---I hate what is happening to our practices and all the CYA we have to do. What stops me from walking away? I want to be there and care for the many patients, who for whatever reason, choose to birth in a hospital. I feel if I walk away, I am denying these folks good, solid nursing care in my case. In other words, they need nurses like me to care!

    Also, if you hear a nurse "laugh" at a pt birth plan, then be an advocate, and discuss it with her. Please don't come here to lament---it does no good nor exacts any change in attitude on the parts of such people. I have never laughed at the birth preferences or plans of any patient----I have found some to be beyond my capability and I will explain why in a respectful manner. But never do I "laugh".

    And I KNOW for a fact, I am NOT ALONE in how I practice! I am feeling like we have to defend ourselves here, and it's not a good feeling, frankly. A little respect for what we do, would be so nice.


    There, said my piece. Now I will shut up. (woops, I guess not)
    Last edit by SmilingBluEyes on Mar 8, '07
  4. by   SmilingBluEyes
    Quote from BreckH
    Did you know that 90% of babies born today have some type of drug in their system and I'm not talking about street drugs?.

    It would be most helpful if you quote statistics, you would point to the source and let us read more. I want to know what drugs, actually, because epidurals tend not to pass drugs onto babies. They are not systemic. And few women where I work choose IV meds for labor relief. They go straight for the "big guns", e.g. epidural. When are they getting drug screens---how long after birth? I mean, some women elect or need to use pain meds postpartum. Percoset, Tyl 3 and Vicodin, as well as much motrin. I would like to know WHAT drugs this is referring to and when.

    Thanks.
    Last edit by SmilingBluEyes on Mar 8, '07
  5. by   SmilingBluEyes
    Just one more thing. Things are being said here, on a nursing board, which while worthy of discussion, are provocative to a majority who are hospital nurses. It would help to understand, nurses really have minimal control over birth experiences, oftentimes. Due to strict policies and patient preferences, our hands are often tied quite tightly. Are there too many interventions? Yes. But do we alone, choose them? Rarely.

    If you truly want things to change, changes in legislation are what you are after, not preaching to a choir, so to speak.


    Most of us, I believe, do our best to care for our patients respectfully and with integrity, despite such difficult situations/limitations. Thanks for listening.
    Last edit by SmilingBluEyes on Mar 8, '07
  6. by   BreckH
    Quote from SmilingBluEyes
    Just one more thing. You are saying these things on a nursing board, which while worthy of discussion, are provocative to a majority who are hospital nurses. It would help to understand, nurses really have minimal control over birth experiences, oftentimes. Due to strict policies and patient preferences, our hands are often tied quite tightly. Are there too many interventions? Yes. But do we alone, choose them? Rarely.

    Most of us, I believe, do our best to care for our patients respectfully and with integrity, despite such difficult situations/limitations. Thanks for listening.
    I'm a nurse too you know.. 18 years and have seen many changes . I watched things drastically change especially in L&D and have seen results change too and as a result have changed my focus from L&D to NICU where the interventions there most of the time are needed. I don't mean to disrespect anyone here and it is not my intention to do this, I do get a little passionate about natural childbirth and that is why I wrote my book to help women stay in control of their baby's birth . I will just sit back and watch for a while, I just thought we are all having a discussion on birthing in America. Sorry if I offended anyone, I really am do mean that.
  7. by   IKSONAK
    I worked in neonatal unit in StLouis.Many home births occurred in surrounding area.I hated getting the urgent msg to ready ourselves cuz a home birth gone awry was coming in!! We had labor rooms where entire families could come, practice their own homegrown technique for delivering a 'home' baby, but if urgent intervention was necessary, they were 20' from the delivery room! Please, God, let these ladies know that we want them to have a beautiful delivery, complete with a pink, perfect, safely delivered baby!
    an old ob nurse!
  8. by   SmilingBluEyes
    Quote from IKSONAK
    I worked in neonatal unit in StLouis.Many home births occurred in surrounding area.I hated getting the urgent msg to ready ourselves cuz a home birth gone awry was coming in!! We had labor rooms where entire families could come, practice their own homegrown technique for delivering a 'home' baby, but if urgent intervention was necessary, they were 20' from the delivery room! Please, God, let these ladies know that we want them to have a beautiful delivery, complete with a pink, perfect, safely delivered baby!
    an old ob nurse!
    well said. I agree.
  9. by   SmilingBluEyes
    Your passion is well-served, Breck. And I completely respect it. But I still say, you are preaching to a large choir. The changes you see as a nurse are not of our making. As a nurse, you know, these things are brought on by government agencies, insurance industries and very overly-reactive risk managers. Few of whom are nurses at all---or if they are, practiced bedside nursing a LONG time ago.

    And the lousy and lazy nurses exist. OH yes, they do, but they can be sanctioned, or if need be, terminated, if they are that detrimental. It takes making them aware and documenting such things and being prepared to take them on, if need be.

    I would be willing to bet, most of such crummy nurses are not members at this site. The ones I meet just don't seem to fit that profile.

    If you want changes, truly meaningful and positive changes, take them the legislative halls and fight that good fight! But be prepared, the insurance lobby is very powerful and a tough opponent.

    Is anyone here a member of a major nursing organization such as ANA or AWHONN? Just wondering...
    Last edit by SmilingBluEyes on Mar 8, '07
  10. by   BreckH
    Quote from SmilingBluEyes
    Just one more thing. Things are being said here, on a nursing board, which while worthy of discussion, are provocative to a majority who are hospital nurses. It would help to understand, nurses really have minimal control over birth experiences, oftentimes. Due to strict policies and patient preferences, our hands are often tied quite tightly. Are there too many interventions? Yes. But do we alone, choose them? Rarely.

    If you truly want things to change, changes in legislation are what you are after, not preaching to a choir, so to speak.


    Most of us, I believe, do our best to care for our patients respectfully and with integrity, despite such difficult situations/limitations. Thanks for listening.
    Yes i contact my congressmen and state representatives regularly along with about 100 other of us. And have you noticed that the choir is the heart of the church and the praises and messages they sing are for the whole of the community?
    And I love being a nurse it is a hard hard job especially when you have to follow orders that, even in NICU, may not seem like the best interest of the patient. And the good nursing part is when you can take that situation and make it work well with the patient and their family, with a great outcome.
  11. by   SmilingBluEyes
    I agree! On most points, I agree. I guess, you can see, some people are either hurt or take exception to the accusations (implied or real) that we enjoy pushing interventions on our patients---or that most OBs are knife-wielding draculas. Just not true! I felt I had to reiterate that.

    I have many days where my actions or advocacy contributed to favorable, and joyful outcomes. That is what energizes me and keeps me going as a nurse, or else I would have quit LONG ago. It ain't the money or "easy" job as a nurse I have that keep me coming back, I assure you.

    Perhaps, some words would be better-received if we encouraged proactivity on the parts of nurses, (e.g. seeking to change legislation) rather than implying we simply don't care about outcomes or what our patients need and want. I guess that is my real point here.
    Last edit by SmilingBluEyes on Mar 8, '07
  12. by   BreckH
    Quote from SmilingBluEyes
    Your passion is well-served, Breck. And I completely respect it. But I still say, you are preaching to a large choir. The changes you see as a nurse are not of our making. As a nurse, you know, these things are brought on by government agencies, insurance industries and very overly-reactive risk managers. Few of whom are nurses at all---or if they are, practiced bedside nursing a LONG time ago.

    And the lousy and lazy nurses exist. OH yes, they do, but they can be sanctioned, or if need be, terminated, if they are that detrimental. It takes making them aware and documenting such things and being prepared to take them on, if need be.

    I would be willing to bet, most of such crummy nurses are not members at this site. The ones I meet just don't seem to fit that profile.

    If you want changes, truly meaningful and positive changes, take them the legislative halls and fight that good fight! But be prepared, the insurance lobby is very powerful and a tough opponent.

    Is anyone here a member of a major nursing organization such as ANA or AWHONN? Just wondering...

    And I've gone one step further, from my husbands suggestion of "if you are so upset about what is happening to laboring women in hospitals today why not write a book." and I did I wrote "Hey! Who's Having This Baby Anyway?" and in it I help women choose their right provider, know their rights in the hospital, tell them about medications in labor, I discuss VBAC, waterbirths, breastfeeding, prenatal classes that are out there and a lot more stuff.
    So I am not out there to just talk the talk, I am trying to make a difference from legislative to the bookstore. Other countries are doing such a better job then us. The Netherlands have a 10% section rate why can't we? How did we end up with the 2 worse country for mortality? Cuba is below us..
  13. by   SmilingBluEyes
    I don't disagree. And I am glad you found your outlet. I just think when you come a board like this, if you want others to be open to hearing you, perhaps choosing words carefully is in order. I agree with most, if not all, of what you say here. I just don't want to feel defensive of my practices. That makes me human, as well as a nurse.

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