Home birth vs. hospital

Specialties Ob/Gyn

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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. I understand that the many interventions used in hospitals can turn a mom off to birthing there, but I still cringe at the idea of a prolapse, abruption, previa, etc. happening at home. Also, in the short time I've had clinicals in a postpartum unit at the hospital, I've seen two babies turn blue from lack of oxygen and been rushed to the special care nursery.

Would any of you care to share incidences where a home birth would have resulted in serious harm? Thanks for your time!

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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 lady partslly. 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)

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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.

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.

Specializes in MS/Med/OB/Peds/Psych/HH/Hospice/ER/ICU.

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!

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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...

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.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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.

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..

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

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.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Just a question; do you discuss the legislative and insurance practices and edicts that seek to limit our choices in the USA regarding birth preferences---particularly in the hospitals? And do you address families' responsibilities in making certain choices? These are issues that need to be given awareness in empowering birthing families, too. If we got more people on board to change the laws, that would be a step in the right direction.

Personally, I would love to read your book; as articulate and passionate as you are here, I am sure it's well-done!

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