Home birth vs. hospital - page 6

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   epiphany
    Quote from fergus51
    Women can and DO choose things for themselves in hospitals. They have that power and saying otherwise is... I don't know what word to use, but condescending or patronizing comes to mind. It might not always be easy, but that's not the same thing. Women do not need doctors or nurses or midwives to make decisions for them, and that goes for advocates of natural childbirth and those who see pregnancy as a disease. They don't need me to protect them from themselves. All I can do is say "here are the pros and cons, what do you want to do?" and if they choose an epidural or not, if they agree to forceps or not, if they want to labor in different positions or not, it's their choice. Believe it or not, I have had more than a few women INSIST on c-sections and episiotomies! I can quote all the studies I want, but some women want the medicalized experience and that's their business.
    Fergus51, I don't agree that it's as simple as you say, that women have the autonomy to choose. In saying that, I think we are not seeing the forest for the trees.

    I think American women generally make choices based on fear of natural births and belief in the miracle of medicine that have been instilled in them by our institution. In contrast, women in Holland, for example, choose less intervention because their society doesn't scare the living daylights out of them, but instead over and over again, prove to them that births should be as natural as possible.
  2. by   fergus51
    Epiphany, I certainly agree that society influences birthing practices. My problem is that at some point women need to take responsibility for themselves. We can't blame society for every non-ideal birth or eating disorder or whatever. Is it easy? Maybe not, but who said it has to be? I am a grown woman and I resent the implication that I need someone to protect me from the medical establishment like I am a child incapable of making my own decisions because I am too scared to be able to do it myself. Women do choose home births, despite being raised in this society. Other women choose birthing centers and others choose hospitals. The fact that more and more women are taking control of their births is proof it can be done, so I have a hard time with people saying it can't because of our society.

    I still remember this topic in my feminism/health class in college. I know some people think pregnant women need protection and are vulnerable. I do agree there is a vulnerability there, I just don't agree that we need some paternalistic patient advocate to save them from themselves. I think they need to be given the facts and then supported in their decision, period. Every patient in the hospital is vulnerable, but they all get to make their own decisions and we encourage them to be proactive in their care, so I don't see why pregnancy is the exception. I don't understand why women are content in giving a doctor or midwife control and then complaining about it afterwards, taking on a victim role. People need to educate themselves and stop blaming society for their decisions.
  3. by   rndani
    Quote from rnmi2004
    Would any of you care to share incidences where a home birth would have resulted in serious harm? Thanks for your time!
    Since this was your original post, I'd like to share with you two stories about home births that resulted in transport to the hospital. First--20yo G1P0, pushing at home for 4 hours with midwife. Brought in per patient request. Fhr supposedly in the 110"-120's. After placing a fetal spiral elecrtode, there was no fhr--they were picking up maternal pulse. She was only 7cm and had a very puffy cervix. She wanted an epidural (which she got) and 5 hours later delivered a beautiful 9#10 boy--dead. The next was a grand multip who came in by her midwife with srom and footling breech--we're talking foot out of the vagina footling breech. The patient would not answer any of my questions, the midwife did all the talking and informed me the patient did not want a c-section. Needless to say after the on call OB came in and explained all the interventions and why we do them and the risks involved (INFORMED CONSENT) she still had nothing to say and looked at her midwife who then said " I think it may be best for you to have the c-section". I was taken aback. The patient couldn't make a decision for herself.

    Now on the flip side of those stories--I know of several of my co-workers (L&D RNs) that have had fantastic home deliveries. And there are many successful homebirths that occur that we at the hospital never hear about.
  4. by   SmilingBluEyes
    Quote from fergus51
    Epiphany, I certainly agree that society influences birthing practices. My problem is that at some point women need to take responsibility for themselves. We can't blame society for every non-ideal birth or eating disorder or whatever. Is it easy? Maybe not, but who said it has to be? I am a grown woman and I resent the implication that I need someone to protect me from the medical establishment like I am a child incapable of making my own decisions because I am too scared to be able to do it myself. Women do choose home births, despite being raised in this society. Other women choose birthing centers and others choose hospitals. The fact that more and more women are taking control of their births is proof it can be done, so I have a hard time with people saying it can't because of our society.

    I still remember this topic in my feminism/health class in college. I know some people think pregnant women need protection and are vulnerable. I do agree there is a vulnerability there, I just don't agree that we need some paternalistic patient advocate to save them from themselves. I think they need to be given the facts and then supported in their decision, period. Every patient in the hospital is vulnerable, but they all get to make their own decisions and we encourage them to be proactive in their care, so I don't see why pregnancy is the exception. I don't understand why women are content in giving a doctor or midwife control and then complaining about it afterwards, taking on a victim role. People need to educate themselves and stop blaming society for their decisions.

    EXCELLENT POST!!!!! A-men.
  5. by   SmilingBluEyes
    I daresay all experienced OB nurses have seen transports that were very scary. Are they the norm? OF COURSE NOT! but it bears repeating and understanding; having a really good midwife who KNOWS his/her limits and knows WHEN To transport is a good thing!!! The majority of births are healthy and without incident. It's that tiny percentage where a cascade of horrible events occurs that can kill ya. Everyone needs to be aware of her risks, and trust in her care provider to look out for her best interests at all times, whether she plans to be at the hospital, a birth center or at home. And yes, women need to assume some responsiblity for themselves, as well as their care providers should. That is given.
  6. by   epiphany
    Quote from fergus51
    Epiphany, I certainly agree that society influences birthing practices. My problem is that at some point women need to take responsibility for themselves. We can't blame society for every non-ideal birth or eating disorder or whatever. Is it easy? Maybe not, but who said it has to be? I am a grown woman and I resent the implication that I need someone to protect me from the medical establishment like I am a child incapable of making my own decisions because I am too scared to be able to do it myself. Women do choose home births, despite being raised in this society. Other women choose birthing centers and others choose hospitals. The fact that more and more women are taking control of their births is proof it can be done, so I have a hard time with people saying it can't because of our society.

    I still remember this topic in my feminism/health class in college. I know some people think pregnant women need protection and are vulnerable. I do agree there is a vulnerability there, I just don't agree that we need some paternalistic patient advocate to save them from themselves. I think they need to be given the facts and then supported in their decision, period. Every patient in the hospital is vulnerable, but they all get to make their own decisions and we encourage them to be proactive in their care, so I don't see why pregnancy is the exception. I don't understand why women are content in giving a doctor or midwife control and then complaining about it afterwards, taking on a victim role. People need to educate themselves and stop blaming society for their decisions.
    Hmm.
    First, with all due respect, your views on woman's rights are obvious, yet it comes off a little lacking in empathy. Even if a woman can or want to make the right decision, doesn't she have to believe that the care giver is indeed giving her the right information - and hence, doesn't it involve entrusting your fate to someone? My need to have a nurturing person whom I can rely on during my pregnancy and labor doesn't make me less strong.

    Second, as an extern in L&D and a senior student trying to benefit from all the experience on this forum, I am sincerely curious to know how you "give the facts" to the woman in the way as you seem to suggest, of empowering her to make a decision, when in this thread alone, with all voices of experience and knowledge speaking, not everyone can agree on the same thing.
  7. by   Mermaid4
    In the home births I have been involved with, both were not planned, that is, those children were determined to be born quickly. I have nothing against home birth and in fact, it is a lovely idea, but as Smiling and Day Ray have pointed out, most people are not adequately informed about what could happen.
    Personally, I feel that we aren't giving patients enough credit..I have no problem with patients wanting epidurals or not wanting them. I support their choices and inform me it has taken many years for me to know the things I do in the realm of childbirth, labor and the like, so I don't expect them to be cognizant of everything right away. I feel personally that if the resouces are available, then there is no harm in using them...We recently had a midwife sued due to a problem outcome with a home birth where hypoxia occurred in utero..How could she have picked that up without some fetal monitoring at least once in awhile? Sometimes if you chance things, you have to take your chances...I am not of the opinion that patients should be able to have it both ways....
  8. by   Mermaid4
    To the student who asked about everyone in this thread agreeing on the same thing, do a few years in the field and then get back to us.......
  9. by   BETSRN
    I am a childbirth educator as well as a staff RN in my L&D in my facility. I teach about all the interventions (thank God we don't use them all just because we have them)and encourage people to advocate for themselves, but so much of the time, they go along with the doc regardless. Our docs are pretty low intervention anyway, but sometimes it is so defeating to teach and teach and feel as though you got nowhere.
  10. by   BETSRN
    You know I can see both sides of this discussion. The statement about women being "helpless vitims of the medical profession." Of course, woman can (and often do) advocate for themselves, but the bottom line is that women still follow )oretty blindly sometimes) what their doctor or CNM suggests. It may not be the best route for the patient (assuming positive outcome either way), but it often gets it over with faster (and then the doc gets to go home or resume office hours). Even in the best of circumstances, I have seen docs pull the wool over the patient's eyes. It's sad, but it happens in the best of facilities (and I work in one of those "small community hospitals" where we pride ourselves in using and encouraging birth plans,etc). There is only so much we can do about this. So yes, I agree that women don't have to be "victims" of the medical profession, but I still think a large majority are once they walk in the door to have the baby.
  11. by   BETSRN
    I would wager that looking at just the low risk population, that there are more potentially unnecessary interventions done to babies in hospitals that have NICU's than in community hospitlas that do not. I know that we do not separate babies from mothers, do septic workups on babies whose moms have had a temp (probably from an epidural). It is my firm belief that babies born in these types of facilities are far more lily to have excessive blood work, IV's, meds, etc done than in a facility that does not have a NICU. NICU's of course are very necessary and we use those close to us when necessary, but I do think in the long run, low risk, community settings give mothers and their babies the best shot at a low intervention experience. Low risk facilitiews are far less likely to do unnecessary vag exams, use scalp electrodes, IUPC's, and other interventions on a more routine basis (usually because someone has to learn).
    Last edit by BETSRN on Aug 31, '04 : Reason: spelling
  12. by   SmilingBluEyes
    that is the beauty of community hospital nursing.......I am with you Betsy. The fewer interventions, the better. I do them as the maternal/fetal conditions call for them not because I want to be convenienced or "learn" on people. That is why I like our community hospital, few are having to "practice" on their patients to develop or hone skills. They usually have years of experience and feel no need to intervene just for the sake of practice, learning or convenience. This is not true of the many teaching hospitals at which I have been a patient.
  13. by   epiphany
    Quote from Mermaid4
    To the student who asked about everyone in this thread agreeing on the same thing, do a few years in the field and then get back to us.......
    But I guess you are one of those nurses who eat their young, as people say? I will do a few years in the field, as you suggest, after which, I resolve never have an arrogant and disrespectful attitude towards people who are just starting out in order to make them bow and stay silent when pearls of wisdom fall from my mouth.

    Any btw, I never said I was confused as to why people don't agree on the same thing. And if you think your shut-up-newbie attitude is intimidating to me, I'm sorry to dissapoint you - that's one of the favorite subjects of conversation among students and new nurses.
    Last edit by epiphany on Aug 31, '04

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