Home birth vs. hospital - page 7

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   traumaRUs
    Epiphany - I honestly didn't take Mermaid's post to be eating our young - I think she meant it as when you have more experience in nursing, then you might change your mind. All of use have different opinions about this subject and I think people are for the most part - being subjective. Giving birth is a very personal experience and we all have different views on how we want it done or how we had it done...I think we are only expressing our own views on this subject. Mermaid - if I misinterpreted your post - please let me know.
  2. by   CA CoCoRN
    I am a pugdy Black woman, age 28 at the birth of my second and (last child) who thought about home birth with the last child, with absolutely NO medical issues, whatsoever.

    I thought better of it, and decided inside to talk to my OB (who I hand picked) about going the route of least intervention.

    I am glad that I delivered in the hospital.

    I SROM'd at home, losing a great deal of fluid. I got to the hospital, and all was well. Since I failed to start labor within a few hours of SROM, Pit was going to be started. It hadn't even started yet, when baby decel'd to 50s-60s for 4 minutes plus. He didn't show any signs of recovery, so I was "stripped" of metal and prepped for surgery (just in case). During this process, amnioinfusion was started, I was lateral trendelenburged, O2, IV bolused, etc. He recovered with the amnioinfusion and a few hours later Pit was started. I delivered 4 hours later. (My first medically necessary induction --severe oligo-- lasted only 6 hours...my body uses Pit well).

    I fear that had I been at home, without continuous monitoring that lil Sol (my sun/son) would not have survived the decel which apparently occurred due to cord compression from losss of fluid.
  3. by   fergus51
    Quote from epiphany
    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.
    I can live with how I come off on a bb, though these certainly aren't things I would say in a L&D room, cause it isn't about me in there and I recognize that.

    I want to be really clear on this because I had no intention of insulting you or anyone else, but I don't think you are less strong because you want a nurturing person to rely on during your pregnancy and labor (I would actually want the same thing and have already told people if I get pregnant I want a doula as a present). Quite the opposite in fact, I think it shows strength to determine for yourself what YOU need and to make sure YOU have it. I'm sure you wouldn't go to an OB who wants you to have internal monitors, labor in one position, IV, epidural, give birth in lithotomy, etc. because it doesn't sound like that's consistent with your view of childbirth, and I wouldn't either! That's strength, that's responsibility.

    One thing women have going for them is their intuition and if you don't feel right about that doctor/midwife, I'm sure you would have the strength to go elsewhere. Certainly there is an element of trusting in caregivers, but that is the same as any other area of the hospital. And certainly there will be individual situations where trust in the caregiver can take precedence over mom's desires, especially in areas where they are limited to the number of providers available. I have worked in towns with ONE doctor who does deliveries and no midwives and it isn't ideal. On the flip side, I have had patients uncomfortable with the recommendations an OB has made and have fetched another doctor to give them a second opinion because I want them to feel they can trust their provider and more importantly, I want them to feel they can QUESTION their provider because THEY are the ones in charge of their experience. Not the doctor, not me, not the doula, not the support person. THEY are. And the only way that becomes a given is if women take it. It's women themselves that will have to change the medicalized culture of childbirth if that's what they want. Liberation, power and equality aren't bestowed on us by someone else. It sucks that we should even have to fight for these things, but that's just the way it is and the sooner we deal with that the better.

    As for how I provide information, I try to discuss the pros and the cons as supported by research... OK, say we're talking about epidurals. I say something along the lines of "Well, the benefits of epidurals are that they are generally very effective at providing pain relief and are safe to insert (though some conditions affect that, like scoliosis). Some downsides are your mobility would be restricted, you would need an IV and a catheter, etc. It can slow down labor, and the doctor will usually try to counteract that by giving you pitocin, but that isn't a guarantee. When it comes time to push, if you are still numb it can be difficult to push effectively (we can deal with that by waiting until feeling returns to push). Sometimes epidurals provide a "patchy" block which means you can still feel certain areas and we are unable to numb them. Now, if you wanted a more natural birth there are other pain control methods which you may prefer (and I usually discuss what type of birth they want when they first come in). If those don't work for you, you can always get the epidural later. I don't want you to feel pressured to make a decision this instant, because there is no time limit. Blah blah blah". And after explaining this and giving them our hospital handout, I ALWAYS leave the room so that the woman and her support person can discuss it in private. When I come back, I give them time to ask questions and answer them honestly. If I don't know the answer, I get them someone who does. Course, some women come in knowing EXACTLY what they want and I'm not going to harp on the spiral of interventions if a woman is yelling for the epidural NOW.... Same thing for episiotomies: "Research has shown that women with episiotomies actually take longer to heal and experience more pain than women who have tears (then I go into my spiel about how to avoid tears). And I go into my examples: think of it like cutting a piece of paper with scissors. It's much easier to rip the paper along that cut than to rip an intact piece of paper... Blah blah blah".... There are some facts proven by research and some areas that are more about opinion. I'm honest about which are which (Reseach has shown... vs. Some providers feel.... others feel...).
    Last edit by fergus51 on Aug 31, '04
  4. by   fergus51
    Quote from 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).
    LOL! I've actually found the opposite In the hospitals with level 3 NICUs I've found the docs are much more comfortable with a wait and see attitude with babies than in smaller hospitals. I've never seen a septic work-up done because mom had a fever or meds given without symptoms. We are busy enough without needing to make work for ourselves I did see less interventions on the L&D side like you mentioned, but more on the babies because the docs were so worried.
  5. by   SmilingBluEyes
    Quote from fergus51
    I can live with how I come off on a bb, though these certainly aren't things I would say in a L&D room, cause it isn't about me in there and I recognize that.

    I want to be really clear on this because I had no intention of insulting you or anyone else, but I don't think you are less strong because you want a nurturing person to rely on during your pregnancy and labor (I would actually want the same thing and have already told people if I get pregnant I want a doula as a present). Quite the opposite in fact, I think it shows strength to determine for yourself what YOU need and to make sure YOU have it. I'm sure you wouldn't go to an OB who wants you to have internal monitors, labor in one position, IV, epidural, give birth in lithotomy, etc. because it doesn't sound like that's consistent with your view of childbirth, and I wouldn't either! That's strength, that's responsibility.

    One thing women have going for them is their intuition and if you don't feel right about that doctor/midwife, I'm sure you would have the strength to go elsewhere. Certainly there is an element of trusting in caregivers, but that is the same as any other area of the hospital. And certainly there will be individual situations where trust in the caregiver can take precedence over mom's desires, especially in areas where they are limited to the number of providers available. I have worked in towns with ONE doctor who does deliveries and no midwives and it isn't ideal. On the flip side, I have had patients uncomfortable with the recommendations an OB has made and have fetched another doctor to give them a second opinion because I want them to feel they can trust their provider and more importantly, I want them to feel they can QUESTION their provider because THEY are the ones in charge of their experience. Not the doctor, not me, not the doula, not the support person. THEY are. And the only way that becomes a given is if women take it. It's women themselves that will have to change the medicalized culture of childbirth if that's what they want. Liberation, power and equality aren't bestowed on us by someone else. It sucks that we should even have to fight for these things, but that's just the way it is and the sooner we deal with that the better.

    As for how I provide information, I try to discuss the pros and the cons as supported by research... OK, say we're talking about epidurals. I say something along the lines of "Well, the benefits of epidurals are that they are generally very effective at providing pain relief and are safe to insert (though some conditions affect that, like scoliosis). Some downsides are your mobility would be restricted, you would need an IV and a catheter, etc. It can slow down labor, and the doctor will usually try to counteract that by giving you pitocin, but that isn't a guarantee. When it comes time to push, if you are still numb it can be difficult to push effectively (we can deal with that by waiting until feeling returns to push). Sometimes epidurals provide a "patchy" block which means you can still feel certain areas and we are unable to numb them. Now, if you wanted a more natural birth there are other pain control methods which you may prefer (and I usually discuss what type of birth they want when they first come in). If those don't work for you, you can always get the epidural later. I don't want you to feel pressured to make a decision this instant, because there is no time limit. Blah blah blah". And after explaining this and giving them our hospital handout, I ALWAYS leave the room so that the woman and her support person can discuss it in private. When I come back, I give them time to ask questions and answer them honestly. If I don't know the answer, I get them someone who does. Course, some women come in knowing EXACTLY what they want and I'm not going to harp on the spiral of interventions if a woman is yelling for the epidural NOW.... Same thing for episiotomies: "Research has shown that women with episiotomies actually take longer to heal and experience more pain than women who have tears (then I go into my spiel about how to avoid tears). And I go into my examples: think of it like cutting a piece of paper with scissors. It's much easier to rip the paper along that cut than to rip an intact piece of paper... Blah blah blah".... There are some facts proven by research and some areas that are more about opinion. I'm honest about which are which (Reseach has shown... vs. Some providers feel.... others feel...).
    Stellar post, Fergus. And thank you for being so respectful. This is really what it's all about. There is room for us all at the table, everyone! Let's respect each other; no one is "young-eating" anyone here! Keeping an open mind and your defenses OUT of it certainly helps! I agree with every word in this post, Fergus!
  6. by   fergus51
    Thanks Deb. People are going to start wondering if the two of us aren't really one person pretty soon....
  7. by   SmilingBluEyes
    i know. or a mutual admiration society...rofl.
  8. by   rnmi2004
    This has been an interesting discussion. Since my OP, I've slogged my way through nursing school and am in the 4th semester where we're talking about L&D complications. I am in the midwest, and unfortunately, our instructor says that in the hospital we do our L&D rotation at, nearly everyone has a high-intervention birth.

    I've been thinking about something else that (for me, at least) plays a factor. When I was pregnant for my first child, I had a birth plan that stated I preferred no episiotomy. Well, when I went into labor, the OB that came in while I was crowning was trying to tell me that he had read my birth plan & understood I didn't want an episiotomy, but he would like to do one because...I'm not sure what all he said, but I was in a lot of pain and delirious and the point I zeroed in on was that it would speed up getting the baby out. At that point I told him to "Just shut up and cut!" (exact words, they're on tape).

    While pregnant I had carefully researched the pros and cons of the various interventions and had decided that I wanted to give birth without interventions. In fact, I had my baby on the floor of this hospital that was designated for low intervention labors--if you decided during labor that you wanted an epidural, you had to be transported to the regular L&D floor. Once the pain became intense, I lost my focus and my LaMaze classes, breathing exercises, and desire for no intervention birth went out the window. I wasn't quite sane, but I did give informed consent to an episiotomy and I'm pretty sure I would have let the staff do just about any other intervention if I thought it would somehow lessen my pain and get the labor over with quicker.

    The next baby I had was delivered by a CNM. When pushing, I remember begging her to just "cut me and get it her out!" She gently told me that I didn't need an episiotomy, that I was doing a great job, and that this baby would come out just fine--and she did. Oh, mah, goodness--the difference between recovering with & without an episiotomy was like night & day! I was so grateful that she didn't give in to my insane pain-induced demands.

    I'm sure I'm not the only woman who has had the same type of reaction to labor pains. The difference in my experience was in the person who was attending my birth. I'm not saying all OB's are one way, and all CNM's are another. I also feel that there is a fine line between encouraging a laboring patient, reminding her of her birth plan, refocusing a tired mom--and just plain unreasonably refusing to provide requested treatment. It's got to be a tough call for the caring CNM, OB, nurse, or anyone else involved in caring for the mom. I think that's where doulas would be very useful, and I think more moms should make use of them.
  9. by   tantalus
    Well here goes...

    As a UK trained and registered midwife since 1992 here's my opinion...

    Yes childbirth is natural, it's been going on since Adam and Eve...what has changed is the morbidity and mortality rates for mothers and babies.
    I've never delivered a baby at home...I have however labored many women at home and then taken them into the hospital in time for delivery...my intervention was no different at home or in the hospital. I have also been unfortunate enough to deliver a stillborn and to be on shift when there was a maternal death (yes they do still happen).

    There are three things at play here...
    1. Doctors decided that this was their field....I don't feel that it is particularly...they are hopefully trained to prevent and cure disease..this is not a disease.
    2. What women expect...in western society women don't expect pain or worse still illness or death from "just having a baby"
    3. The staff midwives, doctors and RNs....just because a piece of equipment is available does not mean it has to be used...I have worked alongside people that appear to have this attitude.

    If we look after a woman in labor it is our task to look ahead, to try to predict abnormalities and to take appropriate action.

    Bev
  10. by   hospitalstaph
    I think that home birth is a reasonable option for many women. Unfortunatly in the area that I live in we have a number of doctors that do not support "natural" labor. We even have one practice that makes you sign a contract that you will not attend Bradley classes! I drove almost an hour to another state to have a midwife attend the delivery of my babies in a hospital with all the bells and whistles. My husband "caught" his last two children and it was a wonderful experience. In my case I was able to get 5 star accomidations with everything that I wanted however, I would have gladly "camped" (at home) if my only option was one of our local drs. It is a shame that there are not more birth centers.

    T
  11. by   BETSRN
    <<We even have one practice that makes you sign a contract that you will not attend Bradley classes!>>
    That's outrageous. I'm not even sure that is legal. Those docs must be so afraid. I'd hate to be an L&D nurse working in their facility. I'd make sure I make loud and clear statements to anyone who eill listen about those docs. How about a couple of editorials in the local papers? Whre are you located and where is OB group?
  12. by   Mimi2RN
    I work in a busy hospital, 350 plus deliveries a month. I know that most of our deliveries are normal, but when things go bad, it's really bad. We do lose babies, despite our care. Beta strep is still a killer. We've lost one, maybe two to feto-maternal transfusion. Results are still out on one of those. We also have pulled another one back from the brink, and quickly transfused the baby. "Pretty in pink" has a different meaning to me!

    None of these were expected, could have happened with any delivery, so home births to me means taking a chance. I suppose that the odds are in favor of having no problems, but things do happen. Of course, most moms are fine, but as others have said, moms do still die. We recently had a 15 year old go into DIC, she did survive, but was very ill. I don't think that her family and friends had any clue that she could die, that childbirth could be fatal.
  13. by   hospitalstaph
    Quote from BETSRN
    <<We even have one practice that makes you sign a contract that you will not attend Bradley classes!>>
    That's outrageous. I'm not even sure that is legal. Those docs must be so afraid. I'd hate to be an L&D nurse working in their facility. I'd make sure I make loud and clear statements to anyone who eill listen about those docs. How about a couple of editorials in the local papers? Whre are you located and where is OB group?
    I am in Kansas City Missouri. I am currently in nursing school with plans to work in L & D (I am currently a breastfeeding counselor). The hospital that this group delivers at is less than 5 minutes from my home. The location makes it ideal for me after I graduate but I think I would lose my mind working in those conditions. Another hospital that actually has a pretty good rep for low tech deliveries is about 10 minutes away but they have been actively fighting to keep midwives out of their hospital.:angryfire

    T

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