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 OB, lactation.

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Specializes in CRNA, Finally retired.
There are several possibilities that I could see theoretically going bad before/during a home-to-hospital transfer (prolapsed cord, post-partum hemorrhage, shoulder dystocia, amniotic fluid embolus, undetected vasa & placenta previas/accreta/perccreta and HELLP (would presumably be detected with blood tests but some homebirthers don't do any testing and physical exam can be otherwise normal), GBS/sepsis, uterine rupture, abruption/DIC), but one that I have personally witnessed in my short time as a nurse (less than a year) is an abruption in which the baby died and the mother would have died too if she had not been immediately taken to the O.R. and given blood/surgery. She narrowly averted death as it was.

She was a model pregnant person without risk factors and was also asymptomatic until moments before she was taken to the O.R., so a transfer from home to hospital would have been too late if she'd been a homebirther. She had no interventions at all in the hospital before the abruption except external fetal monitoring for a short amount of time.

That said, I think that that kind of scenario is rare (and even rarer with healthy women doing home births with no interventions -for this reason most homebirths are healthier than hospital ones in that sense, but it doesn't mean weird emergencies can't happen) and most home births go fine. I support birth in whatever way moms want to do it & have several friends who are home-birthers. But people in any birth setting need to understand that even in this day and age, and even with the healthiest habits, things can go bad.

While women certainly shouldn't be scared into thinking that something bad is likely to happen to them when it isn't, we also shouldn't completely deny that if a (granted, rare-unusual) situation presents itself as in the scenario above, where seconds count, being at a hospital with life-saving medicines/blood products, surgical facilities, and equipment can make a difference.

We had an attempted home birth in our little town where the baby died while mom was refusing to get into the ambulance. I've been a nurse for 30 years and women are falling back into the old maternal arrangements common in the 70's where they simply did what they were told, even when it meant taking the scopolamine. Those of you who are old enough to remember deliveries under scopolamine know that it wasn't very nice. Now, instead of scopolamine, we have epidurals, pitocin drips, c-section for convenience and the patients go for it! Go figure. On the other end, we have rabid home-birthers like the women that lost her baby refusing to go to the hospital. If you're so immature that you would put your emotional needs before your infant's physical needs, you might as well show up at the hospital and take your epidural before delivering at home. Works in the Netherlands? I'll bet they're not as obese, sedentary and ignorant as the majority of our mothers are. Its a small, crowded country where hospitals are never far away. Our hospital has taken pains to make the rooms as homey as possible - all the medical stuff is hidden with the exception of the monitors we use in the birthing and recovery rooms. The problem, of course, is the physicians and the insurance companies - two entities not known to keep things simple. Sometimes I wish they paid CNM's top dollar for an uncomplicated, low-tech delivery and then you got paid less as the procedures mounted up. It would be an interesting experiment.

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

Homebirth in the RIGHT CARE and HANDS is VERY safe for low risk women. It is when poor judgement comes into play that you up the ante risk-wise. I have seen some amazing midwives who obviously knew what they were doing-----and a few wacky nuts who had no clue and were dangerous. I have found many homebirthing women very well-educated and self-aware--and others who scared me with their ignorance.

True story: A couple years back, we had a patient brought in w/her midwife cause she was unable to get her baby delivered. When our OB on-call came in, he used forceps and got her baby out. But then he got this white-pasty look to his face and looked at us nurses and said, "Get ready, cause there is another baby in there and it is breech!" The midwife just giggled like a schoolgirl and said "WOW how bout that for a neat little surprise?" That's right; she had no clue nor did this patient, that she was carrying a twin gestation!

Now, I am sorry, but this did not do a lot to elevate her standing in our eyes. It created an emergent and potential high risk situation for us---not knowing what to expect.

I suppose my point is this: Just like with anything, a few bad ones tend to spoil it for the whole bunch.Kind of like how we nurses are judged harshly by the homebirth community when they unfortunately meet with the one or two lousy nurses on a given unit.

Specializes in NICU.

She narrowly averted death as it was.

She was a model pregnant person without risk factors and was also asymptomatic until moments before she was taken to the O.R., so a transfer from home to hospital would have been too late if she'd been a homebirther. She had no interventions at all in the hospital before the abruption except external fetal monitoring for a short amount of time.

I went to a crash c/s for the same reason on Friday! Mom came in with vag bleeding. Was monitored, baby was profoundly bradycardic and the section was called. Fortunately, all were fine but you know the epi was drawn up and the ETT was ready.

Today we got a HB'ed baby with subdural hematomas x3 and a cerebellar bleed. ???????? They'd refused Vit K but very weird nonetheless.

Crazy thread, one thing no one has mentioned is the impact of the insurance industry on birthing centers. After I gave birth to kids 2,3 &4 at a birthing center, the insurance companies would not write a policy for it. As a result, a local hospital built a birthing wing to accomadate the CNM's and doctors that wanted to continue to provide a "home-like" birth. But the pendulum has swung back towards women wanted less "natural" births. Back when I delivered, saying you wanted an epidural, that was like child abuse! LOL, how times have changed...Peace

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

Insurance companies and lawyers rule practices, ask any OB or midwife about that. Sad but true.

You know it is funny, in the three different hospitals I've worked in and the 18 years I've been a nurse there is hardly anything said about infants that are transported into the NICU because of medical interventions during the labor. WE admit in NICU in San Diego at least one - two a day for observation many who are left in on antibiotics for 7-10 days. Term newborns that are brought in with severe bruising from vaccuum, or forceps, ones that are just so exhausted from hours of high levels of Pitocin and low heart rates or from laying on their cord inutero infants with respiration rates in the high 60's - 90's after an unnecessary section. Ones that have a fever because of mom's on epidurals for hours at a time and long pushing because moms don't have the sensation to push from epidurals or are pushing laying on their back for a long time.. but hey bring in a precipitious delivery from home or a stupid mom with no prenatal care who ends up delivering at home and the whole hospital is buzzing. If home births were so dangerous and babies were dying every day from a home birth don't you think that it would be splashed all over the news to justify that all babies should be born in the hospital. But no, there isn't tons of news of babies born at home with complications. Yes we hear about it once in a while and I'm sure everyone has a homebirth story. But how many are born at home natural and normal and don't get into the news. Look at statistics where hospital births (normal newborn) have a mortality rate of 6.3 midwives in the US have a rate of 2.1. I'm again not saying everyone should have a baby at home but damn it I don't think everyone should have a baby in the hospital, not with the epidural rate up to 98% and section rate now at 30%. WE have had two mom's die of hemmorhage in our hospital in the last 6 months. Deaths happen in births it's just that when it happens at home it is news.

Insurance companies and lawyers rule practices, ask any OB or midwife about that. Sad but true.

66% of the hospitals revenue is birthing. Hospitals turn a blind eye to interventions and unnecessary cesareans because it brings in the bucks..

The biggest problem started when pregnant women went from hiring famly practice providers (who can't perform surgery) to OB/GYN's who are surgeons who can't keep their hands off the surgical equipment. Like OB/GYN's say "When in doubt cut it out!"

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

Breck, your post interests me because it's confounding to my experiences. This 66% statistic is most assuredly not true everywhere. I lost my job in one birthing center due to it being closed. That community hospital no longer offers obstetric services of any sort. I have heard of many hospitals weighing the same action. (usually smaller, community hospitals tired of the "money pit" these centers are perceived as by "bean counters" and administrators. Also risk-wise, many place don't see them worth it, either. So women who would choose these places to give birth, are forced to go to larger or more distant hospitals to have their babies.

Why shut down the birth centers?

Because it (the birthing center in the case I refer to) was a finanacial drain on the corporate bottom line. So many people either were on DSHS ("welfare") or self-pay (often never paid) and we lost money every month we were in operation. Ridiculous amounts of money, I might add. I have worked in 4 different hospitals. In 3 of them, OB was a money-loser, not money "maker", not even close.

So this number you mention is not motivation for increasing interventions in most cases, I think. No, the reasons usually lie in the desire to "cut risks" (appearing to do so anyhow) and operate obstetrics on a 9-5 schedule for so many OBs who want everyone tidily "delivered" by the time offices hours end.

I am interested, Breck. Can you find me the source of your statistic? I am very interested to read the source and learn where this comes from. If you can, Thanks!

This 66% statistic is not true everywhere. I lost my job in one birthing center due to it being closed. WHY? Because it was a finanacial drain on the corporate bottom line. So many people either were on DSHS or self-pay (often never paid) and we lost money every month we were in operation. So this statistic is not motivation for increasing interventions. No, the reasons usually lie in the desire to "cut risks" and operate obstetrics on a 9-5 schedule for so many OBs.

There is a new documentary http://www.pregnantinamerica.com check it out these are the stats they are quoting and the film isn't out yet. As for self pay? when a person is a no pay or illegal and has no insurance the price of their care goes up because the tax payers end up footing the bill and covers the costs of insurance companies that don't pay off the whole amount of a bill.

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

I also am glad to say the OB/GYNs were I work now are rather loath to perform csections unless the women have prior c/section experiences or their babies show clear signs of either distress or not coming out . I can recall many an occasion where the OB was patient and it paid off in a big way. So not all OB/GYNs "like" cutting. That is a rather unfair statement IMO. Do they want their patients delivered in timely fashion? You bet, and it annoys me a lot---- but they are not eager to cut and are very aware of their statistics in this regard.

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