Home birth in NY?

Published

Specializes in Emergency Care.

Hi, I recently read about the closure of St Vincents hospital in NY, and it started a debate on another forum I'm a member of about the different attitudes to home birth between the UK and the US. Below is the reply I posted on another allnurses thread about the closure -

Originally Posted by mree viewpost.gif

I just found this post when searching for info on the closure, as it was mentioned on a UK nurses' forum I frequent. It was brought up as, in the UK, it's encouraged for women to consider home birth if they are considered low risk, but apparently in the US it's discouraged as apparently the US healthcare system seems to think birth is only safe if supervised by a doctor?!!! Is this right, or has someone got it wrong on the UK forum? Here, you only SEE a doctor if there's a problem with your pregnancy, otherwise pregnancy and birth services are midwife-led.

You're right that homebirths in the US are discouraged, generally.

There's lots more to say on the topic but I suggest starting a new thread, in the OB or midwifery forum.

So, I'm starting a new topic as suggested! What does everyone think? Is the medical resistance to home birth and midwifery real in the US, or are we in the UK being mislead on the topic by the media? Why are resistant attitudes developed among medics (if they are)?

Up Vote Up Vote ×
Specializes in Emergency Department.

It's real and it's multifaceted from turf wars, certification/education wars, to $$ wars.

Up Vote Up Vote ×

We need facts, statistics, outcomes, costs, etc. I know excellent experienced Dr.'s who have done home birth for their wives with no problem, but say they would not do it again? I hear of birthing centers that are next to hospitals, sounds like a good alternative? I personally wouldn't have a home birth, why take the risk?

Up Vote Up Vote ×
Specializes in Professional Development Specialist.

It is well documented that home birth for a low risk pregnancy is just as safe (if not safer according to some studies.) But there is still real resistance as well as a negative attitude. Personally I told no one until AFTER my daughter was born. ;) It wasn't worth the argument with uninformed people.

Up Vote Up Vote ×
Specializes in Professional Development Specialist.
We need facts, statistics, outcomes, costs, etc. I know excellent experienced Dr.'s who have done home birth for their wives with no problem, but say they would not do it again? I hear of birthing centers that are next to hospitals, sounds like a good alternative? I personally wouldn't have a home birth, why take the risk?

http://www.bmj.com/cgi/content/full/330/7505/1416

Up Vote Up Vote ×
Specializes in Emergency Department.
It is well documented that home birth for a low risk pregnancy is just as safe (if not safer according to some studies.) But there is still real resistance as well as a negative attitude. Personally I told no one until AFTER my daughter was born. ;) It wasn't worth the argument with uninformed people.

I had three home births after a hospital birth (for no better reason than convenience since the hospital birth was just fine) and was hard-headed enough to tell the world and educate them :)

Up Vote Up Vote ×

Had three homebirths, one in CA and two in MA. I am an RN and so is my husband. All times I had good MD backup and was able to navigate my way through the healthcare system and get the best of both worlds. I had ultrasounds at my backup hospital and at a clinic and with my first I was quite over due so I had a biophysical profile just to be sure all was still well. Also got Rhogam at the hospital in MA and a home in CA (different rules in each state). I have always wanted to do OB nursing so I know all the things that can go wrong, but for me it just felt right to do it at home and I am SOOOO glad that I did. Example: My second child was due in August and it was a warm day so I spent a good part of my labor propped up on some pillows on our hammock in the shade of a tree in my back yard then I got up because I felt like I had to go to the bathroom and my son was born shortly there after (comical scene trying to get off the toilet in time and onto the birthing stool while covered in almond oil. I felt like a greased watermellon!). After my son and I were checked my husband went and got our daughter who had been napping upstairs and we all hung out on a sofa bed in the living room while my midwife cooked up some yummy beef stew. This experience could never have happened in a hospital. Hospitals are great when you need them but I did not and I was able to birth how I wanted. I feel like so many women miss out because of our culture of fear. Homebirth is safe with a good well educated midwife and a client who understands the risks and is willing to transfer if necessary. I wish more women knew how empowing it feels to push out a baby while standing up and with no meds! I am verbal about my experience because I want people to realize that it is a real option.

Up Vote Up Vote ×
Specializes in Pediatric Pulmonology and Allergy.

I think it's true what you heard, that homebirth is generally looked down upon and discouraged. In addition to the reasons that other posters gave, many doctors/nurses have a skewed view of homebirth because they only see the train wrecks. It would be like forming your opinion of driving based only on what you see in the ER. Actually driving a car is probably more dangerous than having a homebirth. And there are all kinds of drivers--experience, inexperienced, safe, unsafe. Well, homebirthers are the same way. There are responsible ones who do their research, get prenatal care, eat and behave in healthy ways during pregnancy, know what to expect during childbirth and what are danger signs. Who is more responsible--those homebirthers, or the women who show up in the hospital for their inductions and epidurals?

Some homebirths do go horribly awry, usually because they're using an unlicensed midwife rather than a CNM. But that's also an effect of the legal situation--we have made it so onerous for qualified midwives to practice that only the lay midwives are left for women who want homebirths. And because they're not legal they will avoid taking women to the hospital until a very late stage. Maybe if hospitals weren't so unwelcoming to homebirth transfers they would transfer at an earlier, safer point. Really, a homebirth transfer isn't "dumping" the problem on the hospital--it is an appropriate use of hospital resources. In every other area of life you go to the hospital only if ther's a problem--you don't hang around in the hospital just in case a problem might develop. And a good, vigilant midwife willl be alert and know well in advance if a problem might develop. Yes, I've heard the stories of how the perfect little labor can turn sour in an instant, but usually when you read the details there were warning signs there beforehand. It's exceedingly rare for the sudden complication to come out of nowhere.

From what I've seen, in-hospital midwives are just glorified L&D nurses and in many cases are barely paid better than floor nurses. Really, what's the point of going through the extra training and getting the title of CNM, to be treated like cr&p? I wish the people responsible for healthcare reform in this country would realize what an asset a CNM can be in insuring healthy, comfortable births for women. Not everyone is a candidate for homebirth and definitely nobody should be pushed into it, but the women who WANT it should have access to it unhindered, without their care providers being outlaws.

Up Vote Up Vote ×
Specializes in Emergency Department.
Some homebirths do go horribly awry, usually because they're using an unlicensed midwife rather than a CNM.

Some home births go horribly awry because sh*t happens, not because there are unlicensed midwives attending births. The study that gets the most attention for effectiveness and safety, mentioned earlier in this thread, was conducted using the data provided by Certified Professional Midwives, or "lay midwives" as the medical field is so keen on calling us. The ACNM, as far as I know, have not conducted a single study of their effectiveness or safety, but regularly tout the study as if they had actively participated in it as a joint effort (disingenuous!). There are a little more than half of the United States licensing "lay midwives" using the credentialing process outlined by NARM. So while many states are still not licensing the non-nurse-midwife, there are a large number of midwives who still answer to an educational and credentialing process as they push toward legislation.

Up Vote Up Vote ×
Specializes in Pediatric Pulmonology and Allergy.
Some home births go horribly awry because sh*t happens, not because there are unlicensed midwives attending births. The study that gets the most attention for effectiveness and safety, mentioned earlier in this thread, was conducted using the data provided by Certified Professional Midwives, or "lay midwives" as the medical field is so keen on calling us. The ACNM, as far as I know, have not conducted a single study of their effectiveness or safety, but regularly tout the study as if they had actively participated in it as a joint effort (disingenuous!). There are a little more than half of the United States licensing "lay midwives" using the credentialing process outlined by NARM. So while many states are still not licensing the non-nurse-midwife, there are a large number of midwives who still answer to an educational and credentialing process as they push toward legislation.

When I use the term "lay midwife" I mean a midwife who has no credentials whatsoever. A certified public midwife has education and training in midwifery. I don't believe it's necessary to go the CNM route to be qualified to attend births, but neither would I use someone who had no education in women's health. Please let us not quibble over this--I am a huge supporter of homebirths and divide and conquer is not the strategy to use in this situation. Furthermore, I explained in my post that legal issues that prevent homebirth midwives from having hospital privileges contribute to poorer outcomes--not that it's the midwife's FAULT that things go wrong.

Up Vote Up Vote ×
Specializes in Emergency Department.
When I use the term "lay midwife" I mean a midwife who has no credentials whatsoever. A certified public midwife has education and training in midwifery. I don't believe it's necessary to go the CNM route to be qualified to attend births, but neither would I use someone who had no education in women's health. Please let us not quibble over this--I am a huge supporter of homebirths and divide and conquer is not the strategy to use in this situation.

I'm not quibbling, I'm merely stating the facts and used your statement "Some homebirths do go horribly awry, usually because they're using an unlicensed midwife rather than a CNM." to do it. Not every nurse reading these threads understands the differences or that a midwife can be licensed but not certified or certified and unlicensed... or be a certified professional midwife and not a certified nurse midwife... or even both of those at the same time! "Lay midwife" is an outdated term.

It's also important to know that ACNM has not conducted their own home birth research studies, especially when the first statement most will make is to support the CNM as safer, better, etc., based solely on a credential.

Up Vote Up Vote ×
Specializes in Emergency Care.

Thanks to all for your views, some interesting replies!

Up Vote Up Vote ×
+ Join the Discussion