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.

I will check that source, thank you. I just have been an OB nurse 10 years and have not found your statistic applies in any of my experiences. But then, my experiences lie in smaller, community hospitals, both in rural and suburban settings in 2 states. Obviously, I have not "been there done that" in every location.

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

Breck what are your experiences in birthing? Are you a nurse, midwife, doula or other birthing professional? Or are you an informed and conscientious consumer? Just curious where you are coming from. Thanks.

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

When I mentioned self-pay, it was in the context of what the hospital lost. And you have to remember: Insurance concerns lie not just with the consumer (birthing moms) but also the doctors and hospitals themselves. Risk management and containment are big business and a forethought of many doctors, hospital administrators and yes, nurses, too! That is just plain out of reach for many professionals, is a big problem that gets worse every year. A lot of good family practice docs, OBs and midwives have ceased attending deliveries due to these unbearable costs. That is a major concern, for us all.

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Breck what are your experiences in birthing? Are you a nurse, midwife, doula or other birthing professional? Or are you an informed and conscientious consumer? Just curious where you are coming from. Thanks.

Hi I was a direct entry midwife in Canada for 6 years and under the supervision of an MD I caught over 250 babies at home, had my two children at home at that time and just last January delivered my own granddaughter 8 lbs. 4 oz without a tear, became an RN in 1988 and went from working in the float pool and L&D which I hated because of all the manipulation to now working in NICU in San Diego, had a doula practice in SF (2000-2002) for 2.5 years, wrote a book that is currently out "Hey! Who's Having This Baby Anyway?" , created iCare (Improving Childbirth Awareness for a Richer Experience) course and have 25 instructors across the US. and used to teach childbirth classes in Canada for ACHI. I have other projects in the works right now but so far that is it.

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

Good to know your background and where you are coming from. I thank you. I am sure your experiences are varied and just fascinating to hear about. I have much respect for midwives (all kinds) as birth professionals. I am self-confessed "birth junkie" believe it or not, and love to hear about all experiences regarding birth and its profound effects on birthing familes, friends and yes, even us so-called "professionals". I consider myself priveledged to be part of these experiences with my patients and their families and do love what I do----caring for people is my thing!

However, I am going to have to ask you to remove your personal website and its reference from your post. You MAY put it in your personal profile here at allnurses.com, but it may not appear in the body of any message you post without prior approval of the site administrators (names in red) or Brian, the site owner, himself. This is spelled out in our Terms of Service for the site, regarding advertising, so feel free to browse that area if you have questions.

Thanks for understanding and answering my questions.

PS Are you referencing Canadian statistics? Just curious. I have not made it to that website you referred before yet. Thanks.

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I'm so sorry for the mentioning of the website. I didn't know. sorry. No the Stats are from the US and current.

Breck

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Specializes in CRNA, Finally retired.
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.

Of course you are right that most home birth are uncomplicated events. But OB is a high risk area precisely because the stakes are so high and when there are problems, the results can be devastating. So why risk it period? Its unfortunate that patients don't have more birthing center options available. The only way to de-fuse the medicalization of birthing is an educated patient but that's not going to happen. When we're pregnant, our brains go out the window. And who's going to argue with an aggressive physician while in labor - its difficult to defend yourself from the staff when someone comes in the room with the pitocin drip as due course.

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I would never have a homebirth, there are too many what ifs. I get tired of hearing how horrible hospitals are. You just have to know where to find a good center where you live and do research into policy before you deliver.

Where I work I would trust the nurses and doctors completely. We are very low intevention, low epidural and c-section rate and EFM only when required. Not every hopsital has intervention happy practioners and even if they are intervention happy you can have informed consent and refuse that which is unnecessary. I have never seen a dr ARM a pt at 2 cm or at a -3 station and would certainly speak to them before they did that.

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Specializes in postpartum, nursery, high risk L&D.
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!

I find this 66% statistic hard to believe too; we are constantly hearing from our management how our unit does not make the hospital any money & that's why they don't want to spend money on remodeling it (it needs it!!)

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

Truer words have never, ever been spoken.

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Specializes in Pediatrics.

Where I'm coming from: I had my 4th (out of 6) at home with a midwife. What took me home wasn't wanting it more natural, but the stress and humiliation I felt at the hands of doctors and nurses in hospital and how I had to FIGHT to not have drugs or to birth in a position I wanted. I got many more prenatal visits than with a doctor, and careful care during labor. The midwife carried pitocin and oxygen, which was important to me, and we were 10 minutes away from a major hospital. Even though all my births until then had been drug free in hospital (which by the way really diverts your energies when you are having to decline to give informed consent to all the "standards of care" that are not necessarily evidenced based or relevant to your case), but at home there was an added dimension-it was so gradual, with much less excitement. My labor never stalled because I got so pumped with adrenaline going to hospital. AND, as an upside, I felt comfortable having 2 more in a hospital, because I had gained the confidence to know it was my show and I could take it anywhere!

I would like to point out a few thoughts I had reading previous posters. SmilingBlueEyes, I totally agree about informed consent. People from any socioeconomic part of society can buy the whole medical model of childbirth without actually educating themselves-sometimes by choice, but sometimes because they don't even realize there is a choice. And RNs too often act like employees, not patient advocates. So many people just fail to realize that everything, from the IV to continuous monitoring, to agreeing to sit,not roam the halls, to placing your feet in stirrups is actually a choice-a choice that may in fact set up the dominoes that then get tipped over to become a very interventionist birth. Also, those who mention infant and maternal mortality rates in the third world, when is the last time you looked at the U.S.'s stats? We don't look so hot! The U.S. has more perinatal deaths that Japan, Canada, Australia and basically all of western Europe (ranked 19th). That doesn't make hospital birth not a great thing, and statistics are complicated, but just injects a little gray into the black and white picture. Lastly, I read a post about a mom who birthed at home and bled out 12 hours later. That's amazing, because I have an acquaintance who birthed at one of the top L.A. hospitals last year and bled out less than 24 hours later, quietly in her pp room. She isn't dead, but she's in a rehab center and devastated for life. So, it just goes to show that anecdotal evidence ain't really such good evidence at all.

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I find this 66% statistic hard to believe too; we are constantly hearing from our management how our unit does not make the hospital any money & that's why they don't want to spend money on remodeling it (it needs it!!)

Google pregnant in america and listen to the trailer that is offered on the home page. This is the documentary that will be presented later this year. In this trailer is the statistics that I quoted about the 66% and when I chatted with Steve ( the producer) he said the statistics quoted in the trailer were current and researched. This may not relate to small hospitals, and ones that are independent but do apply to hospitals like Kaiser, Sharp, Scripps etc..

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