Home birth vs. hospital

JeanettePNP, MSN, RN, NP · Mar 7, 2007

I can understand you preferred your home birth, but I do have to say women who choose the hospital can have just as much say in their experience. I have never worked somewhere that "required" IVs or internal monitoring or AROM or epidurals or hourly vag exams, etc. and even if they do, a woman has the right to refuse any medical treatment. I know I'm going to get flamed, but I think it's time to claim our power and stop blaming doctors and nurses for "subjecting" women to such procedures. I would hope a woman about to give birth would do as much research into it as she would if she were buying a car, and even if she didn't I would hope that her nurses and doctor/midwife would provide her the information she needs to make an informed decision.

The problem is that during labor is not a time when you want to be fending off persistent nurses who want to push procedures on you because "that's the way it's done." With my first birth I wasn't aware of all my options and I did trust the midwives and nurses to make these decisions for me. If they told me I needed internal fetal monitoring, well that's what I was going to have and I didn't argue about why. Only with experience did I learn that not everything that I was subjected to in my first birth was necessary and it probably slowed down the progress of my labor a lot. So, as well-informed as a pregnant mom might be, she still isn't a medical professional and may have a hard time trusting her own judgment in a hospital environment surrounded by people who seem to be so much more knowlegable. The pressures of the moment can also hinder her ability to think through all her options and make an informed choice. Whereas, at home with a midwife you have already selected the caregiver based on compatible views on labor and delivery. You also know exactly who will be with you at birth so you don't have the turnover of caregivers you have in the hospital.

BreckH · Mar 7, 2007

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!!)

Smilingblueeyes spelled it out pretty clear, clinics and small hospitals are closing their doors to birthing and directing the births to larger hospitals which with their complications and interventions are directing their babies into NICU, longer stays in hospitals from cesareans, necessary or not, and with the cesarean now at 30% (google birth statistics ) the hospital is generating more revenue then ever before in births. Over the past 10-15 years more and more babies are being admitting into NICU for even the slightest fever, or any newborn apnea spells including after they are resolved and are kept to Rule Out Sepsis whether the mother was GBS positive or not. I overheard one Neonatologist say to another the other day that he wants the Sharp NICU units in SD (there are three) to generate $1,000,000 a month.

So birth includes labor care, keeping a pretermer in the unit until she gives birth usually on Mag, or Tobuterol or whatever, the delivery and all that goes with it Pit, epidurals, stadol, monitors, etc. The cesarean she may end up because of all of the above, the infant possibly going into the NICU unit for up to 10 days, mom's recovery, lactation consultant, circumcision, and on and on.. So yes, in most hospitals the birthing center does generate 66% of the revenue and the hospitals are willing to bend over backwards to make it the most attractive unit there because if mom has a good to decent birth experience she is going to direct old Uncle Henry and Aunt Martha there to have their bypass surgery and her kids will be going there for everything they have under the sun.

BreckH · Mar 7, 2007

This is current: Pregnancy is big business in America

Published by Roxanne February 26th, 2007 Care

66% of all hospital revenue comes from hospital births (and the C-section rate is 33%), according to a new documentary that examines pregnancy practices in America. When we’re fighting for reproductive rights, I think we need to remember that we have more enemies than just the Christian Right.

Via Lauren.

VegRN · Mar 7, 2007

Of course L&D nurses see the horror stories of births that didn't go right so that is the image they have of non hospital births. What about the majority of home births that go well? They don't see those. L&D nurses have both good and bad images of hospital births to balance out the hospital image of birth.

According to the WHO, 28 countries have lower maternal mortality rates than we do. Also, 41 countries have lower infant mortality. We throw the most money at hospital births than any other country and we have some of the lowest outcomes of any industrialized country.

Women who birth in hospitals are pressured into interventions such as pitocin, c-sections, episiotomies, bottle feeding the baby. They also generally do not know the people that are caring for them and may not even have the same Dr or midwife deliver their baby that provided the pregnancy care (subject to call schedule). And they do not necessarily have good outcomes, case in point, the WHO stats above.

On the contrary, women that birth at home already have selected the people that they want to be there for birth including the midwife. In addition, 80% of births do not need medical intervention. Also, the majority of women have low risk pregnancies and are safe to birth at home. The home birth progresses according to the mothers body. They are generally not pressured according to hospital staff's time schedule. Trained midwives also know when to transfer someone to the hospital and support the mom and baby until then.

2curlygirls · Mar 7, 2007

Over the past 10-15 years more and more babies are being admitting into NICU for even the slightest fever, or any newborn apnea spells including after they are resolved and are kept to Rule Out Sepsis whether the mother was GBS positive or not.

So are you suggesting we should not observe these babies? Babies don't usually get fevers but instead have low temperatures. Babies have very non specific, often subtle s/sx of infection. And get septic from a whole lotta other organisms than betahemolytic strep. And I'm sure you are aware, babies compensate for a long time before they crash. Aka, get really sick, really quick. If my baby had apneic spells, I'd want them observed for long time before I took them home. That's not because I want more money for my NICU, that's because I want everything ruled out. Most people would consider that the most responsible approach.

Not too many people mistake an epidural "fever" for true chorio. Even the new I've seen aren't that twitchy.

nurseyr1 · Mar 7, 2007

I think its time as a new post partum nurse to cancel my membership here and stop reading these boards. I thought this board was for OB-GYN nurses to discuss practice issues in a non-confrentational way and to generate discussion without hostility. I see that there is a real lack of support for OB-GYn nurses, even in an environment that is supposed to be welcoming of them. The general consensus appears to be that we are trigger/IV happy militants who want to sit you down and strap you to fetal monitors completely against your will and without informed consent. There has been little positive said about us nurses who KILL ourselves every day, bending over backwards to ensure that your delivery is safe and your baby is healthy. I've got the message, midwives are saints and nurses should just pack it in and forget about obstetrics. Enjoy your discussions, keep drumming those out of this forum who actually CURRENTLY practice in this area, and cannot speak without getting flammed. You can respond to me all you want. I won't be looking back.

BreckH · Mar 7, 2007

Of course L&D nurses see the horror stories of births that didn't go right so that is the image they have of non hospital births. What about the majority of home births that go well? They don't see those. L&D nurses have both good and bad images of hospital births to balance out the hospital image of birth.
According to the WHO, 28 countries have lower maternal mortality rates than we do. Also, 41 countries have lower infant mortality. We throw the most money at hospital births than any other country and we have some of the lowest outcomes of any industrialized country.
Women who birth in hospitals are pressured into interventions such as pitocin, c-sections, episiotomies, bottle feeding the baby. They also generally do not know the people that are caring for them and may not even have the same Dr or midwife deliver their baby that provided the pregnancy care (subject to call schedule). And they do not necessarily have good outcomes, case in point, the WHO stats above.
On the contrary, women that birth at home already have selected the people that they want to be there for birth including the midwife. In addition, 80% of births do not need medical intervention. Also, the majority of women have low risk pregnancies and are safe to birth at home. The home birth progresses according to the mothers body. They are generally not pressured according to hospital staff's time schedule. Trained midwives also know when to transfer someone to the hospital and support the mom and baby until then.

This is exactly true and accurate, we are a nation, and just about the only one, who have been taught to fear childbirth and to be forced through peer pressure to submit to the wishes of providers and follow the path of others who believe the only safe way to have a baby is in a hospital. When in reality, statistics show, it is actually the opposite. 95% of the population alive today in the world were born at home, and the majority of those who weren't were born in the US and we have the 2nd worse mortality rate in an industrialized country.. Go figure.. If we are to do our births in the hospital, which we always will for most of us, we need to do better, we need to train our mothers not to fear the word no. To come in later, refuse unnecessary routine interventions and medication, get up out of bed and walk, dance, utilize water, and move their bodies around until they are ready to birth their baby's. Mothers need to refuse providers that say they can't have options, that IV's when they walk in the door is routine and that their doula and care plan are not welcome. Until then pregnant couples will not control the outcome of their births, at least not in most of the hospitals that I've heard about, and will be lucky to make a few of the choices in their baby's birth. I have personally seen RN's in L&D who take the birth plans back to the break room and laugh about what the woman wants, and I have seen it put in the back of the chart and never addressed. And yes I have seen some amazing births in the hospital where the nurse worked with the mom all night long, a doula was present and mom was getting everything she wanted and it was amazing. So it is possible. It just takes shopping around for the right birth team and being informed.

JeanettePNP, MSN, RN, NP · Mar 8, 2007

I think its time as a new post partum nurse to cancel my membership here and stop reading these boards. I thought this board was for OB-GYN nurses to discuss practice issues in a non-confrentational way and to generate discussion without hostility. I see that there is a real lack of support for OB-GYn nurses, even in an environment that is supposed to be welcoming of them. The general consensus appears to be that we are trigger/IV happy militants who want to sit you down and strap you to fetal monitors completely against your will and without informed consent. There has been little positive said about us nurses who KILL ourselves every day, bending over backwards to ensure that your delivery is safe and your baby is healthy. I've got the message, midwives are saints and nurses should just pack it in and forget about obstetrics. Enjoy your discussions, keep drumming those out of this forum who actually CURRENTLY practice in this area, and cannot speak without getting flammed. You can respond to me all you want. I won't be looking back.

Although you won't be back to read the responses, I'll respond anyway, for the benefit of other readers of this thread.

The point of this thread was not to diss L&D nurses. Indeed, most (almost all?) of them are hardworking and dedicated to their patients. However, they are working within a certain structure that isn't always supportive of natural childbirth. There isn't much that a nurse can do when she's bumping up against hospital policy or doctor's orders. Homebirth midwives or birthing centers simply have much more flexibility, and that's what we homebirthers are looking for. I certainly have no complaints about the nurses that I encountered during my hospital births; almost all of them were lovely and supportive, to the extent that they could be within the limitations of hospital rules. It was the whole environment that felt alien to me and made me decide to look for other options. Many homebirth midwives started out as L&D nurses in the hospital, got frustrated with what they saw and experienced, and decided to go into homebirth practice.

crysobrn · Mar 8, 2007

I as an Ob nurse do see a lot of intervention that I don't agree with. But women often ask for intervention. I have women that come in that "think" they're in labor for weeks. And eventually they are close to 40 weeks and the dr suggests that they start pit and the patient not only agrees they are exctited. The dr thinks that a c-section is best for whatever reason and many moms are happy about it. I get dissapointed at the rate at which we intervene but I'm the nurse NOT the one writing the order. I can only butt heads with the dr's so many times:)

We've had many deliveries when the women bring in a birthing plan and have taken classes (hypno birthing or otherwise) and I think that most of the nurses that I work with are not only open to these plans but are actually excited to learn something. We try to educate ourselves as well as share information with our patients. I'm sure that there are more than one that I can think of that would have had issues with breastfeeding if not for a nurse standing there reassuring and lending advice and assistance as necessary. I've never had one of my patients that wanted a home birth but ended up at the hospital tell me that she regretted it. They have always said that they were suprised by the attention and cooperation they've received.

My grandmother had 10 children the first 9 were healthy normal deliveries. Her last was a c-section. She was told that he was presenting chin first and that if she would have begun pushing at home she would have broken his neck and she would no doubt have bled out. Yes this is a horror story but I thank God everyday that my Gramma is around!

Is it possible for a baby to be born at home. Well sure. But knowing everything that I know I personally would not take that risk. A woman that I work with told me that in her grandmothers generation a woman that was near the end of her pregnancy she would "pick the dress she wanted to be buried in" just in case. So, she says "if you're gonna deliver at home, you better pick the dress that you wanna be buried in"

BreckH · Mar 8, 2007

I would love to know in which states and cities all of you are from, this makes a lot of differences in the type of birth experiences people have in hospitals and at home.. I'm from San Diego California. The hospital I work at has a 85% cesarean rate before the weekend and before holidays. They have a 98% epidural rate.

SmilingBluEyes · Mar 8, 2007

I am from a medium-sized city in Washington State and practice in a smallish community hospital that sees about 800-850 births/year (and rising as this is a growing area). As liberal as WA State tends to be, I am sad to say, homebirthing practices are in some cases, pretty limited by some of what I call short-sighted laws (for example, NO VBAC allowed in midwife-run birthing centers). Also very few hospitals even allow TOLAC/VBAC at all. Again, lawyers and insurance companies have so much say in these matters.

And I have a problem STILL with the statistics. I realize they can be used/manipulated to prove any point anyone chooses to posit. From all I know, most OB units are a money-drain, not money-maker in most places. And while I can see where people might believe c/sections are revenue-raising enterprises, rather than medical necessities, I simply have not found that attitude to be prevalent among the OBs with whom I have practiced. They still very much prefer to avoid (especially) primary c/section without sound medical reasoning. I do, however, see many, many repeats----often I am aware, the doctors REALLY encourage these and do downplay the positive aspects of TOLAC/VBAC. But again, risk management

And I just really want to say, I support 100% the right for families to choose to birth wherever they choose. I just hope they realize and accept the responsibilities that always run concomittant with such rights. And I know, not all DO!

Respectfully, my observations, of course.

BreckH · Mar 8, 2007

I as an Ob nurse do see a lot of intervention that I don't agree with. But women often ask for intervention. I have women that come in that "think" they're in labor for weeks. And eventually they are close to 40 weeks and the dr suggests that they start pit and the patient not only agrees they are exctited. The dr thinks that a c-section is best for whatever reason and many moms are happy about it. I get dissapointed at the rate at which we intervene but I'm the nurse NOT the one writing the order. I can only butt heads with the dr's so many times:)
We've had many deliveries when the women bring in a birthing plan and have taken classes (hypno birthing or otherwise) and I think that most of the nurses that I work with are not only open to these plans but are actually excited to learn something. We try to educate ourselves as well as share information with our patients. I'm sure that there are more than one that I can think of that would have had issues with breastfeeding if not for a nurse standing there reassuring and lending advice and assistance as necessary. I've never had one of my patients that wanted a home birth but ended up at the hospital tell me that she regretted it. They have always said that they were suprised by the attention and cooperation they've received.
My grandmother had 10 children the first 9 were healthy normal deliveries. Her last was a c-section. She was told that he was presenting chin first and that if she would have begun pushing at home she would have broken his neck and she would no doubt have bled out. Yes this is a horror story but I thank God everyday that my Gramma is around!
Is it possible for a baby to be born at home. Well sure. But knowing everything that I know I personally would not take that risk. A woman that I work with told me that in her grandmothers generation a woman that was near the end of her pregnancy she would "pick the dress she wanted to be buried in" just in case. So, she says "if you're gonna deliver at home, you better pick the dress that you wanna be buried in"

And back in her grandmothers day maybe that was true but not anymore. Statistics show home and clinic births have a much better outcome, IF the woman has prenatal care, has a good diet, has a good birth team, has an uneventful pregnancy and is willing to enter into labor prepared. NO ONE without any of these things should consider birthing outside the hospital. Birthing at home is not something to do because you dont' want to hassle with the hospital, it is something you do because you want to have the best possible outcome for your baby, you want control of how your baby will come into the world with your choices of who will attend your birth. (the provider you want, the midwives and doulas you want, the family you want to have with you) You want a drug free environment and the ability to move around in surroundings that you are familiar with.

Studies have shown that animals that are moved during labor either stop their labor or deliver their young dead. Women who come into the hospital and are sent home with "false labor" would most likely have continued with their labor and had their babies if they had stayed at home. More babies would be born at night like nature intended but birth certificates across the states show that more babies are born between 8-5pm Mon. thru Friday then any other time. Pit, inductions, cesareans and impatient providers have contributed to this.

There are some amazing OB nurses out there I have met many in the different hospitals that I have worked for, but the OB nurses that are working in the hospital here in SD love the epidurals, they want their moms asleep during the night and monitor them from the nurses station. It seems gone are the days (here at least) when they would get them up, get them into the shower, birth ball, walking the halls all of that. The new policy nation wide, in order to get federally funded, is that a patient has to be assessed every 30 minutes for pain management. You ask a laboring mother if she is painful every 30 minutes and eventually she will believe she should be. Then the epidural is offered, and she is bedriddened and inteventions begin.

Women without prenatal care, drug mom's and there are many, difficult pregnancies, pretermers, women who don't have the desire to be totally involved in their pregnancy should have their babies at home, but moms that are not wanting an out of hospital birth should be given every oportunity with midwives in every state, birth clinics in every town and doulas allowed in evey hospital to have the birth they want and to bring their children into the world as natural as possible.

Did you know that 90% of babies born today have some type of drug in their system and I'm not talking about street drugs?.