Home birth vs. hospital

Katnip, RN · May 12, 2003

Smilingblueyes, The hospital I did was in a very affluent area. Most of the patients we saw were highly educated and said they had done a lot of research. Most just felt it was not necessary to feel a bit of pain. Some even insisted on unecessary C-sections--even when they were told about the risks. They just wanted it done as quickly, cleanly, and painlessly as possible. I really think they just blew off risks as something that couldn't happen to them.

We had one woman who was just about to start pushing and screamed for her epidural even though the nurse told her that it would get better in a couple of minutes and really was doing a good job of helping the mom keep in control during contractions. The patient said she'd sue if she didn't get it. She got it. It probably was in effect for all of 7 minutes before the baby was born. But she was happy.

I have a friend who is an L&D nurse in an innercity hospital where most are poor and uneducated. They are always given the options and at least half usually choose to at least try to go without a lot of interventions. Not sure if it had to do with the mother's advice to the patient or what.

It's true, though that many docs and hospitals like the convenience and the extra money.

Not that pain intervention is a bad thing. Believe me, I'm all for it when it's needed. But one thing does tend to lead to another.

I'll stop rambling now.

SmilingBluEyes · May 12, 2003

I hear you cyberkat, but the issues are much broader than pain control........every intervention should be NEEDED and INFORMED consent obtained, not just those pertaining to anesthesia.

dawngloves, BSN, RN · May 12, 2003

I wouldn't deliver at home because the whole time I'd be thinking, "Whose going to clean up this mess??!!"

mother/babyRN, RN · May 12, 2003

My feeling is fine if you want to do that as long as you are absolutely informed and the midwife/doc covering is certain to get a consent form signed because if something untoward or unfortunate occurs at home, it will usually be everyone BUT the parents who are blamed...

mother/babyRN, RN · May 12, 2003

As for social and convenience inductions, of which we see all too many, I have lately had plenty of patients who wanted to be induced to suit their schedules. We recently had a patient do her own vag exams, exercise and take castor oil to attempt labor. It didn't work....

roxannekkb · May 12, 2003

The Netherlands has a very high rate of home births, one of the highest in Europe I believe, and one of the lowest rates of infant/maternal morbidity and mortality. Also one of the lowest C-section rates.

Much of the high rates of infant/maternal morbidity and mortality in the third world have to do with a number of factors, one being that many of the moms may be malnourished, anemic, and so on. Birthing conditions may not be the cleanest (for lack of a better word), especially if we're talking about very crowded areas. Poor sewage systems which breed cholera and dysentary, well, you get the point.

This isn't to say that home birth is better, but it would be interesting to see what they do in the Netherlands and other nations that have a significant number of home births and great outcomes.

renerian, BSN, RN · May 13, 2003

I am one of the women who had birthing complications with both my children, I would have died at home.

Thank goodness for the hospital,

renerian

keeper · May 13, 2003

Well, I'm a homebirther and just wanted to say thanks to roxannekkb for bringing up the points she did. You simply cannot compare third world countries with home midwifery care in the industrialized world. Nor can you compare modern homebirth to birth from a hundred years ago. I also find the Dutch model to be very telling.

I always have to laugh when someone brings up the "mess", because someone always does. Do people really think the midwife just walks out the door leaving mom sitting in a puddle of blood and amniotic fluid? My midwife was vacuuming while I labored in the tub, and everything was disposed of before she left. (Actually, there wasn't really much mess at all to clean up.)

Sarah

webbiedebbie · May 13, 2003

Shame on the doctors. But then again, many women don't really listen to INFORMED CONSENT. They want to have their babies now!. And the doctors are more than willing to accomodate them.

I used to work L&D. I have seen it all.

Many women don't want something bad to happen to them or their babies. They have come to depend on hospitals being the "miracle" place. They think everything is going to be okay. They don't realize what really is happening when their baby is in trouble. Sure, they are worried, but many have a false sense of reality. However, hospitals do have the technology to insure a positive outcome (although this does take some time and a lot of worrying from the medical staff, nurses included). Not to mention the cost involved.

I am an advocate for home births as long as the pregnancy poses no problems. A woman who has a large fetus is not a candidate for a home birth. Home births need to be screened thoroughly during pregnancy.

In my past experiences, the CNM's acted like physicians. They came in to check the patient's once in a while and "call me when she is ready to deliver". I rarely saw them with the patients during labor.

I would think that a CNM would be in the home, assisting with labor needs, and then the delivery, from start to finish. The CNM is capable of resuscitating the infant until the ambulance arrives. The CNM would have the oxygen and medications and tubes needed. No different than what the hospital would do. Although I would believe that these would be rarely needed if the labor is allowed to progress at nature's pace.

To speed up labor in the hospital places the infant at risk. That's why we have all of the monitoring and equipment to keep us out of trouble.

mark_LD_RN · May 13, 2003

CYBERKAT.. affluent area does not equal informed consent. all to often the patient gives coherced consent. or they do something because they think that is what the nurse or the doctor wants. you will never know how many times I heard will I am being induced because my doc told me to, or I am getting pain meds or epidural because i don't want to be a bother to the nurses or doc,or don't want to make a fool of my self etc.

and the interventions refered to are not just pain control issues, its AROM,social inductions, short pushing times,forceps,vaccum,c/s ,pitocin,c/s etc

all to often the attempt is made to deliver on the docs schedule not the moms or baby's as it should be. I have worked all around the country in lots of hospitals and have not seen much of the interventions being truely choosen or suggested by the patient. show me a patient that if given the option to deliver with out forceps would choose them if not suggested or some supposed benifit is told to them. most often it is presented to the patient in a way that makes it sound benificial. ie. going to give you a little pitocin to speed things up, give an episiotomy to speed up delivery or to prevent damage ,( now thats a real good one:) ), or after a primp pushes for an hour the pt being told well we not make progress lets go for c/s. and the list goes on and on.

the patients will often go along with what ever is suggested to them. I know this from personal experience or first birth went the way the doctor suggested , my wife did it because she did not want to upset the doc. and we were from affleunt families and area and well educated. but because doc suggested it, wife ended up with pitocin,demerol,epidural, 3 rd degree episiotomy with forth degree extention after a forceps delivery. baby had bruising from forceps, wife had long difficult delivery of 7 lb baby.

the next two we changed docs decided to do it our way , I delivered our last 2 babys 8LBS and 8 LBS 15 oz wit h14 1/2 inch head myself no meds no pit no epidural intact perineum and home in 12 hours with second one and 4 hours with third one. even during those births the doc and nurses often suggested pain meds or pitocin etc to help things along. funny thing is all her labors were 17 -17.5 hours :)

well enough of my rambling:)

fergus51 · May 13, 2003

Affluent areas tend to equal: too posh to push patients in my experience. I would rather work with inner city, drug using, swearing women than the tptp set.

dawngloves, BSN, RN · May 13, 2003

Originally posted by keeper
I always have to laugh when someone brings up the "mess", because someone always does. Do people really think the midwife just walks out the door leaving mom sitting in a puddle of blood and amniotic fluid? My midwife was vacuuming while I labored in the tub, and everything was disposed of before she left. (Actually, there wasn't really much mess at all to clean up.)

Sarah

I don't know. I've been in some pretty messy delivery rooms.