Home birth vs. hospital

[rnmi2004]

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!

[emhanojoli]

I would bet that no one who works in a NICU would ever recommend at home birth!!

You would lose that bet. I work in the NICU. I'm an OB nurse, but float over there to help when needed. I've seen the worst of the worst. However, most of what you see there is preterm babies. Of course preterm babies shouldn't be born at home. Other things I see, mec aspiration, resp distress, can probably be found to be caused by something done to the mom by hospital staff (pit and epidurals are big one's for these two).

Stacey

[gfmidwife]

I am a student midwife. I have a huge file with homebirth, midwife outcome studies. Please email me [email protected] if you'd like me to forward them to you. The most famous studies are the Mehl studies. You could also look at the books by Henci Goer, Obstetric Myths vs. Research Realities and The Thinking Woman's Guide to Pregnancy. BTW, Henci is not anti Obstetrician or technology.

Lara Nabours-Mentor Program Director, Admissions Advisor [email protected]

AND AAMI 1721 Student Midwife Mama to

Cally 10-1st of 3 Blessings!

Daniel 7.5 homebirth

Katyah 4.5 waterbirth

I believe all mothers are midwives, all women are doulas and we can all educate and advocate for the community and our selves. Birth professionals should look to their community for their calling and respect, not outside organizations that have historically oppressed us.

[emhanojoli]

I know one family member and one friend who have had home births and were lucky enough to have healthy and natural births.

MrsB is correct in saying that many OB practices are not evidence based (partially cause you can't really experiment on pregnant women)

First of all, I wouldn't say they were "lucky." Healthy natural births could be the norm, and in fact, ARE the norm in home births.

Secondly, of course pregnant women are experimented on. What is Cytotec? Certainly not developed for induction. Someone thought, "hey let's try this" and they did. That's experimentation. Everything we now do to pg women was done for a first time, and experimentally, and the list of things we do is growing almost daily. So, yes, they are experimented on.

Stacey

[ktwlpn, LPN]

Secondly, of course pregnant women are experimented on. What is Cytotec? Certainly not developed for induction. Someone thought, "hey let's try this" and they did. That's experimentation. Everything we now do to pg women was done for a first time, and experimentally, and the list of things we do is growing almost daily. So, yes, they are experimented on.

Stacey

I would just like to point out that the above is true of medicine in general.....thankfully we live in a country that values freedom

.You can choose to have your baby anywhere you like--you have that right...

[SmilingBluEyes]

Exactly, ktwlpn. I believe in informed choices and consent as a nurse and mother. I do not wish to debate which is "better" cause that is best left to the women when describing their personal experiences.

[fergus51]

First of all, I wouldn't say they were "lucky." Healthy natural births could be the norm, and in fact, ARE the norm in home births.

Secondly, of course pregnant women are experimented on. What is Cytotec? Certainly not developed for induction. Someone thought, "hey let's try this" and they did. That's experimentation. Everything we now do to pg women was done for a first time, and experimentally, and the list of things we do is growing almost daily. So, yes, they are experimented on.

Stacey

You're misunderstanding me. When I say lucky, I just mean they are fortunate and grateful to have had such good experiences. It isn't a statement on my beliefs about pregnancy. The vast majority of births are healthy, and I consider all those women and children lucky to not be in the minority, cause we all know it's the exceptions that are heartbreaking. It's one reason why my preference for myself would be a CNM delivery in a birth center, but I certainly don't begrudge women the choice to birth at home. The worst thing a nurse can do in my opinion is project her wishes onto her patients and I have tried very hard never to do that in practice.

As far as experimentation, I am talking about doing something as opposed to doing nothing, and you can't set up an experiment to do nothing on a pregnant women and compare it to standard practices. A good example is fetal monitoring. There will never be an experiment done comparing EFM, intermittent auscultation and NO monitoring because we always have to err on the side of doing something whether there has been a study supporting it or not. Maybe you've seen such a study evaluating the safety of no monitoring? I've only seen big studies comparing different methods. I never meant to imply new drugs and technologies weren't tested.

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.

[mscsrjhm]

Ah, and here is where INFORMED CONSENT IS SUPPOSED TO COME INTO PLAY!!!! Right? How many are truly "INFORMED"??! Think about it. So many are "cowed" to do what the doctor feels is best. It is incumbent on the healthcare community to INFORM these families what their consent really means and what the alternatives may be. Remember one thing, for many it is INTIMIDATING being in a hospital with the nurses and doctors "in charge"----- and some people who are normally assertive are NOT when in such an enviroment. A loss of control over one's situation is not unusual in such a place. And not all folks are well-educated in normal childbirth and hospital interventions and how they may not may NOT benefit them. I think EARLY ON people need to be educated so they can truly make the "INFORMED" decisions that are best for them and their babies. JMO.

I had two at the hospital, and one at home. Wish I had talked to you first. No problems with any, but the more I think about what could have happened at home.....

[emhanojoli]

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.

Maybe I'm jaded, but this sounds really idealistic to me. I love to think that it's true that women have the say you say they have. Yes, patients can refuse any treatment. However, most believe that their doctor is making decisions that are best for them, and that's simply not true. Occasionally a decision will be made for the good of a laboring woman or the baby, but usually they don things because they are in CYA mode, or because they want to plan their personal life. There are several studies that have shown that continuous monitoing does not improve outcomes. However, it's still done all the time. That way if something goes bad, the doc can say, "look, we watched that baby the whole time. It never showed signs of distress." How many of us have seen c-sections for distress and baby came out with 9-9 apgars? Or for LGA, and baby is under 8 pounds (women can have big babies, btw. They just often need to be in a position different than lithotomy).

Incidentally, my current hospital requires IV's, and pit is dumped into that IV after every single delivery. Other places I have worked required the hourly vag exams for epidural pts. And I have yet to see a place that does not use continuous monitoring on at least 90% of their pts., but that's probably because that many are on Pit for either induction or augmentation.

Stacey

[MommyLauraRN]

Isn't it nice that we live in a country where we have choices :) I was very grateful that I had my son at the hospital. I had an uncomplicated pregnancy, went into labor on my own at 41 weeks, and was under the care of a CNM. I chose to get an epidural after about 9 hours of hard labor (plus going on 26 hours with no sleep wasn't helping!) I rested a few more hours until I was complete, did some passive descent until I was involuntarily bearing down. I wanted to push but still had an ant. lip. Another several minutes and that was gone. I started pushing (well I might add :) and my son was descending quickly for a primip! His heart rate had looked beautiful until about the third ctrx with pushing. All of a sudden he had a decel to the 70's then down to 50's. His heart rate was under 100 for 10 minutes. I was so grateful that I had doctors who come in and get him delivered with forceps (and that wonderful anesthesiologist who bolused my epi). As it was he needed help from peds, apgars were 6&7, cord pH 7.04. Turns out he had a short cord and it must have entangled in his legs or something. The delivery sucked on my end (fractured tailbone and 4th degree) but I am so grateful that I have a healthy beautiful boy :) Had he not been delivered so quickly who knows what a few more minutes without enough oxygen would have done to him.

And just the other day we had a PT--primip uncomplicated term pregnancy, spontaneous labor and SROM, admitted and placed on monitor. Was having deep variables....SVE by a resident....4cm and felt a loop of cord by baby's head...very calmly said "I feel a cord, we're going to deliver you baby by C-Section, now you need to get on your hands a knees and I'm going to keep my hand in your lady parts to keep your baby's head off the cord" They were able to get a spinal in her on her side, baby girl apgars 8&9! The dad had dropped to his knees and was praying as mom was wheeled to the OR. Mom and dad are both nurses too!

My choice will always be a hospital delivery! Plus I work with a great bunch of nurses and docs--they can take care of me any day! :)

I'm not against homebirths for other people, it's just not the right choice for me. I'm too afraid of of the bad stuff that can happen because I work in a high risk L&D and I see too many close calls!

[fergus51]

Stacey, you just haven't worked in enough places then:). I am a bit of a wanderer and have worked in hospitals in BC and Ontario (Canada) as well as Washington state and now am in California. I have seen the bad, but I have also worked with some excellent doctors and nurses. Intermittent auscultation for low risk women, VBACs, different laboring positions, doulas, etc. were all accepted practice. And I am sure the lactation consultant would have taken me out back and shot me if I ever offered sugar water to a breastfeeding baby:) We bent over backwards to meet patients' desires in their birth plans whenever it was possible. Are you in the midwest by any chance?

Women can and DO choose things for themselves in hospitals. They have that power and saying otherwise is... I don't know what word to use, but condescending or patronizing comes to mind. It might not always be easy, but that's not the same thing. Women do not need doctors or nurses or midwives to make decisions for them, and that goes for advocates of natural childbirth and those who see pregnancy as a disease. They don't need me to protect them from themselves. All I can do is say "here are the pros and cons, what do you want to do?" and if they choose an epidural or not, if they agree to forceps or not, if they want to labor in different positions or not, it's their choice. Believe it or not, I have had more than a few women INSIST on c-sections and episiotomies! I can quote all the studies I want, but some women want the medicalized experience and that's their business. By the time they come to me in labor, it's a little too late for me to change their views on pregnancy and birth.

There will always be a lot of CYA medicine (and a lot of that is BECAUSE of patients, btw. I've seen 2 women insistent on no interventions sue because of a bad outcome and "the doctor didn't do enough to convince me"), but there are doctors and nurses out there who care about their patients and do practice accordingly. I have worked with them, I like to think I am one of them:) I work NICU now, and see a lot of the same issues come up.

[klone, MSN, RN]

I haven't read any of the responses, but I can tell you about a situation where a HOSPITAL birth would probably have ended up with a worse outcome.

Long story short - my daughter was wrapped up in her umbilical cord and would not descend far enough for me to feel the urge to push. As a result, I spent 8 hours in transition, and 4-5 hours fully dilated. My midwives monitored us both closely - heart tones, etc. Had any of us, including myself, felt that either of us were at risk, we would not have hesitated to transport.

Anyway, during those 8 hours, my daughter spent her time unwinding, and she eventually descended. We were all very convinced that had I been in a hospital, I would have ended up with a C/S for FTP.

[fergus51]

Kerry, you would still have had to consent to that c-section. I have never seen a woman strapped down against her will. I have no doubt that if you have the strength to go through labor and childbirth, you have enough strength to follow your heart.