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!

[Mermaid4]

To the student who asked about everyone in this thread agreeing on the same thing, do a few years in the field and then get back to us.......

[BETSRN]

I am a childbirth educator as well as a staff RN in my L&D in my facility. I teach about all the interventions (thank God we don't use them all just because we have them)and encourage people to advocate for themselves, but so much of the time, they go along with the doc regardless. Our docs are pretty low intervention anyway, but sometimes it is so defeating to teach and teach and feel as though you got nowhere.

[BETSRN]

You know I can see both sides of this discussion. The statement about women being "helpless vitims of the medical profession." Of course, woman can (and often do) advocate for themselves, but the bottom line is that women still follow )oretty blindly sometimes) what their doctor or CNM suggests. It may not be the best route for the patient (assuming positive outcome either way), but it often gets it over with faster (and then the doc gets to go home or resume office hours). Even in the best of circumstances, I have seen docs pull the wool over the patient's eyes. It's sad, but it happens in the best of facilities (and I work in one of those "small community hospitals" where we pride ourselves in using and encouraging birth plans,etc). There is only so much we can do about this. So yes, I agree that women don't have to be "victims" of the medical profession, but I still think a large majority are once they walk in the door to have the baby.

[BETSRN]

I would wager that looking at just the low risk population, that there are more potentially unnecessary interventions done to babies in hospitals that have NICU's than in community hospitlas that do not. I know that we do not separate babies from mothers, do septic workups on babies whose moms have had a temp (probably from an epidural). It is my firm belief that babies born in these types of facilities are far more lily to have excessive blood work, IV's, meds, etc done than in a facility that does not have a NICU. NICU's of course are very necessary and we use those close to us when necessary, but I do think in the long run, low risk, community settings give mothers and their babies the best shot at a low intervention experience. Low risk facilitiews are far less likely to do unnecessary vag exams, use scalp electrodes, IUPC's, and other interventions on a more routine basis (usually because someone has to learn).

[SmilingBluEyes]

that is the beauty of community hospital nursing.......I am with you Betsy. The fewer interventions, the better. I do them as the maternal/fetal conditions call for them not because I want to be convenienced or "learn" on people. That is why I like our community hospital, few are having to "practice" on their patients to develop or hone skills. They usually have years of experience and feel no need to intervene just for the sake of practice, learning or convenience. This is not true of the many teaching hospitals at which I have been a patient.

[epiphany]

To the student who asked about everyone in this thread agreeing on the same thing, do a few years in the field and then get back to us.......

But I guess you are one of those nurses who eat their young, as people say? I will do a few years in the field, as you suggest, after which, I resolve never have an arrogant and disrespectful attitude towards people who are just starting out in order to make them bow and stay silent when pearls of wisdom fall from my mouth.

Any btw, I never said I was confused as to why people don't agree on the same thing. And if you think your shut-up-newbie attitude is intimidating to me, I'm sorry to dissapoint you - that's one of the favorite subjects of conversation among students and new nurses.

[traumaRUs, MSN, APRN]

Epiphany - I honestly didn't take Mermaid's post to be eating our young - I think she meant it as when you have more experience in nursing, then you might change your mind. All of use have different opinions about this subject and I think people are for the most part - being subjective. Giving birth is a very personal experience and we all have different views on how we want it done or how we had it done...I think we are only expressing our own views on this subject. Mermaid - if I misinterpreted your post - please let me know.

[CA CoCoRN, RN]

I am a pugdy Black woman, age 28 at the birth of my second and (last child) who thought about home birth with the last child, with absolutely NO medical issues, whatsoever.

I thought better of it, and decided inside to talk to my OB (who I hand picked) about going the route of least intervention.

I am glad that I delivered in the hospital.

I SROM'd at home, losing a great deal of fluid. I got to the hospital, and all was well. Since I failed to start labor within a few hours of SROM, Pit was going to be started. It hadn't even started yet, when baby decel'd to 50s-60s for 4 minutes plus. He didn't show any signs of recovery, so I was "stripped" of metal and prepped for surgery (just in case). During this process, amnioinfusion was started, I was lateral trendelenburged, O2, IV bolused, etc. He recovered with the amnioinfusion and a few hours later Pit was started. I delivered 4 hours later. (My first medically necessary induction --severe oligo-- lasted only 6 hours...my body uses Pit well).

I fear that had I been at home, without continuous monitoring that lil Sol (my sun/son) would not have survived the decel which apparently occurred due to cord compression from losss of fluid.

[fergus51]

Hmm.

First, with all due respect, your views on woman's rights are obvious, yet it comes off a little lacking in empathy. Even if a woman can or want to make the right decision, doesn't she have to believe that the care giver is indeed giving her the right information - and hence, doesn't it involve entrusting your fate to someone? My need to have a nurturing person whom I can rely on during my pregnancy and labor doesn't make me less strong.

Second, as an extern in L&D and a senior student trying to benefit from all the experience on this forum, I am sincerely curious to know how you "give the facts" to the woman in the way as you seem to suggest, of empowering her to make a decision, when in this thread alone, with all voices of experience and knowledge speaking, not everyone can agree on the same thing.

I can live with how I come off on a bb, though these certainly aren't things I would say in a L&D room, cause it isn't about me in there and I recognize that.

I want to be really clear on this because I had no intention of insulting you or anyone else, but I don't think you are less strong because you want a nurturing person to rely on during your pregnancy and labor (I would actually want the same thing and have already told people if I get pregnant I want a doula as a present:)). Quite the opposite in fact, I think it shows strength to determine for yourself what YOU need and to make sure YOU have it. I'm sure you wouldn't go to an OB who wants you to have internal monitors, labor in one position, IV, epidural, give birth in lithotomy, etc. because it doesn't sound like that's consistent with your view of childbirth, and I wouldn't either! That's strength, that's responsibility.

One thing women have going for them is their intuition and if you don't feel right about that doctor/midwife, I'm sure you would have the strength to go elsewhere. Certainly there is an element of trusting in caregivers, but that is the same as any other area of the hospital. And certainly there will be individual situations where trust in the caregiver can take precedence over mom's desires, especially in areas where they are limited to the number of providers available. I have worked in towns with ONE doctor who does deliveries and no midwives and it isn't ideal. On the flip side, I have had patients uncomfortable with the recommendations an OB has made and have fetched another doctor to give them a second opinion because I want them to feel they can trust their provider and more importantly, I want them to feel they can QUESTION their provider because THEY are the ones in charge of their experience. Not the doctor, not me, not the doula, not the support person. THEY are. And the only way that becomes a given is if women take it. It's women themselves that will have to change the medicalized culture of childbirth if that's what they want. Liberation, power and equality aren't bestowed on us by someone else. It sucks that we should even have to fight for these things, but that's just the way it is and the sooner we deal with that the better.

As for how I provide information, I try to discuss the pros and the cons as supported by research... OK, say we're talking about epidurals. I say something along the lines of "Well, the benefits of epidurals are that they are generally very effective at providing pain relief and are safe to insert (though some conditions affect that, like scoliosis). Some downsides are your mobility would be restricted, you would need an IV and a catheter, etc. It can slow down labor, and the doctor will usually try to counteract that by giving you pitocin, but that isn't a guarantee. When it comes time to push, if you are still numb it can be difficult to push effectively (we can deal with that by waiting until feeling returns to push). Sometimes epidurals provide a "patchy" block which means you can still feel certain areas and we are unable to numb them. Now, if you wanted a more natural birth there are other pain control methods which you may prefer (and I usually discuss what type of birth they want when they first come in). If those don't work for you, you can always get the epidural later. I don't want you to feel pressured to make a decision this instant, because there is no time limit. Blah blah blah". And after explaining this and giving them our hospital handout, I ALWAYS leave the room so that the woman and her support person can discuss it in private. When I come back, I give them time to ask questions and answer them honestly. If I don't know the answer, I get them someone who does. Course, some women come in knowing EXACTLY what they want and I'm not going to harp on the spiral of interventions if a woman is yelling for the epidural NOW.... Same thing for episiotomies: "Research has shown that women with episiotomies actually take longer to heal and experience more pain than women who have tears (then I go into my spiel about how to avoid tears). And I go into my examples: think of it like cutting a piece of paper with scissors. It's much easier to rip the paper along that cut than to rip an intact piece of paper... Blah blah blah".... There are some facts proven by research and some areas that are more about opinion. I'm honest about which are which (Reseach has shown... vs. Some providers feel.... others feel...).

[fergus51]

I would wager that looking at just the low risk population, that there are more potentially unnecessary interventions done to babies in hospitals that have NICU's than in community hospitlas that do not. I know that we do not separate babies from mothers, do septic workups on babies whose moms have had a temp (probably from an epidural). It is my firm belief that babies born in these types of facilities are far more lily to have excessive blood work, IV's, meds, etc done than in a facility that does not have a NICU. NICU's of course are very necessary and we use those close to us when necessary, but I do think in the long run, low risk, community settings give mothers and their babies the best shot at a low intervention experience. Low risk facilitiews are far less likely to do unnecessary vag exams, use scalp electrodes, IUPC's, and other interventions on a more routine basis (usually because someone has to learn).

LOL! I've actually found the opposite:) In the hospitals with level 3 NICUs I've found the docs are much more comfortable with a wait and see attitude with babies than in smaller hospitals. I've never seen a septic work-up done because mom had a fever or meds given without symptoms. We are busy enough without needing to make work for ourselves:) I did see less interventions on the L&D side like you mentioned, but more on the babies because the docs were so worried.

[SmilingBluEyes]

I can live with how I come off on a bb, though these certainly aren't things I would say in a L&D room, cause it isn't about me in there and I recognize that.

I want to be really clear on this because I had no intention of insulting you or anyone else, but I don't think you are less strong because you want a nurturing person to rely on during your pregnancy and labor (I would actually want the same thing and have already told people if I get pregnant I want a doula as a present:)). Quite the opposite in fact, I think it shows strength to determine for yourself what YOU need and to make sure YOU have it. I'm sure you wouldn't go to an OB who wants you to have internal monitors, labor in one position, IV, epidural, give birth in lithotomy, etc. because it doesn't sound like that's consistent with your view of childbirth, and I wouldn't either! That's strength, that's responsibility.

One thing women have going for them is their intuition and if you don't feel right about that doctor/midwife, I'm sure you would have the strength to go elsewhere. Certainly there is an element of trusting in caregivers, but that is the same as any other area of the hospital. And certainly there will be individual situations where trust in the caregiver can take precedence over mom's desires, especially in areas where they are limited to the number of providers available. I have worked in towns with ONE doctor who does deliveries and no midwives and it isn't ideal. On the flip side, I have had patients uncomfortable with the recommendations an OB has made and have fetched another doctor to give them a second opinion because I want them to feel they can trust their provider and more importantly, I want them to feel they can QUESTION their provider because THEY are the ones in charge of their experience. Not the doctor, not me, not the doula, not the support person. THEY are. And the only way that becomes a given is if women take it. It's women themselves that will have to change the medicalized culture of childbirth if that's what they want. Liberation, power and equality aren't bestowed on us by someone else. It sucks that we should even have to fight for these things, but that's just the way it is and the sooner we deal with that the better.

As for how I provide information, I try to discuss the pros and the cons as supported by research... OK, say we're talking about epidurals. I say something along the lines of "Well, the benefits of epidurals are that they are generally very effective at providing pain relief and are safe to insert (though some conditions affect that, like scoliosis). Some downsides are your mobility would be restricted, you would need an IV and a catheter, etc. It can slow down labor, and the doctor will usually try to counteract that by giving you pitocin, but that isn't a guarantee. When it comes time to push, if you are still numb it can be difficult to push effectively (we can deal with that by waiting until feeling returns to push). Sometimes epidurals provide a "patchy" block which means you can still feel certain areas and we are unable to numb them. Now, if you wanted a more natural birth there are other pain control methods which you may prefer (and I usually discuss what type of birth they want when they first come in). If those don't work for you, you can always get the epidural later. I don't want you to feel pressured to make a decision this instant, because there is no time limit. Blah blah blah". And after explaining this and giving them our hospital handout, I ALWAYS leave the room so that the woman and her support person can discuss it in private. When I come back, I give them time to ask questions and answer them honestly. If I don't know the answer, I get them someone who does. Course, some women come in knowing EXACTLY what they want and I'm not going to harp on the spiral of interventions if a woman is yelling for the epidural NOW.... Same thing for episiotomies: "Research has shown that women with episiotomies actually take longer to heal and experience more pain than women who have tears (then I go into my spiel about how to avoid tears). And I go into my examples: think of it like cutting a piece of paper with scissors. It's much easier to rip the paper along that cut than to rip an intact piece of paper... Blah blah blah".... There are some facts proven by research and some areas that are more about opinion. I'm honest about which are which (Reseach has shown... vs. Some providers feel.... others feel...).

Stellar post, Fergus. And thank you for being so respectful. This is really what it's all about. There is room for us all at the table, everyone! Let's respect each other; no one is "young-eating" anyone here! Keeping an open mind and your defenses OUT of it certainly helps! I agree with every word in this post, Fergus! :balloons:

[fergus51]

Thanks Deb. People are going to start wondering if the two of us aren't really one person pretty soon....