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 know. or a mutual admiration society...rofl.

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Specializes in private duty/home health, med/surg.

This has been an interesting discussion. Since my OP, I've slogged my way through nursing school and am in the 4th semester where we're talking about L&D complications. I am in the midwest, and unfortunately, our instructor says that in the hospital we do our L&D rotation at, nearly everyone has a high-intervention birth.

I've been thinking about something else that (for me, at least) plays a factor. When I was pregnant for my first child, I had a birth plan that stated I preferred no episiotomy. Well, when I went into labor, the OB that came in while I was crowning was trying to tell me that he had read my birth plan & understood I didn't want an episiotomy, but he would like to do one because...I'm not sure what all he said, but I was in a lot of pain and delirious and the point I zeroed in on was that it would speed up getting the baby out. At that point I told him to "Just shut up and cut!" (exact words, they're on tape).

While pregnant I had carefully researched the pros and cons of the various interventions and had decided that I wanted to give birth without interventions. In fact, I had my baby on the floor of this hospital that was designated for low intervention labors--if you decided during labor that you wanted an epidural, you had to be transported to the regular L&D floor. Once the pain became intense, I lost my focus and my LaMaze classes, breathing exercises, and desire for no intervention birth went out the window. I wasn't quite sane, but I did give informed consent to an episiotomy and I'm pretty sure I would have let the staff do just about any other intervention if I thought it would somehow lessen my pain and get the labor over with quicker.

The next baby I had was delivered by a CNM. When pushing, I remember begging her to just "cut me and get it her out!" She gently told me that I didn't need an episiotomy, that I was doing a great job, and that this baby would come out just fine--and she did. Oh, mah, goodness--the difference between recovering with & without an episiotomy was like night & day! I was so grateful that she didn't give in to my insane pain-induced demands.

I'm sure I'm not the only woman who has had the same type of reaction to labor pains. The difference in my experience was in the person who was attending my birth. I'm not saying all OB's are one way, and all CNM's are another. I also feel that there is a fine line between encouraging a laboring patient, reminding her of her birth plan, refocusing a tired mom--and just plain unreasonably refusing to provide requested treatment. It's got to be a tough call for the caring CNM, OB, nurse, or anyone else involved in caring for the mom. I think that's where doulas would be very useful, and I think more moms should make use of them.

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Well here goes...

As a UK trained and registered midwife since 1992 here's my opinion...

Yes childbirth is natural, it's been going on since Adam and Eve...what has changed is the morbidity and mortality rates for mothers and babies.

I've never delivered a baby at home...I have however labored many women at home and then taken them into the hospital in time for delivery...my intervention was no different at home or in the hospital. I have also been unfortunate enough to deliver a stillborn and to be on shift when there was a maternal death (yes they do still happen).

There are three things at play here...

1. Doctors decided that this was their field....I don't feel that it is particularly...they are hopefully trained to prevent and cure disease..this is not a disease.

2. What women expect...in western society women don't expect pain or worse still illness or death from "just having a baby"

3. The staff midwives, doctors and RNs....just because a piece of equipment is available does not mean it has to be used...I have worked alongside people that appear to have this attitude.

If we look after a woman in labor it is our task to look ahead, to try to predict abnormalities and to take appropriate action.

Bev

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Specializes in ER.

I think that home birth is a reasonable option for many women. Unfortunatly in the area that I live in we have a number of doctors that do not support "natural" labor. We even have one practice that makes you sign a contract that you will not attend Bradley classes! I drove almost an hour to another state to have a midwife attend the delivery of my babies in a hospital with all the bells and whistles. My husband "caught" his last two children and it was a wonderful experience. In my case I was able to get 5 star accomidations with everything that I wanted however, I would have gladly "camped" (at home) if my only option was one of our local drs. It is a shame that there are not more birth centers.

T

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That's outrageous. I'm not even sure that is legal. Those docs must be so afraid. I'd hate to be an L&D nurse working in their facility. I'd make sure I make loud and clear statements to anyone who eill listen about those docs. How about a couple of editorials in the local papers? Whre are you located and where is OB group?

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Specializes in NICU.

I work in a busy hospital, 350 plus deliveries a month. I know that most of our deliveries are normal, but when things go bad, it's really bad. We do lose babies, despite our care. Beta strep is still a killer. We've lost one, maybe two to feto-maternal transfusion. Results are still out on one of those. We also have pulled another one back from the brink, and quickly transfused the baby. "Pretty in pink" has a different meaning to me!

None of these were expected, could have happened with any delivery, so home births to me means taking a chance. I suppose that the odds are in favor of having no problems, but things do happen. Of course, most moms are fine, but as others have said, moms do still die. We recently had a 15 year old go into DIC, she did survive, but was very ill. I don't think that her family and friends had any clue that she could die, that childbirth could be fatal.

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Specializes in ER.
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That's outrageous. I'm not even sure that is legal. Those docs must be so afraid. I'd hate to be an L&D nurse working in their facility. I'd make sure I make loud and clear statements to anyone who eill listen about those docs. How about a couple of editorials in the local papers? Whre are you located and where is OB group?

I am in Kansas City Missouri. I am currently in nursing school with plans to work in L & D (I am currently a breastfeeding counselor). The hospital that this group delivers at is less than 5 minutes from my home. The location makes it ideal for me after I graduate but I think I would lose my mind working in those conditions. Another hospital that actually has a pretty good rep for low tech deliveries is about 10 minutes away but they have been actively fighting to keep midwives out of their hospital.:angryfire

T

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Hi, I am an RN (now working in NICU, have worked L&D in the past), a DEM (direct entry midwife) in Canada and caught over 250 homebirth babies with a provider in attendance, doula (had a practice in SF), childbirth educator (created my own childbirth awareness course iCare) and author of "Hey! Who's Having This Baby Anyway?" so I have a lot of research and experience under by belt. I have been reading your posts about home and hospital births and I'm shocked at how easily swayed some nurses allow themselves to become while working exclusively in hospitals listening to providers bad mouthing home and clinic births. As an RN now working in NICU I have admitted perfectly normal full term babies into the unit because of interventions that providers have introduced into their labor to get them delivered quickly. The misuse of Pitocin, some even starting the Pit on a 2cm -3 station patients as high as 20, is staggering, especially after the epidural has slowed down or stopped labor. I see almost every night I've worked providers who have stated a labor isn't progressing well at 10pm and section her so they can go home. Two of them this last month were already 9 cm but the provider was in house for another birth and wanted to finish this one up. (you can't say you don't see this all the time) I have had three in the last week who have AROM'd -3 station moms and we have had to do emergency sections for a prolapsed cords. Epidurals are 98% at the hospital I work for and this continuously results in malpresentation, failure to progress, maternal low blood pressure, fever and cesarean to the delight of the provider so he won't have to be coming back in the middle of the night. Our section rate is as high as 85% on Thursday, Friday and holidays so they won't have to come in during the weekend. and the average time a baby is born is between 8-5pm Monday through Friday. When I was doing homebirths women were givng birth in the middle of the night like nature intended.

No, I DO NOT believe all women should have their babies at home. There are too many out there that don't know how to take care of themselves, drugs are on the rise, no prenatal care on young mothers is on the rise, and smokers, women living too far from any health care facility, and women who are not looking into researching their options should not have their baby's at home. But with good prenatal care, a healthy pregnancy, a good back up birth team and close to medical facilities yes yes yes a woman can have a safe and healthy baby at home surrounded by people she knows and loves and in control all the time. Birthing is a natural and normal process we have made it into a dangerous and "thank God your baby lived" situation.

And Providers in the hospital should be more responsible on their technique and should take into consideration they got into this business to do no harm. Epidurals and pitocin should be the last resort not the only option women have. Women shouldn't walk into the hospital and blindly accept heplocks allowing access to interventions. And nurses should be willing to take that laboring woman under their wing and take the time to guide her through her labor and get her up and breath with he and let her sit in the shower before she offers her the epidural or pain medication that will leave her helpless in bed.

The US has the second worse death rate in the industrialized country and we spend more money then any country on birth. 66% of revenue to hospitals is generated from birth. One reason why hospitals don't put any kind of control on their providers sections give them lots of insurance money.

Please take a minute and go to pregnantinamerica.com and view an upcoming documentary that is in the works. And go to heyanyway.com and check out my book to help women take control of their baby's birth.

Thank you, Breck Hawk

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It really makes me discouraged to hear the negative light that L&D and post partum nurses are painted in. As a new post partum RN, I have provided the highest level of care to my patients, I have saved lives of mothers who have hemorrhaged in the first 24 hours and not even known that they were bleeding to exess, I have saved lives of babies in Resp. distress, seizing, etc. I do not look down on mothers who have a birth plan, I share in their dissapointment with having crash sections, mid forceps etc. Earlier in the forum, a pro listed of home birthing was not having a nurse wake you up for 6 am vitals. Excuse me? I have yet to meet a mom who is not thankful and interested in both her own and her babies health. I have transferred many a baby at those 6 am vitals with bradycardia, tachypnea, seizure, grunting, silent choking etc.Please watch what you say, I support home birthing and would never begrude someone that experience. So in turn, please support the nurses who work so hard to ensure that you and your babiest transition is free from tradgedy. We are not all monsters who want to drug you, numb you and take away your birthing experience. If you have had a bad experience as a individual, have the clarity of mind to see that this is not the general experience of the whole.

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I don't doubt that you are a good nurse. And as a postpartum RN you are very much needed after a vigorous and aggressive birth in L&D it is the postpartum nurses who do come to the rescue and take care of the over tired and over manipulated women and babies and thank you for being there for them.

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I take that as a backhanded compliment and slam to L&D, sorry. I also take care of women who have been transferred from home births that have gone horribly wrong and who are thankful to god that the worst they have to deal with is overtiredness and manipulation.......

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

If you have had a really bad, or traumatic birth experience, please do check out ivillage.com or other mothering sites. There are some really great support groups for those needing help overcoming traumatic or very disappointing birth experiences. It's helpful to take positive and proactive action when you feel you have been treated badly in the hospital.

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