I hope you don't mind a post from a non-nurse here, but I would appreciate your advice and opinions on birth outside the hospital setting.
I am considering a midwife for my next pregnancy because I feel that my prenatal & labor care would be much better. My OB (and I think this is probably pretty standard) triple-booked for 15 minute appointment slots during my pregnancy, so my average visit was about 5 minutes. And of course, during labor, she was there for just over an hour of my 32-hour labor. Most midwives in my area allow 45 minutes per appointment and tend to stay with women during their entire labor.
With that said, the midwifery program at our hospital has been discontinued and if I were to choose a midwife I'd have to deliver in a non-hospital birthing center or at home. Is it worth the risk? I'm two minutes from the hospital at my house.
Most homebirth information I've found glosses over the possible dangers. I'd like to know, from your experience, if you would recommend homebirth for a low-risk pregnancy.
My second delivery, I monitored myself because of decreased fetal movement. Absolutely flat strip ( no decels initially) MD tried induction but repetitive late decels with emergency c-section for bradycardia. The cord was around his neck 4 times and around his shoulder so tight that it tore upon delivery. Know that my beautiful 2nd son would have died without the use of EFM as just listening with a doppler would have missed the lack of variability and subtle late decels.
My point is that not all interventions and MDs are evil. I personally take advantage of modern medical advances with the knowledge of when they are useful.
I went on to have 4hr and 1hr VBACs without any interventions, but being in a hospital just in case.
It all is a risk/benefit ratio that you need to examine for yourself and examine how you would feel if you had a complication that ends in poor outcome due to being at home.
I am an L&D RN and I would not deliver at home. I am all in favor of low intervention birth but I also know that at the right facility, you can have that and still have the necessary back-up right there should something happen. I have seen things go from good to completely bad in a matter of minutes. I would look around at other hospitals/ birth centers in your area and see what they offer. Even if you have to drive a bit, it might be well worth the inconvenienceof the drive. For instance many hospitals have CNM's on staff and you can do everything with minimal intervention. Some of our patinets don't even get an IV or anything. I know we do that for our patients. Go to the ACNM (American College of Nurse Midwives) website as they have a good directory there of midwives. Good luck.
It all is a risk/benefit ratio that you need to examine for yourself and examine how you would feel if you had a complication that ends in poor outcome due to being at home.
What about poor outcomes in the hosp? They can happen anywhere. The difference is, women who choose to homebirth accept responsibility for their births, regardless of "perceived" risk.
Birthing at home means you plan for the best, and believe the worst won't happen, even if there is a small possibility. It is the "just in case" mentality that leads to problems, according to some. As if, walking around believing there might be a problem, results in the problem, kwim?
As for EFM, I believe it is a necessary evil for high risk patients, but has shown to result in more intervention for low risk pts. I am of the belief, that women who truly trust their bodies in birth, "know" when soemthing is not quite right and will seek help. For example, I labored at home and arrived at the birth center complete and ready to push. Never once had EFM, never had the need. I never felt that anything was amiss with the labor, that there was anything abnormal to worry about, kwim?
L&D, I am curious why (if you believed so much in knowing what's wrong) you did not stay home to give birth? Lots of woman labor at home and arrive near the birth time.Judging from some of the home birth transfers I have seen (and we are very homebirth friendly)I would not go so far as to say all these wome laboring at home know what is in their (and the unborn's ) best interests. Sort of the way some act after the birth of the infant.
I am not a a labor and delivery nurse, I am a mere mom(and ER nurse). Most of the babies born in the world are born without a doctor being present. Most deliveries go off without a hitch. Most babies and moms survive without complication. I guess it depends on how much faith you have in yourself and a midwife to deliver at home. I'm too afraid of what MIGHT happen, I'm also too afraid of pain!! I have a friend that didn't deliver at home but wrote her own birth plan that was pretty much "do what I wanna do". She allowed them to put the monitor on to make sure the baby was ok about once every couple of hours which was about as often as they were checking her cervix. She didn't want an IV but relented and had a hep lock put in. Had the baby without any pain meds, without and epidural etc and went home 8 hours later. Maybe you could do something like that?
L&D, I am curious why (if you believed so much in knowing what's wrong) you did not stay home to give birth?
I transferred care to the birth center in the last week of my pregnancy because my hgb was low and I had a history of bleeding after the birth of my first son, plus I'm a redhead (although I don't think it has ever been scientifically proven that redheads bleed more )So at that point, we weren't planning on staying home for the birth. I was more concerned with post delivery, than the actual delivery, KWIM?
In retrospect, everything was fine. And although I did bleed a little longer immediately following delivery, we just monitored it and let baby nurse. Didn't even require any Pitocin, although the CNM had it ready. I regret that I didn't trust in my body's ability more, and stay home.
)So at that point, we weren't planning on staying home for the birth. I was more concerned with post delivery, than the actual delivery, KWIM?
SmilingBluEyes
20,964 Posts
I am with fergus. Somehow, there needs to be a "happy medium".....extremes are dangerous on both ends....
good post, Fergus.