Home birth vs. hospital

klone, MSN, RN · Aug 30, 2004

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.

You may indeed be right. However, I have heard of many stories of mothers being scared/pressured into C/S. Laboring mothers are in a very vulnerable state, and if there is a suggestion that your child MAY be at risk (and in general, I find OBs in hospital settings to be a bit more conservative and alarmist than midwives in a home setting), I imagine most mothers would consent.

emhanojoli · Aug 30, 2004

Yes, I am in the midwest, and I realize that's 90% of the problem. Worse yet, I'm in Illinois, home of the AMA.

I totally agree with you that women have choices. But it makes me sad to hear how many women don't realize they have those choices. When I had a new admit her bill or rights, I ALWAYS point out that she has the right to refuse anything. I further say that if we recommend anything that she is not comfortable with, tell us. Women in labor are vulnerable. They are in pain, often scared if they are told their baby is at risk, and are willing to do whatever is suggested to them.

Although I am a big advocate of natural birth, I realize that many women don't desire this. My goal as a nurse is to give women the birth they want. They are the one's who have to live their lives with their birth memory. I want them to be very happy with the way it went. I also realize that it's more of a fight to get the natural, intervention free birth, if that is what is desired.

Stacey

fergus51 · Aug 30, 2004

Maybe they would Kerry, and in some cases they'll be right and in others they'll be wrong. The important thing is they would decide one way or the other. I may be a bit of a radical feminist, but I don't believe women are helpless victims of the medical profession. Women are amazingly strong and have incredible power. Just seeing women in labor has convinced me of that.

OT-Anyone remember the name of that French doctor who thinks women are perfectly capable of giving birth on their own?

fergus51 · Aug 30, 2004

Now, how did I know that Stacey I can say, I am not interested in moving to the midwest with the stories I hear about L&D there. I am fortunate to be able to honestly say the vast majority of docs I have worked with have been genuinely interested in providing their patients with choices and giving them all the facts before making recommendations. And recommendations are all that they are.

fergus51 · Aug 30, 2004

Here it is: Michele Odent. I would be interested in knowing what you all think of him. I find some of his views a bit odd, but one thing I agree with is this quote. I do believe women are instinctively able to give birth in most cases:

http://www.parentsplace.com/pregnancy/labor/articles/0,,166277_114897,00.html

To say that the basic need in giving birth is to feel secure and well protected is quite clear. But for the birthing woman, it isn't always so black and white. What makes one woman feel secure may be very different from what another needs to feel protected. Some women feel secure in an operating room with equipment surrounding them while others are only secure in the comfort of their own bedroom.

A birthing woman does not need guidance or help or support. Most of all, she needs to feel secure and protected. This is universal.

epiphany · Aug 30, 2004

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.

Fergus51, I don't agree that it's as simple as you say, that women have the autonomy to choose. In saying that, I think we are not seeing the forest for the trees.

I think American women generally make choices based on fear of natural births and belief in the miracle of medicine that have been instilled in them by our institution. In contrast, women in Holland, for example, choose less intervention because their society doesn't scare the living daylights out of them, but instead over and over again, prove to them that births should be as natural as possible.

fergus51 · Aug 30, 2004

Epiphany, I certainly agree that society influences birthing practices. My problem is that at some point women need to take responsibility for themselves. We can't blame society for every non-ideal birth or eating disorder or whatever. Is it easy? Maybe not, but who said it has to be? I am a grown woman and I resent the implication that I need someone to protect me from the medical establishment like I am a child incapable of making my own decisions because I am too scared to be able to do it myself. Women do choose home births, despite being raised in this society. Other women choose birthing centers and others choose hospitals. The fact that more and more women are taking control of their births is proof it can be done, so I have a hard time with people saying it can't because of our society.

I still remember this topic in my feminism/health class in college. I know some people think pregnant women need protection and are vulnerable. I do agree there is a vulnerability there, I just don't agree that we need some paternalistic patient advocate to save them from themselves. I think they need to be given the facts and then supported in their decision, period. Every patient in the hospital is vulnerable, but they all get to make their own decisions and we encourage them to be proactive in their care, so I don't see why pregnancy is the exception. I don't understand why women are content in giving a doctor or midwife control and then complaining about it afterwards, taking on a victim role. People need to educate themselves and stop blaming society for their decisions.

rndani · Aug 30, 2004

Would any of you care to share incidences where a home birth would have resulted in serious harm? Thanks for your time!

Since this was your original post, I'd like to share with you two stories about home births that resulted in transport to the hospital. First--20yo G1P0, pushing at home for 4 hours with midwife. Brought in per patient request. Fhr supposedly in the 110"-120's. After placing a fetal spiral elecrtode, there was no fhr--they were picking up maternal pulse. She was only 7cm and had a very puffy cervix. She wanted an epidural (which she got) and 5 hours later delivered a beautiful 9#10 boy--dead. The next was a grand multip who came in by her midwife with srom and footling breech--we're talking foot out of the lady parts footling breech. The patient would not answer any of my questions, the midwife did all the talking and informed me the patient did not want a c-section. Needless to say after the on call OB came in and explained all the interventions and why we do them and the risks involved (INFORMED CONSENT) she still had nothing to say and looked at her midwife who then said " I think it may be best for you to have the c-section". I was taken aback. The patient couldn't make a decision for herself.

Now on the flip side of those stories--I know of several of my co-workers (L&D RNs) that have had fantastic home deliveries. And there are many successful homebirths that occur that we at the hospital never hear about.

SmilingBluEyes · Aug 30, 2004

Epiphany, I certainly agree that society influences birthing practices. My problem is that at some point women need to take responsibility for themselves. We can't blame society for every non-ideal birth or eating disorder or whatever. Is it easy? Maybe not, but who said it has to be? I am a grown woman and I resent the implication that I need someone to protect me from the medical establishment like I am a child incapable of making my own decisions because I am too scared to be able to do it myself. Women do choose home births, despite being raised in this society. Other women choose birthing centers and others choose hospitals. The fact that more and more women are taking control of their births is proof it can be done, so I have a hard time with people saying it can't because of our society.
I still remember this topic in my feminism/health class in college. I know some people think pregnant women need protection and are vulnerable. I do agree there is a vulnerability there, I just don't agree that we need some paternalistic patient advocate to save them from themselves. I think they need to be given the facts and then supported in their decision, period. Every patient in the hospital is vulnerable, but they all get to make their own decisions and we encourage them to be proactive in their care, so I don't see why pregnancy is the exception. I don't understand why women are content in giving a doctor or midwife control and then complaining about it afterwards, taking on a victim role. People need to educate themselves and stop blaming society for their decisions.

EXCELLENT POST!!!!! A-men. :)

SmilingBluEyes · Aug 30, 2004

I daresay all experienced OB nurses have seen transports that were very scary. Are they the norm? OF COURSE NOT! but it bears repeating and understanding; having a really good midwife who KNOWS his/her limits and knows WHEN To transport is a good thing!!! The majority of births are healthy and without incident. It's that tiny percentage where a cascade of horrible events occurs that can kill ya. Everyone needs to be aware of her risks, and trust in her care provider to look out for her best interests at all times, whether she plans to be at the hospital, a birth center or at home. And yes, women need to assume some responsiblity for themselves, as well as their care providers should. That is given.

epiphany · Aug 31, 2004

Epiphany, I certainly agree that society influences birthing practices. My problem is that at some point women need to take responsibility for themselves. We can't blame society for every non-ideal birth or eating disorder or whatever. Is it easy? Maybe not, but who said it has to be? I am a grown woman and I resent the implication that I need someone to protect me from the medical establishment like I am a child incapable of making my own decisions because I am too scared to be able to do it myself. Women do choose home births, despite being raised in this society. Other women choose birthing centers and others choose hospitals. The fact that more and more women are taking control of their births is proof it can be done, so I have a hard time with people saying it can't because of our society.
I still remember this topic in my feminism/health class in college. I know some people think pregnant women need protection and are vulnerable. I do agree there is a vulnerability there, I just don't agree that we need some paternalistic patient advocate to save them from themselves. I think they need to be given the facts and then supported in their decision, period. Every patient in the hospital is vulnerable, but they all get to make their own decisions and we encourage them to be proactive in their care, so I don't see why pregnancy is the exception. I don't understand why women are content in giving a doctor or midwife control and then complaining about it afterwards, taking on a victim role. People need to educate themselves and stop blaming society for their decisions.

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.

Mermaid4 · Aug 31, 2004

In the home births I have been involved with, both were not planned, that is, those children were determined to be born quickly. I have nothing against home birth and in fact, it is a lovely idea, but as Smiling and Day Ray have pointed out, most people are not adequately informed about what could happen.

Personally, I feel that we aren't giving patients enough credit..I have no problem with patients wanting epidurals or not wanting them. I support their choices and inform me it has taken many years for me to know the things I do in the realm of childbirth, labor and the like, so I don't expect them to be cognizant of everything right away. I feel personally that if the resouces are available, then there is no harm in using them...We recently had a midwife sued due to a problem outcome with a home birth where hypoxia occurred in utero..How could she have picked that up without some fetal monitoring at least once in awhile? Sometimes if you chance things, you have to take your chances...I am not of the opinion that patients should be able to have it both ways....