Home birth vs. hospital - page 8

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.... Read More

  1. by   BreckH
    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
  2. by   nurseyr1
    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.
  3. by   BreckH
    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.
  4. by   nurseyr1
    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.......
  5. by   SmilingBluEyes
    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.
  6. by   mitchsmom
    post deleted.........
    Last edit by mitchsmom on Jul 12, '07
  7. by   subee
    Quote from mitchsmom
    There are several possibilities that I could see theoretically going bad before/during a home-to-hospital transfer (prolapsed cord, post-partum hemorrhage, shoulder dystocia, amniotic fluid embolus, undetected vasa & placenta previas/accreta/perccreta and HELLP (would presumably be detected with blood tests but some homebirthers don't do any testing and physical exam can be otherwise normal), GBS/sepsis, uterine rupture, abruption/DIC), but one that I have personally witnessed in my short time as a nurse (less than a year) is an abruption in which the baby died and the mother would have died too if she had not been immediately taken to the O.R. and given blood/surgery. She narrowly averted death as it was.
    She was a model pregnant person without risk factors and was also asymptomatic until moments before she was taken to the O.R., so a transfer from home to hospital would have been too late if she'd been a homebirther. She had no interventions at all in the hospital before the abruption except external fetal monitoring for a short amount of time.

    That said, I think that that kind of scenario is rare (and even rarer with healthy women doing home births with no interventions -for this reason most homebirths are healthier than hospital ones in that sense, but it doesn't mean weird emergencies can't happen) and most home births go fine. I support birth in whatever way moms want to do it & have several friends who are home-birthers. But people in any birth setting need to understand that even in this day and age, and even with the healthiest habits, things can go bad.

    While women certainly shouldn't be scared into thinking that something bad is likely to happen to them when it isn't, we also shouldn't completely deny that if a (granted, rare-unusual) situation presents itself as in the scenario above, where seconds count, being at a hospital with life-saving medicines/blood products, surgical facilities, and equipment can make a difference.
    We had an attempted home birth in our little town where the baby died while mom was refusing to get into the ambulance. I've been a nurse for 30 years and women are falling back into the old maternal arrangements common in the 70's where they simply did what they were told, even when it meant taking the scopolamine. Those of you who are old enough to remember deliveries under scopolamine know that it wasn't very nice. Now, instead of scopolamine, we have epidurals, pitocin drips, c-section for convenience and the patients go for it! Go figure. On the other end, we have rabid home-birthers like the women that lost her baby refusing to go to the hospital. If you're so immature that you would put your emotional needs before your infant's physical needs, you might as well show up at the hospital and take your epidural before delivering at home. Works in the Netherlands? I'll bet they're not as obese, sedentary and ignorant as the majority of our mothers are. Its a small, crowded country where hospitals are never far away. Our hospital has taken pains to make the rooms as homey as possible - all the medical stuff is hidden with the exception of the monitors we use in the birthing and recovery rooms. The problem, of course, is the physicians and the insurance companies - two entities not known to keep things simple. Sometimes I wish they paid CNM's top dollar for an uncomplicated, low-tech delivery and then you got paid less as the procedures mounted up. It would be an interesting experiment.
  8. by   SmilingBluEyes
    Homebirth in the RIGHT CARE and HANDS is VERY safe for low risk women. It is when poor judgement comes into play that you up the ante risk-wise. I have seen some amazing midwives who obviously knew what they were doing-----and a few wacky nuts who had no clue and were dangerous. I have found many homebirthing women very well-educated and self-aware--and others who scared me with their ignorance.

    True story: A couple years back, we had a patient brought in w/her midwife cause she was unable to get her baby delivered. When our OB on-call came in, he used forceps and got her baby out. But then he got this white-pasty look to his face and looked at us nurses and said, "Get ready, cause there is another baby in there and it is breech!" The midwife just giggled like a schoolgirl and said "WOW how bout that for a neat little surprise?" That's right; she had no clue nor did this patient, that she was carrying a twin gestation!

    Now, I am sorry, but this did not do a lot to elevate her standing in our eyes. It created an emergent and potential high risk situation for us---not knowing what to expect.

    I suppose my point is this: Just like with anything, a few bad ones tend to spoil it for the whole bunch.Kind of like how we nurses are judged harshly by the homebirth community when they unfortunately meet with the one or two lousy nurses on a given unit.
    Last edit by SmilingBluEyes on Mar 5, '07
  9. by   2curlygirls
    She narrowly averted death as it was.
    She was a model pregnant person without risk factors and was also asymptomatic until moments before she was taken to the O.R., so a transfer from home to hospital would have been too late if she'd been a homebirther. She had no interventions at all in the hospital before the abruption except external fetal monitoring for a short amount of time.

    I went to a crash c/s for the same reason on Friday! Mom came in with vag bleeding. Was monitored, baby was profoundly bradycardic and the section was called. Fortunately, all were fine but you know the epi was drawn up and the ETT was ready.

    Today we got a HB'ed baby with subdural hematomas x3 and a cerebellar bleed. ???????? They'd refused Vit K but very weird nonetheless.
    Last edit by 2curlygirls on Mar 6, '07
  10. by   nj1grlcrus
    Crazy thread, one thing no one has mentioned is the impact of the insurance industry on birthing centers. After I gave birth to kids 2,3 &4 at a birthing center, the insurance companies would not write a policy for it. As a result, a local hospital built a birthing wing to accomadate the CNM's and doctors that wanted to continue to provide a "home-like" birth. But the pendulum has swung back towards women wanted less "natural" births. Back when I delivered, saying you wanted an epidural, that was like child abuse! LOL, how times have changed...Peace
  11. by   SmilingBluEyes
    Insurance companies and lawyers rule practices, ask any OB or midwife about that. Sad but true.
  12. by   BreckH
    You know it is funny, in the three different hospitals I've worked in and the 18 years I've been a nurse there is hardly anything said about infants that are transported into the NICU because of medical interventions during the labor. WE admit in NICU in San Diego at least one - two a day for observation many who are left in on antibiotics for 7-10 days. Term newborns that are brought in with severe bruising from vaccuum, or forceps, ones that are just so exhausted from hours of high levels of Pitocin and low heart rates or from laying on their cord inutero infants with respiration rates in the high 60's - 90's after an unnecessary section. Ones that have a fever because of mom's on epidurals for hours at a time and long pushing because moms don't have the sensation to push from epidurals or are pushing laying on their back for a long time.. but hey bring in a precipitious delivery from home or a stupid mom with no prenatal care who ends up delivering at home and the whole hospital is buzzing. If home births were so dangerous and babies were dying every day from a home birth don't you think that it would be splashed all over the news to justify that all babies should be born in the hospital. But no, there isn't tons of news of babies born at home with complications. Yes we hear about it once in a while and I'm sure everyone has a homebirth story. But how many are born at home natural and normal and don't get into the news. Look at statistics where hospital births (normal newborn) have a mortality rate of 6.3 midwives in the US have a rate of 2.1. I'm again not saying everyone should have a baby at home but damn it I don't think everyone should have a baby in the hospital, not with the epidural rate up to 98% and section rate now at 30%. WE have had two mom's die of hemmorhage in our hospital in the last 6 months. Deaths happen in births it's just that when it happens at home it is news.
  13. by   BreckH
    Quote from SmilingBluEyes
    Insurance companies and lawyers rule practices, ask any OB or midwife about that. Sad but true.
    66% of the hospitals revenue is birthing. Hospitals turn a blind eye to interventions and unnecessary cesareans because it brings in the bucks..