Home birth vs. hospital

gwenith, BSN, RN · May 12, 2003

Any time someone goes on about how "natural" childbirth is and how women all over the owld have babies without interferance I ask them if they have seen the recent statistics on infant mortality in the third world.

Yes! child birth is natural. It has been occuring for thousands of years without our gigantiv medical structure BUT women and babies have been dying for all of those years and our gigantic medical structure is there to try and stop that from happening.

You will probably get a different reply from the UK as home birth has a greater history there but as an Australian well, we tend to head for the nearest hospital.

Dayray, RN · May 12, 2003

This is a subject I have wondered about myself. As I spend more time orienting to L&D I find myself questioning our intervention ridden model of care.

On one hand I defiantly see infants that would have died, had there not been trained staff immediately available. At the same time I think a well-trained CNM with portable 02 , the ability to provide positive pressure ventilation, and warm blankets could stabilize the infant while the ambulance was in route. I also have to question how often interventions contribute to babies needing resesataion. I live in the US and here we have the highest rate of infant mortality of any developed country.

I'm not knocking our model of care just questioning it. I have never seen a homebirth and have only recently began to do some research into it. There are some crazy people out there that compare a hospital delivery to rape. I take offence to that but I think I understand some of the points they make.

The other day I had a multip that was 3 cm she was AROMed 2 hours before. I had just given her some stadol, she was sleeping between contx and had settled into a nice little pattern, baby looked really good. I was working on getting her to relax she was pretty scared and I've noticed that sometimes if the patient can loosen up labor moves along. Then I was told to start pit. I asked why (not because I thought I knew better then those telling me to) but because I really didn't understand why. After some thought I was told that pit would help speed things along and keep the baby from getting tired. I didn't say anything but I couldn't help thinking that the baby looked fine mom looked fine and delivery would be within the next 4 -5 hours (far before reaching 24 hours of rupture).

I'd like to learn more about home birth; it seems that it works well in Europe. I defiantly believe that high-risk deliveries belong in the hospital but for uncomplicated pregnancy I would like to believe home birth is an option. Either way I need to learn more before drawing a conclusion.

I've also noticed that patients have very little understanding of their own bodies and the process of labor, which makes them very reliant on doctors and nurses. I would like to think that a different approach, one that focused more on helping the mother to learn and assisting her in delivery would be more pleasant for her.

It's funny but I got threw 3 1/2 year of nursing school 4 children of my own and 8 + years in health care before I found out you don't actually have to push to deliver a baby and that it will come out with contx alone or a few pushes at the end.

I think much of the way we do things in L&D has developed because we need to time things just right so the doctor can be there to catch and once the doctor is there we have to push the baby out in a short amount of time.

If you cut out the doctor and put in a CNM or even a well-trained midwife with time to wait on the natural timing of labor then the need for allot of our interventions are removed.

I'm only starting to learn about L&D nursing so I can't really have a strong opinion about home birth yet. I am interested to see what others say about this subject.

mark_LD_RN · May 12, 2003

we considered home birth with our last baby,but i was too scared. I guess knowledge of what could go wrong affected our decision. I still think home birth is a viable option if it is a low risk pregnancy, birth attended by certified midwife with proper nrp training and equipment. and in resonable distance from hospital.

ideally my opinion is birth is best done at free standing birth center near a hospital.

just about everyone here knows my opinion on all the interventions we do to laboring patients, social inductions etc. we have way to many interventions and inductions and i believe a lot of the problems are caused by that. pitocin can stress the baby out more than just letting it occur naturally. I really hate it when they AROM a patient at 1-2 cm. that just burns me u

and the pushing thing , yes a lot of the women can just rely on the contactions to labor the baby down,but some do have to push. I know some docs that want you to start pushing at 8 cm. another item i don't agree with.

my opinion is birth is usually best if allowed to occur and progress on it's own time.

DAYRAY I see you pointed out one of my favorite stats. that the US has the highest infant morbidity and mortality of any developed country:)

Katnip, RN · May 12, 2003

Aren't most of the interventions done in a hospital by parents' choice. During my OB rotation, almost every mother who came in chose an epidural as soon as they were in the bed. The few who did not want one, did not get it. That goes for social inductions and yes, social C-sections.

When I had my kids, all three in the hospital, I had nothing but breathing. (Not always by choice-believe me.)

I know a lot of docs actually push of inductions because they won't have to get out of bed in the middle of the night, but ultimately it's up to the patient.

frann · May 12, 2003

About 5 years ago here, a mother died at a home birth from pp bleeding. baby survived just fine. about 12 hours after the birth the woman just bleed to death. I think this was li ke here 5 childbirth. They pressed charges against the midwife, they were talking jail time. Not sure what happened to her, but must have lost here liscense

SmilingBluEyes · May 12, 2003

Originally posted by cyberkat
Aren't most of the interventions done in a hospital by parents' choice. During my OB rotation, almost every mother who came in chose an epidural as soon as they were in the bed. The few who did not want one, did not get it. That goes for social inductions and yes, social C-sections.

When I had my kids, all three in the hospital, I had nothing but breathing. (Not always by choice-believe me.)

I know a lot of docs actually push of inductions because they won't have to get out of bed in the middle of the night, but ultimately it's up to the patient.

Ah, and here is where INFORMED CONSENT IS SUPPOSED TO COME INTO PLAY!!!! Right? How many are truly "INFORMED"??! Think about it. So many are "cowed" to do what the doctor feels is best. It is incumbent on the healthcare community to INFORM these families what their consent really means and what the alternatives may be. Remember one thing, for many it is INTIMIDATING being in a hospital with the nurses and doctors "in charge"----- and some people who are normally assertive are NOT when in such an enviroment. A loss of control over one's situation is not unusual in such a place. And not all folks are well-educated in normal childbirth and hospital interventions and how they may not may NOT benefit them. I think EARLY ON people need to be educated so they can truly make the "INFORMED" decisions that are best for them and their babies. JMO.

RN4jewels · May 12, 2003

In 1995 I had an ultrasound at 37 weeks that showed baby to be 6.5#. Because of this I had an induction the day before he was due. I was induced for 2 days which I learn now is almost unethical. My son was 9# 7 oz and had huge shoulders. I pushed for 3 hours. He was so stuck he could not be vacced out or pushed in to do a crash C. He was a PNB for 6 minutes post delivery which took 15 minutes from the time the head was delivered. Today, by the grace of God I have a bright, loving 7 year old because we were at a hospital with a NICU. I don't want to imagine what the alternative would be. He has Erbs palsy in his Left arm, but I am grateful that is the worst of it. This happens in many cases where no induction is performed. I can't imagine having a child with tonic-clonic CP because I wanted a home birth. It is a personal choice and I respect that but I wouldn't advise it unless it was the only alternative. too bad hospitals still don't do as wonderful a job making the environment as homey as the new age idealism makes it sound. JMHO.

Trauma Columnist · May 12, 2003

I'm an old lady who had my sons in 1980 and 1985. With first one, had a military hospital (Japan) and CNM - had baby in less than 3 hours total. With next baby (Spain), went for routine OB appointment and was 8cm - was double-parked, went downstairs to move car (had gone to appt by myself) and had baby in the lobby as I was coming back in. However, I do endorse home births - don't much endorse having baby in lobby of hospital where you don't speak the language - however, the lobby was empty when I delivered!!!! lol

Dayray, RN · May 12, 2003

I agree with smileing (once again =P) patients reley on doctors for their information. They don't even consider turning down intereventions becuse the doctor has recomended them. I don't see docotors as evil or self serving, they make their recomendations based on our medical cultural norm ie "the faster the better" "lets pit that baby out", Patients are taught this veiw from their first visit and they are not educated as to the physiologic process of birth. once again I don't think doctors or hospitals are purposly trying to be self serving but the way it works now is that the patient labors in the hospital while the doctor does clinc or rounds or whatever, if the doc comes too early it cuases them to miss office appointments or not get something done on time. If they come to late then they miss the delivery. So we make sure patients deliver in a predictable amount of time, this mean pit, coached pushing, deleying pain meds, and in some situations c/s.

much of the pain of childbirth is cuased by these facts pushing too soon or too much hurts and has been proven to cuase tearing and truama. Epidural and many pain meds are needed to treat the patients anxity more so then the pain. Any nurse will agree that a patiens pain is increased when they are scared or upset. I've had some good success teaching visualization and explaining the process of dialation to patients it decreases pain. Contx hurt and the natural response is to fight them. If you explain to the patient that the contx are pushing the baby down and dilating her cervix and tell her to imagine this during contx pain level useualy drops and labor progresses better. I'm not stingy with pain meds though I think they help patients allot but I think if things were taught to them differntly they woudlent need as many. patients are so scared when they come in they will do anythign you tell them too. I am constintly reminding them that they have the choice at all times and explaing things to them but it's kind of hard to learn new concepts when your in pain and scared. I like marks idea of a birth center in fact a friend of mine and I have talked about starting one someday.

Mrs.B · May 12, 2003

Disclaimer: I am not an OB nurse ( I am just a humble School nurse!

However, I am 22 wks with my first and have been doing a lot of research on the topic of birth etc.

From what I understand, in Europe most births do not take place at home, they take place in birthing centers attended by midwives. Only high-risk moms deliver in hospitals with MDs.

It appears to me that many of the interventions that are "offered" in our hospitals are not "evidenced based practice."

That many of the interventions are done routinely for no more reason than, "it's always been done that way."

I personally know that I would not be comfortable with a home birth (b/c frankly, I think I'm gonna want that epidural) but at the same time I am not comfortable with a hospital birth (because I don't want to be cajoled into accepting unecessary interventions). WE NEED MORE BIRTHING CENTERS!

I think what dayray said sums up our medical culture very nicely. Everybody is so used to instant gratification (fast food, cell phones, speeding on the highway etc.) that they just assume that faster is better.

Isn't it better to let nature take its course sometimes?

fergus51 · May 12, 2003

I know one family member and one friend who have had home births and were lucky enough to have healthy and natural births. I supported their decision because they were both very well informed about the risks. It isn't something I would do, but I do understand why people don't want to give birth in a hospital. If there was a birthing center, that would be my first choice. Too many hospitals have the mentality that women are incapable of going through natural childbirth and every intervention is a good idea. MrsB is correct in saying that many OB practices are not evidence based (partially cause you can't really experiment on pregnant women) so it's very important for women to inform themselves beforehand.