opinions about homebirthing

MIcrunchyRN · Jul 13, 2008

I don't necessarily homebirth is becoming more of a trend as much more women are learning that they have options in birth and for many homebirth just seems like the better option.... and more and more women are becomeing less fearful to talk about their homebirths as legislation on homebirth is changing to make it no longer illegal in some states.

I was supposed to have a homebirth. However at 29weeks I went into preterm labor and had to sign off with MW to be under OB care until 36 weeks. By the time we hit 36 weeks we were so nervous of a homebirth from our experience (that almost resulted in a c-section at 29weeks).. that we chose hospital birth with our MW as our doula.

For me I chose homebirth because my first hospital birth experience was aweful. Nothing happened as I wished despite it being a complicated free birth. After researching more a large majority of complications are as a result of interventions that aren't necessary in the hospital.

We interviewed MW's and OB's. My MW was far more trained than my OB. Lets face it.. my OB is a surgeon so when something isn't going quite right they aren't necessarily trained to handle it other than surgery. My MW was trained to do breech births, twin births, how to handle birth situations that arrise and had an extremely low transfer and c-section rate. Lets face it if we leave a laboring mother alone a large majority of the time its a perfectly safe birth that needs no intervention at all.

I hope if my husband and I choose to have another baby we will get our homebirth with the MW we have fallen in love with. If not I still advocate for it 100% because it IS safe. (most of the world delivers at home with a midwife)

clhRN2b2010 · Jul 13, 2008

I don't think more women are choosing homebirth. I would like to see that shift begin. I do think that it is getting a fair amount of press right now and many of us are becoming more aware of it.

I had 3 babies out of hospital and had wonderful Midwives in attendance. I would totally support it and would love to work with a homebirth MW someday! :up:

kcochrane · Jul 13, 2008

The only homebirth I was involved in was as an EMT years back. The baby had already been delivered, so it was limited. I had my first child 23 years ago and my last 10 years ago. I think homebirths were just a "popular", but as someone else mentioned, not talked about alot. I had all 5 of my kids at the hospital.

That being said, I think it is a fine alternative IF you are not high risk, IF you have the proper medical assistance and IF you have a backup plan if something goes wrong. And hopefully that backup plan is not calling 911. As an basic EMT I had maybe 1-2 hours of training in OB.

My concern is with the growing number of women that want to have unassisted home births. Yes, you heard me..there's a whole online community dedicated to that and it is shocking.

Nice timing with this post, the AMA is trying to make it hard to have a homebirth:

http://abcnews.go.com/Health/story?id=5340949&page=1

moongirl · Jul 14, 2008

dont agree with it in my neck of the woods. Nearest hospital ( that I happen to work in) is 40 minutes away from my hometown. If trouble arises, help is too far away.

CEG · Jul 14, 2008

I work in OB and I have had two hospital births and am planning a homebirth with my current pregnancies. Aside from all else, research shows that my/baby's risk of mortality in a homebirth is equivalent to a hospital and my risk of morbidity is lower at home.

The closest hospital to my home is the one where I work. It does not have 24 hour OB or anesthesia in-house so if I were to have an emergency there I would be every bit as up the creek I would be at home. I can leave my home and be at a different hospital with coverage faster than the OB can get his shoes on and get to the hospital.

I do not want to expose my baby to continuous fetal monitoring and all the risks that go with that, timelines, procedures, etc. We wil use intermittent auscultation to monitor the baby- which is just as effective as EFM without the dangers. My midwife will treat my pos GBS status at home with IV amp. I will see her backup doc at 34 weeks to be "cleared." My only concern in planning a homebirth is a shoulder dystocia. This would be much more a problem in the hospital where I am more likely to be confined to bed with pain meds and delivering on my back, but nonetheless still concerns me, but I do not feel being at the hospital would resolve it any better.

The other day I had a laboring patient watching "A Baby Story" (I know, why?!?!) and they were filming a homebirth. She went on and on about how you would have to be crazy to choose homebirth and no epidural. She didn't notice I was just smiling and nodding and not saying a thing.

MarySunshine · Jul 14, 2008

I think home birth can be a great option for women who fit the criteria and are prepared. Sadly, in my area, there are not very many homebirth midwives anymore.

I do have a question for all you OB folks -- what do you do in the case of a prolapsed cord or an abrupted placenta? I know in the hospital they rush people to the OR. I imagine that you would get the patient in the safest position possible in the car, and start driving and call the hospital and inform them of your situation and impending arrival so that they can ready the OR. Does this sound correct? I know it would be completely rare that it would happen, but leave it to an ICU nurse to wonder about the emergencies.

CEG · Jul 14, 2008

I do have a question for all you OB folks -- what do you do in the case of a prolapsed cord or an abrupted placenta? I know in the hospital they rush people to the OR. I imagine that you would get the patient in the safest position possible in the car, and start driving and call the hospital and inform them of your situation and impending arrival so that they can ready the OR. Does this sound correct? I know it would be completely rare that it would happen, but leave it to an ICU nurse to wonder about the emergencies.

Yep, these are two of the rare "true" obstetrical emergencies. These ladies are rushed to the OR. That's assuming it happens at the hospital. Remember that cord prolapse is most likely to happen with rupture of membranes, which may or may not occur in active labor or at the hospital. Abruption can happen any time- risk factors are trauma to the abdomen, cocaine use, and previous abruption. And like many complications, interventions such as induction, pitocin, etc make them more likely than in a physiological labor. At my hospital we do not have in-house OBs or anesthesia so they have to be paged. In fact we had a cord prolapse a few weeks ago in the middle of the afternoon and it took about 25 minutes for a team to be assembled. While waiting the patient would assume a knee-chest position (if possible) with someone preferably holding the presenting part off the cord, this is what I would do on my way to the hospital. With abruption I guess increased fluid volume with a bolus is about all you can do while you wait.

It's imprudent to believe that being in the hospital provides any extra protection from these things when it in fact predisposes one to them and unless you are at a larger facility you will wait just as long for intervention.

BetterLife126 · Jul 14, 2008

While working as a Paramedic earlier this spring I had the opportunity to deliver a baby in the expectant parents home. I have to say that this was an eye opening and beauitifull experience. I have no children, and have only been present for hospital based births prior to this. This couple was planning a Home birth with a MW, but her labor went VERY Quickly, and when they realized that the baby would come before the MW arrived they called 911. I delivered the baby and the MW arrived 5 minuets later. The MW went ahead and took over on her arrival, it was a very relaxing, comfortable environment. The home environment seemed very intimate. The way it seemed to "feel" (if that makes sense) seemed so natural. If I have children I do beleive that I will strongly consider this option for my delivery.

zippidydoula · Jul 14, 2008

Hi there,

I became a doula over ten years ago although I have not practiced in about 6 years. I have witnessed births in various settings and circumstances. I have 3 children born in different places: hospital w/doc, freestanding birth center with midwives, and hospital with a midwife . I caught my last baby. (I risked out of the birth center due to preterm issues) I can honestly say that my favorite memory as a doula was at my best friend's birth at home. The midwife, CNM, was wonderful.

Interestingly enough, if you look at the numbers for infant mortality rates, the US ranks with less industralized countries. Counties that utilize midwifery as the standard for non-complicated births have a lesser incidence of infant deaths.

Nefertari1279 · Jul 14, 2008

I definatly believe it is a valid choice for low risk healthy women. As far as the "unassisted crowd" I also think that should be the woman's choice, as long as she educates herself about the risks thereof and is willing to own the outcome, than who am I to say she is wrong for making that choice?

MW's are awesome and I hope to have one with my first.

The AMA and ACOG, JMHO are ******* themselves because women are realizing that they do have other options. I just watched The Business of Being Born and it blew my mind! I thought the film made some wonderful points without demeaning OB's. It wasn't biased, at least in my view.

Elvish, BSN, DNP, RN, NP · Jul 14, 2008

I'm all for homebirthing in a low-risk pregnancy. So many of the complications we worry so much about we cause by all our unnecessary mucking around with womens' labor.

I have a friend who has had two home births in the last two years, and swears she would do it again. I'm seriously considering homebirthing with my next one (whenever it happens) if all goes well.