opinions about homebirthing

Specialties Ob/Gyn

Published

I have a few friends who've decided to have homebirths. I'm curious about this seemingly growing trend. I'd love to hear some opinions from those who've done it, participated in it, and delivered some of these babies at home.

TIA!! :redpinkhe

Thanks for all the input about homebirthing. I was wondering also about how CNM's measure bilirubins in the home setting... or is that even done? Do the moms just take baby to the Ped the next day or so? Also, does anyone know if fetal monitoring is done during labor at home? :)

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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.

Cord prolapse- Usually mom gets on all 4's with butt way high up in the air.. (thing gravity would help get baby out of pelvis or take pressure off the cord with mom upside down) Then someone would put hand in there and keep pressure off the cord with contractions by holding baby off the cord. In a homebirth this is when you'd call 911 or do immediate hop in your car and go drives. If in hospital you go into the OR just like that.

Crod prolapse is rare, risk factors include too much fluid (polyhydramnios), AROM, or PROM (premature rupture of membranes). So a normal mom who is homebirthing is full term (so that rules out PROM), AROM usually isn't done but may be and MW will make sure baby is nice and low so cord cannot be dragged out when membranes are ruptured, but again AROM doesn't usually happen at home. The high fluid puts mother into a bit more of high risk category normally and usually they aren't home.... It happens but is quite rare.

The placental abruption again is rare in a normal birth. It usually happens with a history of it, trauma of with interventions like pit that is commonly used in hospitals. It can happen spontaneously but its quite rare and doesn't always happen in labor.. the two people I've ever heard of it happening it happened prior to labor. Again mother would be monitored while in labor and excess bleeding they would most likely transfer to hospital to be safe. One of the cases where I seen a placental aburption there was no warning for it, baby died anyways despite her being in hospital laboring fine, mom almost died because it was caught quite late.

There are risks and benefits with both homebirth and hospital birth. We all thnk hospitals are safer.. but are they really? Nosocomial infections run rampant, and how many nurses do you see handeling babies, changing diapers etc without gloves? There is also risks of all of the interventions leading to c-sections which can increase risk of death/ complications for both mother and baby.

The US has the highest morbitity for mothers than any other developed country in the world. And those other countries use 80% midwifes for deliveries... so is our current system really safer? Watch the buiness of being born it really will make you think.

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Midwives use IA monitering as far as I know.

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I would have loved to try it but because of previous complications with my first delivery, it wasn't recommended. What a bummer!!!

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Thanks for all the input about homebirthing. I was wondering also about how CNM's measure bilirubins in the home setting... or is that even done? Do the moms just take baby to the Ped the next day or so? Also, does anyone know if fetal monitoring is done during labor at home? :)

Yes fetal monitoring is done!! Intermittent fetal monitoring. They midwives also come with IV's, pitocinin case of hemmorrage, oxygen etc. They are able to suture in case of any tears 2nd degree or less (most 3rd and 4th need to be done in surgery). Its definatly not like they come over and just watch... they listen to baby just as frequent in the hospital.

As for baby. Usually baby is checked by ped within 48 hours after birth. MW will do assessment on baby as well. Since bili is normally checked within 24 hours if MW feels its necessary then she can order the lab work to get it done or you can see your pediatrician as well about it. They also do the state required newborn screenings for metabolic disorders.

Watch the buisness of being born :p There you can see what a MW does in a homebirth and what they bring. its pretty neat.

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Specializes in OB.
Yes fetal monitoring is done!! Intermittent fetal monitoring. They midwives also come with IV's, pitocinin case of hemmorrage, oxygen etc. They are able to suture in case of any tears 2nd degree or less (most 3rd and 4th need to be done in surgery). Its definatly not like they come over and just watch... they listen to baby just as frequent in the hospital.

As for baby. Usually baby is checked by ped within 48 hours after birth. MW will do assessment on baby as well. Since bili is normally checked within 24 hours if MW feels its necessary then she can order the lab work to get it done or you can see your pediatrician as well about it. They also do the state required newborn screenings for metabolic disorders.

Watch the buisness of being born :p There you can see what a MW does in a homebirth and what they bring. its pretty neat.

mmm.. not always. If your midwives are PNM, not CNM they cannot do IVs, repairs.. they carry no meds, most often than not, they are not even RNs The midwives in my area are PNM.. not certified. Very much changes the options/outcomes. Just make sure of who you are dealing with

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Specializes in Community, OB, Nursery.

Depending on the state (and whether it is legal for CPMs to practice), CPMs do indeed carry pit, O2, can suture, and IVs. My massage therapist (that makes me sound so uppity, I've only seen her like 3 times in 2 years) was a CPM in Louisiana. She did all the above. We've talked shop. She birthed lots of GBS+ moms at home specifically because she could give them their PCN through a medlock.

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Specializes in OB.

Well I had a vbac at home last year, so that's how I feel about homebirth LOL. I was lucky that in my area I still had that option and I had a very experienced, competent midwife. Plus we live just 8 min from the hospital, so if there was a problem we could be at the hospital quickly.

I love telling my patients about my experience (if they ask). I feel like I can open their eyes to another option besides being strapped to a bed, and given pitocin if you dont progress as quickly as the doctor wants.

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In the UK with have both nurse midwives and direct entery midwives they are both reconised as professional care givers to pregnant women. Home birth is safe effective and cheap it is activly encouraged by government and the medical community. Normal healthy babies do not need a bili check - if baby is at risk can be done at home - jaundice at three days is normal. I have personally transferred a prolasped cord in from the community with good out come. I have had shoulders stuck in birthing pool (in hospital) with a good out come because as a highly trained experienced professional in normal birth I have the skills to deal with emerency- by the way I worked with a doctor as a L&D nurse who had an emergency and could not deal with it - I took over and talked the doctor through it - the out come was good only because a midwife was there. The doctor never told the parents they think the doctor saved there babies life.

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So on a home birth, what happens if at birth the mom and the baby both need attention?

On a good birth, once you dry off the baby and place on mom's tummy, baby is fine while you tend to mom and the placenta, etc.

Last night a baby was born, and I was the baby nurse. He was having a hard time breathing. He took a long time to turn pink and then was extra moist, grunting with a weak cry. I spent about 20 minutes with him until I felt OK with his breathing. Meanwhile, the mom was delivering the placenta, and she needed some repair, fundal massage, etc. How would a midwife at home deal with both?

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So on a home birth, what happens if at birth the mom and the baby both need attention?

On a good birth, once you dry off the baby and place on mom's tummy, baby is fine while you tend to mom and the placenta, etc.

Last night a baby was born, and I was the baby nurse. He was having a hard time breathing. He took a long time to turn pink and then was extra moist, grunting with a weak cry. I spent about 20 minutes with him until I felt OK with his breathing. Meanwhile, the mom was delivering the placenta, and she needed some repair, fundal massage, etc. How would a midwife at home deal with both?

A lot of homebirth midwives have an assistant or a second midwife who attends births with them. :nuke:

I loved my homebirth, but realize it's not for everyone. I think it's important to acknowledge that both homebirth and hospital birth have their own unique advantages and disadvantages. You have to take all of those things into consideration and decide which option works best in your own unique situation.

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Specializes in Emergency Department.
mmm.. not always. If your midwives are PNM, not CNM they cannot do IVs, repairs.. they carry no meds, most often than not, they are not even RNs The midwives in my area are PNM.. not certified. Very much changes the options/outcomes. Just make sure of who you are dealing with

What's a PNM? I'm a midwife and thought I've heard all the acronyms for us...

ps: I'd like to point out that while nursing education is a plus, it's not a requirement for being a midwife.

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