Would you consider a home birth?

Jolie, BSN · May 30, 2007

What, do they kill them? I've seen 33 weekers do great....po feed...etc. I can see the puny ones maybe not doing well, but to say under 35 weeks is non-viable is kinda crazy.

I have no first hand knowledge of this but would like to share an experience I had with a pediatrician who was foreign -born and trained in a 3rd World country.

She was an EXCELLENT pediatrician, and well respected by families and staff alike. She was in need of extra money and decided to moonlight in our Level II NICU on nights and weekends. One night, she got into a discussion with a group of staff nurses about how it was wrong to resuscitate preemies, and she would refuse to do so in her role as a moonlighter. We had a Level II NICU, and did not electively deliver any patients less than 28 weeks, but she stated that even that was too young, and in her country, they would be left to die. Fortunately, she was never put in a position of making a decision about a preemie resuscitation. The conversation was reported to administration, who verified it with her, and then invited her not to come back to the NICU.

I don't know just how premature a baby would have to be for her to refuse resuscitation, but thank Goodness we never found out!

BittyBabyGrower, MSN, RN · May 30, 2007

Also in those underdeveloped countries, I am sure that they don't have accurate birth records, so their rates are probably higher than ours, but without the records, it looks lower.

dawngloves, BSN, RN · May 30, 2007

In fact, the infant mortality rate is highest in countries with highly modernized healthcare.....Education is power.

The US doesn't have the best outcome as far as infant mortality:

American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.

http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/

But it is far from the worst in the world. The bottom 10 are:

1. Niger

2.Burkena Faso

3.Mali

4.Chad

5.Guinea-Bassau

6.Sierra Leone

7.Ethiopia

8.Yemen

9.Central African Republic

10.Republic of Congo/Liberia tied

The US has a higher birth rate than other European industrailized nations and more liberal resusitaion rates. This contributes to our high mortality rate.

Neveranurseagain, RN · May 30, 2007

I used to work at a birth center (which is like giving birth at home as far as med emergencies) as well as have attended home births with a Licensed Midwife as well as a CNM. Our approach was we would keep women at home BUT if at the first sign of a complication or at the mothers request, she would be transported to the hospital. Not a fun prospect at 9 cm but the mothers/babies health was always paramount. Did we have any complications...Yep. On my first home birth with a CNM I did my first lady partsl exam to check dilation--(I never worked L & D at a hospital so had never done a dilation check). The CNM had me check first then we were going to compare findings. What did I find? Digits--toes to be exact. I didn't want to alarm mom (maybe my findings were wrong?) but CNM confirmed. Rapid transport for CS. The last homebirth I attended the woman was 1 cm large for dates--no big deal, 3rd babe and last on was 9 lbs. Out pops a 7 lb baby--and no placenta--I did a vag exam and found another babe. With hands shaking, I grabbed the doppler and baby,thank you GOD, had 140 HR- and she pushed out a 2nd 7 lb baby. Back up doc who checked mom 3 days earlier had cleared her for a homebirth. And not every woman gets an ultrasound--especially on 3rd babe with no complications... Did I have a home birth? NO, both my kids by IVF and part of contract was to have baby at hospitial with a NICU available...so instead I gave birth in the hallway outside the elevator..you should have seen the look on the visitors face as he tried to get off the elevator.

TiffyRN, BSN, PhD · May 30, 2007

What, do they kill them? I've seen 33 weekers do great....po feed...etc. I can see the puny ones maybe not doing well, but to say under 35 weeks is non-viable is kinda crazy.

I'm hijacking; I'm sorry. . .

LilPeanut had a wonderful description of her trip to Honduras to help in a hospital; she assisted in the NICU. Search this forum for something like "my trip to Honduras".

We see some incubators in a little glassed in side room, and they tell us those are for their preemies. We asked what gestation they consider viable. The answer: 36w. *sigh* The only good thing is that they aren't great with telling gestational age, so healthier younger babes can easily slip through. They do not have ventilators or monitors

I heard this same report from an NNP I work with that was going on an educational trip to China, that between the lack of resources (including lack of surfactant) few under 35 wks were considered viable.

I've never heard that they "kill them"; I'm sure like us they offer care and comfort to the "non-viable" infants. What would you set at the age of viability if you had no ventilators (conv or cpap), no monitors, unreliable supply of IV meds, og tubes and no surfactant? In the Honduras unit they didn't even have bottles and nipples so everyone had to either successfully breastfeed or syringe feed.

Jo Dirt · May 30, 2007

I'm not going to debate you, but as a homebirthing mother, I feel that giving birth where I feel safest and most comfortable is better for my baby's long-term health. A relaxed mother who is prepared and in control of her own birth has a far lower rate of complications and interventions. Babies go in distress when their mothers do! Not saying that there are no other causes for distress but you cannot deny that it's a factor.
Plus I am not exposing my baby to hospital germs and multiple strange caregivers, many unnecessary invasive tests and procedures, taking my baby outdoors at a very young age, exposing my baby to exhaust fumes and traffic, etc... Don't think that homebirthing mothers do it only for their own comfort and baby be damned. My two homebirthed babies were much healthier and I had far better nursing experience with them than with their hospital-born siblings. Of course I was also a more experienced mother by then but that was part of my reason for choosing homebirth.

I don't know how you can be relaxed while in that much pain.

I have three so far (soon will be four) and I had my second child at home with a midwife (the decision of my husband, not me). I did not feel exhilirated or empowered or relaxed. I thought the night was never going to end.

With my third child I had an epidural. I was relaxed and in no pain and couldn't feel a thing when I "pushed." It was much more pleasant than thrashing around on the bed at home with my husband and kids listening to me cry out in pain.

I still support a couple's right to have their baby at home (I just don't know why they would want to). Hospital isn't perfect but my experiences there haven't been bad.

2curlygirls · May 30, 2007

Wow, the resurrected thread.

I've learned more about this subject since starting this thread last year. Still wouldn't homebirth but I understand why some women do.

LouRN92 · Jun 2, 2007

I was reading through this thread tonight at work and several comments from last year were very derrogatory (did I spell that right?) towards rural outlying hospitals. As a nurse who does OB at an outlying hospital, I would like to say that all of our RN's are trained in NRP and that we, at least at our facility, give excellent care and can easily keep a baby stabilized until transport.

One of the best shifts I ever worked a mom came in and delivered a 28 weeker, breech, stat C -section, that our team resuscitated, bagged, CPR, umbilical line, intubation, and smooth transition to the NICU team that flew in to get him.

This little guy is 4 now and I see him all the time.

I just recertified in STABLE an educational offering designed to help RN's and MD's at outlying hospitals keep these infants safe prior to transport.

I had both of my babies at a rural hospital... I got so much attention I had to go home to get rest!!

I know this thread is about homebirthing vs level III NICU hospital..but I would like to point out that not all hospitals that don't have NICU are bad. I think researching the hospitals in your area is important.

Just a thought. I would never have an unassisted homebirth.

Tofumommy · Jun 11, 2007

I was a lay midwife for many years and had my own children at home both before and after my career as a NICU nurse. If I were having a baby today I would choose to birth at home because I still believe it to be the safest place for low-risk mothers and babies.

My generation grew up with the notion that pregnancy was a disease and childbirth was an accident waiting to happen (thank God for the intervention of hospitals and Modern Medicine!). As a young woman I wanted to know what had happened to American women that they couldn't even give birth through their lady partss anymore. Was it just a coincidence that out of 12 of us NICU nurses sitting in a circle chatting one night, I was the ONLY one who had not personally experienced a cesarean delivery?

As much as I respect and appreciate the high-tech world of obstetrics, and medicine in general, I think it has done normal childbirth an incredible injustice. Women have lost touch with themselves and faith in their bodies' natural ability to give birth without intervention, and that is extremely sad to me.

I am not an advocate for unattended home birth (though I had my first that way), as emergencies can and do happen there as well. I have worked alongside lay, licensed, and certified nurse midwives, and regardless of credentials, it's crucial to have an attendant with strong training and experience in case the unforseen happens.

I'm out of the baby-birthing business now and don't have much energy left for the home-birth argument anymore. My own daughter chose to have her first child in a hospital (there was some coercion on the dad's part) with a CNM, which I was disappointed about but had to support. She's pregnant again and planning to deliver at a free-standing birth center this time, so if there is a number three, who knows? :lol2:

judyblueeyes · Jan 14, 2008

"The Business of Being Born, a documentary directed by Abby Epstein and produced by talk-show host Ricki Lake, is a generous-spirited tribute to the practice of home birth. It's full of moving (and surprisingly ungross) filmed deliveries, including those by Epstein and Lake themselves. Unfortunately, the movie is also a propagandistic brief on behalf of the home-birth movement that's so selective in its presentation of information that it makes Michael Moore look like a fat lady in a blindfold holding a pair of scales. "

"The natural childbirth mantra that "Birth is not a medical event" ignores the unfortunate fact that, in that percentage of cases in which something goes wrong (as Lake herself says in the movie, about 1 case in 10), things can get very medical very fast. Studies in the United States, Australia, and Britain have suggested that the fetal death rate in home births, while still extremely low, is approximately double the rate for hospital births. A statistic that Epstein and Lake would have been free to contest--had they bothered to address it at all. "

http://www.slate.com/id/2181860

MegNeoNurse · Jan 14, 2008

As a NICU nurse? I personally would not (on purpose that is) given my experiences in the NICU. The homebirths we see are the ones with severe MAS who end up on ECMO or on cooling blankets. I know our view is skewed. Wondering what others thought.

Absolutely not. I am not having my babies at the hospital I work at, but I am having them at a "sister hospital" that has a Level II NICU and our NNPs are staffed there 24/7. I made this decision during my OB clinical rotation in nursing school.

SteveNNP, MSN, NP · Jan 15, 2008

Heh, the homebirthing thread comes to life again!

(WARNING: male nurse who has never experienced childbirth about to post!)

My mother birthed all 9 of her children at home with the help of the SAME CNM (over a period of 20 years) The CNM actually came out of retirement to help with my youngest sister...

While it was always a positive experience for my parents, without any complications, I have to say a lot of it was due to the skill and knowledge of the CNM.

My mother did have one hospital delivery with a stillbirth at 34 weeks gestation, which my parents found to be a frightening, sterile and overwhelming experience.

Personally, now that I have worked in NICU for several years, been in the delivery room and resuscitated so many "normal" newborns... I would have to go with hospital deliveries for my family. I probably would have considered home-birth if I had not worked in NICU, but it changes you. You start worrying about every little thing. "Is that bruising, or cyanosis from a cardiac condition?? etc"

Of course it will depend on my (future) wife as well, but we'll definitely go with a Level II hospital with LDRP suites or a certified birthing center.....