Would you consider a home birth?

Jolie, BSN · Apr 9, 2006

Problem is that the people bashing homebirths don't make any distinction between mothers who are uneducated and have no prenatal care giving birth at home, versus mothers who have done their research and and are well-prepared and made an educated decision to give birth at home with a professional caregiver.

Chaya,

I am not bashing homebirths. I firmly believe they should be an option for birthing couples. I didn't "bash" the parents or birth attendant in the situation I described. I simply commented that I found it very sad.

It seems to me that there is sometimes an agenda on the part of those promoting homebirths: that couples who CHOOSE hospital births are somehow un-enlightened. I think some homebirth advocates fail to acknowledge that couples actually weigh the RISKS vs.BENEFITS of homebirth, free-standing birth center, and hospital and decide that the hospital is in the best interests of themselves and their babies, much like the decision making process that homebirthers use.

When I was expecting my babies, I immediately ruled out homebirth, based on my professional experiences and lack of access to immediate emergency care. (I lived in a rural area, with no emergency services near-by.) I investigated the possibility of CNM care and delivery at a free-standing birth center across the street from a hospital with a Level III perinatal center. Due to the distance from my home (approx. 1 hour), I reluctantly ruled that out as well. That left me with 5 hospitals within a 30 minute drive from which to choose. I thoroughly investigated the OB services at each, and chose doctor and hospital that fit my needs and desires.

I acknowledge that there are risks (and benefits) to hospital births, just as there are risks (and benefits) to homebirth. That someone chooses to deliver in a hospital does not indicate that they are blind to those risks, or failing to act in their family's best interests, any more than one can make that assumption of homebirthers. It is also unfair and inaccurate to assume that people who deliver in a hospital do so out of ignorance, rather than choice. It could well be that the couple you mentioned in your tragic example were on the way to the hospital that they had CAREFULLY chosen.

JeanettePNP, MSN, RN, NP · Apr 9, 2006

Bitty Baby Grower, I don't know how big your hospital is or how many homebirthers there are in your community, but 2 NICU homebirthed babies a year doesn't sound like a huge percentage to me.

Jolie, I don't think people who choose hospital births are necessarily uneducated or unenlightened. There are educated people on both sides of the divide. Different people, different choices. It's part of being human and living in a democratic country.

I apologize for butting in to a thread for NICU nurses. I can definitely see how your experiences would skew you to go with hospital births, but then again I wonder how many botched hospital deliveries you've had to deal with.

fergus51 · Apr 9, 2006

I apologize for butting in to a thread for NICU nurses. I can definitely see how your experiences would skew you to go with hospital births, but then again I wonder how many botched hospital deliveries you've had to deal with.

Way less for me. I usually work in hospitals that do a lot of deliveries and their staff knows their stuff or is able to get help. I've never seen them not pick up on meconium stained fluid or not think a prolapsed cord required immediate intervention or not have an extra set of trained hands available for a delivery. That's also why I would deliver in a hospital: I know the people there are good because I've seen them work.

dawngloves, BSN, RN · Apr 9, 2006

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.

I've never seen a distressed baby that was in direct relation to a medical intervention. Usually the intervention, (forcepts, vacuum) were in relation to a baby already being in distress, (ie:nuchal cord, knot in cord). And I can say those thng were not brought on by a a mother being in distress.

We do only get to see the births that go bad. Things can turn on a dime in L&D. Usually the baby is OK, but 1:10 of the bad deliveries end up in NICU and then a percentage of that end up on vents or expire.

No one is knocking your choice of a homebirth, but our expereince has made us think otherwise. I've said it before, I'll only delivery in a hospital with a Level III NICU.

BittyBabyGrower, MSN, RN · Apr 10, 2006

If you noticed, I said AT LEAST two a year. Last year we had 6, yes 6. And these were upper class well educated people. Bad things happen at the last moment and the kids end up going to a smaller hospital and then they have to wait to be picked up by the transport team. Precious minutes wasted. We don't see botched kids that are delivered where I work...I work in a large level three NICU with a large population of high risk moms, and upper to middle class moms too, in the middle of a big city. The most messed up kids we see are from smaller rural hospitals that just aren't equipped to help bad kids. And those are the hospitals that most home birth kids get taken to before we go get them.

Like I said, it is a personal choice and people have to be aware of risks. No one is bashing homebirths.

Gompers, BSN, RN · Apr 10, 2006

I apologize for butting in to a thread for NICU nurses. I can definitely see how your experiences would skew you to go with hospital births, but then again I wonder how many botched hospital deliveries you've had to deal with.

You are more than welcome to post on the NICU board, so please don't worry about butting in or anything like that. This is an open forum. We're not saying that people shouldn't have the choice to homebirth or that there aren't benefits to it. Pure and simple - the question the original poster asked was if we NICU nurses would ever do homebirths ourselves. The answer is overwhelmingly NO because we've all seen very upsetting outcomes to some homebirths that could have been averted in a hospital setting.

We are the ones that physically and emotionally care for these poor babies if something goes wrong. The majority of the time, whatever went wrong probably would have happened whether the mom delivered at home or in the hospital (i.e. meconium, cord prolapse, shoulder dystocia, abruption) - the only difference is that in the hospital, the problem could have been dealt with immediately and the outcome might have been much different. So it's very sad for us, to care for these babies and their families, because we know it didn't have to be that way.

It's not about numbers, either. The fact that it might be "only" 2 babies per year doesn't impress us much. What we see is 2 babies that have severe brain damage (or die) who would have survived intact had they been delivered at a hospital instead of at home. That's what breaks our hearts.

JeanettePNP, MSN, RN, NP · Apr 10, 2006

Thank you, Gompers.

Trust me, I am reading this thread with great interest because like any mother I want my babies to be safe more than anything. I had my first 2 in the hospital because that's what everyone does and I really didn't know homebirth was an option. Only after being unhappy with my hospital experience did I research homebirth and finally with my 4th child I worked up the nerve to do it. I've now had 2 homebirths and the difference was literally heaven and earth. I won't say heaven and hell because the hospital wasn't quite that bad but close. When and if I have a sixth child I cannot envision going back and doing it the hospital way. But, I am constantly open to learning and I do use the information I glean from boards like this to do what I can to minimize the risks to myself and baby, while still having the birth I want. So, professional experienced midwife, check. Professional assistant, check. Oxygen and infant resuscitation, check. My midwife is trained in the same things that a hospital midwife is trained in, and is attuned to all the things that signal distress. The only question is if advance equipment is needed, and I'm questioning in how many cases does the few minutes that it takes to transfer (I'm within 8 minutes of a hospital) make a difference in life and death.

And bitty, if these problems can only be dealt with in the major city hospitals, then anyone who delivers in any rural hospital is taking a ridiculous risk.

Now not to sound callous, OF COURSE to the parents themselves, the ones who have the poor outcome, it's tragic. But we need to look at the numbers in context. Do homebirthers have a higher rate of complications than hospital birthers? Are morbidity rates for homebirths higher? The studies I have seen suggest otherwise. Again I fully understand why an NICU nurse would not personally want to have a homebirth. However, I am wondering if the poor outcomes are blamed on homebirth *itself* rather than on other contributing factors.

Gompers, BSN, RN · Apr 10, 2006

The only question is if advance equipment is needed, and I'm questioning in how many cases does the few minutes that it takes to transfer (I'm within 8 minutes of a hospital) make a difference in life and death.
However, I am wondering if the poor outcomes are blamed on homebirth *itself* rather than on other contributing factors.

Well, can tell you that 8 minutes makes a huge difference when it comes to a newborn baby's brain. It can be the difference between a normal baby and one with severe brain damage, or even death. The thing is, even if the hospital is 8 minutes away, that doesn't mean that treatment starts the second you roll in the door. Say that a crash C/S is needed - even if the midwife has called ahead and the staff gets the OR ready, it still takes time to get you through the ER, up to the OB unit, into the operating room, put under anesthesia, etc. 8 minutes may very well turn into 10-15 minutes.

This is just how NICU nurses think. We understand that a healthy mom and a good midwife are more than likely going to have a great homebirth experience. But because we've seen the worst, we immediately think the worst. We might hear about 99 perfect homebirths, and 1 bad outcome...we'll focus on the bad outcome. Again, it's because in our medically trained minds, that one bad situation could have been averted had an OR or NICU team been seconds away. Our eyes are on prevention. You're talking to a group of nurses who have had very sick babies in our care - so it's natural for us to try and protect them at all costs.

Anyone who's been in a delivery room coding a newborn probably has a bias against homebirths - simply because we can't image not having all that staff, equipment, and medication available to our own children should the need arise. Dealing with a coding baby changes you in so many ways. Life just becomes more real, more brutal, more unpredictable.

We're not blaming the homebirth itself. As I've said, most of the problems encountered in homebirths would probably have happened at the hospital, too. So it's not the homebirth itself that caused the complication, just that the outcome is often much different when these complications arise at home versus in the hospital.

JeanettePNP, MSN, RN, NP · Apr 10, 2006

I could pose the same question to trauma nurses: Given what you've seen, how do you feel about taking your car out of the driveway?

dawngloves, BSN, RN · Apr 10, 2006

I could pose the same question to trauma nurses: Given what you've seen, how do you feel about taking your car out of the driveway?

That's a pretty broad question. That's like asking us, how many of you would have babies?

You could ask, how many Trauma Nurses don't use their seat belt or ride motorcycles?

Jolie, BSN · Apr 10, 2006

I could pose the same question to trauma nurses: Given what you've seen, how do you feel about taking your car out of the driveway?

It all goes back to the risk vs. benefit equation. What risk are you willing to tolerate in your pursuit of a given benefit. That applies to all situations: driving vs. flying, homebirth vs. hospital, medical treatment vs. surgery for a health condition, savings account vs. lottery ticket :), etc.

mom23RN · Apr 10, 2006

Not a NICU nurse but I worked ER and had a baby born with a congenital heart defect.

Well, being one who has had a baby born with a heart defect... NO I would never deliver at home. There are plenty of babies born with conditions that need immediate intervention and I would not want to waste that time just getting the baby transferred to the hospital. I would like immediate intervention.

I guess after everything I've been through it's not about my "birthing experience" it's about the health of my child.