Would YOU ever have a homebirth?

[klone]

Sorry if this topic has been done to death. I've been working since June in OB, focusing mainly on L&D. I have two children of my own, the first one was a fast and uneventful hospital birth, the second was a homebirth (acynclitic and OP, so labor was VERY long and difficult - if I had been in a hospital, I'm pretty sure I would have been sectioned, but all turned out well in the end).

I'm facing the prospect of perhaps having one more in a couple years. I had previously thought that any other children would also be born at home. But now that I've been working in L&D and getting a glimpse of all the potential emergencies and behind-the-scenes things that could go wrong, I'm seriously questioning the safety of homebirth. I guess you could say I'm having a crisis of faith that birth is a natural process that doesn't HAVE to be managed in order to have a good outcome.

Anyway, I was just wondering if other L&D nurses, knowing what they know, would ever opt for a homebirth for their own.

[Jolie, BSN]

I honestly didn't mean to gross anyone out..I thought it was a funny story...guess my sense of humor gets warped when I haven't had much sleep!

Many homebirthers bury the placenta under a tree as sort of a tribute to new life etc. Well that sounded nifty but I didn't have a place to plant a tree, so I stuck it in the freezer. Well I never got around to doing the tree thing and just forgot about it until last week....

Now I'm gonna duck and run and hide! :imbar

You realize that everyone on this board who has recently moved into a new home is getting up from their computers to check the freezers, myself included!

Something to think about when you purchase your new home, SmilingBlue Eyes!

[TweetiePieRN]

When you move into a new home you get the last tenant's refrigerator??? I have lived in different cities in california and we would have to bring our own fridge to each house we moved to, except when I lived in an apartment.

I remember I worked with a nurse from Nebraska, she just moved into her house out here and was shocked that it didn't come with a fridge or washer or dryer! That's usually the norm here.

Just wondering.

[Mommy TeleRN, RN]

Interesting Tweetie.... around here (in the South) it just all depends. Many houses do come with appliances, some don't. I left mine because I had a gas stove and my new home is electric stove. I left the fridge cuz I wanted a

new(er) one (and got a 2 yr old side by side on Freecycle that just needed a $50 repair..whoohoo!)

[smk1, LPN]

not on purpose... lol but that is just me!

[SmilingBluEyes]

You realize that everyone on this board who has recently moved into a new home is getting up from their computers to check the freezers, myself included!

Something to think about when you purchase your new home, SmilingBlue Eyes!

OH MY HEAVENS!!! rofl :chuckle :uhoh21:

[MS Kathy]

I honestly didn't mean to gross anyone out..I thought it was a funny story...guess my sense of humor gets warped when I haven't had much sleep!

Many homebirthers bury the placenta under a tree as sort of a tribute to new life etc. Well that sounded nifty but I didn't have a place to plant a tree, so I stuck it in the freezer. Well I never got around to doing the tree thing and just forgot about it until last week....

Now I'm gonna duck and run and hide! :imbar

I wanted you to know I have 3! placentas in my Freezer I didn't want you to feel all alone :biggringi

I plan to do something with them soon- one moved 3 times with us.

It was sent home - no problem at all from the hosp. The second I really had to emphasize that it was mine and it was leaving the with me. and the 3rd was a home birth.

Someone mentioned not wanting to clean up after- usually the birth attendant and her help takes care of all of that.

Kathy

[Spidey's mom, ADN, BSN, RN]

I wanted you to know I have 3! placentas in my Freezer I didn't want you to feel all alone :biggringi

I plan to do something with them soon- one moved 3 times with us.

It was sent home - no problem at all from the hosp. The second I really had to emphasize that it was mine and it was leaving the with me. and the 3rd was a home birth.

Someone mentioned not wanting to clean up after- usually the birth attendant and her help takes care of all of that.

Kathy

I'm the one who mentioned the mess . . . .and I wouldn't want to make someone else do it - that is my point :imbar - that would be my problem. I can't even hire a housekeeper - how in the world would I make someone clean up my room after I delivered a baby? It is a very messy event - just made for a hospital room. :)

If I could, I'd clean it up myself before anyone else could . . . it would just be awful for me . . . in my own room having someone else have to clean everything up.

But, that is just me and my weirdness.

As to the rest, I still wouldn't want to be at home. Our delivery room is set up like a bedroom . . but all the necessary emergency stuff is handy. And our docs are not big on intervening . . . so we try to do the homebirth experience if we can.

steph

[PegRNBSN]

I have two problems with many moms who are planning on having a homebirth and they need to come to the hospital.

1. Many times they are very angry and resistant to the staff. I understand that their plans are changed and that they may be angry because of that, but it really sets up barriers between the staff and patient as we are trying to care for her.

2. It may just be our hospital, but we have this group of midwives who aren't on the up and up with us when they come to the hospital. They tell us they are doulas, they don't let us know that they were planning a home birth and many times don't share everything that went on in the home before they got there. This started from the very first time they used our hospital. I could see if we had offended them or been judgemental. Unfortunately relations are very strained and often confrontational

Any advise from home birth advocates/midwives on what we can do to alleviate this situation. (we have tried to set up meetings outside of a birth experience and they will not come)

[ljds]

Peg-

I think that some of the anger home birthers feel comes from disappointment (which there is absolutely NOTHING you can do about other than validate it!) and some of it comes from the assumtion that hospitals and medical staff look down on home birthers, find them irresponsible, ignorant, etc. Could the staff unconsciously be giving off this vibe? If so, a little sensitivity training could be in order. But, like many issues of this sort, the insult is in the mind (or unfortunately in the information they are given from their midwife). Do you note this attitude coming from the patients of one particular midwife or group? Or is it more generalized?

Either way, I think the answer to it might be to contact the area homebirth midwives and ask them how your staff can make their clients feel more comfortable, and how you can ease transition. Maybe the admission process is daunting and takes too long. Maybe the staff won't accept the mws' notes and charts, and so the mw feel slighted, and the patient feels like the hospital doesn't care about their health. Maybe the mws' patients could get any of their labwork done through the hospital (if you are a small, community hospital this could work--if you are a large, corporate or teaching hospital, I know it won't), facilitating the transfer of records, as well as making the mw feel like she is a valued part of the patient's health care team. Do these mws and their clients have back up docs? If so, approach the docs. Ask them the same questions -- how can you facilitate any transfer and make the patients and their mws feel more comfortable. Are the docs giving the mws and patients a hard time? If there *isn't* a back up doc, I wonder if the patients get a hard time when they come through the ER, and it leaves a bad taste in their mouth.

When the patient comes in, if the nurse would say something genulinely empathetic to the patient, I think that would go a long way (of course I know this is situation dependent -- if she's coming for a crash section, there isn't going to be alot of chit cat until AFTER the baby's born!). Something like "I know this isn't the environment you envisioned yourself birthing in. I know you're disappointed, but I promise to do my best to help you have a really great birth experience here. Do you have any questions I can answer right now?" Homebirthers and their partners are used to being very involved in their care, being asked permission for everything, being informed of every little thing. Trying to keep this up can be tiring, but it would really go a long way. Also asking them for a quick birth plan -- asking things like "are you planning on breastfeeding? If the baby needs to go directly to the nursery, who is going to accompany the baby? Do you want to delay cord clamping if possible? What sort of baby medications do you want? Would you prefer we give them right away, or delay them an hour? Do you want to keep your placents?" these sort of things.

Trying to do everything possible with the newborn in the mother's room is helpful -- the newborn assessment, vital signs, etc. If they can be done in the mother's arms, the better. If they have to be done in the nursery, make sure to invite the father/partner to watch, and to explain what you are doing, inviting questions and even participation, when appropriate.

Advocate for early release if appropriate and if the mother wishes.

As for the "doulas", find out if they have an overseeing body. Many midwives are affiliated with some organization, often times an accrediting body, or a school. Contact that organization, explain what is going on, what you have tried to do to facilitate a better, more open relationship, and ask for advice and guidance. That might just be enough, if they are violating their practice guidelines; then the organization would take care of it from there. Could it be a situation where lay midwives are illegal in your state? Do these mws have back up docs? If so, try to address it through the back up.

If none of these are solving the problem, I would see about confronting them every time the come to the hospital; in front of the patient, if necessary. Have the floor director or the charge nurse do it. No matter what, SHE MUST REMAIN CALM. Straight up call their bluff. "Why are you dishonest with us about your role in these women's birth? Why won't you provide us with their medical and prenatal information? Why won't you meet with us to help work these issues out?" If they continue to lie about it, I would unfortunately report them. To the state Attorney General, to their accrediting board if any, to their back up docs, if any. I would consider banning them from the floor (on the grounds that they are endangering the patient -- lying about their care) until they meet with you to address the issue. And I would make very clear to the patient that this is a consequence of the mw's failure to make any type of effort to address the situation, and is a result of the mws' continued dishonesty with the hospital. Make sure none of this is taken out on the patient. If the patient feels slighted by the mw, that is a severe consequence. Word of mouth is how most of these mws get their business, and if they get several negative stories circulating about them from former clients, that is going to hurt their business.

I'm sorry you have to deal with them being such jerks. I hope you can get them to start working with you better. It sounds like they are putting themselves before their clients -- the very thing many homebirthers feel that the "medical establishment" is guilty of!

Good luck, I hope this helps.

Lori

[PegRNBSN]

Thanks for the reply. I think it is now becoming a vicious circle, because we are just gearing up for a confrontation whenever we see these women. It has now gone to our medical director and we are working on getting some meetings set up although I am not hopeful. All we are asking for is information and honesty when these patients come in to help care for them.

I tell my co-workers to focus on the patient and not to take the anger personally.

[Jolie, BSN]

These last few posts have been very interesting to me.

I worked in a birth center in NC in the early '90's. Lay midwifery was illegal in NC at that time, but there was a very active "underground" network of lay midwives. About once a month, we would have a patient literally dropped on our doorstep by a lay midwife who would then vanish. The patient and her partner were understandably in shock over a birth experience gone awry, sudden transport to a medical facility, and the disappearance of their trusted caregiver, who was more concerned about legal issues than the continuing support of her client. We had no phone call alerting us to the incoming patient, and no access to records or even a verbal report from the midwife, so were forced to rely on the patient's description of events, which was sometimes difficult to interpret.

By the time they arrived, the moms were typically in crisis, with problems ranging from high fevers, B/Ps in excess of 200/100, and excessive blood loss. The patients and their partners were, for the most part, grateful for our care, but were also fiercely protective of the midwives, going to the extreme of refusing to contact them and ask them to call us to provide needed information. (We knew better than to ask for the midwives' names and numbers!)

Fortunately, these patients and their babies ended up "OK", but we were always fearful of a lay midwife waiting too long to transfer a patient, or failing to provide necessary information for us to provide safe emergency care. It left me with a bad taste toward lay midwives who practice without back-up.

[lisamc1RN, LPN]

It has been my experience that midwives get defensive when going to the hospitals because they are very likely to be blamed for complications (or at least, that is what they perceive). That would cause anyone to be a bit defensive. I don't know if that is the case at your hospital, and I certainly don't agree with not sharing medical records, but I wonder if the experience of working with the hospitals previously has left such a sour taste in their mouths that they are unwilling now? I think you are doing the right thing by reaching out to them. You need to let them know that they are a vital part of the patient's care and that you need them and want them. Once they get in the hospital, you need to help the midwife feel like she's not being judged harshly, blamed, or that you are mad at her. She needs to feel like she is a respected provider of care for the patient and that you can work together to help the mother have a healthy baby. :)