Would YOU ever have a homebirth?

SmilingBluEyes · Sep 2, 2005

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. :)

that is very true.

HOW we receive midwives and patients from homebirths is CRITICALLY IMPORTANT to setting the tone as to things will go. We can set the tone. By NOT being critical. By NOT showing a sense of impatience or condescension when they show up. By being PROFESSIONAL with them, as we would any patient we get in our doors, whether there is doctor assigned or not. Often nursing personnel have within their grasp a lot of opportunity to build trust just by being respectful and caring---and watching our terminology. Calling their experience (in the presence of the patient/midwife) a "failed homebirth" is very hurtful, even if that is what it is.....there are very subtle things we can do to build trust, even in the tense time of receiving these patients, under less-than-optimal conditions. Opening the lines of communications EARLY with the family and careprovider, is critical, whether we like the situation or not. Our judgements, however well-founded, need to be kept to ourselves, just as in any other case. Being professional and compassionate, is the best way to go to handling the tense situation of receiving a disappointed homebirthing couple, who for whatever reason, could not complete things at home.

Remember, they are profoundly disappointed. Remember, they feel very intimidated by hospital personnel and environment (like many folks). That is the reason why so many have chosen to give birth at home in the first place. That sense of a loss of control is very hard for any of us to deal with.

When the crisis that brings them to your care is over, offer the patient and her family choices, wherever possible. Give the mother and her partner what power you can to control their experiences, while in your care. Respect the patient's midwife knows her better than you do, and instead of building an adversarial wall, ask HIM or HER about the patient and family, the things you need to know, anyway. Engage this midwife in your care planning and treat them w/the same respect you would want as a professional, and you may get further with them.

Now, truly hostile people, we can't do much about. But then, hostile folks are everywhere. Not much you can do w/manipulative and difficult folks BUT set gentle, but firm, limits and be strictly professional and caring. Sometimes, hostility can be shut down the minute we address folks gently by name, and really engage in active listening to them about their experiences----as well as show some empathy when they express anger or frustration. IF their behavior is out of hand, you have no choice but elevate the problem up your chain for resolution. I have had to do that before, believe me. It can get tough.......

That is my best advice---and if we think about it----it goes for everyone who shows up in our doors.

Off my silly soapbox now.... :coollook:

PegRNBSN · Sep 2, 2005

How can we treat them professionally when they don't act that way???

We would love to have their input but they don't wnat to share anything with us. I had one instance where the patient had to come in because of preeclampsia. I thought I was working well with the "doula" allowing her to work with the patient as able considering her medical condition. She was 8 centimeters, denied the urge to push(she was a multip). The doula asked for some privacy with the mom. I did my assessments, the patient was on continuous monitoring and I left the room. I saw suspicious spikes on the toco ten minutes later and came in the room to find the mother crowning.

After the birth when I asked for privacy with my patient she told me that the doula told her not to tell me that she had the urge to push because the birth would be horrible. This is the case that really got the ball rolling on trying to improve our relationships with these midwives.

SmilingBluEyes · Sep 2, 2005

Please, did you read my last paragraph?

I said, if the behavior on the parts of patients and their care providers is so prohibitive that it gets in the way of your providing care according to policy/procedures, then you elevate it up the chain. You get the attention of your house supervisor and chief of OB, if needed. You write up an incident/occurence report and involve your risk management department.

Later on, you ask your manager to have it brought before your perinatal committee. Perhaps "meeting of the minds" between the community midwives and your administration is in order. Also, understand, if a person misrepresents who he/she is professionally, that is reportable----- and that person can land him/herself in HOT water---even wind up in jail.

Thank you for the chance to make myself clearer.

PegRNBSN · Sep 2, 2005

Please, did you read my last paragraph?
I said, if the behavior on the parts of patients and their care providers is so prohibitive that it gets in the way of your providing care according to policy/procedures, then you elevate it up the chain. You get the attention of your house supervisor and chief of OB, if needed. You write up an incident/occurence report and involve your risk management department.
Later on, you ask your manager to have it brought before your perinatal committee. Perhaps "meeting of the minds" between the community midwives and your administration is in order. Also, understand, if a person misrepresents who he/she is professionally, that is reportable----- and that person can land him/herself in HOT water---even wind up in jail.
Thank you for the chance to make myself clearer.

Sorry, I focused on the beginning of the post and thought you thought we weren't treating them as professionals. I guess what is frustrating is that it has come to this. I hate going up the chain and waited until that last straw to do so. I think it could be so much better for the PARENTS if we could get beyond this hostility and work together, allowing the midwives to help us and the mom and teach us at the same time. There is always so much to learn and see things from a different perspective

Sorry again for the knee jerk response

ljds · Sep 2, 2005

Peg- it *is*difficult and frustrating; but it is also refreshing to see your interest and desire to help rectify the situation. Those of us who work in out of hospital birthing environments really appreciate the nurses who have attitudes like yours!

Lori

AggieNurse2B · Sep 7, 2005

What a wonderful post! As a prospective nursing student, I'm so very impressed with your attitude...I bet you're a great nurse, and I hope that, if I ever get the opportunity to complete my nursing degree, I can maintain an attitude like yours.

that is very true.
HOW we receive midwives and patients from homebirths is CRITICALLY IMPORTANT to setting the tone as to things will go. We can set the tone. By NOT being critical. By NOT showing a sense of impatience or condescension when they show up. By being PROFESSIONAL with them, as we would any patient we get in our doors, whether there is doctor assigned or not. Often nursing personnel have within their grasp a lot of opportunity to build trust just by being respectful and caring---and watching our terminology. Calling their experience (in the presence of the patient/midwife) a "failed homebirth" is very hurtful, even if that is what it is.....there are very subtle things we can do to build trust, even in the tense time of receiving these patients, under less-than-optimal conditions. Opening the lines of communications EARLY with the family and careprovider, is critical, whether we like the situation or not. Our judgements, however well-founded, need to be kept to ourselves, just as in any other case. Being professional and compassionate, is the best way to go to handling the tense situation of receiving a disappointed homebirthing couple, who for whatever reason, could not complete things at home.
Remember, they are profoundly disappointed. Remember, they feel very intimidated by hospital personnel and environment (like many folks). That is the reason why so many have chosen to give birth at home in the first place. That sense of a loss of control is very hard for any of us to deal with.
When the crisis that brings them to your care is over, offer the patient and her family choices, wherever possible. Give the mother and her partner what power you can to control their experiences, while in your care. Respect the patient's midwife knows her better than you do, and instead of building an adversarial wall, ask HIM or HER about the patient and family, the things you need to know, anyway. Engage this midwife in your care planning and treat them w/the same respect you would want as a professional, and you may get further with them.
Now, truly hostile people, we can't do much about. But then, hostile folks are everywhere. Not much you can do w/manipulative and difficult folks BUT set gentle, but firm, limits and be strictly professional and caring. Sometimes, hostility can be shut down the minute we address folks gently by name, and really engage in active listening to them about their experiences----as well as show some empathy when they express anger or frustration. IF their behavior is out of hand, you have no choice but elevate the problem up your chain for resolution. I have had to do that before, believe me. It can get tough.......
That is my best advice---and if we think about it----it goes for everyone who shows up in our doors.
Off my silly soapbox now....

SmilingBluEyes · Sep 7, 2005

wow ty for that compliment. That means a lot to me, honestly. Good luck in your studies, if you do decide to pursue nursing as a career.

Anjewels · Sep 7, 2005

Yep! I would have homebirthed if DH would have been in agreement.

Per our compromise, all 3 of my births were in the hospital but with a CNM attending. No interventions.

It was actually my L & D Clinicals while going thru LVN school that scared me and made me want to forgo a "managed" birth . I think that's the ideology of alot of homebirthers.

kathmerkin · Sep 8, 2005

There was a time when i thought about becoming a "midwife" but i went on to have 5 children of my own, and due to Motherhood, I never did persue that, but now that I have worked OB, i would personally NOT have home birth. I think that if a woman really wants to, and lives close to a hospital in case of an emergency, and has a VERY GOOD midwife with loads of experience, then I think it usually turns out a wonderful experience.But I have sure seen RAPID emergencies, for both Moms AND infants. I think there is risk involved for sure. Kathie

nadjjaa · Sep 8, 2005

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.

I'm sure this has been said many times already but here goes. No way would I have a home birth. I guess that people opt for home births because they feel more comfortable and relaxed in the home setting than in a sterile hospital with a bunch of strangers around. You know what makes me comfortable? The reassurance that, should something go wrong, that I will be within seconds of help. I wonder sometimes, if the people who opt for home births really have any idea of the things that can go wrong during childbirth, and that precious time is lost when you have to make a mad dash for the hospital.

I'm not knocking home births, they definitely have their advantages, and I would never critisize a mother who wanted to have one. It's a personal choice - and my personal choice would always be to have my babies in a hospital environment.

Also - the L & D rooms in my hospital are like cushy hotel rooms. Everything is wood, and there is TONS of space. When you're done with the delivery and can lay in a real bed, a queen size bed pulls down from the wall and they're VERY comfortable. Sorta makes you want to stay an extra few days before the craziness of having a new baby in your house ensues.

LydiaNN · Sep 8, 2005

Not by choice, I wouldn't, but we all know accidents happen.

kmrmom42 · Sep 9, 2005

BTW - the reason I said 'Physician' is because many hospitals suggest instead of asking a patient if they have a "doctor" some may answer no, because they have a nurse practitioner. They now suggest the term Physician because it is broader and encompasses both. Not meaning I would be a Dr = MD if I got my NP.

I didn't read all the posts but I wanted to just correct this. If someone is suggesting that the term physician refers equally to Nurse Practitioners and Medical Doctors they are mistaken. I think that other folks have clarified that Nurse Practitioners are not only NOT physicians they probably would be offended to be called a physician!! They are proud of their nursing roots and personally I respect those roots almost more than those of the physician. I choose to see Nurse Practitiones instead of physicians whenever possible.

If you want to be sure to include nurse practiioners, nurse midwives as well of physicians when talking to a patient it is appropriate to ask them who their "medical care provider" is. That term includes it all!

I think it is great that you are participating in this forum, getting some of the answers you need, and I wish you the best in your future career!