Homebirths vs Hospital

[2xx1xy1JD]

There is objective, published-in-a-peer-reviewed-medical-journal evidence that planned homebirths can be as safe as hospital births:

http://www.cmaj.ca/content/181/6-7/377.full.pdf

HOWEVER, you need to look at the fine print before concluding that all homebirths are safe. They aren't. They only studied planned homebirths, which were attended by certified midwives in accordance with strict regulations.

Midwives in some Canadian provinces are regulated. This means that they have standard training, they are capable of doing certain things, they carry oxygen with them and they are required to follow some pretty strict regulations. If you are too early or too late or having twins or live more than a certain distance from the nearest hospital or have anything at all that takes you out of the low-risk category, you are not able to have a midwife-attended homebirth.

[Granwych]

As a retired LPN, I always was in favor of a hospital birth. I also had a patient who decided to give birth at home in a kiddie pool of water; the cord was wrapped tightly around the baby's neck and he was born severely handicapped. DD was born in the hospital after 8 hours of a non-productive attempt at induction. Now that my daughter is considering starting her family, I would be okay with a CNM, preferably in a hospital setting. (You can bet that I'll be RIGHT THERE!) There are no birthing centers in this area, unfortunately. I just read an older book called "Spiritual Midwifery" by Ina Mae Gaskin, that was very informative.

Toby's mom

[Kitty Luna]

I haven't read all the responses, but I'm just responding to the OP. I had an unmedicated (aside from getting induced with cervadil) hospital birth with a midwife (CNM). It was a great experience. A CNM is, essentially, as trained as an OB when dealing with vaginal births. In many other countries, a pregnant woman wouldn't see an OB unless there were complications or c-section needed.

The standards for an OB and for a CNM are very different. In my state, a CNM is a nurse who has completed a midwifery course and has passed the ACNM or AMCB boards. After 2 yrs in a Master's Program and 4 years of a BSN, they can be licensed as a CNM. An OB has 4 yrs undergrad, 4 yrs of med school and 4 yrs of residency and completed boards. Sure, when dealing with a normal, vaginal birth a CNM is more than adequate to handle the situation, but they are not equivalent to an OB and their training is not equivalent. A CNM attends far fewer births than an OB does prior to licensing. A CNM cannot prescribe schedule I drugs. A CNM's training is very patient focused and very nursing focused. An OB's training is more object (delivering a baby) focused and medically focused.

I say this as a CRNP who seriously considered the CNM program. I work in the ER as a critical care nurse and while I provide care similar to a physician, my training is not the same as a physician's. Nursing and Doctoring are two different things. I provide support to trauma cases, but I can lead on other cases. Need stitches? I can do that as well as a physician. Stabbed in your abdomen and rapidly losing blood? I'll start your IV, give you drugs and take orders.

[argypargy]

The standards for an OB and for a CNM are very different. In my state, a CNM is a nurse who has completed a midwifery course and has passed the ACNM or AMCB boards. After 2 yrs in a Master's Program and 4 years of a BSN, they can be licensed as a CNM. An OB has 4 yrs undergrad, 4 yrs of med school and 4 yrs of residency and completed boards. Sure, when dealing with a normal, vaginal birth a CNM is more than adequate to handle the situation, but they are not equivalent to an OB and their training is not equivalent. A CNM attends far fewer births than an OB does prior to licensing. A CNM cannot prescribe schedule I drugs. A CNM's training is very patient focused and very nursing focused. An OB's training is more object (delivering a baby) focused and medically focused.

I say this as a CRNP who seriously considered the CNM program. I work in the ER as a critical care nurse and while I provide care similar to a physician, my training is not the same as a physician's. Nursing and Doctoring are two different things. I provide support to trauma cases, but I can lead on other cases. Need stitches? I can do that as well as a physician. Stabbed in your abdomen and rapidly losing blood? I'll start your IV, give you drugs and take orders.

I understand this, and that's why in my last post I corrected it to "routine" vaginal births. A good CNM also knows when things are getting too complicated and require an OB. However, I still stand by that a CNM is prefectly trained to deliver a baby through an uncomplicated, routine vaginal birth. Of course, the midwife group I used was within the same group as a lot of OBs, so they had certain protocols that were followed by the whole group (OBs and Midwives).

I also like the more patient focused feel I got when utilizing a midwife over an OB (I saw an OB for the first 20 weeks of my pregnancy). She was pretty much bedside the entire time, encouraging me to try certain positions or take a walk or breath differently. That's one of the big reasons I went with a CNM over an OB. The OBs I saw were just so matter-of-fact.

[Freyacat]

VBAC is actually a HUGE (possibly the #1) reason women go for homebirths- VBACs are entirely safe if the CS was done for non-emergency reasons (like so many are these days). My CNM who only does hospital births is a huge proponent of giving women the chance to VBAC. A lot of OB's malpractice and hospital policies, however, do not allow for VBACs.

I know of at least one CS that was done after a "failed" induction at 38 weeks, because the mother was "tired of being pregnant". Call me crazy, but I'd rather wait than go in for that experience. Now, a woman like another friend, who had cord prolapse and fetal heartbeat ping-ponging between superfast and v e r y sow.. VBAC may not be the right choice for them. VBAC would be safer (and likely suggested, with the right practicioner) in the first instance, but not necessarily out in the second.

Not that I'm a fan of the Ricki Lake sensationalism of medical practices in birth, but the fact of the matter reamins that a lot of CS are done for convenience or "failure to progress" after less time than could be given to laboring mothers. VBAC is perfectly safe if you're ok'd for it.

One quibble with this. VBACs are not "entirely safe" as you say. They are generally safe. I absolutely think more hospitals/doctors should allow them. But there is a very small elevated risk of uterine rupture. The problem is lawsuits - some patients have had VBACs, had uterine rupture, and then sued their doctors for not doing a repeat c-section, claiming they did not understand the risk of uterine rupture. So now a lot of malpractice insurers won't cover doctors who offer VBAC, so the doctors are unable to offer it even if they want to. I'm not sure how to fix that problem, because I do think women should be able to make a choice to try for a VBAC (once they are fully informed and educated about the small, but present, risk of uterine rupture). I also think, though, that women should be able to choose a repeat c-section if they want to without any pressure from other moms to try for VBAC.

[LadyBlue]

I would think that firing your OB while during labor would be a pretty insane move for a woman who has potentially risky heart issues.

Why? Unless you're in a small hospital that only has the 1 OB, which I think would be a bad idea in itself if you have heart issues, they'll grab another OB for you if you fire yours. It's not like you fire your OB during labour and they close the door & leave you to have an unassisted birth. It's illegal for them to kick you out and they have to treat during labour.

Sure you're taking a chance on what the available OB is going to be like, but if your current one is so bad you're considering kicking them out, odds are pretty good whoever they have will at least be better. You can also refuse to have a particular nurse care for you.

[Slt]

Homebirths terrify the hell out of me. There is a website out there with failed homebirths (severely handicapped children or babies born dead) that helped with that. http://hurtbyhomebirth.blogspot.com/ Didn't break the link because the blog owner would not be disturbed by this subject matter being discussed. - WARNING- Triggering photos.

However, I am an RN and I am far more comfortable with more interventions than fewer. Thankfully, I had a doc on my case who is also a family friend and who followed my pregnancy very closely. When I went into preterm labor at 30 weeks, and my son was already 5.5 pounds (almost double what is deemed normal at that gestation), we knew we'd need a growth U/S later on. He was measuring at 9 pounds at 38 weeks, and I scheduled a C/S for 39 weeks. He ended up being 10 pounds- and not only had his cord wrapped around his neck THREE times, he had two "true" knots- which would have cut off his oxygen had I been allowed to labor naturally.

Best case scenario would have been an emergent C/S and if I had birthed at home, I shudder to think what would happen. There was NO clue to either of those complications with my ultrasound only a week earlier. Anyway, lay midwives (CPMs) are illegal in my state, though I know of many people who have had them recently. I always get very, very nervous as their due dates arrive for their safety, and baby's.

[Freyacat]

Why? Unless you're in a small hospital that only has the 1 OB, which I think would be a bad idea in itself if you have heart issues, they'll grab another OB for you if you fire yours. It's not like you fire your OB during labour and they close the door & leave you to have an unassisted birth. It's illegal for them to kick you out and they have to treat during labour.

Sure you're taking a chance on what the available OB is going to be like, but if your current one is so bad you're considering kicking them out, odds are pretty good whoever they have will at least be better. You can also refuse to have a particular nurse care for you.

Because whatever OB has been seeing the patient throughout pregnancy knows the details of the patient's specific health issues and conditions. I can see switching OBs at the very last minute if you have a very common health issue that any OB can be expected to know about, say pre-eclampsia. But this sounded a little more uncommon and involved. It would be good to have a doctor who had had a chance to find out everything relevant about this issue, IMO.

[eohiken]

There is objective, published-in-a-peer-reviewed-medical-journal evidence that planned homebirths can be as safe as hospital births:

http://www.cmaj.ca/content/181/6-7/377.full.pdf

HOWEVER, you need to look at the fine print before concluding that all homebirths are safe. They aren't. They only studied planned homebirths, which were attended by certified midwives in accordance with strict regulations.

Midwives in some Canadian provinces are regulated. This means that they have standard training, they are capable of doing certain things, they carry oxygen with them and they are required to follow some pretty strict regulations. If you are too early or too late or having twins or live more than a certain distance from the nearest hospital or have anything at all that takes you out of the low-risk category, you are not able to have a midwife-attended homebirth.

QFT because there isn't anything inherently dangerous about childbirth at home. Problems arise from the lack of a qualified birth attendant.

[August]

QFT because there isn't anything inherently dangerous about childbirth at home. Problems arise from the lack of a qualified birth attendant.

There are unheralded complications which make homebirth more dangerous, they're very infrequent, and the stats are balanced by in-hospital complications. But, compare best case hospital birth (which is not common) vs best case homebirth when you have an abruption, or an AFE. If they need to they can have you under and baby out in under ten minutes. That's why I chose hospital. My hospital option was pretty much best possible, though, which most people don't have available.

[HOTW]

My Mum's second homebirth had the complication of the cord wrapped around my sisters neck(it was a very long cord) she realized it as soon as she crowned and went in and cut it blind. My sister was born without complications(she is still a witch) and the worst part was my Dad almost passed out when he was allowed in the room immediately after the birth because she was a tad messy! The Dr said he never worried when she was on the job as she could handle most minor complications

[August]

That hurt by homebirth blog is a load of bull.

First, it's run by Amy Tuteur, who is rabidly dumb.

Second, I'll tally up the stories

Shoulder Dystocia

Breech with risk factors

Hospital birth with dismissive doctors

Pneumonia

Abruption

Malpositioned, negligent midwife

Negligent OB and negligent midwife

DIC, abruption, negligent midwife

GBS pneumonia

36 weeks preemie, negligent midwife

abruption, negligent midwife

That's it - a whole lot of negligent midwives. Not to say that you couldn't have a better abruption survival rate at a hospital, but these all had symptoms their midwife ignored. The pneumonia babies crashed very quickly, one of them wouldn't have been caught in a hospital, but her mother should have had abx.

[FiddleDD]

QFT because there isn't anything inherently dangerous about childbirth at home. Problems arise from the lack of a qualified birth attendant.

And those problems can arise on hospitals as well. Midwives are not perfect, neither are doctors. And of the problems in home births I've personally read about, the only one where there would have been a different outcome at a hospital was the unassisted birthing woman, and her child would have survived if there had been a midwife present. (I'm not talking about cases of gross misconduct on the part of the midwife, I'm referring to rare complications like have been discussed on this thread)

The truth of the matter is, something bad can happen no matter where you are. I'm happy to live in a time where I have the choice of home or hospital. I think everyone should be educated no matter their choice. I wouldn't want someone choosing home birth just because of a trend anymore than I want to see people scheduling c sections because they might go into labor to early in the morning.

[Mama Mia]

I think you can get into a bunch of chicken and egg scenarios when you are comparing complications and what the outcomes would be at home or in the hospital.

For example: I was going to have a second vbac, in the hospital. My Doctor decided to break my water to induce labor as he was going out of town and was concerned the Dr. covering for him would push for a c-section. There was 0 reason to think I would need a c-section. The first c-section had been due to a breech baby and the previous vbac had a quick labor and no complications.

He broke the water, but because the baby was still high up I had a cord prolapse. A true and terrifying emergency, and an immediate c-section.

I could say that the baby would possibly have died if I wasn't already in the hospital and able to have the emergency c-section. But on the other hand, if I had been at home, I wouldn't have been induced and the cord would likely not have prolapsed causing the emergency.

[Freyacat]

That hurt by homebirth blog is a load of bull.

First, it's run by Amy Tuteur, who is rabidly dumb.

Second, I'll tally up the stories

Shoulder Dystocia

Breech with risk factors

Hospital birth with dismissive doctors

Pneumonia

Abruption

Malpositioned, negligent midwife

Negligent OB and negligent midwife

DIC, abruption, negligent midwife

GBS pneumonia

36 weeks preemie, negligent midwife

abruption, negligent midwife

That's it - a whole lot of negligent midwives. Not to say that you couldn't have a better abruption survival rate at a hospital, but these all had symptoms their midwife ignored. The pneumonia babies crashed very quickly, one of them wouldn't have been caught in a hospital, but her mother should have had abx.

ITA they had negligent midwives. The problem is that most of those negligent midwives have no oversight. Many of the midwives in the stories on that blog faced no sanctions whatsoever for their actions; if a doctor missed some of the signs these midwives did, their license would be in serious jeopardy. I am not opposed to homebirth in theory, but I think it's very reckless how little oversight there currently is for midwives in most US states and I wish that would change to a system more like the Netherlands or Canada.

[August]

No argument there, the lack of training and oversight for birth attendants in the US is scandalous.

[LilMissMetaphor]

I don't believe in natural anything.

Natural is fucking painful and often deadly.

And if we're talking about food, artificial often tastes better.

Fuck, I love chemicals.

[August]

Fuck, I love chemicals

And now I have to go and watch Tim Minchin

http://m.youtube.com/#/watch?v=4bEGLbCN ... bEGLbCNRqw

[yewchapel]

I don't believe in natural anything.

Natural is fucking painful and often deadly.

And if we're talking about food, artificial often tastes better.

Fuck, I love chemicals.

As Hank Green would say, everything is chemicals! I agree with you (maybe not about food). Hemlock is very natural, but that doesn't mean I'd want to eat it!

[Arete]

I will never have a baby, but on the off chance that the sun decides to rise in the west and I reverse that decision, it would be better living through chemistry and good drugs all the way.

Carry on ladies, carry on. :mrgreen:

[LadyBlue]

My Mum's second homebirth had the complication of the cord wrapped around my sisters neck(it was a very long cord) she realized it as soon as she crowned and went in and cut it blind. My sister was born without complications(she is still a witch) and the worst part was my Dad almost passed out when he was allowed in the room immediately after the birth because she was a tad messy! The Dr said he never worried when she was on the job as she could handle most minor complications

Argh! This drives me crazy, although until very recently it has been SOP for both doctors and midwives. 1) Cord around the neck is common (somewhere around 30% of babies have one) and rarely an issue unless there is some kind of issue with the Wharton's Jelly or it is extremely tight. My second baby had a nuchal cord, my third had a true knot (which can be more problematic, but wasn't discovered until his placenta was examined after birth) 2) It is the only way the baby is getting any faint bit of oxygen. When it is cut before the baby is born, the baby a)gasps trying to get air, inhaling who knows what from the birth canal and b)very rapidly gets oxygen deprivation. If the baby is not born immediately, that can be a serious problem.

The proper procedure is to "summersault" the baby out, so that the head stays near the vaginal opening while the baby's legs and body fall away from the mother to prevent further tightening, then gently unwrapping the cord and allowing all the blood an oxygen that was trapped in it to revive the baby. Hospitals in England seem to be getting on this these days with the invention of a cart that allows newborn resuscitation without cutting the cord. It hasn't made it's way here yet, for the most part.

http://www.ncbi.nlm.nih.gov/pubmed/16154063

http://midwifethinking.com/2010/07/29/nuchal-cords/ pics of summersault manuver

[eohiken]

I think you can get into a bunch of chicken and egg scenarios when you are comparing complications and what the outcomes would be at home or in the hospital.

For example: I was going to have a second vbac, in the hospital. My Doctor decided to break my water to induce labor as he was going out of town and was concerned the Dr. covering for him would push for a c-section. There was 0 reason to think I would need a c-section. The first c-section had been due to a breech baby and the previous vbac had a quick labor and no complications.

He broke the water, but because the baby was still high up I had a cord prolapse. A true and terrifying emergency, and an immediate c-section.

I could say that the baby would possibly have died if I wasn't already in the hospital and able to have the emergency c-section. But on the other hand, if I had been at home, I wouldn't have been induced and the cord would likely not have prolapsed causing the emergency.

The doc did something wrong, but was there to save you, so you are happy with the doctor?

[Nothing2CHere]

Reading this thread makes me SO glad I opted for a scheduled c-section with all the lovely drugs that were involved ;) But that's because I was also in a really great hospital with really great staff, and I also had no complications from the surgery. I'm one very lucky gal.

ETA: My scheduled c-section wasn't for vanity reasons; they were predicting a large birth weight for my baby and I was terrified that if I tried to give birth vaginally I'd end up with a baby in distress from a hard labor and an emergency c-section anyway, so I decided to just skip to the end. My baby ended up being a pound over what they had estimated.

[hapamama]

I've had 5 vaginal deliveries, all at hospitals... youngest 3 with epidurals. The thought of homebirth never crossed my mind, and I'm pretty granola crunchy. I liked having that 36 to 48 hours after my babies were born to recuperate and get to know the new baby without the stress of housework or entertaining visitors.

[AKay]

I've had one hospital birth and will be having another one this summer. My personal experience was very positive and I had no complications.

I respect the choices of people who opt for a home birth with well-trained professionals after having done their homework, but I personally have zero interest in giving birth in my house. I just don't get the appeal of it at all.