Homebirths vs Hospital

[formergothardite]

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.

Amen. I was all "Natural birth! Squee!!!" and then I was all "fuck that shit. I want drugs. Now."

[sacrilicious]

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

It's one of those things where most of the time everything works out well, and a lot of problems can be detected in enough time to transfer, assuming the midwife is adequately trained which isn't always the case. But a small (but not insignificant) percentage of births go really bad, really fast, and I personally wouldn't want to be home in a situation like that. Even with the best of midwives and being 10 minutes away from the hospital. Babies can die from lack of oxygen and women can bleed to death in less time than that. It's like playing Russian roulette. How lucky do you feel?

[Trynn]

I personally don't think home births (with properly trained midwives) are a bad thing. However, for me personally, I am going to the hospital because they are going to give me that epidural and whatever other painkiller they're legally allowed to throw my way. (except morphine, cuz I don't react well to that.)

[Irishy]

Yeah I was never attracted to home birth because to me, home is my place of work and it's a busy noisy place. Fun, but not quiet and relaxing except on Wednesday nights after 9pm (when the children are asleep and the cleaner's just been).

I had enjoyable normal deliveries at a hospital with just gas & air. But I never ever ever saw a doctor during my hospital stays. Except for a paed to check over the babies before we went home. Normal birth here is handled by midwives and you won't see a doctor unless there's a problem.

I watched that show Deliver Me a few times. Those three ladies are the MOST intervention happy doctors I have ever seen. Oh your progress is slow, let's just do a c section! Oh your baby looks BIG, c section! Baby turns out to be like 8.5 lbs - big whoop. People delivering naturally on that show are portrayed as the big freaks. And the constant pelvic exams pre delivery? We don't get a gloved hand until we're IN labour here. What's the point in telling someone they're 1cm dilated at 37 weeks? So what? You could still be 1cm at 41 weeks. That is the extent of my experience of childbirth in the USofA. End of rant.

[belly_button]

I had both a hospital birth, induced with an epidural, and then a birth with a CPM.

The hospital birth was ok, but it was more impersonal. With the epidural I felt absolutely nothing, until after, recovery was kind of hard. I was induced and felt like I was pushed into an induction (however I've come to find out that doctor tends to do that).

The CPM birth was very patient-based/personal. It sounds really dumb but I had no idea of the level of pain it was going to be, or what labor would be like. Recovery was a breeze. The very next day I felt great.

As someone said, having the cord around the baby's neck when born isn't uncommon. In the hospital, my husband was watching and the doctor quickly unwrapped it and cut it. With the CPM, I don't remember the actual moment of birth but I'm pretty sure I heard someone say later the cord was around baby's neck.

Why did I choose a CPM? Because I wanted a midwife/homebirth and at the time there were no CNMs close by that would deliver. I also had plans to have a waterbirth and none of the hospitals would do that either. I have no known health issues and didn't have any complications during pregnancy. I started out with an OB and about halfway through decided to go with the CPM. I will say that my CPM, per state regulations I believe, had me meet with a CNM several times to make sure everything was ok for a homebirth. She sent me to an ultrasound, suggesting a C-section if baby was breech. (baby turned head down)

During the pregnancy, we discussed our emergency plan several times. We were five minutes from 2 hospitals so I felt we would be just fine. Now that I've been through the birth, I would say 5 minutes away isn't close enough. Had anything gone wrong, there would have been no way to get to either hospital quickly enough. There just would have been no way I could have gotten outside to a vehicle and in the hospital in time, let alone be admitted and taken to the right part of the hospital for whatever needed to be done.

Within the last month, a new birth center has opened up very close to my house. This is run by CNMs, is associated with a local hospital and I'm pretty sure the OBs at the hospital take turns being on call or whatever. We would do it that way. I think that would be the best of both worlds.

No matter how I chose to give birth, I got an earful from people. With the first I heard about how bad it was to be induced and get an epidural. With the second, the advice ranged from how dangerous a homebirth was to how I needed to go ahead and attempt a breech homebirth.

I definitely think it should be the woman's choice of how she wants to have the baby. The goal is a healthy baby, whether that baby comes by c-section or unassisted home birth.

Not relevant to this thread but while I was pregnant with my last one I heard a lot of incredibly rude comments. I did gain a ton of weight but can someone really think it is necessary to tell me how huge I am??

[snowflake_quilter]

A CNM cannot prescribe schedule I drugs.

Actually, schedule I drugs are things like heroin that no one prescribes. Technically, THC is a schedule I drug as well, which gets into some of the issues with medical marijuana.

Prescriptive authority for CNMs varies by state. In my state, I am allowed to prescribe anything that the physician that I work for can prescribe. I prescribe schedule II medications on a pretty regular basis - stuff like fentanyl, percocet, etc.

[August]

Actually, schedule I drugs are things like heroin that no one prescribes. Technically, THC is a schedule I drug as well, which gets into some of the issues with medical marijuana.

Prescriptive authority for CNMs varies by state. In my state, I am allowed to prescribe anything that the physician that I work for can prescribe. I prescribe schedule II medications on a pretty regular basis - stuff like fentanyl, percocet, etc.

I had a midwife, but the doctor put the needle in my spine.

[OkToBeTakei]

Actually, schedule I drugs are things like heroin that no one prescribes. Technically, THC is a schedule I drug as well, which gets into some of the issues with medical marijuana.

Prescriptive authority for CNMs varies by state. In my state, I am allowed to prescribe anything that the physician that I work for can prescribe. I prescribe schedule II medications on a pretty regular basis - stuff like fentanyl, percocet, etc.

I'm assuming drug scheduling is different to where I live as schedule 1 drugs are commonly prescribed in palliative care? I certainly hope that is the case.

[August]

Within the last month, a new birth center has opened up very close to my house. This is run by CNMs, is associated with a local hospital and I'm pretty sure the OBs at the hospital take turns being on call or whatever. We would do it that way. I think that would be the best of both worlds.

A birth center is no different than a home birth, it's just a 'home' with tubs and soundproofing.

[formergothardite]

The hospital I delivered my first at had a birth center attached to it and it wasn't anything like my home. It was nice because when the pain got too much there was no problem with getting pain relief as soon as possible.

[belly_button]

A birth center is no different than a home birth, it's just a 'home' with tubs and soundproofing.

I haven't checked this place out yet but since this birth center is run by CNMs with the oversight of the hospital and the OB-GYN group associated with that hospital, I'm wondering if pain medication/emergency equipment is available. At the very least, I'm assuming that more would be available than what I would have at my home, with a CPM.

This birth center also offers well women checks, which I imagine would include various types of testing and at least some sorts of birth control. Like I said, I haven't checked it out there but since I'm not happy with my current care provider, I'm going to see if insurance will cover this place for my annual exam.

My CPM has a "birth center", too. I think her birth center is more like what you're thinking of. Basically it's her office with a room dedicated to exams/births. Almost like the woman giving birth would be having a "homebirth" at the CPM's home, rather than her own. If that makes sense.

[formergothardite]

Did anyone ever watch that one midwife show that was on Discovery Health a couple of years ago? I can't remember the name, but that midwife was mean! She screamed at the poor moms all the time. I can't figure out why anyone would go to her.

[Madge3]

When I was pregnant with my daughter I thought about using a CNM but decided against it in the end because I was so anxious about labor and not knowing how I would handle the pain. She ended up being posterior and I had a very difficult delivery (18+ hours) and pushed for 3 hours. The Dr finally ripped me (apparently my husband said you could see where I was tearing and she just took her finger on it and pushed down and it ripped open - SO FREAKING GLAD I COULDN'T FEEL THAT!!!) and she was born shortly after. When I got pregnant with my son I considered it again because I realized I could handle the pain and 2nd time around labor is usually much shorter. I ended up with gestational diabetes so I was considered high risk. I ended up going into early labor at 32 weeks which was eventually stopped but I was put on bed rest after a brief hospital stay. I went into labor again at 36 weeks and he was born then. I also had the problem with my son though that some others said with the slow dilation thing. It was taking forever so the nurses were not paying too much attention to me then my contractions became out of this world. Way worse than I had with my daughter. The nurse checked and I was only 7 cm but said she was going to page my ob just in case. My son was born 15 minutes later with the doctor only walking in at the last second. We all thought the nurse would be delivering him. He had to stay briefly in the NICU so I was very thankful for the hospital in those terms. However, I totally understand why someone would choose to do a homebirth.

[argypargy]

I had a midwife, but the doctor put the needle in my spine.

Yes. An anesthesiologist put a needle into your spine. If you had an OB, he/she still would not have given you the epidural. It's outside of their specialty.

[snowflake_quilter]

I'm assuming drug scheduling is different to where I live as schedule 1 drugs are commonly prescribed in palliative care? I certainly hope that is the case.

http://www.deadiversion.usdoj.gov/schedules/

Schedule I Controlled Substances

Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("Ecstasy").

[snowflake_quilter]

Yes. An anesthesiologist put a needle into your spine. If you had an OB, he/she still would not have given you the epidural. It's outside of their specialty.

An anesthesiologist or a CRNA (certified registered nurse anesthetist) puts the needle in the spine. In order to do that, they need an order from me or the OB.

[Violet]

http://www.deadiversion.usdoj.gov/schedules/

Schedule I Controlled Substances

Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("Ecstasy").

Heroin = diamorphine, right? My grandma was given it when she was in the hospice during the last days of her life - it was probably what tipped her heart over the edge in the end but that was the point, she was dying, there were no two ways about it - my dad (who's been a nurse for over 35 years) told me that they give it to patients who are dying (i.e. palliative care) and slowly increase the doses as necessary and you know that at some point you're going to be the one who gives them the fatal dose.

(Edited for riffles.)

[Jinger Jar]

Two years ago the daughter of a close friend of mine had her first child. Rachel, the daughter, wanted me to be there because my friend's husband, Rachel's father, also was going to be there, and I am one of the few people who can put up with his know-it-all attitude for more than a few minutes without getting testy.

A couple of important facts:

She gave birth at home.

Home was a ratty student apartment in Santa Cruz.

She had a midwife.

Her parents were there.

Her father is an obstetrician.

She and her husband had a very Santa Cruz pregnancy: moon goddess meditation, drum circles, crystals, all quite hippie dippy. And hey, it was her pregnancy and she was entitled to have it any way she wanted it, but I think more than a bit of the hippie dippiness was aimed squarely at OB/GYN Dad. Her mother told me that her initial plan was to have a completely unassisted birth, just her and her husband, but her dad went ballistic when he found out and hounded her until she agreed to a midwife.

So she went into labor and the three of us - mom, dad, and I - made the drive over to the apartment. When we got there the Hindu bunting was hung, Buddhists were softly chanting through the iPad, the healing candles were lit. Her husband was chanting along with the Buddhists while massaging her shoulders and back. The midwife seemed quite competent. My friend, the new grandma who is herself an old hippie, was obviously digging the whole thing.

But I thought Rachel's father was going to lose his mind. :lol: He was quite respectful of his daughter and the midwife in that he stayed out of their way, but he spend a lot of time with me in the kitchen fretting. Why did the cat have to be in the apartment? Had anyone thought to sanitize the mattress? Had the bathtub been disinfected with anything more than patchouli oil and prayers? At one point he stepped in the plate of wet cat food with his bare feet (Rachel and her husband are a no shoes in the house couple) and thundered, "This is like delivering a baby in the goddamned zoo!"

We hadn't been there long when I realized why Rachel wanted me there - I gave her dad someone focus on so she could have all of her husband and mother's attention and energy for the labor and delivery. To that end I did my job. The labor was uneventful and she was delivered of an adorable daughter early the following morning while squatting by the couch in the living room.

Grandpa was instantly in love with his granddaughter, but you could so tell part of him wanted to whisk her away to a clean, brightly-lit, hospital nursery. :lol:

[OkToBeTakei]

http://www.deadiversion.usdoj.gov/schedules/

Schedule I Controlled Substances

Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("Ecstasy").

Yes. I don't live in the US. Which I think I mentioned. You might have addressed my other question though. I could easily look up different scheduling of drugs for all countries.

[OkToBeTakei]

Heroin = diamorphine, right? My grandma was given it when she was in the hospice during the last days of her life - it was probably what tipped her heart over the edge in the end but that was the point, she was dying, there were no two ways about it - my dad (who's been a nurse for over 35 years) told me that they give it to patients who are dying (i.e. palliative care) and slowly increase the doses as necessary and you know that at some point you're going to be the one who gives them the fatal dose.

(Edited for riffles.)

Yes it is diamorphine. Normally used in palliative care with an anti-emetic and sedative.

[August]

Yes. An anesthesiologist put a needle into your spine. If you had an OB, he/she still would not have given you the epidural. It's outside of their specialty.

Yes, anaesthesiologists are doctors. There are also nurse anasthesiologists, but not at that hospital. Why do you think an OB would be giving epidurals?

[daisyjane1234]

This is one of the few topics that would pull me out of my longtime lurker status.

There were a few comments about the idea that being in the hospital reduces risks because one can get medical intervention quickly vs. being at home. That is, of course, true. But the shit can hit the fan in a serious way in the hospital as well.

I delivered my son in a hospital and would have been considered a low-risk pregnancy. My son was asphyxiated following a major SNAFU by an OB who had never met me before he walked into the room and attempted to deliver my son. Within a few minutes of his arrival a botched forceps attempt forced a crash c-section. The doc just happened to be the OB on call the day I went in to labour. My care, prior to that point, as is often the case in my part of Canada, was managed by my family doctor. To this day my son lives with profound physical and intellectual disabilities. His care is managed with round the clock nurses in our home. I have often wondered what the outcome of the birth might have been had my care been managed by a midwife. I am quite sure my care during labour would have been transferred to an OB and I would have delivered in a hospital regardless of where I might have started (home or hospital). But my understanding of midwives is that they develop a strong sense of the mother's health and their progress during pregnancy and labour. I have wondered if a midwife would have had a better sense of the emerging complications because of their ongoing involvement in my care and advocated on my, and my son's, behalf once transferred to the OB.

[Seztacular]

I don't think there's anything wrong with either choices.

As for having help at hand, sometimes it doesn't matter if the doctor is in the next room or next town over. If something is going to go wrong it will, regardless of who is present.

[LadyBlue]

It's one of those things where most of the time everything works out well, and a lot of problems can be detected in enough time to transfer, assuming the midwife is adequately trained which isn't always the case. But a small (but not insignificant) percentage of births go really bad, really fast, and I personally wouldn't want to be home in a situation like that. Even with the best of midwives and being 10 minutes away from the hospital. Babies can die from lack of oxygen and women can bleed to death in less time than that. It's like playing Russian roulette. How lucky do you feel?

That's one of those questions that's kind of...ridiculous. Bad things can happen at any point in pregnancy (or life for that matter). Most of the time it doesn't, just like in labour. We don't live in the hospital for our entire pregnancy in case of abruption or cord prolapse (just 2 complications that are very dangerous and occur pre-labour, although prolapse requires that the waters be broken and baby not engaged for it to happen). Also, no matter how fast it goes bad, hospitals consider it great if you can be in an OR and operated on in less than 20 minutes; decision to incision in 20 minutes. That's the goal, it sometimes isn't even that fast, although, rarely, it's faster. If you live closer than that to the hospital and call ahead to tell them you're coming in with 'x' emergency, there needs to be an OR and team, there's a good chance you will be in the OR as fast, or faster in some cases, than if you were in the hospital. At least in part because in the hospital, you're often just left with a machine monitoring you, sometimes for long periods. At home, you're being monitored by a real person who can spot problems earlier than a machine.

One of the 2 women I "know" who had a uterine rupture was having a homebirth, realized something was wrong and went to the hospital. There, they ignored her begging for a cesarean, because the monitors showed the baby was fine (I'm sure this wouldn't happen today, but it was quite awhile ago). By the time the monitors showed a problem, 3 hours later, and they finally did the cesarean, it was too late for her baby.

Are there babies who would have lived or avoided damage if they had been born in hospital, but they were born at home? Of course. Are there babies who would have lived, or avoided damage if they'd been born at home instead of hospital? Yes, there are. Most of what doctors do is actually NOT evidence based. It's easy to find the studies to show that.

Midwifery and OB training both needs to be intensive and evidence based, preferably with regular classes to update their training. And then the decision needs to be left to the mothers, since they and their families are the ones who will have to live with the results.

[Turtle]

That's one of those questions that's kind of...ridiculous. Bad things can happen at any point in pregnancy (or life for that matter). Most of the time it doesn't, just like in labour. We don't live in the hospital for our entire pregnancy in case of abruption or cord prolapse (just 2 complications that are very dangerous and occur pre-labour, although prolapse requires that the waters be broken and baby not engaged for it to happen). Also, no matter how fast it goes bad, hospitals consider it great if you can be in an OR and operated on in less than 20 minutes; decision to incision in 20 minutes. That's the goal, it sometimes isn't even that fast, although, rarely, it's faster. If you live closer than that to the hospital and call ahead to tell them you're coming in with 'x' emergency, there needs to be an OR and team, there's a good chance you will be in the OR as fast, or faster in some cases, than if you were in the hospital. At least in part because in the hospital, you're often just left with a machine monitoring you, sometimes for long periods. At home, you're being monitored by a real person who can spot problems earlier than a machine.

One of the 2 women I "know" who had a uterine rupture was having a homebirth, realized something was wrong and went to the hospital. There, they ignored her begging for a cesarean, because the monitors showed the baby was fine (I'm sure this wouldn't happen today, but it was quite awhile ago). By the time the monitors showed a problem, 3 hours later, and they finally did the cesarean, it was too late for her baby.

Are there babies who would have lived or avoided damage if they had been born in hospital, but they were born at home? Of course. Are there babies who would have lived, or avoided damage if they'd been born at home instead of hospital? Yes, there are. Most of what doctors do is actually NOT evidence based. It's easy to find the studies to show that.

Midwifery and OB training both needs to be intensive and evidence based, preferably with regular classes to update their training. And then the decision needs to be left to the mothers, since they and their families are the ones who will have to live with the results.

Did I read that you are suggesting it's common and/or possible to go from home to the OR faster than from your hospital bed a few feet away to the OR? That's just silly. Even if you call ahead and you have a midwife that works with an attending physician who is familiar with your medical history and happens to be on-call (all big ifs), you still have to get to the hospital, be assessed, IV-ed, etc. If you are being monitored in the hospital by an OB/nursing staff then you skip all those steps. And you are monitored by a real person in the hospital, a trained nurse, plus you have EFM.

If everything goes fine, it doesn't matter where you give birth. But low risk is not no risk, and the consequences are really high.