hospital vs homebirth

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hospital vs homebirth

Post by Aum » Tue Sep 29, 21:04 2015

DarkOne wrote:^Well, part of it is because the decision to go for a c-section is a result of risk management, and a surgical intervention at home is not often an easy option.
Mid-wives are qualified to decide when a woman in labor should go to the hospital to be assessed for potential c-section.

I don't know why anyone would want to give birth in a hospital if their pregnancy isn't high risk. It's been way too normalized. Women shouldn't be so terrified of their own bodies and the birthing process, as the system has led them to believe.
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Re: Real stats for C-Sections?

Post by ablotial » Wed Sep 30, 9:46 2015

Aum, that's true, but I think some women prefer a hospital just for the sake of speed in case of a problem with the delivery. An otherwise low-risk pregnancy there could be a cord prolapse, really short cord, or some other situation that would require an unexpected c-section in a hurry. While in many cases you might have the time it would take to get a robe on, get driven to the hospital, get checked in and prepped, etc, sometimes you won't... and while those cases might be unlikely, some people would rather have the comfort of knowing that all the what-if's are covered.

My hospital was about a 30 minute drive by choice (I live in a populated area but was shooting for delivering with a specific practice I was comfortable with) but back home in northeast Maine the hospital is often 30-60 miles away just because that's where the hospital IS. While there are midwives there and some people do homebirths, most would rather not have the risk of driving such a long distance over the poorly maintained rural roads in an emergency, and it takes a long time for an ambulance to reach you there also.

Plus maybe a lame reason, but the drive to the hospital was uncomfortable enough when I was just beginning to really labor - I can't imagine how miserable I would have been if I'd already been laboring for a long time and was in whatever kind of distress would require the c-section and also the resulting panic I'm sure I'd feel due to the emergency situation... though I suppose at that point I might be reclined in the back of an ambulance rather than in the front seat of my husband's little car.

I get that hospital births are a relatively new thing, but I don't think it's necessarily bad. To me, it's great that women these days have so many choices available to them and can labor however and wherever makes them the most comfortable with the entire process.

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Re: Real stats for C-Sections?

Post by Gnarlbanya » Thu Oct 1, 18:39 2015

I'm really thankful that I had a hospital birth, precisely because I needed an emergency c-section in the end. I chose a low-intervention obstetric practice and the hospital had birth suites with baths and showers, a bed, birth balls, lots of space to walk around, etc. You could pretty much do whatever you wanted, as you would at home, but without having to clean up after... In any case, I didn't have any fear of the birth and was all set to go as natural as possible.

When my waters broke they had merconium in them so we had regular fetal heart-rate monitoring and it was a good thing we did. When bub's heart rate started plummeting with every contraction it was picked up almost immediately. As it was clear that even as a best-case scenario we still had quite a number of hours to go (this was after ten hours of active labour and about 24 of early labour before that), my midwife got the doctor in and we decided a c-section would be the best course of action. They outlined the reasons for it, but left the decision to me. I couldn't be happier with my decision as without the surgery the outcome could have been very bad for my baby. I live at least 45 minutes from the hospital (more with traffic) so being at home, and then transferring to hospital could also have been pretty bad.

In all honesty, having invested ten months into growing my baby, I was going to do everything I could to make sure she arrived safely. In my case that meant having the option of medical intervention if it was necessary. Turns out it was.
Aum wrote:Women shouldn't be so terrified of their own bodies and the birthing process, as the system has led them to believe.
I find this a fairly patronising assumption. I'm an adult, an intelligent and rational person, and perfectly capable of making my own decisions based on an analysis of risk factors and different possible outcomes, not because of what I've been 'led' to believe.

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Re: Real stats for C-Sections?

Post by Aum » Thu Oct 1, 23:47 2015

Gnarlbanya wrote:I find this a fairly patronising assumption. I'm an adult, an intelligent and rational person, and perfectly capable of making my own decisions based on an analysis of risk factors and different possible outcomes, not because of what I've been 'led' to believe.
It wasn't meant to be, but statistics don't lie. Watch "The Business of Being Born", it's a great feminist doc and I think it's free on the web now.
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Re: Real stats for C-Sections?

Post by ohbonobogirl » Fri Oct 2, 5:29 2015

Gnarlbanya wrote:.
In all honesty, having invested ten months into growing my baby, I was going to do everything I could to make sure she arrived safely. In my case that meant having the option of medical intervention if it was necessary.
My thoughts exactly. I had a c section with my little one as he surprised us by being breech when I presented to the hospital after my water broke. Policy dictated a c section at that point, even though I had planned on a birth with as few interventions as possible and was primarily treated by a midwife team with a rate of c sections that hovers at 10%. And, I'm completely comfortable with how things turned out, even though others may say it was an unnecessary section. I wouldn't have wanted to attempt a vaginal breech delivery with providers who aren't well practiced at them, and they just aren't where I live. Now, I have a healthy baby and got an extra two weeks paid off work too.

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Re: Real stats for C-Sections?

Post by Metcodon1 » Fri Oct 2, 9:42 2015

I also want to say that opting for pain relief is a completely valid choice. It doesn't have to do with fear and I'm pretty sure women have been aware that childbirth hurts for all eternity. Feminism is about choice and women taking back control over their own bodies. That choice and control goes both ways. Women should have the right to refuse medical interventions as much as they should have the right to choose them. Just because a woman goes into childbirth being certain that she wants an epidural does not mean she should be a subject of pity.
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Re: Real stats for C-Sections?

Post by Enigma » Fri Oct 2, 15:57 2015

Aum wrote:
Gnarlbanya wrote:I find this a fairly patronising assumption. I'm an adult, an intelligent and rational person, and perfectly capable of making my own decisions based on an analysis of risk factors and different possible outcomes, not because of what I've been 'led' to believe.
It wasn't meant to be, but statistics don't lie. Watch "The Business of Being Born", it's a great feminist doc and I think it's free on the web now.
This is a good documentary. It's on Netflix too.

I think it's very important that a woman do what makes her comfortable. But I do find the variance of csection by region is a little sketchy. Especially when the WHO says that a rate above 15% doesn't improve outcomes.

My niece is due to be born in a home birth in about a month. In a city, near a hospital. My nephews were born in hospitals. If I have kids I'd like to aim for a birthing centre next to a hospital. (I hear there are things like that in my city, I haven't looked into it)
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Re: hospital vs homebirth

Post by spacefem » Fri Oct 2, 16:42 2015

I disagree that "business of being born" is a good documentary. I think it's fear-mongering... which is funny, because natural birth advocates complain that we shouldn't be afraid of birth, but they turn around and use fear like popcorn when they talk about hospitals. I watched "business of being born" after I had my baby and I'm glad I did because it paints hospitals as these awful places. I feel like the documentary shows only two options with NO in between.

1) give birth at home with your candles and music and doula and have a lovely natural experience that brings you closer to your baby

2) give birth in a hospital where doctors immediately cut you open to make it to their golf game and you live in trauma for the rest of your life

Obviously I saw a problem with this because I had a natural birth in a hospital and it went just great. The nurses were very supportive, even physically supportive when I needed help up to get into different positions. At one point I was worried I'd want an epidural so I had an anesthesiologist come bring me the paperwork, and even that guy said, "but this is all totally your choice, you can totally do this without me!"

So to see these documentaries say that hospitals are evil really rubs me the wrong way.

An even worse one is "pregnant in america"... where a guy's wife tries a homebirth, their baby has complications, and he's STILL there yelling at doctors as they're saving his baby's life! it's just painful to watch. Oh and he literally visits the hospital where I gave birth and berates, like, the receptionist about their c-section rate.

I'm waiting for the documentary about how homebirth is NOT safe... I bet it's coming. There's a famous OB who blogs about homebirth statistics, if you're thinking about homebirth you might want to hear what she has to say... warning, it mentions loss.

homebirth has higher death rates:
http://www.skepticalob.com/2014/01/home ... -safe.html

midwives in america get to claim to have "certified practicing midwife" credentials that mean nothing, there's no regulation, they can have a high school degree and visit a few births and call it good!
http://www.skepticalob.com/2015/09/jill ... dwife.html

being 5 minutes from the hospital does not make you safe:
http://www.skepticalob.com/2012/05/pedi ... nutes.html

so just saying, and warning... you might want to read what she has to say:
http://www.skepticalob.com/2012/11/lets ... olish.html

My first birth could have happened at home, sure! I joked that the most important thing the hospital did was be a good cleanup crew. That's what got me reading about homebirth. But the more I read the more I hated what I read. And in a shocking but not shocking turn, my second birth did not go so smoothly... I had retained placenta. Would the midwives have dealt properly with that complication? I like to think so... but after reading about the lack of training that it takes to be a midwife, I'm not so sure. I'm glad I was in the hospital.
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Re: hospital vs homebirth

Post by Aum » Fri Oct 2, 18:20 2015

^ I think in the greater diaspora of documentaries on birthing styles, Business of Being Born is pretty good. But I understand your frustration, being in the U.S. The free market there kind of lets people do what they want in a lot of ways. The system in Canada is different. Midwifery is a university program, a bachelor's degree, usually as an attachment to nursing schools. They get trained in modern medicine and can integrate their lineage birthing traditions with modern cutting edge understandings. It doesn't have to be either/or. Kind of disturbing to hear that people in the U.S. can claim to be midwives with a high school diploma. That sounds like a recipe for disaster. I would hope that most people are interrogating the qualifications of their midwife before they commit.

My sister had her first kid at home, the second at a hospital. Both were appropriate, in different contexts. She said that the hospital offered her different methods and she refused them all. Her baby was breech so she had to be in the hospital, but in the end the baby turned and everything happened naturally.

Regardless if it's a home birth or a hospital birth, it's important to know and understand one's boundaries and limits. I've also heard horror stories about medical interventions that weren't necessary. I just spent a couple months in the hospital in the spring and I experienced the full horror of what happens if you can't speak up for yourself or you have little agency. Their interventions can have consequences which require more interventions, until your situation is spiraling out of control. On the other hand I initially needed the hospital because I had reached the limits of my own knowledge and was aware that I had sufficient ignorance to put myself in jeopardy if I didn't go to the ER.

I don't agree with the notion that there are fewer homebirths because hospital births are so innovative and safe. In North America hospital births have been normalized thanks to the AMA which stamped out all competitive medical systems. In most of the developed world home birth statistics are higher.
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Re: hospital vs homebirth

Post by rowan » Mon Oct 5, 12:50 2015

I really liked my birthing center (attached to a hospital). Midwives or OBs both delivered there, you could pretty much do whatever you wanted, etc. But when my kid got stuck, even my OB was like "shit, this is harder than I'm used to" and went and got a really experienced guy to get her out.
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Re: hospital vs homebirth

Post by Sassquatch » Mon Oct 5, 21:07 2015

The numbers don't lie. Home birth is several times riskier. For myself, being a risk averse type, I wouldn't choose it (even if I lived in a place where midwifery was licensed and part of the health care system.)

I'm not a fan of the fearmongering from birth woo proponents. I had a perfectly fine, no intervention, almost unmedicated hospital birth where my biggest complaint was actually not getting treated enough like a patient. Birth may indeed be a natural process, but it's the most demanding and traumatic natural process our bodies routinely undergo, and there's nothing wrong with treating it as a medical situation, because it is -- its a very significant, acute deviation from the normal everyday operation of our bodies. There's nothing shameful or harmful about acknowledging that,

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Re: hospital vs homebirth

Post by robichek » Tue Oct 6, 12:27 2015

I had a natural birth in a hospital with a very pro-natural-birth OB-GYN who I specifically wanted because he was well-known in the natural birth community. My hospital room had a bathtub we were allowed to labor (but not deliver) in. I did have to fight off multiple pitocin recommendations by well-meaning nurses, but my doctor was great and let me do my thing (which was awfully hard and took a while). I loved having the hospital and ob-gyn there "just in case". The part that sucked the most was that I was not allowed to eat or drink, but I cheated on that anyway.

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Re: hospital vs homebirth

Post by rowan » Wed Oct 7, 9:57 2015

robichek wrote:The part that sucked the most was that I was not allowed to eat or drink, but I cheated on that anyway.
Huh, that's weird. I brought all kinds of snacks.

Not gonna lie, the jacuzzi tub was the best part of my birthing center.
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Re: hospital vs homebirth

Post by ablotial » Wed Oct 7, 11:34 2015

I've heard a lot of hospitals restrict laboring mothers to ice chips in case there is an emergency and they need to be put under general anesthesia their stomachs will be empty. My hospital allowed fluids, but not solids, so I was drinking gatorade to help keep my energy up. To be honest, solids sounded awful to me anyway, I wouldn't have wanted them.

It sounds like robichek and I gave birth at similar hospitals. It was very flexible - I had a birthing ball, labored in the tub for a while which was great, had full mobility until my bloodpressure went to 160/101 ... but I did my research and chose a practice and hospital that allowed all these things and had low rates of intervention. I ended up needing a c-section but trusted the doctor's opinion about this since they are known for avoiding it (after reaching 8cm dilation, labored for 13 hours with no further progress and the baby was still way too high at station -2 ... and when they got in there they said it was a good thing because the cord was between his head and my pelvis and would have gotten pinched. So I would have ended up with an emergency c-section with far less preparation if he'd decided to come out naturally), and was very glad to have already been at the hospital.

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Re: hospital vs homebirth

Post by rowan » Wed Oct 7, 12:31 2015

Yeah I didn't eat any of my snacks, lol. I seriously only wanted the ice water. But I brought all kinds of stuff. Also music. I brought music and then I was like FUCK NO TURN OFF ALL THE NOISE. Birth is weird.

Sound like a bunch of us went with similar birth center/hospital things. :) It would be really nice if everyone had the opportunity of choice that we did.
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Re: hospital vs homebirth

Post by Zeph » Wed Oct 7, 23:40 2015

Human birth is risky. My great-grandmothers only gave birth at home because that was the only option. I like the idea of a birthing center near a hospital. Many hospitals also provide both safety and comfort.

Sadly, not all hospitals are equal and women on government assistance are often pressured into setting a date to induce their labor to work around the doctor's schedule. I've been putting off getting pregnant because I don't have health insurance right now, but there is a hospital near me that gives women a ton of options

Now, I could be able to afford a birthing center uninsured, but my BMI is too high for my local birthing center. I also feel that my nearest hospital has more options, because everything changes when you begin labor.

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Re: hospital vs homebirth

Post by rowan » Thu Oct 8, 14:34 2015

Zeph wrote:my BMI is too high for my local birthing center.
that is ridonkulously stupid.
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Re: hospital vs homebirth

Post by Zeph » Thu Oct 8, 15:07 2015

rowan wrote:
Zeph wrote:my BMI is too high for my local birthing center.
that is ridonkulously stupid.
Yep! Anyone with a BMI 30+, that would be a woman average in height who weighs 175 pounds. Given that at least a third of women in Texas have a BMI 30+, it really sucks. Lower-class women are more likely to be affected by obesity, and are also more likely to require a more affordable option for hospital birth.

It seems like an amazing place to give birth, though. I was born via midwife and my mom said it was her best birthing experience.

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Re: hospital vs homebirth

Post by ablotial » Sun Oct 11, 10:34 2015

rowan wrote: I brought music and then I was like FUCK NO TURN OFF ALL THE NOISE.
Same here! And my husband was super amused by this because we had bought wireless bluetooth speakers and spent weeks putting together the "perfect" birthing playlist. I wonder how often this happens?

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Re: hospital vs homebirth

Post by careme777 » Sat Oct 24, 14:02 2015

Sassquatch wrote:The numbers don't lie. Home birth is several times riskier. For myself, being a risk averse type, I wouldn't choose it (even if I lived in a place where midwifery was licensed and part of the health care system.)
I'd be curious to know which numbers you're referring to. I chose to do a home birth (living in Canada, with government funded midwifery care) after a LOT of research (on an unrelated note, we ended up transferring to the hospital for a C-section during the pushing phase because baby wasn't turned correctly).

I read most of skepticalOB while trying to make my decision and did a basic (given my limited access to databases) lit review. My conclusion was that skepticalOB might have a point when discussing home birth in the US, because of the way midwifery care is stratified into certified nurse midwives and lay midwives. In mostly every other developed country with midwifery care, however, there is no conclusive evidence one way or the other that home birth is less safe than hospital birth for women with low risk pregnancies.

Basically, the perinatal mortality rate in both hospital and home births is so small, that to be able to determine a significant difference between birth locations would require a much larger sample size than there is data readily available to analyze.

After talking it over with the midwives and several of my doctor friends, I decided that the risks of birthing at home (which I acknowledge are non-zero, we talked to A LOT of people about cord prolapse) outweighed the much more likely negative (as I perceive them) outcomes of birthing at the hospital- namely increased intervention.

One of the things in favour of midwifery-supported home birth where I live is that the midwives mostly deliver in hospital and have a strong working relationship with all of the OBs. They also have to notify the paramedics that there is a possibility of transfer with all of the available information, to reduce the risks involved in an emergency transfer. Our transfer was most certainly non-urgent, but the midwife was on the phone with the OB notifying her of our arrival, and the paramedics had arrived before I really knew what was happening.

My understanding of midwifery care in the US is that certified nurse midwives can't get insurance to cover home births because of a few select cases (Baby Catcher by Peggy Vincent discusses this, in addition to being a very good memoir). Which means that either CNMs are practicing while uninsured at home births, or lay midwives are performing home births without the backup of an obstetrical team at a hospital in case of complications. Neither of which is a good situation.

I do believe that home birth, in a supportive system (i.e. with hospital and OB backup and well-trained birth attendants who follow evidence-based practices), is a safe and possibly more fulfilling option. But then again, I'm a bit of a hippy.

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