Tuesday, October 5, 2010

It's an OPINION!

I figured my comment about home-birthing might cause some stir.....and I think I was right. Let me just say up front (again!) that this is MY OPINION. It doesn't mean that it's the only opinion or heck, even the right opinion! It's just how I see things through my eyes.

Someone asked what we have in a hospital that wouldn't be available at home. I'll admit that I've never been to a home birth, but from the research I've done here's a small list (not all inclusive) of things we would have in a hospital (not necessarily at every delivery but available within seconds) that usually wouldn't be available at home:

~ 5 L&D nurses
~ 4 NICU nurses
~ 2 Neonatal Nurse Practitioners
~ a full team to take care of mom after delivery and a separate team to take care of the baby after delivery
~ a labor bed that can be adjusted to many different positions to facilitate McRoberts maneuver (plus lots of others)
~ a full OR team/equipment (including anesthesia) ready for an emergency C/S if/when we decided we needed it

In my situation I think the things that helped the most were having all the (very experienced) hands ready and able to help. If it had been just the doctor and me in the room things could have turned out very differently. There is also no way that I could have taken care of the critical condition baby after he was born AND taken care of mom at the same time.

I know the great majority of births (home and hospital) turn out fantastic, happy healthy mom and happy healthy baby. I know midwives are trained and many have more experience than some doctors. I know that sometimes in hospitals decisions are made because of the extra monitoring that lots of times happens and that lots of times in the hospital we err on the side of  "preventing" instead of "reacting." My experience over the weekend reminded me how quickly a situation can go from normal, routine, and uncomplicated to emergent, critical and life or death. The thought that keeps running though my head is "why would I want to take the chance of the one birth that doesn't go as planned being MY baby's?"

23 comments:

  1. I totally agree with you!! I had 2 shoulder distocia babies and they were incredibly hard to deliver. My last one weighted in at 9 lbs 4 oz and snapped his clavicle on the way out. He shoulders were so stuck that my doctor had to reach her whole hand and arm up inside of me to turn his head and shoulders... IT was traumatic for both of us, but I had a wonderful labor nurse who I credit for such great deliveries. I've had such great experiences with my labor and delivery nurses and heck, I don't even see the dr. come in the room and then they are only there for about 5 mintues... It the nurses all the way that make or break a delivery.

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  2. "why would I want to take the chance of the one birth that doesn't go as planned being MY baby's?"

    Because that's life. You drive to work every day, even though every day somewhere people are killed in car accidents. You eat every day, even though people choke and die on food.

    At home, there's 100% less risk of c-section complications - and failure to wait never results in an "emergency" section in my bedroom. WAY less chance of mom or baby developing MRSA, no hospital mix-up of which baby is mine, whether s/he gets formula or a pacifier, whether he's circumcised even though the consent for is clearly marked not to do so. No bitch nurse telling you that it's "hospital policy" that she gets to carry your brand new baby out of the hospital, even though you're walking out on your own two feet, which triggers your PPD (that happened... to me).

    I've had two mostly great hospital births. But the stats in this country are 1:3 (now inching closer to 1:2) births are now surgical. With those odds, my time is up. Thanks but no thanks - I'll have this one at home.

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    1. Please, stay at home with your terrible attitude. Somebody is a bitch, but it's not the nurse.

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  3. I see your points, and I think they're valid and important to think about because many moms are thinking about birth in this way as well. And I have been in similar emergency situations and know how scary they are -- and how contagious fear can be.

    However, I think a lot of families are becoming more and more frightened about what could go wrong in a hospital. Birthing in a hospital pretty much guarantees every third woman a c-section and interventions that could do harm to their birth process and the health of both baby and mom. These risks of being in a hospital are much more normal than an unplanned emergency -- for which homebirth midwives are trained and prepared for. My point is that not only are homebirths usually safe - even in the case of emergencies, but that the hospital can also be an unsafe place to birth.

    All that said, I think collaboration and mutual respect between hospital-based practitioners and homebirth practitioners is so so important. This is especially true when rare emergencies do happen.

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  4. I had a 3 minute shoulder dystocia with baby turtling on nuchal cord x2 down to 1 minute apgar of 0, and we were at home. It was scary as hell, but our midwives run drills on this stuff constantly, and at 5 minutes our daughter was up to Apgar of 8. We had 2 fully certified midwives and 2 apprentices at our birth, and they worked absolutely seamlessly together. We are very grateful for the care they provided.

    I can definitely understand why you'd feel so much safer with so many more people and a lot more equipment if something is going very very bad very quickly. I still choose and support home birth, but it made me very convinced regarding how terrifyingly unsafe unassisted birth is, and how qualifications for attending home births should be very very high and thresholds for transferring very low.

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  5. I totally agree with you! And sheesh.....I LOVE it when I get called a "bitch" nurse.

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  6. Having a fancy delvery bed has nothing to do w/ McRoberts position. It can be acheived on a regular bed just as easily. In addition, without an epidural a mom can more easily get into hands and knees position for Gaskin manuever.

    I can appreciate how home birthers and hospital L and D nurses feel. They are both right.

    I think the lady who blithely wrote that there are risks w/ life is very cavalier. It's a heavy thing to have on your conscious that if you had delivered in the hospital your baby may have lived.

    Not all home birth attendants are so prepared for complications and most prospective moms do not know what criteria to use when choosing a home birth practitioner. They are looking for someone to support their labor and not necessarily someone who has good clinical judgement and knows when it's time to transfer or can get down and dirty if things are not going well.

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  7. Just found your blog. I LOVE reading all of your birthing/nursing stories. I've had four hospital births, and two birthing center births with a CNM. All four hospital births were inductions with the fourth resulting in a c-section. My last two vbacs were incredible.

    If God chooses to bless us with another we will opt for the birthing center again.

    I will say that in all four of my hospital births I had OUTSTANDING nurses. Especially my nurse that was with my during my c-section. There was a shift change right as I was getting ready for my c-section, but she chose to stay with me during the whole time. She knew I was scared and didn't want to do this and she promised not to leave my side -and she didn't.

    I have SO much respect for nurses, and honestly, they are THE best part about birthing in a hospital.

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  8. I wish I had even a quarter of what you mentioned at my last hospital birth! It was my 6th delivery, shoulder dystocia, we called for help and NO ONE CAME FOR ABOUT 3-4 MINUTES! And on this unit there was an OB hospitalist and a midwife available for these kinds of deliveries. Where were they?! Waiting for the elevator! I was terrified, my nurse was panicking and not making good decisions, my husband was poised to catch the baby, and finally she was yanked out of me. I was totally traumatized and so wished that I had been at home with a midwife. I really would've fared so much better. My baby finally started breathing and was fine. After two years, however, I finally feel a little less traumatized by how afraid and ALONE I was in the hospital. I was not pro-home birth prior to that delivery (my mom and stepmom were labor and delivery nurses), but now I am.

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  9. With my last hospital birth, 6th baby, I couldn't get her out. My husband screamed in the phone for a doctor, but NO ONE CAME FOR ABOUT 4 MINUTES. In that 3 or 4 minutes I was totally terrified trying to get my baby unstuck with this panicking, incompetent nurse who did manage to yank my baby out. This was at a hospital with an OB hospitalist and a midwife on site for these "just in case" deliveries. My regular OB was nowhere around partly due to his own neglect and the fact that THE NURSES NEVER CALLED HIM till I was complete. Too late for a grand multip with a known history of precipitous deliveries. I would have fared much better at home delivering my last baby with a midwife providing constant and competent care. My baby perked up after the midwife took her and the NICU nurse assessed her. I, however, have had a long, painful road in recovering from the trauma of that birth. I'm glad I'm done with OB's and hospitals.

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  10. It may be your opinion, but it's not necessarily based in fact. Perhaps it would be wise to visit with a homebirth midwife to learn about her training, supplies and what typically happens in a homebirth. Midwives are trained for SD. Look at all the articles in Midwifery journals.

    I had a homebirth for my second daughter, after researching my options extensively. I had 2 experienced midwives, plus an apprentice present. They bought a duffel bag full of equipment and oxygen tanks. They had years of experience, including transferring to local hospitals when needed.

    Things go "wrong" in hospitals too, especially with all the interventions that are routine.

    I stand by my statement that for low risk women, the outcome of homebirths with qualified midwives are equal to hospital births. And my labor and postpartum recovery was fantastic.

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  11. Just want to say that I love reading your blog and hope to hear more from you soon! Reading through the archives has kept me occupied for a couple of days. And as I'm sitting home on my 5th week of bed rest, being occupied cannot be under-rated! :)

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  12. I agree with you; you never know what can go wrong during delivery.

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  13. A woman giving birth at home isn't tied to a hospital bed with wires and cords snaking out from her, her movement impeded and her labor stalling and artificial hormones coursing through her veins when her own body is very capable of producing her own hormones to keep her labor going (not all labors are 9 to 5 or should be on a time table).

    A woman giving birth at home is typically moving, laboring for as long as she needs to without the pressure of the clock and pushing in a position other than lithotomy so that her pelvis is opened wide which prevents tearing, shoulder dystocias and other problems.

    There is a much greater risk of getting a cesarean when a woman goes to the hospital (1 in every 3 births!). My midwives have a less than 4% cesarean rate (though they do deliver at a hospital they practice the Midwifery Model of Care with a backup physician) whereas a doctor can have a rate at 30% or greater.

    It's not a black and white issue. Not everyone will choose home birth and not everyone will choose a hospital birth. I recommend reading Pushed by Jennifer Block and Your Best Birth by Ricki Lake & Abby Epstein. There's always room to learn more; I'm not saying you're wrong. Everyone is entitled to do what they feel is safe for themselves and their baby. I cannot tell you, though, how many nurses I've heard say they're giving birth at home and when asked, "Why?! You know what goes on here [on L&D]" and the nurse responds, "Exactly. That is exactly why I'm giving birth at home."

    Hospital births have become something fearful, where interventions have created problems that would otherwise not arise if the woman had been left alone to labor without being tied down to the bed. Perhaps that is why you don't feel comfortable with home birth for yourself? Birth doesn't have to be feared. Things do go wrong but in most emergency situations (in home birth) the woman is able to get to the hospital in time for necessary intervention. The Business of Being Born is also REALLY REALLY good.

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  14. It's always interesting to hear other L&D nurses' opinions. I have been a L&D nurse for ten years. I work in a very busy unit with a Level III NBICU. I chose a hospital for the birth of my first two, but what I witnessed daily at work led me to deliver my third at home. My home delivery was attended by a very experienced Midwife and attendant. Funny how our L&D working experience leads to different opinions....not just yours but all of us.

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  15. I really think you need to actually ATTEND a homebirth with a skilled midwife before you can say anything negative about them. I've had four kids at home in three different states (I tend towards precipitous births and wouldn't make it on time anyway; I'm much better off with everyone coming to me instead of trying to go to them). It isn't like if the baby gets stuck or has a problem, you are automatically screwed.

    And I agree with P3, everything she said above.

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  16. I should also add, with my one hospital birth, I didn't have all the staff that you listed above! We were on an island in a remote location and there was NO NICU, therefore no NICU nurses, nor an entire team (I think there were always about 3-4 nurses around). And the anesthesiologist was not always in-house. So really, even my hospital birth didn't have all the "stuff".

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  17. Thanks for sharing this thought-provoking information because they are very essential and convey message that everyone must know about. Keep going! :)

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  18. I miss you! Hope everything is going well!

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  19. Thank you for using my Guide and if it work for you that makes me happy




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  20. Birthday Nurse, I looked all over for an email address or place to send you a private message but couldn't find anything. I am considering a career change to nursing and searched the web for a L&D blog that could give me some insight into a world I'm dying to learn more about. I found yours a few days ago and have spent hours reading the entire thing (a huge accomplishment for me considering I'm not so fond of reading anything). I've read every single post word for word and wanted to thank you for the time and effort you put into creating this blog. Some posts had me questioning if I have the brains/guts/courage/stamina to be a L&D nurse; other posts had me wondering why I didn't consider this career years ago. I have so many questions and would love to have a "mentor" in this field. I noticed you stopped blogging in 2010 but if you ever feel like chatting about your career again, please please let me know. Thank you again for everything you've blogged about!

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    1. You can e-mail me @ beckie86@hotmail.com and I'd be happy to answer any questions you may have :) I decided to fade from the blog scene as there are just LOTS of controversial issues out there :)

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