home birth

Something I'm not understanding in this thread is the (apparent)
premise that babies normally breathe only after birth. They should be
breathing (filling and emptying their lungs) in utero; assessment of
breathing is part of the standard ultrasound biophysical profile. (By
the way, during the many non-stress tests I had while pregnant with
Hungry Girl, I thought I could hear her breathing, but without
simulaneous US scans I cannot confirm it.)

I'll admit to being not very clear on this area, there are definitely
different kinds of breath, because all the literature seems pretty clear
that the in utero breaths that are linked to meconium aspiration are not the
normal rhythms of the chest moving up and down and fluid circulation, but
deeper, gasping breaths, caused by the distress the baby is undergoing, it
seems to indicate that they are taking the type of breathes they should be
taking when they first get out too early.

There are several causes of failure to breathe, where the newborn
otherwise seems normal. I don't know if a fetal BPP would necessarily
detect these. That is, if the fetus is not breathing in utero, a BPP
will detect that, but if the problem only presents once the baby is in
air, then a BPP will not be useful. The breathing reflex is a fairly
complex neurological process.

Well exactly, but even determination of breathing in utero isn't something
normally tested, even when choosing to test for absolutely everything, so
one presumes that it's not checked for because it wouldn't tell you anything
further. I don't know how often a baby is found not to be breathing on a
BPP, but would it really mean much to the general population, in the main
BPPs are being done on babies that for whatever reason need those additional
checks in utero.

Anyway, re this thread, to be *really* safe, you might want to deliver
all babies in a tertiary hospital with a level 3 NICU. Many women do
choose to do this, assuming that any intervention will improve outcome.
But that is not necessarily true.

Absolutely, it's been shown numerous times, that for low risk women, who
would be eligible for homebirth that fetal outcomes are similar at home to
in hospital and maternal outcomes are better at home. I don't recall any
studies that differentiate the type of hospital though, but knowing stuff
like continuous fetal monitoring causing unnecessary c-sections, it's
entirely possible that the highest level of hospital care could actually be
worse, particularly if you were to look at fetal outcomes beyond the first
few minutes.

Cheers

Anne

In article om,
" wrote:

Chookie wrote:

What on earth was happening that required so many staff? I don't think I
ever had more than 2 hospital staff in the room at once with mine. At birth,
they prefer one mw to look after you and one to handle the baby side, but that
was all.

Not even after you seized?

LOL, yes, but that wasn't *birth*! That was after DH had been asked to "hold
down that big red button and keep holding it". DH estimates 3 mws, plus the
duty ob, and one neurologist. After I was stable they all disappeared except
for one mw who acted like an ICU nurse (ie, constant observation). The
delivery unit wasn't busy that night, and they thought that a quiet delivery
suite was a much less stressful place for me than an ICU full of beeping
things.

I had an OB and a L&D nurse and an anasthesiologist and a neonatologist
and two NICU nurses and DH, but it was emergency surgery six weeks
early. There may have been more people in there (a perinatologist?),
but I was far too terrified to take an accurate head count.

I can imagine, somewhat -- I know what my feelings were when my BP started to
climb during my second labour, even though I knew there was a plan in place if
things did start going wrong.

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"Parenthood is like the modern stone washing process for denim jeans. You may
start out crisp, neat and tough, but you end up pale, limp and wrinkled."
Kerry Cue

-L. wrote:
cjra wrote:

Oh how wrong you are! This is the bane of hospital infection control
staff everywhe getting doctors to *wash* their hands!!!

I can't find it at the moment, but in the spring there was a great
research article in which doctors were asked to put their hands on a
culture plate. And then see what grew. You'd be *shocked*.

No, I wouldn't. Everyone's hands are covered by bacteria. That's a
first-grade science experiment.


The hospital ICs have been asking us for recommendations on how to
*force* doctors to wash their hands for the sake of infection control,
but it's hard to force anyone to do anything.

Don't believe what you see on TV. I'm sure surgeons scrub more when
they're going into surgery, but docs going into rooms? Nope.


I have seen three doctors this year - one FP and two specialists - one
a surgeon. All three washed their hands in front of me. I cannot
believe a doctor who is going in to deliver a baby doesn't a) scrub and
b) wear gloves. Maybe it does happen, but rarely, I suspect. Doctors
going into rooms is a different story altogether, and moot in terms of
what we were discussing - neonatal infection, which *is* most likely
airborne.

FYI - here's the NYT article the lack of hand washing amongst
doctors in hospitals. It made the rounds of all the infection control
groups a few months ago, which prompted more discussion about what can
be done to limit nosocomial infections.

http://www.nytimes.com/2006/09/24/ma...&ex=1167282000

Chookie wrote:
In article .com,
"cjra" wrote:

Oh yeah, in the pushing stage in hospital, the room was full of nurses
yelling. Yes, encouraging things, but there was a point when I wanted
to scream "STFU AND LET ME FOCUS!" I knew they were trying to be
helpful, but it seemed to make things suddenly seem emergency-like.
Having gone from my quiet home with 2 midwives and DH to what seemed
like a Spurs game, I was out of whack. Fortunately, between my DH,
midwife, and the OB, all of whom were at my side saying calm words in
quiet voices I could focus on them and not the 6+ nurses in the room
shouting.

What on earth was happening that required so many staff? I don't think I ever
had more than 2 hospital staff in the room at once with mine. At birth, they
prefer one mw to look after you and one to handle the baby side, but that was
all.

Emergency transfer to hospital for fetal distress, altho the heartbeat
was stable once we arrived.

There were 2 OBs - the chief (teaching faculty) and the resident.
Nurses: 1 to try to stick in the IV (and fail), one to put the BP cuff
on and monitor (which later was pulled off), one who brought me ice and
fiddled with the O2 (also pulled off), a few at the delivery end whom I
think were there just to be the shouting section. This was in addition
to my 2 midwives and DH. It wasn't a 'normal' delivery, officially,
since I was technically an emergency transfer. However there was also
no one else in labor at that time, and only one other person the whole
day, so I think the staff was bored. Heck, the next day I had the chief
OB, the resident who was at delivery, a new resident and a med student
come in to check my stitches. Most of the nursing/OB staff were present
throughout, although I was only there about 2-2.5 hrs before delivery,
and was already pushing hard from the time I arrived.

The real emergency came upon delivery, and that's when the NICU team of
4 came in.