home birth

wrote:
Ericka Kammerer wrote:
Chookie wrote:

Of course, I have a particular attitude because I was "low-risk" right up
until the moment I had eclampsia. Even fifty years ago, I probably would have
left the hospital in a box :-/
There are certainly things that happen, though
I think people often underestimate the ability of midwives
to spot trouble and transfer as needed.

Mine missed the onset of my preeclampsia altogether, and I had to catch
the symptoms myself. By the time I transfered, I was *really* sick,
with a pressure of 220/116 and well into kidney and liver failure.

Granted, not all women with a rise of 40/20 and trace proteinuria are
going to develop severe preeclampsia, but she scheduled my next
appointment two weeks out and sent me on my merry way. It has
convinced me that some midwives do not spot that particular sort of
trouble very well.

True--by no means would I claim that all midwives
are great midwives (just as I wouldn't claim that all doctors
are great doctors). My first midwives jumped all over a
much smaller rise in BP along with trace proteinuria for
me. They were highly motivated to distinguish incipient
pre-eclampsia from something more benign in plenty of time
to make appropriate plans. They even came by my home
frequently to check my BP, rather than waiting until my
next visit (which would have only been a week out by
that point), and my rise was no where near 40/20.

Within a few years everyone we send to midwife care in first world
countries, i.e. 95% of the population, is going to have a stamp on her
chart reading "sFlt-1/sEng PASSED" so it probably doesn't matter all
that much.

Isn't it so exciting all the progress they're making
on this front? To make this kind of progress on one of the
leading killers is just amazing in my book.

Best wishes,
Ericka

wrote:

I hope most midwives *are* aware that a bit of elevated bp and a touch
of protein mean the pregnancy has turned very high risk indeed, that
they are officially out of their league, and that a MFM needs to be
involved in oversight of the rest of the pregnancy.

I think that statement is a bit strong. While slightly
elevated BP and trace protein can be an indication of trouble,
it can also be benign. I think appropriate tests and careful
monitoring are essential, but I don't think a transfer of care
is required until and unless tests or monitoring show that
there actually *is* pre-eclampsia (or at least significant
movement in that direction).

Best wishes,
Ericka

-L. wrote:
Cathy Weeks wrote:
-L. wrote:

I think it's silly and incidental enough not to make a fuss whether or
not you can have one. I mean, seriously. If that's all you have to
worry about, you've got it easy. "Oh woe is me! I can't birth at
home! Whaaaa!!!!!" Please - spare me.

Spare you? Well, you *did* jump into the conversation.

Chick asked for opinions - I gave mine.

If you don't
like the discussion then why did you take part?

Chick askedfor opinions - I gave mine. It's an open, unmoderated
forum.

Just because the topic
causes you pain

It doesn't cause me pain - au contraire. I'll take my kidlets clean,
well fed and dressed in Carter's over ****ting out a football anyday,
LOL...

due to your own situation, doesn't mean it should be
discussed at all, or that people should strive to make their situation
better.

Why do you think I said it shouldn't be discussed? I merely said it's
a trivial problem.


I don't believe any of it - you (generic) can make stats say what you
want. I did it for years.

Uh, ok. Your point is what? That anyone can make the stats say
whatever they want? Doesn't that work borth ways? The hospitals (and
you) can make it look dangerous (even if it's not?). Or are you just
not willing to accept anything that doesn't jibe with your
pre-conceived notions?

Look - it's not rocket science. You have a major complication and a
widwife can't do diddly **** to help you or your baby.

Sigh... you really don't get it do you? YES there are sometimes
complications that might end up with a dead baby or mother.
FORTUNATELY those are very, very, rare. And in the hospital you have
OTHER RISKS, and they sometimes end up with a dead baby or mother. MOST
OF THE TIME, the complications that occur, happen in plenty of time to
get to the hospital, where trained specialists can be found.

Home births do not wind up with lots of dead babies. It's not
particularly risky.

And at home, dearie, you are at almost NO risk of iatongenic infections
as you ARE in the hospital.


No, YOU go Google Megan What's-her-name too whose baby came out DEAD at
home.

Ah, I'm very familiar with her story. Maybe you aren't? Her baby would
have died at the hospital, too. He was born with an underdeveloped
repiratory system, and even with oxygen, and all the trained
specialists at the hospital couldn't revive him. They assured her, that
the homebirth made zero difference in the outcome. She went on to have
another baby, at home.

And why are you against looking up Sophie McGehee's story? How she
felt her entire c-section? Does that risk not exist in your book?

Hospitals aren't panaceas for
birth. They do not save all babies no matter what.

Well no ****, Sherlock. But if your baby has a major neurological
problem, what kind of diagnostic equipment do you have at home? Is
your husband a neurosurgeon or a neonatal specialist? That's just one
example.

Well, no he's not. But does my husband carry germs that are likely to
give my baby an illness the way a doctor would? Nope. Iatrogenic
infections ARE a real risk in the hospital and are not at home.

I very recently met
a baby whose scalp was cut so badly during his c-section birth that it
required stitches. Fortunately, it was in his hair, so it will not be
permanantly disfiguring.

And at home he may have died in the birth canal.

And you know this how? Maybe at home, his birth wouldn't have required
a c-section in the first place. We don't know his story, or why he was
born by c-section. And I'll tell you a little secret. When
complications occur, midwives advise us to go to the hospital. Women
generally don't stay home, when our midwife says "I think you and your
baby are in danger. We need to get to the hospital asap."

nope. Hospitals have a ton of trained specialists to call upon should
a problem arrive. You have yourself, your kiddie pool, a
granola-crunching midwife who fancies herself a doctor and your husband
who probably couldn't find the clitoris without a map.

Those tons of specialists can't do diddly squat much of the time. They
are unnecessary most of the time. And as midwives are direct
competitors to doctors and hospitals, they WANT you to rely on them.

No, I don't think you do. You see, home birth is CHEAPER than hospital
birth. In 2001, when I had my daughter, the cost of my home birth was
$3850 (normally only $3500, but I had a non-stress test at one point).
Your average hospital birth costed $7000, and considerably more for
C-sections - beginning at $10,000. Midwives have a c-section rate of
10% or less, and many hospitals have c-section rates approaching 40% -
the national average is now over 25%. You can do the math if you wish.

It would still require funding another level of birth that is
unnecessary.

So, you want all births to cost $7000 minimum, instead encouraging the
low-risk births to cost $3500 instead?

One of my midwives did her thesis on how homebirth saves money for the
insurance industry (her practice alone had millions of dollars for the
insurance industry).

LOL...especially if it isn't covered.

Mine was covered at 100%. Most insurance companies covered them at
80%. At least according to them.

And in low-income neighborhoods, where midwives
practice (and have the same good outcomes as doctors despite lack of
prenatal care) they save the taxpayers lots of money too.

Ditto above.

So the taxpayers shouldn't pay less money for similar outcomes?

So it's cheaper, often safer, and gives a better level of care.
Midwives usually spot complications earlier in the process than do
doctors, and give more choices. But, I guess nobody ought to have more
and even better, choices. I see.

I don't want to pay for your quackery.

No one asked you to. So, let me ask you this... why should *I* pay for
*your* quackery? Why should my tax dollars and insurance monies go
toward covering a MORE expensive method of care that has NOT been
proven safer for low-risk pregancies? And, given that you think it's
not rocket science, why don't you back it up? Provide us with data.
I'd be happy to provide you with links, but you said you'd never
believe any of them. shrug

Cathy Weeks

Ericka Kammerer wrote:
wrote:

I hope most midwives *are* aware that a bit of elevated bp and a touch
of protein mean the pregnancy has turned very high risk indeed, that
they are officially out of their league, and that a MFM needs to be
involved in oversight of the rest of the pregnancy.

I think that statement is a bit strong. While slightly
elevated BP and trace protein can be an indication of trouble,
it can also be benign. I think appropriate tests and careful
monitoring are essential, but I don't think a transfer of care
is required until and unless tests or monitoring show that
there actually *is* pre-eclampsia (or at least significant
movement in that direction).

I don't think care necessarily needs to be transfered, but I think the
MFM should be called in for oversight according to the NIH Working
Group guidelines and that testing should follow those recommendations.

--
C

Ericka Kammerer wrote:
wrote:

Within a few years everyone we send to midwife care in first world
countries, i.e. 95% of the population, is going to have a stamp on her
chart reading "sFlt-1/sEng PASSED" so it probably doesn't matter all
that much.

Isn't it so exciting all the progress they're making
on this front? To make this kind of progress on one of the
leading killers is just amazing in my book.

It is completely freaking cool. :-)

--
C

-L. wrote:
Chookie wrote:
In article . com,
"-L." wrote:

I think it's silly and incidental enough not to make a fuss whether or
not you can have one. I mean, seriously. If that's all you have to
worry about, you've got it easy. "Oh woe is me! I can't birth at
home! Whaaaa!!!!!" Please - spare me.

Well, you have a baby now. Why are you still whingeing about infertility?
"Oh woe is me! I can't have a baby myself! Whaaaa!!!!!" Please - spare me.

That's not what I said at all. I simply have little sympathy for
people for whom this is a major issue in their lives.

Ok... you did mention your status as a primary infertile, which made it
SOUND like you were whining.

But either way - accept for a moment that not everyone agrees with you
about the "safety" of all hospital births. Stop thinking of us as
nutcakes, and just accept it for a moment. I don't like hospitals. I
don't like how they smell, and I don't like having the janitor outside
my room while I'm stalking around naked. And I don't like having nurse
after nurse whom I don't know, come in and stick her fingers in my
vagina every hour (another practice that has been shown to increase the
chances of infection). And then, when my legs are spreadeagled, I'm in
pain, and in THE MOST vulnerable situation in my life, and some doctor,
whom I've never met comes in and catches my baby for me, and before
that decides to cut my vagina (episiotomies are considered the most
common unnecessary surgery in america, and the ACOG now recommends
against their routine use, not that the OBs actually go by their
recommendations) whether *I* like it or not (that happened to my
stepson's mom, and my husband had nightmares about that for years).

So your "little sympathy" seems incredibly... well wierd. It's like
saying that I shouldn't have the choice of what doctor to go to, what
dentist, what school my child attends. Where to give birth is similar.


I think hospitals are GREAT place to go when you are sick, or when you
do have a complicated birth, or if you are dying. But birth? I wasn't
sick.

Cathy Weeks

wrote:
Ericka Kammerer wrote:
wrote:

I hope most midwives *are* aware that a bit of elevated bp and a touch
of protein mean the pregnancy has turned very high risk indeed, that
they are officially out of their league, and that a MFM needs to be
involved in oversight of the rest of the pregnancy.
I think that statement is a bit strong. While slightly
elevated BP and trace protein can be an indication of trouble,
it can also be benign. I think appropriate tests and careful
monitoring are essential, but I don't think a transfer of care
is required until and unless tests or monitoring show that
there actually *is* pre-eclampsia (or at least significant
movement in that direction).

I don't think care necessarily needs to be transfered, but I think the
MFM should be called in for oversight according to the NIH Working
Group guidelines and that testing should follow those recommendations.

Hmmm...I agree that the testing should be done.
I don't know that I think MFM oversight should be required
in all such situations (depending on what you mean by
"oversight"). I'm not sure what oversight would be
required. If guidelines are clear on the indications
for testing, and the tests are done, I wouldn't think
it would be necessary to bring in a specialist until
and unless the test results move into the realm where
they're at least suggestive of a problem that would
benefit from a specialist considering the results.
Otherwise, you've all of a sudden got a whole lot of
unnecessary demand for specialists. As long as the
test results and monitoring suggest that there is no
pre-eclampsia, a midwife should be capable of continuing
to order appropriate tests and performing appropriate
monitoring. As soon as test results support a diagnosis
of pre-eclampsia (or if the results are in a gray area),
I would agree with oversight. I just don't see why
oversight would be beneficial (especially given the
cost) prior to that point.
Now, one might argue that there's a problem
if some caregivers don't respond well enough to
early indicators, but when that's the case, there's
a bigger problem. *Someone* has to notice indicators
and run tests before the appropriate care can happen.
That can only be dealt with via education, regardless
of the type of caregiver or the setting, unless we're
going to send everyone to a specialist. Still, as you
point out elsewhere, we should soon have a good
screening test that will allow us to send virtually
all of the at-risk women to a specialist plenty early
for appropriate oversight.

Best wishes,
Ericka

No, YOU go Google Megan What's-her-name too whose baby came out DEAD at
home.

then go look at her website and her subsequent birth decisions, she believes
homebirth was the right thing, she fears that had she been in hospital, due
to a long 2nd stage, she may well have had a c-section and instead of the
brief hours she had with her son whilst she was well, she'd have had them in
pain post op, she may have also been left blaming herself as we know there
is greater incidence of respiratory problems following c-section, it's
possible she may have been left wondering if a vaginal birth would have
given him the stimulation he needed to breath. She had her 2nd son at home
20ish months later. What I understood was that there was only the slimest of
chances that Seoras would have survived if born in hospital, he was born
alive, but failed to take a breath, even instant intubation may not have
been able to trigger that reflex, essentially he had an undetectable, but
fatal birth defect.

Cheers

Anne

Cathy Weeks wrote:

Sigh... you really don't get it do you?

No, I just don't buy your argument.

YES there are sometimes
complications that might end up with a dead baby or mother.
FORTUNATELY those are very, very, rare.

It only takes once.

And in the hospital you have
OTHER RISKS, and they sometimes end up with a dead baby or mother. MOST
OF THE TIME, the complications that occur, happen in plenty of time to
get to the hospital, where trained specialists can be found.

You don't know that. You have no idea whether or not you can get to
the hospital in time or not.


Home births do not wind up with lots of dead babies. It's not
particularly risky.

And at home, dearie, you are at almost NO risk of iatongenic infections
as you ARE in the hospital.

....which are extremely rare as well. You can't have it both ways.




No, YOU go Google Megan What's-her-name too whose baby came out DEAD at
home.

Ah, I'm very familiar with her story. Maybe you aren't? Her baby would
have died at the hospital, too.

She doesn't know that. He never had the chance.

He was born with an underdeveloped
repiratory system, and even with oxygen, and all the trained
specialists at the hospital couldn't revive him.

By that time he was already dead.

They assured her, that
the homebirth made zero difference in the outcome.

Who assured her? The doctor that did the necropsy? What the hell do
you think they would tell her? "You killed your baby, Dumbass?" Of
course they are going to tell her not to blame herself.


? She went on to have
another baby, at home.

She still has a dead baby.


And why are you against looking up Sophie McGehee's story?

Why do you think I'm "against" looking it up?

How she
felt her entire c-section? Does that risk not exist in your book?

I don't have time nor do I care. One story does not a case make. I
merely threw out Megan to you as a rebuttal.


Hospitals aren't panaceas for
birth. They do not save all babies no matter what.

Well no ****, Sherlock. But if your baby has a major neurological
problem, what kind of diagnostic equipment do you have at home? Is
your husband a neurosurgeon or a neonatal specialist? That's just one
example.

Well, no he's not. But does my husband carry germs that are likely to
give my baby an illness the way a doctor would? Nope. Iatrogenic
infections ARE a real risk in the hospital and are not at home.

Oh, please! Doctors scrub *way* better than any midwife or layman
could. An acquired infection is most likely acquired through the air -
not from a doctor's hands. An acquired infection can happen anywhere.
Don't be stupid. Of course sick people are going to acquire infections
in hospials - they are immunocompromised to begin with, and MORE sick
people reside in hospitals than at home. If you had equal numbers of
births at home as in hospitals the acquired infection rate would
probably be similar. The bacterial infection you cited - P. aeruginosa
is a prime example. It's mainly seen in cystic fibrosis patients -
presenting as pneumonia.


I very recently met
a baby whose scalp was cut so badly during his c-section birth that it
required stitches. Fortunately, it was in his hair, so it will not be
permanantly disfiguring.

And at home he may have died in the birth canal.

And you know this how? Maybe at home, his birth wouldn't have required
a c-section in the first place. We don't know his story, or why he was
born by c-section.

Exactly. So you can't use that as an example - you have no idea of
whether or not a home birth attempt would not have had the same
outcome. At least in the hospital there are medical staff tained in
MANY SPECIALTIES available to help you.


And I'll tell you a little secret. When
complications occur, midwives advise us to go to the hospital. Women
generally don't stay home, when our midwife says "I think you and your
baby are in danger. We need to get to the hospital asap."

And it may be too late. Sometimes all you have are minutes. No
thanks - not a risk I would take with my life or my kid's life.


nope. Hospitals have a ton of trained specialists to call upon should
a problem arrive. You have yourself, your kiddie pool, a
granola-crunching midwife who fancies herself a doctor and your husband
who probably couldn't find the clitoris without a map.

Those tons of specialists can't do diddly squat much of the time.

Oh, please. They are far better trained than anyone else to do
*something* vs. a midwife who is trained in *no specialty* beyond
birth. They aren't doctors, they have no access to meds, they have no
diagnostic tools - need I go on?

They
are unnecessary most of the time. And as midwives are direct
competitors to doctors and hospitals, they WANT you to rely on them.

As they should - it's two lives you are dealing with here.

snip


So the taxpayers shouldn't pay less money for similar outcomes?

Tax payers shouldn't pay anything for unqualified medical care, period.


So it's cheaper, often safer, and gives a better level of care.
Midwives usually spot complications earlier in the process than do
doctors, and give more choices. But, I guess nobody ought to have more
and even better, choices. I see.

I don't want to pay for your quackery.

No one asked you to.

You're the one saying it should be covered by insurance.

So, let me ask you this... why should *I* pay for
*your* quackery?

You think all doctors are quacks? Really? Man, I feel sorry for you.

Why should my tax dollars and insurance monies go
toward covering a MORE expensive method of care that has NOT been
proven safer for low-risk pregancies? And, given that you think it's
not rocket science, why don't you back it up?

Um, because it's my OPINION....? Look - you can put your kid and your
self at risk all you want - knock yourself out and kill yourself, both.
But don't go stomping your feet and throwing a wobbly when I tell
you A) you're ****ing nuts and B) that I don't want to pay for your
quackery. I'm not the one lobbying for midwifery to be recognized by
insurance compaines and other healthcare programs - you are.


Provide us with data.
I'd be happy to provide you with links, but you said you'd never
believe any of them. shrug

You don't care any more than I don't care about what you believe.
"Data" is only as reliable as the people who fund it and publish it.

-L.

Anne Rogers wrote:
No, YOU go Google Megan What's-her-name too whose baby came out DEAD at
home.

then go look at her website and her subsequent birth decisions, she believes
homebirth was the right thing,

Of course she does - she isn't going to blame herself. The website is
in poor taste - dead baby photos are disgusting. That aside, there is
nothing on that website that discusses his condition other than the
fact that she had a long labor, had trouble "getting pushing", etc -
sounds like a classic case of ****ty birth to me. The kid essentially
went without oxygen so long that by the time they got him to breathe,
it was too late.


she fears that had she been in hospital, due
to a long 2nd stage, she may well have had a c-section

And her kid may have been alive....

and instead of the
brief hours she had with her son whilst she was well, she'd have had them in
pain post op, she may have also been left blaming herself as we know there
is greater incidence of respiratory problems following c-section, it's
possible she may have been left wondering if a vaginal birth would have
given him the stimulation he needed to breath.
She had her 2nd son at home
20ish months later. What I understood was that there was only the slimest of
chances that Seoras would have survived if born in hospital,

Any chance at all is enough for me. You proved my point exactly.

he was born
alive, but failed to take a breath, even instant intubation may not have
been able

May not have been able - but also may have been able, you mean.

to trigger that reflex, essentially he had an undetectable, but
fatal birth defect.

You mean undetectable prior to birth? Or undetectable, period? Of
course they are going to tell her it wasn't her fault.

-L.