home birth

Ericka Kammerer wrote:
enigma wrote:
Ericka Kammerer wrote in
:

Grahame wrote:
Thats true, Im sure if my child died, I would blame myself
anyway, beyond reason.
But to me thats more of an unlikely situation, than
complications of childbirth.
However, *statistically*, that's not true. If you
start
from the baseline of normal, healthy women having normal,
healthy pregnancies, then the vast majority of
complications can either dealt with at home just fine or
give enough time to transport to deal with appropriately.

out of curiousity, how much time *is* 'time to deal with
appropriately'?

The general recommendation is that it's best to
be able to transport within 30 minutes.

on a related note, is it really that uncommon here in the US
to go into a hospital birth with a birth plan spelling out
exactly which interventions you will not allow, or things you
want done? i don't remember everything on mine, except no
drugs, no cutting the cord until all the blood drained, & that
i wanted Tom to help with the delivery. it had a whole page
worth of stuff though.
the OB nurse looked it over, said i could have everything
except Tom helping & it was fine. in the end though, the
doctor overrode the nurse & let Tom help. they did install a
hep lock after 17 hours of labor because i was dehydrating &
they are supposed to give an antibiotic 16 hours after the
water breaks... but the fluids & antibiotic were delivered by
robot & didn't show up until after the birth anyway
(apparently the poor robot got stuck on an elevator).
the point being that delivering in a hospital doesn't mean
you have to give up control.

Many hospitals in the US are exerting more control.
Many people find that their birth plans are not allowed
or are disregarded when the time comes. Many people don't
have enough flexibility in hospital or provider choice
(because of limited availability or insurance limitations)
so it's not always possible to ditch a provider if you
don't like the limitations.
By far, the overwhelming reason most women who
choose home birth choose it is to maintain more control.

Best wishes,
Ericka

Fortunately, not *every* US hospital is that control-happy. Even
though I *knew* that home births could be safe, my subconscious wasn't
ready. Plus, even though I was considered low-risk, the closest
hospital was 30 minutes away in good traffic, 45 minutes or more in
rush hour. I was very lucky that the closest hospital was very
progressive - I was allowed to walk around and move, no continuous
monitoring, no pressure for meds, heplock instead of IV, food and drink
allowed, etc.

Plus, while my goal was to go med-free, I wasn't sure how I'd feel at
the actual time, so wanted to leave my options a little more open.
That is part of the decision for hospital vs home birth that hasn't
been discussed - the easy availability of meds. I think that is a
large part of the decision for women - they won't even consider a home
birth if they have already decided they want an epidural.

I will say, my OB wasn't necessarily supportive of the idea of a birth
plan, I think because he had seen too many detailed ones that talked
about a lot of stuff that didn't apply. Instead, we discussed
everything ahead of time. I realize I was unusual - my OB had his own
practice, not a group. And for dd, I had some narrow timing where I
could've ended up with Joe Random Backup OB - my OB had a death in the
family and had to fly out of town right after dd was born. So in that
way, my OB experience had more continuity than a group midwife practice
would have had, tho I did have the risk of a stranger attending my
birth.

Oh, and my birth plan was pretty loose. Basically, 4 goals - 1)
healthy baby, 2) best start for bf, 3) easiest recovery for me, and 4)
less pain for me (I forget how that last one was worded exactly). The
implications were for a med-free vaginal birth w/out episiotomy, if you
are trying to read between the lines, fwiw.

Irene

wrote:
Ericka Kammerer wrote:
wrote:

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.

Ah, that's probably because you're thinking I'm worried about "a touch
of high bp". :-) I'm worried about women who hit two readings of
140/90 plus a dipstick of +1 not being sent for a 24-hour because their
bloodwork came back good -- when bloodwork is only diagnostic in severe
PE, and mild is dxed with a 24-hour of 300 mg/dL. I'm also worried
about women who aren't followed up on assiduously when they show a rise
of 30/15 or a trace dipstick. Women who call in worried about their bp
and are told that they're probably anxious and they shouldn't take
their bp so often (raises hand.)

Ahhh, okay, then we're on the same page. I do think
that pre-eclampsia is serious enough that any significant rise
in BP should trigger some careful monitoring, but I think the
midwives can handle the monitoring between the "oh, we should
watch this" phase and the "looks like we're starting to meet
criteria for pre-eclampsia here." I think my last midwives
had some ridiculously low cutoff for transfer due to BP,
which I think is silly (fortunately, that was the one pregnancy
where I didn't really have much of any rise in BP). I'd say
shame on them, but I don't think it was really their choice.
So, I do think there are those who are on too much of a hair
trigger to call someone pre-eclamptic and start inducing or
whatever. But, that's just another reason for why it's so
great that we'll hopefully soon have a real screening test.

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.

Exactly. I think we will still need good education for the rare cases
-- what about a woman with a clean test at 20 weeks, and 4 previous
spontaneous vaginal deliveries with no change in her bp, whose
umbillical artery clots off at 34 weeks and infarcts three quarters of
the placenta, for example -- but we should be able shortly to eliminate
this whole problem. I am inclined to think it might eliminate the need
for OBs, actually -- we'd need midwives, and MFMs, and why would we
need OBs?

Who else is going to perform all those elective
c-sections? ;-)

Best wishes,
Ericka

Cathy Weeks wrote:

So, let me get this straight.

1. You don't think hospitals are by default safe.
2. But home births are by nature SO unsafe, that you have to be ****ing
nuts to do it.
3. But taking ANY chance that your baby might die is unacceptable,
depsite the fact that hospitals have their own set of risks where your
baby might die, simply BECAUSE you are in the hospital.

Never said that.

4. You've come to these decisions without doing one shred of research,
nor will you consider ANY research that shows that for low-risk
pregnancies, home birth is as safe as the hospital.

Never said that either. You assume a lot of things.

5. You don't want to give birth and prefer to adopt.
6. You tried to get pregnant for years, and suffered many indignities
in the process, despite preferring not to have to squeeze him out.

After having adopted I felt no desire for a biological child.

7. You think that women who do not wish to go through said indiginties
are whiners because they'd rather NOT have strangers shove speculums,
fingers, etc into their vaginas.

It's a mere inconvenience for the reward.

8. You assume that midwives are untrained quacks, despite the fact that
the average midwive has had 6 years of medical training, and more than
2 years more OB training than family practice physicians.

How many family practice phycians routinely deliver babies?

Certifiied
Nurse Midwives have 4 years of college, and usually 2-4 more years of
specialty OB training. They are trusted by the medical and
pharmaceutical boards to write prescriptions that are honored at any
pharmacy, yet you boil them down to quackery.

They are not the preferred profession to deliver a baby, IMO. Got it?

9. You don't think taxes or insurance dollars should pay for midwifery
care, despite their having A) lower rates of C-sections, B) lower rates
of maternal mortality, C) similar rates of infant mortality, and being
cheaper to the taxpayers and insurance companies
9. But you don't believe the above statement, despite having done no
research one way or the other to see if it's true.

Never said that. You assume way too often. What I said is "data" can
be contrive to report whatever finding it is you want to prove.


I see.

I might also add, that if you DID find research that proves your side
of things, I WOULD change my mind.

What makes you think I am trying to change your mind? It's obvious you
are trying to change mine. I have no intention, nor have I ever had
any intention, of changing anyone's mind.

But you also have to find the
studies that are well constructed and without serious methodological
flaws (you do know how to spot those, right?)

Obviously better than you do.


But, I doubt you are up to such research, because you aren't interested
in anything that doesn't suit your pre-conceived notions.

You are under the mistaken presumtion that I feel a need to prove a
point, or back my opinions with research. I don't. I don't care
enough about it, honestly - I have bigger fish to fry at the moment.
There is nothing pre-conceived about my "notions." I came to the
conclusions I did for a reason - I feel no need to "convince" you of
anything. You can't seem to get it through your thick head that this
is my opinion - one I have the right to hold and put forth on an open,
unmoderated newsgroup. Why that chaps your ass so badly, I'll never
know, but you sure as hell aren't going to change my mind any time soon
and I don't have any desire to change yours - not did I ever have any
desire to do so. So you might as well quit getting yourself so worked
up and quit babbling.

-L.

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.

-L.

Irene wrote:

Plus, while my goal was to go med-free, I wasn't sure how I'd feel at
the actual time, so wanted to leave my options a little more open.
That is part of the decision for hospital vs home birth that hasn't
been discussed - the easy availability of meds. I think that is a
large part of the decision for women - they won't even consider a home
birth if they have already decided they want an epidural.

Sure, although it's always possible to transfer and
get an epidural if you change your mind. That's part of the
"all or nothing" fallacy. I certainly went into my planned
homebirths knowing that if I felt like I needed an epidural,
I'd go get one.

I will say, my OB wasn't necessarily supportive of the idea of a birth
plan, I think because he had seen too many detailed ones that talked
about a lot of stuff that didn't apply. Instead, we discussed
everything ahead of time. I realize I was unusual - my OB had his own
practice, not a group. And for dd, I had some narrow timing where I
could've ended up with Joe Random Backup OB - my OB had a death in the
family and had to fly out of town right after dd was born. So in that
way, my OB experience had more continuity than a group midwife practice
would have had, tho I did have the risk of a stranger attending my
birth.

Well, that's hardly unusual. A fairly substantial
minority of women have their births attended by someone
they've never met or have only briefly met. You had a
slightly higher risk that someone in a group practice,
but even choosing a group practice doesn't guarantee that
you'll get a known care provider.

Best wishes,
Ericka

Cathy Weeks wrote:
-L. wrote:

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.

Interesting. What else is there for us to make decisions about the
relatively safety of anything?

You have to weigh everything. Sometimes what is not said is as
important as what is said.


How can anyone reasonably make ANY informed choice about anything at
all?

You have to be smart, make your own decisions and not trust data
blindly.


And when a doctor hands you a form that says you have a 1-in-X chance
of having this complication, why would you believe it, given what you
believe about data?

I don't. I don't blindly trust anything anyone publishes - everyone
has an agenda.

-L.

Irene wrote:

Fortunately, not *every* US hospital is that control-happy. Even
though I *knew* that home births could be safe, my subconscious wasn't
ready. Plus, even though I was considered low-risk, the closest
hospital was 30 minutes away in good traffic, 45 minutes or more in
rush hour. I was very lucky that the closest hospital was very
progressive - I was allowed to walk around and move, no continuous
monitoring, no pressure for meds, heplock instead of IV, food and drink
allowed, etc.

That's excellent. My own experiences with hospital birth haven't been
all that bad, actually. I've only had one kid, and she was born at home
(and healthy). But I'm much older than either of my brothers, and was
present for their births. Oldest brother was born in a hospital 40
minutes from my parent's home, because my mother didn't trust the local
(VERY small town) hospital, so we went to the university hospital
instead. Baby was born 13 minutes after we got to the hospital,
delivered by the nurse, before the OB could get there. Labor was only
about 90 minutes from start to finish. The nurse did perineal support
and massage, and Mom had no episiotomy. There was no need for walking
around or an IV because everything happened so quickly. This was back
in 1983, before having siblings present was commonplace, and because it
was in the middle of the night, she let me stay (I was 14). She was
also put MUCH more at ease with the idea of me staying, since i'd been
to the childbirth classes with my parents. My second brother was born
at the local hospital, because Mom was worried about birthing in the
car, after the previous short labor. Ironically, she had an 8 hour
labor. She was attended by two doctors actually, who acted like a
couple of midwives. They hung out with us, did perineal massage and
support, chatted, etc. The birth was slightly higher risk, due to her
having early signs of preecclampsia, and the only "intervention" was
they did attach a scalp monitor for awhile. So all in all, my mother
had really good hospital births.

My mother-in-law had my husband at a US Army hospital in Germany,
during the Vietnam war, and her experience was TERRIBLE. Like if she
tried to get out of bed to walk around, they would literally push her
back onto the bed. Stuff like that. Then, when my stepson was born,
they decided to do an episiotomy without consulting either his mom, or
my husband. Doc just said "I'm cutting now!" and did it with no
anesthesia whatsoever. She screamed and lifted her hips off the bed in
response, and my husband said blood squirted everywhere. This was all
due to mild shoulder distocia. They did it because a) the doctor was
an intern doing his OB rotation and was inexperienced, and b) he didn't
think to change her position and c) had her in the classic lithotomy
position and should have had her change position and do the... can't
remember the manuver that helps open things up. What was most
upsetting was that the baby was NOT in distress, and there was time for
them to have at least discussed the options with them.

When my daughter was born, we of course had a backup plan should
something go wrong. We had two hospitals relatively nearby - Princeton
Medical Center was 25 minutes away, but is very very mother-unfriendly
with a 40% c-section rate, a 60% epidural rate and a 75% episiotomy
rate. The other hospital was Mercer Medical Center in Trenton and was
slightly further away - 30 minutes instead of 25. The advantage to
Mercer was that it was midwife-friendly (my midwives had delivery
rights there) so even if I transferred, my midwives could continue
leading my care, unless we decided an OB was called for. The OBs that
my midwives trusted (and who backed up the midwives) were also based
there. And they had a level 3 nursery, which was more advanced than in
Princeton. So we decided that the extra 5 minutes was worth it.

As for your being uncomfortable with homebirth - I completely
understand it, especially given your distance. For us, 30 minutes was
the MAX it would take to get there. Homebirth really isn't for
everyone. My stepson's mom, when she had her second kid, decided
against homebirth herself, despite my recent home birth, and despite
the fact that her mother had assisted in several homebirths (with a
trained midwive leading things, of course!). Teresa just laughed and
said "I don't want to clean up the mess" (my midwives took care of most
of that). I suspect that her husband wasn't comfortable with the idea
either. But what she did do, was choose a midwife practice that did
in-hospital births. She did go to Princeton Medical Center, and I
warned her of their stats, and she laughed and said "I know so much
more now - I've picked the right caregiver." Then she told me who her
midwife was and I had to laugh- Ursula was well-known in the area for
being willing to butt heads with the hospital staff, so that her
patients can walk around, have a hep-lock instead of an IV, use the
birthing pool (only for labor though - the hospital wouldn't budge on
water births - which Mercer Medical did allow), and to get the nurses
to quit suggesting a "little short of something to take the edge off"
every 5 minutes. She also let her patients eat during labor, if they
wanted. Her daughter was born with no pain medication, and without the
need for an episiotomy (she flipped onto her hands and knees). Etc.

One of the things that I realized while I was in labor, that being able
to relax is KEY to making it through an birth without pain meds (if
that's a goal for you). If you can't relax, then it HURTS more.
Despite my having practiced my bradley relaxation exercises through
pregnancy, well... I still found myself tensing up during contractions.
It wasn't until I was in transition that I was starting to get the
hang of relaxing fully. Now in retrospect, I think that if you are
scared of your surroundings, then being able to relax would just fly
right out the window, thus lengthing labor, and possibly even causing
complications.

So unless you are really confident of birthing at home or in a
free-standing birth center and have a backup plan in place, then
birthing out of the hospital is just not a good idea.

Cathy Weeks

Ericka Kammerer wrote:
Irene wrote:

Plus, while my goal was to go med-free, I wasn't sure how I'd feel at
the actual time, so wanted to leave my options a little more open.
That is part of the decision for hospital vs home birth that hasn't
been discussed - the easy availability of meds. I think that is a
large part of the decision for women - they won't even consider a home
birth if they have already decided they want an epidural.

Sure, although it's always possible to transfer and
get an epidural if you change your mind. That's part of the
"all or nothing" fallacy. I certainly went into my planned
homebirths knowing that if I felt like I needed an epidural,
I'd go get one.

True, it's not all or nothing - but it certainly adds another layer of
things you have to do in order to get the epidural. Which can be both
a good and bad thing, of course - you have to really want that epidural
in order to get it!

I will say, my OB wasn't necessarily supportive of the idea of a birth
plan, I think because he had seen too many detailed ones that talked
about a lot of stuff that didn't apply. Instead, we discussed
everything ahead of time. I realize I was unusual - my OB had his own
practice, not a group. And for dd, I had some narrow timing where I
could've ended up with Joe Random Backup OB - my OB had a death in the
family and had to fly out of town right after dd was born. So in that
way, my OB experience had more continuity than a group midwife practice
would have had, tho I did have the risk of a stranger attending my
birth.

Well, that's hardly unusual. A fairly substantial
minority of women have their births attended by someone
they've never met or have only briefly met. You had a
slightly higher risk that someone in a group practice,
but even choosing a group practice doesn't guarantee that
you'll get a known care provider.

I know - I was mainly pointing out that since I think single OB
practices are relatively rare, that my continuity of care with an OB
was correspondingly rare. But since some people (I forget who) were
implying that midwives gave better continuity of care, that perhaps at
least some of that depends on whether it is a single or group practice.

Irene

-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.

Except doctors are supposed to be washing their hands.

Annonymous surveys have been done where docs have *admitted* to not
following strict infection control guidelines such as regular hand
washing. Infection control, and the difficulty with getting doctors to
follow it, is a big issue for most hospitals. That's why there's an
entire department dedicated to it in most places.



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.

Ignorance is bliss eh? Your suspicions would be incorrect. This is an
enormous problem in hospitals. I work with the infection control staffs
of all our area hospitals and it's something we are combatting *daily*.


The best place to acquire an infection is in a hospital.

Anne Rogers wrote:


I think you overestimate the politeness of doctors in keeping their mouths
shut when they thing something is someones fault, many women who have
transferred from homebirths have suffered bullying from doctors, when there
has been absolutely no justification for it.

Definitely overestimating the politeness of doctors.