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#41
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Midwives & Home birth vs. an OB & hospital ?
Will look for the book - but do you recall if the book mentiones anything
about a VBAC at home with a midwife ? I have heard widely varying opinions on the VBAC thing. Don't know who to beleive. Rupturing the uterus is what they are threatening anothe rfriend with. Sh efeels so guilty about doing another C section. They induced the first one for reasons I don't recall. Every single induction of freiends that I remember ended up in excessive hours of labor and fnally a C section. They just don't have induction down yet - we will find some hormone or soemthing that they've been missing all these years to explain the poor rate of induction success. L. "Mary" wrote in message ... However, I completely understand that each person has a right to their own method, and just because I cannot identify with this, it doesn't mean it's wrong. I just have this nagging feeling that if it were me, I'd be concerned that I wasn't doing the best I could do for my baby. I can't help worrying for her but I don't know why... A great book for you to read, to understand the options better, is "The Thinking Woman's Guide to a Better Birth." Statistically, it's safer for the baby to be born with a midwife than with an OB in a hospital (assuming otherwise-equal, low-risk pregnancies, of course -- if you have a medical condition or a pregnancy complication, it's safer to be in a hospital). Everyone's different, and you're certainly not *harming* your baby by going to a hospital with an OB and drugs and all that, but your friend is statistically more likely to have a healthy baby. Mary S. mom to the Sproutkin |
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Midwives & Home birth vs. an OB & hospital ?
LSU Grad of '89 wrote: If I did the home birth mid-wife thing, I would want the extra assurance that the midwife was true blue....somehow I am still a snob about this and I want to figure out why. I think it's simple ignorance of the professionalism of midwives, training they receive, etc. If you live in a state where midwifery is regulated, you can investigate with the state her history to see if it includes complaints. You can ask for her educational history also. Out of curiousity, is this what you did with your surgeon? I'm not being flippant, but I think there is a blanket trust for anyone with "M.D." behind their name. I've known women who struggle to decide over shoes longer than they did to choose their doctor. Maybe I am so afraid of the natural process of giving birth that I think the risks of a birthing disaster are much greater than they really are ? I think given your history of surgical birth, that this is a very real possibility. Kris |
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Midwives & Home birth vs. an OB & hospital ?
LSU Grad of '89 wrote:
I didn't say that to insult anybody, I just could not identify with her choice. I recognize that she cares very much - she's very intelligent. I just was wanting to know other opinions of the midwife thing. I have *never* met anyone before who did the midwife thing 100%. It may just be your area. Midwives are not evenly available around the country, and different states also have different laws (CNMs are legal in all 50 states, but the laws regarding DEMs vary). You might just live somewhere that midwifery is less common, and therefore you have less exposure to it. There is some risk with epidural, yes, but there are all kinds of risks with pregnancy in general. Historially women have died quite often giving birth, correct? Well, yes and no. When you look at the things that have killed women in childbirth historically, they tend to fall into categories that wouldn't make one eligible for a homebirth or midwifery care anyway. For instance, babies who were transverse were extremely dangerous, and would be now as well, but a transverse baby would risk one right out of a homebirth now, so it's totally a moot point. Infection killed an awful lot of women, but that's one area where death rates for women shot *UP* when physicians started attending births (because at that time they didn't know to wash their hands between patients). Infection is something that can be handled just as effectively at home now, and staying at home reduces the risk of iatrogenic infection (which is a not insignificant problem these days, although medical professionals don't like to talk about it). Basically, as long as the pregnancy proceeds normally (and midwives are perfectly capable of determining whether it is), the likelihood that a woman will die in childbirth is excruciatingly low--and no higher than it is in the hospital. In fact, to the extent that interventions like c-sections and epidurals are used without an absolute need for them, they drive the maternal mortality rate *UP*. My whole point is that wouldn't it be safer to have your bets hedged by giving birth in a hospital ? I know that it seems intuitively obvious that this is the case, but study after study have shown that it isn't. And what it really boils down to is that you're right--birth entails some risk, no matter how you do it. The key is that there are *different* risks with hospital and home birth. If you choose to be at home, there is a very tiny chance that an unforseen emergency will develop that if you don't have high tech medical specialists and equipment immediately to hand, the baby or mother will die. On the other hand, if you choose to be in the hospital, you accept the chance that the baby or mother will die *because* of some intervention introduced in the hospital that wouldn't have been introduced at home. While the risks are different, the *magnitude* is roughly the same, which is why the studies show roughly equivalent safety stats. Fortunately, mortality rates are blessedly low whichever way you choose, but you don't *get* to make a choice that removes the risks. You only get to choose *which* risks you'd rather take. Some people are more comfortable with the risk that their baby will die because of something the hospital did, and some are more comfortable with the risk that their baby will die because it took them too long to get to the hospital in a transport situation. Anyone who thinks they're eliminating the risks is just in denial, though none of us like to think of those possibilities. So far in this thread, people have quoted namless statistics. I always felt that not naming sources was pretty lame. (not talking about you here....) Well, but to be fair, where are your stats that hospital birth is safer? There are quite a few organizations that have determined that midwifery care and homebirth are at least safe enough that they should be available as options for all women (e.g., the appropriate governing bodies in England and most of the Scandinavian countries), with some even saying that midwifery care should be the standard for all normal births. In fact, the country that has the highest rate of homebirths actually has *better* infant mortality stats than the US does. The Cochrane Group has determined that there is no evidence that homebirth and midwifery care are unacceptable (they don't discuss the issue in their layperson's _Guide to Effective Care..._, but they do in the big two volume set _Effective Care in Pregnancy and Childbirth_ by Chalmers et al.)--and the Cochrane Group is recognized as one of the leading institutions for evaluating evidence based medicine. There are studies out there that show homebirth to be less safe, but if you look at the studies themselves, you will find seriously flawed methodologies. For instance, some of them lump planned and unplanned homebirths together, when in fact, the safety stats for the two are *very* different. People arguing against homebirth often trot out these studies as evidence that out of hospital birth should not be allowed, but if you actually look at the studies, the ones that are methodologically sound support the safety of homebirth and midwifery care. All in all, I want to stres that my statements here were initially to try and understand the midwife/home/no doctors/less technology route. *Not that it is worse * I repeat-- Not that it is worse, but that I DONT UNDERSTAND IT. Instead of getting some kind direction from open minded people, I get attacked....? You may have inadvertently stepped into the hornet's nest. Women who choose homebirth often find themselves enduring thinly veiled attacks for their entire pregnancy that often take the form that you used. Most have heard things like, "Well, that's nice if you want it, but if *I* had had a homebirth, my baby would be dead," or, "Why would you want to be a martyr--enduring pain doesn't make you a better mother," or any number of other comments that are meant to tell them their choices are dangerous and inappropriate. I think it's somewhat understandable that people who've had to hear those sorts of comments for months on end might get a bit sensitive to them. It does get old after a while that so many people *assume* that you'd make a choice without having any clue about whether it was safe (though of course women who choose to do whatever their doctors say get a pass because the assumption is that their doctors would never tell them anything that wasn't the best possible care). but why would that [whether a midwife could write prescriptions even matter It matters, because this person is adamant about not ever seeing a doctor. But my point is that there's nothing in a normal pregnancy that absolutely *requires* a prescription. You can get prenatal vitamins without a prescription. Midwives who can't write prescriptions simply refer clients to a doctor when and if a prescription would become necessary. As far as your friend being adamant about not ever seeing a doctor, I imagine that has to be qualified with as long as her pregnancy is normal. I rather doubt that she would refuse to see a doctor if she went into labor with a transverse baby and it was either see a doctor or die. In fact, I suspect she'd even go see a doctor if her blood pressure went up and she started spilling protein in her urine (something that any midwife, whether CNM or DEM would be checking for, and which doesn't require a prescription). So what I am saying is that I HOPE my friedn does go to a doctor if her midwife tells her soemthing needs to be checked out better than she (the midwife) can do. That makes sense. You see, when she and I were having this conversation she acted as if hospitals and doctors were evil. I just didn't understand the fervor. Like it's a religion or something. I can definitely agree with her decision not to have doctors strapping her to a bed and not lettign her drink anything for hours of labor. I agree that hospitals are barbaric in many ways. But I never went through that. I had a neat scheduled C-section (not by choice). I guess I have been thinking that hospitals were the only responsible choice. Yes, I had been thinking that, but alot of posts here have changed my mind, and so I got what I came for, albeit attacked for doing so. I'm glad you were able to look past the frenzy. I rather suspect that your friend was as fervid as she was simply because she's swimming against the mainstream. While there are women out there who are so adamant that they won't see a doctor ever, for any reason, they are few and far between. And regardless of the woman's views, many midwives would refuse to take on a client or continue to provide care if the pregnancy showed signs of being so abnormal that a homebirth would be too risky. Many midwives would lose their licensure if they attended high risk births. Certainly, there's argument about precisely where these lines should be drawn, and some midwives and clients are more conservative than others-- but then again, some OBs are more conservative than others too! As far as why people are so passionate about this, I'm sure it's very hard for you to imagine given your background. But honestly, if you had *any* inclination in that direction and you'd experienced homebirth, I think you'd see why. It's not just like a hospital birth but without the interventions. It is a qualitatively different experience. While this difference may not matter for some women, for others it's a pretty big deal. Birth is always a life changing experience no matter how you do it, and I'm not saying that women who've chosen hospital birth are somehow "less than" because they didn't get to experience the "whole thing," but if what you're looking for, in addition to the healthy mother and baby that we *all* want, is more in line with homebirth, the experiential difference is HUGE. It's one of those things that is virtually impossible to describe to someone who hasn't experienced it. That doesn't make those who choose homebirth better in any way, but it does make homebirth a better choice for some women in some situations when that's what they want. And I have to say that while I don't think hospital birth is some sort of horrible thing, I do think it's a crying shame that we live in a society where most women don't even have any *IDEA* what the alternatives are, or even that they exist. They don't know what they're missing, so they're really denied the opportunity to even *make* an informed choice. Even if everyone knew, there would still be women who would choose hospital birth, and that's fine by me, but I think it's a shame that people don't know and that our society and media persistently present a very biased picture that reinforces the notion that only hospital birth is acceptably safe when that is demonstrably untrue. Best wishes, Ericka and sensible as long as she's having a normal pregnancy. And if her midwives are worth their salt, if she shows any evidence of NOT having a normal, healthy pregnancy she will consult with an OB and will change plans as necessary to accommodate the situation. I guess this is where my own trust in a midwife would break down. If I did the home birth mid-wife thing, I would want the extra assurance that the midwife was true blue....somehow I am still a snob about this and I want to figure out why. I think it's simple ignorance of the professionalism of midwives, training they receive, etc. Looks like I still ahve to work on this, but I am closer to overcomign my "snobbery" for lack of a better term. I respect my friend's decision. Truly I do, it's just one of those things where I am having difficulty identifying with it. Maybe I am so afraid of the natural process of giving birth that I think the risks of a birthing disaster are much greater than they really are ? It may be a natural thing, but.....I have had 2 friends with high risk births and pre-eclampsia, and it seems like the extra insurance of havign a birth in a hospital is worth the discomfort of a horrible hospital (metal beds, nurses who demand you breast feed RIGHT NOW at 2 AM and interrogate you like they're the breast police because you defied their desire to stuff a bottle in your helpless babies' mouth - can you tell that I did not have a pleasant experience in the hospital ?!?) I definitely understand her desire to NOT be in a hospital...I just hope that everything goes wonderfully (and I am 99% sure it will.) L. |
#44
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Midwives & Home birth vs. an OB & hospital ?
LSU Grad of '89 writes:
: My whole point is that wouldn't it be safer to have your bets hedged by : giving birth in a hospital ? Actually, no. I tbink Ericka has explained WHY this is not the case adequately enough, so I will let it lie. : So far in this thread, people have quoted : namless statistics. I always felt that not naming sources was pretty : lame. (not talking about you here....) Please see the list of cites for peer reviewed studies at the end of this post. Happy reading. : Instead of getting some : kind direction from open minded people, I get attacked....? As was previously explained, your post came across as an attack on the practice of homebirth, and a personal attack on anyone who chose it. I am glad that was not your intent. : I guess I have been thinking that hospitals were the only responsible : choice. Expressing this sentiment is what you were "attacked" for because it is itself an attack on everyone who makes a different choice. : Yes, I had been thinking that, but alot of posts here have : changed my mind, I am glad. That kind of open mindedness is all we ask. :-) : I guess this is where my own trust in a midwife would break down. : If I did the home birth mid-wife thing, I would want the extra assurance : that the midwife was true blue....somehow I am still a snob about this : and I want to figure out why. I think it's simple ignorance of the : professionalism OK. I have no problem with this as long as you would hold an OB to the same high standard of accountability and require that he (or she) show that (s)he is "true blue." Good luck, Larry PS: Here is the list of cites for articles discussing the safety of homebirth. Note that while many are US articles, there are also articles from all over the world. Articles on the relative safety of homebirths attended by a Direct Entry Midwife versus those attended by an OB in a hospital: Abernathy, Thomas J and Dontia M Lentjes "Planned and Unplanned Home Births and Hospital Births in Calgary, Alberta, 1984-87", Public Health Reports 104 373 (1989) Planned home births: 61, Control group (Hospital): 33,777. The article does not study neonatal mortality but relies on other measures of birth outcome (Onset of respiration, duration of labor, gestational age and birth weight) Burnett IN, Claude A et al. "Home Delivery and Neonatal Mortality in North Carolina", J American Med. Assoc. 244 2741 (1980) Planned home births attended by a midwife: 768, Control group (Hospital) 242,245. Neonatal mortality: 4/ 1000 (12/1000 for the control group. Campbell, Rona et al. "Home Births in England and Wales, 1979: Perinatal Mortality According to Intended Place of Delivery", British Medical Journal 289 721 (1984) lntended homebirths 5917, no control group, NeonatalmorLality:4.1/1000. Cunningham, John D "Experiences of Australian Mothers who Gave Birth Either at Home, at a Birth Centre, or in Hospital Labour Wards", Soc. Sci. Med. 36 475 (1993) The article studies the reported birth experiences of mothers electing home births and compares them with mothers electing births in other locations. Declercq, Eugene R. "Out-of-Hospital Births, U.S., 1978: Birth Weight and Apgar Scores as Measures of Outcome", Public Health Reports 99 63 (1984) Midwife attended home births: 9,504, Control group (Hospital): 3,268,805. The article doesn't use neonatal mortality as a measure of birth outcome. Durand, A. Mark "The Safety of Home Birth: The Farm Study", Am. J Public Health 82 450 (1992) Midwife attended births: 1,707, Control group (Hospital): 14,033. Perinatal mortality 10/1000 (Control group 13/1000). Fedrick, Jean and N R Butler "Intended Place of Delivery and Perinatal Outcome", British Medical Journal 763 (1978) Home births: 156, Control group (Hospital): 14,033 Death rate 8/1000 (Control group: 13/1000) The article concludes that hospital births are safer than home births, however it makes no accounting for birth attendant. Hinds, M Ward, Gershon H Bergeisen and David T Allen "Neonatal Outcome in Planned vs Unplanned Out-of-Hospital Births in Kentucky", J. American Med. Assoc. 253 1578 (1985) Planned home births: 575, Control group unspecified. Neonatal mortality: 4/1000 (Control group: 5/1000) Mehl, Lewis E. et al. "Outcomes of Elective Home Births: A Series of 1,146 Cases", J Reprod. Med. 19 281 (1977) Perinatal mortality: 9.5/1000 (Control group: 20.3/1000) Murphy, J F et al. "Planned and Unplanned Deliveries at Home: Implications of a Changing Ratio", British Medical Journal 288 1429 (1984) Planned home births: 315, Control group: 44,52 1, Neonatal mortality: 3.2/1000 (Control group: 10.7/1000) Schneider, Dona "Planned Out-of-Hospital Births, New Jersey, 1978-1980", Soc. Sci. Med. 23 1011 (1986) Planned out-of-hospital births: 775. The article uses birth weight as a measure of outcome. It examines the demographic makeup of women electing home birth more than it examines outcome. Schramm, Wayne F et al. "Neonatal Mortality in Missouri Home Births, 1978-84", Am. J Public Health 77 930 (1987) Planned, professional-attended home births: 1770. Neonatal mortality: 5/1770 (Expected 3.92/1770) Shearer, J M L "Five Year Prospective Survey of Risk of Booking for a Home Birth in Essex", British Medical Journal 291 1478 (1985) Planned home births: 202, Control group (Hospital): 185. No perinatal deaths in either group. Other factors show home birth outcomes better than hospital births. Shy, Kerkwood K., Floyd Frost and Jean Ullom "Out-of-Hospital delivery in Washington State, 1975 to 1977", Am. J. Obtset. Gynecol. 137 547 (1980) Home births: 1614, Control group: 157,868. Neonatal mortality: 28/1614. The article concludes that home births are more dangerous but doesn't account for birth attendant. Of the 28 neonatal deaths, 15 were the result of prematurity, Of these 12 births were unattended. Sullivan, Deborah A. and Ruth Beeman "Four Years' Experience with Home Birth by Licensed Midwives in Arizona", Am. J Public Health 73 641 (1983) The article traces the decline in the number of complications in home births with time after Arizona began licensing midwives. Additional more general studies comparing the safety of home versus hospital birth. Janssen PA. Holt VL. Myers SJ Licensed midwife-attended, out-of-hospital births in Washington state: are they safe? Birth. 21(3):141-8, 1994 Sep. Woodcock HC. Read AW. Bower C. Stanley FJ. Moore DJ A matched cohort study of planned home and hospital births in Western Australia 1981-1987 Midwifery. 10(3):125-35, 1994 Sep. Sakala C. Health Policy Institute, Boston University, MA 02215 Midwifery care and out-of-hospital birth settings: how do they reduce unnecessary cesarean section births? Social Science & Medicine. 37(10):1233-50, 1993 Nov. Declercq ER. Merrimack College, North Andover, Massachusetts Where babies are born and who attends their births: findings from the revised 1989 United States Standard Certificate of Live Birth Obstetrics & Gynecology. 81(6):997-1004, 1993 Jun. van Steensel-Moll HA. van Duijn CM. Valkenburg HA. van Zanen GE. Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands Predominance of hospital deliveries among children with acute lymphocytic leukemia: speculations about neonatal exposure to fluorescent light Cancer Causes & Control. 3(4):389-90, 1992 Jul. Ford C. Iliffe S. Franklin O. Department of Primary Health Care, Whittington Hospital, London Outcome of planned home births in an inner city practice BMJ. 303(6816):1517-9, 1991 Dec 14. Mehl, L.E., Scientific Research on Childbirth Alternatives: What It Tells Us About Hospital Practice, in Stewart & Stewart, eds., 21st Century Obstetrics Now!, 2nd edition, Vol. 1, pp. 171-208, NAPSAC International, Marble-IEIL 1978. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Murphy PA, Fullerton J Obstet Gynecol 1998 Sep;92(3):461-470 Perinatal loss in planned and unplanned home birth. The Northern Region's Perinatal Mortality Survey Coordinating Group. BMJ 1996;313:1306-9. Home versus hospital deliveries: a prospective study on matched pairs. Ackermann-Liebrich U, Voegli T, Guenther-Witt K, Kunz I, Zullig M, Schindler C, et al. BMJ 1996;313:1313-8. Outcome of planned home and planned hospital births in low risk pregnancies in the Netherlands. Wiegers T A, Keirse M J N C, van der Zee J, Berghs G A H. BMJ 1996;313:1309-13. Prospective regional study of planned home birth. Davies J, Hey E, Reid W, Young G. BMJ 1996;313:1302-5. |
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Midwives & Home birth vs. an OB & hospital ?
"Larry McMahan" wrote in message ... LSU Grad of '89 writes: : I guess I have been thinking that hospitals were the only responsible : choice. Expressing this sentiment is what you were "attacked" for because it is itself an attack on everyone who makes a different choice. It's the wording of "only responsible choice" that's the problem. If it's the only choice YOU would consider as responsible for YOURSELF, that's fine. I chose a hospital birth for my recent VBA2C even though I could have chosen a homebirth with a local homebirth midwife* (the only one in the area who will attend VBACs). I also agreed to a number of interventions (continuous monitoring, external at first, then internal; an ultrasound measurement of my scar, antibiotics for my GBS+ status, etc.) that I felt were good choices in my situation. However, I understand when other people make different choices. A local woman recently had a VBA4C with the aforementioned local homebirth midwife*. *As it turns out, it's as well I didn't go with her as a midwife that night. As it was, I had hired her to be my doula, and she left her pager in the living room and fell asleep in her bedroom. I went into labor at 1am; we called repeatedly from home and the hospital and she never called back nor came. She didn't get the messages until the next morning....5 minutes after my daughter was born. So I shudder to think if I'd been trying to push my baby out for 4 hours with my legs cramping at home, and no one in attendance because the only midwife who would attend me....made a mistake that night. I'm not naming names because anybody can make a mistake, but I'm still glad all the same that I was with my OB (who came in on her day off to attend me) and not with this particular lady. --angela |
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Midwives & Home birth vs. an OB & hospital ?
Chotii writes:
: "Larry McMahan" wrote in message : ... : LSU Grad of '89 writes: : : I guess I have been thinking that hospitals were the only responsible : : choice. : : Expressing this sentiment is what you were "attacked" for because it : is itself an attack on everyone who makes a different choice. : It's the wording of "only responsible choice" that's the problem. If it's : the only choice YOU would consider as responsible for YOURSELF, that's fine. You are absolutely right, Angela! However, the rest of her post clearly implied that she thought the choice of homebirth by her friend was "unreasonable." It is this more or less summary condemnation that I objected to. :-) Larry |
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Midwives & Home birth vs. an OB & hospital ?
On Fri, 12 Sep 2003 11:11:39 +0800, "JoFromOz"
wrote: Naomi Pardue wrote: Just out of curiousity, if a mother says, "No, you will NOT give me pitocin," what happens then? Then the bully doctor (if it is his shift) will come in and tell the woman: "If you were my wife, that is what I'd have you do." Is that when I'd get to say 'if you were my husband, I'd take it?" (sorry, it makkes me puke too) Hope -- Riley 1993 c/s Tara 2002 HBAC http://www.babyslings-australia.com |
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Midwives & Home birth vs. an OB & hospital ?
LSU Grad of '89 wrote:
I agree. What I don't understand is why women remain immobile ? Do they strap you down or something ? I was there when my sister gave birth - in a hospital - and it was a "let's get this over with" experience. She just did not feel comfortable and neither did I. FWIW, I had a friend who was induced because she "might" be having a big baby and had been very uncomfortable for the past week. She also ended up with all kinds of pain drugs, plus continuous monitoring, including an internal monitor on the baby. Plus, just to make matters worse, her DH [who is a friend of mine too, and I like him quite a lot, but I would not, under any circumstances, want him to attend my birth] is a medic working on becoming a physician's assistant. Like the official staff, he, too, was pretty gung-ho about using drugs. My poor friend wasn't strapped down, but she was burdened with a lot of tubes and wires and was kind of whacked out from the drugs. So she stayed where she was told to stay and no one suggested she do otherwise. No idea if this is what happened with your sister, but my friend's situation is definitely one I'm holding up to myself as "don't do it this way!" PS: I'm sorry you've felt attacked. I've thought the posts were reasonable, though often enthusiastic. I think this perspective and the loyality it inspires could be pretty overwhelming to someone who isn't familiar with it already. Take care, Valerie |
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Midwives & Home birth vs. an OB & hospital ?
In article , LSU Grad of '89 wrote:
I have heard widely varying opinions on the VBAC thing. Don't know who to beleive. Rupturing the uterus is what they are threatening anothe rfriend with. Sh efeels so guilty about doing another C section. Purely anecdotal, but a friend of ours and his wife did a home VBAC, and she ruptured. They all piled into the subaru (midwife trainee driving, husband in the front, midwife and mother in the back) and drove to the hospital. Three hours after they got to the hospital she made it into surgery for the rupture. Mother is just fine, and the baby is a happy 5 yr old now. Rupture happens, but I don't think that I would avoid a VBAC based on the rupture risks. Elaine |
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Midwives & Home birth vs. an OB & hospital ?
Elfanie wrote: On Sun, 14 Sep 2003 10:40:08 -0600, hierophant THREE hours after? I'm shocked that she didn't bleed to death and her baby survived without severe brain damage in that time. That's an unbelievably long time. That's because most people, when they hear the word "rupture", picture a complete (catastrophic) rupture. most ruptures are dehiscence of the scar...which is probably what she had. Dehiscence = split, so that's not a big deal? Kris |
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