home birth

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

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

Here's something for you ...

http://www.cnn.com/2006/HEALTH/12/19....ap/index.html

That germ is particularly notorious for running rampant through nursing
homes. Horrible that it's hit a NICU. While I was glad my daughter was
receiving stellar care when in NICU, I lived in constant fear that
she'd acquire some opportunistic infection. Fortunately I knew that
hospital's infection control team well, which calmed my fears a bit.

In any case, that bacterium in particular is not likely to harm a
healthy mother or child, at least not significantly. Its greatest
morbidity and mortality is in immunocompromised patients. For that
reason, I'm not sure it's the *best* example to illustrate your point,
if I get your point correctly. Something like C.difficile, which
commonly infects healthy people - and is very common in C-sections -
may be a more apt example. Staph aureus is another good one.

Anne Rogers wrote:
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.

hang on, you had a rise of 40/20 and trace protein? and she took no further
action? I realise that rise could still put you in normal blood pressure
zone, say 140/80, from 100/60 but isn't that why they take bp each time.

Formally the criteria say that you have to hit 140/90 and that women
with a rise of over 30/15 should be watched carefully. I was at 130/80
from my baseline of 90/60.

Shouldn't trace protein always be investigated, I don't think that vaginal
discharge causes a positive on that, in the same way it does on white cells,
so the only explaination other than there actually is protein there is
amniotic fluid.

UTIs can also cause you to spill protein, and trace protein doesn't
really seem to worry anyone. +1 does, though.

Maybe she was right to not do anything that day, but just a
regular appointment 2 weeks later seems incredibly lax, I don't know whether
the bp was taken at an office visit or not, but the very least I'd expect
would be a 2nd bp reading a day later and if possible doing it at home in
case of white coat hypertension, and education about what signs to watch out
for and when to call etc. Did you follow up afterwards what the course of
action should have been with the changes you mentioned?

The OB to whom I transferred care called her, I believe while he was
debating whether or not to send me to ICU and was trying to get a
better feel for my history, and told me he'd informed her that all
protein merited a 24-hour catch and that I should have been scheduled
for followup more promptly. Wish I'd been a fly on the wall for that
conversation!

On the topic of midwives who are lax about PE symptoms "because a bit
of elevated bp and a touch of protein are normal in late pregnancy" see
this link at the Preeclampsia Foundation forums from last week:

http://www.preeclampsia.org/forum/to...TOPIC_ID=20142

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. It is not under
any circumstances tenable to be going into multiple organ failure
during pregnancy with only midwife oversight, and since it happens in
one of twenty pregnancies I'd expect the vast majority of midwives know
this perfectly well.

But the ones who don't scare me.

--
C

Banty wrote:
In article . com,
says...

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.

Wow - those were pretty much exactly my symptoms (as well as general malaise),
and, as soon as my BP was taken, the nurse turned me to my left side and ran for
my O.B.

Sensible of her. :-)

--
C

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.

Think about it.

--
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

wrote in message
ups.com...
Anne Rogers wrote:
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.

hang on, you had a rise of 40/20 and trace protein? and she took no
further
action? I realise that rise could still put you in normal blood pressure
zone, say 140/80, from 100/60 but isn't that why they take bp each time.

Formally the criteria say that you have to hit 140/90 and that women
with a rise of over 30/15 should be watched carefully. I was at 130/80
from my baseline of 90/60.

Shouldn't trace protein always be investigated, I don't think that
vaginal
discharge causes a positive on that, in the same way it does on white
cells,
so the only explaination other than there actually is protein there is
amniotic fluid.

UTIs can also cause you to spill protein, and trace protein doesn't
really seem to worry anyone. +1 does, though.

Maybe she was right to not do anything that day, but just a
regular appointment 2 weeks later seems incredibly lax, I don't know
whether
the bp was taken at an office visit or not, but the very least I'd
expect
would be a 2nd bp reading a day later and if possible doing it at home
in
case of white coat hypertension, and education about what signs to watch
out
for and when to call etc. Did you follow up afterwards what the course
of
action should have been with the changes you mentioned?

The OB to whom I transferred care called her, I believe while he was
debating whether or not to send me to ICU and was trying to get a
better feel for my history, and told me he'd informed her that all
protein merited a 24-hour catch and that I should have been scheduled
for followup more promptly. Wish I'd been a fly on the wall for that
conversation!

On the topic of midwives who are lax about PE symptoms "because a bit
of elevated bp and a touch of protein are normal in late pregnancy" see
this link at the Preeclampsia Foundation forums from last week:

http://www.preeclampsia.org/forum/to...TOPIC_ID=20142

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. It is not under
any circumstances tenable to be going into multiple organ failure
during pregnancy with only midwife oversight, and since it happens in
one of twenty pregnancies I'd expect the vast majority of midwives know
this perfectly well.

But the ones who don't scare me.

Still, it happens with OB care too. I have a friend who went through almost
two months of pregnancy with HELLP symptoms. Her BP would go up, she'd go in
the hospital, it would go down, they'd send her home. Never did any
bloodwork to notice the hemolysis and liver enzyme levels. The only reason
it got caught, and her daughter delivered, was because her OB wasn't
available one night and the OB on call caught it. I also have heard of
another HELLP patient who had her HELLP ignored entirely in late
pregnancy-the result being that her liver ruptured, and she's still in
critical condition, while her baby is at home with her husband and older
daughter. Her OB said that the borderline PE wasn't anything to worry about
since she was in late pregnancy-unfortunately, it seems that HELLP is about
as often missed as it is caught.

In my case, I had a rise of 30/15, but it was before 20 weeks of pregnancy,
and I'd never seen the same OB twice in a row, so it wasn't caught. At 22
weeks, I was in severe PE and Class I HELLP. I have to believe that having
one continuous caregiver, as I had in my second pregnancy, would have made a
difference. In my 2nd pregnancy, my BP rise was noticed, trace protein was
monitored, and by 22 weeks I was on bedrest, on medication, and being very
closely monitored indeed-which, I feel, made all the difference.

cjra wrote:

In any case, that bacterium in particular is not likely to harm a
healthy mother or child, at least not significantly. Its greatest
morbidity and mortality is in immunocompromised patients. For that
reason, I'm not sure it's the *best* example to illustrate your point,

LOL you are probably right. However, I saw the news piece - and my
sorrow goes out to the parents - but the timing was right to use it
here.

Even if the bug that killed those babies in the NICU isn't one that is
likely to harm a full-term healthy infant, it's still something to
consider - that babies can and do get sick in hospitals, and that
hospitals ARE NOT perfectly safe.

Yes, they are best places to give birth if you are high risk. And they
MIGHT be the best places to give birth even if you aren't. (Just
feeling safer and more comfortable at the hospital is a plenty good
reason, in my opinion). But people ought to know the risks so they can
make an informed decision - thereby taking responsibility for their own
actions.

Cathy Weeks

hang on, you had a rise of 40/20 and trace protein? and she took no
further
action? I realise that rise could still put you in normal blood pressure
zone, say 140/80, from 100/60 but isn't that why they take bp each time.

Formally the criteria say that you have to hit 140/90 and that women
with a rise of over 30/15 should be watched carefully. I was at 130/80
from my baseline of 90/60.

so you'd had the rise that should lead to careful watching, but often
doesn't (cf Donna's first pregnancy)

Shouldn't trace protein always be investigated, I don't think that
vaginal
discharge causes a positive on that, in the same way it does on white
cells,
so the only explaination other than there actually is protein there is
amniotic fluid.

UTIs can also cause you to spill protein, and trace protein doesn't
really seem to worry anyone. +1 does, though.

unless you had white cells present the chances of a UTI would be slim, in
the absence of the blood pressure changes you noted above, I can see why
midwives to discount trace protein, if they didn't, they'd just end up
transferring too many patients unnecessarily and noone would trust them when
they did transfer a patient requiring urgent attention, a bit like the boy
who cried wolf, but you weren't just exhibiting trace protein.

The OB to whom I transferred care called her, I believe while he was
debating whether or not to send me to ICU and was trying to get a
better feel for my history, and told me he'd informed her that all
protein merited a 24-hour catch and that I should have been scheduled
for followup more promptly. Wish I'd been a fly on the wall for that
conversation!

well I'm glad someone followed up with her

On the topic of midwives who are lax about PE symptoms "because a bit
of elevated bp and a touch of protein are normal in late pregnancy" see
this link at the Preeclampsia Foundation forums from last week:

http://www.preeclampsia.org/forum/to...TOPIC_ID=20142

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. It is not under
any circumstances tenable to be going into multiple organ failure
during pregnancy with only midwife oversight, and since it happens in
one of twenty pregnancies I'd expect the vast majority of midwives know
this perfectly well.

But the ones who don't scare me.

I think I'm going to ask some questions about this on a midwifery list I'm
on, it is a tough call, but the distinction here is the gestation it's
happening at, for you it was pre 34 weeks, for this lady on this board it's
35 weeks, that's not in my mind, late pregnancy, and midwifes do have to be
careful with ladies who are around the 40 week mark and have any changes in
bp and urine, because if they send them into the hospital, they will almost
certainly be induced, rather than waiting for other tests to be ordered,
then you end up with 20% or something having a c-section because the
induction failed and it may all have been unnecessary, so maybe it's fair to
behave differently with symptoms like yours at 41 weeks than it is at 33
weeks, at 33 weeks those symptoms probably have a much higher chance of
developing into PE than at 41 weeks, simply because of the underlying rate
of having such symtoms at that gestation.

Cheers

Anne

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.



Hummm....Maybe - just maybe - because if something does go wrong you
have a team of well-trained medical professionals seconds away and not
minutes or hours away? It's not rocket science.

Hmmmmm... it may not be rocket science, then why do as many babies die
every year in the hospital as they do at home? (This is after
controlling for high-risk pregnancies). Those teams of well-trained
medical professionals cannot prevent hospital-caused infections. They
cannot prevent those occasional women who have complications from
anesthesia, and become paralized from the epidural, they cannot prevent
the occasional epidural from not taking so that the mother can FEEL her
abdomen being cut open (Just google Sophie Macgehee over at
misc.kids.pregnancy about that one).

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

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.



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.

In the end, he'll be fine. But hospitals are
NOT without risks to either mother or baby.

never said they were.

So your rocket science
comment was just plain silly.

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.


So you want the tax payer to fund a "whole 'nother" level of birthing
"professional" which is redundant. I see.

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.



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.

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 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.

-L.

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.

-L.

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

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

Here's something for you ...

http://www.cnn.com/2006/HEALTH/12/19....ap/index.html

If you don't believe this article, then don't bother reading any
further.

These were very sick babies (premature) who shouldn't have been born
anywhere but at the hospital - they were in the neonatal intensive care
ward.

Then I guess your example - and point - is moot then.

And by the way, Pseudomonas aeruginosa is a gram-negative bacteria
which can be controlled by a number of classes of antibiotic - but not
in immunocompromised patients. It's often found in swimming pools and
spas - the same swimming pools you birth-at-home types like to use.

However what they died from was a virulent infection that would
have been dangerous to ANY infant despite being healthy at birth. You
cannot truely separate the germs and the sick from the healthy in a
hospital envrironment.

And you can't at home, either. You have P. aeruginosa in the soil in
your plants at home, dearie. You probably have some - or did at one
time - on your skin as well.

-L.