Home Birth

[Anonymous]

Anonymous wrote:Have you watched the documentary “Why Not Home?” It’s very well done and walks thru the evidence on home birth risk. It surprised me to see medical professionals opting for home birth. One OB equated it as a personal comfort level with risk, similar to how we choose to drive our kids around in cars despite the high rate of accidents.

I was reading today about the Turnaway study (the longitudinal study of women who sought abortions, some of whom received abortions and some of whom were turned away). While many states are trying to restrict access to abortions due to concerns over risk, 2 of the women in the study who were denied abortions went on to die as a result of childbirth. As a society we're terrible at risk management. We don't even think about the risks of getting in a car to go to the hospital and of interventions like epidurals and pitocin, not because they are risk free but because they are commonplace.

Of the women who've had traumatic birth events, one was due to a placental abruption, one had a c-section with inadequate pain management, and one had a badly managed birth that railroaded her into a c-section that left her in pain until she had a complete hysterectomy years later. All planned hospital births and all would be considered normal outcomes (and the latter two probably not considered traumatic by the medical community).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Even though baby and I had no risk factors, my third would be dead if I had him at home. Don’t.

This is me exactly... only I'd be dead, baby probably would have made it.

Look at Kara Keough’s recent tragedy.

+1. Was considering it myself until this happened. Also ended up with a c section due to fetal distress. Modern medicine is a good thing.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Even though baby and I had no risk factors, my third would be dead if I had him at home. Don’t.

This is absolutely ridiculous and just the kind of histrionics I'd expect on this board. You have no idea what the issues were with her 3rd or if she really even needed medical intervention. Do you see how many women here claim they needed an "emergency cesarean", yet they weren't placed under general anesthesia? Here's a newsflash, that's called an unplanned cesarean, almost always done unnecessarily.

I've had a free standing birth center birth, homebirth and I'm planning another homebirth. I'm a big advocate for birthing at home.

I will say, it's not for the faint of heart. I doubt many of my friends have the pain tolerance to handle it. They'd likely demand a hospital transfer after a few mins of transition. I do believe it's almost always healthier for the baby and mother to deliver in the home environment. Also brings baby into a calm and loving environment, that's a much better way to be welcomed onto the earth side.

Plenty of necessary sections occur unplanned. Just because a csection isn’t a matter of life and death that very second doesn’t mean it’s not necessary.

Sure but in that case your midwife can say “you’re going to need a c-section, hop in the car and I’ll call the OB at your nearest hospital.” Same with possible meconium aspiration — I have a friend whose baby was born outside a hospital but taken to the NICU for observation anyway. The question isn’t “hospital or no hospital,” it’s “if you start outside a hospital, can you get there if it turns out you need to be there.” My risk tolerance is relatively low so I picked out of hospital midwives whose risk tolerance is similarly low.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Don’t do it

Too much risk

Why chance it ?

Why not educate yourself? There's very little risk involved with a homebirth, they will calculate your risk and determine if you're a candidate. You're far more likely to pick up sepsis in the hospital than have a problem with your homebirth.

Hello, made up statistic! (a/k/a lie)

Risk of maternal sepsis - 4%

Risk of needing a transfer to the hospital during home birth: 10-37%

The vast majority of transfers are for failure to progress or because the mom needs medical pain management. For example, my 3rd was a "failed" birthing center birth because I didn't continue dilating after my water broke and needed pitocin. The numbers you're siting here are comparing grapefruit to eggplant.

A lot of people in this thread are also lumping together unplanned outside of hospital births with planned homebirths with a medical professional. Those are not the same thing at all and the risks are much higher with unplanned out of hospital births. Similarly, you can not assume emergent situations that are the result of hospital practices would also result at home -- e.g. complications of epidurals, while common in a hospital, do not happen during homebirths. You're effectively trading risks.

The one factor that is most worrisome to me is that the hospital system in the US consciously persecuted midwives almost out of existence and the legacy continues today where it's basically unheard of to receive continuity of care during a transfer from a planned homebirth with a CNM to a hospital birth. So even if you do transfer for something as simple as hydration and pain management, your established care provider may not be allowed to stay with you. The other failings of the British medical system aside, this is one thing I wish we could model in the US.

I've had both homebirths and a planned freestanding birthing center birth with a midwife that turned into a hospital birth with a midwife. While birthing in a freestanding birthing center attached to a hospital is probably the best of all worlds, IMO, you have to recognize that the practicing midwives will be bound by agreements they've made with the hospital that will guide what they are or are not allowed to do. For example, almost all of these birthing centers won't allow you to birth in a tub due to these types of regulations on the CNMs.

OP, I'd recommend you contact BirthCare in Alexandria and see if they are running info sessions or can set up an info appointment. They are all CNMs and have a relationship (though of course not privileges to practice) with a hospital. While you can choose a birthing center birth, their birthing center is not attached to a hospital. It is more akin to having a homebirth in their "home".

Actually midwife practices are making a huge return in the USA. Among other things, midwives are cheaper than OB-GYNs.

[Anonymous]

Anonymous wrote:Both of my kids were born vaginally but both came out limp and blue and not breathing. They each had a full NICU team waiting. Both are fine because of my medical team. I would never ever feel comfortable with a home birth after my experiences.

My first got stuck on my hooked tailbone (an issue never previously identfied), which had to broken and she needed a vaccum assist to get over the broken bone. Totally unexpected. Very painful and scary as her heart rate started dropping while they tried to solve the mystery of why she was stuck in the birth canal. She was crowning when the issue arose--not at good time for a hospital transfer.

My second was larger than her ultrasounds predicted. Shoulder dydystocia-i.e., she got stuck after her head had come out. Very, very dangerous and very scary. A midwife might have been able to get her out, but in the hospital I had 6 people assisting. Some pushing on my stomach. Some getting things for the doctor. There is no way a single midwife (or even two) would have been as efficient and every second counts as the baby is being suffocated. I am enormously glad for the NICU team who immediately treated my limp, blue, not breathing baby when she came out.

Do you realize it's super common for all babies to come out like that? They're getting oxygen from the attached cord. You just think the "full NICU team" saved the day.

[Anonymous]

Anonymous wrote:A good CNM will have protocols in place for newborn resuscitation, maternal hemorrhage, meconium aspiration, etc. They will also have relationships with local obstetricians and hospitals and procedures for transfer before or during labor. They will have pitocin and oxygen and all the stuff you hope you won’t need (but might). My third was born with midwives in a hospital and had to be resuscitated by the NICU team; when my fourth is born with midwives at a non-hospital birth center, they will be able to do exactly the same thing if it becomes necessary. (Seriously, they read my chart from the last pregnancy, we discussed it.)

You really think a midwife can intubate a newborn as reliably, effectively, and correctly as a NICU team?

[Anonymous]

Just NO. I was driving by the Birthcare place in Alexandria last week and it had 3 ambulances outside. NO NO NO. Look at what happened to poor Kara Keough.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Both of my kids were born vaginally but both came out limp and blue and not breathing. They each had a full NICU team waiting. Both are fine because of my medical team. I would never ever feel comfortable with a home birth after my experiences.

My first got stuck on my hooked tailbone (an issue never previously identfied), which had to broken and she needed a vaccum assist to get over the broken bone. Totally unexpected. Very painful and scary as her heart rate started dropping while they tried to solve the mystery of why she was stuck in the birth canal. She was crowning when the issue arose--not at good time for a hospital transfer.

My second was larger than her ultrasounds predicted. Shoulder dydystocia-i.e., she got stuck after her head had come out. Very, very dangerous and very scary. A midwife might have been able to get her out, but in the hospital I had 6 people assisting. Some pushing on my stomach. Some getting things for the doctor. There is no way a single midwife (or even two) would have been as efficient and every second counts as the baby is being suffocated. I am enormously glad for the NICU team who immediately treated my limp, blue, not breathing baby when she came out.

Do you realize it's super common for all babies to come out like that? They're getting oxygen from the attached cord. You just think the "full NICU team" saved the day.

NO. No, no ,no.

Babies usually cry at incision or perineum, depending on how delivered. Being limp is not normal. They may not be fully flexed and may be acrocyanotic, but they should be able to transition better than "limp, blue, and not breathing." That's a really low APGAR.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Both home births and hospital births have risks. Stop trying to convince others that one is clearly superior in every aspect than the other. It’s not, they both have pros and cons that are hard to put a value to.

For me the main difference is that for a hospital birth you don’t need to think or prepare for how you’ll deal with every possible complication since there’s already a protocol in place. For a home birth you need to set up those protocols with your midwife and be sure you’re comfortable with the risks for you and your baby.

I’m a FTM and I’m going with midwives in a hospital since that’s the level of risk we feel more comfortable with as a family. We’ll see next time.

Spoken like a FTM who doesn’t understand that not all risks are equal. You really think a 10-37 percent homebirth transfer rate is NBD?

Did you even finish reading my post? I clearly say that not all risks are equal and personally I saw the transfer risk as significant for a FTM and that’s part of why we’re going with a hospital environment.

Stop trying to convince everyone you’re right and belittling anyone with an opinion different than yours.

[Anonymous]

Anonymous wrote:

Anonymous wrote:A good CNM will have protocols in place for newborn resuscitation, maternal hemorrhage, meconium aspiration, etc. They will also have relationships with local obstetricians and hospitals and procedures for transfer before or during labor. They will have pitocin and oxygen and all the stuff you hope you won’t need (but might). My third was born with midwives in a hospital and had to be resuscitated by the NICU team; when my fourth is born with midwives at a non-hospital birth center, they will be able to do exactly the same thing if it becomes necessary. (Seriously, they read my chart from the last pregnancy, we discussed it.)

You really think a midwife can intubate a newborn as reliably, effectively, and correctly as a NICU team?

No, plus another challenge is that when it comes to resuscitating newborns, the standard/best practice in a NICU is that if your intubation and compressions fail, you have to give epinephrine, and the best way to do this is through an umbilical line.

A midwife cannot give epinephrine and doesn't have the training to place an umbilical line.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A good CNM will have protocols in place for newborn resuscitation, maternal hemorrhage, meconium aspiration, etc. They will also have relationships with local obstetricians and hospitals and procedures for transfer before or during labor. They will have pitocin and oxygen and all the stuff you hope you won’t need (but might). My third was born with midwives in a hospital and had to be resuscitated by the NICU team; when my fourth is born with midwives at a non-hospital birth center, they will be able to do exactly the same thing if it becomes necessary. (Seriously, they read my chart from the last pregnancy, we discussed it.)

You really think a midwife can intubate a newborn as reliably, effectively, and correctly as a NICU team?

No, plus another challenge is that when it comes to resuscitating newborns, the standard/best practice in a NICU is that if your intubation and compressions fail, you have to give epinephrine, and the best way to do this is through an umbilical line.

A midwife cannot give epinephrine and doesn't have the training to place an umbilical line.

Yes. That's why I'm not sure people who say they are "comfortable with the risk level" really are comfortable with the risk level. There are even particular NICU docs I'd want doing the resuscitation, rather than other ones. I don't know anybody who resuscitates babies for a living who would consider a midwife's level of skill and familiarity with the process remotely comparable to someone who does it for a living.

[Anonymous]

OP, I was just in the hospital 2 days in a row for decreased fetal movement. Checked in through OB triage and started one day 2 hours and then other 5 hours (waiting on BPP ultrasound). Even though masks and distancing, everyone was lovely. Honestly. Liked almost trying to compensate for the anxiety of COVID by being so kind.

My first hospital birth people were smart and competent and did their job. But they were not warm. My second the nurses were so warm and caring. My third, we shall see, but the most recent trip makes me encouraged.

Good luck on your journey.

[Anonymous]

Former L&D nurse who delivered in the lobby of the hospital with DH, a security guard, and an emergency room nurse. Even though they called a code that alerts L&D and NICU that baby is being born somewhere other than the labor ward, DS was out before they got there.

I'm not against home births but I think you have to do a A LOT of research into them. Stay away from ones that are ultra crunchy and holistic or who badmouth moms who choose homebirth or medication
y ou need to make sure they aren't going to fight a hospital transfer. Unfortunately I've come across them before and usually the outcome is much worse.

Find out their policies regarding hospital transfer. What kind of experience do they have with problematic deliveries? What kind of equipment do they bring?

A provider shouldn't have to convince you to work with them by telling you all about the bad things about hospital births.

I also encourage you to do research into potential complications as well as natural birth. You want to be educated in the process so that if things don't feel right, you can advocate for yourself.

[Anonymous]

Anonymous wrote:OP, I was just in the hospital 2 days in a row for decreased fetal movement. Checked in through OB triage and started one day 2 hours and then other 5 hours (waiting on BPP ultrasound). Even though masks and distancing, everyone was lovely. Honestly. Liked almost trying to compensate for the anxiety of COVID by being so kind.

My first hospital birth people were smart and competent and did their job. But they were not warm. My second the nurses were so warm and caring. My third, we shall see, but the most recent trip makes me encouraged.

Good luck on your journey.

thank you for this PP! I truly appreciate your response and experiences.

[Anonymous]

Anonymous wrote:Just NO. I was driving by the Birthcare place in Alexandria last week and it had 3 ambulances outside. NO NO NO. Look at what happened to poor Kara Keough.

Now imagine if it was rush hour in Old Town. Even though it's geographically close, it would take quite some time for those ambulances to get to INOVA Alexandria (where I assume they were going).