Can we have the negatives discussion?

[thursday2]

We just booked our homebirth and put a deposit down for the MW this week (yay!). I kept my final appt. with my OB because 1) I wanted to make sure to get the U/S referral and another blood test I needed through her to make it easy for insurance and 2) I was hoping to talk to her about being my backup.

While she did agree to be my backup to some degree, she was, as expected, not enthusiastic about my choice to HB, but she was not fear-mongering either. She seemed legitimately concerned about various negative scenarios and frankly seemed pretty hurt that I assumed she would do unwanted interventions. I discussed with her that my fear of rare things like uterine rupture was nil compared to my chances of various hospital scenarios, but she did get me thinking, and I feel a little frustrated by trying to parse out pros vs. cons.

I know the pros of HBing and the statistics, and DH and I are comfortable with our decision to HB, but I also don't like to be ill-informed. The problem is that the negative side of HBing is usually perpetuated by people who are VERY anti-HB, so it's hard not to take it with a giant grain of salt. Can we, HB advocates, have an honest discussion about some of the negatives/scary situations? If you've had a HB in which something went wrong or your transfer was a real emergency and not for exhaustion/breech, etc. (not that these aren't legitimate, I'm just thinking about true disaster situations), or if you're a MW who has had a client start bleeding out after birth, etc., can we talk about the dangers and what happened as a result?

[ColwynsMommy]

I'm not a midwife and my homebirth went well (and I'm planning another), so take my opinion with a grain of salt.

When choosing where to give birth, you have to understand that there will always be risks. The risks that come with giving birth in a hospital are very different from the risks of giving birth at home. Both sets of risks include catastrophic scenarios where both mom's and baby's lives are at risk. You need to look at the risks of giving birth in each place you're considering and decide which set of risks to accept.

I think it's widely believed that giving birth in the hospital is without risks, and that's just not true. Most OBs believe that being in the hospital with lots of technology is the cure to every situation, and don't necessarily understand that just being in the hospital opens you up to a whole new set of risks (which aren't necessarily even related to birth - like nasty, nasty antibiotic resistant infections). Most OBs can't even fathom the fact that midwives have a whole different knowledge base that can prevent a lot of the 'emergencies' that happen in the hospital.

Yes, babies and moms can suffer and die when attempting a homebirth. The same is true for hospital births. There are people who have lost their babies simply because they chose to give birth at home, and there are people who have lost their babies just for choosing to give birth in a hospital. There are going to be losses no matter where you chose to give birth.. you just need to honestly weigh the risks and decide which set you can live with.

ETA: As far as a discussion about specific dangers/complications, that's a conversation that you should have with your midwife (in addition to here and any other reading you do). I think it's really important to know what specific situations your midwife has dealt with, what she did, how it turned out, etc - rather than just knowing what could go wrong. Knowing that PPH or shoulder dystocia could be a problem is one thing, but knowing that your midwife has experience dealing with such things, and has done so successfully, will hopefully put your mind at ease.

[ShwarmaQueen]

I transferred about an hour after delivery for a retained placenta and postpartum hemmorage. It was considered an emergency, but the ambulance sat in front of my house taking my insurance info for 20 min and didn't even use the lights on the sloooooooow ride to the hospital. Does that even count?

[fishmom]

When my dd1's head came out her cord was wrapped tightly around her neck and the MW could not undo it. She said it needed to be clamped and cut right then and we were like, "no, that's not what's supposed to happen!" It turned out she had a very short cord. She was born blue. Apgar of 3 and then 7. It was the scariest minute of our lives. The MW's assistant is also an EMT (she is now our primary MW this time around) and she rescusitated dd. I had pushed for 3 hours.

Our current MW (2,000+ births attended) has told us of other MWs not knowing how or when to properly use the medical equipment they carry with them. That is scary to me. She's told me about quite a few hairy situations and how they were handled either by her or by other MWs. I appreciate these stories b/c it helps me to know that there are protocals that she follows. I like that she has a medical background; not all MWs do. I think there needs to be a good balance between having the knowledge and knowing when and when not to use it.

DS1's birth was almost a transport. He had a large head and wasn't quite finding his way down and out. My previous MW said I'll give you one more push(talk about a motivator!) as my bff was frantically moving cars around outside. I know it was b/c they allowed me to walk around and get in and out of a tub that ds was finally able to situate himself to be born. :-) He was 9.5 lbs w/a 15.5 inch head, but I had no tears or distocia. He was just fine!

I'm convinced that if either of these births had been in a hospital they would have been c-secs. So ultimately, even thought these births were a bit scary, I wholeheartedly believed they were better than being in a hospital. DS2's HB was kinda boring and uneventful in comparison (just the way we wanted it! )

[BtotheG]

Originally Posted by ColwynsMommy

I'm not a midwife and my homebirth went well (and I'm planning another), so take my opinion with a grain of salt.

When choosing where to give birth, you have to understand that there will always be risks. The risks that come with giving birth in a hospital are very different from the risks of giving birth at home. Both sets of risks include catastrophic scenarios where both mom's and baby's lives are at risk. You need to look at the risks of giving birth in each place you're considering and decide which set of risks to accept.

I think it's widely believed that giving birth in the hospital is without risks, and that's just not true. Most OBs believe that being in the hospital with lots of technology is the cure to every situation, and don't necessarily understand that just being in the hospital opens you up to a whole new set of risks (which aren't necessarily even related to birth - like nasty, nasty antibiotic resistant infections). Most OBs can't even fathom the fact that midwives have a whole different knowledge base that can prevent a lot of the 'emergencies' that happen in the hospital.

Yes, babies and moms can suffer and die when attempting a homebirth. The same is true for hospital births. There are people who have lost their babies simply because they chose to give birth at home, and there are people who have lost their babies just for choosing to give birth in a hospital. There are going to be losses no matter where you chose to give birth.. you just need to honestly weigh the risks and decide which set you can live with.

ETA: As far as a discussion about specific dangers/complications, that's a conversation that you should have with your midwife (in addition to here and any other reading you do). I think it's really important to know what specific situations your midwife has dealt with, what she did, how it turned out, etc - rather than just knowing what could go wrong. Knowing that PPH or shoulder dystocia could be a problem is one thing, but knowing that your midwife has experience dealing with such things, and has done so successfully, will hopefully put your mind at ease.

I was going to reply, but Colwynsmommy said it perfectly.

[LiLStar]

My ds had shoulder dystocia. My mw handled it well, and got him out. It took a few minutes and some effort though! I didn't tear, and my baby wasn't injured in the process. I'm very happy with how it was handled. He didn't look so good after he was born (my husband thought he was dead!) he was completely unresponsive. He was resuscitated right there with the cord attached. Within a few minutes you never would have guessed there had been a problem, he was bright eyed, alert, pink, and eagerly nursing!

After everyone left and the house was quiet and I was in bed snuggling the baby, I started thinking... omg I am so glad that didn't happen in the hospital! In the hospital the cord would have been cut and he'd be whisked away to the warmer to be resuscitated. That would have been traumatic for me I think. I didn't have fear with his birth. It was a surreal moment. Like part of my brain was saying, "umm.. hello? Thats YOUR baby lying there blue, limp, unresponsive" but I was completely calm. I just KNEW, intuitively, that he was alright. That he was attached to a pulsing cord, and my midwife knew what she was doing and that he would be fine. He was right there where I could see him. I could see when he opened his eyes, and started making attempts to cry.

soo.. it was a serious emergency, but BECAUSE we were at home, it was not a traumatic one.

[sunfish21]

My HB was an unplaned UAHB because DD came so fast that the MW couldn't get there. I lost a lot of blood and becuase we weren't paying attention to it we couldn't tell her how much it was. Later, it was decided that a transfusion was probably a good idea, but we just didn't know. I was weak for a long time--felt like I missed the first two weeks with DD because I couldn't even sit up without the room spinning. I would guess that in the hospital this wouldn't have been an issue, and I am glad that I wasn't there, but I was in rough shape for awhile.

[J. Jones]

fishmom - An EMT midwife? That sounds awesome!

I also know people who have had midwives deliver their babies in a hospital - because they needed to know a "crash team" was close by, but wanted the midwife's approach to delivery.

I transported from my HB hours after the delivery because of extensive lacerations that the mw couldn't fully handle. I knew she didn't have a lot of experience, but she was the only one available. Now I'm not sure I made the best choice. More midwives in the deep south please!!!!

[Sweetiemommy]

We had premature rupture of membranes (no problem because my midwife wasn't checking dialation), shoulder dystocia, retained placenta (with manual removal), postpartum hemmorage (handled with pitocin)...my midwife has an IV to give antibiotics, fluids etc. She has oxygen, she does breech births, she can do an episiotomy in an emergency. She is great!

The most important thing is to know your midwife and her level of experience. I chose a CNM because she can legally carry all of the things she needs in the case of an emergency. She has a competant assistant, she has been to thousands of births, she is wise and spiritually mature. She is also a Christian woman of faith and that is important to me. I wouldn't feel comfortable birthing at home with just anyone, especially with my risk factors.

[SwanMom]

We had serious meconium aspiration at DS's birth, but that could have happened in the hospital, too. I think I read somewhere that 1 in 2000 babies aspirate as badly as DS did. He had to be on a ventilator for more than a week, and it there were some scary days.

Am I sorry I had him at home? No. Like I said, it could have happened in the hospital. We live a few minutes from the hospital, and 25 miles from the nearest NICU. He still would have needed to have been transported to the NICU, so being at our local hospital wasn't necessarily safer. My midwives handled the situation so peacefully & professionally, and I was amazed at them. I was able to hold DS immediately, look in his eyes (while I held the oxygen), and talk to him as we transported. I think that that first connection was important and may have even helped him through the following week of being drugged & on a machine.

Also, I wasn't ever admitted to a hospital, so I was free to go to the NICU immediately instead of being held in the local hospital for recovery. They gave me a room & a breast pump at the NICU hospital, and I was able to rest there without ever being a patient. I liked my freedom.

His birth was gentle, even though it was an emergency. I was able to push him out myself, and I had a huge birth high. I probably would have had interventions in a hospital, as it was a longish labor.

We're currently planning another home birth. I feel confident that the hospital is riskier for us than home is.

[Gena 22]

Very interesting thread. It's been a while since I was planning my HB, so I'm a little far from the nuts and bolts of exactly what the worries are. So here's my global perspective on it, and please be understanding, this is just my opinion:

The most real effect of birthing at home for me was taking responsibility for the outcome. If something went terribly wrong, it would have been a result of my choices. I was responsible to my children, myself, my family and the outside world. That was a hard realization, but one I was ultimately comfortable. In a hospital, I would not have had full control, and thus would not have been fully responsible for the outcomes. This is a big deal, at least to me. It's a pro and a con.

But in terms of health - the benefit to birthing in a hospital rather than home is the theoretically immediately available technology and specialists. If something happens where life and death or injury are a matter or seconds or minutes, if you're at home, you may not make it. But the reality is that in a hospital you may not get second by second or even minute by minute service either. Many hospitals cannot offer this - thus VBAC bans. I have a friend that waited on the operating table for 25 minutes in a life-threatening emergency situation. With that kind of response, I was as safe at home. I live a mile from 3 hospitals. I could have called ahead and gotten to emergency care just about as fast as I would have in-house. Just about? Well that infinitesimal difference was one I was willing to take.

The reality is that many procedures in the hospital put you at greater risk. The upside is fast availability of help. But if you HB close enough to a hospital that benefit disappears.

[AustinMom]

I think its important for those not savvy on HB to really look into what all a MW brings to the birth. It's not like, she brings, a stick to bite on, a knife to "cut the pain" and a pot to boil water, and that's it. They usually bring up to 3-4 bags of medical equipment. Most of which in rarely used. One of the MWs here said that she buys Pitocin, and before she has the opportunity to use it, it expires, so she pretty much buys it, and throws it away. The are times of course when it is needed like in PP hem. Of what I know, when the emergencies do happen, the MW has things to postpone them from getting worse till she can get you to the hospital for further help.

We are HBACing, and I know the "risks" in it, personally, I feel that the risks of me rupturing are higher in a hospital, as more interventions are done, and I'm less relaxed, there is no hydrotherapy, and if you can get into the position your body wants, it's harder to "feel" what is going on, so I'd be more likely to have a bad outcome in a hospital than at home, calm, in a big birth pool, with patience surrounding me.

[dannic]

I tend to be shocky and lose more than normal amounts of blood after labor. The exception for this was when I delivered #2 in our truck. Minimal loss and felt great immediately.
My first birth-bc-was a transport and they put me on an iv drip that made me swell and literally bleed postpartum for 6 mos. (DS was 6 mos before I could quit using pads)
At my hb I did loose more blood and was shocky. My midwife gave me tinctures to increase cramping and wouldn't let me stopp bfing when the afterbirth pain was unbearable. I drank a lot of electrolytes and water and had a slow recovery. (Like my first) However, I had two weeks of bleeding and could rest and recover at home without 3 am checks and all the other pokes and prods I got with my first.

I have no idea why I am was shocky and had slight hem. with 1 and 3 and not with 2, aside from it being compensation for having a baby in a truck.
Knowing this, I much preferred my hb.

[claddaghmom]

Originally Posted by Gena 22

Very interesting thread. It's been a while since I was planning my HB, so I'm a little far from the nuts and bolts of exactly what the worries are. So here's my global perspective on it, and please be understanding, this is just my opinion:

The most real effect of birthing at home for me was taking responsibility for the outcome. If something went terribly wrong, it would have been a result of my choices. I was responsible to my children, myself, my family and the outside world. That was a hard realization, but one I was ultimately comfortable. In a hospital, I would not have had full control, and thus would not have been fully responsible for the outcomes. This is a big deal, at least to me. It's a pro and a con.

But in terms of health - the benefit to birthing in a hospital rather than home is the theoretically immediately available technology and specialists. If something happens where life and death or injury are a matter or seconds or minutes, if you're at home, you may not make it. But the reality is that in a hospital you may not get second by second or even minute by minute service either. Many hospitals cannot offer this - thus VBAC bans. I have a friend that waited on the operating table for 25 minutes in a life-threatening emergency situation. With that kind of response, I was as safe at home. I live a mile from 3 hospitals. I could have called ahead and gotten to emergency care just about as fast as I would have in-house. Just about? Well that infinitesimal difference was one I was willing to take.

The reality is that many procedures in the hospital put you at greater risk. The upside is fast availability of help. But if you HB close enough to a hospital that benefit disappears.

to all of this.

And especially in our current state of obstetrical mismanagement (and especially in reviewing local hospitals, OBs and state stats) I don't even buy that HB is "as safe" as hospital birth for me.

OP, maybe you are in an area where things are different. And if you don't have your heart set on a particular setting, maybe you should consider the MWs pressure to birth in a hospital. I personally would not be swayed by it and TBH after discourse such as that I would have dropped her and moved on.

But how we get to a HB choice and why are very personal. At any rate, all pregnant women have to come to terms with the dichotomy of carrying life within our wombs while facing death, no matter where we birth or who we allow to be with us at that moment.

[at_the_hip]

I have had two PPH, #2 in hospital with a mw, and #3 a homebirth.

In the hospital, (after a natural birth without any interventions), I started bleeding out huge clots. They were extremely aggressive and the nurses literally shoved their fists into my stomach. It was horrible and painful, and they had also whisked dd away to deep suction her due to light meconium. My 'hep lock' had been pinched at some point in labor, so the medications weren't getting through and it took them a bit to figure that out. I had a lot of trauma from this, and the atmosphere was anything but peaceful.

With #3 dd had a sticky shoulder and I had another PPH. But the difference was night and day how it was handled. NO panicked responses, NO fists in my stomach, dd nursed the whole time. Shots of pitocin in my hips, Arnica, and dd nursing. Yes I had the same complication but instead of traumatized and violated, I felt taken care of and reassured.

With #4 (at HOME again with same mw as #3) we did an IV just prior to the birth, and pitocin once the cord stopped pulsing. She was born direct posterior and it was a hard birth, but otherwise perfectly peaceful, and we successfully prevented a PPH for a great recovery. My trauma from this birth was from the pain of her position alone.

I have confidence in my mw to handle emergencies with skill and calm. In the hospital I did not have that same experience, but YMMV. If I had a reason to need the hospital setting, I would certainly go there with my mw. FWIW, she has resuscitation equipment, oxygen, etc etc to handle birth issues at home. AND she has hospital priveleges, so even if I ended up with an unforeseen complication or surgery, she'd be able to assist.

[bandgeek]

My DD suffered a severe brain injury during our HB. Obviously it happens. But to believe it doesn't happen, or happens less often in a hospital is a bit naive. Does your OB think any bad outcome WON'T happen in a hospital? It would be hard to believe that she's never seen a birth go wrong. It happens all the time.

At first it was very hard because I did believe that maybe it was because she was born at home and like one pp said, there's this tremendous sense of responsibility. IF something goes wrong, you have to deal with it and shoulder the responsibility because many people WILL blame you. Where in the hospital, it's going to be blamed on someone else. But I know now that what happened would have happened anywhere. It was a freak accident and I did not cause it or make the problem worse by being at home. In some ways I'm very glad it happened at home because I don't feel the need to place blame or sue my doctor. Lots of parents of kids with CP endure long, drawn-out lawsuits so they can get some compensation for what happened, but I don't feel the desire to do that, not in the least. I don't blame anyone, not even myself, and I'm very much at peace with what happened, even if I do have lingering anxiety over everything.

$hit happens anywhere. If homebirth is a safe option for you, then don't worry too much. Yes, bad things can happen, but that's a risk you take birthing at all. Obviously you know the risks of both. But there is not ONE bad outcome during a home birth that can't also happen in a hospital. There are many things that can go wrong during a hospital birth from too many interventions that wouldn't happen at home.

[emnic77]

I just want to agree with the sentiment that for me, the biggest "risk" to homebirth is shouldering all the responsibility. If you are in a hospital, no outcome is going to be "your fault." In a hospital, unless there are cases of gross negligence going on, no one is going to say that you screwed up by choosing that OB. Hospitals and OBs are generally faultless when it comes to birth. Yet if the same situation happened at home, even if it were something that could not have been prevented in a hospital setting, you'll feel questioned and guilty. I know I will - it's just ingrained in me. I wish it weren't that way, but it is - I know if something goes wrong at my homebirth I will forever question my decision. And if something were to go wrong at a hospital birth, I probably wouldn't question whether it could've been prevented at home. Logically I know that doesn't make sense, but that's just the way it is.

I've chosen to assume that risk because I do believe HB is safer for me and a much better option than a hospital birth, and I believe that the care from my CPM is and has already been far superior to the care I received from an OB and a midwife-in-a-hospital. I trust her far more than I trusted my OB with #1 or my last group of midwives with #2.

[HappyMommy2]

Talk to your midwife about all possible negative scenarios and what she would do about them. That goes a long way towards feeling confident.

I had an awesome HBAC and would never do it in a hospital again.

Also - there is another thread about this... I will see if I can find it...

[McMandy]

Sometimes we hear horror stories that are more about irresponsibility than homebirthing. My OB told me horror stories that made me roll my eyes. It reminds me of homeschooling- we all know some homeschooled kids who seem to not be very well socialized or educated... all over "different"... and these are those cases that anti-homeschool people shove in my face... nevermind the many, many, many wonderful success stories out there.

I know a woman whose water broke (slowly leaking, she said) and she didn't go in to see anyone about it for two weeks or more. By the time she did go in (she was aiming for a UC), there were some complications with her baby.

My OB told me of stories where women came in and both mom and baby were severely sick and "infected".

These are rare cases.

I do have a friend whose baby died after her UC. Immediately, people began to blame her, but after the autopsy, it was revealed that the child would have died either way- even in the hospital- there was nothing that could have been done.

I know there are legitimate issues- maybe heart issues, diabetic issues, placenta issues.. etc... that, ultimately may lead to transfer to a hospital.

While I do think it's important to understand the issues that could happen during a homebirth, also remember that most midwives are well prepared and able to deal with many issues, or at least get you help as soon as they realize you need it. Don't focus on the bad things- I think people use these as scare tactics.

I could get in my car, drive out to the main road, and get hit by a car- but that doesn't keep me from going places. Get what I'm saying?

[thursday2]

Thank you all so much for your responses! We were set on a HB before, but I think it was the issue of taking on all the responsibility ourselves for our choices, as many pointed out, that made me...falter...though that's not the right word. I'm still just as confident in our decision and becoming more and more excited about it as we grow closer; I just didn't want to feel like I was sticking my fingers in my ears and making "la la la" noises about the negatives, since I was reading and hearing so many positives.

My MW is a CNM, 35 years experience, her partner has 30 yrs experience, etc. - I'm very confident in their care - but knowing that others have had 'negatives' actually makes me feel a lot safer, KWIM? Since every situation will have the occasional bad outcome, I feel like I'm approaching it honestly, fully aware of the risks and willing to take them on, not blinded in favor of my own gut feelings that HB is the way to go. Thanks everyone!