Hospital vs. Home for 1st time moms

[SeattleMolly]

After touring the hospital affiliated with my midwife group, I had a very negative reaction. I felt like it was so public and authoritative. It really filled me with fear as we were touring the birth suites.

When I consider a home birth, I get worried because I heard that 25% of first time moms end up in the hospital any way. Another non-hospital-affiliated midwife told me about that statistic. The thought of a last-minute transfer really bothers me, especially when the only hospital that is in my network does not have a pre-existing positive relationship with any midwifes.

So-what are your feelings of making this decision for a first birth? I would definitely do a home birth for #2, but I just feel very unsure about labor not progressing and a transfer.

Thanks!

[sarahn4639]

I think it's great!  I wish I had my first at home, I didn't really even know it was an option.  My sister just had her 1st baby at home last week.  The transfer rate for 1st time moms is higher, mostly for maternal exhaustion or pain relief, not because of medical comlicatins.  I do think that 25% is very high though.  The 2 midwives I've used have had much lower trasfer rates than that for 1st time moms.  More like 15% I'd guess.  I guess I look at it like this, you don't feel safe and comfortable in the hospital, but you do feel safe and comfortable at home (other than the trasfer issue) so where are your odds of a good birth greatest?  Also, if you were to end up in the hospital at least it would be because you needed to and not just by default, so you're giving yourself the greatest chance at the birth you want.  I'd talk to several homebirth midwives and see how you feel then.

[goinggreengirl]

I planned a homebirth (midwives are not yet licensed for hospital births so choosing a midwife was choosing a homebirth here.) We ended up transferring after 60 hours of labor for exhaustion. I ended up with an epidural and pitocin (wanted to avoid both which is why I chose to stay home). It took a little while to come to terms with the birth, but I do not regret trying for a homebirth for my first baby. I will plan one for my second child as well.

My midwife stayed with me at the hospital as labor support. And, even if the hospital is not midwife friendly, and your midwife comes with you, you could just say she is labor support.

Good luck deciding. I know what a hard decision it is!

[EllisH]

I will be giving birth for the first time also - in January - and am opting for a hospital birth (in an - academic - hospital that I trust).  Home births are very common in the Netherlands, and there's been a lot of research done on it as a result.  It has been shown that the risk of complications is much higher when starting at home and then needing to be transferred vs starting in the hospital. In addition, if the baby needs acute help upon being born, it will also be readily available in the hospital.  I just don't want to take any risks, a healthy baby trumps having the experience at home.  That being said, I will have a birth plan which explicitly states that I want to opt for minimum intervention if at all possible and that I'll discuss with my obgyn beforehand.

[terrordactyl]

you should go check out the home birth forum.

[the janet]

I chose the middle ground: I'm expecting my first in 3 weeks and planning on giving birth at the only freestanding birthing center in NYC. It's not home but it sure ain't the hospital!

I've had all my prenatals at the same place I'll be laboring/giving birth, so it's very familiar to me and I know the entire staff. The midwives work in conjunction with the OBs at the nearby hospital* that women transfer to if necessary, so I am fully confident that if I need any extra medical attention, my midwife will be there and have full privileges.

Should I end up with a natural birth, I will most likely have a home birth next time. :)

* The first birth I attended as a doula was at this particular hospital and it was the best hospital birth experience I've witnessed so far...meaning my client had an extremely hands-off CNM and the nurse had a great bedside manner. My client ended up giving birth naturally and with minimal intervention in the hospital. This, sadly, is not every woman's experience.

[rad]

I had my first at home and it was a great experience. I didn't want to take a chance of having some horrible intervention done that would make it that much harder for me to homebirth the next time around. So I just decided to do it the first time around. And of course, I've had 4 subsequent homebirth that all were great too. Planning another any day now.

[gemasita]

I'm planning to have my first at home in January.  My midwife says it's more like 10-15% of first-time moms that get transferred and it's usually a non-emergency.  So I have about a 90% chance of giving birth at home - sounds good to me.  I've been to hospital births and homebirths as a doula and I think it makes a lot of sense, ESPECIALLY when you don't know what to expect, to be in a setting where you really get to know your care provider on a personal level and interventions are rarely used.  I think of my poor DH in a hospital trying to remember what I did/didn't want and why.  I like that he's on his own turf at home.  And I have felt very private during pregnancy so I am glad I chose a homebirth.  I think I would really tense up in a hospital.  However, if I end up in a hospital, then so be it...I'll know it's because I NEED to be there.  I love my midwife though and the relationship we have built and I am always thinking how I wouldn't have this individualized care from a hospital-base care provider - and boy is that nice for your first pregnancy.  I hear so many people say they had a hospital birth with their first and then went on to have homebirths so I figure, why would I do a hospital birth first the first and have more of a chance of having a different birth than I pictured or what I consider a negative birth and THEN move on to homebirth?  I'd rather have a better chance of having the birth I envision with my first!

[goldenwillow]

We chose a homebirth for our baby and for me, it was the best decision I have ever made.  I did tour the hospital locally just in case of a transfer (as suggested by my MW) and just knew that I could never deliver in a hospital, well unless it was necessary.  I continued to believe in my body and remembered that women have been doing this for centuries.  I feel if there is a need for a transfer, at least a woman is able to labor in her place of choice (ie: home, birth center, etc.) and that alone helps one release to birth.  Personally, I could not imagine laboring in a medical setting with people I don't know running around me. 

[GoBecGo]

I had #1 (and #2!) at home.  The hardest thing for me was the constant doubt from all the medical people (even some of the midwives - it was an NHS homebirth in the UK, for #2 i had an independent midwife instead) that i could "do it".  Ironically only my own assigned ob, who i only met twice, was relatively relaxed about it.  But several midwives and EVERY registrar/SHO i saw (quite a few at the end as i had raised BP) was very down on my choice.  In the end i had an entirely uneventful, surprisingly short, very easy birth.

I was afraid in the hospital.  They had a 38% c-section rate (it's a teaching hospital and major centre for obstetric complication) and that rose to 56% for first-timers.  The staff were friendly but so over-stretched and busy that they had recently lost their baby-friendly certification due to have very poor breastfeeding support available.  I was scared.  Don't go somewhere scary for your birth.  If you feel safer in the hospital then fair enough, but hormonally a labour is like an orgasm - go where you feel safe and supported.

It has been shown that the risk of complications is much higher when starting at home and then needing to be transferred vs starting in the hospital.

That is because people who have no problems delivering DON'T transfer and thus stay at home.  Not because being at home creates complications.  The total number of c-sections is lower amongst those who begin at home than those who begin in hospital, even when one adjusts for known risk factors before the onset of labour.

[expat_canuck]

I'm due with my first in January, and am planning a homebirth.  My midwives say that most transfers of planned homebirthing moms in their practice are for exhaustion/pain relief, and at the mothers' request,  rather than emergent situations. The proportion of emergent situations arising unexpectedly during labour/birth are about the same for them, whether at home or the hospital. 

My midwives work in hospitals as well, and even if I was planning a hospital birth, I would be doing most of my labouring at home - they don't transfer to the hospital until active labour is well established, meaning that no matter whether you are choosing a home birth or a hospital birth, you spend most of your labour time at home.  

I'm not in the least bit concerned about homebirthing my first baby, and, in fact, feel a lot more confident about the birth process in my own home, with my own chosen attendants present, and the ability to labour however I want wherever I want. Obviously, since this is my first, I don't *really* know what to expect in labour (I can read and take classes, and all the rest, but it's all just guessing at the experience until you go through it, you know?) and it makes me feel better and stronger and more prepared to know that know matter what path my labour/birth take, I will be able to respond in whatever ways fit *me* best - no hospital policies or procedures or 'normal' intruding on my birth - if that makes sense. I also totally trust my midwives to make the clinical decisions necessary best support my health and my babies' health - so I'm not even worrying about that part. My partner and my doula will be there for *me* while my midwives take care of the clinical/safety/health part. 

[imogenlily]

Originally Posted by expat_canuck 
My midwives work in hospitals as well,

Hey, I'm having my first baby here in Vancouver as well. What midwife group are you with? I'm using Susie and Beth at Pomegranate.

Feel free to PM me :)

[Climbergirl]

Originally Posted by EllisH 

I just don't want to take any risks, a healthy baby trumps having the experience at home.

Sorry, this is the one sentiment that people tend to have that makes my skin crawl.  Especially since, when I was pregnant with DS, I thought that exactly.  I could not understand why a woman would take such risks!

A hospital does not equal safety or a better outcome.  I wish it did.  I was wrong.  I got 2 hospital stays (one for delivery, one for complications to my c-section) and I really learned a lot about hospitals.  They are nothing like the TV shows.  The hospital discharged me when I said I had trouble breathing and that even though my BP was considered normal, it was elevated for me.  That, right there, almost killed me if my MIL did not beg me to go back.  My MIL could tell I was very sick, even though the nurses said I was fine.  It is very possible my complications were a hospital borne infection.

It isn't just about a healthy baby.  It is about a healthy mom too.  And when you are in the ER and they are telling you that you are very sick and may not ever go back home to see that precious baby, that really hits home.  You health matters too.  And as much as I have been told that I am selfish for thinking that, I know it to be true. 

I am having my baby at home this time because I know my midwife knows me well.  She knows about my history, my life, my worries, and my fears.  She also knows that I run hypoglycemic and sometimes my blood pressure can be as low as 80/50 (and I am not about to pass out).  I trust her.  And therefore, I believe being in her care is much safer than going to a hospital.

You have to go where you feel safe.  I would prefer to transfer to the hospital to receive the care there that I would need versus starting off there.  But that is me :)

[belltree]

EllisH, I believe you are quoting a study published recently by Evers et al (http://www.bmj.com/content/341/bmj.c5639.full) . There are some unique problems in the Dutch system, that could explain the higher complication rate for transferred moms. The authors speculate that this might be mostly due to a lack and delay in communication:

" Firstly, diagnosis in primary care can be delayed because the midwife is not always present during the first stage of labour and fetal heart beats are often checked only every two to four hours.

Secondly, transport can delay treatment in case of an emergency.

Finally, a delay can occur because the obstetrician underestimates the problem as the referred woman is a “low risk” patient.

In addition, essential information can be lost during the referral. "

You should also read a study by deYong, that showed, that homebirth is indeed as safe as hospital births.

In the Netherlands the transfer rate is around 43%

I believe it is better to read and interpret scientific results carefully. 

[Banana731]

Hey Climber girl- that's my normal BP, you are not a freak!  
 

Originally Posted by SeattleMolly 

 I would definitely do a home birth for #2, but I just feel very unsure about labor not progressing and a transfer.

Here is something to think about. Hindsight is 20/20. Most women that I have met, both here and IRL, who have had sentiments like this and chose a hospital anyway have been pretty unhappy with their experiences. No matter how awesome your OB, CNM, or birth plan is- a hospital birth is NOTHING AT ALL like a homebirth. And no matter how great your hospital birth is, it will never be a normal birth. If these are things that appeal to you, you should think carefully about choosing a birth place accordingly. Lots of women give birth at home the first time. If your labor doesn't progress at home (provided you aren't having a problem) your midwife will encourage you to take a nap. If your labor doesn't progress in a hospital, most CP's are going to try to force it to. They are on pretty opposite ends of the spectrum.
 

[allisonrose]

I believe my midwife said that transfer rates for herself, her mentor and associated midwives is around 10%. She didn't have the number broken down for first time moms vs second or more times moms.

I didn't have my first at home. After going through infertility treatments, I let my shaken trust in my body and financial issues of being under an HMO make the decision. I regretted it when I ended up with a bunch of interventions I had hoped to avoid. (Luckily it was a vaginal birth which tells me that my body is capable of this.)

For this second child, I feel more confident that my body will be able to do this. I also feel like I "dodged the bullet" the first in a manner of speaking by having avoided a c-section in the hospital. I don't feel like taking that chance again.

If you already feel uncomfortable about the thought of the hospital, there is something to examine there....

[motherhendoula]

Its a tough decision - i had my first at a free standing Birth Ctr. - but it had closed by the time i had baby #2 - so my options were my midwife at a hospital - or my midwife at home.  It took me months to make up my mind.  I toured the hospital and thought it was a horrible place to be during labor....the bed was so narrow (both me and my baby would not fit together to sleep there!)  - there was no space to walk around in the room (was i really gonna have to walk around in the halls?!)  the shower was so small and cramped (what would i do for pain relief?)  AND two rooms shared a bathroom!  I think it was the shared bathroom that put me over the edge - lol

I had my #2 at home and it was the most memorable, wonderful, experience of my life.  I am officially hooked on home birth - i just recently had baby #3 at home - this was a much harder and faster labor (not the bucolic water birth i had planned!)  - but it was still so wonderful - i wish i could afford to stay home and have more kids!

You really need to let go of the idea that 'something' could go wrong.  The fact is that midwives are trained to do this at home, they know what they are doing, they also know warning signs to look out for.  If you are concerned about labor not progressing...stay away from the hospital!  I dont know anyone who regretted their decision to homebirth.

[globe-trotter]

We did a homebirth for our first also! :)

[~Adorkable~]

Originally Posted by GoBecGo 

It has been shown that the risk of complications is much higher when starting at home and then needing to be transferred vs starting in the hospital.

That is because people who have no problems delivering DON'T transfer and thus stay at home.  Not because being at home creates complications.  The total number of c-sections is lower amongst those who begin at home than those who begin in hospital, even when one adjusts for known risk factors before the onset of labour.

this is an extremely important way to look at this statistic. as so many of them get looked at in too near sited of a way. thank you for pointing it out so clearly.

as to the original poster and question. you need to be where you are comfortable, many first time moms are wonderfully comfortable birthing at home. I am planning my twin birth for my home in Jan. that being said fear is real, and if you cant find a way thru that, listen to it. make sure you are really comparing apples to apples and understand the up and downsides to each choice and then make the right choice for yourself, it may not be what is right for the next lady.

one thing that helped me understand what was best for me was to know that while the hospital might add come medical back up to the situation it also added some clear to understand problems. and in the end the small % of risk that those medical procedures would be used to help mitigate were out shadowed by the larger % of issues that the medical, ridged and unfamiliar setting would add to the birth.

if i was burdened by lots of worry about a home birth, home would not be the best place for me to be. the fact that instead i am burdened by the worry and stress of what i might encounter in a hospital setting is exactly why i don't want to be there unless the immediate situation that outweighs those hospital worries.

i would encourage you to find a good birth education class that is not given by a hospital and instead by folks that believe you can do it your way in your own place of comfort. and them as you learn those things you will find where your comfort place is

[EllisH]

Originally Posted by belltree 

EllisH, I believe you are quoting a study published recently by Evers et al (http://www.bmj.com/content/341/bmj.c5639.full) . There are some unique problems in the Dutch system, that could explain the higher complication rate for transferred moms. The authors speculate that this might be mostly due to a lack and delay in communication:

" Firstly, diagnosis in primary care can be delayed because the midwife is not always present during the first stage of labour and fetal heart beats are often checked only every two to four hours.

Secondly, transport can delay treatment in case of an emergency.

Finally, a delay can occur because the obstetrician underestimates the problem as the referred woman is a “low risk” patient.

In addition, essential information can be lost during the referral. "

You should also read a study by deYong, that showed, that homebirth is indeed as safe as hospital births.

In the Netherlands the transfer rate is around 43%

I believe it is better to read and interpret scientific results carefully.

Belltree, could you please explain what you mean by your last sentence?  I am aware that people here will likely disagree in sentiment / principle with me, but that doesn't mean that I don't read and interpret information carefully.  Also, there is always the need for interpretation of scientific results (and then applying it to yourself), leading to differences in interpretation.

So I am aware of the likely causes the authors cite - but they don't seem to undermine the conclusion.  If you make the point that this doesn't apply to the US, fair enough (I cannot properly judge the ob situation in the US - although I did live there for a number of years and have friends who have given birth in US hospitals, much to their satisfaction), although it's a fact that regardless of location not all complications that would require immediate intervention can be determined upfront and some will only transpire during / immediately post-delivery.  (And I myself prioritize being prepared for that eventuality in my choice where to give birth) .  Other studies that show they are both as safe (in the Netherlands) have come under criticism, since home births should have better outcomes than hospital births, given that it's the high-risk deliveries that tend to be referred for hospital births.

On a different and more general note: I know that C-sections are given (pushed) much more commonly in the US than elsewhere, and I think that's a very bad thing indeed and to be avoided.  However, there are certain advantages to delivering in a hospital that shouldn't be ignored (despite all the problems with the US healthcare system).  In addition, I do not like the sentiment that all hospitals are evil: I have had very good experiences with my obgyn and the rest of the medical staff in the hospital I go to in making me feel comfortable about concerns / complications I had during my pregnancy.  I also was extensively briefed on the procedure and the choices I will have for e.g. pain relief during delivery (but as I already mentioned, I will opt for a natural birth).  In view of my good experience with my hospital in the US and the people that gave me care there (albeit not with L&D) I refuse to believe that no good hospital (i.e. one exercising restraint in interventions and providing a supportive and warm environment) can be found in the US.