The thing about setting is, well, it can matter hugely. Do you happily/unselfconsciously poop at other people's houses? SOme people do, i know, but me, i prefer the security of it being my own bathroom in my own house, y/k? And i KNOW birth is not pooping, but it's a really intimate biological process, and being in a familiar place really DOES, for the vast majority of people, make everything less painful, more comfortable, calmer and "nicer".
It is true that access to the exact same care (which i couldn't get in the UK - in the hospital i get whatever MW is there, with the NHS HB i would get one of "my team" of community MWs but in the event a total stranger turned up, and if we'd transferred she would only have remained with me as long as her shift (which had almost finished when i called her out, with my independent MW she has no jurisdiction in hospital so again i'd be assigned whoever was there at the time) would make things a little easier, but is it REALLY the same care? IS there an Ob in the hospital? Because if there is the MWs are going to treat things differently than if you were at home, they just are, otherwise planned MW births in hospitals would have the same cs rate as planned homebirths and they just don't. Because at home they will listen with the doppler, maybe hear something iffy, listen again a little while later, watch how you're going, listen again, assessing all the time, how is mama? how is babe? how does this labour feel right now? In the hospital they may well use the CFM machine simply because it is THERE, they may feel compelled to get the Ob's 2nd opinion simply because s/he is THERE, once that happens the Ob might drive how things go, and the MW will feel less able to argue because, afterall, it was her who sought the Ob's opinion. You may really end up with a cs, simply because you were there.
Wherever you birth there will be a hierarchy. In your home the MW is fully responsible for you and your baby. She takes this responsibility very seriously. She assesses you carefully, she KNOWS she is where the buck has stopped. You and she are partners, she will guide and support and care for you as you bring your baby out. In hospital, even with a very supportive hands-off Ob, she is NOT where the buck will stop. The Ob can ask her about "how you're going" at any time. The mere presence of someone who is higher up the hierarchy can make a MW doubt herself, second-guess her decisions, overreact to things for fear of being deemed too casual or dangerous. It's fine if you have a very normal, pretty fast labour and delivery, but "normal" is a broad church in midwifery and a narrow one in obstetrics. Midwifery and Obstetrics are not equals, professionally. This is grossly unfair since midwives really are far more specialised and able in the care-provision for normal births than Ob's, but it means that when a MW is dealing with a normal-but-non-textbook delivery under the eye of an Ob she may feel under pressure. She KNOWS you are ok, but she cannot prove it, because you're not doing what the textbook says you should. She wants to wait, the Ob wants to normalise the labour to "help the baby" and arguing with "helping the baby" implies "endangering the baby". Thus she may be compelled just by the environment to be far more conservative than she would be in a home setting, she may feel, in a hospital, far less like a servant to the woman and more of a servant of the institution, the hospital itself. When a MW attends the woman at home she is there for the woman. When a woman attends a MW in hospital the MW has pressures from the woman (who needs her care) AND the hospital (which wants her to meet its own needs). When a MW is in hospital she, to some extent, is a representative of that hospital. At a home she represents herself, her own knowledge and her own abilities.
) We're doing it for the evidence-based, compassionate, and professional maternity care.
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