Hospital vs. Home for 1st time moms - Page 2

[the janet]

Quote:

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.

No, not every birth in a hospital is going to be an awful experience. The first birth I attended as a doula was in a hospital, like I mentioned above. It was actually a very good experience, all around. However, the mama was under the care of a CNM, not an OB, who was hands-off and really trusted the mama's ability to do what she was made to do. Aside from the EFM (which didn't seem necessary but what do you expect, it was a hospital), there were no interventions.

It was also in this mama's favor that her labor was FAST. From her first contraction to the birth, not more than 9 hours had passed. From when she got there to when her son was born, not more than 3 hours had passed. There was no time or need for interventions. But if she had been laboring for the more standard 20+ hours, then they probably would've wanted to hydrate her with an IV (which limits movement) and administer pitocin if she wasn't "progressing" fast enough for their liking (which can make contractions unbearable)...which would likely have gotten her an epidural...which might've won her a trip to the OR.

That potential scenario is why hospitals can be awful places to give birth. You're more likely to be on the clock, especially if it's busy and you're hogging that bed. Your OB (even CNM) won't be with you the entire time...if they're even there at all, as oftentimes you aren't attended by your OB/CNM but whoever's on call. The nurse will be an overworked stranger and you'll get a new overworked stranger if you're there for a shift change.

Some people do have good hospital experiences but it's a total crapshoot and I'm not willing to risk it. The odds of something going wrong during labor are slim. The odds of hospital protocol forcing something to go wrong are pretty great.

[soso-lynn]

I had my first (and 2nd) at home. I would simply like to add the fact that becoming a mother for the first time is a huge event and immediately after the birth, you will be much more able to start that new part of your life in your bed, with your partner (if you have one) and given the opportunity to let your instincts take over. So many breastfeeding relationships are ruined by hospitals. If I could get only one home birth in all my births, it would be the first one. 

I would not worry about transfer rates too much but do ask why 1st time mothers usually transfer. Your midwife's answer will help you better prepare yourself. If you choose a home birth, you have 25% (or whatever it is) chances of giving birth in the hospital. If you choose the hospital, then you have 100% (well 99.9%) of giving birth there. It seems like an easy decision to me.

[Mrs.Music]

I am SUPER excited for my home birth. I say go for it! What do you have to lose giving it a try really? Your midwife will be smart enough to transfer you in the (very unlikely) event of an emergency and then you'll end up where you thought you'd end up anyway, right? It's a no lose. My best suggestion, really, is to just educate yourself. Talk to a lot of home birth moms and midwives. See if it feels right for you. My midwife is awesome, btw. If you're looking for a recommendation. ;)

[Drummer's Wife]

I did not have a horrible hospital experience for my first baby like you hear about sometimes:  my mom and one of her good friends (partner at the practice, at the time) were my midwives, my nurses were hand-picked (my L&D RN was someone I've known my whole life, and she came in just for me), and this was a hospital where my mom was the nurse manager for mother-and-baby for many years before becoming a CNM - so I felt comfortable there.  The back-up OB was someone I trusted with my care. 

That all said, I believe that there is a good possibility that if I had stayed home, or even chose to have my baby at the free-standing birth center, I might have avoided that first c-sections (and likely the 3 c-sections I have had since).  The two times I have labored, it was for 39 and 36 hours - with very little progression.  I honestly wish I had pushed for a homebirth the first time around.  I really do.  But that's just me, and my own comfort level looking back over the past decade since I became a mother.  Some women feel much more at ease in a hospital setting, especially for their first baby.  I guess I would just go with your gut, OP, and if after touring the hospital you felt so uneasy -- well, then, I would say either find another hospital, birthcenter, or start interviewing HB midwives. 

[EllisH]

Originally Posted by ~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.

Actually GoBeCo misses the point: I referred to research showing that for those that need to be transferred from home to the hospital for a certain complication the outcome is more negative (in terms of infant mortality) than for those who will incur that same complication starting in the hospital.  I made no claims about home births *creating* complications (and I don't believe they do - I just believe problems may occur outside anyone's control or foresight).
 

[GoBecGo]

Originally Posted by EllisH 

Originally Posted by ~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.

Actually GoBeCo misses the point: I referred to research showing that for those that need to be transferred from home to the hospital for a certain complication the outcome is more negative (in terms of infant mortality) than for those who will incur that same complication starting in the hospital.  I made no claims about home births *creating* complications (and I don't believe they do - I just believe problems may occur outside anyone's control or foresight).
 

You did not say that.  Your quoted sentence is above, you did not mention mortality, infant or maternal.  Your sentence says that the risk of complication is higher if one begins at home.  That is not true.  The possibility that complications result in better outcomes in hospital might be true (and is according to your one study).  But it is not what you said.

It may well be the case that for certain complications going to hospital is safer.  But those are not complications which can be predicted and some of us are very fearful in hospital.  Having to labour in fear WILL result in a poor outcome for me and my baby.  Should i accept that inevitability of a horrendous labour and risky delivery and poor start for myself as a mother and my baby as a separate human being just in case i have an impossible-to-predict complication?  No.  That is nonsensical!  When i go to the shops i go in my car and wear a seatbelt - i don't call an ambulance to take me just in case i crash and need immediate care to make it.

My last baby would very likely have suffered much poorer outcomes in hospital, maybe even died, the way my labour was handled was very important in that regard.  Yes, sometimes there are terrible outcomes at home.  Sometimes babies and mama's die.  But babies and mamas die in hospitals too.  If you feel it is much safer and better for you to be in hospital, good, go there.  But please don't tell me that it is safer and better for me, because very simply it is NOT.

[EllisH]

Originally Posted by GoBecGo 

Originally Posted by EllisH 

Originally Posted by ~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.

Actually GoBeCo misses the point: I referred to research showing that for those that need to be transferred from home to the hospital for a certain complication the outcome is more negative (in terms of infant mortality) than for those who will incur that same complication starting in the hospital.  I made no claims about home births *creating* complications (and I don't believe they do - I just believe problems may occur outside anyone's control or foresight).
 

You did not say that.  Your quoted sentence is above, you did not mention mortality, infant or maternal.  Your sentence says that the risk of complication is higher if one begins at home.  That is not true.  The possibility that complications result in better outcomes in hospital might be true (and is according to your one study).  But it is not what you said.

It may well be the case that for certain complications going to hospital is safer.  But those are not complications which can be predicted and some of us are very fearful in hospital.  Having to labour in fear WILL result in a poor outcome for me and my baby.  Should i accept that inevitability of a horrendous labour and risky delivery and poor start for myself as a mother and my baby as a separate human being just in case i have an impossible-to-predict complication?  No.  That is nonsensical!  When i go to the shops i go in my car and wear a seatbelt - i don't call an ambulance to take me just in case i crash and need immediate care to make it.

My last baby would very likely have suffered much poorer outcomes in hospital, maybe even died, the way my labour was handled was very important in that regard.  Yes, sometimes there are terrible outcomes at home.  Sometimes babies and mama's die.  But babies and mamas die in hospitals too.  If you feel it is much safer and better for you to be in hospital, good, go there.  But please don't tell me that it is safer and better for me, because very simply it is NOT.

(Last response on this issue) I said: "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 not the same as: "the risk of complication is higher if one begins at home."   My claim only concerns the group who starts at home but then needs a transfer due to complications vs the group starting in the hospital and then develops (the same) complications.  You are right that I further explicated this point (since it was misunderstood) by clarifying precisely what I meant, incl. the reference to infant mortality.

Also, regarding your point that "It may well be the case that for certain complications going to hospital is safer.  But those are not complications which can be predicted" - that is the reason I prefer the hospital, precisely because these complications cannot be predicted. Note that I respect everyone's personal decision in this regard and in fact I myself would much prefer a home delivery over one in the hospital if I could be sure there would be no (unpredictable) complications.  But since I cannot be sure, that's why I personally made the trade-off to deliver in the hospital.

[la mamita]

i had a homebirth for my first and it was a fairly easy decision. i knew i had a good hospital in case i needed to transfer, but i didn't focus too much on that possibility. i don't like hospitals and i read enough about what typical hospital births are like, even the "natural" or unmedicated ones, and the cascade of interventions to know that i would not feel comfortable in that environment unless it was necessary due to some emergency. i read a lot of homebirth stories and tried not to read the horror stories or the ones where the mom says 'oh, i was begging for an epidural an hour into labor'. i read a lot about the stages of labor, so i would know what to expect as far as how things would progress. for me it ultimately came down to knowing that i would go into a fight or flight reaction in the hospital--i don't think i could ever feel comfortable in that environment and i know that fear has seriously hinder the birthing process. i had a pretty quick labor and never ever felt overwhelmed by the pain. i remember transition as the point where i wasn't thinking about anything, just feeling, so i never got panicky. i have serious anxiety, so that was huge for me. everything went smoothly and i'm planning a second homebirth.

[~Adorkable~]

lets see if we can keep focused on the orginal post and helping her out, i worry that we have got very sidetracked on semantics that clearly mean a lot and different things to different folks here.

[IdentityCrisisMama]

I would choose home and I would choose starting with HB midwives if you're unsure.  This opinion is based on person and friend's experiences and not on research.  I had a planned HB with a hospital transfer and it was fine.  Though not ideal, of course, I do feel strongly that had I started in the hospital I would have received many additional interventions and would not have been happy with my first birth.  

Good luck with whatever you choose!!  

[SeattleMolly]

Thanks to you all for all of your input and thoughtfulness! This is a big decision and you helped in my education around home birth. I've also checked out the Home Birth threads and they've also been helpful. Philisophically, I'm probably not as far on the homebirth side of things as people are here on the boards, but I believe that it is necessary for me to listen to all stories before I make a decision.

[IdentityCrisisMama]

SM, 

I was on the fence with my first birth as well.  I felt like I would never be into the HB scene and didn't feel "radical"...I just was interested in HB as a logical choice after reading.  I chatted with a hospital MW and told her that I was thinking of HB and it was actually the hospital birth MW who advised that I start with a HB MW.  She said it is an easier transition to go from HB care to hospital birth care during pregnancy than the other way around.  

What I did was choose a HB MW with a VERY good reputation but who was also more "conservative" (IMO) when it came to transfers.  Their office was very "professional" and the MW shared a practice with 2 MW and had a full time assistant and an office manager.  Now that I'm on my second birth, this particular practice would feel too "OB" for me but it was a good compromise for where I was with my first.  

Another good option would be the lowest intervention type hospital MW or, as others have mentioned, a birth center.  

I wish I could advise some good books that are more neutral but I'll admit that none of the wonderful HB books I've read seem all that neutral to me.  Still, I think "Pushed" is a great read!!   For a more neutral stand maybe you can get your hands on a good infant development textbook that coves birth options.  That was the first place I ever read about HB and that seems like the most neutral tone you'll come across.  

[tourist.]

I had a home birth with my first.  It was a tough decision, but in the end it logically seemed the right thing for me to do.  I chose a conservative midwife team, mapped my route to the hospital in the event of an emergency, did all the things that made me feel more prepared for a "what if" situation.  When labor started, the fact that I was "at home" was quite literally the farthest thing from my mind.  It was so normal and natural that I never even thought about where I was.  In hindsight, I can't imagine choosing (without cause) to go to the hospital for the birth.

I wish you the best as you try to navigate through all the information you will find.

[gemasita]

Originally Posted by 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.

For me, PERSONALLY, the number one reason I am planning a homebirth is for safety. I PERSONALLY feel safer at home with a midwife by my side who knows me well. I've been to some hospital births that I felt were very unsafe because no one was in the room much. For a few, complications arose and I was the first to see them (yikes!). I also know that one of our hospitals has a 40% c-section rate and if mothers and babies are more likely to die during a c-section than a vaginal birth, then I don't feel safer there vs a homebirth with my midwife who has a 5% of so c-section rate. I am not saying hospital births are less safe than homebirths - I'm just saying that because of my experiences, *I* feel safest at home. The "experience" is secondary to the safety - important, but secondary.

[GoBecGo]

I find it very ironic that for example a woman can be told she MUST lie on her back for a VE because her care-provider cannot do them in any other position and she MUST have one (for that care-provider to feel comfortable with how things are going) which is absolutely about how the CARE-PROVIDER is experiencing the birth (because there is no evidence to prove VE's are beneficial or even necessary during a normal birth and yet they are given routinely in hospital, you have to STATE you don't want them because it is assumed you will have them if you don't) but if the WOMAN prefers to stay at home, which has been PROVEN to be a beneficial and for some motherbabe partnerships very necessary for a safe and normal birth, she is being selfish and thinking only of her experience, no matter HOW sound her reasoning or HOW thorough her research and knowledge.

We as a society accept that the staff's right to be comfortable (with how things are "being managed" for example) and safe (from litigation for example) trumps the physical and emotional wellbeing of the mother and the baby and THEIR right to be safe (from unwanted and unnecessary intervention and the morbidity they suffer as a result for example).  Someone must be in control, and it must absolutely NOT be allowed to be the woman herself.

[earth-mama]

We did a homebirth for our first and it was great!  I was very uncomfortable with the idea of going to the hospital, but felt very comfortable at home and with our midwife.  I think you need to decide what feels best for you, because where you are most comfortable is where you will birth best    

[peainthepod]

Another first-time homebirther here. It was a fabulous experience (as was my second homebirth) and I'm so glad we chose home over the hospital. But my experience doesn't matter nearly as much as where you feel most comfortable. If that's at home, then you should strongly consider a homebirth with a competent, experienced midwife for your birth(s). If you'd be more comfortable in a hospital, then it's entirely possible to have a vaginal birth with minimal interventions. Just do your research (don't just go by what the hospital tells you!) and hire a doula to give yourself the best possible chance for a normal, non-medicalized birth.

Do keep in mind that women have been having their first (and subsequent) babies at home or in a home-like setting for many thousands of years of human history. Homebirth is very much the expected norm for millions of women across the planet.

Whatever you decide, good luck in your search and congratulations on the pregnancy!

[*MamaJen*]

Every woman needs to choose the type of birth that is right for them. However, it's inaccurate to say that it's a choice between a risky homebirth or a safe hospital birth.

There's a lot of research showing that home birth, for a low-risk mom, with a professional midwife, with procedures in place in case of transfer, is as safe as hospital birth.

Also, in America today, one third of births -- an this includes first-time births -- are via C-section. (As a reference point, the C-section rate in the Netherlands is about where it should be, at 7 - 12 percent). Maternal mortality is actually rising significantly in the U.S.

It's great if you find a sympathetic provider and a good hospital that is willing to deliver evidence-based, low intervention care. However, the reality for many women who want a natural birth is that "you buy the hospital ticket, you take the hospital ride." IMO, many women are bait-and-switched by providers who say they'll respect a natural birth plan but literally have no idea how to facilitate a normal birth. There are many, many ways that our current system of obstetrics is not evidence-based. 

In terms of the OP, I had a fabulous homebirth for my first (and only) delivery.

I would recommend reading "A Thinking Woman's Guide to a Better Birth." There is a huge amount of information out there about the way birth happens in America. It's a real eye-opener.
 

Originally Posted by 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.

[carriebft]

I have had 2 in hospital and one at home and am planning another homebirth. If I had to do it over again, not knowing how my body handled birth, I would still have had my first in the hospital.  I told my sister the same thing when she asked me whether she should have her first at home...I didn't want to tell HER what to do, but I shared that I would have my first in a hospital with as few interventions as possible (get a doula, go for CNM in hospital). That's just the way I feel; for ME, it was comforting to know when I did chose homebirth for a subsequent birth, that I was not one who bled easily after birth, that I had no tearing issues, I had some history in the length of my labors, etc. Obviously its not a 100% thing, but it helped me.

[alegna]

I had both of mine at home.  If I had had my first in the hospital it would have been a traumatic section for a lot of reasons.  Yes, I'm sure there are fabulous, woman-friendly and baby-friendly hospitals out there.  Not in this town (Houston).  The section rates are THROUGH THE ROOF.  

I saw no reason to risk myself and my first baby to an awful (and dangerous) experience just because it was my first baby.  I knew myself and I knew I wouldn't want to transfer unless it was an emergency.

-Angela