Hospital vs. Home for 1st time moms - Page 3

[seraf]

Both of mine were born at home.  I knew my family had a hisory of quick, easy labors.  I knew I was strong and healthy.  I had great midwives and lived in a large city with a hospital 10 minutes away. 

My favorite thing about homebirth wasn't realized until later.  The hospitals I toured and the births I observed, there is more seperation of the mother and child (right after birth when the baby is being assessed and also a 3 hour period in the nursery where they get bathed, vaccinated, pricked and warmed).  I feel strongly that there should be less of that within my own family.  So staying home was my best option for my newborns and myself. 

[GoBecGo]

Originally Posted by seraf 

Both of mine were born at home.  I knew my family had a hisory of quick, easy labors.  I knew I was strong and healthy.  I had great midwives and lived in a large city with a hospital 10 minutes away. 

My favorite thing about homebirth wasn't realized until later.  The hospitals I toured and the births I observed, there is more seperation of the mother and child (right after birth when the baby is being assessed and also a 3 hour period in the nursery where they get bathed, vaccinated, pricked and warmed).  I feel strongly that there should be less of that within my own family.  So staying home was my best option for my newborns and myself. 

A great point, a woman recently told me at a toddler group that her 3rd delivery was the best because she was allowed to have 40mins skin to skin with her newborn before they took him to do all the weighing and so on.  She asked did i have skin to skin.  I told her, yes, DD2 was born at 7.56am and i got her dressed at 7.30pm and she was totally shocked at the idea.  Even DD1, which was a far more hospitalesque NHS homebirth i had 3.5 hours skin to skin before getting the baby dressed.

[MegBoz]

Yes, true, first-timers have a higher transfer rate, but it shouldn't be as high as 25%! if a MW tells you that's her transfer rate for FTMs, I'd be worried (is she not giving adequate support to help labor progress?) & I'd look into other MWs.

Some people view transfer as "proof" that HB is a bad idea in the first place. I find this a little nuts. One poster here had a transfer after a long, long labor & said she still thinks HB is great & the fact that she was trying to HB in the first place saved her from CS!!! If she hadn't done like 30+ hours of laboring at home first, the hospital REALLY would have rushed things along with pitocin and/or AROM earlier in the process - leading to the infamous "cascade" ending in a CS. The fact that she was able to labor at home without intervention for so long meant that when she did go to the hospital for an epidural so she could sleep, her body could keep working & she had a vaginal birth.

Makes perfect sense to me!

Knowing that hospitals tend to "push" and rush birth along, and that FTMs labor for longer than second-timers, it makes a lot of sense for FTMs especially to HB!

I just think it's important to have good transfer plans - & I would factor in the details of what a transfer scenario would look like into my decision making process.

If you can, "establish" care with HCPs at the hospital you'd transfer too. We're lucky in Baltimore that we have one HB MW who's a CNM & has priviledges at a great hospital - so transferring is easy - she can still be your HCP! I'm using a CPM, who happens to be illegal in Maryland (even though she's legal & licensed in neighboring Virginia - so stupid!), but she's friendly with the CNMs at the hospital where I had DS (same hospital to which I'd transfer.) So I won't be met with hostility or the type of situation where my MW is disregarded as not a "real" health care provider, or I'd have to LIE & claim I'd had NO pre-natal care in order to protect my MW.

(Incidentally, I had a hospital birth with my DS only because my stupid, clueless Bradley teacher told me HB was illegal in Maryland. Totally not true! I did like the CNMs at the hospital I switched to at 20 Weeks & didn't want to consider transferring my care AGAIN when I learned the truth about the matter even later in pregnancy. While I had a good experience, there was no need for me to have gone there & I really should have started with HB in the first place & am now planning HB for #2.)

As for the old, "You don't know what to expect because you haven't been there." Well, whatever, that's kinda silly, IMO. Every birth is different & while the odds are good that since I had a fast birth & the pain was totally manageable, my 2nd will be even faster yet & still manageable... there is also still a chance that labor could throw me a curve ball & be much different & much more difficult. NO ONE every really and truly "knows what to expect" from birth & the rate at which labor will progress & the pain level. So don't let people hold that over your head as if you are naive & clueless because you haven't done it before. I HAVE done it before, but I still don't totally know what to expect from #2, KWIM?

Originally Posted by the janet 
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.

Yes, the odds of having a good hospital experience in the US are slim, VERY SLIM!

And I am saying this as someone who did have a GREAT experience in the hospital. I'm lucky to have had the hospital, the CNMs, and the nurses I did. Very lucky. But I realize it is all rare... very, very RARE. That is the fact of the matter.

(Oh, but the lactation consultants were ATROCIOUS, absolutely awful. It was only my insane determination that saved us. I'm sure it would have been better in an HB. Heck, being left solely to my own devices to use the internet & library would have yielded a better outcome!!!!!!!)

[goldenwillow]

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.

Wow!  This too makes my skin crawl. 

My baby was COMPLETELY HEALTHY and I didn't take any risks by having my DS at home.    I have known quite a few women that had their babies in a hospital with explicit birth plans and still had interventions they didn't want with their MW/Doulas there.  Just because you will be in a hospital does not mean they will respect your wishes completely.  Good luck to you.

Edited by goldenwillow - 12/1/10 at 9:01am

[liberal_chick]

My first birth was in the hospital via c-section, but my pregnancy was fraught with complication.  I never even went into labor and ds1 was born at 30 weeks (it was all necessary; I have no beef with the hospital or my OB over this).  Even if I'd have had the philosophy then that I do now, a HB would've never worked.

I decided to have my second child (and later my third) at home.  I felt it was my best shot at getting a VBAC and I was absolutely right.  I recently had a nurse that works L&D in my little town tell me that I would've for sure been sectioned with my ds2 simply b/c my labor was 30 hour long.  An OB I had do my GBS test with ds3 said the same thing.  And it all would've been for no reason!

My labor with ds3 ended up being another 30 hour marathon.  But I was at home, supported by a great midwife and my amazing dh.  I was able to labor for all that time without worry that someone would get tired of waiting and want to cut me open.  And my MW worked her rear off to make sure I didn't tear again (I had a 2nd degree with ds2).

[Sol_y_Paz]

Originally Posted by EllisH 
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.  

The whole reason I am considering a home birth is for the baby and their direct health, to minimize the risks.  If I was only thinking about myself and others I would go for lots of drugs so I couldn't feel much and a normal birthing experience for those around me who are concerned with such things.  The hospitals in the US in my area have an uncomfortably high premature rate and c-section rate.  Here is a link to how typical that is in the US hospitals http://www.marchofdimes.com/padmap.html

[Climbergirl]

Originally Posted by Xantho 

Originally Posted by EllisH 
 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.

 Just because you will be in a hospital does not mean they will respect your wishes completely.  Good luck to you.

Yeah, I had one of those too.  Didn't help much honestly.  Things are taking too long, we need pitocin.  I don't want pitocin.  You need pitocin.  Is everyone ok?  Yes.  Then no pitocin.  30 minutes later, if you don't have pitocin, the doctor wants to perform a c-section for Failure to Progress.  But we are fine.  Blah, blah, blah.  And then, of course, the stress of fighting over this made things worse and I ended up with pitocin.  Which put the baby in "distress" (his heartrate came back down but no one actually told this to me).  And because I have a CERVICAL LIP (which any midwife could handle) with the urge to push, we had to do the c-section NOW or I would damage myself to the point of not being able to have any more children.  Yes, that was what I was told and I did not know any better.  And I got a c-section.  And there was no informed consent because we signed the paperwork 2 hours after surgery.  They forgot to do it beforehand.

It depends on your nurse and how she presents things to your doctor (which is most likely NOT at the hospital).  A birth plan can be useful, but don't expect it to really be followed every single time.  And don't think that will somehow protect you.  Because I thought mine would, and it didn't.  Now, I am writing up a little card of things my husband can agree to or decline so he can just refer to that in case we transfer.

[Partaria]

I'm doing a homebirth for my first, due in May.

It's a tough decision for many women, and it's (of course) completely your choice. It's about you having the birth you need and want. For me, the decision was not that hard. I have a pretty long standing distrust of the mainstream medical industry and I am terrified of hospitals. When I saw The Business of Being Born (my introduction to the idea of homebirth), my gut immediately said, "Ann, this is for you."

Transfer rates are a concern, of course. It's important in selecting a homebirth MW to ask her about her xfer rate, esp for first time moms. We interviewed two midwives we really really liked, but the deciding factor was their xfer rate. Midwife A hadn't been practicing quite as long, and said she had about a 30% xfer rate for maternal exhaustion. Midwife B has been practicing much longer, and said that in her early years her rate was higher. But in the last three years, she hasn't transferred anyone for exhaustion, first time mom or not. So we went with MW B.

All I can say is you're on the right path. You're clearly trying to listen to your gut reactions and do your research at the same time. I know you'll come to the right decision. Keep having faith in yourself, and listen to what you need.

[smeep]

I had my son in a freestanding birth center...which basically IS the same thing as home. It's just not my home. I will be having this one at the FSBC as well (I wanted to do it at home but Medicaid only covers FSBC births, not homebirths, even though the safety is exactly the same - give or take ONLY depending on which location is closer to a hospital in case of transfer). 

I grew up being taught that homebirth is where you go unless mum or baby are sick, period. My mother had us at home. The complication rates are much lower out of hospital than in hospital. Most transfers occur for maternal exhaustion and/or pain relief, not because of true emergency. Even with a true emergency that warrants immediate transfer, most midwives know quicker than doctors in a hospital because they are with the mum the entire time and know her personally. They can also call and get an OR prepped on the way to the hospital (I believe the prep time is on average 19 minutes?). Often times the woman will get there before the OR is even ready. 

I think you should interview local midwives and find one who clicks with you. Everyone has their own ideas on birth and the care and management of it. Some women prefer more medicalized/interventive midwives and some prefer completely crunchy ones and some in between...chances are you'll find one who fits your ideals best. And if you decide not to homebirth, then that's your choice, but at least you can say that you interviewed midwives and really felt your current route was the best one. :) 

[pregnant@40]

Originally Posted by 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.

SeattleMolly, which hospital are you considering? I'm wondering if you have been shocked by either UW or Swedish First Hill, the hospital behemoths.

I delivered at Swedish Ballard the first time, and plan to deliver at NW Hospital this second time. Smaller hospitals w/ attached birth centers seem like a great way to go. I had a wonderful delivery w/ my first -- family practice doc w/ some traditional midwifery training and a significantly low C-section rate for his patients. No routine episiotomies and total control over my own birth plan, of course. I feel that being in a hospital w/ a respiratory team & that particular doc saved my kiddo's life (ie. the umbilical cord was wrapped tightly around his neck twice preventing his descension & causing drops in heartrate, his apgars were very low & he needed resuscitation at birth; luckily the doc was skilled enough to quickly realize what was happening & manually assist the baby out before he was too distressed, or even worse, at greater risk of cerebral palsy or other complications).

If you don't choose a home birth & do want a different hospital, there are options. As for the hospitals, the smaller ones have large birthing suites & some comfort measures. They try to make it look like home. NW has jacuzzi tubs, music, allows for free movement/eating/drinking, an online nursery, a grand celebratory meal for both parents, and gifts of baby hats knit by elderly community volunteers. I've chosen an OB doc whose wife handmade the moomoos his pts wear for exams (instead of hospital gowns in the office) and takes pictures of all the newborn babies. The doc is even known to play guitar at the mom's bedside after delivery! He's very accomodating w/ birth plans, personal wishes regarding epidurals/meds, free movement, midwives, doulas, etc. ... And IF there is an emergency, there is 24-hr anesthesia and a level II nursery down the hall. Personally, I want all of the emergency personnel readily available in case the unexpected happens & time is of the essence, even though there is a slim chance. You never know w/ birth. But I want to deliver in what feels "homey" and allows free movement, too. Hence the birthing suite.

As for nosocomial infection rates, smaller hospitals also have an advantage over the larger multipurpose facilities. Like the homebirthers, I don't want to expose my newborn to MRSA or other hospital infections. These are much less likely to be present in birthing centers.

So if you have choices w/ your particular insurance, see what else is out there. I recently switched from Swedish First Hill at 30 weeks pregnant b/c it feels so institutional. It's never too late to change. Your midwives may be able to practice in another hospital organization.

Edited by pregnant@40 - 12/2/10 at 2:06am

[goldenwillow]

I find it interesting when folks say a free standing birth center is the same as a homebirth.  IMO, it is similar, but not completely the same.  

[the janet]

Quote:

Originally Posted by Xantho 

I find it interesting when folks say a free standing birth center is the same as a homebirth.  IMO, it is similar, but not completely the same.  

I agree...it's not the same. You experience a disruption by leaving your comfort zone at home, getting in a car, then having to recreate that environment of comfort and safety all over again.

But it's still closer to the experience of having a home birth than having a hospital birth.

[GoBecGo]

Originally Posted by Xantho 

I find it interesting when folks say a free standing birth center is the same as a homebirth.  IMO, it is similar, but not completely the same.  

I don't think it's the same.  It's like having a homebirth in someone else's home.  So for me, who really finds security in familiar surroundings, it would be a very distant choice - basically if i couldn't have a homebirth for medical reasons a birth centre would be no use to me, i'd need a hospital, because i'd only go someplace else if it was for medical intervention, and most birth centres cannot give any (i have a friend who had a BC birth last time and she couldn't even have syntometrine for the 3rd stage without transferring to the obstetric unit).  Though in her case the BC was IN the hospital, and the obstetric unit was down the hall...  I don't see the point in "home from home" though i'm sure others probably do.

[the janet]

I wanted to add that there were two big reasons for my choosing the freestanding birth center over my home:

• I don't feel "at home" in my home. The apartment building I live in has walls made of paper and there is a very loud unsupervised teenager who hangs out in the hallways with his equally loud friends. I know there's no way I could deal with the intense part of labor in that kind of environment.

• The two closest hospitals to my apartment (and they're very close) that I could potentially transfer to are basically inner city hospitals and cater to a very low-income clientele. I have been to a birth at one of them (with a CNM) and it was a pretty awful experience. I've been to a birth at the hospital I would transfer to if there were problems at the birthing center, and it is a way better facility.

[GoBecGo]

Originally Posted by the janet 

I wanted to add that there were two big reasons for my choosing the freestanding birth center over my home:

• I don't feel "at home" in my home. The apartment building I live in has walls made of paper and there is a very loud unsupervised teenager who hangs out in the hallways with his equally loud friends. I know there's no way I could deal with the intense part of labor in that kind of environment.

• The two closest hospitals to my apartment (and they're very close) that I could potentially transfer to are basically inner city hospitals and cater to a very low-income clientele. I have been to a birth at one of them (with a CNM) and it was a pretty awful experience. I've been to a birth at the hospital I would transfer to if there were problems at the birthing center, and it is a way better facility.

If i felt that way (the bolded bit) i would definitely look at the BC my friend went to.

[SeattleMolly]

Pregnant@40-

Thanks for the reply. I'm in South Seattle, so Valley Medical in Renton is 10 minutes away. It was touring this hospital that really turned me off, even though it  is gorgeous and very homey. It is rather large, but allows a midwifery model and is close to home. I've been seeing the nurse midwives from Valley, and they are pretty great, and have a 17% c-section rate.  

I have heard great things about [who I think is] your doctor. Two pregnant friends have reported the same stories for a male OB out of Northwest-must be him! He is like a midwife, hehe!

My sister delivered at Swedish and it is huge (and parking is a real pain). Kind of a "baby factory." I have not heard good things about UW.

After talking to my husband last night, we decided that home birth is our frontrunner right now, as long as we can transfer to Valley (since it's so close and in network). Seattle Home Maternity was impressive, but they are the group that told me about the 25% transfer rate for 1st time moms. I'm going to check some other midwives out, and in the meantime, still go to my appointment next week at the nurse midwife clinic.

Originally Posted by pregnant@40 

Originally Posted by 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.

SeattleMolly, which hospital are you considering? I'm wondering if you have been shocked by either UW or Swedish First Hill, the hospital behemoths.

I delivered at Swedish Ballard the first time, and plan to deliver at NW Hospital this second time. Smaller hospitals w/ attached birth centers seem like a great way to go. I had a wonderful delivery w/ my first -- family practice doc w/ some traditional midwifery training and a significantly low C-section rate for his patients. No routine episiotomies and total control over my own birth plan, of course. I feel that being in a hospital w/ a respiratory team & that particular doc saved my kiddo's life (ie. the umbilical cord was wrapped tightly around his neck twice preventing his descension & causing drops in heartrate, his apgars were very low & he needed resuscitation at birth; luckily the doc was skilled enough to quickly realize what was happening & manually assist the baby out before he was too distressed, or even worse, at greater risk of cerebral palsy or other complications).

If you don't choose a home birth & do want a different hospital, there are options. As for the hospitals, the smaller ones have large birthing suites & some comfort measures. They try to make it look like home. NW has jacuzzi tubs, music, allows for free movement/eating/drinking, an online nursery, a grand celebratory meal for both parents, and gifts of baby hats knit by elderly community volunteers. I've chosen an OB doc whose wife handmade the moomoos his pts wear for exams (instead of hospital gowns in the office) and takes pictures of all the newborn babies. The doc is even known to play guitar at the mom's bedside after delivery! He's very accomodating w/ birth plans, personal wishes regarding epidurals/meds, free movement, midwives, doulas, etc. ... And IF there is an emergency, there is 24-hr anesthesia and a level II nursery down the hall. Personally, I want all of the emergency personnel readily available in case the unexpected happens & time is of the essence, even though there is a slim chance. You never know w/ birth. But I want to deliver in what feels "homey" and allows free movement, too. Hence the birthing suite.

As for nosocomial infection rates, smaller hospitals also have an advantage over the larger multipurpose facilities. Like the homebirthers, I don't want to expose my newborn to MRSA or other hospital infections. These are much less likely to be present in birthing centers.

So if you have choices w/ your particular insurance, see what else is out there. I recently switched from Swedish First Hill at 30 weeks pregnant b/c it feels so institutional. It's never too late to change. Your midwives may be able to practice in another hospital organization.

[SilverFish]

i chose a homebirth the first time. it didn't end up happening because my water broke at 35 weeks, but even then, my midwife gave me the choice to deliver at home and potentially transfer after the birth, or to go straight in. i am so glad i was on a homebirth track. i think it really helped me progress quickly because all along the plan was to do it at home, so even though things were kind of up in the air and scary because of the PPROM, i still felt relaxed and happy at home. and, i am SO incredibly glad i had a midwife, homebirth or not. she was my attendant at the hospital, i never had to see another hospital staff person until we were officially transferred into the NICU a few hours post birth.

honestly, if anything, i wish i had stayed at home, because even with "complications" and a baby who "needed help" a lot of the stuff the hospital staff did was unnecessary and overcautious. they took her to a warmer to stabilize her temps, without even trying any skin to skin... from that point on, we were on their clock, so that feeding progressed directly to tube-feeding without even trying breastfeeding first, and any destabilization in her vitals put us back 48 hours. it was really the most frustrating and demoralizing experience ever. it honestly felt like they just looked at her chart and based her treatment off of a formula without taking her into consideration at all.

[Climbergirl]

Originally Posted by SilverFish  it honestly felt like they just looked at her chart and based her treatment off of a formula without taking her into consideration at all.

That is a hospital.  Those nurses are overworked and have to deal with so much.  Yeah, you have to be a formula in order to handle all they do.  That is EXACTLY how I felt during both my hospital stays.  Don't get me wrong, they were some really nice ones, but really, I felt that could not see me for the individual person I am.  I really feel there has to be a better way for hospitals in general.

[Mama Metis]

I am in the same position as the OP, but with a bit more time to decide (EDD in July). I have been reading about homebirth for years now and I am well aware of the benefits, but I have some concerns to overcome. I'd love to see some discussion about what specific forms of treatment the homebirth skeptics feel is not available at home. Particularly for the baby. I know oxygen is available, but can a midwife intubate a newborn? Provide CPAP? I don't think so but I'm not sure.

In my case, I have a homebirth midwife (CNM) who will also deliver in the hospital if you prefer (although she strongly favors homebirth). Her orientation is completely toward physiological birth, so I have no fears of excess intervention in the hospital. I also don't have any strong fears or anxieties about being in the hospital (although home is always nicer for sure.) I guess in part, I'm questioning whether I can justify a homebirth since I have access to a "safe" hospital birth.

I'm not making an argument here, just wanting to hear what others think. Thanks for the helpful thread, OP.

[caned & able]

I had my first baby at home.  Why not?  What is wrong with your first baby that you should go to the hospital and fight for everything you want or fight off what you do not want?  If you end up in the hospital, that is where you belong.  Even if 25% end up transferred, that means that 75% do not!  

Find a good homebirth midwife to work with.  Ask her what her transfer rate is during labor and usually for what problem.  A midwife with a low transfer rate knows what she can handle and what she cannot.