Homebirth vs Hospital, How Can I Decide? Thank you

[kr mom]

LONG story short-

fist baby: planned homebirth, transferred due to asynclitic position of baby and baby NOT coming out after hours of pushing. Poor care received by midwives which made the homebirthing part traumatic, hard, feeling lost & alone without the needed support and direction/care from midwives.

Transferred to hospital all through the pushing stage, so it was not a very smooth transfer! Pushing in the car on the way etc. With it being my first baby you can only imagine how scary this was!!!  

Hospital experience ended up not being so bad. Nurses were extremely nice and caring, provided much more support than midwives who left the hospital before baby was even cleaned up or had the chance to nurse. 

Now for my next baby I am so conflicted about where to plan L&D. If planned at home again, it would obviously be with a different midwife, already found an awesome one!! But have also found a wonderful, low intervention OB as well. I am SO TORN- what questions could I ask myself to help me decide. It is a HUGE deal as my first was not a pleasant experience and I think that has a big impact on mommies. I really want to have a good experience this time around. HOW can I decide which way to go?

Thanks for any help, I really appreciate your time.    BTW: CNM in a hospital isn't an option in my area :(

[MrsWhite]

I'm kind of in your same situation, except reversed.  I had a pretty good hospital experience (excellent until DD had shoulder dystocia and I had PPH the second she was born and it wasn't handled nicely) with a CNM who is no longer practicing.  Now I can't decide what to do either.  Hospital is free, homebirth isn't, but everyone says homebirth is so awesome and worth the money.  IDK.  I also just found a low intervention OB who delivers at a hospital with awesome policies and am meeting with him tomorrow, but was not completely sold on the one midwife that will work with our military situation and offer a great discount.  

I've found it helpful to ask myself how I would feel worst case scenario in a hospital vs. worst case scenario hb.  well... maybe not really helpful, but something to think about.  

 Did you ask the midwife you found what she would have done in the situation with your last birth?  And how active and supportive she is during labor?  

Sorry if this isn't very helpful - I'm interested to see your replies.  

[miriam]

...Hospital is free, homebirth isn't,...

The hospital is NOT free.  Your and everyone's insurance premiums pay for it, and even then there may be deductibles.  You or your employer or your husband's employer have been paying insurance premiums; the insurance company is telling you that a hospital birth is the only choice you have, but that is only because that is the only venue that is covered.  

Why let an insurance company decide where you are going to give birth?  

[beccamama31]

It seems that every woman/ family has different needs during labor and delivery..

I would definitely recommend HB to any woman that would want it. 

I have had 2 HB's. The first one was a fairly short labor and a longer 2 nd/pushing stage.. 

My second HB was amazing.. I had a water birth and my dd was born VERY quickly!!

I really believe that having faith in oneself and having the quiet/space to birth the baby//preferably in water (this is just my experience) will result in the best outcome for both mom and babe.. 

I am expecting again soon and am planning on another home/water birth..  

I would recommend watching the Video/movie, Birth As We Know It,made by Elana Tonnetti...

It is so inspiring and beautiful to watch..

Good Luck!!!

[PunkElmo]

Originally Posted by miriam 

The hospital is NOT free.

  I'm paying out of pocket no matter where I go and I can honestly say homebirth is SO much cheaper

A hospital birth wouldn't be just worrying about interventions that I really don't want, but the COST of said interventions too! Shot of pit? oh, that'll be $324 for the pit, $586 for the Dr's time, and a $20 fee because someone physically came and saw you, a $53 charge for the IV... yeah.

[mistiblue02]

I'm sorry you had such a terrible experience. I am pregnant with baby #3 and we are planing for a home birth. My first was a typical hospital birth. Second I was with an OB but decided to switch to midwives at a birthing center late in my pregnancy. I'm so glad I did, because even though it ended up as a hospital birth (I had to go get induced at 36 weeks due to complications), the care I received from them was totally worth it. I have moved since then, and I am currently working with a wonderful midwife with a backup OB that I am totally comfortable with. 

I think the care you receive is so important during your pregnancy- no matter what you choose to do. I wouldn't completely rule out a home birth, but I would definitely find a midwife or OB that I was totally confident and comfortable with.

[msmiranda]

Originally Posted by miriam 

The hospital is NOT free.  Your and everyone's insurance premiums pay for it, and even then there may be deductibles.  You or your employer or your husband's employer have been paying insurance premiums; the insurance company is telling you that a hospital birth is the only choice you have, but that is only because that is the only venue that is covered.  

Why let an insurance company decide where you are going to give birth?  

I think she meant that *her* out of pocket costs for a home birth would be much higher than for a hospital birth.  For anyone who has a generous insurance policy (e.g. a copay only policy), this is likely to be the case.  (Obviously for those with deductible plans, the patient would be responsible for paying the deductible before receiving any benefits; and for those with coinsurance they would be out a large chunk of change as well.  For those folks, home birth might well be cheaper, depending on the details of the plan).  And if her insurance is provided by her employer or her partner's employer, they may not even have to contribute to paying the premiums.  I have had insurance policies in the past where I not only paid nothing toward the premiums but seriously could have had a hospital birth for one $30 or $40 copay and that's it, no additional out of pocket costs.  Whereas home birth, if covered, would be covered as an out of network provider (unless you successfully fought for a gap exception) so you would only get a percentage of the money back.  Whether this is an important consideration to the OP or to anyone else really depends on their personal financial situation and the importance of home birth to them vis a vis other things they could be spending money on.  There are no right or wrong answers.

[MrsWhite]

Originally Posted by miriam 

The hospital is NOT free.  Your and everyone's insurance premiums pay for it, and even then there may be deductibles.  You or your employer or your husband's employer have been paying insurance premiums; the insurance company is telling you that a hospital birth is the only choice you have, but that is only because that is the only venue that is covered.  

Why let an insurance company decide where you are going to give birth 

We are military... so yeah, it is absolutely free.  

ETA: and I meant my specific situation... I was just thinking out loud.  I know for lots of people its cheaper to have a HB.  

[wennerk]

Hi,

I was mulling over your question of what kinds of things you can ask yourself to decide between homebirth and hospital.  First, I would ask yourself how you want to be cared for prenatally.  With doctors I found that I was just another patient and they fit me into an allotted time slot.  With my midwife I found that she scheduled for what worked for both of us.  I usually had appointments at her house or mine and a lot of it simply involved talking about how life was going at the present time (along with belly palpations and listening to heartbeats).  I felt like she really cared about my situation and wanted to know the full picture whereas docs usually just look at the baby, how much weight you're putting on, and what you're eating.  An appointment with my midwife always lasted about an hour.  It really helped me feel comfortable with her before the birth.

Second, ask yourself what kind of care you want to be provided to your baby after delivery.  Do you want to wait until the cord stops pulsing before clamping?  Do you want your child to get Vitamin K and the eye glop they put in?  Do you want to be treated for Hep-B?  These might seem mundane or out there, but they are choices that you have the option of declining in homebirth whereas you don't in a hospital. 

Lastly, and most importantly, do you trust your body to give birth?  If you do, I'd say go for the homebirth.  No matter whether you love a doctor, he/she is still subject to the hospital protocols where you deliver. 

As for me, I have one DD.  I started prenatal care in a midwife-staffed birth center, but moved out-of-state during my sixth month and after looking at both doctors and midwifes, I found an awesome midwife with whom I had a home water birth in a 3-foot high kiddie pool.  I absolutely loved it!  I loved the peacefulness of the whole experience.  Plus, I had the confidence that my midwife was prepared for anything that might happen...and that I could do it.  Sorry this is so long, but I hope it helps.

[goldenwillow]

Originally Posted by wennerk 

Hi,

I was mulling over your question of what kinds of things you can ask yourself to decide between homebirth and hospital.  First, I would ask yourself how you want to be cared for prenatally.  With doctors I found that I was just another patient and they fit me into an allotted time slot.  With my midwife I found that she scheduled for what worked for both of us.  I usually had appointments at her house or mine and a lot of it simply involved talking about how life was going at the present time (along with belly palpations and listening to heartbeats).  I felt like she really cared about my situation and wanted to know the full picture whereas docs usually just look at the baby, how much weight you're putting on, and what you're eating.  An appointment with my midwife always lasted about an hour.  It really helped me feel comfortable with her before the birth.

Second, ask yourself what kind of care you want to be provided to your baby after delivery.  Do you want to wait until the cord stops pulsing before clamping?  Do you want your child to get Vitamin K and the eye glop they put in?  Do you want to be treated for Hep-B?  These might seem mundane or out there, but they are choices that you have the option of declining in homebirth whereas you don't in a hospital. 

Lastly, and most importantly, do you trust your body to give birth?  If you do, I'd say go for the homebirth.  No matter whether you love a doctor, he/she is still subject to the hospital protocols where you deliver. 

As for me, I have one DD.  I started prenatal care in a midwife-staffed birth center, but moved out-of-state during my sixth month and after looking at both doctors and midwifes, I found an awesome midwife with whom I had a home water birth in a 3-foot high kiddie pool.  I absolutely loved it!  I loved the peacefulness of the whole experience.  Plus, I had the confidence that my midwife was prepared for anything that might happen...and that I could do it.  Sorry this is so long, but I hope it helps.

Fantastic post.

I am sorry OP that your first experience was not what you expected but grateful to hear your hospital experience was good.  I chose HB because I do not care for hospitals or western medicine regarding birthing.  I had a really bad experience 2 months prior to conception from a MVA where I fractured my neck C6/7.  That said, I decided to investigate HB or a FSBC.  At the time I had DS, there was no birth center close to my home.  Decision made.  I was blessed to find a fantastic, hands off MW on our first interview. 

Go with your gut. 

Edited by goldenwillow - 5/4/11 at 4:21pm

[Shmuzra]

Originally Posted by MrsWhite 

We are military... so yeah, it is absolutely free.  

ETA: and I meant my specific situation... I was just thinking out loud.  I know for lots of people its cheaper to have a HB.  

If you switch to standard it should be free.
You just have to find a midwife willing to work with TriCare, I was able to find one and didn't pay a dime out of pocket.
3 other spouses have as well, and only one of them got charged ($20 because she got some kind of shot for the pain)

[abc123xyz]

Your story sounds so similar to mine! My first was a planned homebirth and after 36 hours of hard 3-4 minute contractions, we transferred due to an acynclitic and posterior presentation baby. I was not pushing on the way to the hospital, but in severe pain from the sitting position. It was horrible. My midwife was AMAZING!!! She didn't stay long at the hospital with us because there was nothing she could do and the environment was very hostile. We had a horrible hospital experience from the time we got there to the time we left. And after, really! He came 44 hours after the start of labor, vaginally, despite being pressured to have a section and told all of my babies would be positioned this way! Because of all of that, we planned a homebirth with our second, with the same midwife because she is now one of my best friends, and ended up with a surprise breech baby born 10 hours from start of labor to end at home. Now, with our third, I know I can do ANYTHING! We are planning our third homebirth. I realized that baring death, I am staying home to have my babies. The way we were treated in the hospital proved so much to me about what I believe in the system and business of it all. I read this article the other day, I will pass it along and maybe it will help you, although you probably already know these things. I feel like, if I were you, I would owe it to myself to prove that I could do anything! It is an amazing feeling. That sense that you did the absolute best for your baby despite your pain and discomfort. My homebirth experience was FAR FAR superior to my hospital birth experience and I wish other women could be witness to the difference. Hope you are encouraged to do what your heart leads you to. Having a new midwife sounds necessary!

I don't know if you'll be able to access this but if not, I can PM it to you. It's really long but worth the read!

http://www.facebook.com/#!/notes/mary-ueland/an-obstetricians-lament-published-in-acogs-green-journal-may-2011/10150183948386840

[MrsWhite]

Originally Posted by wennerk 

Second, ask yourself what kind of care you want to be provided to your baby after delivery.  Do you want to wait until the cord stops pulsing before clamping?  Do you want your child to get Vitamin K and the eye glop they put in?  Do you want to be treated for Hep-B?  These might seem mundane or out there, but they are choices that you have the option of declining in homebirth whereas you don't in a hospital. 

Yes, you can decline these things in a hospital (unless maybe your state has specific regulations and requires them, in which case you can still get an exemption).  My DD didn't even get a bath or the PKU at the hospital and was never separated from me, but you may have to fight harder than I had to because our hospital is pretty crunchy. 

Quote:

Originally Posted by Shmuzra 

If you switch to standard it should be free.
You just have to find a midwife willing to work with TriCare, I was able to find one and didn't pay a dime out of pocket.
3 other spouses have as well, and only one of them got charged ($20 because she got some kind of shot for the pain)

     CNMs are the only ones tricare will cover and there are none that do hb in my state.  I do switch to standard though, I want to be able to pick my provider and hospital so I'm thankful for that.  

OP did you make a decision?
 

[msmiranda]

Originally Posted by wennerk 

Lastly, and most importantly, do you trust your body to give birth?  If you do, I'd say go for the homebirth.  No matter whether you love a doctor, he/she is still subject to the hospital protocols where you deliver. 

Hmmm.  I'm sure this wasn't meant as a dig to women who choose to give birth in a hospital, but it kinda sounds that way.  I trust my body to give birth, and I have chosen to give birth in a hospital this time.  Ironically, I think I trusted my body's ability to give birth much *less* last time, when I chose home birth.  That's why I felt I needed a very natural-minded care provider, so that I could trust someone else to tell me if I needed intervention or not.  It's only because of my current level of confidence in my body (and mind) that I felt comfortable going the hospital route.  I am fortunate to have found a super-NCB-supportive OB, who delivers at a hospital that sees a LOT of NCB (because of my doc and a midwifery practice that deliver there) and knows how to support it.  If I didn't have those options -- and I know that not everyone does -- I might be more inclined to choose home birth again.  Anyway, I guess my point is that the hospital/OB picture isn't all black and white -- there are better and worse ones out there and in some places it is possible to have a NCB in a hospital without having to fight for it. 
 

[kr mom]

thanks everyone, especially msmiranda :) You're right there are good & bad OBs just like there are good & bad midwives! I think I too may have found a great, NCB friendly doctor. 

[Alenushka]

I had a hospital birth with my acupressure therapist as doula. My water broke first. I went to the hospital. I had horrible back labor. By the 18th hour I was hallucinations from pain and exhausted. We had tub , shower and I moved around in the hallway a lot but nothing was working. The hallucinations were pretty but my mind left my body and the labor stalled. I had pitocin and pain got worse.  My husband called the doctor in and I agreed to epidural because I was loosing it. I took a 3 hour nap. I woke up fully dilated and feeling all energized. I felt powerful and on the  brink of something amazing. I pushed for 30 mins and my handsome 8.6 lbs baby was born. I was crying and laughing from happiness. My OB was amazing. her c-section  10%. I did not want episiotomy and she really took a great care of stretching everything just right. I did not have a single tear. Everyone was OK with Hep B refusal. The baby was my chest right away and nursing. RNs were very encouraging about nursing. We went home in 8 hours.

I spent next 2 weeks feeling really guilty for having an epidural. But then I told myself "^)(&$ it.  Just because something sound ideologically right it does not mean it is right for me. Pain control helped me rest and have energy and my ultimate goals were fulfilled. I wanted to have  live baby, to be alive, have no c-section or epidural. I did it."

With the second child I went with the same OB and same hospital. I stayed home longer.  When I came in I clearly stated to nurse what I wanted and how. I did not wait for hallucinations. I had an epidural but with less medicine than usually given. I dilated fully pretty quickly and  pushed by 9 lbs  baby in 15 mins. I guess I really wanted to see him. I felt very much in control the second time around and guilt free.

I think it is hard to predict how thing will go and where. I really liked my OB because she new what she was doing and listened to me. I think setting playes a role but also the people. I would rather have respectfull OB than a rude MW.

[kr mom]

Alenushka, thanks for the time you took to share your experience with me. I have decided it really does come down to your provider, be it a great mw or great OB. There are good and bath of both! And where I will feel most confident laboring, which currently I am thinking in a hospital. I have found an OB who actually had home births herself and has a holisitc philosophy of care. So she may be just what I need :)  I agree with you in that it is impossible to predict what will happen in L&D. And I am starting to think epidurals are not the devil as many make them out to be LOL

I have seen SO MANY stories the epidural IS what allows the mother to finish giving birth naturally/vaginally. It allows them to relax, rest and regain some strength to complete the task. Thanks again for your help & thoughts.

[Alenushka]

What I realized after my first birth is that my feeling of self worth does not lay in whatever I can cope with pain without pain meds or not. No, I do not trust my body all the time. It has failed me more than once. This is what bodies do and this is why we have medical care. I have some chronic illnesses that just genetic misfortune  and no one can do anything about.

No one would call my husband a victim of health-care system for taking pain meds for his very natural back pain.  If pain really promoted bonding I would love my first son more  but I do not. Both of my children are dear to me.

Also, if pain is so important for bonding, why do not we put father's testes into some sort of pain inducing device during labor?

This entire idea that pain and suffering is good  for mom and baby make me thing of Bible and how Eve was punished for her sins. That particular passage  always seem very misogynistic and patriarchal to me.  I feel that the natural childbirth movement , in the ironic way, contributes to the misogynist and patriarchical view that women should suffer and suffer a lot simply because they are women.