Considering Homebirth? Think Hard....

[guvly]

All-

Here's a message from a dad with a word of warning to those considering homebirths.

I have two children, both born in a hospital with a certified nurse midwife attending. Consider the following:

Our first child was born in the hospital after a long labor to a C-section only after our nurse midwife said it was time to consider one due to complications. We trusted her, so we believed her when she said that if we didn't go with a C-section, we risked damage to mom and baby.

Our second child was born in the hospital to a successful VBAC, despite the fact that the midwife was held up at another birth and arrived halfway into labor.

Yes, hospitals can be difficult, but please consider your options carefully before dismissing hospital birth. There is a lot of pressure in the homebirthing circles to have a "normal" birth. I can't tell you the number of inconsiderate homebirthing advocates who responded after mom's C-section with comments such as the following:

"That's too bad- what went wrong?"
"It's too bad the doctor was so manipulative"
"You'll do better next time."

My wife felt so bad, for a very long time, because she felt she had failed somehow. It wasn't until after the birth of our second child 3 years later that she was able to overcome the stigma placed on her by these "advocates." Any birth that results in a healthy and happy mother and child is a successful birth in our shared opinion.

Consider also that insurance companies don't insure home birth for a reason. Insurance companies care about one thing- Money. If home births were cheaper, they'd insure them in a minute. But in the end, it's less expensive for insurance companies to have babies in the hospital because it's safer. Consider also that if birth complications arise, or your midwife makes an error (everyone makes errors) which results in a birth defect, the parents may be liable for a lifetime of costly medical expenses that can leave a family destitute, not to mention the guilt that comes with thinking that the defect may have been avoidable.

There are other options- consider birth in a hospital with an attending doula or nurse midwife to serve as your advocate. This ensures that someone will be your advocate while mom labors and dad assists, but also ensures that medical assistance is available if needed. If your local hospital doesn't offer this service, look for another hospital, or stay with friends and family near a hospital that does. Make these considerations before you decide to become pregnant so you don't get rushed into a situation you don't like and so you can make arrangements for adequate financial support to pay for your ideal arrangement.

Anyhow, those are just some thoughts, offered with the best of intentions. Best of luck to you and your kids.

Guvly

[Rainbow]

I've had two hospital births... so I'm not some huge HB advocate (though I was born at home and love the idea)

You see- my husband is an actuary for an insurance company. Guess what? He's calculated the risk based on government statistics and the COST risk is much, much higher in hospitals. Even with risk of transport- the risk of C section, risk and cost of drugs and prevenatative monitoring in hospitals bring up the cost risk a great deal.

And not all insurances deny to pay it- the company he works for- which is our insurance- covers it at a rate of 60%-equivalent to an out of network provider.

And I still don't get where you are saying the risk and danger comes from in a homebirth- could you be more clear on the facts? You say you had two hospital births so can I ask where your experience and information on homebirth comes from?

[Rainbow]

oh, just saw your post count- where is the "dont feed me" icon when you need it.

Are you just on a crusade against homebirth or here as an actual member of MDC?

[MamaSoleil]

I can't find the don't feed me icon either

[girlfromthefuture]

I posted my comments on your first thread. Not sure why you created two threads?

And you're correct, any woman having a birth should "think hard" about ALL the choices she has to consider during pregnancy and birth.

I wonder if your wife ever educated herself about homebirth, maybe she didn't consider it out of fear from a lack of support from her partner?

An educated person, educates themselves about all the options.

[guvly]

Rainbow-

Thanks for your thoughtful reply. You are probably right that the costs of cost of the birth is much, much higher in the hospital. I can't really get into details, because I don't want to divulge information that's not mine to divulge. In instances where birth defects occur at home, it often can't be determined if the result of the defect was due to birth trauma caused by neglect by the attendant or unavoidable birth trauma.

The point is, since many midwives aren't covered by insurance, the parents will never know, and could be saddled with years of costly medical payments. IF the defect is caused by neglect, and the birth happens in a hospital, they'd have some recourse to avoid the huge financial impact this will have, and get the child the care that it needs. But because midwives are generally not insured, parents risk the burden and guilt of never knowing and struggling to find appropriate medical care for the child. That's a heavy price to pay. I'd suspect the real financial burden to insurer's is the risk of long term payouts due to negligence (however well meaning) in an uncontrolled environment.

IF the midwife was a certified nurse, and IF she was covered by insurance that covered any negligence/accidents, we may have considered homebirth, but it never arose because we HAD a midwife in a hospital where the liability was covered, and in effect, had the best of both worlds.

Originally Posted by Rainbow

I've had two hospital births... so I'm not some huge HB advocate (though I was born at home and love the idea)

You see- my husband is an actuary for an insurance company. Guess what? He's calculated the risk based on government statistics and the COST risk is much, much higher in hospitals. Even with risk of transport- the risk of C section, risk and cost of drugs and prevenatative monitoring in hospitals bring up the cost risk a great deal.

And not all insurances deny to pay it- the company he works for- which is our insurance- covers it at a rate of 60%-equivalent to an out of network provider.

And I still don't get where you are saying the risk and danger comes from in a homebirth- could you be more clear on the facts? You say you had two hospital births so can I ask where your experience and information on homebirth comes from?

[jessitron]

In the hospital, it is still unknown whether a problem was caused by birth trauma or already existed.

IF the defect is caused by neglect, and the birth happens in a hospital, they'd have some recourse to avoid the huge financial impact this will have, and get the child the care that it needs.

That "recourse" is exactly what the malpractice insurance companies fear. That's what drives up the cost of hospital birth and the intervention rates. The high intervention rates are a large part of what makes hospital births more dangerous than home birth for many healthy mothers.

Show us some scientific evidence that hospital births are safer for low-risk births, and we'll be very interested. Try to "protect" us from our carefully researched and thought-out decision, and we'll just be disgusted or ignore you.

Your wife's births are both great. Congratulations on your children. If you both feel more comfortable in the hospital, then that is the best place for you to be. If we are in the same situation as her first birth, we can safely transfer to the hospital for C-section. You supply no evidence at all that home birth is undesirable for us.

I'd say we've thought a lot harder about this than you have.

[guvly]

Some posted a bit earlier asking if I was a legitimate poster. Of course, there's no way to prove that, so you'll have to take the comments for what they are worth.

I was hoping to have a legitimate conversation about the issue, but after reading some of the reply posts, I don't think I'm willing to wade through them for legitimate response. My posting was respectful and moderate, but a large portion of the replies, such as the following:

"I wonder if your wife ever educated herself about homebirth, maybe she didn't consider it out of fear from a lack of support from her partner? An educated person, educates themselves about all the options."

...reflect the same attitude towards opinions that are different from one's own that I mentioned in my original post. My wife is not an idiot, nor am I, and just because I disagree with homebirth (an opinion my wife shares) doesn't mean I'm a non supportive partner.

I thought I could provide some information that people would find helpful, perhaps an alternative opinion. I've done that, and will let the flaming continue without further reply. But I will include a final caution to pending parents that if for whatever reason you don't have a birth like hardline homebirth advocates dictate, expect a large number of them to cast aspersions on your character as they have in this thread.

[StacyL]

Yes, I agree with the post above. If I may say so, the women I come into contact with who have had a homebirth or are planning one tend to be VERY well educated. And they tend to know FAR more about birth and its associated risks in general than the average woman who would go to a hospital to give birth. This is never a decision made lightly.

I don't know what the OP's point was in posting here, but it seems to me you're on the wrong board and are far outnumbered by women who can't possibly agree with you. And again, as someone else asked, since you have no personal experience with homebirth, what HAPPENED to make you feel the need to sound an apparent "alarm" to those who plan to do so?

Stacy

[cottonwood]

Well, the OP seemed heartfelt enough, so I'll just assume that he isn't up on internet forum etiquette.

Guvly, I'm so sorry that your wife felt bad about the well-meaning comments about her cesarean. But if she herself hadn't felt there was room for a better experience, she wouldn't have tried for a VBAC. Consider that from the "homebirth advocates" perspective, they might have felt they were only encouraging her in that. Surely they didn't mean to cause her further pain.

Rainbow is entirely correct about the insurance issue. You would think that a company whose main priority is to make money would be logical about what they do and don't insure. Unfortunately, it isn't quite that simple -- the consultants that insurance companies work with on medical issues are often doctors, who have a bias and a financial stake in keeping maternity care in the hospitals (which is also the reason that homebirth midwifery is illegal in some areas -- doctors make a lot of money, and so have a lot of money to hire lobbyists.)

In fact, there has arisen no hard evidence that homebirth is ultimately costlier or less safe than hospital birth. There are countless studies that have shown or implied just the opposite. Thankfully, though, many insurance companies have begun to do their own independant research and now do insure homebirth. So by your own argument -- that insurance companies only insure what is "safe" -- would you assume now that homebirths are safe? I doubt it. You would do your own research, right? If you are interested, please reply and I'd be more than happy to post references.

[love2all]

I do not even know what to say..............

[guvly]

Blue-

Well- I'll give it one more go since Blue's response was so nice.

If you read my posts, you'll see that safety isn't particularly my issue- my concern is negligence liability, which happens everywhere, whether in homebirth or in hospitals.

I also said that if in our state we could have had an insured homebirth, we might have considered homebirth. Given that we had an advocate midwife in the hospital, we didn't need to. I still stand by my original assessment- regardless of the comparative risk between home and hospital birth, even if home birth IS safer, it's not prudent to have a home birth without negligence insurance.

Suffice it to say that I know of families that have been financially wiped out and struggle to find appropriate health care for their children because their midwives weren't insured and a defect occurred that might have been avoidable. I wouldn't wish that on anyone.

[cottonwood]

A few more points -- some of the "flaming" that you feel you're being met with is -- that slightly angry, offended tone -- is to be expected considering that most people who have chosen homebirth have met a great deal of resistance and judgement from others, and your post could just be considered more of the same. You complain about your wife being told that she could have a better experience. But has she been harassed and hounded by family members to *not* have a hospital birth? Has she been told that she cared more about having a "nice experience" than a healthy baby? Has she been threatened with a call to CPS or to 911 once she goes into labor?

There is a huge amount of irrational fear regarding homebirth, and all of us who have chosen it have had to deal with that to some extent, and it's not a pleasant thing. So please know that this is not a simple issue of fanatical homebirthers vs. sensible hospital birthers. There are rude, misinformed people on both sides of the fence.

Guvly wrote: "In instances where birth defects occur at home, it often can't be determined if the result of the defect was due to birth trauma caused by neglect by the attendant or unavoidable birth trauma."

I assume you don't have sources for this statement and just believe that it's a reasonable conclusion to come to? Because in fact the same can be said of hospital birth. I have heard countless stories in which some trauma occured in the hospital, and there was no concensus as to why. Because obviously the care providers don't want to implicate themselves, but who better to know what really happened?

"IF the defect is caused by neglect, and the birth happens in a hospital, they'd have some recourse to avoid the huge financial impact this will have, and get the child the care that it needs. But because midwives are generally not insured, parents risk the burden and guilt of never knowing and struggling to find appropriate medical care for the child. That's a heavy price to pay."

However, consider that in matched-population studies, it has been found that birth complications occur at a significantly higher rate in hospitals than at home. In fact, iatrogenic complications are considered to be a huge problem by the medical establishment itself. There is something about the obstetrical model of care that is creating problems in what would otherwise be a healthy, normal process. In other words, by having a homebirth I am much more likely to avoid complications that would necessitate costly medical care. This has actually been researched extensively, yet hospitals still fail to practice evidence-based medicine in order to avoid these problems. Again, if you are interested in references, I would be happy to get you started.

Consider also that parents who hire uninsured homebirth midwives have generally put a lot of thought into the decision. Given that it is considered such an irresponsible choice by society in general, they do their research in defense. Most of us are quite aware of these issues. I intentionally chose an unlicensed, uninsured midwife in spite of being very aware that I could not expect a malpractice settlement from her or anyone else. In my case, however, the benefit of doing so far outweighed those risks. Namely, the benefit of *not* giving birth in an environment and with management that would interfere with the normal birth process, which would have greatly increased the risks of complications and iatrogenic damage.

[gingerlane]

I guess I just don't understand what prompted you to post under this forum. You didn't have a homebirth, so why come and post here? I respect that you are trying to help, but what you are doing is the equivalent of hawking formula at a LLL meeting. We're given enough messages about how "unsafe" HB is, despite the overwhelming evidence that it IS safe. We know that hospital births can lead otherwise healthy moms into c-sections by imposing time limits, fetal monitoring, evasive vaginal checks, etc. I'm sure your intentions are good, but we just don't need more people telling us that HB is bad... that's why we come to this forum, to get support!

Do with it as you will and I really do hope you're well intentioned.

[annakiss]

The day I start making decisions based on liability concerns and not on my family's best interest is the day I have stopped being human. Living itself is a risk. That doesnt mean I choose not to have children simply because it may turn out bad for us. Don't come on this board and tell women the risks. All you have to do is read the the other boards to know we are very well aware of them.

[cottonwood]

Guvly wrote: "Suffice it to say that I know of families that have been financially wiped out and struggle to find appropriate health care for their children because their midwives weren't insured and a defect occurred that might have been avoidable. I wouldn't wish that on anyone."

I wouldn't either. What a terrible burden. Knowing that wouldn't change my decision though, because it's not the only factor in the equation. There are no guarantees, no matter what choice one makes -- it comes down to what the risk/benefit ratio is, and that is going to be different for everyone depending on their special circumstances.

[Crystal_clear]

Originally Posted by guvly

Any birth that results in a healthy and happy mother and child is a successful birth in our shared opinion.

Well, I'm not going to get into the debate over the safety of homebirth simply b/c the facts are stacked against the hospitals. One only has to look at the US's perinatal mortality rate to realize that the majority are doing it all wrong here.

I do, however, want to address the statement quoted above. First, I would ask you to define healthy. You see, there is more to a healthy baby than a heartbeat and lack of visit to the NICU. As a primer, I would suggest looking into the mounds of research Dr. Michael Odent has accumulated on the effects of traumatic birth.

Next, I would ask you to define happy. In the case of your wife, at least, it would seem she suffered emotional distress at the outcome of her unplanned birth experience as well as the reactions of homebirth advocates around her. I am one to believe that no one can *make* us feel guilty about anything. Her unhappiness may have stemmed not from the "pressure" in the homebirth community, but rather *her own innate knowledge* that what was done to her was not natural, necessary, or in the best interest of her/her child. In situations such as this, it's quite normal to ignore that little voice and instead find a way to justify/rationalize/defend the course that was taken.

At any rate, it sounds like she underwent a major shift after her VBAC. To what do you attribute her satisfaction with that birth experience? Personally, I would attribute it to the fact that she gave birth vaginally (meaning the normal physical & chemical processes of birth were not as disturbed as in the first birth, and hormones that facilitate bonding were allowed to do their job) as well as the fact that the MW wasn't there for much of her labor (and therefore unable to "direct" or "manage" her).

[mamaley]

annakiss (and everyone else)

I do, however, want to address the statement quoted above. First, I would ask you to define healthy. You see, there is more to a healthy baby than a heartbeat and lack of visit to the NICU. As a primer, I would suggest looking into the mounds of research Dr. Michael Odent has accumulated on the effects of traumatic birth.

worth repeating

[momto l&a]

Many insurance companies are starting to cover my mw fees, and she is convincing more to do the same. Ours though is problably going to be one of the last to do so. : Oh well, its still cheeper for us to have a home than hospital birth.


If hb's wherent safe, all of us wouldnt be here. There have been more hb's than hospital births.

Erin, who will have her 3rd hb come this fall

[jessitron]

safety isn't particularly my issue- my concern is negligence liability, which happens everywhere, whether in homebirth or in hospitals.

Oh, now I get it! You're warning us about a risk some people may not have considered. By using a midwife without malpractice insurance, we are giving up our opportunity to sue if there is a birth defect that will affect us financially.

Personally, I don't believe it is ethical to hold the doctor financially responsible for something that may or may not have been his fault. Problems happen. Cerebral palsy happens. Even if a jury can be convinced that the caregiver was responsible, I would not take a doctor or midwife to court even if there was a problem with the birth unless I thought the person deliberately harmed me or my baby. A random doctor in the hospital, maybe that could happen. My midwife, no! She's in the business in spite of the laws against it because it is her passion to help moms and babies. Between the lower incidence of problems at home and my own ethics regarding lawsuits, this is not a disadvantage of home birth in my case.

It is possible that other people may not have my ethical objections to suing and would find the lack of legal recourse a disadvantage to home birth. There, you have a valid point. Sorry that we did not understand that from your original post. Thank you for clarifying.