Pro-homebirth risk ethics

[alegna]

Okay, this has a homebirth slant, but I put it out here in the hopes of getting other input as there are parts of it that are not exclusive to homebirth.

We've all heard the argument that some women think that ethically it's best to be in a hospital to "protect" the baby lest anything go wrong. The stats don't support that thinking, but there are women who abide by it.

What if you turn that around. Is it ethically okay to be in a hospital and risk hospital caused injury and infection to a newborn simply because the mom feels safer there?

What about drugs? Epidurals and other pain relief drugs in labor carry a risk (yes a small one) is it ethically okay to take that risk just because you want to?

discuss.

-Angela

[Arwyn]

Well, I happen to agree with that ethical assessment (I wouldn't risk going into the hospital - unless I had to - because I wouldn't risk putting myself or my baby in that situation!), but I think the ethic of self-determination is higher. That is, although I don't agree with the risk women going into the hospital to have an epidural are taking, I fully and completely support their right to make that decision for themselves - I completely support everyone's right to be stupid! [disclaimer - that was completely meant to be tongue-in-cheek, not a particular indictment of hospital birthers.]

Now, the fact that it isn't truly an informed choice when they falsely believe homebirth is unsafe is another thread...!

I do think it would be an interesting tact to take with someone who used the "oh, I wouldn't take the risk!" line to disparage homebirth. But I also think it must be done with care, because it would be too easy for a woman choosing hospital birth to feel attacked by a turning of the tables of that statement (regardless that they basically just attacked the person chosing homebirth - more flies with honey, and whatnot).

Ok, I don't know if that actually made any sense because I'm quite tired and cold, and my brain may therefore be a bit sluggish.

[alegna]

Thanks for the thoughts- I absolutely agree that the mom gets to make the choice. It's entirely her choice to make (who pays for it, I could argue, but that's a different thread)

I'm just looking at it from the point of view of a mom wanting to make the most ethically sound choice. Like the whole- careful to not drink or have caffine or sugar or whatever then gets drugged up at birth.

Looking forward to others' thoughts.

-Angela

[sapphire_chan]

Forget delivery, what about pregnancy?

Have an ultrasound? Unknown risk, benefit mainly consists of deciding if you need to decide:
amniocentisis? 3% abortion risk to maybe find out that baby might have genetic disorder
Tested for GD, Rh-, hypertension, GB strep? And if the result is positive are you going to have the antibiotics, Rh balancing thingy (the name of which I do not recall), insulin?

And what are the odds of actually getting to make a decision with any of the above in the current model of hospital care? (2%? 1.5%? 99% amoung MDC mamas who *had* to go to the hospital?)

[LavenderMae]

I felt so UNsafe when I had my ds in the hospital. It was down right scary. I wish that insurances companies would realize how risky and more expensive hospital births are and how much safer and less expensive it can be at home. Money was my barrier to the homebirth I wanted. If homebirth wasn't wrongly seen as risky or at the very least riskier than a hospital birth then I could have given birth where I felt safer.
I think it comes down to money and as long as birth is big business we aren't going to see the truth about safety out there in the mainstream.
I totally think all women should know all the facts/risks so they can make a truly educated decision. That would not only be ideal but should be standard. It is unethical that it is not the standard.

[alegna]

good thoughts.... morning bump.

-Angela

[Wugmama]

There are risks and benefits associated with EVERYTHING in life - hospital/home birth, vax/no vax, WOHM/SAHM. Find me one important life decision that does not have pros and cons - I don't think you can. We ALL have to make the decisions we feel most comfortable with - and be willing to live with ALL the potential outcomes of those decisions. When the stakes are high they can be very personal choices. Not everything can be decided just looking at the stats - which are never "if you do this you will have a %100 chance of winning".

I can't for the life of me understand why you would want to propose that having a hospital birth is an unethical choice. As a proponent of homebirths (as it sounds like you are) haven't you had that argument applied to you enough times to realize what a crock that kind of statement is? Do you REALLY feel justified in bringing that up, or are you just trying to start a, "How do you feel when it is applied to you" thread?

There are members here who have had a hospital birth and their babies DIED and now they are left to wonder what if.... There are members here who have had a homebirth and their babies DIED and they are left to wonder what if. So do you want to, or are you honestly inviting the rest of us, to tell some of these mothers that they made an unethical decision about where to birth their babies???

I just don't get it. Like there aren't enough people out there to tear mothers down for one thing or another. No one needs this kind of invitation.

BTW, hospital birth with midwives the first time, plannng a January homebirth the second time -so I've been on both sides of the fence.

~Tracy

[stafl]

everybody has to weigh the risks vs. benefits for themselves. Is being clean worth the risk you might fall and bust your head open to take a shower every day? It's not for anyone to make those decisions for anyone else. They call it informed consent for a reason. Inform yourself, and make the best decision given your own situation and your own comfort levels, and stay out of anyone else's freedom to do the same. This same argument (from the other point of view) is exactly why so many doctors and hospitals will not allow/attend vbacs anymore. It isn't anyone else's decision to make, nor should it be, besides the woman who will have to live with the memory of the birth of her children the rest of her life.

[Storm Bride]

Originally Posted by stafl

It isn't anyone else's decision to make, nor should it be, besides the woman who will have to live with the memory of the birth of her children the rest of her life.

This seems very sad to me. Why do so many of us "have to live with the memory" of our children's births? Shouldn't that be something to treasure more often than something to endure? I've been thinking about this a lot lately. I know that sometimes things do go horribly wrong and there's nothing that can be done...I'd never try to deny the pain of a stilbirth, a birth-damaged baby (whether iatrogenic or just bad luck), or damage to the mother's body. But, I also believe that births that are looked back on later with regret, anger, etc. should be in the minority.

As to "homebirth vs. hospital birth". I'm leaning more and more towards homebirth as time goes on. But, I don't think it's unethical to have your baby in the hospital. I think it may be riskier in some respects, but...if there are 100 cases where a homebirthed baby would do better, and 1 case where a hospital-birthed baby would do better, I don't think it's up to me to tell a mom which way she has to choose. I don't know what factors lead her to where she is.

I hope homebirth becomes much more mainstream. I don't know anybody offline who's ever had one...I don't know anybody offline who knows anybody who's had one. That seems...tragic. Of course, I find everything about the hospital unpleasant (I have an irrational fear of hospitals, schools, government buildings, airports...any large establishment with its own rules, protocols, etc.), so my reaction may be a little extreme. But, I think every woman needs to find the place where she's most comfortable giving birth, because I don't think fear is good for her or the baby.

[LavenderMae]

What is unethical is the fact we aren't getting the truth. The medical establishment does not give us all the facts, they actually give us very few. Women are not making informed decisions because it's pretty hard in this culture to become informed. I do not know one woman who had a hospital birth (including myself) who made a truly informed decision. I know women who think they did but they are mistaken. All the info needs to be out there and easily available to everyone. How can you weigh the risk and benifits when you don't truly know what they are?

[alegna]

Originally Posted by sapphire_chan

Forget delivery, what about pregnancy?

Have an ultrasound? Unknown risk, benefit mainly consists of deciding if you need to decide:
amniocentisis? 3% abortion risk to maybe find out that baby might have genetic disorder
Tested for GD, Rh-, hypertension, GB strep? And if the result is positive are you going to have the antibiotics, Rh balancing thingy (the name of which I do not recall), insulin?

And what are the odds of actually getting to make a decision with any of the above in the current model of hospital care? (2%? 1.5%? 99% amoung MDC mamas who *had* to go to the hospital?)

Yeah, I feel the same way about pregnancy risks. We can incorporate that into the discussion too if there's interest.

Is it okay to take ANY risk (u/s may or may not be a risk, not enough is known) for NO medical reason (to see that they're in there and find out sex)?

-Angela

[alegna]

Originally Posted by Sheacoby

I felt so UNsafe when I had my ds in the hospital. It was down right scary. I wish that insurances companies would realize how risky and more expensive hospital births are and how much safer and less expensive it can be at home. Money was my barrier to the homebirth I wanted. If homebirth wasn't wrongly seen as risky or at the very least riskier than a hospital birth then I could have given birth where I felt safer.
I think it comes down to money and as long as birth is big business we aren't going to see the truth about safety out there in the mainstream.
I totally think all women should know all the facts/risks so they can make a truly educated decision. That would not only be ideal but should be standard. It is unethical that it is not the standard.

This is an interesting bit as I have wondered if perhaps in the future insurance companies will jump on the homebirth wagon as it is so much cheaper for them.

Personally I think homebirth should be the standard of care and you should need special approval from your insurance co. to have a HOSPITAL birth if anything.

-Angela

[alegna]

Originally Posted by Wugmama

There are risks and benefits associated with EVERYTHING in life - hospital/home birth, vax/no vax, WOHM/SAHM. Find me one important life decision that does not have pros and cons - I don't think you can. We ALL have to make the decisions we feel most comfortable with - and be willing to live with ALL the potential outcomes of those decisions. When the stakes are high they can be very personal choices. Not everything can be decided just looking at the stats - which are never "if you do this you will have a %100 chance of winning".

I can't for the life of me understand why you would want to propose that having a hospital birth is an unethical choice. As a proponent of homebirths (as it sounds like you are) haven't you had that argument applied to you enough times to realize what a crock that kind of statement is? Do you REALLY feel justified in bringing that up, or are you just trying to start a, "How do you feel when it is applied to you" thread?

There are members here who have had a hospital birth and their babies DIED and now they are left to wonder what if.... There are members here who have had a homebirth and their babies DIED and they are left to wonder what if. So do you want to, or are you honestly inviting the rest of us, to tell some of these mothers that they made an unethical decision about where to birth their babies???

I just don't get it. Like there aren't enough people out there to tear mothers down for one thing or another. No one needs this kind of invitation.

BTW, hospital birth with midwives the first time, plannng a January homebirth the second time -so I've been on both sides of the fence.

~Tracy

I think that everyone has to weigh the risks of everything. Yes, it's tragic when babies die in any setting, but it happens, like it or not. I'm not here to make anyone feel bad- I just want people thinking.

I do think that it's valid to discuss the ethics of our decisions. I am not in any way saying that I think that those ethics should be used to force us into a government decision. Rather we should individually use those ethics to make our own decisions.

-Angela

[LavenderMae]

Originally Posted by alegna

Personally I think homebirth should be the standard of care and you should need special approval from your insurance co. to have a HOSPITAL birth if anything.

It most certaintly should be and in some countries it is and in said countries their infant/maternal death rate is much lower than it is here. I do think that makes this topic truly an issue of ethics. Our birthing business puts mothers and babies at undue risks and it shouldn't be allowed. Our birthing climate in this country leaves much much to be desired. In the US it is mostly about money and until our ethics as a collective whole changes I don't see that changing.

[Arwyn]

Originally Posted by Wugmama

I can't for the life of me understand why you would want to propose that having a hospital birth is an unethical choice. As a proponent of homebirths (as it sounds like you are) haven't you had that argument applied to you enough times to realize what a crock that kind of statement is? Do you REALLY feel justified in bringing that up, or are you just trying to start a, "How do you feel when it is applied to you" thread?

There are members here who have had a hospital birth and their babies DIED and now they are left to wonder what if.... There are members here who have had a homebirth and their babies DIED and they are left to wonder what if. So do you want to, or are you honestly inviting the rest of us, to tell some of these mothers that they made an unethical decision about where to birth their babies???

I just don't get it. Like there aren't enough people out there to tear mothers down for one thing or another. No one needs this kind of invitation.

This is what I meant when I said:

Originally Posted by Arwyn

I do think it would be an interesting tact to take with someone who used the "oh, I wouldn't take the risk!" line to disparage homebirth. But I also think it must be done with care, because it would be too easy for a woman choosing hospital birth to feel attacked by a turning of the tables of that statement (regardless that they basically just attacked the person chosing homebirth - more flies with honey, and whatnot).

Wugmama, I don't believe the original intent was to attack or shame mothers who choose hospital births. It is an interesting ethical question - what risks are acceptable to take? For someone who won't drink ANY tea in pregnancy (not even decaf) because of the "risk of caffeine" does it really make sense to take the risks of going into the hospital and accepting induction, narcotics, episiotomy? (That was my sister, by the way.) Why is one "risk" - truly minute, if not nonexistant, in the case of minor amounts of caffeine - less acceptable than other - giving birth in the hospital with the use of pitocin and narcotics, both with well documented, unnecessary side effects?

I do think the problem arises (and as you can see, I am guilty of it) in part from the use of "acceptable" or "ok" as though a choice deemed (by some) less ethical is "unacceptable" or "not ok" - what does that, then, mean? Does it mean no one should be allowed to choose the (deemed unethical) "unacceptable" risk? I would venture to say that no one here is of that position. I would hope everyone here believes that the rights of the individual (of self-determination, as I would put it) are vastly more important than what we, as outsiders (ie not the person choosing) would choose based on a judgment of "ethical" or "unethical".

It also relates to a broader question of "the system" (as in, the hospitals, OBs, some CNMs, HMOs, and others who deliberately work to make hospital birth not just the norm, but the only option). Is what "they" are doing ethical, by manipulating data and emotions to convince mothers that homebirth is an "unacceptable risk" (that's a direct quote from far too many OBs)? What use might it serve if homebirth supporters turned the tables and proposed that, for the majority of women, it is hospital birth that is the "unacceptable risk"? I would guess, from your above post, that you would say it doesn't serve our purpose. I would like to hear more from you about these topics.

I really hope we can continue this conversation in a respectful, non-attacking, non-defensive manner.

[Wugmama]

I do think that it's valid to discuss the ethics of our decisions. I am not in any way saying that I think that those ethics should be used to force us into a government decision. Rather we should individually use those ethics to make our own decisions.

I guess I'm not sure what you mean. Words like "moral" and "right actions" are used in the definition of ethics. Whose ethics to you mean when you say "those ethics should [not] be used to force us into a government decision"? The ethics of those practicing medicine or the ethics (moral actions) of those choosing for themselves where to give birth? Whose ethics do you mean when you say, "we should individually use those ethics to make our own decision"?

If we each use our own ethics, what we feel to be moral and right, then wherever we choose birth would be the correct location for us. It seems to me this isn't what you are saying. It seems to me you are inviting people to each share their own ethics, or moral views, on where mothers should give birth. To come to a concensus in this thread about which location for birth is "moral"? Or just to have everyone say out loud where they think is/was the "moral" place to give birth?

Just seems like an invitations for more judgement to me. I would personally never think someone was immoral because they chose to give birth in a hospital or at home. Seems really over the top to me.

This thread isn't at all what I thought it was going to be when I saw the title.

Certainly not trying to attack you Alegna - it is a sort of interesting topic. I think it would be more interesting to talk about the ethics of ob-gyns in their management of hospital births I guess. I'm just really sick of judgemental attitudes accross the board (including my own at times which I am trying to reign in) kwim?

~Tracy

[Wugmama]

I agree with what you are saying Arwyn. But this is one of the questions posed in the original post:

Is it ethically okay to be in a hospital and risk hospital caused injury and infection to a newborn simply because the mom feels safer there?

This could easily be translated to, "Is a mother who decides to give birth in a hospital making an immoral decision?".

That is what I was responding to in my earlier thread.

It isn't so easy to read/discuss in this thread when you are 6 months pg, emotional, and facing a birth in 12 weeks. It isn't so hypothetical anymore, it seems rather personal. I bet you can understand.

~Tracy

[alegna]

Tracy-

I am saying that I have no suggestion of forcing the "ethical" decision on anyone via laws. I do think that some choices are more ethical than others. I do not think it is as simple as "what you think is right" For example, I think it is unethical to deny your child the right to breastfeed when you are physically able to. Do I think we should hold down mothers and attach their babies to their boobs? No. But I do judge that moms that CHOOSE to formula feed are making an unethical choice. I have no problem with judging other people. Not baggage that I carry. I think that when I have researched a topic I can judge decisions made on the topic.

I don't have the time or energy to discuss ob-gyns and how they manage birth. The bottom line is that they have no business being involved in normal birth. They are trained for surgery, so that's what they aim for.

-Angela

[alegna]

Originally Posted by Wugmama

This could easily be translated to, "Is a mother who decides to give birth in a hospital making an immoral decision?".

Okay- is a mom who CHOOSES not to breastfeed making an immoral decision in your eyes? Because in mine she is.

-Angela

[AllyRae]

WOW....I can't believe I'm reading people saying it's unethical NOT to choose a homebirth. Wow. So, um, what happens if you live an hour away from the nearest hospital? What happens if you're not comfortable going u/c, but there are no midwives in your state? What if you are just not comfortable having a baby in your home for any reason? I do NOT equate it to choosing to formula feed...sometimes a hospital birth is more warranted for medical reasons, sometimes for personal reasons. But you CAN have a med free intervention free birth in a hospital.

For me, I chose a homebirth. However, due to GBS, it would have actually been unethical for me to have the baby at home because the nearest major hospital was an hour away so I switched to a hospital birth. Now, the baby didn't make it through birth and it doesn't matter where he was born, his death couldn't have been prevented. However, I did not make the unethical choice to have him in a hospital...

I think it's unethical to take away choices. I think it's unethical to pressure women to birth where you want them to. I do not see anything unethical about making an educated decision on where to birth based on the risks and benefits. For some people, a homebirth is not a wise choice, whether it be medical risk factors or proximity to a place where emergency medical treatment could be received. When discussing ethics, it's important to understand that not everyone's situation is identical to your own. But, the ethical decision is to do the research, make the decision based on the facts, and not to allow other people's idea of "right" pressure you into doing something that isn't right for you...

Now, obviously this can be expanded to breastfeeding. YES, there are instances when breastfeeding is unethical--especially if you are on medications required for your own health that will hurt or kill your child. However, most people, when doing the research, will not find themselves in a position where the risks of breastfeeding are greater than the benefits, so choosing otherwise may be unethical. However, choosing to FF is not unethical in itself...if anyone considers ff to be unethical, it's choosing to FF when the benefits outweigh the risks. The same can hold true if someone were to consider hospital birthing unethical.