Pro-homebirth risk ethics - Page 9

[honeybee]

I'm coming in on this late, but after spending ds's entire nap period reading these posts, I couldn't resist at least posting my $0.02.

I think the whole climate of birth in our contry is screwed up. Many routine obstetrical practices are unethical.

But, I just can't say that choosing a hospital birth is unethical... whether you're truly informed about the risks or not. I just do not think you can separate the cultural context from peoples' decisions. If one BELIEVES the hospital is the safest place to give birth and that homebirth is unsafe, how can you say they are making an unethical choice, even if the "facts" don't back that up? If you KNOW something to be true, why would you feel the need to research it?

I am a researcher by nature, but the reality is most people aren't. Many truly don't have the skills or the understanding of statistics, etc. to really understand how evaluate studies effectively. And, of course, there is the excellent point a pp made about poverty and access to information, etc.

I would say I was fairly well informed about the risks with my first birth. Actually, reading Henci Goer and posts like these on boards had me pretty freaked out about going to a hospital to birth. I was really paranoid that the whole thing would be one big fight. BUT, I wasn't in any way, shape, or form ready for a homebirth. It took a lot of changing of my cultural paradigm for me --which included experienceing a hospital birth!--- for me to be ready for that step. Luckily, I HAD done my research, took some precautions (like choosing my caregiver and hiring a doula), and had a really good hospital experience. So, knowing the risks, was it really "unethical" of me to choose to birth at the hospital--especially when I felt educated enough to know how to avoid the risks???

This time around, I'm eagerly anticipating a homebirth. I'm learning a LOT more about the whole process of birth. I wasn't UNINFORMED before, but now I have access to different sources and types of information.

We do the best we can with what we know at the time.

[AnditheBee]

Originally Posted by WC_hapamama

I think that our lawsuit happy society factors pretty heavily into why many doctors and hospitals "do not allow" VBACS. With the way that malpractice insurance is skyrocketing for OB/GYNs, and how many people will file lawsuits will he, nil he, the OB/GYNs and hospitals are probably not supporting VBACs more because they don't want to be liable if something goes wrong, whether it's their fault or not.

I know for certain that this is why I can't get a VBAC locally (something that used to be done here). Our OB's will lose their insurance if they support someone who intends to have a homebirth, or if they support/perform VBACs, as will our hospital if it allows them to be performed there. This is what happens when a corporation is making decisions on medicine--the result is bad medicine! One of the newer OB's in town wanted to meet with the local midwives and develop a friendly working relationship, but the insurance company threatened to pull her coverage if she did. That is unethical.

Hospital birth itself is not, IMO, unethical. What is unethical is the way some birthing women are treated--like sheep being penned for shots or shearing--put through "the assembly line" of birth without adequate respect, information, or real concern for their health. Also unethical is the no-choice situation I and other VBACs are so often put into. It forces doctors to risk harm to their patients via surgery they don't need, and undermines the legitimate use of cesarean for women/babies who need it.

[SneakyPie]

"And actually, in some cases, I have no problem telling people that their choices were hands down wrong."

That attitude would fit right in with the OBs.

Of course it's not unethical to choose a hospital birth. If the maternal or neonate death rates out of hospitals were 1 in 50 or something like that, sure. But they aren't. And I don't think there's enough reason for me to turn the "it's wrong to try homebirth" argument around on pro-hospital mothers. The original argument is totally flawed but I don't see a need to replace it with another flawed and judgemental statement.

[Mamma Mia]

Originally Posted by alegna

HOWEVER, there are situations where I believe abortion is unethical.

Well I personally can't see a situation where abortion is unethical unless it's forced. I'm also pro abortion. I think it's a wonderful form of birth control. Feel free to add me to your ignore list and/or hate everything I say accordingly. That said, I'll shut up about because I know we're uber-not-allowed-to-talk-about-it and I don't want to cause trouble.

[Mamma Mia]

Originally Posted by SneakyPie

"And actually, in some cases, I have no problem telling people that their choices were hands down wrong."

That attitude would fit right in with the OBs.

Of course it's not unethical to choose a hospital birth. If the maternal or neonate death rates out of hospitals were 1 in 50 or something like that, sure. But they aren't. And I don't think there's enough reason for me to turn the "it's wrong to try homebirth" argument around on pro-hospital mothers. The original argument is totally flawed but I don't see a need to replace it with another flawed and judgemental statement.

I agree with quite a bit of this. I do think it's safer, based on my own research and experience, to birth at home. I still think that women who have all the facts can choose hospital birth and it's not unethical. Women should birth where they are most comfortable. Period.

[the_lissa]

I love you Mamma Mia.

[ZeldasMom]

Originally Posted by alegna

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?

Yes. But ideally it should be an informed choice and all women should have access to home birth midwifery so the decision to birth in a hospital is a real choice and not just something that happens by default.

Great question. Sorry, but I have not had a chance to read the replies (my online time is kind of feast or famine lately), look forward to doing so soon!

[alegna]

Okay- then is ANY place the mom feels safe ethically okay? (even if it is not, in fact safe?)

-Angela

[tinyshoes]

Originally Posted by alegna

Okay- then is ANY place the mom feels safe ethically okay? (even if it is not, in fact safe?)

-Angela

I can see what you mean, Angela.

I was going to post about my mother--but didn't want to snark it up...but now I'll go ahead and contribute this perspective.

My mother would have felt unsafe laboring without her cigarettes, whether at home or in the hospital. She smoked throughout her first two pregnancies, and during labor, at the hospital (everyone smoked at the hospital, remember?)

But now Mainstream America would deem smoking while pregnant unsafe, uncool, and therefore quite possibly unethical.

(And Mainstream America isn't exactly consistant...no pregnant woman should use narcotics....uh, unless she's in a hospital gown, I guess...Then it's )

[alegna]

THANK YOU! Someone got it. My concern is that we're just saying that the hospital is ethically okay because 1. it's the HOSPITAL and 2. it's what we're used to. If it was some other place, holding the same risks a lot of people would FREAK.

-Angela

[Mamma Mia]

Originally Posted by the_lissa

I love you Mamma Mia.

Wow! Thanks!

[Mamma Mia]

Originally Posted by alegna

Okay- then is ANY place the mom feels safe ethically okay? (even if it is not, in fact safe?)

-Angela

Pretty much. Her birth, her choice.

[Mamma Mia]

Originally Posted by tinyshoes

I can see what you mean, Angela.

I was going to post about my mother--but didn't want to snark it up...but now I'll go ahead and contribute this perspective.

My mother would have felt unsafe laboring without her cigarettes, whether at home or in the hospital. She smoked throughout her first two pregnancies, and during labor, at the hospital (everyone smoked at the hospital, remember?)

But now Mainstream America would deem smoking while pregnant unsafe, uncool, and therefore quite possibly unethical.

(And Mainstream America isn't exactly consistant...no pregnant woman should use narcotics....uh, unless she's in a hospital gown, I guess...Then it's )

The hysteria about drinking and smoking in pregnancy is mostly about controlling women's bodies. Light drinking and smoking in moderation during pregnancy really isn't a serious threat to a fetus. Ultrasound can lead to IUGR, and fetuses (fetii? ) have a strong reaction to u/s soundwaves. There are risks to many procedures considered safe and ethical, even among the radicals here. I'd write more but I need to go for now.

[alegna]

Originally Posted by Mamma Mia

Ultrasound can lead to IUGR, and fetuses (fetii? ) have a strong reaction to u/s soundwaves. There are risks to many procedures considered safe and ethical, even among the radicals here. I'd write more but I need to go for now.

Interesting side-track since you bring it up, I don't consider routine u/s ethical. If there is a medical reason, sure. But to find out gender? Nope. No good reason? Nope.

-Angela

[ZeldasMom]

Originally Posted by Mamma Mia

Pretty much. Her birth, her choice.

This is my take too. I agree with whoever said that there is too much emphasis on controlling women's bodies when it comes to birth. I take the view that mama knows best. I'm all for helping women get access to information and resources. But then I think we need to step back and trust them to make the decisions that they feel are best.

[eilonwy]

Originally Posted by alegna

Okay- then is ANY place the mom feels safe ethically okay? (even if it is not, in fact safe?)

I don't know that this is a valid point against hospital birth. Regardless of the scare tactics which are so favored here at MDC, hospital birth is not, in fact, outright dangerous. Sorry, but there's no comparison to be made between giving birth in a hospital and giving birth while swinging from a trapeeze 150 feet up; even taking into account medical errors and iatrogenic birth injuries, there's no comparison.

Is any place the mom feels safe ethically okay? Personally, I'd say no-- however, there are different levels of safety and everyone has a different idea of risk assessment. Comparing hospital birth to homebirth is reasonable-- the outcomes are very similar. Comparing hospital birth to giving birth in a tree, not so much.

Interesting side-track since you bring it up, I don't consider routine u/s ethical. If there is a medical reason, sure. But to find out gender? Nope. No good reason? Nope.

What defines "a good reason," in your own personal estimation? Is it safe to assume that perhaps your idea of a good reason may not jive with anyone else's? I mean, it's a total judgement call. Some people think that peace of mind about your baby is a very good reason to have an ultrasound, others think that you shouldn't have one unless you're pretty well convinced that your baby has died in utero. Still others think that finding out the sex and thus saving themselves from months of arguing with their spouse about names or obsessing about the daughter/son that they're not going to have is a good reason. Some people think that you shouldn't have an ultrasound for any reason during a pregnancy, and others think that if you've already had a child with birth defects it's reasonable to have an ultrasound in every subsequent pregnancy. Everyone has, once again, a different set of criteria by which they assess risk. And once again, I think that what's unethical is that it's very hard to come by solid information and evidence, especially around here where everyone thinks that they know what everyone else should do, but they don't even try to find the (in this case, very little) research that's been done on the subject to try to convince others. Lots of scare tactics, yes, but very little rational discussion.

[SunRayeMomi]

Originally Posted by alegna

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?

When a mom has done her research first and has conceded that she would in fact feel safer at the hospital than anywhere else, and also has determined to take her delivery into her own hands and out of medical science's, yes.

But how much research is enough? Is there a par amount of researching hours that we should all strive for when it comes to such things? I feel like when it comes to researching my decision to homebirth, I fall short of the standards implied in this thread. But then again, my mom is a midwife, so I guess I more or less skipped the research lab and went straight to interning Anyway, I am doing more "researching" now that I'm moving toward pregnancy and birth #2 than I did with #1. But I had my dd1 at home and not the hospital. So I guess I passed "the ethics test" as is implied here

[orangebird]

Originally Posted by applejuice
Many doctors and nurses will push procedures on mothers in labor saying, "It is the best thing for your baby!", -OR- "Don't you care about your baby?", -OR- doctors love to play the hero by saying, "If you let me - [fill in with your favorite intervention/procedure], - I can guarantee you a perfect baby!"

DO NOT DENY IT! I have heard this veiled threat many times from a doctor while a mother is having a difficult labor.

This is not true.

I've had 3 hospital births (4th coming up in December). I've dealt with a total of 3 different OBs and more L&D nurses than I can remember. None of them ever told me such a thing.

No, what applejuice said is absolutely true.

My first baby was born in the hospital and I was told such things. The nurses told me that my baby would probably die if I didn't follow their commands and stay in bed and consent to an epidural.

On top of that, I am a nurse who attends a few births now and then and just from my experience, I have heard nurses and doctors make threats of such nature.

Maybe you, one person, hasn't experienced it, but it is out there. I have heard it from both sides of the fence.

Yes, not all doctors and L&D nurses lie, but enough of them do to make the hospital not such a safe place and quite a risk. You never know when to believe these people, the people you have paid to be able to trust. So very sad indeed.

[applejuice]

Thank you, mara. I knew I was not imagining or hearing things.

[WashingtonMama]

There is alot to be said for homebirths, but sometimes going to the hospital is in your best interest. I speak from two misguided home birth experiences...the second being a rupture. There are some midwives who do not monitor you as you should be monitored. I expereinced that just recently. Homebirths must be thought through very carefully. You never know what will happen.