Safety compared to no-intervention hospital birth

[SaveTheWild]

Hi all,

So I have read, and believe, the studies that say homebirth is as safe or safer than hospital births for low risk mothers. It seems that the vast majority of the risk of hospital births come from the interventions, however. Have any of you seen studies comparing hospital births with no interventions versus homebirths? I presume in those circumstnaces hospitals come out "safer" (even with the increased infection risk). Not that I think it is possible to actually have a completely intervention-free birth in a hospital, of course, but I want to be prepared with good stats, if they exist, to combat my super argumentative, highly-analytic family.

thanks!

SaveTheWild

[violetbutterfly]

I think you can have a great experience at the hospital if you're with the right care providers and are very confident in your ability to make the right decisions for you and your baby. As an aspiring doula I can tell you I have been to some hospital births that beat the pants off of some of the homebirths. I don't know if it was the state I was in or what, but one midwife was downright bossy and controlling. In comparison the CNMs at the hospital were a dream. I've had hospital and home births and I prefer my homebirth but that's not everyone's experience. I think you could have a very safe hospital experience if no interventions were allowed. I had a no intervention hospital birth. The thing I didn't like in the hospital was AFTER the birth everyone messing with my baby and trying to freak me out that things were wrong when they weren't. Like jaundice (he didn't have) and low blood sugar (didn't have that either) but that didn't stop them from trying to mess with him and poke his little heel a million times. I"m not sure if that answers your question, but that's my two cents

[mama_at_home]

From what I have read the studies show that homebirths are "just as safe" as hospital births. My personal belief is homebirths are safer, even than non intervention hospital births. But from the studies I have read they just qualify them as "just as safe."

[Guest*]

I'd still think that homebirth would come out as "safer," because hospital still harbor lots of germs that cause disease and infection in otherwise healthy individuals. Of course going completely intervention free with no IV, no internal checks, etc will reduce the risk of infection, but the risk of contracting something is still higher in a hosptal than at home.

Nothing to back this up, just my opinion.

[*guest]

My first thought was "how often do no intervention hospital births actually happen?" I know that doesn't answer your question, but I do think that would be a very hard study to find since it seems like interventions go with the territory. What are you counting as an intervention? Big stuff like epidurals and episiotomies, or seemingly minor things like IV fluids and continuous fetal monitoring? Restricting food intake? AROM? Just leaving my house during labor sounds like an intervention.

I am always a little leery of trying to out-statistic skeptics. When I've tried that approach, it seems like people take it as an invitation to debate further, even though my mind is made up. At a certain point, your wishes for your own care are all that matter, although I know some parents and family members do try to make it hard on us.

[alegna]

I've never heard of a no-intervention hospital birth. Low-intervention, but never no-intervention.

-Angela

[TurboClaudia]

Hand each one who is questioning you a copy of Henci Goer's The Thinking Woman's Guide to a Better Birth and tell them that only after they read it in its entirety are you open to having a *discussion* about why you are choosing homebirth.

~claudia

[hrutledge]

I agree there is no such thing as a non intervention hospital birth.

[TurboClaudia]

some freebirthing advocates would go so far to say that there are no intervention-free midwife attended homebirths, either.

i think it really depends on what you as the individual consider acceptable interventions. i personally consider a hospital iv saline lock a normally not acceptable intervention, but a vaginal exam during labor a probably acceptable intervention. someone else might feel differently about both these things.

so to the original poster, what kinds of interventions are you hoping to avoid should you choose a hospital birth? that might help others better answer your question.

~claudia

[SaveTheWild]

Originally Posted by TurboClaudia

so to the original poster, what kinds of interventions are you hoping to avoid should you choose a hospital birth? that might help others better answer your question.

all of them, which is why I am planning to birth at home.

I was just curious about the statistics when comparing "apples to apples" to the extent it is possible. e.g. a "home-like" hospital birth vs. a homebirth on a pure maternal/baby outcome basis.

Basically, I imagine the following being said to me by my brother and SIL (who had a natural, largely intervention free midwife attended birth in a hospital (she did have some intermittent fetal monitoring and possibly an IV):

"If you have the baby in the hospital and avoid the interventions that are the root cause of the dangers of hospital births (induction, epidurals, epis, membrane sweeping, breaking the waters, etc.) then you are better off there in case something unexpected does go wrong."

And statistically, I am just wondering if they would be right? (this obviously ignores all the other reasons for having a homebirth, I am just focusing on pure statistical outcomes.)

[the_lissa]

I doubt it because like someone pointed out, hospitals are a horrible place for germs.

My mom had my sister in 98 with midwives, low intervention, etc. Buts he got very, horribly sick from something in the hospital and had to stay in the hospital for a couple weeks, etc.

Most of the things that can go wrong that may require hospitalization can be seen well in advance, giving one enough time to transfer.

[alegna]

In attempting to make it apples to apples, you will always have the germ factor. Hospitals are NASTY dirty places. Look for stats on hospital aquired infections.

-Angela

[the_lissa]

Plus, there is the stress and comfotr factors and the time factor. I had a 36 hour labour. An OB later told me she would have given me a c/s, and everyone I know with a similar story did have a c/s. You don't have to consent, but fighting every policy and doctor and whatnot has got to be stressful during labour.

[TurboClaudia]

I suspect that the reason you are having a hard time finding "statistics" that address that exact question is because there would be little money in finding out the answer. Well over 95% of the women in the U.S. (where it seems a majority a medical research is taking place) give birth in hospitals, so why would they need even further support to convince women that hospitals are the place to give birth. And planned homebirths with qualified attendants don't really have the money to spend on such research.

Not that a statistical evaluation of that type wouldn't be interesting and useful, just unlikely that it has already been done on a wide enough scope.

Hypothesizing here, but putting aside the superbugs that can thrive in hospitals and the increased chance of acquiring such an infection, from my knowledge there would be very few cases where being in a hospital would truly be safer for the birthing mother and the not-yet-born or just-born baby: prolapsed cord, placental abruption and previously undiagnosed placenta previa for the mother come to mind, and previously undiagnosed spina bifida, previously undiagnosed congenital heart defects and other physical anomalies for the baby come to mind. but in most cases of maternal laboring abnormalities, a midwife would be trained to recognize these emergent-care requiring situations within minutes or even seconds. For the baby situations, while already being in a tertiary-care hospital with an experienced neonatal intensive care team and a specific pediatric focus hospital-wide would make the care for baby accessible within minutes as opposed to hours, it might also deprive the parents of connecting with their new baby as soon as the little one is born. And although the U.S. does have a pathetically low infant mortality rate when compared with other developed nations in the world (I think we were 37th or something while Sweden ranked first), there is a lot of success in perinatal care for infants with certain types of physical birth defects. For parents of newborn infants with previously undiagnosed severe and life-threatening birth defects with little to no chance of survival, being a hospital might also deprive those parents of a quiet and peaceful albeit very short time to spend with their baby and turn it into a fearful and overwhelming experience.

[sapphire_chan]

For me just the stress of worrying about having to refuse interventions would have a negative effect. You can't take the need for a totally safe space out of the picture. Regardless of how your family feels about a location, if you don't feel comfortable birthing there, it's automatically more dangerous.

[AnneCordelia]

Isn't the #1 killer of moms and babies infection from those super-germs. Of course, I have nothing to back this up, but I remember my mom (who is a doula) saying something to that effect. :

~Emily

[TurboClaudia]

Originally Posted by AnneCordelia

Isn't the #1 killer of moms and babies infection from those super-germs. Of course, I have nothing to back this up, but I remember my mom (who is a doula) saying something to that effect. :

~Emily

ummm... I'm not sure about that. Maybe for moms who have had surgical births, but I don't seem to recall that about the babies from Thomas Strong's research from Expecting Trouble: The Myth of Prenatal Care in America. Many of the top 10 reasons for perinatal mortality cannot be prevented by the standard of prenatal care currently offered in the U.S. But that's another issue.

[pamamidwife]

you're forgetting the fragile piece of a woman's physiological state during birth. the delicate hormonal balance that occurs and the intervention that is just merely walking out of her front door in labor. being in an unfamiliar place, with unfamiliar people wanting to do very intimate things to you under an element of fear (both by the providers and the woman) all creates a disturbance to the hormonal and physiological aspect of birth.

It's not always about having the water broken, etc. It's mostly about the delicate normalcy of birth. Sadly, that sometimes doesn't even happen at home.

[Charmie981]

Originally Posted by pamamidwife

you're forgetting ...the intervention that is just merely walking out of her front door in labor.

:

The effect of leaving your home in labor is very often underestimated. And from the perspective of someone who had a birth center birth, it doesn't matter if the new environment is low-intervention or not; you've still disrupted your labor. IMO, mine would have been probably 4 hours shorter (for a total of a 4 hour labor) if I'd just stayed home.

[mamaverdi]

Quoting our pediatric urologist, a surgeon mind you: "You do not have to convince anyone of anything. You just tell them what they can and cannot do."

You have no need to convince your argumentative family of anything. You tell them: I am having a homebirth; if you cannot support me, we will not discuss it, and you are not invited. If you want to understand so you can support me, read the Goer book, then we can talk.

Even the cleanest and nicest hospital (and I've been to several) are still not just germ factories, but they are places for sick people and people who need surgery. Look up statistics on how IV misplacement or IV non-monitoring can cause permanent morbidity....permanent loss of an arm's function. No intervention is something to be taken lightly. And no true informed consent is given, no matter the care giver. They don't have the time to list for you everything that could go wrong because of what they are doing.

And another thing: I know of several cases where babies were born with previously undetected birth defects. The babies bonded to the family, and then suddenly presented with symptoms of the defects. These babies were taken for emergency care and survived, in part or whole because they had bonded to their family and were treated when it became necessary.

One case was a baby who only had 2 valves in his heart. He lived 5 months before it was discovered. He made it through all of his surgeries and recoveries very quickly. His surgeon is the one who declared that because he was breastfed AND born at home did he survive. The survival rate is usually 2%, yes two percent. The babies are born by c/s and then whisked away to surgery.

Babies who live through normal labor and birth have a much better chance of making it when "modern" cut and paste medicine need be applied. Of course the rate things are going these days, this is simply a never to be tested theory.

mv