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I have to ask

post #1 of 58
1/10/07 at 1:27am
Thread Starter 
Ive been lingering on this website since I found out that baby # 2 is coming in July. I have read nearly every post, and I have to ask, where do so many people come up with the courage to homebirth??? It sounds so natural and right and beautiful, but really (and please don't be offended by this) I would be terrified that something would go wrong and I just couldn't live with myself if I lost a child due to my choice to homebirth or even to birth in a birthing center. I have really been going over this in my head and would love to have a non-medicated birth this time around, and I know that I could do it, but a hospital with all the regulations is not at all conducive to a non-medicated birth (IMO), what with IV's and not being able to move around and lying on your back for delivery. For me I feel as though I will just have to make the sacrifices of giving birth according to hospital policies in order to feel that I have done everything to give my baby the best chance at a healthy birth. I guess I am just wondering if anyone out there has a source that changed your way of thinking or an experience or anything.
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post #2 of 58
1/10/07 at 1:50am
I don't have a source at my fingertips now, but I researched this and in recent studies in developed countries the rates of maternal or infant death within low-risk women are the same or lower (for the out of hospital births) than births in hospitals. That put my mind right at ease. The rate of c-section, needless interventions, etc is also lower (obviously).

Do you have the option of a freestanding birth center that is located near a hospital? I know here one of our birth centers is literally a 2 minute drive. Seriously, there is very little that could go wrong that wouldn't survive a 5 minute transfer, kwim? So that might put your mind at ease.

At my last appointmen I asked my midwife what her experience was with hospital transfers. She told me that 99% of her transfers were first time moms and that they hadn't had a negative outcome from any of them. Even when the hospital is 40 minutes away. She's been practicing for 10 years. Really, the chance is so small and midwives are really good at monitoring and picking up the littlest sign of distress that it really almost seems safer to avoid the hospital.
post #3 of 58
1/10/07 at 2:02am
I had read as much medical literature as I could find, and my conclusion was that planned midwife-attended homebirths are equally as safe as low risk hospital births, but with much less chance of ending up with medical interventions such as c-sections. I really wanted to avoid drugs and surgery, so I had a homebirth.

Here is a good study to look at:
http://www.bmj.com/cgi/content/full/330/7505/1416
post #4 of 58
1/10/07 at 2:06am
I talked to midwives. And read research. My midwife let me know that when she has a transfer, it is rarely a "big hairy deal panic emergency". She says they work more on prevention of complications than OBs do and then during labor are with you constantly instead of just showing up at the end.

So...Having a caregiver who is personally acquainted with you keeping an eye on your safety at all times at home... or having caregivers you never met watching and listening occassionally to machines they apply to you...

Another point is that at home, you can change your mind and go to the hospital for any reason. But at the hospital if you aren't happy, are you going to get up, pull out your IV and walk out the door?
post #5 of 58
1/10/07 at 2:17am
I haven't had a homebirth yet, but I am planning to with our next child. As far as losing a child solely because you were at home, it's pretty unlikely. There are a few true obstetrical emergencies that happen- shoulder dysocia, abruptio placenta, hemorrhage. These things will happen in the hospital or at home, and actually because of some of the things they do in the hospital they are actually more likely to happen there.

If you were to have a placental abruption in the hospital they would rush you to the OR. A true emergency C-section can happen very quickly, possibly quicker than if you were at home and had to transfer BUT keep in mind that you have to wait for anesthesia, a surgeon, and an OR to be prepped. If those people are not all there and ready to go then it can be a few minutes. For me, if we were to call the hospital as we left my house and tell them we were coming, they could get everything ready and waiting for me. I love about 10 minutes away and I think it would be done in the same amount of time either way.

As for something like a shoulder dystocia, it is something that is unpredictible and has to be resolved within a short time. Nothing changes about the management in a hospital or at home, except possibly the Zavanelli maneuver, but few babies survive that anyway, and that goes back to the previous post about c-sections.

As for hemorrhage, most homebirth providers carry pitocin or other drugs to stop hemorrhage. Also, not having all the hospital interventions reduces the risk of hemorrhage. If a woman needs blood, it takes the hospital a few minutes to get the blood sent up, same amount of time as it would take me to get to the hospital.

Most of the "emergency" c-sections you hear about are just unplanned c-sections for a long labor. There are very few true emergencies.
post #6 of 58
1/10/07 at 2:41am
I had dd1 in a hospital (with a midwife - totally natural birth). So it is possible. Good thing about it was that I learned to trust my body. I didn't use all the technology they had at the hospital, not any of it.

Dd2 was born in a freestanding birth center two blocks from a major hospital (but not affiliated). It was an AMAZING experience. I thought the first birth was good, and it was, but nothing like the birth center.

So with two natural births under my belt, it wasn't scary to decide to homebirth. There is nothing at the birth center that they don't bring to your house (sans the tub.... ). Same midwives as birth #2. Again very amazing.

It isn't scary; it isn't risky. I truly believe that both baby and I are in much more danger birthing at the hospital. And I am probably one of the most mainstream moms at MDC.

25% of hospital births end in c-section. That is insane. To have a good hospital birth (and I know they are possible because I had one), you have to be very educated, and very sure of yourself, and not afraid to buck the system, and have a great supportive dh who will also buck the system to get the birth you want.

Natural birth in the hospital is a lot of swimming upstream. It is so much easier to go someplace that has the same theory of birth as you do. Birth centers (and homebirth midwives) want what you want.

Try reading Natural Childbirth the Bradley Way by Susan McCutcheon-Rosegg. And take a Bradley class; they are incredible. I walked out of the first one (when pregnant the first time) KNOWING I would have a natural birth. It was a great feeling.

Hospital birth is a business. They make money. The more interventions and technology they can "help" you with, the more they can charge you. And the more your risk goes up with all this "help". Every single thing they do to you - from the IV to restricted food/fluids to restricted positions and on down the intervention line - ups your risk, the danger to you and baby, and your chance of a c-section. Not nearly as safe as they lead you to believe....
post #7 of 58
1/10/07 at 3:11am
Courage? To homebirth? What I want to know is how any educated woman can walk into a hospital in labor.

Really. Homebirth is safe.

Hospitals are dangerous.

-Angela
post #8 of 58
1/10/07 at 3:18am
Well, some guides recommend that if you couldn't live with yourself if something went wrong at a homebirth, you shouldn't have one. Not because things are more likely to go wrong there (quite the opposite) but just because, in this society, you'll get more judgement for making an unconventional choice.

But to answer your question, it doesn't take courage at all for me, nor for most of us I think. Just the knowledge, based in research and evidence and science, that homebirth is as safe or safer (depending on which factors you're looking at) than hospital birth for all but a minority of birthing women. It takes no courage at all to do what you know is safest and right for you. I do think it can take courage to start looking into this path and doing the research, because it's so outside what our culture says is acceptable, but once you've done that, the actual decision to homebirth is, well, easy.
post #9 of 58
1/10/07 at 11:20am
i totally agree with what arwyn said...

obviously, every woman is different...if you have the fear of something going wrong at home more than the fear of something going wrong in the hospital, then homebirth isn't for you.
for me, it was opposite....much more stress/worry-free to have a homebirth than a hospital birth. what took courage for me was to go against what my family (who includes many doctors and nurses) felt was normal and to keep my own confidence up while dealing with them.
post #10 of 58
1/10/07 at 11:38am
It didn't take courage for me to have a homebirth with both my children...it took education. I would have been very fearful if I would have given birth in a hospital or had to transfer because I'd have to fight for respect and dignity in most cases.

Read the BMJ article that a previous poster provided. Homebirth IS safe. The infant and maternal mortality rates are about the same, but the instances of trauma in homebirth is MUCH lower and the satisfaction rate is MUCH higher.
post #11 of 58
1/10/07 at 11:52am
Quote:
Originally Posted by alegna View Post
Really. Homebirth is safe.

Hospitals are dangerous.
:
post #12 of 58
1/10/07 at 12:33pm
Not all hospitals are bad places to have an unmedicated birth. At mine, I chose the epidural, but had no pressure to (and was offered the option to say in my birth plan that I didn't want it suggested, either). There was a hot tub, a squat bar, birthing balls, soft lighting, etc. There was no requirement to have an IV unless you got the epidural, and they warned me when I asked for an epidural that it meant I'd have to lie down. I'm absolutely sure that if I'd insisted on a natural birth there, I'd have had one.

I'd suggest checking out the hospitals in your area and finding out how progressive their policies are before deciding. You may be able to work out a compromise (some hospitals have attached birth centers with midwives), or you may decide that you can't stand the policies and you'd be safer at home. Either way, it doesn't hurt to do the research.
post #13 of 58
1/10/07 at 12:36pm
Quote:
Originally Posted by jackieslilpie View Post
...I would be terrified that something would go wrong and I just couldn't live with myself if I lost a child due to my choice to homebirth or even to birth in a birthing center... For me I feel as though I will just have to make the sacrifices of giving birth according to hospital policies in order to feel that I have done everything to give my baby the best chance at a healthy birth. I guess I am just wondering if anyone out there has a source that changed your way of thinking or an experience or anything.

This is almost PRECISELY the way my husband was feeling about our decision to homebirth our first child (due in June). Even so, he was willing to support my desires to birth at home much to my astonishment. I have had a strong interest in homebirth well before I knew much about it and when I still believe it to be a risky option. I am the kind of person that does not perform well with an audience and knowing that maternal stress is very bad for both mother and child, we made the decision to homebirth based on what we thought would be the less risky option.

What came to us as a surprise and great relief was how much statistical information there is floating around out there that proves the safety of homebirth. It has been very interesting to see my husbands' reaction to our research. This is a guy who is very bright and also very mainstream. He is a critical thinker and does not often make emotional decisions. He grew up without sisters or female cousins and so somehow escaped hearing about what women's bodies do during childbirth. He had never heard of an episiotomy, foreceps delivery, or vaccuum extraction. He learned of these things with the kind of horror you'd expect to see from a person with a healthy trust of his own body. He learned that his previous *naive* expectations of childbirth were very much aligned with the homebirth model of childbirth, and not at all congruent with the medical model. Learning about the high incident of interventions at hospitals--and many birth centers--and the lame reasons that most of these interventions take place, really blew our minds. The worst reason, in my opinion, is that labor isn't progressing fast enough to meet hospital regulations. They simply can't have you in there hanging out unless your birth is imminent, so they make sure that it is imminent through various means. My understanding is that many of the measures they take to increase your progress dramatically increase fetal (and maternal) stress and diminish the laboring woman's ability to do the work she is being required to do. I once watched a woman whose "natural" labor wasn't going fast enough (everything else was fine but the speed) so the OB required a pitocin drip to speed it up. Then she was laboring too hard (fetal stress indicators) and so they "slowed her down". The baby did not respond well to all the help so an emergency C-section was performed and the baby was born amidst a pool of meconium and self-congratulations among the delivering physicians for a job well done and for warding off such a disasterous situation. Seeing this made my heart hurt and further soured my trust of the medical model.

The two books that made the biggest impact on our feelings of saftey are: "Ina May's Guide to Childbirth" and "The Homebirth Advantage". Both of them provide astonishing statistical information as well as some good, down-home wisdom regarding approach to childbirth no matter where you have it.

Cheers,

Tomi
post #14 of 58
1/10/07 at 12:54pm
Quote:
Originally Posted by jackieslilpie View Post
I would be terrified that something would go wrong and I just couldn't live with myself if I lost a child due to my choice to homebirth or even to birth in a birthing center.
of course!

this is a scary idea, that a mother's choices could affect her child living or dying.

But you must must must ask yourself the complete questions, to get decent answers for your decision-making process.

How could you loose a child due to a homebirth choice?

Think of all the scary scary ways that scenario could happen....see if you can articulate that fear and worry so you can get some answers to your questions. Post them here, ask homebirth midwives you want to interview (we asked the 3 midwives we interviewed what they do concerning meconium-stained water, cord around the neck, etc.)

Also,
think very carefully about what the hopsital does truly offer a laboring woman and her newborn child. You have correctly pointed out that hospital procedures have little to do with ensuring a natural, nonmedicated birth.

What else do hosptials do? Is it possible that they are risky places--the 30.2% cesarean rate comes to mind, meaning, 1 out of every 3 pregnant woman who walks into the hospital is wheeled out in a wheelchair, post-op.

I am a conservative person--a worrywort, and anxious. I choose homebirth for my second birth because after doing the research, and getting the cultural "hospital = birth" nonsense out of my brain, I felt it was safer.

I feel it is less safe to labor at a hospital, with monitors strapped to my belly transmitting data to a montior at the nurses' station down the hall, in contrast with a homebirth midwife, who is the primary care provider (not "just the L&D nurse") with her hands ON my belly, her ear to the fetoscope or her hand on the doppler, listening. Right there, taking in all the data--my contractions, my face, my belly, my baby's heart tones.

That is the type of care that I think is safe, because I think that labor is the time when "problems" will occur during childbirth.

What if the baby's heart rate is flucuating? who will notice that first--that midwife with her face next to my belly at my house, or someone who's clocked-in at the nurses' station at the hospital?

Then--what will they do about it? the homebirth midwife will encourage position change (to get baby off the cord, for example) whereas a L&D nurse needs to consult with the care provider (she can't make a decision) and what will that care provider decide? position change? or c-section?

And what if at home, heart tones were nonreassuring--then you'd go to the hospital....what is the amount of time that elapses from 1st nonreassuring heart tones noticed to baby removed from womb via c-section for a homebirth transfer? how does that time frame contrast with the amount of time that elapses in a typical hospital scenario? Is it possible that both scenarios could be about 30-40 minutes? would the OR prep happen while you're in the car driving? is time a factor here, or not? A question whose answer might help you make your decisions.

Also, as far as post-partum hemmorage is concerend: yes, that is what kills women. A woman will bleed to death within an hour.

So--absolute worst-case scenario, you're 30 minutes from the hospital, if that baby flies out of your womb after a 40-minute labor (it could happen) and you start bleeding uncontrollably, you could get to an ER and get a shot of Pit or whatever, and the bleeding could be stopped.....or if not, emergency surugery could be performed to remove your womb (a last-resort effort!) to save your life.

But then--what about the factors that contribute to post-partum hemmorage? Number 1: cord traction, meaning, when a care provider pulls on the umbilical cord, in an effort to deliver the placenta after the baby is born.

Another factor: Pitocin use during labor. Many, many hospital labors are augmented with Pitocin.

Both of those factors that contribute to post-partum hemmorage are not present in a homebirth situation. That is interesting--this idea that the hospital staff could cause problems, in addition to just being in the way of a nonmedicated noninterventive birth.
post #15 of 58
1/10/07 at 12:57pm
My biggest fear is one of my children dying, inutero or otherwise. I don't fear something happening to my baby at home but I do have a fear of something happening to my baby in the hospital. Their policies are not evidence based and can lead to a cascade of interventions which can harm the mother and the baby. Sure I can fight those policies but thats just something I don't want to do. Not when I can have a hb. I just don't see the point of me having a baby in the hospital unless something was wrong. To me its like taking unnecessary risks.

I would suggest that you write down all the things that scare you and research point by point. Find out what would happen at home vs the hospital. Mws are usually very generous with their time and would spend hours with you talking about each point and how they would handle certain situations.

Read all you can. There are many good books about hb and articles about childbirth practices and hb safety.
post #16 of 58
1/10/07 at 1:07pm
You have received some wonderful answers to your questions! I just wanted to add - I've had two homebirths and two "natural" hospital births.

I birthed my first child at home. It was really a no brainer for me. I was born at home as were 5 of my 9 siblings. We have a wonderful homebirth midwife. I knew there was a small risk being at home. By I knew there were huge risks being at the hopsital. Birth is risky at times! My mw has oxygen, pit, methergine, various herbs and all the tools she could possibly need. I knew she could stabilize me in case of hemhorrage in order to get to the hospital. She knew how to handle dystocia. She gives such complete care. She knew the position of the placenta etc. Things most drs wouldn't even check for. It was a beautiful and glorious experience.

My next two children were born in a hospital in Montana. My husband was in the AirForce and I didn't know that I could have a homebirth. I went into my hospital birth (I thought) prepared. I had a CNM. I had a birth plan. I knew what I wanted and didn't want. It was a very umpleasant experience. The CNM ended up being a big jerk during labor. The nurse was a very unpleasant person. I had to fight for everything. She was very medical model oriented and really made things hard. We ended up compromising on the eyedrops and a few other things because we were afraid she was going to report us for refusing SO many things. (we were very young.) She wouldn't even let me squat to deliver. She said it would make me tear. : (course I squatted with my first and didn't tear......) It was a very humiliating experience and I still have a lot of anger about it.

When I was pg again, I found a different CNM who was much better. She was still pretty clueless and did some rather awful things (stripping my membranes at 37wks without my permission....) I was SOOOOO scared to go back into that hospital. If I knew that people had unassisted births I would have done so. I had gained some experience from the last birth so I knew what to expect. It went much better, but I still had to FIGHT the whole time to avoid interventions. It was so stressful.

My fourth was born at home with the same mw as my first.

For me, the stress is so unpleasant at the hospital, I will never set foot in there to birth unless I have an extreme reason to do so. I much prefer to concentrate on my labor and baby without having to fight every step of the way. I am willing to take on a risk (albeit very, very small) to accomplish that. I truly believe that my baby and I are safer at home. (No risk of nasty hospital infections is a big one for me.)

Hope that helps!
post #17 of 58
1/10/07 at 1:29pm
I had a medicated hospital birth last time and want a homebirh next time. After reading that the nations with the highest maternal/infant mortality rate were the ones where the majority of births take place in hospitals, and that the majority of deaths (I think it was like, 80%) resulted from a medical intervention like anesthesia or c/s it really confirmed what I already was beginning to feel.

Being in the hospital again seems like more of a risk because last time I felt that despite my desire for a natural birth and a birth plan that instructed nurses not to perform certain procedures (and this is a very mother friendly hospital) it was like once they got started I couldn't control or stop what they were doing. Had I felt there were very big risks involved in any one of the procedures they performed against my consent I would have felt even more betrayed by the medical system. I really felt many of the things they did were completely unnecessary (and they had already agreed not to perform them) and had something gone wrong with any of them how much guilt would I have then felt? I do not believe that they were trying to ignore or break the 'rules' we had agreed on for my birth, they just really didn't think anything of it.

Now that I've experienced birth and had my midwife and nurses disregard my feelings/intuition because of conflicting information from a beeping machine I know I wouldn't want to birth again unless the person delivering me trusted me as much as I trusted her.

I also feel, after having a midwife at a hospital, that the biggest thing missing was that relationship homebirthing mw build with their clients. How much better is a caregiver able to take care of you and make informed decisions when they know you very well and can remember your desires/fears/history and such off the top of their head?

Those are just some of the reasons and of course I absolutely believe that you should birth wherever you are most comfortable because that is where you will birth best. It sounds like you are seeking information and educating yourself, unmedicated hospital birth are ABSOLUTELY POSSIBLE! Good luck, and feel free to PM me if you'd like to talk about unmedicated hospital births more. There are things I wish I'd known to watch/prepare for ahead of time!
post #18 of 58
1/10/07 at 2:13pm
There's been so much good stuff in this thread and I hope that what follows contributes and does not detract from that momentum:

Does anyone think there are guarantees in life (in general), let alone guarantees of total safety birthing in a hospital? Life is a risk from the beginning no matter what. I think this is a really important point: Life and Death naturally walk hand in hand from the time of every human's birth- so we need to get real about that magical thinking that leads to regarding hospitals and docs as some sort of gods and places where everything is under absolute control.

That said:

Hospitals are for high risk, urgent and emergent situations- as necessary. The diagnostic and obstetric resources found there are for those situations of necessity, not for normal birth. Midwives' skills should be respected, and their use of hospital-based resources, which should be easily accessible whenever necessary, should be supported across the board, welcomed and applauded; their contributions to the best in evidence-based perinatal care in this country should be valued more highly than it is...across the country.

Women (and their partners) should not be underestimated as researchers, and evidence-based decision-makers about their own birth options. Taking control of one's birth experience is quite empowering and creates its own momentum of confidence. Knowledge is power.

There is a time and a place for everything. I believe that yes, high risk situations are likely best managed and supported in a hospital- but that percentage of individual experiences does not include everyone who births, by a long shot.

So what should be the norm? Choice and options inclusive of homebirth to accommodate the continuum of needs in a more common sense approach and likely most cost-effective manner, or across-the-boards, litigation-driven mandatory institutionalization and industrialization of birth?

And shouldn't this be a part of our reproductive rights as women in this country: to determine wisely, by virtue of the evidence, where and with whom in attendance we will birth? Shouldn't open access to hospital-based resources for our birth attendants/care providers also be a part of our basic reproductive and health rights?

I have had three children in my lifetime. I had one in a hospital- and it was simple and relatively uneventful- mostly because I was poor and the doc was not going to squander his expensive technology on me (thankfully)...I was even discouraged from use of the birthing room because it'd be "messy".

I had my next two children at home using illegal (at that time) midwives. I felt it was up to me and my partner to never take anyone's word for anything about our care. We researched whenever some supplement, or other action was suggested- then we made decisions based on the evidence. All of that was over 20 years ago now.

Of course there are jitters initially about such a momentous decision as choosing homebirth- because it puts the power right in your own hands and is not what is considered normal (but that will change). The more is learned about risks and the probabilities, as well as about the normalcy of birth, the process and ways to help yourself in that process, the more power you have to make the very best decisions and wisest choices...and the more confident you become....and the more likely, in my opinion, you are to feel more confident in your birthing and beyond- about decisions in parenting also.

The centralization of the birth experience in hospitals happened about the time industries began mass manufacturing in assemblyline (time is money) fashion. Thus babies in nurseries being cared for en masse, rather than being cared for by their mothers. Midwives were systematically eliminated from the process, male docs were developing and using "modern" technology, and the public deferred to the medical model across the board in our country. There's certainly more to it than that of course.

When my grandmother had her children, she had them in a hospital and fed them from a bottle, why? Because as I have heard along the way from so many in that generation: "Her husband could afford it!". It was considered backward to have a baby at home and breastfeed- sort of a status symbol type deal, for a woman to have a baby in the hospital/bottle feed.

In all the years since then, there has been absolutely no evidence to support the assertion that women should birth in hospitals because it is safer. Midwives are not the male-promoted myth of dirty, dangerously ignorant women in whom others place undeserved trust with life and death. In fact, traditionally, midwives are much more experienced and well-versed in "normal" while OB's, from what I have heard, are not necessarily trained to know what's normal- they are surgeons by training.

Midwives are, from the beginning of your relationship with them, more attentive, present, watchful and observant so therefore recognize when something is up, from the beginning of the perinatal experience.

And when you look at the stats about infant-maternal mortality compared to what are considered to be third world countries, you begin to get a more realistic picture of what the results of those industrial and technological influences have been.

Hospitals have the best support for high risk situations, so it only follows that those high risk situations can benefit most from occuring in a hospital. It's really all common sense. That's what those institutions are there for- that's how we can best use them to best advantage.

There is a time and a place for everything- when it is your time to give birth, may you have the evidence and support to determine the best place for your experience.

Joyce in the mts.
post #19 of 58
1/10/07 at 2:47pm
I gave birth at a birth center with a midwife. I think it's a happy medium
post #20 of 58
1/10/07 at 3:16pm
Quote:
Originally Posted by stacyann21 View Post
I gave birth at a birth center with a midwife. I think it's a happy medium
I think birth centers are usually nothing more than a mind game. But, if that's what you need- go for it. A birth center has nothing over a homebirth midwife (unless you live quite a distance from a hospital otherwise or have a situation at home that makes birthing there a bad idea)

-Angela