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#61 of 192 Old 11-21-2011, 08:45 AM
 
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".....and you can do all of this and still have everything go wrong. Or you can stumble upon the worst midwife in the history of birth....and have a perfect outcome. But you should try, at least, to find out everything you can about the person you are counting on to act swiftly, instinctively and in your best interest should things take a turn for the worst."

 

I think you also need to acknowledge the extremes of some of the rhetoric out there -- the "trust birth", "birth is normal", "breech is a variation of normal", "twins are a variation of normal", "I am obese, hypertensive and of advanced material age but high risk is just something doctors make up to scare you out of homebirth" type stuff.   I see a lot of normalizing of high risk scenarios in homebirth discussions -- after all its just the "cascade of interventions" that's the problem, right?  After all, doctors just like to "play the dead baby card".  And I see a lot of "if I just think happy thoughts everything will be okay" -- so I think there are people that have stepped away from the idea that you need a caregiver who really knows what she's doing because, after all, isn't that just a "medwife" and aren't you just demonstrating that you don't "trust birth" after all?


Twins are not inherently high risk. Breech birth IS a variation of normal. I would feel comfortable giving birth to a breech baby at home. I've witnessed breech birth, I've read extensively about breech birth(no, not just birth stories)....breech is not inherently dangerous unless you are unprepared and start freaking the hell out.

 

An obese, hypertensive mother of advanced age COULD be at higher risk in a hospital setting where her "condition" is pigeon holed, instead of actually evaluated on an individual basis to see what her labs, body and baby are ACTUALLY saying about her risk factor. <---that statement doesn't mean anything more than the fact that in a hospital scenario, that women would be a prime candidate for the ole "you know you HAVE to have a c/s, right?" - when it COULD BE that she would be just fine delivering vaginally and that proper nutrition, birth preparation and support during pregnancy/labor could mean that the risks associated with doing major abdominal surgery could be higher than those of letting her deliver naturally. That doesn't say anything about WHERE she has that natural birth....because that's not my business and this hypothetical woman is a bit too hypothetical to be able to say.....but the point is, that each woman, each baby, each set of circumstances needs to properly evaluated and that it can't be "homebirth no matter what" OR "hospital birth no matter what" - there is a perfect place for each birth....and a mother and her gut/research/provider/whatever need to evaluate the specific factors involved in each scenario to decide where that perfect place is.

 

For me, that perfect place was out of hospital with both of my kids. With this third baby...well, three months in, that seems still to be that case. But any number of things could come up which may possibly change my mind. Information, self honesty and being partnered with competent caregivers will all come into play in the final decision.

 

Partnering with  midwife you KNOW makes risky decisions, even sitting in on a hearing involving one of her cases gone wrong due to actual malpractice...and then choosing her as a provider and being shocked when things go terribly wrong, is disregarding information, lying to yourself and seeking out known incompetence to partner with. It's just stupidity. Sorry, but it is. Ignorance is just that. Intentionally disregarding facts is not ignorance...it's recklessness.

 


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#62 of 192 Old 11-21-2011, 10:36 AM
 
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I noticed that too.

 

I am also noticing that the OP does not seem to be able to give any details about what went wrong besides the fact that she chose a homebirth.

 



Except that she didn't choose a homebirth at all.  She called the facility a 'birthing center'.  Not even a solo standing birth center, but a 'birth center', which are generally attached TO or ON hospital grounds.

 

Oh, and posterior wasn't the cause, except for when it was.

 

::: head scratch :::


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#63 of 192 Old 11-21-2011, 11:48 AM
 
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You know, I'm not a homebirth supporter but I am a loss mom and a longtime member of MDC and I'm ashamed reading this thread.

 

When women come and talk about the trauma they've experienced in hospital, generally they are supported. The same regarding c-sections. That the homebirth community doesn't seem to be able to listen to the same is probably one of the main things that keeps me from being a supporter. And I want to be.

 

There was no need to attack this individual's experience. It's just fine to say "I think this is a good reminder to ask a lot of questions of your midwife" or whatever. But there was a lot of cruelty here -- in the name of advocacy -- and it makes me very sad. Whether or not you agree, that was this mother's experience.

 

BTW I had a posterior baby in hospital in January. He was monitored pretty closely as he was also near-term and we got to where the OB said "we need this baby out in the next ten minutes or we have to discuss options." We knew he was posterior. I had no interventions and laboured and pushed in several positions. I don't think it helps people's credibility to make sweeping, ignorant statements either in the name of supporting homebirth, and to do it after calling this grieving mum out was really disappointing to read.

 

I do hope everyone has a really good homebirth journey but please be kind to women in such pain eh?

 

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#64 of 192 Old 11-21-2011, 01:41 PM
 
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I don't think anyone was being cruel at all.  At most, someone made sweeping statements about midwives with nothing factual to back it up.  All we asked for was more information because the story doesn't make sense.

 

When we do have bad experiences, or even good experiences, it doesn't necessarily mean that your opinion about that experience is correct.  When you choose to share it, there will at times be dissenting views.

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#65 of 192 Old 11-21-2011, 05:34 PM
 
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"Twins are not inherently high risk. Breech birth IS a variation of normal. I would feel comfortable giving birth to a breech baby at home. I've witnessed breech birth, I've read extensively about breech birth(no, not just birth stories)....breech is not inherently dangerous unless you are unprepared and start freaking the hell out."

 

I'm sorry but just no.  A twin pregnancy and birth has a higher risk of something going wrong (or being wrong in the first place) than a singleton pregnancy and birth.  A breech birth has a higher risk of something going wrong (or being wrong in the first place) than a vertex birth. 

 

Those are the facts and calling something like that a variation of normal is just semantics.  You can call crap chocolate ice cream if you want, but it doesn't make it so.

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#66 of 192 Old 11-21-2011, 05:46 PM
 
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"Twins are not inherently high risk. Breech birth IS a variation of normal. I would feel comfortable giving birth to a breech baby at home. I've witnessed breech birth, I've read extensively about breech birth(no, not just birth stories)....breech is not inherently dangerous unless you are unprepared and start freaking the hell out."

 

I'm sorry but just no.  A twin pregnancy and birth has a higher risk of something going wrong (or being wrong in the first place) than a singleton pregnancy and birth.  A breech birth has a higher risk of something going wrong (or being wrong in the first place) than a vertex birth. 

 

Those are the facts and calling something like that a variation of normal is just semantics.  You can call crap chocolate ice cream if you want, but it doesn't make it so.



And yet, there are doctors who will deliver twins and breech babies vaginally.  So, obviously, to some, these issues do not warrant an automatic c-section.

 


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#67 of 192 Old 11-21-2011, 07:10 PM
 
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Originally Posted by Buzzbuzz View Post

"Twins are not inherently high risk. Breech birth IS a variation of normal. I would feel comfortable giving birth to a breech baby at home. I've witnessed breech birth, I've read extensively about breech birth(no, not just birth stories)....breech is not inherently dangerous unless you are unprepared and start freaking the hell out."

 

I'm sorry but just no.  A twin pregnancy and birth has a higher risk of something going wrong (or being wrong in the first place) than a singleton pregnancy and birth.  A breech birth has a higher risk of something going wrong (or being wrong in the first place) than a vertex birth. 

 

Those are the facts and calling something like that a variation of normal is just semantics.  You can call crap chocolate ice cream if you want, but it doesn't make it so.


This is my biggest freaking problem with the "homebirth vs. hospital birth" debate.

 

...highER risk....does NOT equal HIGH RISK. You say higher risk like the risk jumped from .04/1,000 morbidity/mortality to 100/1,000. That's BS.

 

Yes, because you are talking TWO babies, one baby shifting its position a lot due to the first baby vacating the womb, questions about placentas and cords and all of that....yes, there are MORE factors that CAN go wrong and, therefore highER risk than a singleton birth.

 

That does not mean that a twin birth is an inherently high risk situation. Period. Each case has to be properly evaluated, just like EVERY SINGLE expectant mothers situation has to be evaluated when she is making a decision about where to have her baby. Breech IS a variation of normal. The "optimal" position is not the ONLY position.

 

What you are basically saying, is that vertex is chocolate ice cream...and breech is crap. You are drawing a line between the two as if they can never be called the same thing, BIRTH. More like, vertex is chocolate and breech is strawberry. They are variations of the same thing. They are different. They should be treated as different....but one is not feces, thank you very much.

 

You cannot apply a blanket assignment of "danger" to any variation of normal. You just can't. If you think you can...please explain away for me, the thousands of women who walk into hospitals every year with vertex, seven pound babies, facing the right way and end up experiencing traumatic births...and then, in the same breath, please reach into your bag of  "inherently dangerous" breech birth scenarios, and pull out all the examples of women who have breech babies, double footling twin births, etc and tell me how it's possible that in the skilled attendance of well experienced MWs and, sometimes, with no attendance whatsoever, so many women are able to successfully and completely without trauma or trouble, birth these "dangerous" babies at home, in birth centers and in hospitals, when they are lucky enough to find an OB who will let them birth naturally. Explain it. How something SO freaking risky, goes well SO much of the time.

 

You cannot point to a single, or a few, or even a pile of births that go wrong at home or even breech births...and insist that it is inherently dangerous, without allowing me to point at the single, or a few, or even a pile of women who birth at the hospital and experience birth gone wrong and use that as an example of the inherent danger in hospital birth.

 

It doesn't work that way. I can only point to one woman at a time and say "look, see, her situation was evaluated properly and her decision to birth at XYZ place was right on" - OR, "look, see, her situation was poorly evaluated....her decision to birth at XYZ place was risky, what was her OB/MW/Self thinking....".

 

For MOST women(prepared for homebirth), breech birth at home really wouldn't be a problem.

 

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#68 of 192 Old 11-21-2011, 07:55 PM
 
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Just because things go right sometimes does not make them safe. That's not how risk works. People get lucky.

It's totally ridiculous for you to say that people need proper nutrition or they need not to freak out and then in the same breath dismiss the idea that having monitoring, an OR, NICUs, and the like close at hand reduces the risk of certain problems. You say that death exists and isn't something we can control and then go on to blame someone for not doing enough research (so there are things we can control).

If you genuinely believe that some babies aren't meant to live, then maybe just say so, and we can have this conversation from a position of honesty where you think that certain risks are acceptable because it's okay for certain babies to die even if they could be saved elsewhere, because they were meant to die. Then we can quit quibbling about breech and twins and your unwillingness to acknowledge that some things are dangerous and that the choices people make can cause their babies to die.
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#69 of 192 Old 11-21-2011, 07:56 PM
 
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Do you not understand the concept of risk?  I am not saying a 100% of women attempting a homebirth of twins will have Twin B die.  Just that they have put themselves in a situation where there is a higher risk of that occurring.  

 

Which is, yes, considered "high risk".  As far as I am aware, all homebirth studies that have demonstrated safety (assuming we take them on their face) have only shown safety where the homebirthing mother was low risk (in other words not twins or breech).

 

"Ms Kerr was asked what she would tell other expectant mothers who were considering having twins at home.

"I'd tell them when you're looking at the risks, one looks like a really small number but somebody has to be the one."

"If you're the one, it's really final, you can't do it over. And I was the one."

 

http://www.abc.net.au/news/2011-11-17/mother-recalled-homebirth/3677842

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#70 of 192 Old 11-21-2011, 08:09 PM
 
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"And yet, there are doctors who will deliver twins and breech babies vaginally.  So, obviously, to some, these issues do not warrant an automatic c-section."

 

And there is absolutely no additional services that an OB, having a mother of twins giving birth in a hospital, can provide above and beyond what a DEM midwife at home can do?  No teams of people standing by to do NRP with the benefit of the correct equipment and frequent skill-set drills?  No pediatricians on hand to evaluate the babies for any specific issues immediately after birth? 

 


I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#71 of 192 Old 11-21-2011, 08:28 PM
 
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If you genuinely believe that some babies aren't meant to live, then maybe just say so, and we can have this conversation from a position of honesty where you think that certain risks are acceptable because it's okay for certain babies to die even if they could be saved elsewhere, because they were meant to die. Then we can quit quibbling about breech and twins and your unwillingness to acknowledge that some things are dangerous and that the choices people make can cause their babies to die.


If you believe that some women are just meant to be subjected to unnecessary surgery, just say so, and we can have this conversation from a position of honesty where you think that certain risks are acceptable because it's okay for certain women to be cut open (and made high risk in all subsequent pregnancies) even if they could have avoided that elsewhere, because some women were meant to be cut open.

 

The biggest problem I have with the homebirth vs. hospital birth debate is that there are certain flawed assumptions at work. One is that every baby and mother who come through a homebirth in good shape would also have come through a hospital birth in good shape. The second is that if a baby died in the hospital, it would have obviously died at home, as well. These are apples and oranges comparisons, because it's not a simple matter of one being safe, and other not safe...in either direction.

 

My son may or may not have died because I tried to have a HBA3C. My son may or may not have died, because I had had three medically unnecessary (but "prudent", in the eyes of the OBs) before I had him. But, because I was a homebirth transfer, he'll be considered another proof that homebirth is inherently risky, even though nobody knows the whole story (because I've never told it in one piece), and nobody even knows what killed him. (I actually do have my own thoughts on that - if I'm right, it wouldn't have happened outside a hospital, but it was also a direct result of a choice *I* made in the hospital...and things weren't going well at that point, in any case.) His death is put completely on the shoulders of homebirth, while the fact that the medical community was directly responsible for my single biggest risk factor - the uterine scarring - even being present is completely and totally whitewashed.

 

I've never typed up Aaron's birth story in full, and I may never do so. But, one thing does stand out. I didn't have a uterine rupture - and the concern about that happening is the only reason that I wasn't "allowed" to have a hospital birth.


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#72 of 192 Old 11-21-2011, 08:43 PM
 
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"And yet, there are doctors who will deliver twins and breech babies vaginally.  So, obviously, to some, these issues do not warrant an automatic c-section."

 

And there is absolutely no additional services that an OB, having a mother of twins giving birth in a hospital, can provide above and beyond what a DEM midwife at home can do?  No teams of people standing by to do NRP with the benefit of the correct equipment and frequent skill-set drills?  No pediatricians on hand to evaluate the babies for any specific issues immediately after birth? 

 


Why are we discussing DEMs?  However, my point is this and will always be:  It is a woman's right to choose how she wants to birth.  I would probably say that most women pregnant with twins will not choose to have a homebirth.  With any choice, there are consequences.  We each have to weigh them and make a decision.


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#73 of 192 Old 11-22-2011, 12:13 AM
 
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 I didn't have a uterine rupture - and the concern about that happening is the only reason that I wasn't "allowed" to have a hospital birth.


Wait-- what's going on in Canada? Is that like England where some women aren't allowed to give birth in a hospital  and still get it paid for by national insurance? Why wouldn't they let you have a hospital birth?

 

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#74 of 192 Old 11-22-2011, 02:07 AM
 
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Wait-- what's going on in Canada? Is that like England where some women aren't allowed to give birth in a hospital  and still get it paid for by national insurance? Why wouldn't they let you have a hospital birth?

 

 

Maybe I'm wrong but I assumed she meant that she couldn't find an OB willing to support her to have a VBAC in hospital so went with home birth as the only way to avoid another c-section?

 

I'm a bit confused by your England comment. I'm in the UK and have never heard of anyone not being allowed to give birth in hospital, it's absolutely standard here but both home birth and hospital birth (and birthing centres) are paid for by the NHS, unless you hire a private midwife but even then she will be NHS trained and registered with the Nursing & Midwifery Council, and will need to update her skills every year to keep her registration active. 
 

 


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#75 of 192 Old 11-22-2011, 05:27 AM
 
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Just because things go right sometimes does not make them safe. That's not how risk works. People get lucky.
It's totally ridiculous for you to say that people need proper nutrition or they need not to freak out and then in the same breath dismiss the idea that having monitoring, an OR, NICUs, and the like close at hand reduces the risk of certain problems. You say that death exists and isn't something we can control and then go on to blame someone for not doing enough research (so there are things we can control).
If you genuinely believe that some babies aren't meant to live, then maybe just say so, and we can have this conversation from a position of honesty where you think that certain risks are acceptable because it's okay for certain babies to die even if they could be saved elsewhere, because they were meant to die. Then we can quit quibbling about breech and twins and your unwillingness to acknowledge that some things are dangerous and that the choices people make can cause their babies to die.


Just because things go right sometimes with certain kinds of birth does not mean said kinds of birth are completely safe all the time. Just because certain kinds of birth go wrong sometimes doesn't mean that said kinds of birth are inherently dangerous and to be avoided (by just signing up for c/s) at all cost. You're right. That's not how risk works. Is my keyboard broken?? Because I feel like some of you are reading something different than I'm typing....but then, two people have "liked" your posts...so maybe I'm just an idiot who loves the idea of dead babies and I just never knew it.

 

I never, ever said:

 

Quote:

 

"...people need proper nutrition or they need not to freak out and then in the same breath dismiss the idea that having monitoring, an OR, NICUs, and the like close at hand reduces the risk of certain problems."

 

Of course having an OR, NICU and the like down the hall reduces risk in certain situations...what person would say that's not true?? In certain situations the OR, NICU, etc lower your risk significantly. In ALL situations, having a proper diet and taking care of your body with sleep, appropriate exercise, etc lower your risk.

 

So...where are we in disagreement? Everyone should eat a proper diet, sleep enough and move their bodies to give them the best shot of a normal pregnancy and happy birth. If for one of the many reasons that can come up, taking good care of yourself is not enough to keep things progressing "normally" or if you have a perfectly normal pregnancy, but as your birth approaches or while you are in labor, some high risk situation comes up...yes, moving your birth plans to "down the hall from the OR and NICU" - significantly reduces your risk of death or permanent injury.

 

Me acknowledging that death visits laboring women and their babies sometimes doesn't mean that I think we shouldn't try to help babies in difficult situations because "they're just the ones that are meant to die" - please refrain from putting heinous words like that in my mouth.

 

If that is honestly what you are getting out of my posts, then our problem is not being on the same wavelength. If you honestly think that what I'm saying is a baby who goes into distress during birth is just "meant to die", our problem lies in your ability to put your own attitude aside and really process what it is I'm saying.

 


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#76 of 192 Old 11-22-2011, 06:01 AM
 
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Do you not understand the concept of risk?  I am not saying a 100% of women attempting a homebirth of twins will have Twin B die.  Just that they have put themselves in a situation where there is a higher risk of that occurring.  

 

Which is, yes, considered "high risk".  As far as I am aware, all homebirth studies that have demonstrated safety (assuming we take them on their face) have only shown safety where the homebirthing mother was low risk (in other words not twins or breech).

 

"Ms Kerr was asked what she would tell other expectant mothers who were considering having twins at home.

"I'd tell them when you're looking at the risks, one looks like a really small number but somebody has to be the one."

"If you're the one, it's really final, you can't do it over. And I was the one."

 

http://www.abc.net.au/news/2011-11-17/mother-recalled-homebirth/3677842


"High risk" to WHOM???

 

Let me see if posting this in a different fashion, will help you to understand what I'm saying:

 

 

LOW risk:

 

Most women will fall into this category. Most women in this category will have a birth that is just fine. Some of them will have traumatic births. Some of them will die, have their baby die or be injured or have an injured baby. <--- facts of LIFE, not MY personal fantasy (despite the best efforts by some to make it seem that way.)

 

 

ELEVATED risk:

 

Some women start in the LOW risk category...and then discover that they have twins, that their baby is breech, find any number of things in their urine at the docs/MWs office or experience any number of the various things that can come up in pregnancy or birthing that elevates their risk of having things go wrong. More examples of moving from the LOW risk category, to the ELEVATED risk category:

 

-breech

-being induced

-getting an epidural

-having a rare, pregnancy related stroke or paralysis, etc....VERY rare, but worth mentioning.

 

Now...here is the thing about moving from ELEVATED risk, to HIGH risk.....there are different measures of HIGH risk, different ways of deciding whether or not a womans ELEVATED risk of problems, is significant enough, that she needs to be moved to the HIGH risk category, abandoned her plans to give birth at home/in a center and sign up for a c/s or induction or whatever else in a hospital setting.

 

You think breech birth is SO dangerous, that it automatically moves a woman to a HIGH risk situation. I SAY....that a breech birth can present ELEVATED risk....but I ALSO think that the "remedy" for the "all consuming danger that is breech birth" in the hospital - MANDATORY no questions asked C-SECTION - comes with it's own problems which ALSO move a woman into the ELEVATED risk pool...and MY personal feeling, having done the research, etc...that breech vaginal birth (almost always emergent, surprise breech, or transfer situation, because they don't LET you go breech in almost every hospital in this country) in a hospital is EXTREMELY dangerous, because most OBs don't know what the hell they are doing, because they are not taught how to catch breech babies like they used to be...they are taught how to cut them out, pre-term. It is also my feeling, that the risks associated with a c-section are pretty on par with an educated, well prepared and competently assisted mother delivering her breech baby at home.

 

So, you say breech is HIGH risk always. You say twin births are HIGH risk always. I say that these and many other situations that present ELEVATED risk...have to be compared to the risks associated with going to the hospital for a pre-term induction, or c-section or whatever the "remedy" for the risk elevating factor is and that a mother and her (non-incentivized, truly educated) care provider need to judge where her risks truly lie.

 

 

You are not going to convince me that breech is high risk. You are not going to convince me that TWINS are high risk. Just like being a mother over 35 is not high risk and all the other things they try to say are automatically HIGH risk truly need to be evaluated on a case by case basis instead of treated with the typical "one size fits all" "our insurance company says we have to XYZ in a case like this" approach that Obstetrics tends to take these days.

 

I'm sorry Ms Kerr had a terrible twin birth at home. Are we really back to the point in the thread, where we are debating whether or not an anecdotal story of woe is acceptable proof of across the board danger in a certain kind of birth? Because if so, I'm way too tired to go back there....but I guess this is the part where I'm all "what about people who lose a twin in a hospital birth...or even hospital c/s birth" and then you're all...."yeah but at least they were in the hospital and did everything they could to ensure a good outcome....." eyesroll.gif

 

 

 

 


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#77 of 192 Old 11-22-2011, 07:02 AM
 
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I've been reading along this thread since it first got posted back in September.  Having some vague interest in the SkepticalOB and a sort of weird curiosity about how we function as a group on MDC when dealing with issues of how we make our personal choices.  Although in general I don't gel well with the way this thread is working out I find myself nodding along with Sbraz, even though one could maybe say that her post was rather blunt.  It was blunt, but not personal.  Or so it seemed to me.  
 

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You know what the problem with the internet is? (or humanity i guess)... All the time I see comments on articles and in forums with people thinking their 1, or 6 experiences/opinions are more important than anything experienced by anyone else. ever. 

And you know what happens? other people get upset when their own experiences/opinions/desires are disregarded.  Also people get upset when someone wants to take away their options just based on someone else´s one personal experience in a different context.  Some things are not all about you.  Intellectual convo about pros and cons of hb, hospital birth, uc, ncb, whatever, doesnt take place when people say, oh well, i had x lb baby with x complications in x setting and x provider and it was terrible!! you should NEVER do x, in fact it should be illegal.

one personal experience, while valid to the person, should not dictate entire discussion about a macro topic.

 


I agree that there is sometimes this idea that if someone is sharing a tragedy their opinion, feelings, story feels like it carries more weight.  I don't think this vibe even has to come from that person.  Perhaps we all, on some level, kind of agree with this idea...at the same time that we disagree.  The fact of the matter is that if we were all in the same room we simply would just stop talking about philosophy and hug this mama and hear her story.  To those who say that homebirth mamas are weird and unsupportive (or whatever) I say that this is not the case at all.  People are weird when they are on the internet.  

 

To throw a huge wrench in the convo I will say that I do appreciate KmAndrews posts.  Not so much her posts here as much as reading her blog.  I feel like I got a better perspective on the issue of malpractice reading about her experience.  Of course I knew that midwives in my state don't carry malpractice (or at least the ones I was interested in seeing).  It's easy to shrug that off if, like me, you were kind of like, "If my baby is dead I won't care about money."  I never really thought about a child who is living but who would benefit from alternative therapies not covered by insurance.  How heartbreaking.  Big hugs to you mama.

 

It also occurred to me the process of establishing responsibility for your child's injuries would be therapeutic regardless of outcome, which is not available to you.  It seems like the opportunity to have your day in court would be healing - either you establish fault and get some help for your child or you establish that noone is at fault (which seems like that would be healing in its own way - but that may be presumptuous of me to say).  

 

From your story I was really sad to read about how you felt about the treatment you got from your MW after the birth.  This is a relatively common emotion from the stories I've heard about negative homebirth outcomes.  I wonder if it has to do with higher expectations and tighter bonds with our homebirth midwives?  

 

 

I really have no point.  I think of the issue of personal responsibility when it comes to homebirth and then how that applies to an outcome as negative as KmAndrews. I also wonder about the issue of personal responsibility and why exactly we hire professionals in the first place. Was KmAndrews advised throughout pregnancy of optimal fetal positioning? Is that something we expect the mother to come up with on her own?  Because that is one thing (perhaps the only thing in my entire pregnancy/birth) that my midwife told me that I didn't already know a lot about. And, I think it was perhaps the most important thing of all!!  I'm rambling but I guess I'm just saying that it is reasonable to expect guidance from our MW.   KmAndrews, I think homebirth with a midwife is more of a partnership. 

 

And then, yea, none of us should be getting information that we weigh any more than fraction of a percent from internet threads.  I have seen 100% incorrect information all over these boards and even some that is dangerous so always check a more reputable source for sure!  

 


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#78 of 192 Old 11-22-2011, 09:36 AM
 
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Just wanted to point out again, that kmandrews did not have a homebirth.

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Just wanted to point out again, that kmandrews did not have a homebirth.
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Yes, true, and she also was not pregnant with twins, she did not have a breech baby. From what I can tell, she did have an incompetent midwife, undoubtedly. But why are we talking about breech or twins? Many women would not choose to have a homebirth in those situations, myself included. 

 

I guess what I am saying is the posters who are anti-home birth and bringing up what may or may not be considered "high risk" or "higher risk", how does this make homebirth a dangerous choice for EVERY woman??


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#80 of 192 Old 11-22-2011, 09:53 AM
 
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I guess I rarely meet a homebirth advocate who thinks everyone should have a homebirth.  I know those people are out there and I feel that attitude used to crop up here  a lot but I don't see it as often here.  Even as I planned my first hb, there was parallel care done just to ease my mind in case of transfer I wouldn't have to deal with any backlash.  I would never hire a mw who wouldn't come into the hospital with me.  I even had an induction scheduled based on my information for ME.  I would not just put my fingers in my ears and had a homebirth at any cost. 

 

And I second what NishaG just said.  I haven't read Km's blog.  Was this a FSBC?


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#81 of 192 Old 11-22-2011, 10:16 AM
 
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what makes me sad is that people who are very pro-homebirth and people who are very anti-homebirth dont neccessarily understand everything that goes in medical or midwifery land. Things arent as black and white as people make them out to be. While obstetrics isnt exactly a model of evidenced based care they arent horrible people, they are doctors who are practicing how they were trained, and not all midwives are competent and well versed. (and yes Im very pro-homebirth/natural birth).

 

I see a lot of people posting about their birth experiences and blaming certain factors on outcomes and experiences but dont neccessarily understand what it means or what other factors play in.

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Originally Posted by NishaG View Post

Just wanted to point out again, that kmandrews did not have a homebirth.


 

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Originally Posted by Youngfrankenstein View Post

 

And I second what NishaG just said.  I haven't read Km's blog.  Was this a FSBC?

 

Very true and very relevant.  I assume that KmAndrews birth was at a FSBC because her midwives did not carry malpractice, which seems unlikely if they were practicing in a birth center attached to a hospital.  I also think I read somewhere a description of the transfer, which involved a car - maybe?  I'm not sure.  I don't mean to talk about this mama without her participating, which seems like it may be the case.  Sorry to speculate or give answers which may not be accurate.  

 

I felt like I had already taken up a lot of space on the thread but I do think the distinction between even a FSBC and a homebirth is rather large.  Many of the benefits of homebirth, IMO, come from being in your comfortable, home environment.  I don't know much about FSBC births but I can say that they would almost certainly not be for me.  I think that if I were not to have the benefits of birthing in my own home I would opt for the benefits that hospitals have to offer.  But, that's just me.   
 

 


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Wait-- what's going on in Canada? Is that like England where some women aren't allowed to give birth in a hospital  and still get it paid for by national insurance? Why wouldn't they let you have a hospital birth?

 


 

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Maybe I'm wrong but I assumed she meant that she couldn't find an OB willing to support her to have a VBAC in hospital so went with home birth as the only way to avoid another c-section?

 

 

Yes. This.
 

 


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#84 of 192 Old 11-22-2011, 11:37 AM
 
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"High risk" to WHOM???

 

Let me see if posting this in a different fashion, will help you to understand what I'm saying:

 

 

LOW risk:

 

Most women will fall into this category. Most women in this category will have a birth that is just fine. Some of them will have traumatic births. Some of them will die, have their baby die or be injured or have an injured baby. <--- facts of LIFE, not MY personal fantasy (despite the best efforts by some to make it seem that way.)

 

 

ELEVATED risk:

 

Some women start in the LOW risk category...and then discover that they have twins, that their baby is breech, find any number of things in their urine at the docs/MWs office or experience any number of the various things that can come up in pregnancy or birthing that elevates their risk of having things go wrong. More examples of moving from the LOW risk category, to the ELEVATED risk category:

 

-breech

-being induced

-getting an epidural

-having a rare, pregnancy related stroke or paralysis, etc....VERY rare, but worth mentioning.

 

Now...here is the thing about moving from ELEVATED risk, to HIGH risk.....there are different measures of HIGH risk, different ways of deciding whether or not a womans ELEVATED risk of problems, is significant enough, that she needs to be moved to the HIGH risk category, abandoned her plans to give birth at home/in a center and sign up for a c/s or induction or whatever else in a hospital setting.

 

You think breech birth is SO dangerous, that it automatically moves a woman to a HIGH risk situation. I SAY....that a breech birth can present ELEVATED risk....but I ALSO think that the "remedy" for the "all consuming danger that is breech birth" in the hospital - MANDATORY no questions asked C-SECTION - comes with it's own problems which ALSO move a woman into the ELEVATED risk pool...and MY personal feeling, having done the research, etc...that breech vaginal birth (almost always emergent, surprise breech, or transfer situation, because they don't LET you go breech in almost every hospital in this country) in a hospital is EXTREMELY dangerous, because most OBs don't know what the hell they are doing, because they are not taught how to catch breech babies like they used to be...they are taught how to cut them out, pre-term. It is also my feeling, that the risks associated with a c-section are pretty on par with an educated, well prepared and competently assisted mother delivering her breech baby at home.

 

This really hits home for me. I was low risk in my first pregnancy, and was never considered anything else, right up to my last prenatal visit, which turned out to be the day before I went into labour. (FWIW, and on a tangent, my doctor did a VE, and there was no indication that I was going into labour anytime soon - I was in full blown labour about 30 hours later.) My son had turned breech, during labour...and lots of "experts" have assured me that it's not possible for a baby to change presentation at term, so...yeah. I went into the hospital, after labouring at home for about 20 hours, to be assessed. I was still "low risk". One of the nurses told me that I didn't really look like I was in "real" labour, but I could go up and be assessed, "if [I] wanted to". I was 8cm dilated, and still "low risk"...and then they determined that the presenting part was a bum, not a head, and took me in for a c-section, which I refused, for all the good it did me.

 

And, for the remaining 16 years of my reproductive life, I was "high risk" and everything about every subsequent pregnancy was negatively affected by the scar on my uterus. Maybe having the idiot OB (he really was - I have no doubt whatsoever that he fell into the "became an OB because he hates women" category) that was on call attend my breech birth would have been a bigger disaster, because he didn't know how to handle it. But, the odds are pretty good tha, if I'd had ds1 vaginally, I wouldn't have been "high risk" when dd1 came along.

 

I was "high risk" for 16 years (not anymore, because I had a tubal), and I never once had any indicator of a health problem of any kind during any of my pregnancies - not once. The only reason I was high risk was because I'd been cut.

 

Maybe "breech is a variation of normal" is an oversimplification. But, so is "OMG - breech is soooo dangerous - we have to cut".


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#85 of 192 Old 11-22-2011, 11:57 AM
 
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Quote:
Originally Posted by starrlamia View Post and not all midwives are competent and well versed. (and yes Im very pro-homebirth/natural birth).

 

ABSOLUTELY!  Here in Ohio, you have to do your own digging and homework because the state does not recognize it as a profession.  The first interview with a hb mw we had was shockingly bad.  I honestly will not be surprised if I read about something horrible happening at a birth of hers.  Of course I pray it doesn't but she was completely unqualified to handle anything beyond a text-book case and was very flippant about the whole thing.  Some of her answers to interview questions were:  PPH?  "I have herbs for that". Do you carry oxygen?  "More studies are showing that it's not good to give oxygen to newborns."  How many births have you done?  "Gee, I don't remember.  It's been so many."  Who is your backup "I've never missed a birth.  I have a doula who helps me."

 

I was so worried dh would nix the hb right there.  The next interview was the one we hired (interviewed 3)  She answered our questions before we could ask them.  She was very business-like and that's what we liked.  She had a straight-forward attitude.  She's done over 1,000 births.  She works very closely with government people working to get hb legal in the state. 

 

I'm just covering the basics here but those are the two personal expericences I've had that was proof before my eyes.
 

 


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#86 of 192 Old 11-22-2011, 05:01 PM
 
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Quote:
Originally Posted by Youngfrankenstein View Post

ABSOLUTELY!  Here in Ohio, you have to do your own digging and homework because the state does not recognize it as a profession.  The first interview with a hb mw we had was shockingly bad.  I honestly will not be surprised if I read about something horrible happening at a birth of hers.  Of course I pray it doesn't but she was completely unqualified to handle anything beyond a text-book case and was very flippant about the whole thing.  Some of her answers to interview questions were:  PPH?  "I have herbs for that". Do you carry oxygen?  "More studies are showing that it's not good to give oxygen to newborns."  How many births have you done?  "Gee, I don't remember.  It's been so many."  Who is your backup "I've never missed a birth.  I have a doula who helps me."

 

I was so worried dh would nix the hb right there.  The next interview was the one we hired (interviewed 3)  She answered our questions before we could ask them.  She was very business-like and that's what we liked.  She had a straight-forward attitude.  She's done over 1,000 births.  She works very closely with government people working to get hb legal in the state. 

 

I'm just covering the basics here but those are the two personal expericences I've had that was proof before my eyes.
 

 



That was my experience in Indiana 8 years ago, another state where midwifery is not recognised. Shockingly, here in Florida, where midwifery is very regulated, I also had this experience.

 

State regulation is not enough to protect you. Any women seeking a homebirth, no matter where they are in the US, needs to learn all they can about birth and birth complications and ask hard questions when interviewing a midwife. It's not that hard to see the difference between a safe, I'm-not-going-to-sit-around-and-hope-for-the-best type midwife and a midwife that is not going to be there for you if things get serious. You don't even have to know what the right answers are to every question to get a sense of a midwife's professionalism.

 

 

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#87 of 192 Old 11-23-2011, 05:42 AM
 
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I'm sorry, but "elevated risk" versus "high risk" is just playing at semantics again.  

 

Once again, all homebirth studies of which I am aware only demonstrate safety for homebirth for low risk mothers and specifically exclude twins and breech births.  This seems appropriate to me since twins, on average, have a risk of death 5x higher than singletons.

 

You can make up any old scheme for what you think are appropriate risks for you to undertake.  Heck, you can try to give birth at home with placenta previa as some of the more crazed homebirth websites mention.  But you should make it clear that this is not what the scientific literature says.

 

I have found no reputable scientific studies that endorse ANY of what you are saying WRT breech/twin homebirth risks.  I am happy to be educated otherwise but both my sister and I did extensive looking into this issue when she was pregant with twins.

 

I find it funny that you so definitely threw "epidural" into  the so-called "elevated" risk category.  As far as I am aware, the evidence as to an increase in risk (as to needing further interventions) from an epidural is very mixed and actually weighted towards it not being an issue. 

 

 

 

 

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#88 of 192 Old 11-23-2011, 06:42 AM
 
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I'm sorry, but birth is not black and white....as most things in life are not. Saying that there is only "low" and "high" risk without acknowledging that there are elevated risk factors that can come into play that make a birth perhaps, statistically, a BIT more risky, but still pretty reasonable for homebirth...is ridiculous. So....a woman is low risk and anything that elevates her risk automatically makes her high risk? OR, a woman is low risk....and anything that elevates her risk makes her still low risk...until her risk level is elevated ENOUGH to be high risk? Well, what is "enough"? So, there's no such thing as a MW saying "Yeah, I think this elevates your risk, but we'll keep an eye on it and if it's your wish, I still feel comfortable with a home birth" - is that just stupid? Or completely imaginary...just never happens?

 

 

I don't know where the hell you are getting your research, but an epidural ABSOLUTELY increases your risk for all sorts of things, not to mention that for many women it can lead to stalled labor, not being sure when to push, etc, which all come with their own risks. Spinal headaches, total blocks, long term back pain and less commonly, shocking things like paralysis and permanent headaches, etc....the list of things you have to acknowledge and consent to on a hospital form before the anesthesiologist will come and stick a needle into your spine is long....and it DOES increase your risks during birth. Am I in the freaking twilight zone? Oh, oh I get it....nothing bad can happen at the hospital...the hospital would NEVER allow for any treatment, medication or practice that could harm you or your baby. Gotcha. thumb.gif

 

Just to recap....I'm on the HomeBirth forum, here at Mothering.com...listening to someone tell me that twin birth can absolutely never happen at home, as it's too high risk, and the same goes for breech birth...and there is absolutely no risk elevation in your birthing, long term recovery, etc in getting an epidural. (They just make you sign the consent for because they like to see your signature a bunch at hospitals...you know how it is).

 

OK. Yup. Sounds like business as usual for MDC lately.


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#89 of 192 Old 11-23-2011, 06:43 AM
 
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Quote:
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Once again, all homebirth studies of which I am aware only demonstrate safety for homebirth for low risk mothers and specifically exclude twins and breech births.  

 

This has been my experience as well.  Although, I kind of half-assed looking into issues like breech presentation, feeling like it would be something to come back to in great detail if I were to find myself making a choice about that.  But one reads time and time again when research the safety of HB that this is for "low risk" mothers and you often even see breech and twin births excluded.  

 

What I wonder, actually, since the topic of risk categories is being discussed, is if "elevated risk", "high risk" or even "low risk" are even specific, definable terms that can be applied across the spectrum of maternity care.  If I were to guess I would say that "low risk" probably does have a specific definition, which is used in studies.  But, "low risk" may be subjective when we're talking about client care -- evaluated by care providers on a case by case basis.  Does anyone know if "elevated risk" or "high risk" are meaningful terms?  

 

 


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I'm sorry, but "elevated risk" versus "high risk" is just playing at semantics again.  

 

 



...oh, and I'm sorry, but it's not playing at semantics when it means the difference between "we;ll monitor, but I think you're still okay, I'm not going to risk you out, let's try to do this VBAC!" and "I'm sorry, I know I'm the only person you've been able to find who can deliver you VBAC at home, but I think I'm going to have to risk you out and send you to the hospital".

 

It's a big deal when it's the difference between "You know what, I think this elevates your risk, but let's just watch it. I think you need extra monitoring, but I don't want to call you high risk just yet." and hearing: "I'm sorry, I've gotta call this a high risk birth and that means that this this this and this on your birth plan aren't really feasible unless you do this this this and this procedure that I know you specifically don't want...but...you know...hospital policy for high risk patients, sorry."

 

High risk is a big deal for a lot of women. Sometimes elevated risk needs to be taken into account and managed...but not being labeled high risk is a big deal to a lot of women.


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