I don't understand "show up to the hospital pushing" - Mothering Forums

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#1 of 61 Old 04-23-2010, 04:31 PM - Thread Starter
 
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I don't understand why so many women will give advice to "show up pushing" at the hospital, yet are not willing to UC. I keep getting the impression that a lot of fetal distress or problems are picked up during monitoring, and don't just spontaneously happen as soon as the baby exits the womb. I'm personally a fan of UC and plan to do it, so I don't understand why if someone's comfortable with no monitoring whatsoever, they still need someone to 'catch the baby'. Any help here? I'm genuinely puzzling over this one, not trying to start a debate either way.
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#2 of 61 Old 04-23-2010, 05:01 PM
 
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Well, two of the "scary" and somewhat unavoidable childbirth emergencies are shoulder dystocia and hemmorhage. Also, keeping an eye on baby activity (or lack thereof) is a form of monitoring.

I dunno... I've had a "show up at the hospital pushing" birth (not planned that way), and a birth with 22 hours of regular monitoring. Even the worst hospital couldn't have ruined the first baby's birth/performed unnecessary interventions that could have led to problems. The second one could have gone very differently in another hospital with more interventionist policies (I had ruptured membranes for over 30 hours, and mec in the water). Usually, I don't think women really get the advice to show up pushing... the advice is more along the lines of staying at home until labor is undeniable and progressing regularly. There's usually lots of time between the first twinge of "is this labor"? and "I need to push this baby out right now", especially with a first baby...
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#3 of 61 Old 04-23-2010, 05:02 PM
 
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fear of the unknown, lack of trust in one's body, fear of legal prosecution if the baby dies, desire to avoid clean-up at home, desire to placate partner, desire to take advantage of hospital stay as a break from household duties/older kids, desire to be close to OR "just in case" in VBAC women

Bring back the old MDC
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#4 of 61 Old 04-23-2010, 05:04 PM
 
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That's an interesting question and I've never considered it, perhaps because after my two labors (short/intense/very painful and precipitous/ridiculously intense/horrendously painful) I know that if I'm already to the point where I'm almost pushing #1. it's too late to go to the hospital anyway and #2. there is no way in hell someone is getting me into a car. However, I can tell you why I'm not interested in UC, even after having a home birth during which the midwife was only present for the last ten minutes of pushing (out of a total of maybe 15 or something). For me, while I'm perfectly capable of learning what I need to know to do it completely alone, I don't want to do it completely alone.

DD1 had the cord wrapped around her neck three times. It didn't cause any problems at all, but the midwife (CNM at a hospital) had to loop it up over her head for me to push her out safely. Not a big deal at all, but not something I want to have to think about unless absolutely necessary. I was prepared for this possibility at DD2's home birth, especially once we realized that, due to a precipitous labor and a road block we didn't know about, our midwife really might not make it on time, but I just didn't want to have to deal with it. I wanted someone else to notice those kinds of things so that I could concentrate on the work at hand. If I had another baby, I'd want a midwife again, even though I know odds are she'd only get there at the last minute. DD2's shoulders didn't slide right out like they should have. I'm not trying to be overly dramatic, so let me be very clear that there was no real emergency, we did not have a shoulder dystocia or anything like that, but she was a little sticky and the midwife definitely was a help in maneuvering her out. Again, not something I want to have to worry about.

I know that there aren't as many problems that would require monitoring in really fast labors, so my perspective is different than some people's. For me, there's no reason for anyone to be monitoring - the baby is coming and it's probably coming before anyone has time to notice anything wrong. But I want someone else there to notice if the cord is around the neck and therefore needs to be unlooped or to help me if the baby is a little sticky. Just my opinion and experience.

Edit: Sorry, this didn't seem so related to hospital births, but my point was that I can see why someone might want to have someone else catch the baby, even if they didn't want to labor at the hospital.
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#5 of 61 Old 04-23-2010, 05:30 PM
 
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fear of the unknown, lack of trust in one's body, fear of legal prosecution if the baby dies, desire to avoid clean-up at home, desire to placate partner, desire to take advantage of hospital stay as a break from household duties/older kids, desire to be close to OR "just in case" in VBAC women
These in bold are pretty much it for me in a nutshell, especially the fear of the unknown, and I have a lack of desire/drive to acquire of all the things I would need on my own. If my insurance covered it, I would seriously consider a homebirth with a midwife, but I am not especially interested in preparing everything I'd need for a UC, and I've seen some very lengthy supply lists. Also, my DH would freakin' freak out.

Honestly, I don't want to show up quite at the pushing stage because I'd like to settle in and get comfortable, but an hour or two at the hospital before pushing would be enough.

Amy (34): mommy to DD1 (11/07) and DD2 (7/10), wife, wohm, and wannabe suburban homesteader.
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#6 of 61 Old 04-23-2010, 05:50 PM
 
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I think a lot of times this is mentioned is in an area where there is high intervention/c-section rates in ALL the local hospitals/care providers, especially if a specific woman has been threatened with a certain treatment regardless such as "your only option is to schedule a c-section" or " Everyone is required to be in bed with a strapped on monitor at this hospital" or some other nonsense.

If you live in an area that is consistantly respecful and you have a variety of choices for care, I don't think it would matter TOO MUCH when you went in.
I also agree with a pp that monitoring during labor is really overdone and also are some hospital's need to augment or otherwise fool around with a laboring woman.

SOme people feel a need to give birth at the hospital for various reasons and laboring at home can be a nice part of the process and still get the need for that hospital care (because so many people would never consider a homebirth, also for various reasons)

I think primarily it is the first thing I mentioned, when the hospital is a hostlie enviroment for a particuar woman for a certain reason.
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#7 of 61 Old 04-23-2010, 05:58 PM
 
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I like delivering at the hospital (I love my OB and have had great natural births with his care). I also like laboring at home, and would prefer to avoid hospital policies like no eating, staying in the room, etc. I don't like the idea of LITERALLY "going in pushing" (though it happened to me once)...I'd rather go in just before transition and get settled...having a hour at the hospital would be a lot less hectic than last time, when it was only about a 1/2 hour!

Laboring at home is nice, but the birthing at my hospital is also nice. I like having both.

I'm also GBS positive, so I feel most comfortable getting antibotics by IV while I'm laboring (or pushing, as it turned out).

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#8 of 61 Old 04-23-2010, 06:49 PM
 
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If a person plans on hospital delivery (for whatever reason, and they may have a perfectly valid one), and wants to avoid interventions, going in late in labor is one of the best ways.

With my three, I arrived around 7-8 cm and feeling pushy. It worked out perfectly. They didn't have time to mess with me.

I have a variety of reasons why UC is not for me, and feel no need to defend them, really. Since my only other option was hospital birth, "going in pushing" was my defense against unwanted interventions.
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#9 of 61 Old 04-23-2010, 07:03 PM
 
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I don't understand it because having been through transition, I don't see how the hell I could have made the 45 minute car drive.

I have absolutely no desire to UC, ever, under any circumstances. But I also want to make sure labor is established before going to the hospital. With my vba2c I got there at 7cm, which was pretty good. I'd prefer more like 5 or 6 so the baby can be properly monitored, but it worked out well. I had two days of regular contractions that petered out before labor really got going, so I'm glad I didn't rush to the hospital right away.
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#10 of 61 Old 04-23-2010, 07:04 PM
 
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Originally Posted by cappuccinosmom View Post
If a person plans on hospital delivery (for whatever reason, and they may have a perfectly valid one), and wants to avoid interventions, going in late in labor is one of the best ways.

With my three, I arrived around 7-8 cm and feeling pushy. It worked out perfectly. They didn't have time to mess with me.

I have a variety of reasons why UC is not for me, and feel no need to defend them, really. Since my only other option was hospital birth, "going in pushing" was my defense against unwanted interventions.
I could have written most of this post. I came in a 9 centimeters each baby. Had a C.N.M. help me and all went beautifully.
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#11 of 61 Old 04-23-2010, 07:12 PM
 
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Originally Posted by cappuccinosmom View Post
If a person plans on hospital delivery (for whatever reason, and they may have a perfectly valid one), and wants to avoid interventions, going in late in labor is one of the best ways.

With my three, I arrived around 7-8 cm and feeling pushy. It worked out perfectly. They didn't have time to mess with me.

I have a variety of reasons why UC is not for me, and feel no need to defend them, really. Since my only other option was hospital birth, "going in pushing" was my defense against unwanted interventions.

This. I wasn't ready for a homebirth with my last baby, for emotional reasons that I won't get into, so I wanted to go to the hospital late enough that there wouldn't be enough time to fight about the antibiotics and GBS+ status specifically...so, getting there at 8cm was the best way to do that. They didn't argue because clearly at 8cm it was a moot point, I wasn't going to get the "right" dose in time anyway. He was born less than 3 hours after we got there, with zero intervention (not even a heplock), with a good nurse that contorted herself every which way so I wouldn't have to stay still for fetal monitoring, and labored through transition in a tub in the dark with no one around but my dh. My CNM closed the door and said "call me when you need me." we left 10 hours after he was born.

Em, married to Alex, mom to Samantha (11 yrs) and Cullen (5yrs) and Maybe (5/16/2010) Trying to grow 4,000lbs of produce on .2 acres. See my blog!
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#12 of 61 Old 04-23-2010, 07:13 PM
 
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I imagine a lot of women would want to labor at home, but not necessarily deliver there. It's not really a mystery to me. Women prefer all sorts of different things when it comes to birthing.

This is something I'm considering if I have another child because of my history. My DD had a severe brain injury and I'm not sure any midwives would take me. I'm not 100% comfortable with a UC. But I'd hate to go into the hospital before 8-9 cm and have them force all sorts of interventions one me. So there's one scenario I guess. As far as being "ok" with no monitoring but not feeling comfy with UC...for me they have nothing to do with each other. I'm ok with no monitoring because I know by the time the baby does into REAL distress there's a good chance you can't get them out in time anyway (which is why continuous fetal monitoring and an increase in c-sections hasn't improved fetal outcome). Going in would be more to do with not messing with clean-up and avoiding legal problems if something went wrong. If any of my future babies goes into major distress we won't be resuscitating anyway if they can't breathe on their own without intubating.
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#13 of 61 Old 04-23-2010, 08:11 PM
 
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#14 of 61 Old 04-23-2010, 10:13 PM
 
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I'll tell you why I think "show up pushing" is a bad idea. As a disclaimer, let me say that I have no problem with people who don't want to homebirth for whatever reason. If people feel best about birthing in a hospital, go for it! Give birth wherever you feel safest.

That said.. I think if you want to wait until you feel like pushing to go to the hospital, you need to be prepared for a UC. I've had precipitous pushing stages with all of my children, even my first. My first birth, in the hospital, I pushed for maybe ten minutes tops. The OB didn't even have time to put her gloves on, she rushed into the room and caught the baby as he slid out. There's no way they could have predicted that.. my OB actually thought I might end up with a c-section because the baby didn't engage at all until well into labor - they thought my pelvis might be too small. My next two were pretty much the same. Now, I only live 5 minutes from the closest hospital, but there's no way that I would get there in time. And while I think homebirth is great, had my third at home and am planning another homebirth, I would not want to risk giving birth in the car. Nor do I think it's a good idea to knowingly risk UC without also preparing for UC.

I do feel bad for women who have no good choices, who can't homebirth for whatever reason, but are likely to end up with a terrible birth in the hospital. If they want to show up pushing, fine.. but they'd be most responsible to also prepare for a UC in that case. If you want to give birth in a hospital, then do so responsibly. If you want to UC, then do so responsibly.

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#15 of 61 Old 04-23-2010, 10:37 PM
 
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#16 of 61 Old 04-23-2010, 11:48 PM
 
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Originally Posted by veryhappydog View Post
I don't understand why so many women will give advice to "show up pushing" at the hospital, yet are not willing to UC. I keep getting the impression that a lot of fetal distress or problems are picked up during monitoring, and don't just spontaneously happen as soon as the baby exits the womb. I'm personally a fan of UC and plan to do it, so I don't understand why if someone's comfortable with no monitoring whatsoever, they still need someone to 'catch the baby'. Any help here? I'm genuinely puzzling over this one, not trying to start a debate either way.
I don't think I could handle an emergency if the baby came out and was unable to breathe or had some type of unforeseen health problem that quick action in the hospital could save their life. I'll labor at home, but I have no medical training that would make me comfortable with handling a newborn that may not be healthy.

Kelly (28), in love with husband Jason (38) and our awesome babies:  Emma 4/09, and Ozzy 8/10

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#17 of 61 Old 04-24-2010, 12:20 AM
 
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I've always taken the "show up pushing" idea to mean show up very late in active labor rather than literally to show up while you're pushing.
Definitely NOT to mean don't even start to go until you are pushing!
I still stand by my assertion. Even if you plan to get there when you're 8cm, there's no guarantee that active labor will be textbook. It might go an awful lot faster than you expected. Again, for my births.. I have very long early stages and do most of the dilation very, very quickly. My third, I went from 2cm to babe-in-arms in under an hour--the first half hour of which I had no idea that it was progressing so quickly.. so that would have given me under a half hour, once I realized what was going on, to get to the hospital.

All I'm saying is.. if you're trying to cut it that close, don't count on a textbook labor, because you might end up UCing when you had no intention to. And better to get to the hospital early or hire a midwife for a homebirth than have a medical emergency and not be prepared at all. If you want to plan to show up at the hospital very late in labor, then prepare for a UC just in case, that's all. I'm assuming most people who want to deliver in a hospital are worried about safety and having appropriate medical attention.. so I hope they'd be responsible about covering all their bases just in case.

-Rachel
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#18 of 61 Old 04-24-2010, 12:34 AM
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i UC myself, but i recognize that it's not for everyone.

for my money, i think that everyone should be prepared to UC because you never know how quickly things will go--whether you will get to the hospital or the midwife would arrive or whatever. KWIM?

but, i can understand that people may not *want* to choose to UC. prep for it, sure, but not actually *plan* it.

it's perfectly valid to choose otherwise, and it's a great idea to go later in labor (or when pushing) so that one is less likely to be subjected to policies and procedures that would lead to interventions, yk?
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#19 of 61 Old 04-24-2010, 08:19 AM
 
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I don't see why there is such an issue surrounding a woman's choice to wait til late labour if that's what she's comfortable with.

Personally, I think any pregnant woman should know the basics of birth and what to do in the situation of being alone at home (or elsewhere) if the baby decides NOW is the time it needs to come.

Instead of being all judgey about a perfectly valid choice- that in the great majority of cases will turn out just fine, and very much more than likely help to avoid unnecessary interventions- we focus on supporting a woman's choice to birth her baby the way she's most comfortable.
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#20 of 61 Old 04-24-2010, 11:05 AM
 
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I've pondered this before OP so I totally get where you are coming from with this question. I get the responses too. There are reasons but I think our birth culture has put an awful lot of focus on the dangers of miso, pit and epidurals and for so many women, their only desire is to avoid those things. I would like to see more focus on the risks associated with 2nd and 3rd stage provider management. There needs to be more awareness about that IMO. I think the most harm can be done during those stages and women are going into the hospital right when they are happening and those stages are being managed in a panic and often without enough time for a woman to relay her desires to said provider.
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#21 of 61 Old 04-24-2010, 11:15 AM
 
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for my money, i think that everyone should be prepared to UC because you never know how quickly things will go--whether you will get to the hospital or the midwife would arrive or whatever. KWIM?
ITA with this, especially after DD2's birth last month. I don't want to UC, but even if I hadn't planned on waiting until the last minute, I wouldn't have made it to the hospital in time. Granted, I was planning a home birth, but it could just as easily happen to someone planning a hospital birth. The hospital we would've gone to is 45 minutes away. My birth actual labor was 52 minutes long. There was a road block. We would've had to wait for care for DD1 to arrive or drop her off somewhere or get her up and get her ready if we'd been taking her with us. There's just no way we would've made it to the hospital in time and my midwife almost didn't make it to our house in time. In fact, I have 2 midwives and only one of them made it in time. The other was abotu 5 minutes too late.

Colwyn, an unintentional UC could happen no matter WHAT you do. You could go from 2 to 10 in an hour or you could go from 0 to 10 in 30 minutes or you could not have been checked and only know that you went from first real contraction to babe in arms in 52 minutes, like me. How dilated you are when you started doesn't actually even matter, because you can go from 0 to 10 in 30 minutes. No one should ever think that an accidental UC won't happen to them because they aren't dilated "enough" or something.

In spite of all that...I know what to do once the baby's out. I know to check for a cord around the neck and then unloop it if it's loose or hold the baby's head to the thigh and let them somersault out if it's not. I know to get on hands and knees if there's a prolapse or a shoulder dystocia. BUT, I don't want to worry about that. I don't want to UC.
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#22 of 61 Old 04-24-2010, 11:29 AM
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Yeah, we got the "show up pushing advice" and took it to mean, show up when you feel like you're going to start pushing soon. We also live very close to the hospital where our super natural-friendly OB works. And we had a great childbirth instructor/doula over at our place for a little while before heading over, which made us feel like someone who's seen lots of births was keeping an eye on things, could tell probably how close I was, etc. It was perfect, b/c I was entering transition, had a quick trip in the car (which wasn't fun but was okay) and then got settled in, worked through the rest of transition very comfortably with no interventions, and pushed DD out. But my OB is actually right there with you the whole time you push, and things like shoulder dystocia are the reason I'm not comfortable with UC. I like having an expert in getting baby out, should expert help be needed/useful. We very well might do a HB this time, but at the time, that was our OB under insurance, the whole birth was free, and he was basically like a birthcenter midwife, so we went with it!

ETA: I agree that EVERYONE should be ready for a UC. My favorite birth books all seem to have chapters on this, so you can be prepared for the possibility. But if I was stuck at home, I'd be calling up my birthy friends who all live within walking distance fast, too
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#23 of 61 Old 04-24-2010, 11:35 AM
 
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why does it matter to some so much what other women do? I feel like it's probably no ones business in all reality. I planned a UC and transferred during transition due to meconium. Turns out I made the RIGHT decision there because I also had a placenta issue and myu baby was FULL of meconium. I think if a woman feels her instincts say to show up crowning have at it! It's not fun but hey it helps avoid monitoring and interventions so that's what some women are trying to avoid. Not everyone has to agree with UC or hospital birth but geez do we have to keep judging each other for our birth choices?

Blissful Mama to DD-(5), DS-(6) and someone new due in November!
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#25 of 61 Old 04-24-2010, 02:40 PM
 
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why does it matter to some so much what other women do? I feel like it's probably no ones business in all reality. I planned a UC and transferred during transition due to meconium. Turns out I made the RIGHT decision there because I also had a placenta issue and myu baby was FULL of meconium. I think if a woman feels her instincts say to show up crowning have at it! It's not fun but hey it helps avoid monitoring and interventions so that's what some women are trying to avoid. Not everyone has to agree with UC or hospital birth but geez do we have to keep judging each other for our birth choices?
I didn't think we were being judgy. If someone wants to go to the hospital, go for it. I just worry that people will assume that making a plan to get to the hospital just in time to push the baby out relieves them of their responsibility to educate themselves on what to do in case they don't make it. People who plan homebirths (UC or otherwise) generally seem pretty well educated on what to do in case of an emergency. A lot of people I know in real life, who plan hospital births, have no clue. I don't care where people give birth, so long as they're acting responsibly.

And I do agree that *everyone* should be prepared for UC regardless of where they plan to give birth, but I think those who are hoping to get to the hospital in early labor are more likely to actually make it there.

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#26 of 61 Old 04-24-2010, 06:42 PM
 
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A lot of women who have hospital births may "have no clue," but if a woman is planning on laboring at home I'm betting many of them DO have a clue of what to do in emergencies. I know I do.

Women who make these choices aren't idiots just because part of their birth choices involve a hospital. In fact, I'd guess that very few birth-uneducated women choose to labor at home. We labor at home, and make the choices we do, because we HAVE educated ourselves.

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#27 of 61 Old 04-24-2010, 06:54 PM
 
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Women who make these choices aren't idiots just because part of their birth choices involve a hospital. In fact, I'd guess that very few birth-uneducated women choose to labor at home. We labor at home, and make the choices we do, because we HAVE educated ourselves.
Thank you.
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#28 of 61 Old 04-24-2010, 09:24 PM
 
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Originally Posted by redoakmomma View Post
a lot of women who have hospital births may "have no clue," but if a woman is planning on laboring at home i'm betting many of them do have a clue of what to do in emergencies. I know i do.

Women who make these choices aren't idiots just because part of their birth choices involve a hospital. in fact, i'd guess that very few birth-uneducated women choose to labor at home. We labor at home, and make the choices we do, because we have educated ourselves.
ita!
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#29 of 61 Old 04-24-2010, 11:54 PM
 
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With my first baby, I showed up at 8cm because I figured the longer I stayed home, the less the hospital could annoy me. I really didn't know that homebirth was an option in my area, as I didn't know any MDC-type moms before I had ds1.

My next three were out of hospital births.

Midwife (CPM, LDM) and homeschooling mama to:
13yo ds   10yo dd  8yo ds and 6yo ds and 1yo ds  
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#30 of 61 Old 04-25-2010, 12:09 AM
 
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Originally Posted by blessedwithboys View Post
fear of the unknown, lack of trust in one's body, fear of legal prosecution if the baby dies, desire to avoid clean-up at home, desire to placate partner, desire to take advantage of hospital stay as a break from household duties/older kids, desire to be close to OR "just in case" in VBAC women
Honestly the bolded is a bit offensive. Just because a woman chooses to birth in a hospital does not mean that she doesn't trust her body. I don't understand why the choices a woman makes regarding her birth matter to anyone else - if you (in general) do not want to be judged for birthing at home/choosing UC/choosing VBAC/ whatever then the mom who chooses a hospital birth deserves the same courtesy.
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