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#91 of 107 Old 12-09-2010, 03:10 PM
 
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I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!

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#92 of 107 Old 12-09-2010, 03:16 PM
 
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Birth centres must be different in Canada?  In the UK you have to be on the obstetric ward for augmentation, at a BC you get literally what you could have had at home (i.e. gas and air, stitches in a 1st or 2nd degree tear, not a whole lot more in terms of intervention).  My MW's with DD1 (my NHS homebirth) were very clear that if i had to transfer it would be to the hospital labour ward because there was nothing happening in the BC that would be of any use.  Are they more of a "halfway" option in Canada?  The differences are very interesting to me.
 

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I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!



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#93 of 107 Old 12-10-2010, 12:58 AM
 
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I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!



Were you pushing for 8 hrs after your water broke? Just wondering, I forgot how the whole thing works.

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#94 of 107 Old 12-10-2010, 05:32 AM
 
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I just wanted to say that I've had two hospital births, one traumatic in the worst-case scenario of the word (my daughter died as a result of her birth injuries) and one excellent. So excellent that I am cheerfully returning to the second for my third delivery. I felt welcomed and supported every step of the way. 

 

I realize that a lot depends on your specific hospital, practitioner, and so on but not all hospitals are intervention-crazy or disrespectful. I'd say probably most hospitals are less personal, but I personally prefer that by personality. I don't want to be arguing or feel disrespected, and I would like some rapport - but I also really don't personally need some extra-special relationship with the team; I tend to get really focused within and as long as my husband's there, I'm good. I also have short labours (10 hrs start-finish with my first and that includes 4 hrs of pushing against the cord; 5 hrs start-finish with my second. Watch this one be 30 hrs. smile.gif)

 

I also, understandably due to my history, would not be able to relax at home. I wouldn't want to have to make a transfer decision either - having that "should we go or stay" question over my head would really bother me. For me, I want to be in an all-stop shop so I can just focus on getting baby out. Also, the laundry etc. would bother me, as well as having to have my home "homebirth-ready" for weeks. Again, it's just very personal.

 

It's policy at my hospital that the baby stays with you (there isn't a nursery that's not a NICU), lots of skin-to-skin and all those good things. The only minor discussion I had in my second birth was that I opted to sit in the visitor's chair at one point and my husband got in the hospital bed with our son on his chest and the nurse was slightly miffed that I wasn't "getting the bed." I also got vaguely conflicting breastfeeding advice (very pro-BF) but looking back, the different approaches were probably good to be exposed to as my son and I worked it out -- I just sort of wanted there to be One True Way that would work.

 

So a lot of it is knowing yourself. I hope you find a solution that works for you. But I wanted to bring one perspective on lovely hospital births.


~ Mum to Emily, March 12-16 2004, Noah, born Aug 2005, Liam, born January 2011, and wife to Carl since 1994. ~
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#95 of 107 Old 12-10-2010, 11:49 AM
 
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I don't think that we have any (or many) true birth centres anywhere here yet (definitely not in Alberta). I went to a "health centre" which is kind of a very small hospital that has limited services, in a small town outside of my city. It's the only place that midwives are allowed to work as midwives and where we run the smallest chance of intervention, but they do have limited things available and the midwife can consult with a doctor to get things like the the augmentation or if needed I think they could do an epidural. For a Csection or if they thought there'd be any problems with the baby they would have had to send me to a big hospital in the city.

They have private rooms with big beds for family to stay in, and jacuzzis, and are about as close as you come to a home birth without being at home (but you still have to have nurses present as well as follow the regulations for hospital births, but they are a bit more lenient in believing what the midwife says if she can justify it!). It is actually really hard to get a midwife anywhere in Canada and in my metropolitan area (over 1 million people) there are I think 8 midwives and only a few of those will do home births.
 

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Birth centres must be different in Canada?  In the UK you have to be on the obstetric ward for augmentation, at a BC you get literally what you could have had at home (i.e. gas and air, stitches in a 1st or 2nd degree tear, not a whole lot more in terms of intervention).  My MW's with DD1 (my NHS homebirth) were very clear that if i had to transfer it would be to the hospital labour ward because there was nothing happening in the BC that would be of any use.  Are they more of a "halfway" option in Canada?  The differences are very interesting to me.
 

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I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!


 


 

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#96 of 107 Old 12-10-2010, 11:53 AM
 
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Something like that! My MW broke my water at 8 AM as I was fully dilated and the sac was bulging but not breaking. I stayed home trying different things till about 1pm. I pushed off and on and went for the augmentation where I had to "rest" for a few hours as well within that time. My daughter wasn't born until 6pm. I was threatened with a C Section before I managed to get her out and I have no idea how I did it! Oh, and in hospital, for some reason, they only "let" you push for 2 hoursin most cases  before they cut the baby out, even if everything is fine.
 

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I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!



Were you pushing for 8 hrs after your water broke? Just wondering, I forgot how the whole thing works.



 

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#97 of 107 Old 12-10-2010, 11:55 AM
 
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Ah yes, that's similar to what they used to call (in the UK) "GP units" - more medical than a Birth Centre, less so than a hospital.  In those you could generally have more pain relief than in a BC, though not an epidural, and SOME help (like a manual breech extraction, not that you'd want one!) but nothing like a csection.  They're all gone now i think.  Though some remote areas have smaller obstetric wards - my friend had a planned HB but had to transfer for mec in the waters (turns out baby was 10lbs11oz and needed forceps to come out) but she knew if she needed a cs they could do it, but only under a general as they didn't have the staff for an epidural and planned cs, only a crash cs.

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#98 of 107 Old 12-10-2010, 11:57 AM
 
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That's amazing is it puppies, what incredible stamina!  Did you have the urge to push all that time?  Or was the baby still high?  Did you ever figure out what was going on?  Malposition or wrapped cord or something?  Or did she just take her sweet time?
 

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Something like that! My MW broke my water at 8 AM as I was fully dilated and the sac was bulging but not breaking. I stayed home trying different things till about 1pm. I pushed off and on and went for the augmentation where I had to "rest" for a few hours as well within that time. My daughter wasn't born until 6pm. I was threatened with a C Section before I managed to get her out and I have no idea how I did it! Oh, and in hospital, for some reason, they only "let" you push for 2 hoursin most cases  before they cut the baby out, even if everything is fine.
 

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Originally Posted by is it puppies? View Post

I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!



Were you pushing for 8 hrs after your water broke? Just wondering, I forgot how the whole thing works.



 



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#99 of 107 Old 12-10-2010, 02:39 PM
 
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innocent.gif thanks, unfortunately the problem was the lack of contractions for pushing, I think, as well as malposition. I was maybe getting 4-6 decent ones per hour. by then I was probably too worn out, but whatever it was they weren't working very well or I wasn't working very well and was really too tired and sore to do much for moving around etc. DDs head was kinked the wrong way and her hand was by her face, I think, and she was stuck behind something because of her angle (was it my pubic bone? I'm not really sure) but they could see her hair so they knew her head was there I just couldn't get her out. It probably didn't help that she was 9lb3oz! but when she finally started getting accelerations in her HR I got her out! The midwife had to keep telling the nurses that there's no reason to transfer me to a real hospital as the baby is right there and fine, but with the accels that would have been it happytears.gifso thankfully somehow I managed (I am very stubborn when I want to be). By then I had been on the full dose of pit for two hours (that's on top of the 2-3 hours maybe where they told me not to push while they brought it up) and it hadn't increased my contractions much at all as far as I know.
 

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That's amazing is it puppies, what incredible stamina!  Did you have the urge to push all that time?  Or was the baby still high?  Did you ever figure out what was going on?  Malposition or wrapped cord or something?  Or did she just take her sweet time?
 

 

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#100 of 107 Old 12-10-2010, 03:18 PM
 
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Birth centres must be different in Canada?  In the UK you have to be on the obstetric ward for augmentation, at a BC you get literally what you could have had at home (i.e. gas and air, stitches in a 1st or 2nd degree tear, not a whole lot more in terms of intervention).  My MW's with DD1 (my NHS homebirth) were very clear that if i had to transfer it would be to the hospital labour ward because there was nothing happening in the BC that would be of any use.  Are they more of a "halfway" option in Canada?  The differences are very interesting to me.
 

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I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!


 

I live in Vancouver, Canada, and unlike in Edmonton, we have many, many midwives offering services, and they almost all do home births. There is also a birth centre, but in order to go there for any part of labour (full labour, transfer, anything) you have to be registered with them and have them do your prenatal care. They have midwives on staff, but your prenatal care at the BC is done by a multidisciplinary team. I prefer to have my prenatal care supervised by just a midwife, with the knowledge of the risk that if I have to be transferred, it will be to a hospital.



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#101 of 107 Old 12-11-2010, 12:48 PM
 
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Beautifully stated!! 

 

Women aren't leaving hospitals for the shallow motive of some "perfect birth experience" (an oxymoron in my mind, but I don't like birth! redface.gif)  We're doing it for the evidence-based, compassionate, and professional maternity care.

 

Honestly, with so many "failure to progress" cesareans being done on first-time moms, I think it's actually a good idea to do home birth for the first baby.  Once you have that cesarean with your first baby, it can really limit your options down the road if you ever have another baby and want a VBAC.  A competent HB MW will be skilled at monitoring fetal heart tones while patiently letting labor run its natural course. 

 

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  • As an anxious first-time-mom, I had tons of questions, and needed loads of advice about "what to do" with my pregnancy.  (Which chiropractor do I see?  What supplements should I take?  Is raspberry leaf tea a good idea?  Can I take hot baths?  Is my diet ok?  Should I be doing yoga every day?  Etc.)  My home-birth midwives spent a huge amount of time answering all those questions, asking me all sorts of questions about my lifestyle and diet and emotional health, and just piling on love and attention to me AND the baby.  It was wonderful.  I went to several HCP's before choosing them, and always left feeling sort of cold -- I was just an object to be poked, prodded and measured.  My midwives treated me like a person.  And they treated my baby as a person, too, long before she was born.  It was the perfect kind of environment to be in to prepare for motherhood. 

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#102 of 107 Old 12-13-2010, 07:26 AM
 
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This is all very true, of course! But for me, the more relevant/interesting question has been - if you can get the same compassionate, high-quality care regardless of setting, (i.e. the same midwife) why choose home over hospital? I know of many possible reasons, but this was the question I felt I needed to answer fully (for myself) before I could move forward in planning for a birth.

 

FWIW, I think I've made my decision, after lots of discussion with my mw and my dh. We are going to plan a homebirth. My primary fear was/is having a baby who needs extra assistance at birth, and not having a full range of life-saving treatments available at home. While this fear hasn't disappeared entirely, I have a lot of confidence in my midwife, and feel she could spot a potential problem early and make the right call. My mw has been awesome, and even though she strongly favors homebirth, has not pushed me at all, and says we have many more months before we have to make a final decision.

 

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Beautifully stated!! 

 

Women aren't leaving hospitals for the shallow motive of some "perfect birth experience" (an oxymoron in my mind, but I don't like birth! redface.gif)  We're doing it for the evidence-based, compassionate, and professional maternity care.

 

Honestly, with so many "failure to progress" cesareans being done on first-time moms, I think it's actually a good idea to do home birth for the first baby.  Once you have that cesarean with your first baby, it can really limit your options down the road if you ever have another baby and want a VBAC.  A competent HB MW will be skilled at monitoring fetal heart tones while patiently letting labor run its natural course. 


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#103 of 107 Old 12-13-2010, 10:51 AM
 
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This is all very true, of course! But for me, the more relevant/interesting question has been - if you can get the same compassionate, high-quality care regardless of setting, (i.e. the same midwife) why choose home over hospital?

Definitely an interesting Q!
However, I don't think there ever will really, truly be an "EQUAL" comparison.


For example, I have fantastic hospital-based MWs that I had my DS with, but there are still some hospital disadvantages vs. HB (& these are all very typical):

  • There are 4 hospital MWs, one of whom I really dislike, & I get whoever is on call
  • I get whatever nurse(s) are on call & they're total strangers to me whereas I also know my MW's asst (she's at every prenatal)
  • 15 min vs. 1 hour prenatal apts as the norm with the HB MW (I really, highly doubt you'll find prenatals that are regularly so long in-hospital in the US)
  • While the hospital has a tub to labor in, I can't birth in the water (again, water birth in American hospitals is rare)
  • Even though this is a great, NCB-friendly hospital, they still have more "rules" than my HB MW has (for example, I can't even labor in the tub post-42W, etc.)

 

& even in the case of truly "equal" care scenarios:

  • No need to travel in labor
  • My own bed that night (hospital bed was totally uncomfortable!)
  • MUCH better food having what DH cooks & we have frozen vs. the awful hospital food
  • No other germs
  • The emotional comfort of "my own turf" (HUGE for me personally)
  • If I want DS to be there for birth, much less stressful for him to be playing in his own house with his aunt (my dear sister) while I labor upstairs, then to hang out in a hospital (strange place) waiting for 2nd stage.
  • Less worry with a fast labor -

i.e. my MW knows my DS, my 1st, was less than 5 hours total for 1st stage, so she will probably come out if I've only been having ctrx for 1 hour. Whereas the hospital may not admit me so early.

 

Also, if the HB MW comes & labor slows again, I would view that as relatively less hassle & less worry, whereas I do NOT want to accidentally end up laboring in a hospital for 12-24 hours (if I go in early, but labor isn't as fast.)

 

With my DS, I'd planned to labor at home as long as possible before going to the hospital, which is a common plan for mamas wanting NCB, but I feel like such a plan would be riskier for me now that I've had such a fast 1st labor. IOW, I think if I planned another hospital birth, I'd be more likely to end up with an accidental UC, whereas I'm more comfortable calling the HB MW right away.

 

Finally, I just don't feel the need to go anywhere. I don't feel the need to travel, leave the comforts of home, subject myself to the presence of strangers, etc. For me, HB is just as safe because I'm low-risk & healthy with access to several fantastic HB MWs and not far from a great hospital in case of transfer (transfer would also be smooth & hassle-free for numerous reasons). So given that, I don't feel the need to go anywhere.

 

I ended up accidentally doing all my laboring at home with my DS (didn't think it would go that fast, was shocked when I felt the urge to push). I resisted the urge to push as we drove to the hospital, then we got into a room & I pushed him out in 45 min. There was just no reason for that trip to the hospital. ;) There just wasn't. Would have been fantastic to just have the MW come to me, so that was an easy decision for #2.

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#104 of 107 Old 12-13-2010, 03:16 PM
 
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There's a lower chance of a cesarean if you have a home birth.  If you can avoid an unnecessary cesarean (e.g. a "time's-up" cesarean, or one based on an inaccurate fetal monitor reading), you can avoid the risks and hassles that come with it (e.g. recovery, increased risk of neonatal and maternal mortality, future VBAC denial). 

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This is all very true, of course! But for me, the more relevant/interesting question has been - if you can get the same compassionate, high-quality care regardless of setting, (i.e. the same midwife) why choose home over hospital?

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#105 of 107 Old 12-13-2010, 04:18 PM
 
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The thing about setting is, well, it can matter hugely.  Do you happily/unselfconsciously poop at other people's houses?  SOme people do, i know, but me, i prefer the security of it being my own bathroom in my own house, y/k?  And i KNOW birth is not pooping, but it's a really intimate biological process, and being in a familiar place really DOES, for the vast majority of people, make everything less painful, more comfortable, calmer and "nicer".

 

It is true that access to the exact same care (which i couldn't get in the UK - in the hospital i get whatever MW is there, with the NHS HB i would get one of "my team" of community MWs but in the event a total stranger turned up, and if we'd transferred she would only have remained with me as long as her shift (which had almost finished when i called her out, with my independent MW she has no jurisdiction in hospital so again i'd be assigned whoever was there at the time) would make things a little easier, but is it REALLY the same care?  IS there an Ob in the hospital?  Because if there is the MWs are going to treat things differently than if you were at home, they just are, otherwise planned MW births in hospitals would have the same cs rate as planned homebirths and they just don't.  Because at home they will listen with the doppler, maybe hear something iffy, listen again a little while later, watch how you're going, listen again, assessing all the time, how is mama? how is babe?  how does this labour feel right now?  In the hospital they may well use the CFM machine simply because it is THERE, they may feel compelled to get the Ob's 2nd opinion simply because s/he is THERE, once that happens the Ob might drive how things go, and the MW will feel less able to argue because, afterall, it was her who sought the Ob's opinion.  You may really end up with a cs, simply because you were there.

 

Wherever you birth there will be a hierarchy.  In your home the MW is fully responsible for you and your baby.  She takes this responsibility very seriously.  She assesses you carefully, she KNOWS she is where the buck has stopped.  You and she are partners, she will guide and support and care for you as you bring your baby out.  In hospital, even with a very supportive hands-off Ob, she is NOT where the buck will stop.  The Ob can ask her about "how you're going" at any time.  The mere presence of someone who is higher up the hierarchy can make a MW doubt herself, second-guess her decisions, overreact to things for fear of being deemed too casual or dangerous.  It's fine if you have a very normal, pretty fast labour and delivery, but "normal" is a broad church in midwifery and a narrow one in obstetrics.  Midwifery and Obstetrics are not equals, professionally.  This is grossly unfair since midwives really are far more specialised and able in the care-provision for normal births than Ob's, but it means that when a MW is dealing with a normal-but-non-textbook delivery under the eye of an Ob she may feel under pressure.  She KNOWS you are ok, but she cannot prove it, because you're not doing what the textbook says you should.  She wants to wait, the Ob wants to normalise the labour to "help the baby" and arguing with "helping the baby" implies "endangering the baby".  Thus she may be compelled just by the environment to be far more conservative than she would be in a home setting, she may feel, in a hospital, far less like a servant to the woman and more of a servant of the institution, the hospital itself.  When a MW attends the woman at home she is there for the woman.  When a woman attends a MW in hospital the MW has pressures from the woman (who needs her care) AND the hospital (which wants her to meet its own needs).  When a MW is in hospital she, to some extent, is a representative of that hospital.  At a home she represents herself, her own knowledge and her own abilities.

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#106 of 107 Old 12-14-2010, 06:07 AM
 
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Wherever you birth there will be a hierarchy.  In your home the MW is fully responsible for you and your baby.  She takes this responsibility very seriously.  She assesses you carefully, she KNOWS she is where the buck has stopped.  You and she are partners, she will guide and support and care for you as you bring your baby out.  In hospital, even with a very supportive hands-off Ob, she is NOT where the buck will stop.  The Ob can ask her about "how you're going" at any time. 

 

Excellent points! Something I totally forgot about.

 

yes, even in my very NCB-friendly hospital with great MWs, they still have a degree of "oversight" from the OBs. I don't think they closely monitor the MWs - and I personally never even met any of the OBs b/c my whole PG & birth were healthy & text-book. But friends of ours birthed there with the same MW & pushed for like 4 hours. They said the MW chased away the OB on several occasions. :( Mama & baby were doing OK, tired but OK & really wanted to continue. But I believe this hospital, like most American ones, has a policy to limit the time for 2nd stage (I'm thinking 2 hours max is common?)

 

At one point, the MW yelled as OB tried to walk in, "Baby is crowning, get out!" A total LIE at the time, but it bought them more time and she DID successfully push out that baby.

 

But yeah, excellent points - the 'oversight' of OBs & being a servant of the institution itself are certainly non-issues in HB.

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#107 of 107 Old 12-14-2010, 08:04 AM
 
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Yeah, I guess my situation is more unique than I thought, which in many ways is unfortunate. I would have the same exact midwife regardless of setting (home, freestanding birth center, or hospital). She is an independent practitioner and practices the same way regardless of setting (at least as far as medical calls and interventions go). Really for most of you, it sounds like a homebirth truly is the only tenable option. I don't think I fully appreciated that before. It seems that more midwives should be able to practice the way mine does, so that women who truly want (or need) to be in the hospital can be without compromising their care or increasing their risk of unnecessary interventions.

 

That said, MegBoz and GoBecGo, your points definitely resonate with me, which is why I'm planning a homebirth myself.


Metis, partner to a peaceful soul, mothering DD born July '11

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