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I was talking to a friend about homebirth and this topic came up. For people/OBs who are opposed to homebirth or feel that it isn't safe, what specifically are they concerned about? I hear people bring up specific medical issues or emergencies that can arise and how they feel in those situations it would be better to be in a hospital but I'm not sure what some of those examples are. Does anyone know what conditions/complications people tend to site as possible outcomes that they feel makes homebirth dangerous? I'm a research/stats/numbers person and would love to be able to know some of the specific concerns so I can actually look up the numbers on the prevalence of those conditions and how OBs would handle them in a hospital vs how a mw would handle them at home.... stuff like that. Thanks!
 

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most of what I've heard are: the baby is going to come out not breathing/no pulse and no one will be able to resuscitate it, I will bleed to death, I will need an omgrightthissecond c-section because the baby's heart stopped beating. Yeah, I think that pretty much covers it.
 

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Most of the things I hear people bring up are complications with a high mortality rate and the need for fast transfer. Cord prolapse is the biggest one I've heard in that category. Other kinds of cord accidents are very often mentioned to me - though many people assume any incident of cord around the neck as an automatic emergency when it is actually quite common. Placental abruption, maternal hemorrhage, uterine rupture, infant or maternal stroke, shoulder dystocia, congenital health problems in the baby. As far as I know these are rare and all of these can and do happen in a hospital too. But they are what gets brought up by docs and others opposed to home birth.
 

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I think OB's freak too because they see a lot that goes wrong, often caused by the interventions they inflict on birthing mothers (i.e. pitocin and epi's, plus continuous fetal monitoring).

Often OB's don't see a normal birth... or if they do they are definitely NOT the norm.
 

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I think one of the main things is a haemorrhage, and also a few rare complications. If you go to http://www.homebirth.org.uk/ and click on 'But What If', it explains how complications can be overcome.

I was meant to have a homebirth, but had to be transferred to hospital due to a 47 hour labour and a rise in the baby's heartbeat. I'm glad I did because I had a haemorrage they had trouble stopping, and I think it would've been worse if I stayed at home.
But most of the time they can be dealt with, so don't let my experience put you off. I think in general it's rare for something like that to cause problems with a homebirth.

But personally I think I might go for the hospital next time. Fortunately at my hospital they allow you to birth how you want. They even supply birth balls and pools which is great. I would've liked to have had a homebirth, but the haemorrage put me off a bit.
 

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I have to agree with what everyone else has posted so far. My midwife's assistant goes over every single scenario that could happen in one of our birthing classes, and for some reason it didn't freak me out as much as I thought it would. The things that stick out in my mind are, as mentioned above, hemorrhage after the birth (usually fixed by a shot of Pitocin) or the cord getting wrapped around the baby's neck.

One of the doctors in one of the documentaries (Pregnant in America I think) gave an example that will forever stick in my mind. It was a story about a woman who went in for a normal hospital birth and they ended up giving her Pitocin because she was taking longer than 12 hours in labor, but complications arose from the Pitocin, so she ended up having 'an emergency c-section'. Everyone's comment was, "Well, thank god she was at the hospital because she might've died if they couldn't save her and the baby." But nevermind the hospital was likely the cause of the original problem!

Midwives are far more trained than most people realize. For instance, in case of hemorrhage, a midwife shows up with the exact same tools a hospital would use - a shot of Pitocin. Granted a MW can't perform surgery if needed, but usually the Pitocin is all that is needed (and an ambulance can always be called). They carry oxygen tanks and other tools in case of a baby needing it. Most are pretty much like doctors without the degree.

I do hope you will find the statistics on what the perception is of things 'going wrong' in a homebirth and the reality of the number of incidents for low risk women. I've found, both through research and info from my midwife (who has performed over 500 homebirths) that exhaustion is usually the biggest issue in homebirths. A lot of women don't rest enough in early labor and stay awake instead of sleeping, and exhaustion at the time of hard labor can cause transport to the hospital (unable to push good enough) and puts the mother at risk for hemorrhage.
 

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Quote:

Originally Posted by nettlesoup View Post
Fortunately at my hospital they allow you to birth how you want. They even supply birth balls and pools which is great. I would've liked to have had a homebirth, but the haemorrage put me off a bit.
I wish we had hospitals like that here in Georgia. We don't have any birthing centers at all and our C-section rate is over 47% for most of our hospitals. If I had a hospital that would be that easy going on birthing, I probably wouldn't be so deadset about homebirth. The hospital is literally my last resort here. If my midwife decides for some reason I am not a candidate for homebirth, I am going so far as to drive the hour and a half up to northern Chattanooga to give birth at Ina May Gaskin's farm. I can definitely understand why you are put off or worried about a homebirth!
 

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From a personal experience, my mom had a beautiful home water delivery with my youngest brother when I was 15. When she tried to deliver the placenta, she started to hemorrhage. She had a placental accreta, which is very rare, but very serious. It took her skilled midwives knowing when that situation was out of their control and knowing when they needed to transport, or else she very well could have bled to death. That being said, even if she had had her baby in the hospital, there would have been no way of detecting that was going to happen to her, no matter where she had given birth. Even having witnessed this as a teenager, this has not deterred me in any way from wanting a home birth of my own. Things do go wrong, but you have to have trust and faith in your midwife's abilities to know the line between normal birth and something more serious.
 

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For some people it's not about fear. The idea of homebirth was nice, but our hospital had a terrific midwifery group, a labor pool, birth balls, etc and is certified "Baby Friendly." And when we walked out the door with our baby we were handed a bill for $3.

A home birth would have cost around $3,000. It was an easy decision.

Now, if the local hospital had not been all that it was, I would have considered hb far more seriously than I did.
 

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Most of the major reasons that health care professionals might be against homebirth have already been covered, but it's also good to keep in mind that in some of these cases, being in the hospital won't necessarily "save" you either. If you have a good transport plan in place, and can get in touch with the hospital en route, you might not actually be any "farther" away from necessary interventions time-wise than in a hospital, where they still need to prep an OR or page a certain doctor. But of course, it's an issue of comfort level, and if you come in they haven't been in touch with what's happened in labor so far. On the other hand, the risks of many complications go up with interventions which are typically done in the hospital (for example, uterine rupture due to induction of labor, or an amniotic fluid embolism), so if you're low risk anyway you probably have a lower chance of ever developing certain complications if you're at home.

Another thing to keep in mind is postpartum complications--hospitals have lots of bacteria, so nasty infections are more likely in a hosptial than at home (assuming you don't live in a pigsty anyway!). Antibiotic resistant infections are really scary. The argument from an OB's side would probably be that in the hospital you can catch and treat infections more quickly, but again--some of these infections are caused by just being in the hospital. So there are two sides to most of these concerns.
 

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Quote:

Originally Posted by trauerweidchen View Post
Another thing to keep in mind is postpartum complications--hospitals have lots of bacteria, so nasty infections are more likely in a hosptial than at home (assuming you don't live in a pigsty anyway!). Antibiotic resistant infections are really scary. The argument from an OB's side would probably be that in the hospital you can catch and treat infections more quickly, but again--some of these infections are caused by just being in the hospital. So there are two sides to most of these concerns.
That is such a good point that I always forget to bring up to people. I think your average person thinks of a hospital as a pristine, sterile environment and that's simply not true. I believe in natural immune systems and many midwives agree that being born in a more natural environment that the mother lives in and where the baby will live actually strengthens the immune system. A hospital introduces too many things foreign to both mother and baby. Such a great point.

And I also agree with the transport point. Despite homebirth being mostly illegal here in Georgia, homebirths are on the rise and my midwife's practice has a silent but understood relationship with local hospitals. She knows who to contact should a client need to be transferred and they are always ready when the ambulance/car hits the ER. That piece of info has helped to put DH's family at peace a little more.
 

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Cord prolapse (HIGHLY unlikely in a homebirth without PROM, but could happen), fetal distress (also way less likely in a homebirth), hemorrhage (another one that's less likely if you haven't had pit or been induced), placental abruption.

Honestly though with a trained professional or even just a well researched mama, if you were close enough to a hospital , your chances of you and babe being just fine are quite high.

Although freak things can happen and it might be better to be in a hospital if they do, those things are more often than not caused by the hospital (oh, the irony!). And being in a hospital raises many other risks not in a homebirth such as infections or even just the cascade of interventions.
 

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I think b/c MDs/ACOG are so adamently opposed to homebirths, and they are so rare (I'm probably the first person many people know to have a homebirth) people have this nebulous fear of 'WHAT IF???'

I don't have the time to post what my aunt-in-law said but three times I needed to tell her to lay off, that I did my research and I'm comfortable, and that she needs to support me in this or be quiet.
 

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Honestly, when OB's try to get all scary about HB, I rarely hear specifics. It's usually something vague about how all of the sudden in a normal labor, "things" can take a turn for the worst. That leaves it all to your imagination, as if childbirth can cause a healthy woman to convulse and die within seconds.


Other what-ifs that I hear from Big Medicine are truly inane. For example, "the baby might get stuck." That's called shoulder dystocia, and CPMs are perfectly trained to deal with it, (better trained, arguably, because they know how to handle it without reaching for the surgical tools). PPH is the other one that I hear, but doctors in so many states are trying to stop MWs from getting licensed, which would allow them (MWs) to carry pitocin. So much for these docs caring about women's safety...
 

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Quote:

Originally Posted by Turquesa View Post
Honestly, when OB's try to get all scary about HB, I rarely hear specifics. It's usually something vague about how all of the sudden in a normal labor, "things" can take a turn for the worst.
YES!!!

This is by far my biggest beef with the medical folks I've talked to about home birth: they shake their head with a gloomy expression and say, "oh, the things I've seen in my years doing OB! The things that can go wrong!" I've even said to them, "please be specific. What "things" are you talking about?" and they just shake their head again - even gloomier - and say, "well, you can just never predict what can happen..."

:

After the last conversation that went this way (with an OB nurse who teaches the hospital 'obedience training' - er, I mean, childbirth class), I just smiled and said sweetly, "Well, I don't know anyone whose birth went seriously wrong where it wasn't in some way caused or exacerbated by a medical intervention. So, as far as those 'things' are concerned, I'll take my chances in an environment where my labor is less likely to be interfered with."



Sorry about that... back on topic now.

The "things" that seem to be the biggest issue with HB appear to be those things that are immediate and unpredictable (because anything serious that is predictable or slower to arise will immediately trigger a call for a hospital transfer from any birth professional worth her salt).

Here's my list of things I'm aware of that could be a serious and immediate problem, in what I think is (more or less) the order of likelihood:
- severe postpartum hemmorhage
- baby not breathing (or similar issues with baby)
- shoulder dystocia
- cord prolapse
- weird placenta issues (placenta abruptia, placenta accretia)
- weird cord issues (like cord breaking during pushing phase, or cord wound ridiculously tight around the baby)
- ruptured uterus

The first three, midwives are trained to deal with, at least long enough to get an ambulance there, so I'm not terribly worried about these, honestly. I know my midwife has experience breaking the baby's collarbone to get out a "really stuck" baby, so I'm confident in her ability to keep my little one safe in that kind of situation.

Cord prolapse can happen anytime, including before labor begins. I imagine that plenty of people with cord prolapse intended a hospital birth but their water broke (washing the cord out with it) before they had any intention of heading in that direction. If it happened to occur in the hospital, treatment for it could be a bit faster, but I imagine it often doesn't occur in the hospital at all - regardless of the woman's chosen place of birth.

Weird placenta and cord issues, as well as ruptured uterus, are of course incredibly rare. They are potentially deadly, but my sense is that they are not much more dangerous at home than in a hospital. In fact, women often receive closer, more personal monitoring for this sort of thing from HB midwives than they do on a standard L&D floor (in our backup hospital, they don't have enough nurses for everybody, so they hook all the laboring women up to monitors and then they watch all the monitors from a central computer station). This means that someone experiencing one of these issues may receive just-as-fast or faster treatment in a transfer scenario as someone starting off in a hospital setting.

 

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Quote:

Originally Posted by Comtessa View Post
YES!!!

This is by far my biggest beef with the medical folks I've talked to about home birth: they shake their head with a gloomy expression and say, "oh, the things I've seen in my years doing OB! The things that can go wrong!" I've even said to them, "please be specific. What "things" are you talking about?" and they just shake their head again - even gloomier - and say, "well, you can just never predict what can happen..."
I really couldn't agree with you more. It has occurred to me since reading your comment that people are so vague about 'all the horrible things that could go wrong'. I think I already mentioned that in our homebirthing class held by our midwife's assistant that we took an entire class and went over all the things that could go wrong. It was basically the details of all the things you mentioned. I expected it to be all doom and gloom, and afterward, I was kind of like, "Really? That's it?" I mean, I don't take them lightly at all. But when you look at the things that COULD go wrong and how infrequently they do go wrong, it's quite the eye opener. People in medical practice make it sound so traumatic and frequent and it's just not. In my head I was assuming my midwife used the Pitocin for hemorrhage quite frequently (since that's everyone's biggest worry it seems) since she's done over 500 births, but I found out she uses the Pitocin like once very two to three years. I'd say that's pretty impressive statistically.

And I absolutely agree about the shoulder dystocia. My midwife has had that scenario a few times. In a hospital they will either send you into surgery immediately if they can or they will break the clavicle to get the baby out which is traumatic. A trained midwife, on the other hand, will have other techniques to dislodge the shoulder and only break the clavicle if absolutely necessary.

I had also wrongly assumed that having a breech baby would automatically mean going to the hospital and forgoing HB, which would obviously mean c-section. But my midwife is specially trained in birthing breeched babies if the mother is willing to put in the extra effort. She also has techniques that will usually turn the baby before birth.
 

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The funny thing is that the "concern" I hear most often is: "What if the baby's cord is wrapped around his neck". People seem to think that is a life or death situation, yet it happens a LOT and the cord is just slipped off the neck and things usually progress normally. Last I heard it happens in 1/3 of all births and is rarely an issue at all.
 

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Quote:

Originally Posted by Comtessa View Post
YES!!!
Weird placenta and cord issues, as well as ruptured uterus, are of course incredibly rare. They are potentially deadly, but my sense is that they are not much more dangerous at home than in a hospital. In fact, women often receive closer, more personal monitoring for this sort of thing from HB midwives than they do on a standard L&D floor (in our backup hospital, they don't have enough nurses for everybody, so they hook all the laboring women up to monitors and then they watch all the monitors from a central computer station). This means that someone experiencing one of these issues may receive just-as-fast or faster treatment in a transfer scenario as someone starting off in a hospital setting.
:

What I've basically come up with when trying to answer the same question for myself is: You are just as safe (more so, actually) having the baby at home as in the hospital because
A)you won't be having the baby at home if you're already high risk,
B)the "things" that can go wrong that are most frequently observed by OBs in low-risk births are usually related to the hospital intervention,
C)of the remaining 5% of normal births that have serious complications that the midwife is unable to handle, the majority are noticeable in plenty of time to transfer to a hospital, and of those that are so sudden the transfer is wasting precious time that it could affect the outcome, you're in just as much of a time crunch starting at the hospital, because they still have all of the prep work to do: call the Dr, get the staff ready, move you to the appropriate room, etc etc etc, and this will be happening during your transit if you're transferring anyway.
 

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Quote:

Originally Posted by callieollie View Post
I was talking to a friend about homebirth and this topic came up. For people/OBs who are opposed to homebirth or feel that it isn't safe, what specifically are they concerned about?
You know what is interesting? I went to a hospital maternity ward tour a week after my homebirth night class, just to get both perspectives and be certain that we felt we made the right choice in having a homebirth. At this tour, I asked our nurse "Why should I choose a hospital birth over a home birth?"

She wouldn't answer! All she said was that homebirths are perfectly safe for low-risk mothers, and that it's a personal choice which you have. At the time I was a little bit annoyed at her seeming lack of passion about her workplace, but in retrospect I really appreciate that she was trying to be considerate and supportive of the woman making her own choice.
 
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