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Why is a "good" birth experience so important, and does a Mom's need for comfort during labor override risk associtated with not having immediate access to NICU care and emergency c-sect in cases of dire need (placenta rupture or some sort of unforseen true emergency)?<br><br>
This question, has come up in conversation several times with friends who have opted for hospital births (these are nice people, many of them into AP patenting and aspects of natural family living btw, honestly seeking alternative viewpoints).<br><br>
Since this is something I'm struggling with myself I really don't have an easy answer. I feel that a Mom's comfort does help a birth proceed w/o problems and thus lessens the chance of a baby/mom's need for those emergency services. On the other hand, I feel that I have to admit that it is possible to be a statistic. Ya know, one of those one in a thousand cases where something unforseen happens where NICU or emergency care is needed and the 10 minutes it takes to get to the hospital is the difference between a minor or major emergency.<br><br>
Anyway just kinda musing and wanted to share thoughts....
 

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I believe MANY problems encountered in hospitals are CAUSED by intervention, stress, and the hospital environment. There are rare cases where a true emergency happens, even in homebirths, but most of these situations are ones that will end badly regardless of the location. EVERY single study of homebirth for low-risk women has shown better outcomes for both mother and baby. *To me* the "risk" of going to the hospital and having a bad outcome because of the intervention and medical attitudes there is bigger than my risk of having "something" go wrong at home that my midwife can't handle. Statistically speaking, I am safer at home with my good health and my history of healthy babies/easy births. Going to the hospital actually INCREASES my risk of "something" going wrong due to being given medications I do not want/need (happened to me), or having my child's umbilical cord cut too soon due to VERY light meconium, and the distress and heart decels that caused (happened to my DD), and I do not want to have to FIGHT while I am in labor to avoid unnecessary medications (doctor tried to give me pitocin for NO other reason than her convenience!), or to get needed comfort measures (my sister was not given any ice packs or ANYTHING for her episiotomy until hours and hours after she gave birth. What they eventually did was tell her DH to get a rubber glove and put ice chips in it!!! They also did not bring her any food all day that she could eat because she has food allergies, and when she asked for some food they told her the cafeteria was closed and her family had to go buy her a meal from a restaurant... for this you pay over $1,000/day. No thank you.)<br><br>
So, while I do firmly believe there are times when hospital care is very necessary and life-saving, going there "just in case" when I am NOT sick and have no reason to believe my child is sick, it just doesn't make sense to me. A "good" birth experience is a healthy birth experience, and is good for both mother and baby.<br><br>
The scare tactics used by the medical establishment against homebirth are not based on any evidence, just like so many of the procedures they inflict on pregnant and birthing women. I prefer to make my decisions based on facts, not rhetoric from people who are afraid to lose the cash cow of obstetrical "care" to midwives who treat women with respect and dignity.<br><br>
Just my thoughts... can't wait to homebirth again anytime in the next couple weeks!
 

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That is my primary reason for having a hospital birth over a home birth - I'd be afraid that if God forbid something was wrong with the baby then the 1/2 hour it takes us to get to the hospital would be too long.<br><br>
I've also had 3 hospital births with natural labors and have had great experiences, so that makes me feel better about it.<br><br>
I have learned to spend as much of my labor as possible at home - there is no reason to get to the hospital too early and I like to be in comfortable surroundings for as long as possible. It's the best of both worlds <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
Kitty
 

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Why does a mom's need for the comfort of a hospital setting outweigh the risks to both the baby and mama?
 

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cause if you have a horrible birth experience like I did you might end up with ptsd like I did and barely be able to function in the world.
 

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Discussion Starter · #6 ·
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<div>Originally Posted by <strong>KittyKat</strong></div>
<div style="font-style:italic;">I believe MANY problems encountered in hospitals are CAUSED by intervention, stress, and the hospital environment. There are rare cases where a true emergency happens, even in homebirths, but most of these situations are ones that will end badly regardless of the location. EVERY single study of homebirth for low-risk women has shown better outcomes for both mother and baby. *To me* the "risk" of going to the hospital and having a bad outcome because of the intervention and medical attitudes there is bigger than my risk of having "something" go wrong at home that my midwife can't handle. Statistically speaking, I am safer at home with my good health and my history of healthy babies/easy births. Going to the hospital actually INCREASES my risk of "something" going wrong due to being given medications I do not want/need (happened to me), or having my child's umbilical cord cut too soon due to VERY light meconium, and the distress and heart decels that caused (happened to my DD), and I do not want to have to FIGHT while I am in labor to avoid unnecessary medications (doctor tried to give me pitocin for NO other reason than her convenience!), or to get needed comfort measures (my sister was not given any ice packs or ANYTHING for her episiotomy until hours and hours after she gave birth. What they eventually did was tell her DH to get a rubber glove and put ice chips in it!!! They also did not bring her any food all day that she could eat because she has food allergies, and when she asked for some food they told her the cafeteria was closed and her family had to go buy her a meal from a restaurant... for this you pay over $1,000/day. No thank you.)<br><br>
So, while I do firmly believe there are times when hospital care is very necessary and life-saving, going there "just in case" when I am NOT sick and have no reason to believe my child is sick, it just doesn't make sense to me. A "good" birth experience is a healthy birth experience, and is good for both mother and baby.<br><br>
The scare tactics used by the medical establishment against homebirth are not based on any evidence, just like so many of the procedures they inflict on pregnant and birthing women. I prefer to make my decisions based on facts, not rhetoric from people who are afraid to lose the cash cow of obstetrical "care" to midwives who treat women with respect and dignity.<br><br>
Just my thoughts... can't wait to homebirth again anytime in the next couple weeks!</div>
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Could you share your sources of stastistics? There are so many variables at play, and I'm interesed in knowing how such things are quantified.<br><br>
FWIW my first child suffered from hospital/MD related birth complications, so I am by no means questioning anyone's choice to birth elsewhere.
 

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You can have a safe birth and an empowering birth.<br><br>
I don't feel that mothers how birth at home are forgoing their child's safety for a "good experience". On the contrary, with low-risk healthy women, birthing at home has been shown to be as safe if not SAFER for both mom and baby.<br><br>
You can have a planned cesarean and have a good birth experience. A good birth experience doesn't mean you have a homebirth necessarily. It's about TRUE INFORMED <b>CHOICE</b> (rather than *consent*) and empowerment on the mother's part.<br><br>
And, yes, I think a positive birth experience is essential - it defines who we are as women, as mothers, as lovers and partners.
 

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<div>Originally Posted by <strong>natashaccat</strong></div>
<div style="font-style:italic;">Could you share your sources of stastistics? There are so many variables at play, and I'm interesed in knowing how such things are quantified.<br><br>
FWIW my first child suffered from hospital/MD related birth complications, so I am by no means questioning anyone's choice to birth elsewhere.</div>
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I know there was one study of two groups of the same number of women with similar socio-economic staus, health, age, prenatal care, etc and the home birth group fared better. I don't remember the name, but maybe someone here will.
 

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<div>Originally Posted by <strong>pamamidwife</strong></div>
<div style="font-style:italic;">You can have a planned cesarean and have a good birth experience. A good birth experience doesn't mean you have a homebirth necessarily. It's about TRUE INFORMED <b>CHOICE</b> (rather than *consent*) and empowerment on the mother's part.</div>
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Very well said. A good birth experience is something that is totally individual - only you can say what will provide you with a good birth experience.
 

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My positive birth experiences empowered me as a person and a parent. I talk about the birth of my babies with a huge grin on my face.<br><br>
Yes, it is just one day. Keep in mind, the ripples last a lifetime.
 

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I believe that a "good" birth (whatever that is to the mother) is critical for empowering the mother in her journey. I have a holistic view of birth---what is good for me is good for baby (and vice versa). Birth is a major cultural rite of passage, and how we treat it has deep meaning for a society as well as the individual.<br><br>
Personally, I reject my culture's ingrained fear of birth and love affair with technology for technology's sake and mere convenience. I believe women deserve to birth where they feel most comfortable, safest and loved. If that's in an institution, great! Home, great! The end does not justify the means, IMO.<br><br>
PP, Are you talking about the Mehl study with matched pairs---I only wonder how much worse the stats are with the current birth climate in the US?<br><br>
According to this published study: Mehl, L., Peterson, G., Shaw, N.S., Creavy, D. (1978) "Outcomes of 1146 elective home births: a series of 1146 cases." Journal of Reproductive Medicine, 19:281-90:<br><br>
Neonatal Outcomes:<br><br>
*In the hospital, 3.7 times as many babies required resuscitation.<br>
*Infection rates of newborns were 4 times higher in the hospital.<br>
*There were 2.5 times as many cases of meconium aspiration pneumonia in the hospital group.<br>
*There were 6 cases of neonatal lungwater syndrome in the hospital and none at home.<br>
*Babies were 30 times more likely to sustain physical injury in the hospital. There were 30 birth injuries (mostly due to forceps) in the hospital group, and none at home.<br>
*The incidence of respiratory distress among newborns was 17 times greater in the hospital than in the home.<br>
*While neonatal and perinatal death rates were statistically the same for both groups, Apgar scores (a measure of physical well being of the newborn) were significantly worse in the hospital.<br><br>
The Maternal Outcomes of the Mehl Study show mothers in hospitals have a five-fold increase of maternal hypertension during labor and a three times higher rate of postpartum hemorrhage than mothers at home. According to Mehl, 1977, the low use of obstetric interventions during planned homebirths explains the discrepancy between hospital and home outcomes.
 

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<div>Originally Posted by <strong>georgia</strong></div>
<div style="font-style:italic;">I believe that a "good" birth (whatever that is to the mother) is critical for empowering the mother in her journey. I have a holistic view of birth---what is good for me is good for baby (and vice versa). Birth is a major cultural rite of passage, and how we treat it has deep meaning for a society as well as the individual.<br><br>
Personally, I reject my culture's ingrained fear of birth and love affair with technology for technology's sake and mere convenience. I believe women deserve to birth where they feel most comfortable, safest and loved. If that's in an institution, great! Home, great! The end does not justify the means, IMO.<br><br>
PP, Are you talking about the Mehl study with matched pairs---I only wonder how much worse the stats are with the current birth climate in the US?<br><br>
According to this published study: Mehl, L., Peterson, G., Shaw, N.S., Creavy, D. (1978) "Outcomes of 1146 elective home births: a series of 1146 cases." Journal of Reproductive Medicine, 19:281-90:<br><br>
Neonatal Outcomes:<br><br>
*In the hospital, 3.7 times as many babies required resuscitation.<br>
*Infection rates of newborns were 4 times higher in the hospital.<br>
*There were 2.5 times as many cases of meconium aspiration pneumonia in the hospital group.<br>
*There were 6 cases of neonatal lungwater syndrome in the hospital and none at home.<br>
*Babies were 30 times more likely to sustain physical injury in the hospital. There were 30 birth injuries (mostly due to forceps) in the hospital group, and none at home.<br>
*The incidence of respiratory distress among newborns was 17 times greater in the hospital than in the home.<br>
*While neonatal and perinatal death rates were statistically the same for both groups, Apgar scores (a measure of physical well being of the newborn) were significantly worse in the hospital.<br><br>
The Maternal Outcomes of the Mehl Study show mothers in hospitals have a five-fold increase of maternal hypertension during labor and a three times higher rate of postpartum hemorrhage than mothers at home. According to Mehl, 1977, the low use of obstetric interventions during planned homebirths explains the discrepancy between hospital and home outcomes.</div>
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Yes! Thank you!<br><br>
I have also read that the U.S. has the lowest rate of home births and the highest rate of intra and post partum infant and maternal injury and death than any other developed nation. I definitely see a correlation.<br><br>
I do think however that a woman should have the birthe xperience she wants- home or hospital. I just think it is sad that our society instills women with fear that they must birth in the hospital, and that they cannot trust their bodies.
 

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Addressing purely the mother's perspective, asking why a "good" birth is important is kinda like asking why not being raped is important.
 

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<div>Originally Posted by <strong>girlndocs</strong></div>
<div style="font-style:italic;">Addressing purely the mother's perspective, asking why a "good" birth is important is kinda like asking why not being raped is important.</div>
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Exactly.
 

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All of the statistics showing that a hospital birth is actually less safe for Mom and Baby are because of unnecessary interventions that cause problems.<br><br>
I had a completely natural, unmedicated hospital birth (arrived at the hospital at 6cm) after laboring at home for 9 hours. It went exactly as I had planned unlike my first birth where I was not as prepared and empowered.<br><br>
An unmedicated hospital birth with no interventions, for me, is a fine and safe choice. All of my birth choices are discussed beforehand, agreed to, and I have my dh and a doula to support and advocate for me during labor.<br><br>
I think a good birth experience is one where the Mom feels safe and supported and in control. That can be at home or in a birth center, or at a hospital.
 

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If there was a true emergency where 10 minutes in a car ride would be too long, a skilled professional home birth attendant should know enough to call 911 and stabilize the situation until they arrive. Every midwife that I've hired comes prepared with oxygen tank, medications for injection if necessary, etc.<br><br>
I really don't think people are selfishly choosing to have babies at home because they like it better and then if there is a problem they run to the car and rush to the hospital. Who doesn't like their home better than a hospital? Even IF someone makes a homebirth decision based on that reasoning, that's not the facts. The facts are that hiring a birth professional to attend your birth means that you are hiring someone with the knowledge of how to handle complications should they arise.<br><br>
Even in a hospital, should the need arise for an emergency c-section, it's not going to be immediate. They would have to make sure there was an open surgery room and make sure there was an anesthesiologist (if the mother didn't already have an epidural in place) and a team to perform the surgery. PLUS, they would have to transfer the mother from the L&D room to the surgery room. If the ride from home to hospital is only 10 minutes, then a midwife can call ahead and ask them to begin prep for the c-section.<br><br>
Aside from emergency measures, homebirths have less complications in general. Also, the signs of complications are generally apparent well before there is a life or death emergency. I can't even think of a life/death emergency which would suddenly suprise a home birth team and be completely beyond the scope of their ability to stabilize the situation and respond appropriately.<br><br>
Note: This response is only addressing attended homebirths, not UC.
 

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<div>Originally Posted by <strong>the_lissa</strong></div>
<div style="font-style:italic;">Why does a mom's need for the comfort of a hospital setting outweigh the risks to both the baby and mama?</div>
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LOL <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up">
 

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Here are some US studies, there are lots of studies from other countries too but I think it is good to see ones done with our own population. Being that the studies were within the context of our culture and such.<br><br>
Burnett CA et al. Home delivery and neonatal mortality in North Carolina. <i>JAMA</i> 1980;244(24):2741-2745 <i>(the neonatal mortality in planned homebirths and unplanned homebirths were compared. Planned outcomes were identical to hospital births (6/1000 and 7/1000) and the rate of death among the unplanned was much higher (120/1000)</i><br><br><br>
Hinds MW, Bergeisen GH and Allen DT. Neonatal outcome in planned v unplanned out-of-hospital births in Kentucky. <i>JAMA</i> 1985;253(11):1578-1582. <i>(another planned vs unplanned study)</i><br><br>
Schramm WF, Barnes DE, and Bakewell JM. Neonatal mortality in Missouri home births. <i>Am J Public Health</i> 1987;77(8):930-935. <i>(again, a planned vs unplanned study)</i><br><br>
Mehl LE et al. Outcomes of elective homebirths (this is the same one already written about in the above post)<br><br>
Sullivan DA and Beeman R. Four years' experience with home birth by licensed midwives in Arizona. <i>Am J Public Health</i> 1983;73(6):641-645. <i>("Evidence from this study population strongly suggests that home delivery is a safe alternative for medically screened healthy women")</i><br><br>
Koehler MS, Solomon DA, and Murohy M. Outcomes of a rural Sonoma county home birth practice: 1976-1982. <i>Birth</i> 1984;11(3):165-169.<br><br>
Anderson R and Greener D. A descriptive analysis of home births attended by CNMs in two nurse-midwifery services. <i>J Nurse Midwifery</i> 1991;36(2):95-103<br><br>
Duran AM. The safety of home birth:The farm study. <i>Am J Public Health</i> 1992;82(3):450-453.<br><br>
All these and more are in the book <i>Obstetric Myths vs Research Realities</i> by Henci Goer, anyone interested in this topic should have this book. It also has research regarding many of the typical hospital interventions (AROM, pitocin, EFM, c-sections, all kinds of pregnancy and labor management)<br><br><br>
Now to answer the question simply, as a healthy pregnant woman I feel it is a huge risk to myself and my baby stepping into a hospital unless there is a known or suspected problem. If there isn't one, and you eneter a hospital, they will surely find one and try to "fix" you and manage your labor often causing complications that would not have arose in the home enviornment. Simple as that.
 

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<div>Originally Posted by <strong>kunama</strong></div>
<div style="font-style:italic;">cause if you have a horrible birth experience like I did you might end up with ptsd like I did and barely be able to function in the world.</div>
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I was going to say something close to this. After having a HORRIBLE birth i will never go to a hospital again unless i am faced with a complication that warrants it. I don't give a flying hoot about "what ifs" either way. What if we aren't there and something happens OR what if this hospital/doctor is different?<br><br>
Anyone who HAS gone through a horrible birth experience won't ask those questions. (not trying to be argumentative or mean by that statement)
 

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<div>Originally Posted by <strong>mara</strong></div>
<div style="font-style:italic;">Now to answer the question simply, as a healthy pregnant woman I feel it is a huge risk to myself and my baby stepping into a hospital unless there is a known or suspected problem. If there isn't one, and you eneter a hospital, they will surely find one and try to "fix" you and manage your labor often causing complications that would not have arose in the home enviornment. Simple as that.</div>
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Just to play devil's advocate, why is it a guarantee that the hospital will try to find a complication and then fix it? If you have had discussions with your ob/cnm beforehand and it is clear that you will not have IV/EFM/any interventions etc. the nursing staff need only be told that by you, your support person or doula and given a copy of your birth plan.<br><br>
I found it quite empowering to give birth in the hospital setting completely unmedicated and with no interventions. The nursing staff respected me and my doctor did everything that I asked her to do (or not to do). Perhaps my situation was out of the norm but a hospital experience can be pleasant and safe, too.
 
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