Free Birthing

[megumic]

Date: 3/9/2010 9:16:00 PM
Author: Jas12
I think birth is something that is meant to be supported. Part of our social nature as human beings is to be surrounded by others, and that goes for birth. Not too many ppl go at it alone. Other social animals like dolphins have what appears to be a midwife support system. Throughout time, woman have looked to older, experienced woman (and now doctors/nurses/OBs/doulas etc) to provide guidance for birth.
So for that reason i wouldn''t want to do it alone, not to mention i would not want to deal with a complication during that crazy time. Deep emotion gets involved when it''s your own child/spouse at risk and i don''t know if a husband or wife could act appropriately even if they had planned ahead of time. That part scares me.

I will say this about hospital birth vs home birth : (sorry if i repeat, i didn''t read the whole thread).
Hospital births are NOT safer for low risk woman. They are about the same risk as *assisted* home births. A huge canadian study was just done on this topic and showed the same result. The problem with stats in the past is that in the category of ''home birth'' they included unplanned, unassisted home births (like toilet bowl births) in the stats.

I wouldn''t go for a free birth, but i can see where it stems from...
The USA has one of the WORST maternal and infant death rates of the developed nations, yet some of the HIGHEST use of medicine and surgery in birth. So ppl should not be lulled into a sense of security in a hospital.
I think we have a tendency to just blindly trust medicine, but medicine and birth don''t always mix well. It totally floors me that people ignore this. Most ppl spend more time researching the purchase of a new appliance than the standard care & drugs they''ll receive for the birth of their child. We claim we want what is best for child and mom, but then subject ourselves to all sorts of procedures that may do the opposite. I think many free birthers know this, but then take it to the next level of rejecting ALL support.

I guess when something goes wrong in a hospital we don''t question it and think ''well, it could have been worse, we did what the doctor said, etc. etc.''. You would *never * hear ''well, if only you were at home''. Even though, in some cases being home might have been best (as was the case of girl in my city who''s baby died after contracting a bacteria that was in the hospital at the time of birth) but when something goes wrong at home, we alone are left with the burden of guilt and questioning. I am sure that''s a big reason ppl avoid birthing at home (especially Free birthing) There is that potential for judgment. God knows if my home birth goes badly, i would feel like ppl would be thinking ''she put the baby at undue risk by doing it at home'' even tho I know that from a purely statistical perspective, this isn''t true
So anyway, every mom does what they think is right for their family. Some ppl think it''s selfish and foolish to have a birth without doctors around, some think its selfish & foolish to schedule your induction or c-section b/c it fits into your schedule better. We are human, we have different motivations and i guess at the end of the day, only we alone need to be comfortable with our decision.

I agree with a lot of what you mentioned and appreciate your thoughts. I do think we trust medicine entirely too much and that we are quick to trust a doctor''s judgment or opinion without giving it much thought. Births in the US are far over-medicalized.

I also think being in a hospital makes "patient" moms much more accepting of a doctor''s position. I think doctors tend to play the safety card constantly and while I''m a conservative when it comes to health care, giving birth and pregnancy are not medical conditions. Instead of giving the mother a chance to just labor and birth, often doctors raise minor concerns that might possibly maybe could turn serious in several hours if things don''t progress, but we had better do something immediately type of over hazardous attitude. This makes mothers nervous and in such a moment, I too would defer to the doctor. But if I were home, this potential not yet mature threat wouldn''t even come about in such a fashion.

 

[waxing lyrical]

The stories part of the DH special are not anything like UC I''m familiar with. I know a lot of UC''ers. Shoot, I''ve had to plan/prepare for UC twice because I precip and will have to prepare for yet another one with the next baby.

The women I know that UC (some UP) are highly educated and well researched. It''s no light matter, forgoing a birth attendant. It isn''t something that is decided on overnight. Most I know spent a good deal of time contemplating their choices and preparing and educating themselves on what can take place.

I''ve spent the last 5 years focusing on matters related to pregnancy and childbirth. I won''t step foot in a hospital unless absolutely medically necessary. I fully support informed choice and a woman''s right to choose her birth place. I, however, much prefer having a midwife, though I/we have no qualms with preparing for a UC. With ds2, my fear was cord prolapse due to my severe case of polyhydramnios. My midwife and I discussed measures we could take to lessen the chance of PROM and cord prolapse. We talked about doing a controlled AROM. It never came down to that, but I knew what to do in the event of PROM and cord prolapse. It would call for immediate medical attention and an emergency c-section.

No pp hemorrhage problems with the women in my family. I''ve never had bleeding problems. However, in the event of pp hemorrhage, I had hemhalt and sheperd''s purse on me. Both very good at treating pp hemorrgage. Putting baby to the breast to signal the body the baby and placenta have been birthed also helps the uterus to contract and close off open blood vessels. I''ve even known moms to cut off a piece of the placenta and place under their tongue so the hormones can signal the body to do what it needs to do.

I was never worried about it, but was prepared. I was more aware of SD as I know with larger babies their shoulders can get stuck behind the pubic bone during rotation. I knew what maneuvers (Gaskin and McRoberts) to do in the event babe got sticky shoulders. True SD is extremely rare and happens most often when mom is pushing in the lithotomy position as it narrows the pelvic outlet.

Intermittent monitoring isn''t difficult to perform. I have my own doppler. The same kind used by OBs and midwives. I also have a BP monitor.

I spent time going over everything from malpositioned baby (often the result of induction and mother''s position during labor/birth) to mec stained fluids and non-reassuring heart tones, which is uncommon in non-augmented/induced births. I knew it to be normal for heart tones to decel during a contraction and pick back up after it was over. I knew that prolonged heart rate decels can be a sign of a problem, especially after position changes (babe can be lying on the cord). In the event of ROM I knew to keep my hands out of my vagina (yes, I checked my cervix -- not that difficult to do) to lessen the chance of infection (VEs after ROM increase the chances of infection). I also knew to check my temp after membranes have been ruptured for a certain amount of time. Maternal fever can also lead to fetal tachycardia.

The three main things I focused on when preparing for UC with my boys were pp hemorrhage, SD and mec stained fluids. Even though there was a small chance I''d have to face these situations it was vitally important I informed myself. With my history it would have been irresponsible not to.

 

[natalina]

Even with tons of research and support, I was still so scared about the whole birthing experience, there was NO WAY I would have considered birthing at home. Now that I have been through childbirth (in a hospital) and it was much better than I thought it would be, I still would be too nervous to do it at home, but say kudos to the homebirthers out there! I am seriously in awe of you! As for free birthing- sorry to say I agree with those that say it''s nutso.

In regards to hospitals/interventions, I will say that I often wonder if I should have asked to go longer without Pitocin to see how I would progress. I went into labor Saturday night and didn''t go to the hospital until Tuesday evening. Water broke on its own shortly after arriving at hospital. They put me on Pitocin pretty quickly, and I ended up pushing Weds morning for almost 3 1/2 hours- and they ended up using suction, too. I feel like if we had skipped/delayed the Pit, maybe DD would have been more "ready" to make her appearance and the pushing stage would not have been so long or difficult. But she arrived healthy, so no regrets!

 

[waxing lyrical]

Date: 3/9/2010 3:52:59 PM
Author: rockpaperscissors67
The umbilical cord around a baby''s neck is not an emergency, although many people think it is. Please see this page, which contains information and links to studies. That page states that ''Nuchal cords rarely cause fetal demise and are not intrinsic reasons for intervention.'' My 14 year old son had the cord wrapped around his neck once and it broke when the doctor tried to slip it over his head. My 5 week old had the cord wrapped around his neck three times, which is quite rare.


That page also goes on to say that a cord that''s constricted can''t be diagnosed prenatally and most infants with it are stillborn. Is being in the hospital going to save that baby? Nope.


I get the impression that some of you think that the people that choose UC do so without putting any thought or planning into it, which is far from the truth in my experience. You don''t just decide, ''Hey, I''m going to have this baby at home with no preparation or planning!'' Instead, you learn as much about birth and the possible complications as possible so that you ARE prepared if something goes wrong. The partners are also prepared so that they know what to do if the laboring woman can''t tell them.


Take post-partum hemorrage, for example. Preparation for that includes knowing how much blood is too much and what that amount looks like, which may involve doing a trial run of birth by spilling a colored liquid in the same amount either on chux pads or into a filled birth tub. To avoid hemorrage, you want to get the baby to your breast asap to encourage contractions to deliver the placenta, allow the placenta to detach naturally (no pulling on it!), and afterwards, do fundal massage. Shepherds purse and cayenne tincture are 2 things you can use to avoid or help stop a pph, as well as continued nipple stimulation, and if the woman has already delivered the placenta, eating a piece of it will help. It''s not like pitocin is the only game in town!


UC might be silly, irresponsible and selfish to many of you, but it seems that this is a visceral reaction to something outside the norm, rather than an opinon based on education about and experience with childbirth or interaction with UCers. If we''re basing opinions on the risk to the child, is there the same attitude about co-sleeping, delayed vaccinations, using formula, feeding fast food or allowing a child to play contact sports?

Thank you for dispelling the myth behind nuchal cords. More can be read
here. Cord stricture is extremely rare and more often results in stillbirth. Many times there''s a cord abnormality, like short cord or Wharton''s Jelly defect, that leads to issues either before or during labor. If the cord is too short and wrapped around the neck then it can prevent baby''s descent and reduce blood flow. If there''s a knot and Wharton''s Jelly defect then it can reduce or cut off blood flow. It would take a lot, serious entanglement or stricture to actually cause death. To the bold, that''s exactly what I did. Midwife told me how to spot what too much blood loss looks like.

 

[qtiekiki]

Blenheim
I do consider UC as free birth, but I was confused by RPS b/c I thought she was using as if she has an UC. And I was asking her to clarify for her situation. Then I realized that she just meant that she would consider UC not saying that her last L&D was an UC. Thanks for your response though.

 

[Dreamer_D]

Date: 3/9/2010 5:30:45 AM
Author: Pandora II

Date: 3/8/2010 10:59:17 PM
Author: megumic

Date: 3/8/2010 10:09:43 PM
Author: dreamer_d
OK PEOPLE


I just read the rest of the comment.


Home birth when supervisd by a midwife is NOT the same thing as ''free birth''. Supporting a woman''s right to choose does not extent to blantant insanity. I don''t think that we should support people giving themselves an apendectomy at home, so why support this?

And yes yes, they are not the same thing because birth is natural etc. But there are risks and those risks need to be given real weight when considering how to birth your child. No, it is not a mdeical emergency. But it is the one place where women still routinely die and babies also die. That means no birthing in the woods in my book.


And I am very pro midwife. Had one myself. But it is just very bizarre to me to think of giving birth without an attendant.

Women and babies routinely die in car crashes everyday too, but that doesn''t stop us from leaving the house. While I personally am not a proponent of free birthing, for some women the benefits outweigh the risks. It may be insanity to you, but the free birthing mom''s may think going to the hospital to birth is insane. I don''t think it''s about supporting or not supporting free birthing, I think it''s about letting a couple and the mother choose their own methods of giving birth, as opposed to what society thinks is the ''right'' way for women to give birth and what is mainstream.

I agree 100% that it is bizarre to give birth without some sort of professional assistance, but I stand by women having the option to birth as they please. We don''t have laws against women drinking or smoking while pregnant, which is undoubtedly harmful to the baby, so why should we have laws about how women should give birth, which may or may not be harmful to the baby?

Sorry, but exactly what are the benefits of free-birthing compared with a professionally assisted home-birth other than pandering to some selfish woman''s ego?

First, haha Pandora.

Second, we wear safety belts in cares by law, and out kids are in car seats by law. Same parallel here in my book, if you want to make the argument about driving being akin to childbirth.

Third, I am not even concerned about this for the sake of the baby (that is a can of worms)... I honestly think that unless this is a woman''s sixth child and she is personally trained in midwifery, then the woman who would choose this is diplaying such a lack of judgement that I would worry for *her* safety and would worry about her ability to be making choices like this. Listen, I am as big a feminist as you will find. I don''t talk the talk, I walk it. But I still think that we can and should have regulations regarding health care and safety standards that are designed to help people make choices when they do not have all the necessary knowledge to make them, or when people routinely make poor choices because they do not want to accept that bad things can happen.

 

[Mrs Mitchell]

Date: 3/10/2010 2:32:28 AM
Author: dreamer_d

Date: 3/9/2010 5:30:45 AM
Author: Pandora II

Date: 3/8/2010 10:59:17 PM
Author: megumic

Date: 3/8/2010 10:09:43 PM
Author: dreamer_d
OK PEOPLE


I just read the rest of the comment.


Home birth when supervisd by a midwife is NOT the same thing as 'free birth'. Supporting a woman's right to choose does not extent to blantant insanity. I don't think that we should support people giving themselves an apendectomy at home, so why support this?

And yes yes, they are not the same thing because birth is natural etc. But there are risks and those risks need to be given real weight when considering how to birth your child. No, it is not a mdeical emergency. But it is the one place where women still routinely die and babies also die. That means no birthing in the woods in my book.


And I am very pro midwife. Had one myself. But it is just very bizarre to me to think of giving birth without an attendant.

Women and babies routinely die in car crashes everyday too, but that doesn't stop us from leaving the house. While I personally am not a proponent of free birthing, for some women the benefits outweigh the risks. It may be insanity to you, but the free birthing mom's may think going to the hospital to birth is insane. I don't think it's about supporting or not supporting free birthing, I think it's about letting a couple and the mother choose their own methods of giving birth, as opposed to what society thinks is the 'right' way for women to give birth and what is mainstream.

I agree 100% that it is bizarre to give birth without some sort of professional assistance, but I stand by women having the option to birth as they please. We don't have laws against women drinking or smoking while pregnant, which is undoubtedly harmful to the baby, so why should we have laws about how women should give birth, which may or may not be harmful to the baby?

Sorry, but exactly what are the benefits of free-birthing compared with a professionally assisted home-birth other than pandering to some selfish woman's ego?

First, haha Pandora.

Second, we wear safety belts in cares by law, and out kids are in car seats by law. Same parallel here in my book, if you want to make the argument about driving being akin to childbirth.

Third, I am not even concerned about this for the sake of the baby (that is a can of worms)... I honestly think that unless this is a woman's sixth child and she is personally trained in midwifery, then the woman who would choose this is diplaying such a lack of judgement that I would worry for *her* safety and would worry about her ability to be making choices like this. Listen, I am as big a feminist as you will find. I don't talk the talk, I walk it. But I still think that we can and should have regulations regarding health care and safety standards that are designed to help people make choices when they do not have all the necessary knowledge to make them, or when people routinely make poor choices because they do not want to accept that bad things can happen.

I wouldn't dream of having an unassisted birth. I would not have a great deal of respect for someone who told me that was their choice. I don't see any benefit at all.

All that said, I am far more horrified by the notion of any legislation that dictates what a woman does with her own body. Compelling people to accept any form of medical treatement, having their own decisions over ruled by a professional is a dangerous thing, if you look back through history. Also, what about people who do have the knowledge to make choices? Should they be over ruled too?

Not a choice I'd make in a million years, but a choice, nonetheless.

 

[icekid]

Date: 3/9/2010 10:29:14 PM
Author: megumic

Date: 3/9/2010 9:16:00 PM


I also think being in a hospital makes ''patient'' moms much more accepting of a doctor''s position. I think doctors tend to play the safety card constantly and while I''m a conservative when it comes to health care, giving birth and pregnancy are not medical conditions. Instead of giving the mother a chance to just labor and birth, often doctors raise minor concerns that might possibly maybe could turn serious in several hours if things don''t progress, but we had better do something immediately type of over hazardous attitude. This makes mothers nervous and in such a moment, I too would defer to the doctor. But if I were home, this potential not yet mature threat wouldn''t even come about in such a fashion.

Slight thread jack- If you don''t like physicians who practice conservative, CYA (cover your a**) medicine, then PLEASE by all means speak to your representative. This is an issue that will not change without tort reform and NOT the fault of physicians. Despite your claim that "pregnancy is not a medical condition," it is often complicated by things that ARE medical conditions. Obstetricians have some of the absolute highest malpractice insurance because parents WILL sue. Many are leaving certain states in droves because of this issue. Tort reform is necessary, but far from a priority of our current legislative branch.

And I''ll ditto cara, very well said.

 

[Pandora II]

For those who practiced looking at what a PPH looks like... well, I've seen the real thing and it happened very fast. Over half your blood volume spreading over the floor is not a sight you forget! It was round about the time that my BP was 63/39 and I lost conciousness as they tried to pass me the baby to feed to help reduce it. I wouldn't even have got as far as the telephone if I'd been alone.

The surgical team did everything they could... rubbed up contractions, got the placenta delivered asap (managed 3rd stage is one of the greatest contributors to lowering incidences of PPH) and got fluids into me. I then had FIVE transfusions over the next two days.

Just out of interest, how would you manage a complete uterine prolapse on your own?

My father spent 30 minutes with his hand shoved right up holding a woman's uterus in following the birth of her 7th child in a tiny operating theatre on a pacific island two thousand miles from a big hospital. He also saved a woman whose baby was transverse and it took 3 days in a canoe to reach him when things went wrong... guess I grew up hearing too many of those stories to be interested in anything but a nice big hospital!

 

[steph72276]

I''m confused. I can see how someone would want a home birth. However, what exactly would be the benefit of not having a trained professional there to help in case of an emergency? Maybe I''m missing something.

 

[waxing lyrical]

Date: 3/10/2010 10:23:49 AM
Author: Pandora II
For those who practiced looking at what a PPH looks like... well, I''ve seen the real thing and it happened very fast. Over half your blood volume spreading over the floor is not a sight you forget! It was round about the time that my BP was 63/39 and I lost conciousness as they tried to pass me the baby to feed to help reduce it. I wouldn''t even have got as far as the telephone if I''d been alone.


The surgical team did everything they could... rubbed up contractions, got the placenta delivered asap (managed 3rd stage is one of the greatest contributors to lowering incidences of PPH) and got fluids into me. I then had FIVE transfusions over the next two days.


Just out of interest, how would you manage a complete uterine prolapse on your own?


My father spent 30 minutes with his hand shoved right up holding a woman''s uterus in following the birth of her 7th child in a tiny operating theatre on a pacific island two thousand miles from a big hospital. He also saved a woman whose baby was transverse and it took 3 days in a canoe to reach him when things went wrong... guess I grew up hearing too many of those stories to be interested in anything but a nice big hospital!

One can use very rare situations as an argument for OOHB altogether, whether a birth attendant is present or not. If mom has a severe case of PPH nothing is going to stop it. Not a shot in the leg with pitocin, hemhalt, sheperd''s purse--nothing. It doesn''t matter if a midwife, EMS or OB is present.

What is the occurrence of complete uterine prolapse? What''s the occurrence of complete placental abruption or overt cord prolapse? That can happen anywhere if membranes rupture. The right conditions have to be in place for such to occur. What about cord compression? A friend of mine lost her daughter mere minutes before birth to cord compression while in the hospital. She had CFM as well. Another friend lost her daughter and almost lost her life to complete placental abruption. Monitoring heart tones at home saved her life as had she gone to the hospital she would have been sent home because she was in early labor. She labored briefly at home with her midwife. Had some spotting, which isn''t unusual in early labor/cervical change. Nothing alarming. They checked heart tones and they were low, 80''s. They decided to head to the hospital when she started bleeding more and felt dizzy. She recovered. They decided to check heart tones again and nothing. Got to the ER and that''s when blood gushed everywhere. Her daughter was gone and she was rushed in for a crash c-section. Lost tons of blood. Had multiple infusions.

Her case was rare. Very rare. She just went on to have a beautiful VBAC in Jan and plans on a homebirth with the next baby. Really, what she went through could have taken place anywhere. She was only 3 cm. In early labor. Another friend lost her son 12 hours after birth in the hospital due to undiagnosed vasa previa and velamentous cord insertion. It should have been detected. I know of a midwife that lost her 5th or 6th baby to SD in a homebirth. A woman whose baby died as a result of the obstetrician on duty that freaked out when her son''s shoulders got stuck behind the pubic bone. He tried pulling/tugging on the head, a big no-no, and when he couldn''t figure out what to do next he performed the Zavanelli maneuver and by the time she went in for the c-section he was gone. He should have tried other maneuvers to free the baby''s shoulders. Zavanelli is a last resort before a c-section. His freaking out and panicking resulted in her baby''s death. I''ve read and heard it all. Hospital, homebirth and UC horror stories. Being friends with other mothers that have lost babies certainly opens one''s eyes to all sorts of situations that can occur during pregnancy and birth.

It''s sad that mothers are treated poorly when medical attention is needed whether it''s UC or homebirth. A friend that UC''d received a lot of flack from family and medical personnel when they had to call EMS because her son was born depressed and not breathing. Come to find out he had congenital diaphragmatic hernia that went undiagnosed prenatally (she didn''t UP). Had our first son not died before labor he would have passed either during or shortly after labor. It would have been blamed on the homebirth when really it was his undiagnosed heart defects that caused his death. There are so many factors involved when it comes to a baby dying in or after childbirth. Not all can be blamed on place of birth or who is in attendance.

In any case, if we''re going to use extreme and rare situations as the basis of an argument then it should apply to just about everything. Amniotic fluid embolism is extremely rare and very deadly obstetric condition. What should pregnant women do to increase their survival chances should this rare condition occur? How ''rare'' or uncommon does something have to be in order to safely assume it''s not likely to happen?

PPH is often associated with a heavily managed labor (e.g., pitocin and misoprostol). Pitocin and misoprostol can lead to uterine atony and thus measures needed to treat hemorrhage. Some moms have an undiagnosed blood clotting disorder. There are ways to lessen the likelihood of very serious complications. My midwife with my last baby has been attending births for 20 years. She''s yet to lose a mom. She has had moms with excessive bleeding, but none that required emergency medical attention.

When going over my birth history she did ask many times if I had any issues with bleeding as very precipitous births can lead to uterine atony and excessive bleeding. Uterine atony accounts for the majority of PPH cases and uterine atony can be caused by a myriad of interventions. In my case it made sense to prepare for a UC as there was no guarantee my midwife would make it.

Anyhoo, enough of that.

 

[sbde]

FL Steph - if i remember the documentary clearly, the most common reasons women gave for not wanting anyone there were their previous bad experiences with medical professionals or that women had been dealing with childbirth alone forever and so it was a completely natural thing to do.

 

[steph72276]

I guess I just don''t get why they wouldn''t at least want a trained professional on standby in another room for those rare emergencies that do occur. That would be like riding around in your car without auto insurance, sure you''re probably not going to get into an accident, but they happen everyday.

 

[anchor31]

I don''t get the "it''s natural" argument. So is a stroke... And nobody would want to go through that unassisted. Sure, women have been doing that for ages... They''ve been dying of it for ages too. I also don''t buy the "problems are extremely rare" argument. Because it''s rare doesn''t mean it doesn''t happen, and it reminds me of the "it won''t happen to me" magical thought. I believe that preparing for the unexpected is part of responsible parenting. You want to labour on your own fine, but at the very least have a midwife standing by in your home.

 

[waxing lyrical]

Date: 3/10/2010 12:28:11 PM
Author: FL Steph
I''m confused. I can see how someone would want a home birth. However, what exactly would be the benefit of not having a trained professional there to help in case of an emergency? Maybe I''m missing something.

I won''t say this is the case for all UC''ers, but some of the ones I know have had homebirths or want a homebirth, but financial situations prevent them from hiring a midwife. While some insurance providers cover homebirth, you don''t get reimbursed until after the birth. That means the family has to come up with $2500-10+k (varies based on region/area) before the birth.

Others just feel they can birth without an attendant present. They trust birth and spend a good deal of time preparing and researching and getting certified in infant CPR and reading what they can on NR. Emergency Childbirth manual is a favorite among homebirthers and UCers. There can be many reasons why one would want a UC. Birth philosophy and spiritual/religious beliefs has a lot to do with it for some.

I don''t find it unusual. It''s not for me, as in, I fully intend to have a midwife present for future births even though we prepare for a UC, but I ''get'' it. I love the relationships I have with my midwives/birth teams. I don''t want to give that up.

 

[somethingshiny]

waxing~ I just had to say that I think you''re smart about preparing for UC even though you intend on having a midwife present. When you''re only depending on a finite number of people to assist, I think it''s appropriate to know as much about UC as you can just in case it becomes necessary. However, I still think intentional UC is way too risky.

 

[Hudson_Hawk]

Date: 3/10/2010 12:55:23 PM
Author: FL Steph
I guess I just don''t get why they wouldn''t at least want a trained professional on standby in another room for those rare emergencies that do occur. That would be like riding around in your car without auto insurance, sure you''re probably not going to get into an accident, but they happen everyday.

I agree. I think it''s totally selfish.

 

[Puppmom]

You make a good point, Anchor. *Problems* really aren''t that rare but some of them are taken care of so easily with the proper medical care that we don''t think of them as problems.

 

[LtlFirecracker]

I have seen first hand too many of those "super rare" medical problems to consider them that rare. Many of the worst deliveries I have seen were going fine until the last few minutes....I remember one baby who''s shoulder got stuck for 3 minutes...I am so glad that the neonatologist (with 25 years experience) showed up from the next hall to help get that first breath into the baby.

I have seen many mothers and babies who would have died had there not been an operating room around the corner ready to go at any minute. And the hospital I trained at did have midwives, and for those low risk woman who wanted it, natural births were an option and supported. The OB''s did not get involved in those cases unless a mid-wife came to them and asked for help.

I could never give birth at home after what I have seen. And I want a trained professional at my delivery. I can take care of other people''s children, but I know my emotions would get in the way of making rational decisions for my own child and would want to turn that over to another professional who could take a step back and give a more objective opinion.

I am also as feminist as they come, but I am also an advocate for the rights of the child who has no voice in these kinds of situations. I don''t think unassisted births should be "just another option" as it could potentially endanger the child.

 

[Dreamer_D]

Just a comment that came to mind reading some of the recent posts...


I live in Canada where midwives are government funded and approved medical proctitioners with limited hospital privaleges. The midwifery practice that I worked with had 10 midwives and assisted at 400 births each year. Of those, about 20% wanted home births. But only about 2% actually had home births and none were first babies. I don''t know anyone who successfully had a home birth for their first child, all were transferred for the reasons cited in the research Blen posted. Homebirth is safe because midwives make infrmed decisions to transfer care to a hospital *before* emergencies happen. And since I too could not even choose between Gatorade and water when I was in labour

, that forethought it why an attendant is so important.

 

[misssoph]

Its a strange strange world!
For years I have donated money to a fistula hospital in Ethiopia that repairs the obstetric injuries that make women unable to control bladder/bowel function and make them shunned by their communities. These are women who give birth without even the option of a skilled birth attendent. This program also trains midwives so that the women in these communities can have a midwife present at their births which has greatly improved both maternal and infant deathrates.
It is true that most births are uncomplicated and I understand why you would wish to give birth in a non-hospital environment but not to have a midwife present...To plan to give birth without a skilled birth attendant seems to me an act of great selfishness: to put your own idealised "birth experience" so far above the health and safety of your child.

 

[Jas12]

Waxing, i think you are very well educated in birthing and make some important points. We can *always* come up with examples where we deem medicine as "saviour" but we ignore the thousands of births each day that are complicated by medicine. Oftentimes medicine saves itself from well, itself.
.....
IMO what we need is a good balance. As DD said, midwives in canada are *highly* trained (4 years of universtity education with hundreds of more hours observing natural birth than an OB would ever recieve). The fact that their home births turn out to be as safe as a hospital, with a fraction of the complication rates, is a good reminder that there is a better way to do things. A balance of medical education and good old fashion coaching and the expertise to know what should happen when. One in three births is NOT an emergency (as c-section rates would suggest) so we need to get this number way down. We don''t need to banish medicine from birth, we need to utilize it when necessary, have it available, but try to let birth happen the way it is intended to happen. The only person i know that recieved zero pitocin for her birth was a homebirther. Does that not strike anyone else as odd? We shouldn''t have to birth at home or birth alone to have access to an environment that is both supportive and offers access to modern medicine. But it seems like that is how things are....

Anchor--i totally think a midwife or someone should be present. But the comparison b/w a stroke and childbrith is well...

. Childbirth is woman''s body at it''s most powerful.The body is perfectly designed to do it even tho most of us don''t have the confidence in it. Seriously, complications aside, it''s crazy what we can do. It is 100% meant to happen (the pain, bleeding, stretching etc.) That is SO not the case of a stroke or any other disease that either ends in permanent disablity or death and is a result of something going terribly wrong in our bodies

 

[partgypsy]

Jas - I think your experiences regarding pictocin are unusual. The vast majority of women I knew who gave birth (in a hospital) did not receive pictocin. My first birth I had pictocin because my water broke and my labor did not progress, but my second birth (at the hospital) progressed naturally, no pictocin.

Getting away from the free birth argument, I do see the allure of home births as being: less medical, less interventionist, and less expensive. It''s a sad thing to say, but the high rate of c-section in the US is not just due to doctor preference, but the poor physical health of high percentage of mothers in the US. But I do feel there can be things done especially regarding billing, that gives people more choice about more natural versus more medicalized births, especially as there is more demand for it.

I was thinking about my mother. She did have a bad experience with her first birth (unneeded med). Did that mean she wanted the rest of her births at home? Nope, her following births she just made her wishes abundantly clear so there was no room for misunderstanding!

 

[jewelz617]

Date: 3/11/2010 1:33:18 PM
Author: part gypsy
Jas - I think your experiences regarding pictocin are unusual. The vast majority of women I knew who gave birth (in a hospital) did not receive pictocin. My first birth I had pictocin because my water broke and my labor did not progress, but my second birth (at the hospital) progressed naturally, no pictocin.


Getting away from the free birth argument, I do see the allure of home births as being: less medical, less interventionist, and less expensive. It''s a sad thing to say, but the high rate of c-section in the US is not just due to doctor preference, but the poor physical health of high percentage of mothers in the US. But I do feel there can be things done especially regarding billing, that gives people more choice about more natural versus more medicalized births, especially as there is more demand for it.


I was thinking about my mother. She did have a bad experience with her first birth (unneeded med). Did that mean she wanted the rest of her births at home? Nope, her following births she just made her wishes abundantly clear so there was no room for misunderstanding!

Could you clarify what you mean by "It''s a sad thing to say, but the high rate of c-section in the US is not just due to doctor preference, but the poor physical health of high percentage of mothers in the US."

Just not sure I get what that is supposed to mean.

 

[somethingshiny]

I only know 4 people who ever received pitocin. All were inductions, and only 2 ended up getting an epidural. It''s very uncommon in my experience. And as far as unnecessary c-sections. Out of my HUGE family, my SIL and I are the only ones to have a c. Also, none of us were encouraged to have any narcotics or epidurals. The nursing staff really works to help you find comfortable positions, tons of walking and tubs. Perhaps our drs are more traditional?

 

[RaiKai]

Date: 3/11/2010 2:34:10 PM
Author: somethingshiny
I only know 4 people who ever received pitocin. All were inductions, and only 2 ended up getting an epidural. It's very uncommon in my experience. And as far as unnecessary c-sections. Out of my HUGE family, my SIL and I are the only ones to have a c. Also, none of us were encouraged to have any narcotics or epidurals. The nursing staff really works to help you find comfortable positions, tons of walking and tubs. Perhaps our drs are more traditional?

Yes, I don't know many women who have received pitocin either as an "automatic". Maybe one or two of them did. My mother did when she had me 30+ years ago...however I was also a couple weeks overdue by that point and her water had broke. It turned out to be a difficult birth overall (72 hours of labour, and I was breech to boot - she would have liked a c-section but they were reluctant!) but I don't think this is the "standard" these days.

My SIL just had her first three weeks ago - she went and had a "belly massage" about a week before her due date and went into labour the next day. She said a couple of her friends swore by it getting things going, and it seemed to work for her too! Before going into labour she was also deadset against using an epidural. When she later started asking for one, the nurses encouraged her to try milder drugs first as she had told them she did NOT want to go the epidural route and to sort of "discourage" it if she started ask and wanted to find that balance of encouraging her, and yet also respecting her wishes. She did, but then when she finally said she wanted the epidural, they listened. She was glad she got it, and glad they did not immediately push it on her too.

I think very good balance CAN be found in hospitals and with medical professionals, including trained midwives (I am also in Canada where they are licensed, etc). I have seen some of those birthing rooms too and heck they are quite comfortable (and it means someone else has to change the sheets, ha).

I am not fond of the high c-section rate, however, glad they are there in true emergencies. I also know a couple of my friends who elected to have them to avoid a VB rather than for any medical reason. I find it a little scary that they elected that route and I really think they downplayed the fact it was major surgery, but I think things like that may skew stats a bit too.

I still think the risks are very present, and to brush them aside seems to be playing with fire.

I will take people's real life stories over anecdotal evidence. For example despite what I have read here about say, the cord not being that dangerous when around baby's neck - there is a baby in my province right now who is on life support and has been since October when he was born. He became brain damaged from the cord around his neck depriving him of oxygen. It has turned into a big court battle as the doctors advised removal from life support but the parents have fought that in court.

Pandora II talked about her very personal experience and I can only imagine how terrifying that would of been. One of my friends went through the same 15 years ago, and even though she was in a hospital with an OR right there, she did actually "die" on the table before she was revived (and fortunately is healthy...though she did decide that would be her first and only child). If she had been at home, she would have been dead before she could even have seen her daughter.

Someone else mentioned they don't think any of the children they work with who are brain damaged were home birthed - all I think when I read that is well, maybe these are the ones that survived, or maybe they did make it to the hospital and were birthed there. Many people who plan home birth may end up at hospital when complications arise and the records won't reflect they had a home birth...as they didn't end up being able to. High risk births are generally in hospital right away, so there is a "higher risk" in first place to those babies and mothers which is reflected in the stats. My mother has spent a great number of years (something like 30) working in liability insurance for hospitals, and often a review of records shows that to be the case.

 

[Jas12]

somthingshiny--actually, your experience would be more the exception. Most women have their labor augmented or induced at some point. I think the commonly quoted study from the uni of texas is around 80% !!!! Whoa. I am not sure if it has changed (haven''t look into myself) but my hunch would be that it has not changed much. Of course, i am sure it''s different in certain hospitals, states etc. But i know it is staggeringly high. My labor was already 12 hours in and i still got it b/c things were not ''fast enough'' for the OB on call. All my friends who birthed in the hospital got it too...in varying degrees

 

[anchor31]

jas - I wasn''t comparing birth to a stroke, I was just saying that both are natural occurences that we usually wish to have assistance to go through. I didn''t get any pitocin at my hospital birth btw.

waxing - Since I saw the title of this thread I wondered when the financial aspect would come up. I''m Canadian and I cannot imagine having to pay for a birth. I had to pay for the room I stayed in after the birth, and my insurance reimbursed me. I can understand that some people would not want to pay outrageous fees to give birth, but having the dillemma of the safety of myself and my child vs. money, I would choose safety.

 

[Hudson_Hawk]

Date: 3/11/2010 2:30:53 PM
Author: PinkAsscher678

Date: 3/11/2010 1:33:18 PM

Author: part gypsy

Jas - I think your experiences regarding pictocin are unusual. The vast majority of women I knew who gave birth (in a hospital) did not receive pictocin. My first birth I had pictocin because my water broke and my labor did not progress, but my second birth (at the hospital) progressed naturally, no pictocin.



Getting away from the free birth argument, I do see the allure of home births as being: less medical, less interventionist, and less expensive. It''s a sad thing to say, but the high rate of c-section in the US is not just due to doctor preference, but the poor physical health of high percentage of mothers in the US. But I do feel there can be things done especially regarding billing, that gives people more choice about more natural versus more medicalized births, especially as there is more demand for it.



I was thinking about my mother. She did have a bad experience with her first birth (unneeded med). Did that mean she wanted the rest of her births at home? Nope, her following births she just made her wishes abundantly clear so there was no room for misunderstanding!

Could you clarify what you mean by ''It''s a sad thing to say, but the high rate of c-section in the US is not just due to doctor preference, but the poor physical health of high percentage of mothers in the US.''


Just not sure I get what that is supposed to mean.

Perhaps our overall problem with poor stamina/endurance? To not have good stamina and endurance means you''re going to tire quickly and not necessarily be able to push as effectively as needed. That''s all I can think of. I mean, there are very fit obese women and very poorly fit thin women, so I doubt she''s making a blanket generalization that because American''s are more likely to be obese we have a higher rate of medicalized births. That would be feeding herself to the vultures and she''s too smart for that

 

[cara]

Date: 3/11/2010 11:55:00 AM
Author: Jas12
IMO what we need is a good balance. As DD said, midwives in canada are *highly* trained (4 years of universtity education with hundreds of more hours observing natural birth than an OB would ever recieve). The fact that their home births turn out to be as safe as a hospital, with a fraction of the complication rates is a good reminder that there is a better way to do things. A balance of medical education and good old fashion coaching and the expertise to know what should happen when. One in three births is NOT an emergency (as c-section rates would suggest) so we need to get this number way down. We don''t need to banish medicine from birth, we need to utilize it when necessary, have it available, but try to let birth happen the way it is intended to happen. The only person i know that recieved zero pitocin for her birth was a homebirther. Does that not strike anyone else as odd? We shouldn''t have to birth at home or birth alone to have access to an environment that is both supportive and offers access to modern medicine. But it seems like that is how things are....

I don''t know that the science is there to totally support that statement unqualified. Studies show that homebirth can be low risk in some situations (low-risk screening prior, skilled birth attendent, institutional and infrastructure support for hospital transfers, as implemented in certain countries or locations) but I haven''t seen studies with the appropriate statistical power and design to support saying that there is scientific consensus that home birth is exactly as safe or safer than hospital birth everywhere without a lot of caveats. Which is not to say that the science isn''t good and can''t be used to say something about the risks, it just isn''t perfect or complete. Here are some of the issues:

1) Size of study. With neonatal mortality rates on the order of 1 per 1000, you need more babies to really get great statistics. 100,000+ would be great but even something in the tens of thousands would help.

2) Self-selection bias. This is not a small problem. Seems entirely reasonable that women choosing homebirth are in some way different (lower risk, more fit, better family history or personal history of uncomplicated births) than women choosing hospital birth. Or maybe that is true only in certain areas, and other places home birth choosing-woman are more risky (ie, poorer, farther from hospital, resistant to medical care, etc.) Most studies allow women to select home birth or hospital birth rather than screening them all for home birth and assessing their willingness, and then randomly assigning them to home or hospital. Obviously I''m for women having input into their birth process, but it really mucks up the science.

3) Barring randomization, prospective studies would be better than retrospective, but you need prospective enrollment of both the home birthers and the control group, ie. hospital birthers. Many retrospective studies also lack access to patient charts that would allow for more detailed classifications of patient risk level going into birth, and type of complications or reasons for death. Even the timing of death is often not precisely known, and combined with the insufficient numbers makes for a blurry picture. There are a few prospective studies of home birth safety, but the N.American one I''ve looked at did retrospective selection of a control group.

4) Local effects: infrastructure, legal issues, population differences, etc. The netherlands, I think, has one of the highest home birth rates in the developed world. But how applicable are Dutch safety statistics to other places? What about a particular place other place? How densely settled is the area, what are the hospital transfer times, what are the education requirements on home-birth attendants, how friendly and competent are the hospitals at dealing with home-birth transfers, how bad or good are the hospitals and their doctors and nursing staff? Does population matter? Maybe the Netherlands has especially healthy pregnant women. Maybe they are much less likely to have certain types of birth complications. What is the legal environments? Lets face it, the US is sue-happy and nowhere does that come up more than OB issues.

I''m not saying that home birth with skilled attendent for low-risk women is super-risky, I think the data shows it''s not. But as to evaluating the *precise* long odds, I think the science is not entirely settled. For example, the recent Canadian study using B.C. data (1) shows neonatal mortality of home birth w/ midwife compares very well with hospital births, but there are only 7 deaths in the entire study and this limits how precisely you can compare the groups. In contrast, a recent study on US home births (2) found that home birth *were* riskier than hospital births when both were attended by certified nurse midwives (about twice the risk of neonatal death for home births, and it was statistically significant). The home births were even more risky when attended by ''other'' types of midwives. But hospital and birthing center risks were more similar.

Anyway, I''m totally with you on finding ways to make birth more safe and supportive, whether at hospital or home or birthing center. And part of that is figuring out exactly what are the additional risks of home birth or hospital birth and various interventions or lack of interventions, and for that you need careful well-controlled studies to tease out some of the more difficult issues.

(1) Janssen, Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician, CMAJ, 2009.
(2) Malloy, Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004, J. Perinatology, 2010.