The only funny part was the combat boots and peasant dress…
Even the WHO says that the hospital has never been proven to be a safer place for healthy, low risk births. There is a lot of data demonstrating safety.
Key is – you have to have an experienced, professional midwife who works within a collaborative system of referral.
Three hours is not okay! And a good midwife would know that. But don’t slam homebirth. Even if it’s not your cup of tea — women have a legal right to make their own informed choices.
I parallel a LOT of homebirth candidates in my community and I’m still struggling with the practice. On the one hand, we have a lot of terrific HB midwives who work closely with us and encourage their clients to adhere to a healthy lifestyle. These midwives have an open dialogue with us and transfer their client’s care to the hospital before things go wrong at home. On the other hand, there are a few midwives out there who lack the good judgement one would hope for in a midwife. The scenario of “newborn, 3 hours, breathing problem” is NOT unheard of up here–that kid was in the hospital for 14 full days of antibiotics. His midwife had used up an entire tank of oxygen before transferring.
I support homebirth as an option for low-risk women, but I will say it continues to scare me because of the range of practice styles among HB midwives. A hospital might not be a safer place for a birth, but in my experience, the range of practice styles is much narrower than among HB practitioners, and the range of outcomes is similarly more predictable.
My son had breathing problems initially in the hospital, and my very experienced pediatrician told me that, if he was fresh out of residency, he would have been worried, but he had seen such issues often and they do resolve themselves. And it did. Of course, he made an educated decision at the scene, as the midwife in the story was doing. By the way, my baby was born in a hospital, but my birth was attended by a midwife.
My point isn’t to demonize hospital birth. However, you can find horror stories about anything if you try.
Our maternal mortality rate is double that of the Netherlands. Our infant mortality rate is consistently higher, also. They have a 30% home birth rate. I think we have a lot to learn from them, and maybe we shouldn’t be so afraid. I am glad I had my midwifery experience and then training before I entered medical school, because of the open hostility and exaggeration of risks that seems to be rampant in the medical community.
There are risks whatever a woman chooses, hospital or home birth, but I chose hospital for the births of my seven children simply because I felt the risks were lower. All pregnancies (6) were normal, as were the births (vaginal) and I got healthy, happy babies. My only bad experience was with the first who was born at the time that doctors were insisting pregnant women gain no more than 15 lbs! I think that was stupid. I asked my doctors repeatedly for intrauterine birth control and they refused (no pills then!). I asked to be sterilized but was told no, I was too young! I had moved to a different state where I had my seventh baby. When I met the obstetrician I was referred to by my primary doctor, the first thing he said was Let’s do a tubal ligation (laparoscopic) right after the birth! Yes! And the second thing he said was I don’t deliver drugged babies! Yes! He was brilliant!
I don’t know the Netherlands data. Do you have a reference? I’d be interested in seeing it.
I can give you lots of hostpial horror stories if you want to hear them. Not sure any of those stories would have had better outcomes at home, however.
Anonymous – Since I don’t do OB anymore, I have no financial self interest in whether or not births take place at home or in the hospital, and I resent the implication. I do have an opinion, however, one that has been informed by years of delivering babies and seeing what can go wrong with a “normal ” pregnancy at the last minute, and being thankful I was in a situation to handle it properly.
I think the ideal place to give birth for a low risk pregnancy would be a birthing center attached to a hospital. With a midwife it is the patient’s preference. I’ve worked with midwives and have nothing but respect for what they do. Just do it in the right place.
Why is it that whenever an Ob/Gyn makes any comment about delivering in a hospital setting, it is deemed as motivated by convenience or financial self-interest by those advocating “natural” birth? Frankly, most OBs that I speak with have no opposition to patients delivering at birthing centers with midwives.
However, as an ob/gyn resident at a busy institution I have done my share of deliveries and have seen a fair number of “normal, uncomplicated pregnancies” turn into horrendous shoulder dystocias or significant postpartum hemorrhages. I have also received transfers from home midwives and birthing centers for intrapartum and postpartum complications. That being said, I dont object to a patient stating their preferences and delivering with a midwife without the use of analgesics, induction agents, or monitoring. However, I do agree with Dr. TBTAM, that in my opinion it should be done in a location with available access to medical intervention in the case of an emergency.
As for “resenting” the implication that your views are financially drive, you should get a thicker skin.
Even if you don’t practice ob anymore, your views about proper ob practice are still financially interested, as keeping midwives out just protect the MD guild monopoly which you benefit financially from.
As for all your protestations about not caring about where women give birth, why don’t you express them to your professional organizations? I know from personal experience lobbying in MI the hostility and power the AMA wields against midwifery.
To the above poster… Correct me if I am wrong, but you sound like you are a widwife or at least closely involved with widwifery.
I respect your opinion, however, isn’t your lobbying for women to deliver with midwives financially interested as well? I think it a bit hypocritical that you find it acceptable to completely blast OBs in specific and the medical community as a whole for expressing their views and opinions when you are doing exactly the same.
Truth be told, women have the final say in what their birth will be like. Even if I counseled a woman on how important it is to deliver in a hospital or affiliated birthing center…if, at the end of the day, she wants to deliver at home with a midwife, that is what she will do…and vice versa.
Furthermore, many OB practices and hospitals employ midwives who work hand-in-hand with physicians and most of the time this is a very cordial relationship that offers patients an option.
Most midwives I have met have been extremely knowledgeable and are solid advocates for the patients. However, I have seen situations where midwives or doulas, instead of listening to their patients’ desires will attempt to make decisions for them (based on biased ideology)– and they say doctors are paternalistic!
I could go on, but it would be counter-productive and pointless.
it’s not my place to say that people choosing home births are wrong — not my choice, because i wanted to be sure things were covered if something went wrong
but what kind of parent waits 3 hours and *then* calls around for various opinions when his newborn is having breathing problems? i can’t see the humor here at all. kid breathing = priority. period.
This is anon. Sorry, not a midwife, not a mother, not even a woman . . . . though all my children were born in birth center. No financial interest in midwifery, except the generalized one that doctors use their influence over insurance companies and state legislatures to disadvantage non-physician providers. This is an old story. To deny it, TBTAM, would be “counterproductive”
You mention birth centers attached to hospitals as an option. But where are they?!? How many are in Manhattan? How many still function? More and more are closing or risking women out for the most trivial reasons, leaving women with what choices? Medical intervention hospital birth following all the standard practices, or home. I for one would love to think of hospitals as safer, but do not want to have to fight for basic things in labor (no IV, no continuous monitoring, able to eat light broths if I choose). My 2C, if the defensive protective medicine of OB does not change, there will be more homebirths. Either the OB’s AGOG and lawyers can work together to make a hospital birth a low intevention event, or the medical mindset will continue to chase women away.
“It’s only funny….” True.
The only funny part was the combat boots and peasant dress…
Even the WHO says that the hospital has never been proven to be a safer place for healthy, low risk births. There is a lot of data demonstrating safety.
Key is – you have to have an experienced, professional midwife who works within a collaborative system of referral.
Three hours is not okay! And a good midwife would know that. But don’t slam homebirth. Even if it’s not your cup of tea — women have a legal right to make their own informed choices.
I parallel a LOT of homebirth candidates in my community and I’m still struggling with the practice. On the one hand, we have a lot of terrific HB midwives who work closely with us and encourage their clients to adhere to a healthy lifestyle. These midwives have an open dialogue with us and transfer their client’s care to the hospital before things go wrong at home. On the other hand, there are a few midwives out there who lack the good judgement one would hope for in a midwife. The scenario of “newborn, 3 hours, breathing problem” is NOT unheard of up here–that kid was in the hospital for 14 full days of antibiotics. His midwife had used up an entire tank of oxygen before transferring.
I support homebirth as an option for low-risk women, but I will say it continues to scare me because of the range of practice styles among HB midwives. A hospital might not be a safer place for a birth, but in my experience, the range of practice styles is much narrower than among HB practitioners, and the range of outcomes is similarly more predictable.
My son had breathing problems initially in the hospital, and my very experienced pediatrician told me that, if he was fresh out of residency, he would have been worried, but he had seen such issues often and they do resolve themselves. And it did. Of course, he made an educated decision at the scene, as the midwife in the story was doing. By the way, my baby was born in a hospital, but my birth was attended by a midwife.
Here is why hospital births scare me:
http://www.wftv.com/news/6253589/detail.html
Unfortunately, it is not funny at all.
Here’s another story that’s not funny at all, and the mother did not survive:
http://www.msnbc.msn.com/id/9818616/
My point isn’t to demonize hospital birth. However, you can find horror stories about anything if you try.
Our maternal mortality rate is double that of the Netherlands. Our infant mortality rate is consistently higher, also. They have a 30% home birth rate. I think we have a lot to learn from them, and maybe we shouldn’t be so afraid. I am glad I had my midwifery experience and then training before I entered medical school, because of the open hostility and exaggeration of risks that seems to be rampant in the medical community.
There are risks whatever a woman chooses, hospital or home birth, but I chose hospital for the births of my seven children simply because I felt the risks were lower. All pregnancies (6) were normal, as were the births (vaginal) and I got healthy, happy babies. My only bad experience was with the first who was born at the time that doctors were insisting pregnant women gain no more than 15 lbs! I think that was stupid. I asked my doctors repeatedly for intrauterine birth control and they refused (no pills then!). I asked to be sterilized but was told no, I was too young! I had moved to a different state where I had my seventh baby. When I met the obstetrician I was referred to by my primary doctor, the first thing he said was Let’s do a tubal ligation (laparoscopic) right after the birth! Yes! And the second thing he said was I don’t deliver drugged babies! Yes! He was brilliant!
Pace ACOG, the data simply does not show that hospitalized birth is any safer than home for women not presenting complications.
You simple exchange one set of risks for another – – – –
It’s quite irresponsible (though consistent with financial self-interest) for this medical blogger to suggest otherwise.
HIlary –
I don’t know the Netherlands data. Do you have a reference? I’d be interested in seeing it.
I can give you lots of hostpial horror stories if you want to hear them. Not sure any of those stories would have had better outcomes at home, however.
Anonymous – Since I don’t do OB anymore, I have no financial self interest in whether or not births take place at home or in the hospital, and I resent the implication. I do have an opinion, however, one that has been informed by years of delivering babies and seeing what can go wrong with a “normal ” pregnancy at the last minute, and being thankful I was in a situation to handle it properly.
theresa –
Thanks for your comments.
I think the ideal place to give birth for a low risk pregnancy would be a birthing center attached to a hospital. With a midwife it is the patient’s preference. I’ve worked with midwives and have nothing but respect for what they do. Just do it in the right place.
Why is it that whenever an Ob/Gyn makes any comment about delivering in a hospital setting, it is deemed as motivated by convenience or financial self-interest by those advocating “natural” birth? Frankly, most OBs that I speak with have no opposition to patients delivering at birthing centers with midwives.
However, as an ob/gyn resident at a busy institution I have done my share of deliveries and have seen a fair number of “normal, uncomplicated pregnancies” turn into horrendous shoulder dystocias or significant postpartum hemorrhages. I have also received transfers from home midwives and birthing centers for intrapartum and postpartum complications. That being said, I dont object to a patient stating their preferences and delivering with a midwife without the use of analgesics, induction agents, or monitoring. However, I do agree with Dr. TBTAM, that in my opinion it should be done in a location with available access to medical intervention in the case of an emergency.
I believe this is the Netherlands study:
http://www.ncbi.nlm.nih.gov/pubmed/8942693
As for “resenting” the implication that your views are financially drive, you should get a thicker skin.
Even if you don’t practice ob anymore, your views about proper ob practice are still financially interested, as keeping midwives out just protect the MD guild monopoly which you benefit financially from.
As for all your protestations about not caring about where women give birth, why don’t you express them to your professional organizations? I know from personal experience lobbying in MI the hostility and power the AMA wields against midwifery.
To the above poster…
Correct me if I am wrong, but you sound like you are a widwife or at least closely involved with widwifery.
I respect your opinion, however, isn’t your lobbying for women to deliver with midwives financially interested as well? I think it a bit hypocritical that you find it acceptable to completely blast OBs in specific and the medical community as a whole for expressing their views and opinions when you are doing exactly the same.
Truth be told, women have the final say in what their birth will be like. Even if I counseled a woman on how important it is to deliver in a hospital or affiliated birthing center…if, at the end of the day, she wants to deliver at home with a midwife, that is what she will do…and vice versa.
Furthermore, many OB practices and hospitals employ midwives who work hand-in-hand with physicians and most of the time this is a very cordial relationship that offers patients an option.
Most midwives I have met have been extremely knowledgeable and are solid advocates for the patients. However, I have seen situations where midwives or doulas, instead of listening to their patients’ desires will attempt to make decisions for them (based on biased ideology)– and they say doctors are paternalistic!
I could go on, but it would be counter-productive and pointless.
it’s not my place to say that people choosing home births are wrong — not my choice, because i wanted to be sure things were covered if something went wrong
but what kind of parent waits 3 hours and *then* calls around for various opinions when his newborn is having breathing problems? i can’t see the humor here at all. kid breathing = priority. period.
This is anon. Sorry, not a midwife, not a mother, not even a woman . . . . though all my children were born in birth center. No financial interest in midwifery, except the generalized one that doctors use their influence over insurance companies and state legislatures to disadvantage non-physician providers. This is an old story. To deny it, TBTAM, would be “counterproductive”
You mention birth centers attached to hospitals as an option. But where are they?!? How many are in Manhattan? How many still function? More and more are closing or risking women out for the most trivial reasons, leaving women with what choices? Medical intervention hospital birth following all the standard practices, or home. I for one would love to think of hospitals as safer, but do not want to have to fight for basic things in labor (no IV, no continuous monitoring, able to eat light broths if I choose). My 2C, if the defensive protective medicine of OB does not change, there will be more homebirths. Either the OB’s AGOG and lawyers can work together to make a hospital birth a low intevention event, or the medical mindset will continue to chase women away.