Friday, March 21, 2008

Hospitals are our friends

I was lurking on a blog the other day - one that I frequent - and the post really made me stop and think, and the more I thought about it, the more irate I became. You see, the author is pregnant with her 2nd child and this time around, she's doing the whole midwife / home delivery thing.

I could not disagree with her more.

When I was pregnant with Caden I gave about 10 minutes of thought to the idea of a home birth. Enough time to say, "Gee, I guess that's an option; what would that entail?" After a few minutes, I decided that no, that most certainly was not for me.

And it's a good thing, too.

Because if I had? I wouldn't be a mom right now. I wouldn't have had a baby to bring home from the hospital. I wouldn't have ever known Caden.

We had a prolapsed cord situation and 5 minutes after my doctor discovered it, my son was born via emergency C-section. We're talking straight off an ER script - my 8-months-pregnant doctor is riding on my gurney with her hand holding Caden's head off the cord; nurses are yelling "STAT"; doctors and nurses are running from every direction in the hospital; cords are flying. The last thing I remember is them POURING iodine on my stomach and asking me how much I weighed so they would get the anesthesia right. (I was oh so tempted to lie and say "a buck twenty", but you don't want to lie when numbing is at stake).

The doctor looked at my husband afterwards and said, "That's why you have babies in hospitals."

So I feel mighty strongly against the whole home birth thing. Isn't that what people in the 1800s did??? Didn't we have a lot of babies and WOMEN die in childbirth???

My stomach churns when I hear someone say they are more "comfortable" giving birth at home.

Me? I'm more "comfortable" knowing life-saving equipment and a staff of medical personnel are there to save my baby if needs be.

7 comments:

Amanda said...

Amen sister say it again!!! I totally agree, there is a reason why we have hospitals and monitors!

SarahPerdue said...

Congratulations on the safe arrival of your son. I am happy that you had your birth in the place where you felt safe and comfortable. But it concerns me that you take a strong position on home birth based on your one experience. The fact is you don't know if you would be a mom right now if you had planned a home birth.

I didn't attend your labor, so I cannot comment on your specific situation; however, experienced midwives assist labor in ways that minimize the risks of cord prolapse. Midwives do not induce labor or rupture membranes before the baby's head is fully engaged. Midwives recommend transfer of care to a doctor and hospital birth for conditions that indicate higher risks such as pre-eclampsia or pre-term labor. And midwives have successfully transferred mothers and babies to hospitals while holding the baby off of the cord just as your doctor did. It's a longer ride, but it can be done.

Midwives carry oxygen, pitocin to stop postpartum hemorrhages and resuscitation equipment among other necessary items for delivering a baby.

For healthy women and normal pregnancy, midwife attended home birth has been proven as safe as hospital birth with similar mortality rates and much lower interventions (3.7% cesarean section versus 19% and 2.1% episiotomy versus 33% CPM2000, BMJ 2005). According to the World Health Organization, midwives are the most appropriate primary health care provider for the care of normal birth including out of hospital settings such as home.

Studies show excellent outcomes for planned home births with healthy women attended by professional midwives, and the American Public Health Association endorses increasing access to midwife attended out of hospital birth in the United States.

I cannot speak to the specific experience of your birth. Babies die in home births, but they die in hospital births as well. The babies of healthy women who have had normal pregnancies die at the same rate in home births attended by professional midwives as they do in hospital births.

So when you speak of "comfort," please understand that all of us are seeking the comfort of safety. While the infant mortality rates for home and hospital births are similar, those of us who chose home birth believe that there is a significant benefit to reduction in interventions.

Women in the United States who chose midwife attended home birth take full responsibility for their decisions and spend a lot of time researching the safety issues before deciding to birth at home.

You are entitled to your opinion, but please look into the facts. The US is stands alone among developing countries in its institutionalized opposition to midwives and out of hospital birth; it spends more on health care per capita than any other developed nation and has the second worst newborn death rate in the developed world. In the United Kingdom, The Royal College of Obstetrics and Gynaecologists and Royal College of Midwives jointly support midwife attended home birth.

Informed choice is very important. While it does not bother me that you chose to birth in the hospital, it does bother me that you state that it is safer to do so there without investigating the available evidence. I am sure that your doctor also believes that birth out of hospital is dangerous because the doctors who trained her told her it was. What most people in the US don't realize is that there is very little clinical evidence to support this assumption. Doctors are trained scientists, but they fail to use their training to evaluate the available data about birth.

Women in the US would benefit from accurate information about birth, the cooperation of physicians, hospitals and midwives, and the support of other women. We can all benefit from increased access to safe, professional health provider options.

Sarah Perdue

DeAnn Aalbers said...

For anyone reading the above comment, I do welcome intelligent discourse on this blog.

Ms. Perdue, you do seem quite knowledgeable on the topic of midwifery, though I am not as convicted as you are about our lagging infant mortality rate. There is some controversy over the tabulations of other countries' rates based on what they define as a 'live birth'. If the baby is stillborn (showing no signs of life at birth), that delivery is not factored in as an infant death, which seems a bit shady to me. The US does factor stillbirths in their statistic which would explain the reason our rate is higher.

For me, the main issue is that of proximity. While I am very glad that midwives carry various pieces of equipment, I am still convinced that it is safer to birth in a hospital. I would rather be 30 feet from life-saving technology, instead of being dependent on traffic jams and stoplights.

brickmomma said...

There is a reason Jansky is a hero in my book. I would probably do anything she told me to.....how high should i jump? She also saved our lives with my precious #1 and a controlled emergency csection!!

Anonymous said...

I am also very thankful for hospitals,because we still have our daughter and our fabulously healthy grandson.I do not know if I could trust a midwife enough to make life threatening decisions for me or my unborn child.As I am sure there are a FEW who are, I would hate to have the one and only one that didn't know a dadgum thing.Being only a few feet from the delivery room made all the diffreance in these beautiful lives.And I am sooooo thankful that I have someone to play trucks with. Caden's Nanna

Anonymous said...

Could not agree with you more. I know a woman here who chose to do a home birth. The baby's weight was underestimated (he turned out to be 13 lbs.) Since she'd never had an ultrasound or seen an MD..they didn't know this. Then the cord prolapsed and by the time they got to the hospital (in an ambulance..btw), my friend had to deliver a dead baby. Besides the awful tragedy of losing the baby..because of his size, she was quite torn up.

I normally don't comment on blogs, but I just couldn't help it on this topic. I am someone who had a C-section with my first..probably as the result of being induced..however, I don't regret having a healthy baby. Although my situated might be classified by some as the result of an "intervention"..I say better safe than sorry.

I can't help but notice that in all of Ms. Perdue's comments, she kept referring to home birth being just as safe for "healthy women and normal pregnancy." I had the most normal pregnancy you could have and I was very healthy. The fact is that you cannot predict what things might go wrong during labor/delivery. Better to be 30 seconds away from EVERY available life saving measure for both mother AND child, than 10 minutes (or more) from a hospital. Sometimes...and I would say in emergency situations, MOST times..those few minutes make the difference.

My friend who lost her baby was on her 12th (yes, I said twelve) child and had had babies every way you possibly can (hospital, home, twins, etc.) They were experienced and still had an emergency situation, that had she been in a hospital, probably would have resulted in a live birth.

Also a good argument for being checked by an MD with an ultrasound for a true measurement of the size of the baby.

This woman also is just as pro-home birth as anyone, but her next baby was born in a hospital.

It's nice to have principles, but I think being handed a dead baby might tend to put things in a little perspective. Sorry to be so blunt, but I still carry the memory of seeing the pictures of my friend in the hospital holding her dead son.

--Clayton's mom

Natalia said...

My situation was different. I had a large baby, in hospital, and had cord prolapse at transition. 20 or so minutes later I had the emergency c-section and he died (or had just died).

I had been considering a home birth. I could speculate, going from my previous and later births, that if I had, I could have pushed him out quicker than it took them to start the section, and he still might be here today.

I haven't gone for a home birth since then, but I want to say that proximity of equipment and experts isn't always the answer either. 5 minutes is VERY fast and I doubt more than half of hospitals could do that.