Hospitals and Home Births, According to a Labor and Delivery Nurse

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Home births are more common and popular in different areas of the United States. Honestly, my knowledge of home births is very limited. I am only witness to the ones that don’t go as planned, the ones who show up to the hospital when someone is in distress and action has to be taken quickly to prevent additional harm to mother or baby. As a labor and delivery nurse, it is these situations that send a shiver down my back and makes an uneasy feeling settle in the pit of my stomach. I know that there are many home birth stories out there that have a happy ending. The majority of them probably do. What I do know, having been the nurse who had to act quickly to save a mother or a baby who showed up to the hospital when things at home unexpectedly went south, is that no one wants to deliver a dead baby, or a baby whose brain has been affected because of a lack of intervention, or a delay in appropriate care. Everyone wants a happy, healthy mom and baby.

I think there are probably a lot of women who are good candidates to have one of those happy, healthy home births. I just know I’m not one of them. I was overweight when I got pregnant, I counted every carb that went into my mouth and still ended up gestational diabetic, and then had severe preeclampsia at 35 weeks. Working in labor and delivery, I see how complicated pregnancy and birth has become. I don’t believe the birthing process is complicated, I think the birthing process remains so sweetly simple. But now, women have so many other problems complicating their pregnancy. So many women are overweight, and many women don’t know how this affects their pregnancy and delivery. We see more diabetics, more women with high blood pressure, and more placental abnormalities. There are a lot of other issues that can come up during a pregnancy, and these issues make it dangerous to deliver at home.

Even if you remain completely healthy throughout your pregnancy, the baby might not “come down” because of a short umbilical cord, or a cord that’s wrapped too tightly around its neck or body. The baby could be in a weird position (we call this acynclitic), making it difficult (or impossible) to deliver vaginally. The baby could get trapped (this is called a shoulder dystocia), where the head is delivered and the shoulders are stuck, and then every minute matters to prevent permanent brain damage. And sometimes everyone is surprised with a baby who just does not want to breathe. I can’t count the number of times I’ve seen a baby who was born who unknowingly had a heart defect, making it difficult for them to breathe on their own. Sometimes babies have trouble maintaining their sugar levels, which doesn’t sound like a big deal, but for babies, this messes up everything. And many times, signs of distress are so subtle. All of these things aren’t extremely common, but they do happen. And if there is no intervention, or that intervention is delayed, it could have devastating consequences for everyone. These things could happen to anyone, regardless of how healthy you are, or how many times you have previously delivered a baby vaginally. As a mother, I wouldn’t want to know that a delay in care caused harm to my baby, harm that could have life-long consequences. I don’t want to be responsible for that.

Journey 5

I love the idea of birthing at home. I think it would be so great to be surrounded by familiar things, and not worry about strangers being a part of a process that is so beautiful. I think it would be so incredibly special to experience this with my family. It makes me a little sad knowing that I will never be able to even consider this as an option, because my previous history makes me incredibly high risk. As a labor and delivery nurse, as someone who truly loves the people I take care of, the only thing I can do is focus on how I can change the birthing experience of the people who do decide to have a hospital delivery.

Women should be empowered to make their own decisions, and if a home birth is the right option for you, then I genuinely hope you have the happy, healthy delivery you expect. If you choose to have a hospital birth, know that it can still be special. You can still be surrounded by the people that you love. You still have rights. I want every single woman who decides to deliver in a hospital to know that it remains your body. None of us can do anything to you without your permission. That is a fear that I think drives many women to choose to have a home birth. Talk to different physicians or midwives. Talk to doulas. Talk to other women in your area and find the right option for you. A home birth might be an option for many women out there. But for many more women, it shouldn’t even be considered, and I don’t want any woman out there to let fear of a hospital propel a choice that could completely change your life or the life of your baby.

I am not writing this article to convince a woman to deliver at one place over the other. I want every woman who reads this to make the best decision for themselves and their family. To any woman out there that decides to have a home birth, I hope you have the absolute best experience possible. After all, if you get that, what a wonderful, magical experience that must be! And to any woman who decides to have a hospital birth, I hope you also have an incredible experience. Remember that you have control over what that experience looks like.

Make educated decisions. Remember your rights. As an obstetrical nurse, my ultimate goal is a healthy mother and a healthy baby. Choose what’s best for you, your family, and your pregnancy. And above all, may every single one of you have a healthy pregnancy, labor, and delivery 😃  Regardless of where you decide to have your baby, what a beautiful process we get to be a part of 😃

 

Until my next delivery ❤

 


21 thoughts on “Hospitals and Home Births, According to a Labor and Delivery Nurse

  • February 27, 2015 at 7:22 pm
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    Thank you for being honest of your experiences and so focused on a families right to choose what is best for them. A woman should birth where she feels the most comfortable, home or hospital.

    Most hospital providers are ignorant about home birth. What happens there, what level of monitoring and prenatal care occur. I am a homebirth midwife. I agree that in my approximation 30% of midwives are not properly trained and don’t transfer until you have hit “train wreck potential”. With a well trained, certified and licensed provider the client has many options. I do labs and ultrasounds on top of quality prenatal care to screen appropriately for those who have no business attempting a homebirth. I monitor closely during labor and don’t uneccesarily push limits. I can administer IV antibiotics, IV’s for hemorrhage, pitocin, Cytotec and other such anti hemorrhage drugs. A good midwife transfers appropriately, early, and with equipment ready to provide appropriate care(IV in place etc). Anyone who tells you that birth is safe and can guarantee you a healthy baby is lying, doctor or midwife. Birth can not be guaranteed. Everyone’s goal is a healthy mother and baby. In many countries home based midwifery is the norm and they have far lower rates of maternal and infant loss. The difference? Trained midwives, a hospital system that works well with transports, and informed parents. I have gotten a client of mine to the hospital prepped for a cesarean and beat the doctor who was down the street and the anesthesiologist who was eating lunch in the cafeteria. Most good midwives risk out about 10-20% of potential home birth clients in prenatal care. Additionally 5-10% risk out during labor (the majority of those non critical for things such as fever, augmentation, etc.). 1% postpartum referrals, 1% neonatal referrals. See Vedam , etc al., 2007.

    A good midwife won’t take undue risks. I have the personal cell numbers of two of my nearest OB hospitalists. They may not understand why parents may choose to stay at home but they are supportive of quality care. Parents should have choices. Midwives and doctors and nurses have the obligation to work together to serve families. Finger pointing serves no one. My favorite perinatologist tells every client that I send to him that he sees the worst of everything birth, that I see the best and that the truth is probably some where in the middle. He is so correct! Nurses are scared because they are trained to be afraid. Most midwives error on things as a variation of normal. A VBAC client of mine I risked out for hypertension was nearly given a repeat cesarean because of a lab error. Even when the error was discovered by the doctor they were going to continue on with the cesarean with out discussing it with the patient. It was only when the anesthesiologist brought it up that they included her in the decision. Healthy hospital based VBAC. Mistakes happen all around we just need to work to reduce them as much as possible. Thank you for your honesty.

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    • February 27, 2015 at 9:18 pm
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      Thanks for the honest posting! And thank you to Dy for a great commenting post as well – you said everything I was thinking. I’m not a midwife, but am a certified birth doula, I work for midwives, and currently doing my RN refresher training with the intent of working on L+D. I am a huge advocate for home births, when conditions are normal. I’m also from Canada, and I do think there is a big difference here from what you experience in the USA. Here, all midwives are regulated – and the Homebirth candidates are chosen carefully. At the first sign of a problem, they “risk out” or are a transfer. In my years of experience, the only negative outcomes were planned hospital births, not in the planned homebirths – whether they were transferred in or not. I believe that says a lot.

      I hope and pray that I never lose sight of the normalcy of birth when I’m working L+D!!

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  • February 27, 2015 at 9:28 pm
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    Thank both of you!! It’s funny how this is more popular in different parts of the country. I never would have thought that people did this where I’m from, and then I found out a friend from high school delivered her baby at home. I thought it was so cool. Knowing very little about it, I just hope that people who do this do it the safest way possible. I pushed one time worth my son. .. it would have been cool to have him at home. But it’s not an option for me. More power to the women who successfully do this at home! Lol I know it’s a good decision for many women. .. But a lot of other women need hospital care due to their comorbidities. Thanks again for reading and commenting!

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  • February 27, 2015 at 10:40 pm
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    I’ve read your blog for a long time, but I honestly don’t know if I’ve ever commented? I always enjoy your posts though. :) Coming out of the wood work to say that I truly believe the more you learn about home birth, the less scary it feels and the safer you will realize it is. I had my daughter in a hospital (30 miles down the road, the closest one to where I live) and my son at home (assisted by a male midwife who has delivered 800+ babies at home over the past 30 years – he is fantastically experienced and not afraid to transfer if need be, especially considering how far we are from the local hospital). The experiences don’t even compare, and I freely admit that I had a pretty good hospital experience (granted I showed up at a 10 and pushing only 2.5 hrs after my first contraction!). At any rate, I NEVERRRR thought I’d do homebirth and thought my friend who did it (2 yrs before my first pregnancy) was absolutely nuts, and yet the more I researched and learned about it, the more I realized how much sense it made (with a qualified provider), and my husband who was VERY anti-homebirth now swears that if we have a 3rd, there is no question, we will do a homebirth again if at all possible. Just saying that I agree with the commenters above, and I REALLY wish there was more regulation in this country regarding midwives. My midwife is an EMT-I, trains all the local ambulance squads, is incredibly knowledgeable, and his wife is a retired NICU nurse and his full time birth assistant. They did all the normal checks you’d do at an OBs office (on the same timeline) AND came to my house at 1, 3, and 7 days postpartum, plus I did a 6w checkup at his house. Most fantastic experience of my life, hands down. I hope that every woman feels the freedom to birth where she feels more comfortable, because that’s what is most important! Feel free to read more about my homebirth experience on my blog if you want. I’m an oversharer by nature. ;) Thanks for another great post!

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    • February 27, 2015 at 11:54 pm
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      I TOTALLY agree with you! My fear is based on my limited experience AND the fact that it’s so unregulated. I don’t even think it’s about where you feel most comfortable, I think it’s what’s best for you and your pregnancy! Some people may feel more comfortable at home, but just shouldn’t do it (like me!). I would have loved to have experienced a home birth. If only I wasn’t afraid of stroking out. lol

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  • February 28, 2015 at 4:47 am
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    Interesting perspective, and nice to hear someone from the hospital side who does not automatically put down a non-hospital birth. I attempted natural birth in a certified birthing center with a midwife who came highly recommended. Annabelle had other plans– she was OP and stuck– I was the one who didn’t want to give up, but my midwife insisted after 5 hours of pushing. The intake nurse at the hospital said such cruel things about my midwife, but she did admit that Annabelle was never in danger. After ending up with a c-section, I will have to deliver in a hospital IF we try again. I’m still a little bit envious of those who had a peaceful, successful, natural birth, but all is well that ends well.

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  • February 28, 2015 at 5:23 am
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    Working in inpatient mama/baby medicine I’ve been surprised by how many of our L&D and postpartum RNs opt for out of hospital births, then again I live in an area where home birth is becoming more prevalent.
    While we see the home births gone wrong, we also see so many appropriate and timely transfers of care. It bugs me to no end that these appropriate transfers are documented or talked about as “failed home births.” There is no failure in an out of hospital provider appropriately transferring to a higher level of care when needed! I think Dy’s comment is so on. Hospitals really should work to build relationships with providers in the community, help midwives to feel safe consulting with OBGYNs, build one another up rather than each side criticizing the other thereby not contributing to the mommy wars that I think play into some “birth plan” related decisions. One of the most powerful moments for me after my home birth that had complications a few weeks postpartum (very small and stubborn piece of retained placenta) was when the OBGYN who did my D&C told me that she thought my birth had been awesome and how much she would love to give birth at home. She knew that I made an educated decision with providers who valued informed consent and practiced within their scope and that I got a higher level of care when needed. I had been so nervous to go to the hospital, fearing judgement, but her warmth and openness to out of hospital birth made the process so much easier.

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    • February 28, 2015 at 11:45 am
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      I completely agree with you. I remember a mother coming in once when she just wouldn’t deliver and I was surprised at the animosity on both sides!

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  • February 28, 2015 at 8:50 pm
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    I think the animosity comes from hospital personnel being perceived as a “2nd choice” for homebirthers. Add in any l & d nurse and ob/gyn’s prior experience with messy transfers with bad outcomes and you get a potentially tense situation. Also, many homebirthers eschew a lot of standard medical procedures which baffles hospital staff. I completely understand how unpleasant birth can be in a hospital setting compared to your own home. Most outcomes are good at home, too – even with women who should have been risked out. But a nursing school classmate of mine was a Certified Professional Midwife who was conscientious and intelligent and what she saw among her colleagues prompted her to shut down her home birth business and go to nursing school for formal medical training. There are many scary things that occur that are not reported, underreported and not discussed publicly. Help being only “5 minutes away” at a homebirth is rather misleading as well – especially if that woman is not registered at the hospital “just in case.” To read the stories and see the pictures of dead babies who probably would not have died had they been born in a hospital is infuriatingly heartbreaking.

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      • February 28, 2015 at 9:11 pm
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        I will add that I had an acquaintance who had a homebirth transfer that ended in an emergency C-section. Her son is fine now and her experience at the hospital was wonderful. If I had a patient who was a homebirth transfer I would be EXTRA kind and compassionate because couples invest so much emotionally, relationally (with their midwife), and financially that to transfer to a hospital can be devastating and frightening. I would assess the woman and her husband to see how much encouragement or teaching about their particular situation they might need. But I would be extra, extra sweet and accommodating because those transfers, even the ones with “good outcomes”, can be so devastating to moms who desperately wanted a home birth. And I want all moms to be as happy as I, their nurse, can make them :).

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  • February 28, 2015 at 9:13 pm
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    I am having a hard time figuring out my account, but I am both momof6 and tlcat625. I’ll figure it out eventually!

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  • March 21, 2015 at 11:07 am
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    24 years ago we had our first child. He was born with a diaphragmatic hernia and it was unknown until shortly after his birth. This is my reason for never considering a home birth. Had he not been in a major hospital with neonatal surgeons on call we would not be celebrating his birthday next week. I have many friends who give birth at home or in birth centers and I don’t say anything to discourage them. I just pray that they are blessed with healthy babies and no complications. It is not a given.

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  • March 22, 2015 at 12:26 am
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    As a labor nurse and mother I would have to say that a healthy mom and baby are, of course, what we all want but there is more to it than that. I hear nurses and docs say that phrase all the time to patients (sometimes leaving our the mom part). I had a terrible experience with my first and really mourned the delivery for a long time and I got so sick of my providers saying, “well, at least you have a healthy baby, that’s all that matters.” Of course women want a healthy baby but that’s not all they want.

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  • April 5, 2015 at 6:53 am
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    Thank you for a thoughtful post on a topic that has people on all sides of it up in arms much of the time! I had a very low risk pregnancy (not a single risk factor outside of smoky being pregnant) and attempted a home birth with a certified direct entry midwife. My little Bug was firmly wedged right side posterior and as worth the vast majority of transfers, I went in for exhaustion and dehydration after 18 hours (pushed out a healthy baby after another 9.5 hours, phwew!). Overall I had a good experience, but I wish so very much that there could be more trust, more communication, and more respect between hospital and home birth attendants. I just wanted to say that your comments show me that it’s possible.

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    • April 5, 2015 at 11:49 am
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      Good! It is so possible. I get it. I’m sorry you didn’t have the delivery you thought you would, but I’m glad you had a healthy vaginal delivery! ❤

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  • April 10, 2015 at 8:47 am
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    As a labor and delivery nurse myself, I thoroughly enjoy your posts! I think you summed it up very well – we want our patients to have the best experience possible, whether that’s a home or hospital delivery. I agree that the regulations of home birth attendants and the lack of oversight is what scares me about home births in my state. With that being said, I have worked with some great providers who did bring their patients to us as soon as a problem occurred that was beyond their capabilities. On the flip side, I have had mothers come in with dead babies because they waited too long and babies who came with severe problems after a home birth. If you have a hospital birth, my job is to be your advocate and do what is most comfortable for you. Research the local hospitals and talk to us about what you want! We want this to be an amazing experience and so do the providers. For example, I had a mother brought in after the midwife noted that the baby was in distress during labor. We monitored the baby and were able to get things under control enough for her deliver vaginally. The physician stood back while the midwife did most of the care for the patient and delivered the baby. It truly was the best of both worlds and the patient was so grateful that her midwife was part of the care and birth. We really are not your enemies and vice versa. We both want the best outcomes and need to work together.

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  • May 19, 2015 at 5:48 pm
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    Reblogged this on Ex Natural Childbirth Advocates and commented:
    Home birth midwives deliver (comparatively) few babies, and few people see more births than an L&D nurse. Listen to the wisdom in this post- things happen, no matter how healthy you are or what measures you take, and being in a hospital is the best way to deal with the aftermath of a complication.

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  • May 19, 2015 at 5:50 pm
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    Thank you for writing this piece. The most destructive idea I have found in the world of home birth is that if you are just good enough (trust birth enough, follow the right diet, whatever) things will work out.

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