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Old 02-13-2014, 11:30 AM   #201
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Re: Homebirth increases adverse outcomes and death

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Studies have shown that patients immediately forget 40-80% of the information they are given by healthcare providers. The more information they receive, the more they forget.

My OB (who is a woman, FWIW) gave me a book about pregnancy and childbirth at my first appointment, along with a folder full of information. I had two appointments during pregnancy which were designated for education. She recommended and encouraged us to register for a childbirth class. At every appointment I am invited to ask questions. The practice is fairly busy, so my appointments don't normally take an hour, but she clearly values patient education and tries to fit it in to each visit.

I can't argue with your experiences, and it's understandable that given your negative experiences you do not have positive feelings about hospitals or medical professionals. But your personal experiences can't be generalized to all of medicine as a whole, just as my one positive experience doesn't mean that all doctors and nurses everywhere are perfect.
You clearly had a good doctor. That has not been my experience in 5 different hospitals and multiple different ERs and and doctors offices. I wish it were because I don't like not being able to fully trust those I have no choice but to rely on for medical care.

Except for 2 doctors. My children's pediatrician and my last OB. Although even then I don't get nearly the information you got.

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Old 02-13-2014, 12:05 PM   #202
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Re: Homebirth increases adverse outcomes and death

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Vanderbilt quit using housekeeping in patient care areas. You might just get your wish and not have to mess with nursing at all. http://www.wsmv.com/story/23364976/v...es-cleaning-up
I cannot easily follow your link right now. However I don't have any issues with working with nurses. I do have issues with those who push work onto others and go out of there way to make things difficult for others. That would be with any worker be they a nurse or anyone else.
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Old 02-13-2014, 02:56 PM   #203
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Re: Homebirth increases adverse outcomes and death

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I guess I'm not seeing HB people ignoring the data from this study. Here and on other conversations I've seen online I see people in the HB community as concerned. I think this thread is getting heated because there are some people on this board who consistently talk in this way....
...

Etc. etc. etc. I don't think it's so much that HB people are ignoring the data I think it's more the tone that comes along with this thread and others like it in the past that turn people off from certain posters. I think a lot of women get into the natural birth community BECAUSE they've been treated baldy/assaulted/have bad local hospital care etc... so hearing the other comments about how great our options besides HB are is a little difficult for some people to believe.

Personally I've seen a lot of good discussion about how to improve HB. I've also seen more negative comments about how all women need to deliver in a hospital because HB is terribly dangerous. Unfortunately that is the wrong path to take IMHO. Our maternity community is a dangerous one, no matter where you are delivering. DR's and CNM's need to work together but sadly I fear that isn't going to happen. DR's are valued more in this society and they are only going to continue pushing midwives away and it's only going to make our ENTIRE birthing community more dangerous for Mom's and babies.
Where are you seeing the good discussion about improving HB? Or anyone in the HB community even discussing the increased risk of HB? Because if you could provide anything to back that up , it would be very reassuring to me, as I can't see any evidence of it. MANA doesn't want to address it (on their website, they seem to just argue that you can't compare the stats, but no real explanation why), and the only place I'm really seeing concern expressed is on blogs that are already critical/skeptical of homebirth.

On the face of things, I don't see why a homebirth for a low-risk mother with a CNM couldn't be nearly as safe as a hospital birth. I say this because:

1. Advanced practice nurses, when working within their scope of practice, generally have excellent outcomes.
2. Studies from other countries, where midwifery is more regulated and midwifes are trained to CNM-like standards, show homebirth safety to be on par with hospital births.

All that being said, the stats show that homebirth in the US is NOT as safe as hospital birth. Why not? There's good reason to suspect that is because of DEMs, but the MANA study did not break down the data by credentials and so we can't really say for sure. Fact is, the large majority of homebirths in the US are attended by direct-entry midwifes (CPMs, LMs, etc.). So most of the "homebirth community" consists of DEMs who don't seem to welcome increased regulation of their profession. (Which is not to say that some DEMs aren't qualified or skilled, but in most states there is nothing to ensure that they are)

And lastly, I am far less pessimistic than you about the future of OB-CNM collaboration. I think it is something that we are highly likely to see more of, given the shortage of OBs and the expanded use of APRNs we see in other aspects of medicine. Why do you say that Drs are pushing CNMs away? ACOG and AAP recently changed their positions to be less anti-homebirth than before. ACOG seems eager to reach out to ACNM. This seems like fertile ground that could improve care for all women, regardless of where they give birth.

Last edited by saturn; 02-13-2014 at 02:57 PM.
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Old 02-13-2014, 03:01 PM   #204
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Re: Homebirth increases adverse outcomes and death

I have a lot of thoughts, and I'm not sure they're all coherent, so bear with me as I work them out!

I was unhappy with my first birth experience (cascade of interventions, c-section that I believe was avoidable) so I had a VBAC for my second. I understood my increased risk of uterine rupture (though mitigated by the fact I'd only had one uterine surgery) and felt that the benefits outweighed the risks, and knew that c-sections had their own risks. So I can understood why a mother would feel that the benefits of home-birth would outweigh any slight increase in adverse outcomes.

The data seems to support the idea that this isn't about midwives vs. doctors, but about proximity to an OR should the worst happen. I personally would want that safety net of being in a fully equipped hospital should the worst happen. But I live in a fairly large city; what if I lived in the middle of nowhere and a fully equipped hospital wasn't local to me anyway?

Birth is such an emotional event for mothers and if anything didn't go according to plan, you're bound to have strong feelings and regrets. I have a friend from high school whose newborn contracted a blood virus in the hospital and died at one day old. Who could blame her if she felt she didn't want to return to a hospital for subsequent births? I have another friend whose OB used forceps with an episiotomy because his shift was ending and he wanted to get home. She had a fourth degree tear and a rectal fistula. Who would blame her if she wanted to use midwives or avoid hospitals in the future? On the other hand, I've read stories of homebirths where the baby died from something that was probably preventable. Who would blame these mothers if they felt turned off from homebirth? I don't blame any of these mothers, just sympathize with them.

I do feel it's important to do your own homework, but equally important is to pick a care provider that you have full faith in, and for our society to require proper training and oversight of those providers. I'm not a doctor and don't feel qualified to make all medical decisions on my own no matter how many studies I read. At a certain point you've got to trust expert advice. I had my VBAC with a midwife; I believe midwives can provide a level of attention and care that is difficult for OBs to provide for a low-risk vaginal delivery. Me personally, I'm also glad that I had the OR right across the hall ready to go (and only later did they tell me it was actually ready for me because of decels). The on-call OB was very encouraging and told me that I'd have the baby without a doctor in the room, yet she and the anesthesiologist were there if I'd needed them, literally right there because it seemed like I wasn't going to get her out for a bit.

I have great respect for the psychological needs of the mother, and the comfort a mother feels in her own home. Women have birthed in their homes for ages, so I don't see anything inherently wrong with it. Obviously it's a beautiful thing if it turns out OK, as it almost always does. And I didn't have to choose between delivering with midwives on my terms and a large hospital with a neonatal intensive care because of where I live. For some people, it might be an either/or, and the slightly increased risk might be something they're comfortable with. I don't feel the same way but I can't judge.
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Old 02-18-2014, 05:59 PM   #205
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Re: Homebirth increases adverse outcomes and death

I initially thought about having a homebirth, my mother (a former nurse) urged me to have my firstborn at the hospital. I took her advice and am glad I did as I had a 32 hour labor that ended in an emergency C-section (baby's heart rate dropped).
It was scary and traumatic at the time but had a very happy ending that I am eternally grateful for.
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Old 02-21-2014, 05:30 PM   #206
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Re: Homebirth increases adverse outcomes and death

Has this article been posted yet here?

I know this thread is just beating a dead horse by now, but I thought this article was really, really good.

http://www.improvingbirth.org/2014/02/versus/
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Old 02-21-2014, 07:20 PM   #207
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Re: Homebirth increases adverse outcomes and death

I have had 3 hospital births. The first, I had a great doctor who I loved. However, she was newly out of school and lacked experience. Even though I was progressing she told me my baby was very big and she thought I wouldn't be able to push him out and we needed to do a c-section. He was 6 lbs even. My second birth, the doctor wasn't there when my son's head began to emerge so the nurse told me to "cross my legs and hold him in" until he could get there. Being young and stupid, I did what she said, not knowing any better. Luckily, he is okay. My 3rd birth, I had my first nurse leave, as her shift was over, and noone came back in to check on me until the Anesthesiologist came in to do my epidural. The nurse came in, but never checked my cervix. It wasn't until during the epidural administration, that I felt the baby's head coming out, I asked him to stop. I would up with a wet tap.

With that said, I would rather not have another hospital birth. However, I do believe the doctors and nurses meant no harm. Most of the time, I think the errors were due to them having way too many responsibilities at one time/ too many patients at once.
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Old 03-26-2014, 11:03 AM   #208
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Re: Homebirth increases adverse outcomes and death

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Originally Posted by Lammy View Post
....
I also wonder how different these statistics would be if all midwives worked underneath doctors here. I know when I was trying to find an ob to do all the tests so I wouldn't have to go to the health dept no ob would see me (not even the one who was my provider for my first two births) because I was going to have a home birth. I wonder if obs and midwives were able to work together if the homebirth stats would improve over all.
I agree with the bolded!
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