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Home births: On the rise, and safer?

I've desired a home birth from afar since I was pregnant with my second son, Truman. There was no way I was going to convince anyone of that after I suffered a partial placental abruption in week 23, especially as an attempted VBAC, and sure enough, I ended up with a cesarean, taking home births (at least in my husband's opinion) forever off the table. (Monroe, my third, was a VBAC in the hospital.)

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flickr / eyeliam

Whether or not I have another baby and try to convince the interested parties in the sensibility of such a birth, I'm still head over heels in love. I've had several friends who birthed at home; my neighbor did, and so did a friend whose basement birthing room (next to the laundry machine) I ooh-ed and ahh-ed over, wishing. Home births are on the rise in the U.S., up 20% between 2004 and 2008, and not just because of the romance or (as I heard someone say on the radio) the "feminist machoism" -- there are a lot of us without insurance, and home births are just far cheaper. A midwife's services for a home birth are usually around $2,500 to $3,000 for the whole pregnancy and delivery; we all know that hospital births, without private insurance, can top $12,000 for a simple dilate-and-push procedure.

Today on Here & Now, I listened to a midwife whose statistics gave me a thrill. Detractors bring up the scary what-if scenarios, but according to these numbers, of 100 home births 88 were successfully accomplished at home, with 12 going to the hospital; and nine of these only requiring very minor medical intervention once they arrived, with only three of 100 being emergencies. This sounds extremely safe to me; I doubt the statistics of in-hospital births could compare to such a low intervention rate.

I know we have a lot of home birthers here in Portland; does anyone know if there have been statistics kept on such things here? If you've wanted a home birth, how did it go -- both the negotiations and the actual birth?

Comments

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When I read comparisions of home vs hospital intervention rates it always reminds me of private vs public school numbers. One is a self selecting, specialized group that excludes high risk and difficult situations and so will understandably have (on paper) better outcomes than institutions that take everyone regardless of risk, disability, health, history, preparedness and familial involvement. There is a place in society for both but straight comparisons are unfair and counterproductive.

Personally, I've known a handful of women who did not have the best outcomes at home. In two cases, the baby died. Some of these direct entry midwives just do not have enough training and experience to put your life and your baby's life in their hands.

My CNM has a four year nursing degree and then a three year midwifery degree on top of that. I had amazing natural, no intervention childbirths at the hospital with the NICU just steps away in case anything did go wrong.

To Anon - I think that is a valid point, but doesn't that in some ways give more confidence to the person pursuing a home birth? To know that the midwives are concerned with your well being and their numbers enough to not accept you as a client if they don't think you're a good candidate? I don't think it's for everyone (high risk or not) but I think the numbers are still a good way to try to make your decision because no reputable midwife is going to take on someone who shouldn't be having a home birth.

I stated that I think that I think there is a place for both. If your goal is to instill confidence in that select group then the comparison makes sense. I'm sure people choosing OES like to know the select group in which they will be a part is safe/wonderful/etc. But I don't think that comparing the outcomes of a cohort of low risk women whom are hand picked with a hospital setting in general that accepts everyone and will include women with a variety of issues makes sense. My public school's numbers don't look as good as OES but we serve a more diverse group whether it be income levels, SPED students, race/ethnicity, etc and so of course our numbers aren't as 'good' since they won't have the multitude of issues that come with accepting and working with all people regardless of situation and they don't in general face many of the difficult problems that we face.

Anon, you have a valid point but what about the statistics from pretty much every other country there is that states that a hospitalized birth is simply unnecessary.

The Netherlands, for example? Women there regularly birth at home. It's just seen as common. A hospital is foreign to them, and most wouldn't consider it. A hospital is a sick house. For sickness, and medical emergencies. To them, it isn't for birthing babies.

In fact, most countries outside of the US have more home births than hospital births, maybe not in the same volume since populations vary. But generally speaking.

"The Netherlands has the highest home birth rate in the western world at 30 per cent, thanks to a streamlined transportation and referral system that allows women who plan a home birth to access specialist, emergency obstetric care in hospital should complications arise."

From: http://www.smh.com.au/lifestyle/lifematters/midwife-home-birth-as-safe-as-hospital-says-study-20090416-a8wu.html

I don't have a strong opinion on this. But it is not true that most women in the Netherlands "wouldn't consider" having a birth in the hospital -- roughly 70% of women in the Netherlands do indeed have hospital births (and the rate is higher in other developed nations).

I'm sure that the countless women who have faced life threatening difficulties or lost a loved one in child birth would disagree that "hospitalized birth is simply unnecessary". There should be a variety of options available so that women facing health issues or other difficulties in pregnancy can have the opportunity to give birth to a healthy child even though she is high risk. There is no way the situation in the US and in the Netherlands is in any way analogous. I have friends and family that have chosen everything from home birth to scheduled c-section and in each case it was the exact right thing for their pregnancy/situation. If you are blessed enough to have a low risk pregnancy be grateful because there are many women out there struggling with everything from diabetes to cancer to anomalies with the fetus, to difficulties with multiples and for them a hospital birth is not only necessary but desired.

My background: Two births: one in a stand-alone birth center (bec I was worried I'd be too stressed out at home, go figure); and one a "failed" homebirth--planned to be at home, but induced at hospital by a CNM at 39 wks bec of pre-eclampsia.

Frankly, I was disappointed both times by my midwives and my birth experiences. I keep wishing for "do-overs." For birth #1 (direct-entry midwife, reputable birth center), postpartum complications for me were very serious, and no one caught it (specific problem would not have occurred in hospital); and there were other questionable practices. For birth #2, well, I didn't get to have my dreamed-of homebirth bec my body failed me, but there were other issues w/that midwife that weren't positive (whereas the CNM was great, go figure).

I used to be so gung-ho about midwifery and at-home births, and 100% completely against hospitals for *healthy, low-risk* moms/babies, but now? I hate to say it, but I'm very disillusioned about it all: I still believe hospitals and their *unnecessary* interventions are outrageous, AND I now believe that direct-entry midwives/out-of-hospital births are hardly all roses and butterflies and rainbows, AND I wonder, sadly, if some of us just get the births of our dreams, and some of us don't. I still dream of the "perfect" homebirth, which isn't going to happen for me. Sad.

DisillusionedMom, mine didn't go as planned either...I was in a multiple car accident on the highway at 37 weeks and ended up rushed in an ambulance and having a full on induced hospital birth...exactly what I had planned so hard against! But she's going graduate high school soon and she's the light of my life and the birth experience and my expectations around it are so faded that they no matter. We all do what we can. I hope with time your sadness can pass too. : )

I'm a dad, not a mom. But the idea that if there was a problem we might lose the baby meant that our 3 kids were born at SW Washington. First one we lived in Vancouver and were worried about I-5 bridge being up for Emmanuel or traffic jam for Kaiser Sunnyside. Had a great experience at SW Washington with #1 and #2 and #3 were born there even though we lived in Portland by then. But if we'd had trouble going from Portland to Vancouver, we would have gone to the nearest hospital.

Totally agree that an umbilical cord around the neck or other complications are going to be rare. Not 3 in 100. Not 3 in 1000. If you're OK losing the baby in those circumstances, that's your decision. We did 10 weeks of Bradley classes for the first one and looked at midwives and doulas.

Well done.. Keep up the good work!
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I know people who've had home births and loved them. I also know someone who had a home birth and has a severely disabled child because intervention was not available during the home birth and emergency personnel arrived too late. I think each to his own but for me the risks were too scary.

I also wanted to add that any woman in Oregon who is pregnant and uninsured is automatically eligible for OHP Plus, which means births are free. Some people are underinsured rather than uninsured and perhaps the costs are a problem for them, but not the completely uninsured.

I had a great home/water birth even though my child was delivered breech. My midwife was also a ND and I have every confidence that she would have been able to handle whatever came her way. I would highly recommend that each woman should do what makes them comfortable and make sure they have a Dr/midwife they trust. For me, having a baby in a hospital would have been distracting and uncomfortable. If I ever have any more children I will have another home/water birth.

I am with A Dad. The risk of complications in home birth is very low, but when it comes to my baby, I will not accept any risk that I don't have to accept. Period.

Also, I do agree with one of a previous posters that you are at risk of unnecessary medical procedures in a hospital. But, this is mainly true about private practice doctors because they get reimbursed for each procedure. That is why I choose Kaiser. There is just no need for Kaiser to do unnecessary procedures as they are also the insurer. And before anybody suggests that Kaiser could go the opposite way and deny necessary procedures - there is no reason for them to do so because I will still be their patient. So if they deny me a necessary procedure now, they will have to deal with a more expensive problem later as the condition worsens. That is how I see it.

I ended up having an emergency Caesarian which I believe was unnecessary. It would not have happened if I had not been in the hospital on bed rest for a partial previa. My doctor (who was out of town at the time) wanted to reassure me that it had been necessary and so ordered an autopsy on the placenta. It showed no sign of any problem.

I believe that the extremely stressful way that my baby was born started health problems that still affect him today. We had a rough start with nursing (and then it turned out the doctor had not removed all the placenta during the Casarean) which meant he got a lot of formula. Now he has severe problems with his stomach lining (celiac) and flora (lack of normal probiotics). I was not surprised when I learned recently that a very strong connection has been found between Caesarian birth and celiac disease. I suspect it's that Caesarian babies are given formula right off the bat. Another recent study found that a component of mother's milk long known to be indigestible by humans exists for the purpose of feeding a strain of probiotic that only exists in babies. It coats and protects the stomach lining. Even one bottle of formula, the study said, can damage that process for a month.

But I digress. My point is to say avoid hospitals if at all possible. I think the documentary The Business of Being Born gets it spot on.

My first child was born a Providence Portland with a CNM attending, and it was a relatively quick, uncomplicated, natural labor and birth. My second child was born at home, in my bedroom with a CNM/ND and two experienced RN's attending.
Although my hospital birth experience was fine, I was not comfortable there after the baby arrived (noise, light and disturbance all day and night when we were needing to rest, bad food, nowhere for my husband to sleep other than the tiny couch/window seat, hard bed for me, nurses telling me that it was hospital policy leave the hours-old baby in the isolette to sleep, etc). So I decided to go for a home birth the second time around.
I am one of those underinsured people where it was going to cost about the same either way between home and hospital, so money wasn't really a factor in the decision. The most difficult part was telling my parents, which I put off till about my 30th week. My mom is a labor and delivery nurse so she has seen many cases of home births gone wrong brought in as emergencies over the years. Of course she doesn't see or hear about the majority that go just fine. So she had a lot of fears for me and the baby. I invited her to come along to a prenatal appointment with me so she could ask any questions that she had (and she had some good ones that I would never have known to ask, such as about what they can do to resuscitate the baby at home if necessary, what medications they can give for different situations, and what was their protocol specifically on hospital transfers).
The midwives were good about being up-front with me about the risks and benefits of home birth. There are rare situations that can arise unexpectedly such as placental abruption, where being at home would definitely be less than ideal, and a few minutes really do make a big difference in how much the baby will be impacted.
I noticed that during my labor at home, the midwives were monitoring the baby's heartbeat much more frequently than they had at the hospital, probably because they wanted to be on top of it if anything did start to go wrong with it and we needed to transfer. And even through three hours of pushing his heartbeat never slowed except during the contractions!
There is such a divide out there between practitioners of home births and hospital births, which is why I made the choice to go to one of the two home-birth practices in Portland where the midwives are CNM's, educated at OHSU. It felt like the best of both worlds because it was important to me to work with a midwife who 1) understood the hospital world and 2) wasn't afraid of it or biased against it in such a way that they would delay making a hospital transfer if that were needed, and 3) believed that for a low-risk pregnancy, home birth was a safe (and better) option than hospital birth. For me, it was a process of weighing the costs and benefits between the two and ultimately I chose the comfort, peace and serenity of a home birth over the security of being at the hospital only because of the tiny chance of a time-sensitive emergency arising.

A home birth in my case is very expensive compared with going with my insurance (Kaiser). over $3000 for home birth and over $4000 in a birthing center. My insurance will not cover it at all. I'd rather pay my copay at a fraction of that cost. My first baby was born at adventist and was an amazing experience. All that really matters is that we have a healthy baby at the end of the day (and mama). I have had a few friends who had problems with the birth so I'm inclined to think I'd rather be in the hospital if that were to happen (stillborn with no explanation for one, 4th degree tearing for another, etc....) I did have preeclampsia at the end with my first and was about to be induced but went into labor on my own. the umbilical cord was almost completely seperated from the placenta and I was told he could have been a stillborn had he stayed in longer. the risks may be few but they can be very serious.

I was in Colorado, and had a midwife who'd birthed just over a 1000 babies at home and a doula who was wonderful. We started at home, and I really loved being there - I could walk around, hop in the shower, eat something, whatever. We were five minutes from the hospital, which is where we went for a C-section when labor stopped progressing. That also went smoothly. I think the key factor was the experience of the midwife and doula, who knew when it was time to go to the hospital and had no problem with that. By the time my husband got home that day, the house was completely cleaned up, and they both were a great support at the hospital and for aftercare.

Did you know that there are stillborn babies born in the hospital? Or that 4th degree tears happen there too? Why does everyone think bad things only happen at home?? Stillbirth is very tragic, very sad, and not always understood. Are you going to switch from hospital to home because you had a stillbirth or 4th degree tear? I doubt it.

Also, when can we get over the cord wrapped around the neck debate? Your baby isn't even breathing yet and is getting tons of good oxygen through the cord. He/she isn't gaging and gasping! Cords are quite frequently around the neck, you just gently loop it over the head. The end. Why do we have to make all these normal aspects of birth this big complicated thing?
Also, some insurance companies are grouchy about covering home birth. BUT, I've had a lot of luck just calling and writing letters about it. Everything in life is negotiable, including insurance coverage. If you want a home birth, be your own advocate! It's amazing what you can get if you are persistent. Also, most insurance coverage will cover all your prenatal and postnatal care is you use a CNM (and some will cover other's like DEM or CPM.) So then you're only out of pocket a grand or so, which is what you most likely owe with a hospital birth, and most midwifery practices accept monthly payments to pay it all off.
My deliveries: In a hospital w/ a CNM, and a home birth. I had so many physical and emotional problems from my hospital birth it is un.real. Their brushing off my my "symptoms" nearly cost me my daughter. They also chose to take it upon themselves to do a ton of things to me and my baby during delivery without asking.
That's why, being low risk (important to note that) I decided to choose a home birth for my second delivery. And, if complications came up, I was OK with the idea of going to the hospital. Because that's what the hospital -should- be for......complications.
Of -course- I wanted my baby and I to be safe. And so do midwives! Does everyone think they're just these crazy women trying to pull babies out with no care and no education? No. But just like OB's, you have to research and check out your Midwife. There's some not so nice one's out there. I had several with my first delivery.
But these midwifery women -are- trained. Some have done thousands of vaginal deliveries. (How many has your OB done vs. C-Section?)
I know this is an emotional topic, but I wish people would research the facts of how SAFE home birth is. Read up on it. Really give it a chance before you damn us all as idiots. I'm not berating you for your hospital birth. (Even though I don't agree with it.) So lay off, and live and let birth!

MM, you misunderstood the arguments for going to the hospital. There could be (rarely) unforeseeable complications that can only be addressed in the hospital and when every minute counts. We are talking about the unforeseeable - things that could happen even with a low risk pregnancy. For every case like that, there are thousands cases where a home birth was a great experience. Still, who can promise that my experience will be the latter? I understand that complications occur in hospital, but there is an army of people trained to deal with it and the operating room is behind the corner.
Second - I don't know why you think the birth must cost at least $1,000. My coworker paid $200 of hospital admission and that was it. I paid nothing through my husband's insurance.

Oh! And for the original poster, HB2380-B was recently passed, and includes more accurate data recording on Birth and Fetal Death Certificate's to accurately capture data on transfers to hospitals. This will really help sort some stuff out.
Here's some numbers on out of hospital birth in Oregon, 2010:
45886 births
417 were birth center
988 were home birth

I don't have my link handy to list the %'s of individual hospital's c section rates.
Or anything else statistic related. I'll do some link/folders surfing in awhile.

Who damned you all as idiots? As for what the hospital "should be" for it should be for the same thing home is for...an informed choice/option for women. There are many reasons other than "complications" that women choose hospitals and many reasons other than "being an idiot" that women choose home birth but as soon as you start making assumptions, casting aspersions and judging the choices of women you don't know you fall into the exact same thinking you criticize in your post.

There are countless reasons why a woman might not want to birth at home and an equal number of reasons why she might not want a hospital birth and another list of why someone would prefer a free standing birth center and still others a hospital based birth center.

Perhaps you should take your own advice and lay off your persecution complex since the majority of posts here have been pretty balanced and thoughtful.

Let's just remember: no prize is given to the mamma who delivers home or hospital. no prize is given if the delivery is natural or otherwise. What do you get? Hopefully a beautiful, healthy baby! Something many woman would give anything to have.

To the person who said "Did you know that 4th degree tears happen there too?" meaning in the hospital. I think the point here is that a midwife can easily stitch up a minor tear at home, not a major one. You will have to go to the hospital for a major stitching, so some women would rather be there in the first place if they may end up there anyway.

I'm sorry, but all the fear based responses about home birth -do- make those of us that choose home birth feel like we're less than. We care less than. We know less than. Don't you think we've researched and weighed options, here? Most birth centers are just a mile or two from a hospital. Most complications you can see coming. For those that you do not, you call 911 and transport. 911 can keep everyone stable until you arrive at the hospital. There -are- the exceptions where bad things happen. But like I said above, they happen in the hospital, too.
If you do experience a 4th degree tear at home, yes you will have to go get stitched up. But that is a small if. Why just throw your hands up in the air and say oh well, might as well just be in a hospital. Give your birth a chance.

As far as paying for birth, well, I guess that depends on what's important to you. Some people work for the bigger house/better cars. Some work for private school vs. public school. Some like to travel and save for that. So if birthing at home is important to you, there are flexible options to pay for it. Even OHP covers birth centers.

Also, -are- women in the hospital informed of their choices? When you consent to something, do they hand you something with the risks and benefits? Or even talk to you about it? I never ever had them do this with me. Nor during my pregnancy. And that was a group of CNM's, not even OB's.

MM your responses seem more about your own issues than any discussed here. As for the jab about women who choose hospitals not really being informed it's always depressing when women choose to diminish and insult other women in an failed attempt to elevate their own choices on what should be women friendly/safe sites. It's a sad reminder that we are often our own worst enemies.

I've had 2 homebirths. My first was amazing and my midwives were amazing. My second was just as wonderful, but no midwives attended due to the quickness of the labor. My husband caught our son and the midwives arrived 15mins later. As was previously stated, I think you really have to go with what you are comfortable with. For me, I would not have been comfortable in the hospital setting so I chose to be at home with a very educated, very experienced and very nurturing birth team. Had I been at the hospital with my first birth (52hrs total) I am sure I would have been induced or had a C-section, and I am glad it didn't turn out that way. I respect all women for what they choose, knowing that we all come from different backgrounds and experiences. There is no right or wrong answer here. We are all members of the same tribe!! Let's support each other.

Anon - I was simply responding to the main article, what other people have said, and sadly having to again defend what I said.
Also, it wasn't a jab about women in hospitals not being informed, it was an honest question. Was I the only one they didn't properly inform? Does it happen to other women, too? And if they didn't discuss it with you (maybe because you were deep in labor land), did they discuss it with your partner?

And the main poster asked our opinion and for our experiences. So I shared mine.

I had two planned c-sections and I could not nurse either due to a breast reduction surgery. Despite what some would suggest was a pair of sub-par mothering situations, I have two healthy little girls who I am deeply bonded with. If you make the best of every situation you come out ahead. Period.

Unrealistic expectations of labor, delivery and all parenting situations sets parents up for disappointment. The constant arguing about whose method is better, who is more informed and who will have a "better" child are unproductive and hurtful.

Perhaps a minor point of clarification but, Mamasita, I had two c-section babies and breast-fed both from the start. Not sure why you assume "Caesarian babies are given formula right off the bat." But C, I second you. Let's just try to accept that we all try to make the choices we believe are best for us and for our children. I think I went into the birth experience well-informed on my own situation and my options but with no real expectations or desires beyond coming away with a healthy living baby. Not all went as projected except that bottom-line outcome and in the big picture, that's enough for me.

I had a home birth with the Alma midwives. It was the single most peaceful and uplifting experience of my life. Things seem tense on here so I won't go into details.....but I'm thankful to live in a state where midwifery is legal. (Because that isn't the case nationwide.)

I had two hospital births with midwives (standard at Kaiser, unless you are in a high risk category and/or you want an OB). And I bought my own doula both times, as I wanted a drug-free delivery and felt I would need extra support to accomplish this. In my case with my insurance, a hospital delivery was way cheaper. But I have excellent insurance (and believe me, I know many do not)

They were wonderful experiences. All the staff were incredibly supportive. But I did have to be an advocate for myself, both during prenatal care and delivery, because my birth plan was not the standard for Sunnyside. At the time, I think about 30% of births were drug-free.

I personally would not want a home birth because I kind of wanted the "cocoon" of the hospital room. Home was more chaotic. Besides, who would clean up the mess of birthing afterward (only half-kidding . . . !)?

I think it's really fascinating to hear the Dad perspective. My husband said similar things about wanting the safety of the hospital. Is it because, at home if something went wrong, the father would assume "protector" role and feel helpless and responsible? Whereas in the hospital, it's in the dr's hands? Seems pretty logical and understandable. But still really interesting, I think.

My first ended up a life threatening emergency (took me to hospital guess that makes me a loser) so my second was with a midwife in a hospital based birthing center in New Mexico where that's very common (guess I get partial cred?) I hate the judgment surrounding this debate and hate the way that women who face serious and even life threatening challenges are made to feel like quitters or suck ups to the patriarchy. Have your baby wherever you want; it don't make you nothin but a mother like the rest of us...no better; no worse.

I saw this post last night, and I was looking forward to sharing a little bit about my experiences. But after reading the other comments, I feel like this isn't this best forum. And I feel that way often. After a grueling hospital birth with my first and a comparably smooth homebirth with my second, I am always looking for opportunities to share the experience. But, what I have found is that it is too sensitive a subject for most mamas. It is as if women think I'm judging them just by sharing the fact that I gave birth at home. I've also felt judged after saying I was going to give birth at home. Most of the time, the conversation doesn't go much further, because I don't want to cause tension in our otherwise supportive relationships. It is too bad women can't discuss birth more openly and cut each other some slack. At least we should try to enter conversations about hospital and homebirths without so many assumptions about others' motivations and situations.

The only other things I'd like to add are that I had remarkable care during my second pregnancy. My midwife who was also an ND met with me for hour-long appointments. She monitored my diet much more closely than my OB did. She also invested a lot of time in listening to the story of my first birth and helping me work through fears I had. I think she helped so many women give birth safely at home in large part because she does screen her clients so carefully. There is a long check list of traits a good midwife requires her clients to have before she willingly assists their births. Also, you should see the emergency equipment they bring along. They are prepared to resuscitate. I felt very safe, very comfortable, and completely in control laboring and delivering at home. I felt insecure, dependent, anxious, and demoralized at the hospital. Now, this was in part because it was my first birth. But it was also in part because it wasn't the right place for me to be. It just didn't feel right for me. I know others who had very positive experiences at the hospital. My homebirth midwife also visited me for hour-long appointments for the three days following my birth and then every three days for the next week. She was monitoring my physical and emotional health as well as the baby's well-being. I really appreciated this. If I had been on the verge of postpartum depression, she would have been aware of it.

I read everything leading up to my first birth and reread it leading up to my second. I did what I felt was right for me. I wanted to have the best possible birth for both of my children. I was fortunate to have the health and environment necessary to have a really beautiful experience with my second. I wish all women could experience that.

I guess it's just part of contemporary motherhood that no matter what you do you feel judged and no matter what choice you make you're made to feel bad or wrong. The weird thing is after so many years my kids are practically grown and all these things that seemed to matter so much at the beginning don't now. If I am outside of high school I cannot tell who had a hospital birth or who was breast fed or who had a working mom, or when they ate solids or were potty trained or gave up their binky or ate an Oreo. I meet all kinds of brilliant,wonderful kids and none of that stuff ultimately matters.

Hey there, Anon at 9:23. I think I love you.

I posted about the stillborn and 4th degree tearing and both were in a hospital. not a home birth. And I'm not sure why I even read this site anymore. Calling other mothers idiots for their choices? wow. I have quite a few friends and family who have done home birth and I also have a naturopath midwife now along with my kaiser midwife for more of a balanced approach. It is not in my budget to have a homebirth or birth center birth. regardless of what wanted, and believe me...I love my midwife at the natural birth center- If I could see her all the way through I would. I'm not an idiot for going with my insurance or for looking at past birth experiences that have been scary. my first hospital birth was great. if it had been terrible then I might not be inclined to go back. I'm fine with either one really. in my case the covered birth makes more sense for us. and by covered I still pay at least $1000 total. ohp I believe is covered fully for homebirth.

As far as I can tell no one called anyone an idiot...it was one poster who contrived that others did when that was clearly not the case.

I have had four low risk births at 2 hospitals in Portland with an OB. Each time my wishes to be able to walk around, labor in water, with a ball, with my other children present, and in my own way, and have my partner help deliver our babies was honored.

I fully respect those who choose homebirths and other methods of bringing their babes into the world. For us, we chose the hospital because it wasn't home ... odd, I know, but to be in a place that's out of the ordinary, to be able to rest without me stressing about the house, the other kids, and countless other things I think about when I'm at home. I just wouldn't be able to relax and enjoy the first couple days with our babe. I know doulas and others may help with this, and I have several doula friends, but it wasn't what we wanted. Ultimately, bringing the babies home to our house was an event we celebrated and was part of our birth experience.

To each her own, I say. It is vital to be informed about whatever choice you make. But, please, with all this discussion - and certainly others have had different experiences - I think it's important not to judge, make assumptions that those who choose "the other" are uninformed or "idiots," and that not all hospital births are restrictive and forceful.

peace.

Love the supportive, balanced perspectives on here, esp from moms of teenagers.

My conflicting, emotional tension has to do with my disappointment and confusion about my births --which I had despite, yes, being EXTREMELY well-informed, having done tons of research, read the statistics, talked to moms w/a variety of experiences, soul-searched, etcetcetcetcetc. After all that? Still didn't go as I had expected, and location didn't mean diddly squat.

Gee, kinda sounds like mothering in general, doesn't it! Being a mom isn't always what we expect, hope for, prepare for. Let's be gentle w/each other around this tough lesson, okay?

I have to say, I am completely with those who say it just doesn't matter. Come on ladies (and dad), aren't we all just trying to do what's right for our kids. Aren't we all facing each day of this glorious if not some times insurmountable job called motherhood?

Don't we all beat ourselves up enough trying to do the best we can for our kids? Yeah, that's what I thought.

I have three kids. All three were birthed in a hospital. I had inductions both times. My twins were birthed naturally (i.e.: no c section) even if in an operating room. One of them had the cord wrapped around its neck twice. That baby was born blue. I was happy to have the nicu staff steps away, and thankfully all turned out fine.

I have to be honest and say that on this subject, I don't have any strong opinions, and I also don't really understand "planning" a birth. I mean - it's all so unpredictable, isn't it? And we all end up with a *hopefully* healthy baby added to our families. Does it really matter how that life comes into the world? Does it matter whether that little babe enters the world in a car on the freeway, in a hospital, or in a bathtub at home? No, it doesn't matter one little bit.

The same is true for a lot of these "crucial" first year things. As the other poster said...my kids now 4 and 6 don't really stand apart from their friends. I can't tell who potty trained when, who had a daycare or a nanny, who walked when they were 9 months old and who did when they were 15 months old. It all evens out. So mamas, get off your pedestals and support your fellow moms, but we are all just trying to do the right thing, whatever that is.

And to the mom beating herself up over her baby having celiac. Don't. A lot of it comes down to genetics. Period. Here's a little story for you...My first - I breastfed exclusively for 6 months. At that point, I gave the baby a taste of something with milk protein in it, and she exploded - full blown anaphylaxis requiring an ambulance ride to the hospital because her milk allergy (of which we were unaware) almost killed her. I thought I was doing the right thing by breastfeeding. Against all odds, it turns out she would have been better off with a hypoallergenic formula from day one. Guess what - I went that route with the twins. I didn't breastfeed them at all (well, I did pump and supplemented with bottled breastmilk as much as I could - which wasn't that much - for 6 weeks until it looked like one of my twins was having some trouble.) Formula fed, healthy, and now not one allergy between the two of them. Go figure. What I am trying to say is that when your child has a health issue, it's natural to dissect everything you did to see what you could have done differently to prevent it. Don't. It's wasted energy. It is what it is. Focus on what your child has going for them and be thankful it's something as easy to deal with as celiac. And no, I don't say that lightly. I know what you are dealing with. We live that life, too.

mamas...lighten up...take a walk, have a bath, be thankful for what you have. And stop beating each other up.

I had my kids in hospitals. All three were attended by CNMs. Two were born in NY, one was born in Portland. For me, having a midwife deliver the baby in a hospital seemed like the perfect blend of naturalness+safety net.

I found my hospital experiences to be about what I expected--although the births in NY were, interestingly, more "hands-off" than the Portland birth. Go figure--with Portland's liberal/progressive bent, I kinda expected it to be the other way around.

Like Leslie mentioned above, I preferred the hospital because it wasn't home. Especially once I already had a child. I don't think I could have relaxed at home.

That being said, I have heard some really beautiful home birth stories that made me go, "Huh...maybe having a baby in a kiddie pool in the backyard could be okay..."

In my opinion, home delivery is for pizza. Too many things can go wrong.

I think depends on your personality. I have several friends and an aunt who have done home births and it suits them perfectly. They were looking for something from their birth experience that seemed only achievable in a home setting. Most of them had their hearts set on it before even becoming pregnant. I had a cnm at a hospital based birthing center and my experience was akin to Leslie's and was wonderful. I had no desire to birth at home and the birthing center was set up to be warm and non-clinical while still providing the support I needed. My SIL is an engineer and she wasn't even crazy about the birthing center. She has no problems with technology since it's her life and livelihood and she found the whole earth mother trip very uncomfortable. She found the midwives to be too pushy, didn't like the cup of tea conversations and overall thought the whole thing was weird. She was friends with her female OB and felt they were like colleagues, she had no problem with a more clinical setting since she spent her days in either a lab or a fab and I can tell you she is very intelligent/informed and made a great decision for her.

I have heard some really beautiful home birth stories that made me go, "Huh...maybe having a baby in a kiddie pool in the backyard could be okay..."I have to be honest and say that on this subject, I don't have any strong opinions, and I also don't really understand "planning" a birth. I mean - it's all so unpredictable, isn't it? And we all end up with a *hopefully* healthy baby added to our families..good blog.

I had a wonderful home waterbirth with my son, and it was the best place for me. My ND midwife handled a potentially serious post-birth complication perfectly and we got a great start to breastfeeding. It was exactly what I wanted to give birth at home and to stay there getting to know each other in those early days.

I think this topic is so heated because it's just so personal and we would all like to think our experience was the right way. Maybe if we do all the right things then that can ease our fears a little. I realized as I was watching my 3 year old play at the park a few months back that I will never stop worrying about my son and the choices that we make as parents because I think that is the joyous burden we bare. We can plan and do everything right and things don't always go according to plan but that's not just birth, that is life. There is no right or wrong way to be born. A few generations back we might have been born in a field during harvest.
With my son I labored for 46 hours and I need no badge of courage, after 28 hours I took the drugs but because of the position my son was stuck it made no difference. If this was 100 years ago I would have been one of those women that died in child birth. I was so thankful when my doctor said "honey you aren't going to do this naturally, let's get him out of there so you can meet your baby boy." At that moment that was exactly what I needed to hear and that was how it was meant to be. There is no right or wrong way to meet your little miracle.
We should be so grateful to have been able to conceive and give birth and celebrate the miracle of growing your family and loving that little being more than your could have ever imagined possible.
I think it's healthy to talk about birth stories and understand each others experiences with respect. But I never tell my birth story to first time pregnant mamas, they will have enough to worry about once that little person makes their entrance in their own unique way. It might be a good story for teenagers though with much more details about the pain.

N,

Just curious, was your baby born posterior? My daughter was, and that is a major reason why I was so glad to be in the hospital where they could use a vacuum to get her out!

I didn't progress past 9 cm, my ob said I had a "lazy uterus" she said it very tongue and cheek. The ob that did my c-section said he was stuck facing posterior, he came out with a cone head. The first midwife I saw in labor and delivery told me he was facing posterior and that walking, bouncing on the ball might help move him. I honestly cannot say enough positive things about the labor and delivery team at kaiser sunnyside. They were absolutely amazing. The post delivery on the other hand was less responsive but I couldn't have done it without that team of people most I had never met before. Both of my labor and delivery nurses visited us after delivery checking on our recovery, they were truly amazing.
I would have loved to deliver naturally but it just wasn't in the cards. I think the next go round I still want to experience labor and try on my own but it will be in a hospital and if I need a c-section I will be in the hospital due to my lazy uterus :)
For me I will just have to be flexible given my first experience.

From k8 -
For me, having a midwife deliver the baby in a hospital seemed like the perfect blend of naturalness+safety net.

***************
Exactly, I loved my natural births in the hospital with my beloved CNM. Babies were born at night, I was home shortly after lunch the next day. Hubby and I still rave about how fantastic it all was.

It is really difficult to get a straight story on which homebirth midwives in the Portland area are the best and safest. The state does a horrible job of making stats available to the public, and a lot of women who had bad experiences are afraid to post about it online because others will rally around and blame them or argue with them. There's a belief that it's wrong to be honest about your bad homebirth because it could "hurt the cause."

Because of this I have started a blog for Oregon moms like me who just want a chance to know the truth even when it's ugly, and to tell their stories even when they are difficult, sad, or frustrating. Please send me an email at oregonhomebirthinfo@gmail.com if you want to share your experiences, and check out the site at http://oregonmidwifereviews.blogspot.com

To Astraea....

Great site. I hope you get more feedback on there. I think its hugely irresponsible of the state of Oregon not to have some more stringent standards. Not every mom will have time to thoroughly research their birth attendant... better help from the state is needed to keep moms and babies healthy.

jln- That link isn't very helpful to the conversation. The woman in that story chose to hire 2 ladies that were unlicensed to help with her birth. It is unfortunate that she didn't spend a little more time researching.
I didn't have a home birth but I did birth at a birthing center. I was accompanied by 2 certified nurse midwives (one of which was also a NICU RN), and a 3rd woman that was an intern. I spent a lot time researching my birth options to ensure that I was going to be providing the healthiest option for our family. I was a 3 minute drive from a hospital if there was something unforeseen that came up. I have serious anxiety in hospitals and am glad that I had the option of a birth center. If I ever decided I wanted another child (assuming I was still considered low-risk), I would choose home birth- without a doubt.
Much love to all mothers that put thought and research into their births. Remember that the best choice that you can make for your family's experience might be very different from the best choice someone else will make for theirs. Do what is right for your situation. Be thankful that we have so many choices.
Oh- thought it might be worth mentioning that an umbilical cord wrapped around a baby's neck does not mean the baby is being strangled or not receiving oxygen. Remember, the baby isn't breathing out her mouth while in the womb. The baby is receiving the oxygen through the umbilical cord. Approximately 35-40% of babies come out with the cord wrapped around the neck- at least once. Really. A lot of fears surrounding birth can be eased with a little research.

Bah, your post reminded me of something I read here: http://www.10centimeters.com/oregonmidwives/
It basically tears the "you'll be safe if you just do a little research" argument to threads.
I quote:
"So just do your homework, right? Like Mothering and Birth Without Fear are always telling us, just make sure your midwife is one of the competent ones and nothing bad will happen to you! But how can you tell? Unfortunately, the Oregon Health Licensing Agency, the entity that regulates direct entry midwives (DEMs) in Oregon, has done a terrible job of protecting consumers. Thirty percent of licensed Oregon midwives have complaints against them pending before the Board. Which ones are they? You won’t be able to tell from the OHLA website, since even midwives currently on probation have no special notation regarding their status on the Board’s searchable database. There is no malpractice database, as there is for OB/GYNs and CNMs, so you can’t easily find if a midwife in whom you’re interested has been sued. Why not? Because licensed midwives aren’t required to carry malpractice insurance, either, so even in the most egregious cases there has not only been no compensation for the victims, but there is no warning for future victims either."
It's a really informative article.

"There is no malpractice database, as there is for OB/GYNs and CNMs, so you can’t easily find if a midwife in whom you’re interested has been sued."
Uhh, I had 2 CNMs. Sorry if that wasn't clear in my first post. I also didn't say that "you'll be safe with just a little research"...please don't put words into my mouth. I'll go ahead and step out of the conversation now, I've said all that I wanted to say regarding this matter.

Ha, that's my tummy. And I had my first in a hospital, second at home. The second time was so much better for everyone involved. I know a few people who have had babies who either died or were seriously injured as a result of a hospital birth. Does that mean you can say "OMG someone's baby died in the hospital, clearly hospital birth is dangerous!" ?? No... and just because babies die or are injured in homebirths doesn't necessarily make it more or less dangerous. My midwives were amazing. At the hospital I had a birth "plan" that included no drugs, as little intervention as possible, etc. But it ended up including an episiotomy that the Dr. didn't bother to even tell me he was doing and I had no idea about until my baby was born. The home birth was peaceful, less stressful, and my midwives communicated with me the whole time but mostly just stood back and didn't step in unless they were needed.

The whole argument that there MIGHT be some crazy complication with a home birth that you need a hospital for is ridiculous. Things happen in hospitals that hurt or kill babies that could be avoided with a low intervention home birth. I know someone who lost her baby because a stupid doctor swept her membranes after she'd tested positive for GBS, which let the bacteria in and killed the baby. A midwife probably wouldn't have done that, but she chose the "safe" route of dr./hospital birth...

Responding to the original post, regarding homebirth versus hospital safety: Although not Oregon specific, the post here and the comments are all quite interesting. http://www.10centimeters.com/friday-fallacy-babies-die-in-the-hospital-too/

My problem with home births is what is something goes wrong and there is no doctor near. Also what if the baby is in distress. I have had two children born that went straight to the neonatal unit. Midwives are great but sometimes you need the experience only the doctor has.

A home birth in developed countries is an attended or an unattended childbirth in a non-clinical setting, typically using natural childbirth methods, that takes place in a residence rather than in a hospital or a birth centre, and usually attended by a midwife or lay attendant with expertise in managing home births.

One of the problems with homebirth in Oregon is that we do not have the same carefully researched and thought-out risk criteria that are in place in nations where homebirth is widely available, popular, and relatively safe such as the Netherlands, New Zealand, the UK, and Canada. Further, our risk criteria have gotten looser and looser since midwives were first licensed here in the early 90s, for no particular reason other than they and their lobbyists want it that way. I actually did some side-by-side comparisons here:

http://oregonmidwifereviews.blogspot.com/2011/09/game-of-risk.html

I'm with ugg boots.

From the testimony today at the Oregon legislature by certified nurse midwife Judith Rooks. She analyzed the information on planned home birth versus planned hospital birth that the state now collects on all birth certificates. The death rate for babies was 0.6/1,000 hospital births, and 4.5/1,000 home births. This is the first time this information has been collected and analyzed in Oregon.

"Many women have been told that OOH births are as safe or safer than births in hospitals. This is true in some places, including British Columbia." (B.C. has very high standards for midwifery training and accountability, and integrates midwives and their patients into the overall hospital system.)
"But," Rook continued, "out of hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all
the knowledge, skills and judgment needed by midwives who practice
in any setting."

https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585

http://www.skepticalob.com/2013/03/oregon-releases-official-homebirth-death-rates-and-they-are-hideous.html

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