Why would u consider home births

sweetpotato

Tue, Sep 06 2016, 6:50 am

amother wrote:

They have some sort of emergency equipment (oxygen, etc) but they can't do an emergency c section. Being through a very scary experience with my first resulting in an emergency c section I would never risk being far from an OR.

I'm not at all denigrating or taking issue with your experience, please don't think I am, but part of the logic that's being applied in the argument that home births are patently less safe than hospital births seems to be the idea that the only safe way for all women, in all cases, to give birth is within the same physical building as a fully-staffed OR and NICU (I.e, a major hospital). But in highly developed countries around the world (Australian, Netherlands, Japan, UK, etc.) that have much better maternal/fetal outcomes than the US, women give birth routinely at home and in birth clinics that don't have ORs or NICUs or the full complement of advanced emergency equipment immediately at hand. Their medical establishments, which are almost inarguably better than ours in most respects, do not consider it at all a necessity in a low-risk pregnancy (which various data shows is at least close to 1 in 2 pregnancies).

In the U.S., birth centers (which have no special equipment that a fully trained CNM homebirth midwife would not carry with her to a home birth) are also fully legal and recognized as a safe choice for low-risk women.

I'm not saying women shouldn't have the choice to give birth in a hospital with every aspect of emergency equipment, specialist staff, etc. at hand. They absolutely should, whether it's medically indicated or not. But clearly commonly accepted practice shows it's not necessary is all--or even many--cases to give birth that setting, or safer or better.

You could definitely make the argument that homebirth in the U.S. currently is not as safe as a hospital or birthing center birth because, for example 1) our medical system overall is not great, especially for women/babies 2) we don't have the same kind of infrastructure and widespread adoption of non-hospital and CNM-led prenatal and obstetric care as those other countries do, so the midwives don't have the enough integration into the hospital system if a circumstance arises that necessitates transfer of care 3) we don't have the same extensive post-partum support systems as those other countries do 4) we allow less qualified midwives (CPM, not CNM) to perform homebirths, etc.

But you can't argue that homebirth (or birth center birth) are inherently unsafe, if all those circumstances are satisfied, and that all or most women need to be in a major hospital with an OR, NICU etc., in order to give birth with optimum safety, because the way it works elsewhere in the developed world contradicts that.

Marion

Tue, Sep 06 2016, 10:53 am

amother wrote:

What I am saying is that there are choices you can make (midwife vs doctor, which hospital, etc) which are more mother and baby friendly. There are not only two choices.

Those choices might be limited by where you live. In Israel ALL births are attended by midwives (except c-sections)...you see an OB for your pregnancy, have a hospital midwife attend your birth, and are followed up (maybe) by your OB for yourself and a nurse for your baby. You never see a paediatrician unless your child is sick. There is no such thing as a birth centre. (And don't talk to me about the "Natural Birth Suite" at Ein Karem; if you read their rules and actually speak to the midwives you'll find that you're paying 3800NIS - last I checked - and their rules and guidelines are identical to those in the regular L&D unit...the chances of you "risking out" and being transferred halfway through your labour are about 40%...)

Part of the choice of homebirth in Israel is a continuity of care issue. You can pay a midwife (licensed m/w run about 5K NIS) for a homebirth, but you can't pay a private midwife in the hospital; it's against the rules. Yes, in all hospitals. If you want continuity of care you could also spend upwards of 11K NIS for a private physician who you would see during your pregnancy and would deliver your baby. For comparison's sake, bituach leumi pays about 11K NIS to the hospital for every birth (vaginal or c-section). The licensed home birth midwives have all spent at least 3 years on L&D wards as part of their training; most are hospital midwives who disagree with the way the hospitals are run with respect to L&D and have therefore moved on to provide homebirth services. I am not getting into the unlicensed midwives; many of whom are CPMs (a designation which doesn't actually exist in Israel) or are licensed in their countries of origin but not in Israel.