Home Birth - - What Medical Options/Tech do you Lose compared to small hospital?

[sste]

Not considering it personally (my risk profile is not a good fit - - nor my personality) but I have been thinking about this alot since the thread where I learned that many hospitals do not have an anesthesia person readily available. Learning that made me way more open-minded about home birth!

So, for me, I go to a large academic hospital and my reasoning is that I have: 1) 24-hour anesthesia and of course surgically trained ob so I can get an emergency c-section on the spot; 2) NICU; 3) crash cart, oxygen, other emergency stuff; 4) ability to transfer me to an ICU if that is needed. (BTW there are also downsides in terms of intervention and BF support with this type of hospital but I have been able to manage that through provider choice).

But, if you are low-risk and choosing a hospital that does not have an anesthesia person right there, does not have an NICU, or an ICU then I just curious as to what the advantage is over home birth? For example, do home birth providers have their own emergency oxygen? Can they shock (crash cart)?

Not asking this to provoke a heated ideological debate, I am just curious as to what are the medical technology/staffing gains from birthing in small hospital without anesthesia/nicu versus a home birth?

[wellyes]

First thing that came to my mind was having your OB or midwife present. You could hire a midwife for home birth but only a certain % will do it. If you want to use the practice that has given you ob-gyn care all along home birth isn't that much of an option.

UNASSISTED home birth is a whole other ball-o-wax.

[WolfpackMom]

Rapid transfer to a big hospital that can deal with high risk situations should an emergency come up?
ETA: If an emergency did come up a hospital would have more people on hand, some to deal with mom, some to deal with the baby should both end up in distress wheras at home you would prob just have your partner and midwife or doula.

[sste]

Oh, I didn't even think of that . . . I was assuming professionally (well-trained midwife) ASSISTED home birth!!

Coming from my perspective, I can't fathom unassisted birth in any setting.

I guess what I am wondering about is that in learning more about small hospitals it seems that many of the advantages that always drew me to hospital delivery aren't necessarily there . . .

[luckytwenty]

I'm just too much of a chicken to consider anything other than a big hospital with a NICU. Wouldn't trade the nicest doula or midwife in the world for that kind of peace of mind--I feel that way now, after having a difficult emergency c-section with my first child in which I got a staph infection and spiked a super-high fever...and I'm glad I felt that way before having him, when I was considering birth options. All the power in the world to people who are braver than me and are willing to go the extra mile for a more profound birth experience, but my personal take on it is that with anything life or death, every second can count. But again, I'm a chicken about this kind of stuff and never was that interested in the whole "birth experience," just wanted to get a healthy baby out of the 9 month ordeal!!

[bostonsmama]

You should also consider the infant mortality rate in home births vs those at hospitals. My guess is, and with any data you have to look at their inherent gaps, that less babies born at home (assisted) have complications than those born at hospitals, partly due to the fact that homebirths are uncomplicated, non cesarean, term, etc. Those w/ GD, pre-E, are pre-term, breech, etc, are usually born in big hospitals with access to crash carts, NICUs, on-call pediatricians, surgical OBs, etc...and to an extent, these conditions lead to higher rates of infant mortality. So...it's hard to accurately compare assisted homebirths vs smaller hospitals vs larger hospitals b/c it's not as black and white as more deliveries are complicated and babies need help/die at this place vs X place.

[sste]

Bostonsmama, I agree. I never was persuaded when people said research has shown that home birth is just as safe because of exactly what you say - - its not a prospective, randomized study. People like me and you with risk factors self-select out of the home birth pool.

But, that said, as someone who would never have remotely considered home birth, after hearing about the lack of anesthesia person at many small hospitals it has made me think twice. *If* I was a younger, low-risk mom who was about the same distance from the small hospital as the amount of time it would take the hospital to page in an anesthesia person . . . I would be asking alot of questions about the gains from small hospital versus home.

[swissair81]

Several points:
1. Unless it is referred to as an unassisted homebirth, all planned homebirths should have a midwife present.
2. Usually the midwife brings an assistant. One person for the mother and one for the baby.
3. Midwives are birth professionals. Therefore they have everything they need except a mobile OR. They bring oxygen & a whole lot of emergency equipment. Anyone who has ever worked in L & D has NRP certification (neonatal resuscitation) & midwives are usually trained in ACLS (Advanced CPR & Life support) as well.
4. Good midwives call 911 & get pre-clearance for an OR when things get sticky. You need to live within a certain distance from your closest hospital or you will risk out & no one will do a homebirth for you.

[daisymommy]

Several points:
1. Unless it is referred to as an unassisted homebirth, all planned homebirths should have a midwife present.
2. Usually the midwife brings an assistant. One person for the mother and one for the baby.
3. Midwives are birth professionals. Therefore they have everything they need except a mobile OR. They bring oxygen & a whole lot of emergency equipment. Anyone who has ever worked in L & D has NRP certification (neonatal resuscitation) & midwives are usually trained in ACLS (Advanced CPR & Life support) as well.
4. Good midwives call 911 & get pre-clearance for an OR when things get sticky. You need to live within a certain distance from your closest hospital or you will risk out & no one will do a homebirth for you.

My midwife brought 2 canisters of oxygen--one for me, one for the baby, as well as a portable shock unit/defibrillator, shots of [what's it called?] for if you are bleeding too much and need to stop the bleeding, supplies for stitches, etc. Basically everything except the operating room Never had to use any of it, and 9 times out of 10 they don't need to. But I think most people have no clue that a midwife has just as much skill, knowledge, and training (and then some when it comes to delivering babies)--as an OB. She just can't do surgery or give an epidural.

With Andrew, I was at 10 cm. for over an hour, and had no urge to push. Were I in a hospital, as soon as they found me at 10 they would be telling me "it's time to push!" as though a magical turkey timer had popped up. My midwife was able to gently feel around and tell that his head and body was not lined up perfectly, and that no amount of pushing would be able to maneuver him out until he was positioned correctly. She had me in all kinds of funny positions to get him to line up right, including walking side ways like a crab up and down our flight of stairs. No doctor would have done that. I would have been pushing forever, and then He would have called it "failure to descend" and would have said I needed a C-section. Once he got into position, it only took a few pushes and out he came, no tears at all.

[Katigre]

In terms of your question, my midwife (CNM) said that she came equipped with everything in a Level III trauma ER (low level ER) - she had an O2 tank, was trained in neonatal resucsetation (sp?) and also had medication to stop a hemorrage - there were three levels of meds there. Methargine tablets, pitocin injection, and cytotec injection (which causes the uterus to contract back down. She was also trained in suturing and basic newborn assessment. We had a plan in place for if a transfer were necessary - what the nearest hospital would be and the route, what records to bring with us, etc...

Bostonsmama, I agree. I never was persuaded when people said research has shown that home birth is just as safe because of exactly what you say - - its not a prospective, randomized study. People like me and you with risk factors self-select out of the home birth pool.

That is why I say "Homebirth is just as safe as hospital birth for a low risk pregnancy" because I feel that is an accurate statement. (Some 'high risk pregnancies' like being over age 35 I also believe HB would be just as safe as a hospital for).

I do believe women should have the right to choose HB even in a higher risk situation (VBAC, twins), but would not make the above argument in support of it ("It's so much safer"). In those higher risk cases it should be acknowledged that there are greater risks for the baby (or mom) but that they are choosing that option anyway due to their specific circumstances/beliefs/intuition. (I.e., someone HBAC'ing would acknowledge that a rupture at home vs. hospital is more dangerous, but would still choose it b/c the risk of rupture is small and the risk of a repeat csection and those associated complications in the hospital is much higher).

I know in my case I had DS in a hospital (and had a great experience) and during my pregnancy with DD I felt very strongly in my intuition that a hospital would not be the best environment for her birth - I am so thankful I made the choice to homebirth (and had it as an available option, even though I had to drive an hour for my midwife appts). For another pregnancy I'm open to both hospital and home depending on the specific situation.