# Hospital vs. Home for 1st time moms



## SeattleMolly (Oct 23, 2010)

After touring the hospital affiliated with my midwife group, I had a very negative reaction. I felt like it was so public and authoritative. It really filled me with fear as we were touring the birth suites.

When I consider a home birth, I get worried because I heard that 25% of first time moms end up in the hospital any way. Another non-hospital-affiliated midwife told me about that statistic. The thought of a last-minute transfer really bothers me, especially when the only hospital that is in my network does not have a pre-existing positive relationship with any midwifes.

So-what are your feelings of making this decision for a first birth? I would definitely do a home birth for #2, but I just feel very unsure about labor not progressing and a transfer.

Thanks!


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## 98741 (May 17, 2006)

I think it's great! I wish I had my first at home, I didn't really even know it was an option. My sister just had her 1st baby at home last week. The transfer rate for 1st time moms is higher, mostly for maternal exhaustion or pain relief, not because of medical comlicatins. I do think that 25% is very high though. The 2 midwives I've used have had much lower trasfer rates than that for 1st time moms. More like 15% I'd guess. I guess I look at it like this, you don't feel safe and comfortable in the hospital, but you do feel safe and comfortable at home (other than the trasfer issue) so where are your odds of a good birth greatest? Also, if you were to end up in the hospital at least it would be because you needed to and not just by default, so you're giving yourself the greatest chance at the birth you want. I'd talk to several homebirth midwives and see how you feel then.


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## goinggreengirl (Nov 7, 2009)

I planned a homebirth (midwives are not yet licensed for hospital births so choosing a midwife was choosing a homebirth here.) We ended up transferring after 60 hours of labor for exhaustion. I ended up with an epidural and pitocin (wanted to avoid both which is why I chose to stay home). It took a little while to come to terms with the birth, but I do not regret trying for a homebirth for my first baby. I will plan one for my second child as well.

My midwife stayed with me at the hospital as labor support. And, even if the hospital is not midwife friendly, and your midwife comes with you, you could just say she is labor support.

Good luck deciding. I know what a hard decision it is!


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## EllisH (May 29, 2010)

I will be giving birth for the first time also - in January - and am opting for a hospital birth (in an - academic - hospital that I trust). Home births are very common in the Netherlands, and there's been a lot of research done on it as a result. It has been shown that the risk of complications is much higher when starting at home and then needing to be transferred vs starting in the hospital. In addition, if the baby needs acute help upon being born, it will also be readily available in the hospital. I just don't want to take any risks, a healthy baby trumps having the experience at home. That being said, I will have a birth plan which explicitly states that I want to opt for minimum intervention if at all possible and that I'll discuss with my obgyn beforehand.


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## terrordactyl (Jul 19, 2006)

you should go check out the home birth forum.


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## the janet (Sep 28, 2009)

I chose the middle ground: I'm expecting my first in 3 weeks and planning on giving birth at the only freestanding birthing center in NYC. It's not home but it sure ain't the hospital!

I've had all my prenatals at the same place I'll be laboring/giving birth, so it's very familiar to me and I know the entire staff. The midwives work in conjunction with the OBs at the nearby hospital* that women transfer to if necessary, so I am fully confident that if I need any extra medical attention, my midwife will be there and have full privileges.

Should I end up with a natural birth, I will most likely have a home birth next time. 

* The first birth I attended as a doula was at this particular hospital and it was the best hospital birth experience I've witnessed so far...meaning my client had an extremely hands-off CNM and the nurse had a great bedside manner. My client ended up giving birth naturally and with minimal intervention in the hospital. This, sadly, is not every woman's experience.


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## rad (Jan 21, 2004)

I had my first at home and it was a great experience. I didn't want to take a chance of having some horrible intervention done that would make it that much harder for me to homebirth the next time around. So I just decided to do it the first time around. And of course, I've had 4 subsequent homebirth that all were great too. Planning another any day now.


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## gemasita (Jul 1, 2005)

I'm planning to have my first at home in January. My midwife says it's more like 10-15% of first-time moms that get transferred and it's usually a non-emergency. So I have about a 90% chance of giving birth at home - sounds good to me. I've been to hospital births and homebirths as a doula and I think it makes a lot of sense, ESPECIALLY when you don't know what to expect, to be in a setting where you really get to know your care provider on a personal level and interventions are rarely used. I think of my poor DH in a hospital trying to remember what I did/didn't want and why. I like that he's on his own turf at home. And I have felt very private during pregnancy so I am glad I chose a homebirth. I think I would really tense up in a hospital. However, if I end up in a hospital, then so be it...I'll know it's because I NEED to be there. I love my midwife though and the relationship we have built and I am always thinking how I wouldn't have this individualized care from a hospital-base care provider - and boy is that nice for your first pregnancy. I hear so many people say they had a hospital birth with their first and then went on to have homebirths so I figure, why would I do a hospital birth first the first and have more of a chance of having a different birth than I pictured or what I consider a negative birth and THEN move on to homebirth? I'd rather have a better chance of having the birth I envision with my first!


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## goldenwillow (Jan 5, 2010)

We chose a homebirth for our baby and for me, it was the best decision I have ever made. I did tour the hospital locally just in case of a transfer (as suggested by my MW) and just knew that I could never deliver in a hospital, well unless it was necessary. I continued to believe in my body and remembered that women have been doing this for centuries. I feel if there is a need for a transfer, at least a woman is able to labor in her place of choice (ie: home, birth center, etc.) and that alone helps one release to birth. Personally, I could not imagine laboring in a medical setting with people I don't know running around me.


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## GoBecGo (May 14, 2008)

I had #1 (and #2!) at home. The hardest thing for me was the constant doubt from all the medical people (even some of the midwives - it was an NHS homebirth in the UK, for #2 i had an independent midwife instead) that i could "do it". Ironically only my own assigned ob, who i only met twice, was relatively relaxed about it. But several midwives and EVERY registrar/SHO i saw (quite a few at the end as i had raised BP) was very down on my choice. In the end i had an entirely uneventful, surprisingly short, very easy birth.

I was afraid in the hospital. They had a 38% c-section rate (it's a teaching hospital and major centre for obstetric complication) and that rose to 56% for first-timers. The staff were friendly but so over-stretched and busy that they had recently lost their baby-friendly certification due to have very poor breastfeeding support available. I was scared. Don't go somewhere scary for your birth. If you feel safer in the hospital then fair enough, but hormonally a labour is like an orgasm - go where you feel safe and supported.

Quote:


> It has been shown that the risk of complications is much higher when starting at home and then needing to be transferred vs starting in the hospital.


That is because people who have no problems delivering DON'T transfer and thus stay at home. Not because being at home creates complications. The total number of c-sections is lower amongst those who begin at home than those who begin in hospital, even when one adjusts for known risk factors before the onset of labour.


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## expat_canuck (May 16, 2010)

I'm due with my first in January, and am planning a homebirth. My midwives say that most transfers of planned homebirthing moms in their practice are for exhaustion/pain relief, and at the mothers' request, rather than emergent situations. The proportion of emergent situations arising unexpectedly during labour/birth are about the same for them, whether at home or the hospital.

My midwives work in hospitals as well, and even if I was planning a hospital birth, I would be doing most of my labouring at home - they don't transfer to the hospital until active labour is well established, meaning that no matter whether you are choosing a home birth or a hospital birth, you spend most of your labour time at home.

I'm not in the least bit concerned about homebirthing my first baby, and, in fact, feel a lot more confident about the birth process in my own home, with my own chosen attendants present, and the ability to labour however I want wherever I want. Obviously, since this is my first, I don't *really* know what to expect in labour (I can read and take classes, and all the rest, but it's all just guessing at the experience until you go through it, you know?) and it makes me feel better and stronger and more prepared to know that know matter what path my labour/birth take, I will be able to respond in whatever ways fit *me* best - no hospital policies or procedures or 'normal' intruding on my birth - if that makes sense. I also totally trust my midwives to make the clinical decisions necessary best support my health and my babies' health - so I'm not even worrying about that part. My partner and my doula will be there for *me* while my midwives take care of the clinical/safety/health part.


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## imogenlily (Nov 15, 2010)

Quote:


> Originally Posted by *expat_canuck*
> My midwives work in hospitals as well,


Hey, I'm having my first baby here in Vancouver as well. What midwife group are you with? I'm using Susie and Beth at Pomegranate.

Feel free to PM me


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## Climbergirl (Nov 12, 2007)

Quote:


> Originally Posted by *EllisH*
> 
> I just don't want to take any risks, a healthy baby trumps having the experience at home.


Sorry, this is the one sentiment that people tend to have that makes my skin crawl. Especially since, when I was pregnant with DS, I thought that *exactly*. I could not understand why a woman would take such risks!

A hospital does not equal safety or a better outcome. I wish it did. I was wrong. I got 2 hospital stays (one for delivery, one for complications to my c-section) and I really learned a lot about hospitals. They are nothing like the TV shows. The hospital discharged me when I said I had trouble breathing and that even though my BP was considered normal, it was elevated for me. That, right there, almost killed me if my MIL did not beg me to go back. My MIL could tell I was very sick, even though the nurses said I was fine. It is very possible my complications were a hospital borne infection.

It isn't just about a healthy baby. It is about a *healthy mom too*. And when you are in the ER and they are telling you that you are very sick and may not ever go back home to see that precious baby, that really hits home. You health matters too. And as much as I have been told that I am selfish for thinking that, I know it to be true.

I am having my baby at home this time because I know my midwife knows me well. She knows about my history, my life, my worries, and my fears. She also knows that I run hypoglycemic and sometimes my blood pressure can be as low as 80/50 (and I am not about to pass out). I trust her. And therefore, I believe being in her care is much safer than going to a hospital.

You have to go where you feel safe. I would prefer to transfer to the hospital to receive the care there that I would need versus starting off there. But that is me


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## belltree (Mar 10, 2009)

EllisH, I believe you are quoting a study published recently by Evers et al (http://www.bmj.com/content/341/bmj.c5639.full) . There are some unique problems in the Dutch system, that could explain the higher complication rate for transferred moms. The authors speculate that this might be mostly due to a lack and delay in communication:

" Firstly, diagnosis in primary care can be delayed because the midwife is not always present during the first stage of labour and fetal heart beats are often checked only every two to four hours.

Secondly, transport can delay treatment in case of an emergency.

Finally, a delay can occur because the obstetrician underestimates the problem as the referred woman is a "low risk" patient.

In addition, essential information can be lost during the referral. "

You should also read a study by deYong, that showed, that homebirth is indeed as safe as hospital births.

In the Netherlands the transfer rate is around 43%

I believe it is better to read and interpret scientific results carefully.


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## Banana731 (Aug 4, 2006)

Hey Climber girl- that's my normal BP, you are not a freak!









Quote:


> Originally Posted by *SeattleMolly*
> 
> I would definitely do a home birth for #2, but I just feel very unsure about labor not progressing and a transfer.


Here is something to think about. Hindsight is 20/20. Most women that I have met, both here and IRL, who have had sentiments like this and chose a hospital anyway have been pretty unhappy with their experiences. No matter how awesome your OB, CNM, or birth plan is- a hospital birth is NOTHING AT ALL like a homebirth. And no matter how great your hospital birth is, it will never be a normal birth. If these are things that appeal to you, you should think carefully about choosing a birth place accordingly. Lots of women give birth at home the first time. If your labor doesn't progress at home (provided you aren't having a problem) your midwife will encourage you to take a nap. If your labor doesn't progress in a hospital, most CP's are going to try to force it to. They are on pretty opposite ends of the spectrum.


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## allisonrose (Oct 22, 2004)

I believe my midwife said that transfer rates for herself, her mentor and associated midwives is around 10%. She didn't have the number broken down for first time moms vs second or more times moms.

I didn't have my first at home. After going through infertility treatments, I let my shaken trust in my body and financial issues of being under an HMO make the decision. I regretted it when I ended up with a bunch of interventions I had hoped to avoid. (Luckily it was a vaginal birth which tells me that my body is capable of this.)

For this second child, I feel more confident that my body will be able to do this. I also feel like I "dodged the bullet" the first in a manner of speaking by having avoided a c-section in the hospital. I don't feel like taking that chance again.

If you already feel uncomfortable about the thought of the hospital, there is something to examine there....


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## motherhendoula (Feb 13, 2009)

Its a tough decision - i had my first at a free standing Birth Ctr. - but it had closed by the time i had baby #2 - so my options were my midwife at a hospital - or my midwife at home. It took me months to make up my mind. I toured the hospital and thought it was a horrible place to be during labor....the bed was so narrow (both me and my baby would not fit together to sleep there!) - there was no space to walk around in the room (was i really gonna have to walk around in the halls?!) the shower was so small and cramped (what would i do for pain relief?) AND two rooms shared a bathroom! I think it was the shared bathroom that put me over the edge - lol

I had my #2 at home and it was the most memorable, wonderful, experience of my life. I am officially hooked on home birth - i just recently had baby #3 at home - this was a much harder and faster labor (not the bucolic water birth i had planned!) - but it was still so wonderful - i wish i could afford to stay home and have more kids!

You really need to let go of the idea that 'something' could go wrong. The fact is that midwives are trained to do this at home, they know what they are doing, they also know warning signs to look out for. If you are concerned about labor not progressing...stay away from the hospital! I dont know anyone who regretted their decision to homebirth.


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## globe-trotter (Feb 11, 2009)

We did a homebirth for our first also!


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## ~adorkable~ (Nov 7, 2007)

Quote:


> Originally Posted by *GoBecGo*
> 
> Quote:
> 
> ...


this is an extremely important way to look at this statistic. as so many of them get looked at in too near sited of a way. thank you for pointing it out so clearly.

as to the original poster and question. you need to be where you are comfortable, many first time moms are wonderfully comfortable birthing at home. I am planning my twin birth for my home in Jan. that being said fear is real, and if you cant find a way thru that, listen to it. make sure you are really comparing apples to apples and understand the up and downsides to each choice and then make the right choice for yourself, it may not be what is right for the next lady.

one thing that helped me understand what was best for me was to know that while the hospital might add come medical back up to the situation it also added some clear to understand problems. and in the end the small % of risk that those medical procedures would be used to help mitigate were out shadowed by the larger % of issues that the medical, ridged and unfamiliar setting would add to the birth.

if i was burdened by lots of worry about a home birth, home would not be the best place for me to be. the fact that instead i am burdened by the worry and stress of what i might encounter in a hospital setting is exactly why i don't want to be there unless the immediate situation that outweighs those hospital worries.

i would encourage you to find a good birth education class that is not given by a hospital and instead by folks that believe you can do it your way in your own place of comfort. and them as you learn those things you will find where your comfort place is


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## EllisH (May 29, 2010)

Quote:


> Originally Posted by *belltree*
> 
> EllisH, I believe you are quoting a study published recently by Evers et al (http://www.bmj.com/content/341/bmj.c5639.full) . There are some unique problems in the Dutch system, that could explain the higher complication rate for transferred moms. The authors speculate that this might be mostly due to a lack and delay in communication:
> 
> ...


Belltree, could you please explain what you mean by your last sentence? I am aware that people here will likely disagree in sentiment / principle with me, but that doesn't mean that I don't read and interpret information carefully. Also, there is always the need for interpretation of scientific results (and then applying it to yourself), leading to differences in interpretation.

So I am aware of the likely causes the authors cite - but they don't seem to undermine the conclusion. If you make the point that this doesn't apply to the US, fair enough (I cannot properly judge the ob situation in the US - although I did live there for a number of years and have friends who have given birth in US hospitals, much to their satisfaction), although it's a fact that regardless of location not all complications that would require immediate intervention can be determined upfront and some will only transpire during / immediately post-delivery. (And I myself prioritize being prepared for that eventuality in my choice where to give birth) . Other studies that show they are both as safe (in the Netherlands) have come under criticism, since home births should have better outcomes than hospital births, given that it's the high-risk deliveries that tend to be referred for hospital births.

On a different and more general note: I know that C-sections are given (pushed) much more commonly in the US than elsewhere, and I think that's *a very bad thing* indeed and to be avoided. However, there are certain advantages to delivering in a hospital that shouldn't be ignored (despite all the problems with the US healthcare system). In addition, I do not like the sentiment that all hospitals are evil: I have had very good experiences with my obgyn and the rest of the medical staff in the hospital I go to in making me feel comfortable about concerns / complications I had during my pregnancy. I also was extensively briefed on the procedure and the choices *I* will have for e.g. pain relief during delivery (but as I already mentioned, I will opt for a natural birth). In view of my good experience with my hospital in the US and the people that gave me care there (albeit not with L&D) I refuse to believe that no good hospital (i.e. one exercising restraint in interventions and providing a supportive and warm environment) can be found in the US.


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## the janet (Sep 28, 2009)

Quote:



> In view of my good experience with my hospital in the US and the people that gave me care there (albeit not with L&D) I refuse to believe that no good hospital (i.e. one exercising restraint in interventions and providing a supportive and warm environment) can be found in the US.


No, not every birth in a hospital is going to be an awful experience. The first birth I attended as a doula was in a hospital, like I mentioned above. It was actually a very good experience, all around. However, the mama was under the care of a CNM, not an OB, who was hands-off and really trusted the mama's ability to do what she was made to do. Aside from the EFM (which didn't seem necessary but what do you expect, it was a hospital), there were no interventions.

It was also in this mama's favor that her labor was FAST. From her first contraction to the birth, not more than 9 hours had passed. From when she got there to when her son was born, not more than 3 hours had passed. There was no time or need for interventions. But if she had been laboring for the more standard 20+ hours, then they probably would've wanted to hydrate her with an IV (which limits movement) and administer pitocin if she wasn't "progressing" fast enough for their liking (which can make contractions unbearable)...which would likely have gotten her an epidural...which might've won her a trip to the OR.

That potential scenario is why hospitals can be awful places to give birth. You're more likely to be on the clock, especially if it's busy and you're hogging that bed. Your OB (even CNM) won't be with you the entire time...if they're even there at all, as oftentimes you aren't attended by your OB/CNM but whoever's on call. The nurse will be an overworked stranger and you'll get a new overworked stranger if you're there for a shift change.

Some people do have good hospital experiences but it's a total crapshoot and I'm not willing to risk it. The odds of something going wrong during labor are slim. The odds of hospital protocol forcing something to go wrong are pretty great.


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## soso-lynn (Dec 11, 2007)

I had my first (and 2nd) at home. I would simply like to add the fact that becoming a mother for the first time is a huge event and immediately after the birth, you will be much more able to start that new part of your life in your bed, with your partner (if you have one) and given the opportunity to let your instincts take over. So many breastfeeding relationships are ruined by hospitals. If I could get only one home birth in all my births, it would be the first one.

I would not worry about transfer rates too much but do ask why 1st time mothers usually transfer. Your midwife's answer will help you better prepare yourself. If you choose a home birth, you have 25% (or whatever it is) chances of giving birth in the hospital. If you choose the hospital, then you have 100% (well 99.9%) of giving birth there. It seems like an easy decision to me.


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## Mrs.Music (Jun 15, 2010)

I am SUPER excited for my home birth. I say go for it! What do you have to lose giving it a try really? Your midwife will be smart enough to transfer you in the (very unlikely) event of an emergency and then you'll end up where you thought you'd end up anyway, right? It's a no lose. My best suggestion, really, is to just educate yourself. Talk to a lot of home birth moms and midwives. See if it feels right for you. My midwife is awesome, btw. If you're looking for a recommendation.


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## Drummer's Wife (Jun 5, 2005)

I did not have a horrible hospital experience for my first baby like you hear about sometimes: my mom and one of her good friends (partner at the practice, at the time) were my midwives, my nurses were hand-picked (my L&D RN was someone I've known my whole life, and she came in just for me), and this was a hospital where my mom was the nurse manager for mother-and-baby for many years before becoming a CNM - so I felt comfortable there. The back-up OB was someone I trusted with my care.

That all said, I believe that there is a good possibility that if I had stayed home, or even chose to have my baby at the free-standing birth center, I might have avoided that first c-sections (and likely the 3 c-sections I have had since). The two times I have labored, it was for 39 and 36 hours - with very little progression. I honestly wish I had pushed for a homebirth the first time around. I really do. But that's just me, and my own comfort level looking back over the past decade since I became a mother. Some women feel much more at ease in a hospital setting, especially for their first baby. I guess I would just go with your gut, OP, and if after touring the hospital you felt so uneasy -- well, then, I would say either find another hospital, birthcenter, or start interviewing HB midwives.


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## EllisH (May 29, 2010)

Quote:


> Originally Posted by *~Adorkable~*
> 
> Quote:
> 
> ...


Actually GoBeCo misses the point: I referred to research showing that for those that need to be transferred from home to the hospital for a certain complication the outcome is more negative (in terms of infant mortality) than for those who will incur that same complication starting in the hospital. I made no claims about home births *creating* complications (and I don't believe they do - I just believe problems may occur outside anyone's control or foresight).


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## GoBecGo (May 14, 2008)

Quote:


> Originally Posted by *EllisH*
> 
> Quote:
> 
> ...


You did not say that. Your quoted sentence is above, you did not mention mortality, infant or maternal. Your sentence says that the risk of complication is higher if one begins at home. That is not true. The possibility that complications result in better outcomes in hospital might be true (and is according to your one study). But it is not what you said.

It may well be the case that for certain complications going to hospital is safer. But those are not complications which can be predicted and some of us are very fearful in hospital. Having to labour in fear WILL result in a poor outcome for me and my baby. Should i accept that inevitability of a horrendous labour and risky delivery and poor start for myself as a mother and my baby as a separate human being just in case i have an impossible-to-predict complication? No. That is nonsensical! When i go to the shops i go in my car and wear a seatbelt - i don't call an ambulance to take me just in case i crash and need immediate care to make it.

My last baby would very likely have suffered much poorer outcomes in hospital, maybe even died, the way my labour was handled was very important in that regard. Yes, sometimes there are terrible outcomes at home. Sometimes babies and mama's die. But babies and mamas die in hospitals too. If you feel it is much safer and better for you to be in hospital, good, go there. But please don't tell me that it is safer and better for me, because very simply it is NOT.


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## EllisH (May 29, 2010)

Quote:


> Originally Posted by *GoBecGo*
> 
> Quote:
> 
> ...


(Last response on this issue) I said: "It has been shown that the risk of complications is much higher when starting at home and then needing to be transferred vs starting in the hospital." That is not the same as: "the risk of complication is higher if one begins at home." My claim only concerns the group who starts at home but then needs a transfer due to complications vs the group starting in the hospital and then develops (the same) complications. You are right that I further explicated this point (since it was misunderstood) by clarifying precisely what I meant, incl. the reference to infant mortality.

Also, regarding your point that "It may well be the case that for certain complications going to hospital is safer. But those are not complications which can be predicted" - that is the reason I prefer the hospital, precisely because these complications cannot be predicted. Note that I respect everyone's personal decision in this regard and in fact I myself would much prefer a home delivery over one in the hospital if I could be sure there would be no (unpredictable) complications. But since I cannot be sure, that's why I personally made the trade-off to deliver in the hospital.


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## la mamita (Apr 10, 2005)

i had a homebirth for my first and it was a fairly easy decision. i knew i had a good hospital in case i needed to transfer, but i didn't focus too much on that possibility. i don't like hospitals and i read enough about what typical hospital births are like, even the "natural" or unmedicated ones, and the cascade of interventions to know that i would not feel comfortable in that environment unless it was necessary due to some emergency. i read a lot of homebirth stories and tried not to read the horror stories or the ones where the mom says 'oh, i was begging for an epidural an hour into labor'. i read a lot about the stages of labor, so i would know what to expect as far as how things would progress. for me it ultimately came down to knowing that i would go into a fight or flight reaction in the hospital--i don't think i could ever feel comfortable in that environment and i know that fear has seriously hinder the birthing process. i had a pretty quick labor and never ever felt overwhelmed by the pain. i remember transition as the point where i wasn't thinking about anything, just feeling, so i never got panicky. i have serious anxiety, so that was huge for me. everything went smoothly and i'm planning a second homebirth.


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## ~adorkable~ (Nov 7, 2007)

lets see if we can keep focused on the orginal post and helping her out, i worry that we have got very sidetracked on semantics that clearly mean a lot and different things to different folks here.


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## IdentityCrisisMama (May 12, 2003)

I would choose home and I would choose starting with HB midwives if you're unsure. This opinion is based on person and friend's experiences and not on research. I had a planned HB with a hospital transfer and it was fine. Though not ideal, of course, I do feel strongly that had I started in the hospital I would have received many additional interventions and would not have been happy with my first birth.

Good luck with whatever you choose!!


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## SeattleMolly (Oct 23, 2010)

Thanks to you all for all of your input and thoughtfulness! This is a big decision and you helped in my education around home birth. I've also checked out the Home Birth threads and they've also been helpful. Philisophically, I'm probably not as far on the homebirth side of things as people are here on the boards, but I believe that it is necessary for me to listen to all stories before I make a decision.


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## IdentityCrisisMama (May 12, 2003)

SM,

I was on the fence with my first birth as well. I felt like I would never be into the HB scene and didn't feel "radical"...I just was interested in HB as a logical choice after reading. I chatted with a hospital MW and told her that I was thinking of HB and it was actually the hospital birth MW who advised that I start with a HB MW. She said it is an easier transition to go from HB care to hospital birth care during pregnancy than the other way around.

What I did was choose a HB MW with a VERY good reputation but who was also more "conservative" (IMO) when it came to transfers. Their office was very "professional" and the MW shared a practice with 2 MW and had a full time assistant and an office manager. Now that I'm on my second birth, this particular practice would feel too "OB" for me but it was a good compromise for where I was with my first.

Another good option would be the lowest intervention type hospital MW or, as others have mentioned, a birth center.

I wish I could advise some good books that are more neutral but I'll admit that none of the wonderful HB books I've read seem all that neutral to me. Still, I think "Pushed" is a great read!! For a more neutral stand maybe you can get your hands on a good infant development textbook that coves birth options. That was the first place I ever read about HB and that seems like the most neutral tone you'll come across.


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## tourist. (Feb 1, 2008)

I had a home birth with my first. It was a tough decision, but in the end it logically seemed the right thing for me to do. I chose a conservative midwife team, mapped my route to the hospital in the event of an emergency, did all the things that made me feel more prepared for a "what if" situation. When labor started, the fact that I was "at home" was quite literally the farthest thing from my mind. It was so normal and natural that I never even thought about where I was. In hindsight, I can't imagine choosing (without cause) to go to the hospital for the birth.

I wish you the best as you try to navigate through all the information you will find.


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## gemasita (Jul 1, 2005)

Quote:
Originally Posted by *Climbergirl* 

Quote:


> Originally Posted by *EllisH*
> 
> I just don't want to take any risks, a healthy baby trumps having the experience at home.


Sorry, this is the one sentiment that people tend to have that makes my skin crawl.

For me, PERSONALLY, the number one reason I am planning a homebirth is for safety. I PERSONALLY feel safer at home with a midwife by my side who knows me well. I've been to some hospital births that I felt were very unsafe because no one was in the room much. For a few, complications arose and I was the first to see them (yikes!). I also know that one of our hospitals has a 40% c-section rate and if mothers and babies are more likely to die during a c-section than a vaginal birth, then I don't feel safer there vs a homebirth with my midwife who has a 5% of so c-section rate. I am not saying hospital births are less safe than homebirths - I'm just saying that because of my experiences, *I* feel safest at home. The "experience" is secondary to the safety - important, but secondary.


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## GoBecGo (May 14, 2008)

I find it very ironic that for example a woman can be told she MUST lie on her back for a VE because her care-provider cannot do them in any other position and she MUST have one (for that care-provider to feel comfortable with how things are going) which is absolutely about how the CARE-PROVIDER is experiencing the birth (because there is no evidence to prove VE's are beneficial or even necessary during a normal birth and yet they are given routinely in hospital, you have to STATE you don't want them because it is assumed you will have them if you don't) but if the WOMAN prefers to stay at home, which has been PROVEN to be a beneficial and for some motherbabe partnerships very necessary for a safe and normal birth, she is being selfish and thinking only of her experience, no matter HOW sound her reasoning or HOW thorough her research and knowledge.

We as a society accept that the staff's right to be comfortable (with how things are "being managed" for example) and safe (from litigation for example) trumps the physical and emotional wellbeing of the mother and the baby and THEIR right to be safe (from unwanted and unnecessary intervention and the morbidity they suffer as a result for example). Someone must be in control, and it must absolutely NOT be allowed to be the woman herself.


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## earth-mama (Oct 3, 2009)

We did a homebirth for our first and it was great! I was very uncomfortable with the idea of going to the hospital, but felt very comfortable at home and with our midwife. I think you need to decide what feels best for you, because where you are most comfortable is where you will birth best


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## peainthepod (Jul 16, 2008)

Another first-time homebirther here. It was a fabulous experience (as was my second homebirth) and I'm so glad we chose home over the hospital. But my experience doesn't matter nearly as much as where you feel most comfortable. If that's at home, then you should strongly consider a homebirth with a competent, experienced midwife for your birth(s). If you'd be more comfortable in a hospital, then it's entirely possible to have a vaginal birth with minimal interventions. Just do your research (don't just go by what the hospital tells you!) and hire a doula to give yourself the best possible chance for a normal, non-medicalized birth.

Do keep in mind that women have been having their first (and subsequent) babies at home or in a home-like setting for many thousands of years of human history. Homebirth is very much the expected norm for millions of women across the planet.









Whatever you decide, good luck in your search and congratulations on the pregnancy!


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## *MamaJen* (Apr 24, 2007)

Every woman needs to choose the type of birth that is right for them. However, it's inaccurate to say that it's a choice between a risky homebirth or a safe hospital birth.

There's a lot of research showing that home birth, for a low-risk mom, with a professional midwife, with procedures in place in case of transfer, is as safe as hospital birth.

Also, in America today, one third of births -- an this includes first-time births -- are via C-section. (As a reference point, the C-section rate in the Netherlands is about where it should be, at 7 - 12 percent). Maternal mortality is actually rising significantly in the U.S.

It's great if you find a sympathetic provider and a good hospital that is willing to deliver evidence-based, low intervention care. However, the reality for many women who want a natural birth is that "you buy the hospital ticket, you take the hospital ride." IMO, many women are bait-and-switched by providers who say they'll respect a natural birth plan but literally have no idea how to facilitate a normal birth. There are many, many ways that our current system of obstetrics is not evidence-based.

In terms of the OP, I had a fabulous homebirth for my first (and only) delivery.

I would recommend reading "A Thinking Woman's Guide to a Better Birth." There is a huge amount of information out there about the way birth happens in America. It's a real eye-opener.

Quote:


> Originally Posted by *EllisH*
> 
> I will be giving birth for the first time also - in January - and am opting for a hospital birth (in an - academic - hospital that I trust). Home births are very common in the Netherlands, and there's been a lot of research done on it as a result. It has been shown that the risk of complications is much higher when starting at home and then needing to be transferred vs starting in the hospital. In addition, if the baby needs acute help upon being born, it will also be readily available in the hospital. I just don't want to take any risks, a healthy baby trumps having the experience at home. That being said, I will have a birth plan which explicitly states that I want to opt for minimum intervention if at all possible and that I'll discuss with my obgyn beforehand.


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## carriebft (Mar 10, 2007)

I have had 2 in hospital and one at home and am planning another homebirth. If I had to do it over again, not knowing how my body handled birth, I would still have had my first in the hospital. I told my sister the same thing when she asked me whether she should have her first at home...I didn't want to tell HER what to do, but I shared that I would have my first in a hospital with as few interventions as possible (get a doula, go for CNM in hospital). That's just the way I feel; for ME, it was comforting to know when I did chose homebirth for a subsequent birth, that I was not one who bled easily after birth, that I had no tearing issues, I had some history in the length of my labors, etc. Obviously its not a 100% thing, but it helped me.


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## alegna (Jan 14, 2003)

I had both of mine at home. If I had had my first in the hospital it would have been a traumatic section for a lot of reasons. Yes, I'm sure there are fabulous, woman-friendly and baby-friendly hospitals out there. Not in this town (Houston). The section rates are THROUGH THE ROOF.

I saw no reason to risk myself and my first baby to an awful (and dangerous) experience just because it was my first baby. I knew myself and I knew I wouldn't want to transfer unless it was an emergency.

-Angela


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## seraf (Feb 1, 2002)

Both of mine were born at home. I knew my family had a hisory of quick, easy labors. I knew I was strong and healthy. I had great midwives and lived in a large city with a hospital 10 minutes away.

My favorite thing about homebirth wasn't realized until later. The hospitals I toured and the births I observed, there is more seperation of the mother and child (right after birth when the baby is being assessed and also a 3 hour period in the nursery where they get bathed, vaccinated, pricked and warmed). I feel strongly that there should be less of that within my own family. So staying home was my best option for my newborns and myself.


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## GoBecGo (May 14, 2008)

Quote:


> Originally Posted by *seraf*
> 
> Both of mine were born at home. I knew my family had a hisory of quick, easy labors. I knew I was strong and healthy. I had great midwives and lived in a large city with a hospital 10 minutes away.
> 
> My favorite thing about homebirth wasn't realized until later. The hospitals I toured and the births I observed, there is more seperation of the mother and child (right after birth when the baby is being assessed and also a 3 hour period in the nursery where they get bathed, vaccinated, pricked and warmed). I feel strongly that there should be less of that within my own family. So staying home was my best option for my newborns and myself.


A great point, a woman recently told me at a toddler group that her 3rd delivery was the best because she was allowed to have 40mins skin to skin with her newborn before they took him to do all the weighing and so on. She asked did i have skin to skin. I told her, yes, DD2 was born at 7.56am and i got her dressed at 7.30pm and she was totally shocked at the idea. Even DD1, which was a far more hospitalesque NHS homebirth i had 3.5 hours skin to skin before getting the baby dressed.


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## MegBoz (Jul 8, 2008)

Yes, true, first-timers have a higher transfer rate, but it shouldn't be as high as 25%! if a MW tells you that's her transfer rate for FTMs, I'd be worried (is she not giving adequate support to help labor progress?) & I'd look into other MWs.

Some people view transfer as "proof" that HB is a bad idea in the first place. I find this a little nuts. One poster here had a transfer after a long, long labor & said she still thinks HB is great & the fact that she was trying to HB in the first place saved her from CS!!! If she hadn't done like 30+ hours of laboring at home first, the hospital REALLY would have rushed things along with pitocin and/or AROM earlier in the process - leading to the infamous "cascade" ending in a CS. The fact that she was able to labor at home without intervention for so long meant that when she did go to the hospital for an epidural so she could sleep, her body could keep working & she had a vaginal birth.

Makes perfect sense to me!

Knowing that hospitals tend to "push" and rush birth along, and that FTMs labor for longer than second-timers, it makes a lot of sense for FTMs especially to HB!

I just think it's important to have good transfer plans - & I would factor in the details of what a transfer scenario would look like into my decision making process.

If you can, "establish" care with HCPs at the hospital you'd transfer too. We're lucky in Baltimore that we have one HB MW who's a CNM & has priviledges at a great hospital - so transferring is easy - she can still be your HCP! I'm using a CPM, who happens to be illegal in Maryland (even though she's legal & licensed in neighboring Virginia - so stupid!), but she's friendly with the CNMs at the hospital where I had DS (same hospital to which I'd transfer.) So I won't be met with hostility or the type of situation where my MW is disregarded as not a "real" health care provider, or I'd have to LIE & claim I'd had NO pre-natal care in order to protect my MW.

(Incidentally, I had a hospital birth with my DS only because my stupid, clueless Bradley teacher told me HB was illegal in Maryland. Totally not true! I did like the CNMs at the hospital I switched to at 20 Weeks & didn't want to consider transferring my care AGAIN when I learned the truth about the matter even later in pregnancy. While I had a good experience, there was no need for me to have gone there & I really should have started with HB in the first place & am now planning HB for #2.)

As for the old, "You don't know what to expect because you haven't been there." Well, whatever, that's kinda silly, IMO. Every birth is different & while the odds are good that since I had a fast birth & the pain was totally manageable, my 2nd will be even faster yet & still manageable... there is also still a chance that labor could throw me a curve ball & be much different & much more difficult. *NO ONE every really and truly "knows what to expect" from birth* & the rate at which labor will progress & the pain level. So don't let people hold that over your head as if you are naive & clueless because you haven't done it before. I HAVE done it before, but I still don't totally know what to expect from #2, KWIM?

Quote:


> Originally Posted by *the janet*
> Some people do have good hospital experiences but it's a total crapshoot and I'm not willing to risk it. The odds of something going wrong during labor are slim. The odds of hospital protocol forcing something to go wrong are pretty great.


*Yes, the odds of having a good hospital experience in the US are slim*, VERY SLIM!

And I am saying this as someone who did have a GREAT experience in the hospital. I'm lucky to have had the hospital, the CNMs, and the nurses I did. Very lucky. But I realize it is all rare... very, very RARE. That is the fact of the matter.

(Oh, but the lactation consultants were ATROCIOUS, absolutely awful. It was only my insane determination that saved us. I'm sure it would have been better in an HB. Heck, being left solely to my own devices to use the internet & library would have yielded a better outcome!!!!!!!)


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## goldenwillow (Jan 5, 2010)

Quote:


> Originally Posted by *EllisH*
> 
> I will be giving birth for the first time also - in January - and am opting for a hospital birth (in an - academic - hospital that I trust). Home births are very common in the Netherlands, and there's been a lot of research done on it as a result. It has been shown that the risk of complications is much higher when starting at home and then needing to be transferred vs starting in the hospital. In addition, if the baby needs acute help upon being born, it will also be readily available in the hospital. I just don't want to take any risks, a healthy baby trumps having the experience at home. That being said, I will have a birth plan which explicitly states that I want to opt for minimum intervention if at all possible and that I'll discuss with my obgyn beforehand.


Wow! This too makes my skin crawl.

My baby was COMPLETELY HEALTHY and I didn't take any risks by having my DS at home. I have known quite a few women that had their babies in a hospital with explicit birth plans and still had interventions they didn't want with their MW/Doulas there. Just because you will be in a hospital does not mean they will respect your wishes completely. Good luck to you.


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## liberal_chick (May 22, 2005)

My first birth was in the hospital via c-section, but my pregnancy was fraught with complication. I never even went into labor and ds1 was born at 30 weeks (it was all necessary; I have no beef with the hospital or my OB over this). Even if I'd have had the philosophy then that I do now, a HB would've never worked.

I decided to have my second child (and later my third) at home. I felt it was my best shot at getting a VBAC and I was absolutely right. I recently had a nurse that works L&D in my little town tell me that I would've for sure been sectioned with my ds2 simply b/c my labor was 30 hour long. An OB I had do my GBS test with ds3 said the same thing. And it all would've been for no reason!

My labor with ds3 ended up being another 30 hour marathon. But I was at home, supported by a great midwife and my amazing dh. I was able to labor for all that time without worry that someone would get tired of waiting and want to cut me open. And my MW worked her rear off to make sure I didn't tear again (I had a 2nd degree with ds2).


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## Sol_y_Paz (Feb 6, 2009)

Quote:


> Originally Posted by *EllisH*
> In addition, if the baby needs acute help upon being born, it will also be readily available in the hospital. I just don't want to take any risks, a healthy baby trumps having the experience at home.


The whole reason I am considering a home birth is for the baby and their direct health, to minimize the risks. If I was only thinking about myself and others I would go for lots of drugs so I couldn't feel much and a normal birthing experience for those around me who are concerned with such things. The hospitals in the US in my area have an uncomfortably high premature rate and c-section rate. Here is a link to how typical that is in the US hospitals http://www.marchofdimes.com/padmap.html


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## Climbergirl (Nov 12, 2007)

Quote:


> Originally Posted by *Xantho*
> 
> Quote:
> 
> ...


Yeah, I had one of those too. Didn't help much honestly. Things are taking too long, we need pitocin. I don't want pitocin. You need pitocin. Is everyone ok? Yes. Then no pitocin. 30 minutes later, if you don't have pitocin, the doctor wants to perform a c-section for Failure to Progress. But we are fine. Blah, blah, blah. And then, of course, the stress of fighting over this made things worse and I ended up with pitocin. Which put the baby in "distress" (his heartrate came back down but no one actually told this to me). And because I have a CERVICAL LIP (which any midwife could handle) with the urge to push, we had to do the c-section NOW or I would damage myself to the point of not being able to have any more children. Yes, that was what I was told and I did not know any better. And I got a c-section. And there was no informed consent because we signed the paperwork 2 hours after surgery. They forgot to do it beforehand.

It depends on your nurse and how she presents things to your doctor (which is most likely NOT at the hospital). A birth plan can be useful, but don't expect it to really be followed every single time. And don't think that will somehow protect you. Because I thought mine would, and it didn't. Now, I am writing up a little card of things my husband can agree to or decline so he can just refer to that in case we transfer.


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## Partaria (Sep 7, 2010)

I'm doing a homebirth for my first, due in May.

It's a tough decision for many women, and it's (of course) completely your choice. It's about you having the birth you need and want. For me, the decision was not that hard. I have a pretty long standing distrust of the mainstream medical industry and I am terrified of hospitals. When I saw The Business of Being Born (my introduction to the idea of homebirth), my gut immediately said, "Ann, this is for you."

Transfer rates are a concern, of course. It's important in selecting a homebirth MW to ask her about her xfer rate, esp for first time moms. We interviewed two midwives we really really liked, but the deciding factor was their xfer rate. Midwife A hadn't been practicing quite as long, and said she had about a 30% xfer rate for maternal exhaustion. Midwife B has been practicing much longer, and said that in her early years her rate was higher. But in the last three years, she hasn't transferred anyone for exhaustion, first time mom or not. So we went with MW B.

All I can say is you're on the right path. You're clearly trying to listen to your gut reactions and do your research at the same time. I know you'll come to the right decision. Keep having faith in yourself, and listen to what you need.


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## smeep (May 12, 2006)

I had my son in a freestanding birth center...which basically IS the same thing as home. It's just not my home. I will be having this one at the FSBC as well (I wanted to do it at home but Medicaid only covers FSBC births, not homebirths, even though the safety is exactly the same - give or take ONLY depending on which location is closer to a hospital in case of transfer).

I grew up being taught that homebirth is where you go unless mum or baby are sick, period. My mother had us at home. The complication rates are much lower out of hospital than in hospital. Most transfers occur for maternal exhaustion and/or pain relief, not because of true emergency. Even with a true emergency that warrants immediate transfer, most midwives know quicker than doctors in a hospital because they are with the mum the entire time and know her personally. They can also call and get an OR prepped on the way to the hospital (I believe the prep time is on average 19 minutes?). Often times the woman will get there before the OR is even ready.

I think you should interview local midwives and find one who clicks with you. Everyone has their own ideas on birth and the care and management of it. Some women prefer more medicalized/interventive midwives and some prefer completely crunchy ones and some in between...chances are you'll find one who fits your ideals best. And if you decide not to homebirth, then that's your choice, but at least you can say that you interviewed midwives and really felt your current route was the best one.


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## [email protected] (Sep 7, 2010)

Quote:


> Originally Posted by *SeattleMolly*
> 
> Thanks to you all for all of your input and thoughtfulness! This is a big decision and you helped in my education around home birth. I've also checked out the Home Birth threads and they've also been helpful. Philisophically, I'm probably not as far on the homebirth side of things as people are here on the boards, but I believe that it is necessary for me to listen to all stories before I make a decision.


SeattleMolly, which hospital are you considering? I'm wondering if you have been shocked by either UW or Swedish First Hill, the hospital behemoths.

I delivered at Swedish Ballard the first time, and plan to deliver at NW Hospital this second time. Smaller hospitals w/ attached birth centers seem like a great way to go. I had a wonderful delivery w/ my first -- family practice doc w/ some traditional midwifery training and a significantly low C-section rate for his patients. No routine episiotomies and total control over my own birth plan, of course. I feel that being in a hospital w/ a respiratory team & that particular doc saved my kiddo's life (ie. the umbilical cord was wrapped tightly around his neck twice preventing his descension & causing drops in heartrate, his apgars were very low & he needed resuscitation at birth; luckily the doc was skilled enough to quickly realize what was happening & manually assist the baby out before he was too distressed, or even worse, at greater risk of cerebral palsy or other complications).

If you don't choose a home birth & do want a different hospital, there are options. As for the hospitals, the smaller ones have large birthing suites & some comfort measures. They try to make it look like home. NW has jacuzzi tubs, music, allows for free movement/eating/drinking, an online nursery, a grand celebratory meal for both parents, and gifts of baby hats knit by elderly community volunteers. I've chosen an OB doc whose wife handmade the moomoos his pts wear for exams (instead of hospital gowns in the office) and takes pictures of all the newborn babies. The doc is even known to play guitar at the mom's bedside after delivery! He's very accomodating w/ birth plans, personal wishes regarding epidurals/meds, free movement, midwives, doulas, etc. ... And IF there is an emergency, there is 24-hr anesthesia and a level II nursery down the hall. Personally, I want all of the emergency personnel readily available in case the unexpected happens & time is of the essence, even though there is a slim chance. You never know w/ birth. But I want to deliver in what feels "homey" and allows free movement, too. Hence the birthing suite.

As for nosocomial infection rates, smaller hospitals also have an advantage over the larger multipurpose facilities. Like the homebirthers, I don't want to expose my newborn to MRSA or other hospital infections. These are much less likely to be present in birthing centers.

So if you have choices w/ your particular insurance, see what else is out there. I recently switched from Swedish First Hill at 30 weeks pregnant b/c it feels so institutional. It's never too late to change. Your midwives may be able to practice in another hospital organization.


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## goldenwillow (Jan 5, 2010)

I find it interesting when folks say a free standing birth center is the same as a homebirth. IMO, it is similar, but not completely the same.


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## the janet (Sep 28, 2009)

Quote:



> Originally Posted by *Xantho*
> 
> I find it interesting when folks say a free standing birth center is the same as a homebirth. IMO, it is similar, but not completely the same.


I agree...it's not the same. You experience a disruption by leaving your comfort zone at home, getting in a car, then having to recreate that environment of comfort and safety all over again.

But it's still closer to the experience of having a home birth than having a hospital birth.


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## GoBecGo (May 14, 2008)

Quote:


> Originally Posted by *Xantho*
> 
> I find it interesting when folks say a free standing birth center is the same as a homebirth. IMO, it is similar, but not completely the same.


I don't think it's the same. It's like having a homebirth in someone else's home. So for me, who really finds security in familiar surroundings, it would be a very distant choice - basically if i couldn't have a homebirth for medical reasons a birth centre would be no use to me, i'd need a hospital, because i'd only go someplace else if it was for medical intervention, and most birth centres cannot give any (i have a friend who had a BC birth last time and she couldn't even have syntometrine for the 3rd stage without transferring to the obstetric unit). Though in her case the BC was IN the hospital, and the obstetric unit was down the hall... I don't see the point in "home from home" though i'm sure others probably do.


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## the janet (Sep 28, 2009)

I wanted to add that there were two big reasons for my choosing the freestanding birth center over my home:

• I don't feel "at home" in my home. The apartment building I live in has walls made of paper and there is a very loud unsupervised teenager who hangs out in the hallways with his equally loud friends. I know there's no way I could deal with the intense part of labor in that kind of environment.

• The two closest hospitals to my apartment (and they're very close) that I could potentially transfer to are basically inner city hospitals and cater to a very low-income clientele. I have been to a birth at one of them (with a CNM) and it was a pretty awful experience. I've been to a birth at the hospital I would transfer to if there were problems at the birthing center, and it is a way better facility.


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## GoBecGo (May 14, 2008)

Quote:


> Originally Posted by *the janet*
> 
> I wanted to add that there were two big reasons for my choosing the freestanding birth center over my home:
> 
> ...


If i felt that way (the bolded bit) i would definitely look at the BC my friend went to.


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## SeattleMolly (Oct 23, 2010)

[email protected]-

Thanks for the reply. I'm in South Seattle, so Valley Medical in Renton is 10 minutes away. It was touring this hospital that really turned me off, even though it is gorgeous and very homey. It is rather large, but allows a midwifery model and is close to home. I've been seeing the nurse midwives from Valley, and they are pretty great, and have a 17% c-section rate.

I have heard great things about [who I think is] your doctor. Two pregnant friends have reported the same stories for a male OB out of Northwest-must be him! He is like a midwife, hehe!

My sister delivered at Swedish and it is huge (and parking is a real pain). Kind of a "baby factory." I have not heard good things about UW.

After talking to my husband last night, we decided that home birth is our frontrunner right now, as long as we can transfer to Valley (since it's so close and in network). Seattle Home Maternity was impressive, but they are the group that told me about the 25% transfer rate for 1st time moms. I'm going to check some other midwives out, and in the meantime, still go to my appointment next week at the nurse midwife clinic.

Quote:


> Originally Posted by *[email protected]*
> 
> Quote:
> 
> ...


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## SilverFish (Jan 14, 2010)

i chose a homebirth the first time. it didn't end up happening because my water broke at 35 weeks, but even then, my midwife gave me the choice to deliver at home and potentially transfer after the birth, or to go straight in. i am so glad i was on a homebirth track. i think it really helped me progress quickly because all along the plan was to do it at home, so even though things were kind of up in the air and scary because of the PPROM, i still felt relaxed and happy at home. and, i am SO incredibly glad i had a midwife, homebirth or not. she was my attendant at the hospital, i never had to see another hospital staff person until we were officially transferred into the NICU a few hours post birth.

honestly, if anything, i wish i had stayed at home, because even with "complications" and a baby who "needed help" a lot of the stuff the hospital staff did was unnecessary and overcautious. they took her to a warmer to stabilize her temps, without even trying any skin to skin... from that point on, we were on their clock, so that feeding progressed directly to tube-feeding without even trying breastfeeding first, and any destabilization in her vitals put us back 48 hours. it was really the most frustrating and demoralizing experience ever. it honestly felt like they just looked at her chart and based her treatment off of a formula without taking her into consideration at all.


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## Climbergirl (Nov 12, 2007)

Quote:


> Originally Posted by *SilverFish*  it honestly felt like they just looked at her chart and based her treatment off of a formula without taking her into consideration at all.


That is a hospital. Those nurses are overworked and have to deal with so much. Yeah, you have to be a formula in order to handle all they do. That is EXACTLY how I felt during both my hospital stays. Don't get me wrong, they were some really nice ones, but really, I felt that could not see me for the individual person I am. I really feel there has to be a better way for hospitals in general.


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## Mama Metis (Feb 10, 2010)

I am in the same position as the OP, but with a bit more time to decide (EDD in July). I have been reading about homebirth for years now and I am well aware of the benefits, but I have some concerns to overcome. I'd love to see some discussion about what specific forms of treatment the homebirth skeptics feel is not available at home. Particularly for the baby. I know oxygen is available, but can a midwife intubate a newborn? Provide CPAP? I don't think so but I'm not sure.

In my case, I have a homebirth midwife (CNM) who will also deliver in the hospital if you prefer (although she strongly favors homebirth). Her orientation is completely toward physiological birth, so I have no fears of excess intervention in the hospital. I also don't have any strong fears or anxieties about being in the hospital (although home is always nicer for sure.) I guess in part, I'm questioning whether I can justify a homebirth since I have access to a "safe" hospital birth.

I'm not making an argument here, just wanting to hear what others think. Thanks for the helpful thread, OP.


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## caned & able (Dec 8, 2005)

I had my first baby at home. Why not? What is wrong with your first baby that you should go to the hospital and fight for everything you want or fight off what you do not want? If you end up in the hospital, that is where you belong. Even if 25% end up transferred, that means that 75% do not!

Find a good homebirth midwife to work with. Ask her what her transfer rate is during labor and usually for what problem. A midwife with a low transfer rate knows what she can handle and what she cannot.


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## *MamaJen* (Apr 24, 2007)

That definitely sounds like a better hospital situation than most women have, but in that case, I would still lean towards birthing at home. Often, in a midwife-attended hospital birth, you find yourself fighting hospital policies and protocols that the midwife isn't in favor of but doesn't have the authority to over-rule, such as time limits. Many hospitals also don't permit waterbirths, which would be a deal breaker for me. And again, it's much easier to achieve a physiological, normal birth when you're in your own home environment. Birth is an incredibly psychological experience and it progresses much easier when you feel safe. We're just mammals, after all. If you put a cat or a horse or a deer into an unsafe environment, their labor will stall. We're just the same.

As far as what your particular midwife can do at home -- ask her. Sit down and talk with her about protocols for various emergency situations. I'd also ask her why she prefers homebirth, and what hospital protocols she disagrees with.

Quote:


> Originally Posted by *Mama Metis*
> 
> I am in the same position as the OP, but with a bit more time to decide (EDD in July). I have been reading about homebirth for years now and I am well aware of the benefits, but I have some concerns to overcome. I'd love to see some discussion about what specific forms of treatment the homebirth skeptics feel is not available at home. Particularly for the baby. I know oxygen is available, but can a midwife intubate a newborn? Provide CPAP? I don't think so but I'm not sure.
> 
> ...


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## [email protected] (Sep 7, 2010)

Your plans sound very exciting, and having Valley only 10 minutes away is pretty safe in case anything happens. I'm not brave enough to do the home birth thing, due to my job and personality I guess, but I really admire those who choose this route in uncomplicated pregnancies. I know several people who chose home births w/ great success, but we're in Seattle after all. Best wishes to you!

Quote:


> Originally Posted by *SeattleMolly*
> 
> [email protected]-
> 
> ...


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## Sfcmama (Aug 29, 2010)

Quote:


> Originally Posted by *goinggreengirl*
> 
> I planned a homebirth (midwives are not yet licensed for hospital births so choosing a midwife was choosing a homebirth here.) We ended up transferring after 60 hours of labor for exhaustion. I ended up with an epidural and pitocin (wanted to avoid both which is why I chose to stay home). It took a little while to come to terms with the birth, but I do not regret trying for a homebirth for my first baby. I will plan one for my second child as well.
> 
> ...


Whoa. Could have written the exact same response. No regrets for me either. Especially as I would have had to transfer afterward anyways (retained placenta).


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## GoBecGo (May 14, 2008)

Mamametis, have you asked the MW why she favours homebirth? It might be because she finds it much harder to do her job in hospital. Or because she has to fight and fight the interventions she knows her ladies don't want. It's worth having a conversation about it with her.

Ditto the intubation query. Discuss the SPECIFIC situations you feel CPAP or intubation would be necessary. My MW would have transferred me long before a baby who was going to be born needing that sort of help arrived. She is very careful during the labour, she watches both mother and babe carefully, she observes very very astutely. For example my labour was very stop-start prodomal then suddenly very active, at one point, when i was already fully dilated, DD's heartrate seemed very high. It was reactive and came down with the contraction ending, but it was higher than she would have expected to see. Was it tachycardia or an acceleration? She asked herself this question, she observed that i was acting like a woman beginning the foetal expulsion reflex (which was NOTHING like the 2nd stage with DD1, with DD2 it was like throwing up out of my vagina, i had no control, i was merely observing my body, i couldn't even catch my breath and my body utterly took over, panting at the right moments and all!) and since when i had asked her to do a VE (which she doesn't require, she could tell i was fully from other signs) she had used the opportunity to guage how big DD's head was and how much room i had and she knew i had plenty of room. So she decided it would be ok - i had a lot of room and pushing was likely to be very short given the expulsive reflex is very effective that way. She was right. DD was out in 6 minutes, apgars 10, 10, 10, and with a true knot in her cord. The knot pulled tight as i held her, so it's likely it was tightening as she descended (and she was only at spines 6mins before birth, she did the "risky" bit of the descent in a huge hurry) which was causing her accelerated heartrate. But my MW's experience meant she was able to get a good, full picture of it all. If the heart rate had been having such fast accelerations early in labour she would have advised transfer. Had the baby been bigger or my pelvis been smaller she would have called an ambulance. As it was she had everything needed for an emergency set up when DD was born, we just didn't need any of it. She had a student there observing and the student was amazed at the subtlety of my MW's observations, in hospital they rely on intermittent observations and/or a machine to warn them of such things and a doctor to save them if it's all gone too far before someone find time can read what the machine is saying. The formula's which "keep you safe" in a hospital are set up to fight fires caused by a lack of continuous one-to-one observation by an experienced attendant. Yes, some babies will be born needing help, but it's very rare that there is NO indication of that outcome before the moment of birth.

I would turn the question on its head. Not can you justify a homebirth when you could have a safe hospital birth, but can you legitimise a hospital birth when you can have a safe homebirth. Hospital birth is NOT safer. Homebirth with a qualified MW is as safe in terms of mortality and safer in terms of morbidity because the interventions in hospital often result in injury that would have been avoided if the intervention had.

Quote:


> Originally Posted by **MamaJen**
> 
> That definitely sounds like a better hospital situation than most women have, but in that case, I would still lean towards birthing at home. Often, in a midwife-attended hospital birth, you find yourself fighting hospital policies and protocols that the midwife isn't in favor of but doesn't have the authority to over-rule, such as time limits. Many hospitals also don't permit waterbirths, which would be a deal breaker for me. And again, it's much easier to achieve a physiological, normal birth when you're in your own home environment. Birth is an incredibly psychological experience and it progresses much easier when you feel safe. We're just mammals, after all. If you put a cat or a horse or a deer into an unsafe environment, their labor will stall. We're just the same.
> 
> ...


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## MegBoz (Jul 8, 2008)

Quote:


> Originally Posted by *the janet*
> 
> Quote:
> 
> ...


Just another voice of agreement.

I think they are "the same" in terms of medical safety. (Unless of course birthing at the BC would leave you significantly closer to a hospital in case of the need for transfer) - but aside from that, exactly the same.

Personally once I found that out, I totally ruled out BC as an option (I actually have several hospitals close by, one of which is actually fantastic & where I had my DS.) Of course, a BC could also offer other nice perks for some, such as big jetted jacuzzi tubs (yeah, you can get a birth tub, but hard to get one with jets), & not having to buy a birth kit & set up the tub yourself. I'd also imagine they'd take care of the birth cert for you - my hospital did - ZERO effort on my part, whereas for my HB, I have to deal with the Maryland state dept of health myself, which I've read can sometimes be a headache.

But all minor stuff & certainly nothing anywhere near compelling enough for me to leave the comfort of "my turf." Plus, with a BC, you get whatever MW & nurse are on call, whereas I know MY MW and her asst - no gamble that I'll be stuck with my least fav from a group.


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## MegBoz (Jul 8, 2008)

Quote:


> Originally Posted by *Mama Metis*
> 
> I guess in part, I'm questioning whether I can justify a homebirth since I have access to a "safe" hospital birth.


I think you've already received excellent answers from MamaJen & GoBecGo, but just wanted to add my thoughts.

I think that's a very good question & I have to say I felt the same way. The MWs & nurses at the hospital where I had my DS were really fantastic! Really great. So part of me has thought, "Well, I probably should go there just in case." I mean, if you're faced with an atrocious hospital with a 50% CS rate, 25% episiotomy rate, 90% epidural rate for vaginal births, mandatory eCFM, no hydrotherapy options, "nothing by mouth" etc. etc. etc. - then the choice is REALLY obvious - I would UC before I'd birth in a place like that!

First though - what are post-partum experiences like at this great hospital? Mercy in Baltimore city is widely regarded as the best for natural birth - they even allow water births! But I've heard TONS of stories on how awful PP care is. Even a friend of mine who's DH is a physician with privileges there said she still had a terrible time PP. So consider that too. Even at my awesome hospital, the lactation consults were ATROCIOUS - really awful. I have no doubt I would have been better off never meeting with them & being left to my own devices with the internet & library books.

For me though, I accidentally did ALL my laboring at home! Less than 5 hours from the first, "oh, huh, that was finally a contraction." To "AAHH! I really want to push, we gotta go!" I don't know if it would have been that fast & manageable if I'd been in the hospital. I personally DID have a lot of anxiety about birthing in a hospital and I"m fairly confident it would NOT have been so fast & smooth being in foreign territory. I also have huge issues with feeling "Bossed around" so the policies like being on CFM for 15 min out of ever hour, having a hep-lock, etc. would like have irritated me, ticked me off, and therefore not been too productive.

Plus, there is the fact that with DS birth, my first, having been so fast, I might accidentally have #2 at home anyway - even if I'd planned a hospital birth! So better to have a MW who knows me & is willing to come out when I say I've been laboring for only 45 minutes.

I'm lucky that I won't be hesitant to transfer since I know this hospital will be friendly & not hostile. (Plus, the CNMs there know my MW & are friendly with her! & I've seen them a few times to establish care & ease a transfer.) So I think I have the best of both worlds in this case. I just think the "what ifs" of HB for me are so slim that I'm willing to chance it. -- Yes, I do know it's possible for some unforeseen complications to arise that can't be dealt with adequately at home that could be better managed in hospital. BUT - even with a good hospital, the same applies, There's a possibility of hospital acquired infections, mistakes where I'm given the wrong drugs (happens ALL.THE.TIME)

So I guess all this is to say that I really don't feel that even a great hospital is all that much better on the risk side of the equation.


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## Mama Metis (Feb 10, 2010)

Thanks everyone for the thoughtful replies. OP, I hope I didn't hijack.









It was nice to hear that a couple of you had no regrets in planning a homebirth even after a transfer was needed. I think this was one thing I needed to hear.

MamaJen, it's true that I need to take into account the added safety of a normal labor progression, which can best be acheived at home.

GoBecGo, you're totally right that it's unlikely to have a baby who suddenly needs lots of support without a lot of warning ahead of time. This was also something I needed to remember.

MegBoz, you make a good point about postpartum care. The hospital I would go to is definitely not some kind of wonderland, it's just that they basically let my midwife run the show for her own clients, and she releases you when you're ready. However, it's hard to say what the situation will be with nurses, lactation consultants, etc. I guess I have been looking at these concerns as just nuisances, in contrast to my concerns about the baby's safety.

I do realize what a low-liklihood event it would be to need an emergency transfer for the baby, but for whatever reason, this is the precise fear I'm always coming back to. I do need to talk to my mw, I know that will help. It's an odd experience for me to feel this way because I have been a strong advocate for homebirth for a long time now. Now that I'm actually pg, these latent fears are coming to the surface.

Can I blame hormones?


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## lizsky (Sep 14, 2009)

Quote:


> Originally Posted by *SeattleMolly*
> 
> Thanks to you all for all of your input and thoughtfulness! This is a big decision and you helped in my education around home birth. I've also checked out the Home Birth threads and they've also been helpful. Philisophically, I'm probably not as far on the homebirth side of things as people are here on the boards, but I believe that it is necessary for me to listen to all stories before I make a decision.


OP, I hear you on this. I had never heard of homebirth until I stumbled across MDC forums last fall, and while I now believe it is a great birth choice for many women, it still doesn't really feel right for me. (I felt anxious about the transfer process, and I felt like I wouldn't be able to relax at home as we live in a rowhouse with thin walls...ultimately I had a very peaceful waterbirth at a NCB friendly hospital with a great doula). There are plenty of others who have provided you with tons of data about how homebirth is a safe option, and tons of other who can provide great homebirth stories. I think its great to gather data and do research. But at the end of the day, you and your partner need to make the choice that feels right for you, and where you feel most at peace, whether that be at home, a birth center, or a hospital. Best wishes for a smooth pregnancy and a peaceful birth.


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## Climbergirl (Nov 12, 2007)

I am a VBAC, so when I called the local hospital and found out all the "requirements", I started to cry. Nothing by mouth (and I run hypoglycemic so that won't work), mandatory CFM (so no movement), heplock, etc. It just seemed like too many obstacles.

You have to remember that even in an emergency c-section, it takes time to set up an OR and get the personnel in there. The standard for "decision to incision" is 30 minutes. My mom's group had a tour with the local fire department and I asked them about the timelines. Once they have the call, they must be out of the fire station in 1.5 minutes. The ride time to my place (they knew what subdivision I am in) is 4 minutes. From my house to the hospital is 7 minutes. If we called 911, we could then have them get an OR ready for when I get there and I will probably get there before the OR is even ready! So, being in a hospital really does not "help" me get quicker access to care. Sure, it will be scary as hell. But you know what, having a midwife say "you need a c-section" when her c-section rate is about 5% is preferable to me. If she says it, I know she means it.

Anyway, just another way of looking at it.....


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## goldenwillow (Jan 5, 2010)

For me, I cannot imagine getting into a car after 1st stage of labor. I also couldn't imagine having to put DS in a car seat immediately after having him. My thoughts on birthing somewhere other than home.... smells are different, people I don't know there (other women's family members, etc.), not my comfort zone. I agree with the idea if you are not comfortable in your current space to go to a birth center. We had DS in a OLD cottage that was pretty run down (looking back). I wasn't completely comfortable with our home at that time but I knew my things were there, my scents, etc....

I have had a few women say that a birth center is the same as home and those conversations really didn't end up that well. They didn't "get it".

Everyone does what is best for themselves.


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## dayiscoming2006 (Jun 12, 2007)

I think if you study up on stages of labor and have an idea what to expect you could have a very successful homebirth with your first.

I gave birth to my first in the hospital with an epidural and pitocin which was recommended by the nurses since I was taking too long. I really wasn't. It's perfectly normal to take longer to go through labor with a first baby. They simply said it will get it done with faster and didn't tell me there were any potential side-effects. It was really not at all what I'd expected and it sucked. I was also given an episiotomy that I am sure I didn't need. And that took over a year to stop being painful when DTD.

I planned an unassisted homebirth with my second but I ended up living with my in-laws at the end of the pregnancy so it didn't happen sadly and I ended up having a very traumatic hospital birth experience but the labor and most of the pushing went great because in Romania they just shove you off in a room with a bunch of other laboring moms and leave you to do your thing until the end. That part was good. It was the end and the horrible hospital care baby and I received after that sucked.

I far preferred the natural birth over the epidural/pitocin birth.

I know I would have been able to do the birth myself without an issue at home as the doctor didn't even do anything til the very end and every she did do messed things up.

So, if it were me and I could go back, I would give birth at home every time unless there is a very particular complication that forces you to be in a hospital.

Hospitals just suck. It feels like you lose all control and they take over.

I'd look for a homebirth midwife that is somewhat hands-off but very supportive and then I would study up on labor and delivery like crazy so you could feel confident about it. If you were at all comfortable with it I'd even recommend unassisted birth of a first baby.

Hope that helps.


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## MegBoz (Jul 8, 2008)

Quote:


> Originally Posted by *Mama Metis*
> Can I blame hormones?


LOL, yes, absolutely!

The most important thing is to birth where you feel safe - and where you feel most comfortable. For me, the more I read, the more anxiety I had about a hospital. I've never really had any significant anxiety about HB - even prior to having DS (I was just misinformed on my MW options). Sure, I realize there are risks, it would be silly to say I have "ZERO" anxiety, but it's never been significant and it's always felt right for me.

But if if doesn't feel right for you, and the hospital DOES make you feel safe, secure, cared-for, etc. then that is where you need to be. Nothing wrong with that given it IS a decent hospital. (of course, I'd definitely recommend a doula in that case.)

Yeah, I didn't think about the PP care that much myself, but it really does effect your baby's health too. Some things are just a nuisance, such as if they aren't prompt in getting your paperwork for you to checkout. But my friend made it sound like the problems were major & actually potentially a threat to her baby's health! We didn't get into details, this was over email & we're not super close, so I didn't want to pry, but that's my impression based on her statements.

& obviously I can see how bad PP care can be a threat to your baby. I've heard all kinds of nutty horror stories such as mandatory blood sugar tests for bigger babies & mandatory formula if their blood sugar is low (hello - killing BFing!), mandatory nursery time. That latter is particularly unlikely at a good- pro-NCB hospital. But certainly a risk to consider & factor into the equation.

Quote:


> Originally Posted by *Climbergirl*
> But you know what, having a midwife say "you need a c-section" when her c-section rate is about 5% is preferable to me. If she says it, I know she means it.


This is another excellent point! Yes, so true. I'm so much less stressed this time around - I don't think I'll even have a formally written birth plan for my MW & her asst! (Although I will have one just in case of transfer.)

There is such a deeper level of trust here! I won't wonder if my birth is just being "pushed" & rushed along for convenience or if something is recommended because someone is concerned about her liability risk. My MW doesn't practice defensively (I believe she doesn't even has any sort of malpractice insurance.) I can relax, trust her, know that she & her asst know me, know they know my wishes, and I can know, with confidence, that if she recommends something I don't really want (transfer, CS, pushing in another position, etc.) it's because it really & truly is the best thing. *That is a huge weight off my shoulders!* It hadn't really hit me just how significant this is until I read Climbergirl's statement above.


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## Sudonk (Nov 29, 2005)

I thought the same way with my first baby, and did have a hospital birth. I went on to have both birth center and homebirths with later children. I was amazed during my out-of-hospital births by how much better the care was for my baby and me. At the hospital, I went hours without anyone even coming into the room. Monitoring was sporatic and was done by machine. Once they put the monitor on, they would tell me they'd be "right back" and not return until my husband went and begged them to come back, often over an hour later. We eventually started taking the monitor off after the 20 minutes we had agreed to. No one cared or mentioned it.

With my out-of-hospital births, my caregivers actually cared for me! My baby was monitored by hand, far more frequently. My progress and I were both closely observed, and assessed regularly. Someone was with me every minute, usually 2 or 3 people, but I also had the option of asking for privacy if I wanted. That was never an option at the hospital. The staff was so busy, they came in my room when they could spare a minute and my needs/desires had nothing to do with it.

I've since heard the arguement that choosing a homebirth for a first baby is arguably even more important than making that choice for subsequent children, and can see the logic. Why? Because the first birth does tend to be a bit longer and being in a hospital for a longer time increases the odds of unnecessary interventions which can lead to an unnecessary c-section. Avoiding that first c-section can make an enormous difference in the course of someone's reproductive life. I still shudder to realize how close I came to a c-section with my first baby, and how much smoother things would have gone had I avoided going to the hospital in the first place. If any other OB in the practice had been on-call that day, I have no doubt I would have had a c-section - a couple of them told me that themselves.


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## annablue (Apr 6, 2010)

Quote:


> Originally Posted by *Climbergirl*
> 
> You have to remember that even in an emergency c-section, it takes time to set up an OR and get the personnel in there. The standard for "decision to incision" is 30 minutes.


Yes, that info was really helpful to me when I was deciding whether or not to birth out-of-hospital.


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## seaheroine (Dec 24, 2004)

I had number one (and number two!) at home, after having many of the same feelings. I started seeing my MW at 20 weeks (kept shadow care with the OB during the first in case I *did* have to transfer) and had the best birth experience at home, in my own bedroom.


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## ButtonGirl (Dec 5, 2010)

I chose to do hospital birth for my first-born (less than 4 months ago!) because I felt that as much as I read and studied and questioned, I really had no idea what birth would be like - so the hospital was my security blanket. Now that I do know, I absolutely plan to choose home birth next time. My hospital experience wasn't bad, but it wasn't anything like what I imagine birth could be in your own familiar, relaxed environment. They will turn it into a clinical, streamlined (in their way) situation - it's what they're programmed for, and they don't do anything else. (One of the biggest issues for me was that I wanted to wear my own clothes, and they wouldn't let me - I had to change into a gown. Simple and silly, perhaps, but it was such an important thing for my own personal comfort - a small comfort that would have meant a lot to me - and it was a no because it didn't fit into their regular operation.) Also, even though the nurses in the birth room were great, and my midwife was there with me, the ward I went to afterward was awful - crowded, loud, hot, and one busy impersonal nurse for 4-8 new moms and babies - I couldn't wait to get out of there and get home!

Ultimately though, the best advice I've had and will give as a mother - do what feels most right for you - you won't regret it.  Best wishes for your birth!


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## VeganCupcake (Jun 13, 2007)

I chose to have a homebirth with my first after doing a lot of research. I was determined that my first birthing experience be a positive one, physically, emotionally, and spiritually. As a healthy woman with a low risk pregnancy, I recognized I was just as physically safe at home, and my other needs were more likely to be met. I chose a midwife I trusted and never looked back.

A lot of people asked me why I didn't have my first baby in the hospital, "just in case I couldn't have a vaginal birth", but I preferred to assume that I could rather than assume that I couldn't.

Our second homebirth is planned for the spring.


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## mamasbirth (Dec 5, 2010)

I had my first at home. It wasn't a decision I took lightly as I live over an hour away from a hospital that handles births. Finding this site was very helpful to me:

http://www.homebirth.org.uk/firstbaby.htm

Don't let your birth attendant (if you choose one) decide for you. If you choose one, search until you find the right fit. I cannot stress this enough. If your attendant is uncomfortable with homebirth, your chances of transfer are higher. Do some soul searching on the reasons why you are uncomfortable with homebirth. If after research and reflection, you discover you still have reservations, then explore your other options.

Do the research, but follow your heart. Don't let a statistic decide for you. And fear based decisions--live without them! Most of all, remember that YOU know what's best for you and for your baby!

Best of luck!


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## DanteLoganMom (Feb 17, 2009)

I had double footling breech twins and serious pre-eclampsia - not a midwife nor Ob on the planet would knowingly allow that natural birth to happen. It was a "planned" c-section. When I say planned, I mean when I went to my OB the Monday before they were born, he told me point plank that I was starting to go into the early stages of kidney failure and if I wanted we could drive over to the hospital and have them right then and there. I said no way, I'm not ready, so we negotiated. He told me Thursday was the latest this pregnancy was going and I was to be monitored daily to make sure nothing changed. He tired to get me to go in Tuesday, but I just wasn't quite there and everything was stable plus I was supposed to teach a self defense class that Wednesday night and they don't let you do that after surgery in the morning. I'm glad we waited because I really needed that time to mourn the loss of the natural birth we had planned, as I had a textbook pregnancy until two weeks before that. He was really cool and even did a quick ultrasound before the C-section to triple check that the lower twin hadn't turned - he hadn't. c section took 27 minutes from rolling me in to rolling into recovery. I was blessed to have him and would go back for other pregnancies. the hospital staff were also amazing. It's a really small rural hospital and they treat their patients really well. All the rooms are private and the babies automatically room in unless you ask for them to be out. And each room has it's own jacuzzi - which i didn't get to use.


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## Kimrose (Mar 13, 2006)

Well, I just had to add my two cents as I did briefly consider a homebirth with my first...almost in a wistful "wouldn't that be great?" way - and when my DH seemed freaked out by the mention I thought that being educated and strong in a hospital setting would be my best bet. I did EVERYTHING I could think of to prepare for the birth - Hypnobirthing, a great one page birth plan that the staff asked us if they could use as a "how to" example in their classes, signs for the door, informed cooperative OB re: our plan and goals. That said - with all my research - you CAN'T prepare for exactly how your birth will go - because there is simply NO way of knowing...I NEVER dreamed that I would do exactly as I'd planned - have a completely unmedicated labor and stay strong in all my wishes...to have the "residents on call" at our teaching hospital - MISS that my son was frank breech until I was pushing. I ended up with an emergency cesarean and a "T" incision - and was unconscious when my son entered the world. I say this NOT to put negativity out there - only to say that TRULY the reason for my cesarean was staff that LITERALLY did NOT know how to deliver a breech baby vaginally - and were in a setting where it was protocol not to. It changed my story - it changed my future - I'm 28+ weeks pregnant now and TOTALLY planning a homebirth. There was NO other option for me this time as I simply don't trust hospital care unless there's a need - unless something's wrong - and if you know your research - a frank breech baby and Mom who've made it to fully dilated and pushing - are NOT a reason for an emergency cesarean. To put it in perspective as well - I'm VERY strong minded and what they told us in the moment was "We know this is the opposite of what you wanted - but none of that matters now - THE BABY'S IN DANGER AND WE HAVE TO GET HIM OUT - NOW." They had no signed consent form - and truly - there never was informed consent - b/c I would have chosen 200% to continue to push my baby out. My point is that the truth is you CAN'T control you labor or birth - truly - there's no way of knowing how the story will play out. I will always have to wonder how easily my son might have been born beautifully were a midwife waiting to watch him enter the world instead of the terrified residents I had. What you CAN DO )here's the positive part) is give yourself the BEST ODDS of having a peaceful, natural, beautiful birth if that's what your shooting for!! In a perfect world I'd deliver in a home-like peaceful supportive environment with immediate access to medical care if necessary - but with no medical involvement unless necessary. The truth is I'm MORE scared about possibilities in a hospital environment than I am risks of being at home and having to transfer. Another consideration is that my DS, now 5 years old had a shocking, glaring, opposite-of-what-I tried desperately for type of birth. This time around he has the chance to be part of a beautiful birth. That's the best I can do for him now - for his story. It doesn't heal my heart - but it would help - a little. ♥ Again - my point is really to say that ANY BIRTH CHOICE has risks and different possible hurdles - you REALLY have to search your heart for your OWN BEST CHOICE - and realize that no matter what - you will probably be nervous - and the truth is that things may not go perfectly - but if you prepare well - and choose well - odds are GOOD that you overall you will have a GREAT BIRTH! ♥ Here's wishing us all the right informed choices and a BEAUTIFUL BIRTH


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## kindacrunchymama (Dec 30, 2008)

My one and only was born at home, with a midwife. I felt very confident my decision, despite the fact that my nearest transfer hospital was 30 min away. The book that cemented my gut feeling about it was Ina May Gaskin's - Guide to Childbirth. Best health care decision I have made to date.

Transfer rates very A LOT by midwife; yes, many have about a 25% transfer rate, but some have a much lower (and a few higher) transfer rate. That is a crucial question to ask any midwife during an interview. If you have ANY concerns about your ability to complete a natural homebirth, I would also highly recommend getting a doula. Most transfers are due to "lack of progress" (I really hate that phrase), or "maternal exhaustion", both can be mitigated by having a doula by your side to coach you (and your spouse, if present) through the roughest spots and keep things progressing.

What ever your decision, be sure it is one you feel VERY comfortable with; only a comfortable, confident, relaxed mother can birth successfully. Any fears or trepidation will stall the labor process. This is not touchy-feely, goddess, mother earth speak, this is based in science and the body's hormonal/chemical reactions that take place when in fear vs in a relaxed state. Adrenaline shuts off the body's functions (fight or flight) and inhibits Oxytocin production (the naturally produced chemical needed to keep labor progressing). Birth where ever and with whom ever you fell most secure and comfortable.

Do your research, interview practitioners, READ Ina May's book, and search the MDC forums and then make the best decision for you. YOU have to birth this baby, no one else.


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## fruitfulmomma (Jun 8, 2002)

My oldest was born at home too. I had no complications and everything went smooth, but labor was long and drawn out until the last few hours. I feel strongly that he would have been a c-section for failure to progress if we had been in the hospital.

My next two births were in the hospital - one a non-emergency transport because I was exhausted and swollen after trying to push out a baby whose head was cocked funny. She was born vaginally in the hospital an hour or so after we arrived. Next baby we chose to transfer care to the on-call OB for an AROM induction and NICU care for our baby whom they suspected had birth defects. (She is okay and thriving at 6yo.)

As far as hospital births go, I think they were great but I still prefer and believe home birth is safe and often safer for both mom and baby. My next two were born at home as well with no complications.


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## Banana731 (Aug 4, 2006)

Quote:


> Originally Posted by *Sudonk*
> 
> I've since heard the arguement that choosing a homebirth for a first baby is arguably even more important than making that choice for subsequent children, and can see the logic. Why? Because the first birth does tend to be a bit longer and being in a hospital for a longer time increases the odds of unnecessary interventions which can lead to an unnecessary c-section. Avoiding that first c-section can make an enormous difference in the course of someone's reproductive life. I still shudder to realize how close I came to a c-section with my first baby, and how much smoother things would have gone had I avoided going to the hospital in the first place. If any other OB in the practice had been on-call that day, I have no doubt I would have had a c-section - a couple of them told me that themselves.


That is such an important thing, and I wish that more women truly understood and considered it as heavily as they should. There are so many places where VBAC is not an option right now. Some things can't be undone.


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## SeattleMolly (Oct 23, 2010)

Thanks, mamas, for sharing your unique perspectives. You all are gems and contribute so much to my own story when my friends and family don't have experience with home birth.


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## laceysmama (Nov 12, 2010)

It seems to me that you are nervous about a hospital birth whether it is intentional or emergent, so maybe the answer is more simple than you think. Being comfortable in your surroundings is very important for the progression of labor. Fear leads to tension and pain, which can in turn, slow labor. I suggest that wherever you choose to give birth, accept this decision and don't think about the "what ifs." Both are equally acceptable decisions, so the important factor is yout comfort level with giving birth in your home or the hospital. To help prepare for birth, wherever you decide to do it, you could try hypnobirthing classes. During sessions you could work through any fears you have so that they don't surface during your labor.

For what it's worth, I chose to give birth in my local hospital for my first child and don't regret it. The only reason I did this was because I felt completely comfortable there (I work there and knew the midwives, and one of my coworkers was my labor nurse). However, I will choose homebirth for my next child because of an insurance change which would require me to go to a different hospital. Just remember to have peace with your decision, whatever it may be.


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## Theresa42 (Feb 5, 2007)

I have had two births, both at home. I am very glad I had my first at home. I would write more but my hands are full with baby number two.


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## Monarchgrrl (Aug 16, 2007)

I just had my first baby at home 5 weeks ago. Everyone I knew IRL thought we were nuts! But it went so smoothly (ok it hurt much worse than I thought it would!!), but I'm so glad I did it. We didn't even tour the hospital or pack a just in case transfer bag. I had 27 hours of back labor and then my body pushed for 20 minutes and baby came out. No issues and our midwife was really hands off. It could have been a UC, as smooth as it was. Baby and I were laying in my clean bed within a few minutes and no one bothered us. I was mostly worried about the hospital because of what they'd try to do to the baby, rather than me. Our baby wasn't weighed or measured for a few hours and her cord and placenta stayed attached for a couple of hours. It was just great to be able to relax and not worry about fighting off nurses or hospital "protocol". I just trusted birth and my body and knew that if we had to transfer that it would be for a true medical reason and I trusted my birth team with that determination. Good luck, OP, and trust your gut to do what's best for you and your family.


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## Comtessa (Sep 16, 2008)

After so many great responses, I'm hesitant to add my own $.02... but I'm going to anyway. 

We planned a home birth for #1, but ended up among the small percentage of first-time birthers who transfer in labor. I hated the idea of going to the hospital (it was a NOT natural-birth-friendly place, just like all the others that our HMO would cover) but by the time I got there, it was OK because I really did need their intervention. It was a non-emergent transfer for exhaustion (after 3 days in labor).

We're actually planning a hospital birth with a midwife this time around, in part because our transfer experience made DH so anxious, and in part because I have a 'gut feeling' that this baby might need more help at birth and I'd rather be somewhere just in case that hunch turns out to be correct (I hope it's not, of course).

Here's my perspective: *If I had to do it all over again, knowing I would transfer and knowing I would plan a hospital birth for #2, I would still have done it exactly the same way. * Here's my reasons:


As an anxious first-time-mom, I had tons of questions, and needed loads of advice about "what to do" with my pregnancy. (Which chiropractor do I see? What supplements should I take? Is raspberry leaf tea a good idea? Can I take hot baths? Is my diet ok? Should I be doing yoga every day? Etc.) My home-birth midwives spent a huge amount of time answering all those questions, asking me all sorts of questions about my lifestyle and diet and emotional health, and just piling on love and attention to me AND the baby. It was wonderful. I went to several HCP's before choosing them, and always left feeling sort of cold -- I was just an object to be poked, prodded and measured. My midwives treated me like a person. And they treated my baby as a person, too, long before she was born. It was the perfect kind of environment to be in to prepare for motherhood. 
I felt that I got a lot of advice about ways to prepare for a natural birth -- even though I ended up medicated, it wasn't for lack of trying or for lack of resolve or for lack of education. It was because I really needed medication. If I hadn't done all that preparation with the midwives, I would not have been able to be OK with the decision to get an epidural in the end. 
Having a home birth plan made me feel very empowered and prepared. *I* had to do the work to prepare -- nobody else was gonna do it for me. Nobody was going to "save" me if I chickened out. It meant that I felt spectacularly well-prepared for labor and birth, and very powerful in labor. 
My transfer, though I didn't want one (obviously), actually went really smoothly because I had prepared an extensive backup birth plan "just in case." It meant that I received the kind of care I wanted (as much as was possible in that place), and knowing what I wanted/didn't want meant that I felt very empowered to refuse unnecessary interventions. 
My MW strongly suggested that DH and I take a natural-birthing class -- we drove over an hour each way to get there, once a week for 8 weeks, and it was worth every minute, because it was totally the opposite message of the 2-hour hospital "birthing class" we went to (which was basically, 'here's how to behave so we will treat you nicely here'). It really prepared us both for birth. I don't think we would have bothered if we hadn't been planning a home birth. 
Now, in my second pregnancy, I feel much more laid-back about most things, and I feel much more comfortable trusting myself and my body to birth the way that it is supposed to. Ironically, that means I am much less afraid to birth in a hospital, because I feel confident that I can manage my care the way that I need to for my own health and the baby's. 
Our experience with the HMO meant that this time around, we switched health insurance providers BEFORE we got pregnant! Choosing an insurer who would cover a good CNM with a stellar reputation is making all the difference in the world to my peace of mind and overall health in this pregnancy. Trying to get a home birth, or a midwife, or even a natural birth that didn't involve stirrups, covered (or even considered) by an HMO was a 'learning experience,' to say the least. 

So, with all of that said, I say -- go for it, plan a home birth, have a good backup plan in case you transfer, get well-educated and make sure you have lots of strong women around you to help you feel empowered and able, and see what happens! Nobody can 'plan' what will happen in birth, but we can certainly set up the circumstances so that they are most favorable!!!


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## Smokering (Sep 5, 2007)

Quote:


> I have had a few women say that a birth center is the same as home and those conversations really didn't end up that well. They didn't "get it".


It's not the same, but - as someone who planned a HB for her first baby (but ended up with a hospital induction for pre-e) and is planning a birth centre birth this time... not everyone feels the same way about birthing at home.

For some reason, I just don't feel that attached to a HB this time around. Partly it's disappointment from having invested SO much energy (and some money) planning my first HB. We hired the pool, I had pads and tarpaulins and all that jazz set up, and I focused so much on the experience of birthing at home that when that was taken away from me, it really threw me for a loop. I had put all my expectations into the birth pool and the atmosphere and having chicken soup simmering on the stove... and not enough thought into how I'd cope with the PAIN!

But also...I dunno. I like this house, but it's a rental and doesn't feel like "mine" exactly. It's not usually pristine.  And I'd have to have the curtains shut for privacy from the neighbors - so for me, labouring at home might actually be somewhat dingy and depressing. The birth centre, on the other hand, has huge awesome jacuzzi-type tubs for waterbirthing, pretty good food, and a nice clean bright atmosphere. Also, we have a flatmate, so kicking him out of the house while I laboured would be somewhat awkward! And in a way I'd rather have the first wave of visitors at the birthing centre than at home, because at home I'd feel guilty if I didn't have homemade cookies to offer them, or if the house was dirty. (I know, I'm odd.)

Don't take this to mean I'm anti-homebirth now. If I'd succeeded in HBing the first time round it's probable I'd be doing it again. But for me, a birth centre birth just seemed like less of a hassle. And because it doesn't have quite the same emotional grip as a HB, if I have to go to the hospital again I won't be so upset (and I won't have spent all that money on the birth pool!). Maybe if I have a successful birth this time, and buy a house in the nearish future, I'll have any subsequent babies at home. I dunno. But I'm definitely not as dogmatic about it as I was. There are definite advantages to homebirth - the whole "your own germs" theory, for one - but for me, there are advantages to being out of my home as well, which have nothing to do with snazzy emergency care (which the birth centre doesn't have - it's like birthing in a hotel).


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## homebirthing (Nov 10, 2002)

I think that the transfer rate is more like 15% and almost always non-emergent. Meaning long labor and maybe pain relief is needed, or IV fliuds or pitocin.


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## is it puppies? (Oct 30, 2009)

I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!


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## GoBecGo (May 14, 2008)

Birth centres must be different in Canada? In the UK you have to be on the obstetric ward for augmentation, at a BC you get literally what you could have had at home (i.e. gas and air, stitches in a 1st or 2nd degree tear, not a whole lot more in terms of intervention). My MW's with DD1 (my NHS homebirth) were very clear that if i had to transfer it would be to the hospital labour ward because there was nothing happening in the BC that would be of any use. Are they more of a "halfway" option in Canada? The differences are very interesting to me.

Quote:


> Originally Posted by *is it puppies?*
> 
> I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!


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## [email protected] (Sep 7, 2010)

Quote:


> Originally Posted by *is it puppies?*
> 
> I was a first time homebirther who ended up with a transfer to what was essentially a birth centre (and then threatened with the hospital transfer for a section from there after my pit augmentation didn't help). I am SO THANKFUL I didn't start out in a hospital ( or even the birth centre) or I would have had a section. I was pushing for a total of about 8 hours! My MW kind of got in trouble for letting me push so long, but there was nothing wrong with me or baby. She said that in retrospect my augmentation didn't help anyways and we shouldn't have bothered!


Were you pushing for 8 hrs after your water broke? Just wondering, I forgot how the whole thing works.


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## GuildJenn (Jan 10, 2007)

I just wanted to say that I've had two hospital births, one traumatic in the worst-case scenario of the word (my daughter died as a result of her birth injuries) and one excellent. So excellent that I am cheerfully returning to the second for my third delivery. I felt welcomed and supported every step of the way.

I realize that a lot depends on your specific hospital, practitioner, and so on but not all hospitals are intervention-crazy or disrespectful. I'd say probably most hospitals are less personal, but I personally prefer that by personality. I don't want to be arguing or feel disrespected, and I would like some rapport - but I also really don't personally need some extra-special relationship with the team; I tend to get really focused within and as long as my husband's there, I'm good. I also have short labours (10 hrs start-finish with my first and that includes 4 hrs of pushing against the cord; 5 hrs start-finish with my second. Watch this one be 30 hrs.







)

I also, understandably due to my history, would not be able to relax at home. I wouldn't want to have to make a transfer decision either - having that "should we go or stay" question over my head would really bother me. For me, I want to be in an all-stop shop so I can just focus on getting baby out. Also, the laundry etc. would bother me, as well as having to have my home "homebirth-ready" for weeks. Again, it's just very personal.

It's policy at my hospital that the baby stays with you (there isn't a nursery that's not a NICU), lots of skin-to-skin and all those good things. The only minor discussion I had in my second birth was that I opted to sit in the visitor's chair at one point and my husband got in the hospital bed with our son on his chest and the nurse was slightly miffed that I wasn't "getting the bed." I also got vaguely conflicting breastfeeding advice (very pro-BF) but looking back, the different approaches were probably good to be exposed to as my son and I worked it out -- I just sort of wanted there to be One True Way that would work.

So a lot of it is knowing yourself. I hope you find a solution that works for you. But I wanted to bring one perspective on lovely hospital births.


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## is it puppies? (Oct 30, 2009)

I don't think that we have any (or many) true birth centres anywhere here yet (definitely not in Alberta). I went to a "health centre" which is kind of a very small hospital that has limited services, in a small town outside of my city. It's the only place that midwives are allowed to work as midwives and where we run the smallest chance of intervention, but they do have limited things available and the midwife can consult with a doctor to get things like the the augmentation or if needed I think they could do an epidural. For a Csection or if they thought there'd be any problems with the baby they would have had to send me to a big hospital in the city.

They have private rooms with big beds for family to stay in, and jacuzzis, and are about as close as you come to a home birth without being at home (but you still have to have nurses present as well as follow the regulations for hospital births, but they are a bit more lenient in believing what the midwife says if she can justify it!). It is actually really hard to get a midwife anywhere in Canada and in my metropolitan area (over 1 million people) there are I think 8 midwives and only a few of those will do home births.

Quote:


> Originally Posted by *GoBecGo*
> 
> Birth centres must be different in Canada? In the UK you have to be on the obstetric ward for augmentation, at a BC you get literally what you could have had at home (i.e. gas and air, stitches in a 1st or 2nd degree tear, not a whole lot more in terms of intervention). My MW's with DD1 (my NHS homebirth) were very clear that if i had to transfer it would be to the hospital labour ward because there was nothing happening in the BC that would be of any use. Are they more of a "halfway" option in Canada? The differences are very interesting to me.
> 
> ...


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## is it puppies? (Oct 30, 2009)

Something like that! My MW broke my water at 8 AM as I was fully dilated and the sac was bulging but not breaking. I stayed home trying different things till about 1pm. I pushed off and on and went for the augmentation where I had to "rest" for a few hours as well within that time. My daughter wasn't born until 6pm. I was threatened with a C Section before I managed to get her out and I have no idea how I did it! Oh, and in hospital, for some reason, they only "let" you push for 2 hoursin most cases before they cut the baby out, even if everything is fine.

Quote:


> Originally Posted by *[email protected]*
> 
> Quote:
> 
> ...


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## GoBecGo (May 14, 2008)

Ah yes, that's similar to what they used to call (in the UK) "GP units" - more medical than a Birth Centre, less so than a hospital. In those you could generally have more pain relief than in a BC, though not an epidural, and SOME help (like a manual breech extraction, not that you'd want one!) but nothing like a csection. They're all gone now i think. Though some remote areas have smaller obstetric wards - my friend had a planned HB but had to transfer for mec in the waters (turns out baby was 10lbs11oz and needed forceps to come out) but she knew if she needed a cs they could do it, but only under a general as they didn't have the staff for an epidural and planned cs, only a crash cs.


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## GoBecGo (May 14, 2008)

That's amazing is it puppies, what incredible stamina! Did you have the urge to push all that time? Or was the baby still high? Did you ever figure out what was going on? Malposition or wrapped cord or something? Or did she just take her sweet time?

Quote:


> Originally Posted by *is it puppies?*
> 
> Something like that! My MW broke my water at 8 AM as I was fully dilated and the sac was bulging but not breaking. I stayed home trying different things till about 1pm. I pushed off and on and went for the augmentation where I had to "rest" for a few hours as well within that time. My daughter wasn't born until 6pm. I was threatened with a C Section before I managed to get her out and I have no idea how I did it! Oh, and in hospital, for some reason, they only "let" you push for 2 hoursin most cases before they cut the baby out, even if everything is fine.
> 
> ...


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## is it puppies? (Oct 30, 2009)

thanks, unfortunately the problem was the lack of contractions for pushing, I think, as well as malposition. I was maybe getting 4-6 decent ones per hour. by then I was probably too worn out, but whatever it was they weren't working very well or I wasn't working very well and was really too tired and sore to do much for moving around etc. DDs head was kinked the wrong way and her hand was by her face, I think, and she was stuck behind something because of her angle (was it my pubic bone? I'm not really sure) but they could see her hair so they knew her head was there I just couldn't get her out. It probably didn't help that she was 9lb3oz! but when she finally started getting accelerations in her HR I got her out! The midwife had to keep telling the nurses that there's no reason to transfer me to a real hospital as the baby is right there and fine, but with the accels that would have been it







so thankfully somehow I managed (I am very stubborn when I want to be). By then I had been on the full dose of pit for two hours (that's on top of the 2-3 hours maybe where they told me not to push while they brought it up) and it hadn't increased my contractions much at all as far as I know.

Quote:


> Originally Posted by *GoBecGo*
> 
> That's amazing is it puppies, what incredible stamina! Did you have the urge to push all that time? Or was the baby still high? Did you ever figure out what was going on? Malposition or wrapped cord or something? Or did she just take her sweet time?


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## imogenlily (Nov 15, 2010)

Quote:


> Originally Posted by *GoBecGo*
> 
> Birth centres must be different in Canada? In the UK you have to be on the obstetric ward for augmentation, at a BC you get literally what you could have had at home (i.e. gas and air, stitches in a 1st or 2nd degree tear, not a whole lot more in terms of intervention). My MW's with DD1 (my NHS homebirth) were very clear that if i had to transfer it would be to the hospital labour ward because there was nothing happening in the BC that would be of any use. Are they more of a "halfway" option in Canada? The differences are very interesting to me.
> 
> ...


I live in Vancouver, Canada, and unlike in Edmonton, we have many, many midwives offering services, and they almost all do home births. There is also a birth centre, but in order to go there for any part of labour (full labour, transfer, anything) you have to be registered with them and have them do your prenatal care. They have midwives on staff, but your prenatal care at the BC is done by a multidisciplinary team. I prefer to have my prenatal care supervised by just a midwife, with the knowledge of the risk that if I have to be transferred, it will be to a hospital.


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## Turquesa (May 30, 2007)

Beautifully stated!!

Women aren't leaving hospitals for the shallow motive of some "perfect birth experience" (an oxymoron in my mind, but I don't like birth!







) We're doing it for the evidence-based, compassionate, and professional maternity care.

Honestly, with so many "failure to progress" cesareans being done on first-time moms, I think it's actually a good idea to do home birth for the first baby. Once you have that cesarean with your first baby, it can really limit your options down the road if you ever have another baby and want a VBAC. A competent HB MW will be skilled at monitoring fetal heart tones while patiently letting labor run its natural course.

Quote:


> Originally Posted by *Comtessa*
> 
> 
> As an anxious first-time-mom, I had tons of questions, and needed loads of advice about "what to do" with my pregnancy. (Which chiropractor do I see? What supplements should I take? Is raspberry leaf tea a good idea? Can I take hot baths? Is my diet ok? Should I be doing yoga every day? Etc.) My home-birth midwives spent a huge amount of time answering all those questions, asking me all sorts of questions about my lifestyle and diet and emotional health, and just piling on love and attention to me AND the baby. It was wonderful. I went to several HCP's before choosing them, and always left feeling sort of cold -- I was just an object to be poked, prodded and measured. My midwives treated me like a person. And they treated my baby as a person, too, long before she was born. It was the perfect kind of environment to be in to prepare for motherhood.


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## Mama Metis (Feb 10, 2010)

This is all very true, of course! But for me, the more relevant/interesting question has been - if you can get the same compassionate, high-quality care regardless of setting, (i.e. the same midwife) why choose home over hospital? I know of many possible reasons, but this was the question I felt I needed to answer fully (for myself) before I could move forward in planning for a birth.

FWIW, I think I've made my decision, after lots of discussion with my mw and my dh. We are going to plan a homebirth. My primary fear was/is having a baby who needs extra assistance at birth, and not having a full range of life-saving treatments available at home. While this fear hasn't disappeared entirely, I have a lot of confidence in my midwife, and feel she could spot a potential problem early and make the right call. My mw has been awesome, and even though she strongly favors homebirth, has not pushed me at all, and says we have many more months before we have to make a final decision.

Quote:



> Originally Posted by *Turquesa*
> 
> Beautifully stated!!
> 
> ...


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## MegBoz (Jul 8, 2008)

Quote:



> Originally Posted by *Mama Metis*
> 
> This is all very true, of course! But for me, the more relevant/interesting question has been - if you can get the same compassionate, high-quality care regardless of setting, (i.e. the same midwife) why choose home over hospital?


Definitely an interesting Q!
However, I don't think there ever will really, truly be an "EQUAL" comparison.

For example, I have fantastic hospital-based MWs that I had my DS with, but there are still some hospital disadvantages vs. HB (& these are all very typical):


There are 4 hospital MWs, one of whom I really dislike, & I get whoever is on call
I get whatever nurse(s) are on call & they're total strangers to me whereas I also know my MW's asst (she's at every prenatal)
15 min vs. 1 hour prenatal apts as the norm with the HB MW (I really, highly doubt you'll find prenatals that are regularly so long in-hospital in the US)
While the hospital has a tub to labor in, I can't birth in the water (again, water birth in American hospitals is rare)
Even though this is a great, NCB-friendly hospital, they still have more "rules" than my HB MW has (for example, I can't even labor in the tub post-42W, etc.)

& even in the case of truly "equal" care scenarios:


No need to travel in labor
My own bed that night (hospital bed was totally uncomfortable!)
MUCH better food having what DH cooks & we have frozen vs. the awful hospital food
No other germs
The emotional comfort of "my own turf" (HUGE for me personally)
If I want DS to be there for birth, much less stressful for him to be playing in his own house with his aunt (my dear sister) while I labor upstairs, then to hang out in a hospital (strange place) waiting for 2nd stage.
Less worry with a fast labor -

i.e. my MW knows my DS, my 1st, was less than 5 hours total for 1st stage, so she will probably come out if I've only been having ctrx for 1 hour. Whereas the hospital may not admit me so early.

Also, if the HB MW comes & labor slows again, I would view that as relatively less hassle & less worry, whereas I do NOT want to accidentally end up laboring in a hospital for 12-24 hours (if I go in early, but labor isn't as fast.)

With my DS, I'd planned to labor at home as long as possible before going to the hospital, which is a common plan for mamas wanting NCB, but I feel like such a plan would be riskier for me now that I've had such a fast 1st labor. IOW, I think if I planned another hospital birth, I'd be more likely to end up with an accidental UC, whereas I'm more comfortable calling the HB MW right away.

Finally, I just don't feel the need to go anywhere. I don't feel the need to travel, leave the comforts of home, subject myself to the presence of strangers, etc. For me, HB is just as safe because I'm low-risk & healthy with access to several fantastic HB MWs and not far from a great hospital in case of transfer (transfer would also be smooth & hassle-free for numerous reasons). So given that, I don't feel the need to go anywhere.

I ended up accidentally doing all my laboring at home with my DS (didn't think it would go that fast, was shocked when I felt the urge to push). I resisted the urge to push as we drove to the hospital, then we got into a room & I pushed him out in 45 min. There was just no reason for that trip to the hospital.  There just wasn't. Would have been fantastic to just have the MW come to me, so that was an easy decision for #2.


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## Turquesa (May 30, 2007)

There's a lower chance of a cesarean if you have a home birth. If you can avoid an unnecessary cesarean (e.g. a "time's-up" cesarean, or one based on an inaccurate fetal monitor reading), you can avoid the risks and hassles that come with it (e.g. recovery, increased risk of neonatal and maternal mortality, future VBAC denial).

Quote:


> Originally Posted by *Mama Metis*
> 
> This is all very true, of course! But for me, the more relevant/interesting question has been - if you can get the same compassionate, high-quality care regardless of setting, (i.e. the same midwife) why choose home over hospital?


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## GoBecGo (May 14, 2008)

The thing about setting is, well, it can matter hugely. Do you happily/unselfconsciously poop at other people's houses? SOme people do, i know, but me, i prefer the security of it being my own bathroom in my own house, y/k? And i KNOW birth is not pooping, but it's a really intimate biological process, and being in a familiar place really DOES, for the vast majority of people, make everything less painful, more comfortable, calmer and "nicer".

It is true that access to the exact same care (which i couldn't get in the UK - in the hospital i get whatever MW is there, with the NHS HB i would get one of "my team" of community MWs but in the event a total stranger turned up, and if we'd transferred she would only have remained with me as long as her shift (which had almost finished when i called her out, with my independent MW she has no jurisdiction in hospital so again i'd be assigned whoever was there at the time) would make things a little easier, but is it REALLY the same care? IS there an Ob in the hospital? Because if there is the MWs are going to treat things differently than if you were at home, they just are, otherwise planned MW births in hospitals would have the same cs rate as planned homebirths and they just don't. Because at home they will listen with the doppler, maybe hear something iffy, listen again a little while later, watch how you're going, listen again, assessing all the time, how is mama? how is babe? how does this labour feel right now? In the hospital they may well use the CFM machine simply because it is THERE, they may feel compelled to get the Ob's 2nd opinion simply because s/he is THERE, once that happens the Ob might drive how things go, and the MW will feel less able to argue because, afterall, it was her who sought the Ob's opinion. You may really end up with a cs, simply because you were there.

Wherever you birth there will be a hierarchy. In your home the MW is fully responsible for you and your baby. She takes this responsibility very seriously. She assesses you carefully, she KNOWS she is where the buck has stopped. You and she are partners, she will guide and support and care for you as you bring your baby out. In hospital, even with a very supportive hands-off Ob, she is NOT where the buck will stop. The Ob can ask her about "how you're going" at any time. The mere presence of someone who is higher up the hierarchy can make a MW doubt herself, second-guess her decisions, overreact to things for fear of being deemed too casual or dangerous. It's fine if you have a very normal, pretty fast labour and delivery, but "normal" is a broad church in midwifery and a narrow one in obstetrics. Midwifery and Obstetrics are not equals, professionally. This is grossly unfair since midwives really are far more specialised and able in the care-provision for normal births than Ob's, but it means that when a MW is dealing with a normal-but-non-textbook delivery under the eye of an Ob she may feel under pressure. She KNOWS you are ok, but she cannot prove it, because you're not doing what the textbook says you should. She wants to wait, the Ob wants to normalise the labour to "help the baby" and arguing with "helping the baby" implies "endangering the baby". Thus she may be compelled just by the environment to be far more conservative than she would be in a home setting, she may feel, in a hospital, far less like a servant to the woman and more of a servant of the institution, the hospital itself. When a MW attends the woman at home she is there for the woman. When a woman attends a MW in hospital the MW has pressures from the woman (who needs her care) AND the hospital (which wants her to meet its own needs). When a MW is in hospital she, to some extent, is a representative of that hospital. At a home she represents herself, her own knowledge and her own abilities.


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## MegBoz (Jul 8, 2008)

Quote:


> Originally Posted by *GoBecGo*
> 
> Wherever you birth there will be a hierarchy. In your home the MW is fully responsible for you and your baby. She takes this responsibility very seriously. She assesses you carefully, she KNOWS she is where the buck has stopped. You and she are partners, she will guide and support and care for you as you bring your baby out. In hospital, even with a very supportive hands-off Ob, she is NOT where the buck will stop. The Ob can ask her about "how you're going" at any time.


Excellent points! Something I totally forgot about.

yes, even in my very NCB-friendly hospital with great MWs, they still have a degree of "oversight" from the OBs. I don't think they closely monitor the MWs - and I personally never even met any of the OBs b/c my whole PG & birth were healthy & text-book. But friends of ours birthed there with the same MW & pushed for like 4 hours. They said the MW chased away the OB on several occasions.  Mama & baby were doing OK, tired but OK & really wanted to continue. But I believe this hospital, like most American ones, has a policy to limit the time for 2nd stage (I'm thinking 2 hours max is common?)

At one point, the MW yelled as OB tried to walk in, "Baby is crowning, get out!" A total LIE at the time, but it bought them more time and she DID successfully push out that baby.

But yeah, excellent points - the 'oversight' of OBs & being a servant of the institution itself are certainly non-issues in HB.


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## Mama Metis (Feb 10, 2010)

Yeah, I guess my situation is more unique than I thought, which in many ways is unfortunate. I would have the same exact midwife regardless of setting (home, freestanding birth center, or hospital). She is an independent practitioner and practices the same way regardless of setting (at least as far as medical calls and interventions go). Really for most of you, it sounds like a homebirth truly is the only tenable option. I don't think I fully appreciated that before. It seems that more midwives should be able to practice the way mine does, so that women who truly want (or need) to be in the hospital can be without compromising their care or increasing their risk of unnecessary interventions.

That said, MegBoz and GoBecGo, your points definitely resonate with me, which is why I'm planning a homebirth myself.


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