Monday, February 28, 2011

The Truth About Home Birth And Hospital Birth

By Sheila Stubbs ©2005


Home birth should never be recommended to anyone who is afraid of having the baby at home. If a woman feels safer in the hospital, she will labor better in the hospital.

In spite of all the childbirth education available today, it seems that women fear childbirth as much as they ever did – and perhaps even more so. Thanks to the media, childbirth is perceived as a risky event. The hospital is considered to be the safest place for both mother and child because of its modern technological equipment.

What do the Statistics Say?

Did you know that no study has ever proven that hospital birth is safer?

When hospital birth has been defended as safer than home births, all out-of-hospital births were used in the statistical data, including births that occurred in taxi cabs and newborns found in trash cans.i That is not a realistic representation! A well-informed, healthy, couple planning a homebirth should not be compared to a fifteen-year-old drug addict who gives birth in a toilet at the mall! A reliable comparison between home and hospital births would have to include parents who were matched, couple by couple, for age, number of pregnancies, education, socioeconomic status, and risk factors.

Such a study was actually done in California by Dr. Lewis Mehl, MD, and included over 1000 couples.

· A bottle of champagne and a cake for the party afterward!
· Birth Day Party gifts for other children, wrapped and ready. (Some find a video is a good gift, using it for mom/baby rest time.) Surprise your helper with a gift for her too.

Other Things Some Couples Like to Have
· a large mirror - to watch the birth
· hot water bottle or heating pad
· talc or lotion for back massage
· bendable drinking straws, ice chips
· rocking chair
· your favorite laboring music.
· disposable diapers
· petroleum jelly – helps clean off those first black baby poops.


Other preparations
· Be prepared to meet with negative reactions. Some people may think you have just taken a terrible risk!
· Be prepared to prove the baby is legally yours! A camera that stamps the date might be a good idea.
· Be prepared to limit visitors. They may forget that just like hospital patients, you still need your rest.
· Be prepared to accept help. If someone offers, they will be happy to know exactly what they can do. “How nice of you to offer! There’s a load of laundry in the dryer that needs folded, and could you sweep the kitchen floor please?”

This study, outlined below, clearly shows that planned home birth by informed, healthy couples had superior outcomes to hospital birth. ii


Hospital Birth Home Birth
1st Stage of Labour 8 hours average 12 hours average
2nd Stage of Labour 42 minutes avg. 72 min. average
3rd Stage of Labour 5 minutes avg. 22 min. average
birth injuries 30 0
elective induction 22 0
amniotomy 56 6
episiotomy 87.4% 9.8%
pain medication 75% 5%
oxytocin - 3rd stage 95% 24%
forceps 35% 1.6%
oxygen required 8.9% 1.2%
Cesarean required 8.2% 2.7%


You will notice that all stages of labour all are accomplished in less time in the hospital than at home. This seems to be a benefit. However, it is the increased use of interventions - the amniotomy, episiotomy, oxytocin and forceps – that shorten labor. And note that those long labors at home required little pain medication.


When this study was done in 1976 the cesarean rate in the hospital was only 8.2%. As you are probably aware, it’s now over 20%, even 30% or more in some hospitals. But even that low rate of C-Sections is three times higher for couples who planned their births in the hospital, than for couples who planned their births at home.


The study also found that in the hospital births,


Resuscitation was required 3.7 times more than home births
Newborn infection occurred 4 times more than home births
Meconium aspiration pneumonia 2.5 times more than home births
Newborn respiratory distress 17 times more than home births
Fetal distress occurred 6 times more than home births
Meconium staining occurred 3.5 times more than home births
Shoulder dystocia occurred 8 times more than home births
Maternal high blood pressure 5 times more than home births
Maternal hemorrhage 3 times more than home births
3rd degree tears 5.5 times more than home births
4th degree tears (into the rectum) 14.6 times more than home births


Why would there be more cases of shoulder dystocia in the hospital? Why would there be a greater risk of maternal hemorrhage where there is more technology ensuring your safety? Why should there be a greater likelihood of 3rd - and 4th degree tears dependent upon the location where a woman chooses to give birth? Does this make sense?

Or, is there something about being in the hospital that actually makes birth riskier?


Things Your Obstetrician Doesn’t Want You To Know


§ Doctors are only human. They have made mistakes about birth and continue to make mistakes.
§ Most of the maternal deaths in the 1800’s were a result of childbed fever, an infection which was caused by the doctors themselves, spreading infection from patient to patient.
§ The obstetrical practice of shaving the woman’s vulva to prevent infection caused more infection than it prevented.
§ Doctors believed modern formulas were an improvement upon Nature and discouraged mothers from breastfeeding in the last century.
§ Many of the ‘things that can go wrong’ during birth go wrong because of unnecessary risks taken in the hospital.
§ All interventions carry risks.
§ Interventions are often used in the best interest of doctors, not patients. Why? A hospital is a place of business. Interventions speed and control unpredictable labors to make their business run more efficiently.
§ In a court of law, the use of interventions helps the doctor’s case by proving he used all the available technology to ensure a safe birth.

How Routine Interventions Can Cause Problems


We will look at typical interventions used during a normal labor and how they can turn a normal birth into a surgical procedure.


1. You arrive at the hospital late one evening. The doctor orders a sedative.

Reason given: To help you sleep through those early contractions so you (and the doctor) will be well-rested for the birth.
Risks: - Your baby may be affected by the drug.
- It might slow his heart rate to the extent that he shows signs of distress, necessitating cesarean.
- The baby could require resuscitation.
- Sedatives would not be prescribed during pregnancy because of the risks to the baby, but doctors deem them safe as a labor drug.


2. The hospital policy requires Electronic Fetal Monitoring.
Reason given: “It lets us check on how the baby is doing”
Risks: - Whenever a hospital starts using fetal monitors, their cesarean rates increase.
- There has been an increase in the rate of cesareans being done since routine fetal monitoring began, but this has not resulted in any improvement in mortality and morbidity rates.iii


3. Bed rest for labor.
Reason given: Get as much rest as possible. Avoid infection.
Risks: - The weight of the baby presses on your back when in bed, causing pain, increasing the need for medication.iv
- Labor is slowed down increasing need for augmentation
- When mother can’t move about freely, baby may become wedged into an awkward position increasing the need for forceps delivery.


4. Rupturing Membranes (Breaking your water)
Reason Given: This will “help speed things up a bit.”
Risks: - Increase your infection risk.
- The cord may prolapse making a cesarean necessary.
- Your contractions will become more intense and painful.


5. Augmentation: The use of artificial hormones to stimulate labor
Reason given: This will increase and/or regulate contractions.
Risks: - Can cause uterine contractions so strong that it increases the risk of uterine rupture
- Substantially more painful than natural contractions.
- More likely to need pain medication.
- Abnormally strong contractions can cause fetal distress.


6. Pain Medication
Reason given: Pain Relief
Risks: - Could adversely affect your baby, causing respiratory difficulties.
- Your baby may be lethargic and have more trouble breastfeeding.
- Some drugs have been known to have an adverse affect on intellectual and motor development of the childv
- Can make the mother feel lightheaded and not in control


7. Epidural

Reason given: The epidural will allow you to be awake and alert for the birth, but feel no pain.

Risks: The epidural has been related to an increase in neonatal jaundice.
- Some women experience a backache that might last up to several months.
- Occasionally the numbing effect of the drug accidentally goes up instead of down, causing the woman breathing difficulty.
- Slows down labor, increasing the need for further augmentation.
- You can’t feel the pushing urge.
- Forceps delivery is more likely, because your ability to push is affected.
- Adversely affects the hormonal surge following birth that aids bonding

8. Lithotomy or semi-sitting position
When it is time to deliver, you will usually be positioned on your back or semisitting.
Reason given: Allows the doctor better access to deliver the baby
Risks: - Lying on your back makes your uterus work harder.
- Increases the need for forceps.
- Increases the risk of tearing as it puts the most pressure on the perineal tissues.
- The weight of the uterus rests on your major blood vessels, possibly making you lightheaded and also...
- Reduces the oxygen supply to the baby, causing fetal distress.
- The main reason for you to be in that position is so the doctor can do an episiotomy, but the main reason you need the episiotomy is because he has you in this position!


9. The Episiotomy
Reason given: to enlarge the vaginal opening and make it easier for the baby to come out, and to prevent a tear that would be difficult to repair.
Risks: - Studies have shown there is a higher risk of second- and third-degree tears with an episiotomy, than without one.
- Increases the risk of acquiring an infection.
- It will be painful to sit on those stitches for days, at best, weeks sometimes, and that some women have painful intercourse for months after an episiotomy.
- The birth may occur a few minutes sooner but repairing the incision takes up to an hour.


What about the Baby’s Safety?

- Both you and your baby have a much higher risk of picking up a dangerous infection in the hospital.

- You are immune to the germs in your own home.

- A cord around the baby’s neck is not uncommon, occurring in about 30% of births, and is not inherently dangerous.

- What about cutting the cord? Within a few minutes the cord goes cold and white. Tie string around it so it won’t leak, and cut it.

- The common practice of putting alcohol on the cord to help it heal was proven in one study to be useless.

- Hospital nurseries were necessary when babies were adversely affected by amnesic drugs given to the mother. Healthy mothers can look after their own babies.

- The nursery undermines a woman’s confidence in her ability to care for her child. Mothers feel inadequate compared to the medical experts who keep her baby under observation in the nursery.

- When nurses ignore babies’ fussing as insignificant, mothers assume that as the “experts” they must be right.

- Separating mom and baby interrupts an important learning period in which mother learns to interpret baby’s signals. This can affect breastfeeding success.

- Babies should be welcomed to the world with love, not kept in a nursery with strangers!


The Move to the Hospital
There is a common misconception that women stopped giving birth at home because hospital birth was safer. The truth is that from the early 1900’s and continuing to today, studies have shown that mortality rates were higher in doctor-attended births than midwife-attended births, and highest in hospitals.vi


Why do they continue to use hospital s if home birth is safer?
1. Convenience. It was easier for the doctor to have the patient come to him, than for him to have to travel to the patient. Thus, while the woman was laboring in the hospital under the watchful eyes of the nurses, the doctor could continue to see other patients. This brings us to the second reason:
2. Money. The doctor could earn more money if his patients came to one central location, where he could manage several patients at once.
3. Power and control. In the hospital, the doctor was in his own domain. He had authority, could dictate how things were run and refuse admittance to outsiders. At homebirths, doctor was not the leader, but the helpful guest.

Home Birth: Not only safe, but fun!
§ You don’t have to worry about going anywhere. Your doctor or midwife comes to you instead.

§ There is little to do in the hospital but focus on having the baby, and time can drag in the hospital (making augmentation more appealing). At home, you can move about freely, doing what you might normally do.
§ Preparing your home for the baby – “Feathering your nest” – is an emotionally satisfying way to pass the time.
§ No coping with admission procedures and paperwork.
§ No asking permission or arguing policy. Eat what you want, go where you wish. Cry, scream, dance, or talk on the phone. No rules to follow.
§ You can have whoever you want at the birth, as many people as you want. You can be all alone if you prefer.
§ Your privacy is respected. You don’t have to worry about staff walking in at any time.
§ You can do whatever you feel like doing with that privacy. Kissing and lovemaking, by stimulating the right hormones, can actually help your labour along!


What should you do if “Something goes wrong”?
· If something goes wrong, go to the hospital of course!
· Most problems can be detected well in advance of disaster.
· If the umbilical cord has prolapsed into the birth canal, call the hospital to prepare for an emergency C-Section. Kneel on the back seat of the car with your head down and bottom up to protect the cord from getting compressed. Being in the hospital would not have avoided this complication.
· Some blood is normal in labor, but too much would be worrisome. Go to the hospital to be checked out.
· Hemorrhage after the birth. (3x more likely in hospital) Nursing the baby and massaging your belly will help your uterus to contract. Go to the hospital if the bleeding is profuse.
· A cord around the baby’s neck: The cord can usually be slipped over the baby’s head. If it can’t be slipped off, tie it and cut it and deliver the baby as quickly as possible.
· Shoulder dystocia (baby’s shoulders get stuck) occurs eight times more often in hospital. Usually a change of position will help: standing up, or on all fours, or squatting. A midwife or other attendant can reach in a finger and gently pull one shoulder from under the pubic bone. If not, call 911.
· Baby doesn’t breathe: (Seventeen times more likely in the hospital!) Do infant CPR as described in any First Aid Book.
· If a long, difficult labor is exhausting you, you can always go to the hospital for relief.

· If you simply have a “gut feeling” that something is just not right, trust your instincts.


Handling the Pain
§ Pain is usually easier to handle in your own home as you know when you feel ill at work. You want to go home where you’re able to cope better.
§ At home you don’t have to wear the same image you wear in public. Hospitals are public place. At home you “let loose,” and that relaxation leads to a faster, easier, less painful labor.
§ Often when you feel like you can’t handle the pain it’s because you are only a few contractions away from pushing your baby out.
§ Pain is worse when accompanied by fear. At home, the fear of the unknown is reduced because of your familiar surroundings.


Birth Attendants
You will likely have two midwives at the home birth, so there one pair of hands for mom and one for baby. You might want another attendant to help out as well. There are several things to consider when you decide who you would like at the birth.
· A “doula” is a woman you can hire who has training in labour support. Or you could just ask a caring, supportive neighbor to be your doula.
· How many people? Some like having the support of many close friends. Others like to keep it private and intimate.
· What do you want them to do? Housecleaning? Childcare? Backrubs? It’s nice to have someone do cleanup while you enjoy the new baby. Pick someone who won’t mind doing a little housework.
· With other children, you may wish to have a person who knows your other children well can take them out to play if you request it, or can reassure them if they watch the birth.
· Don’t make the mistake of inviting someone to your birth because it would be a good experience for her. This is your day, and you have enough to do without performing the perfect birth for someone else’s benefit.
· It must be someone who is supportive. If your best friend thinks you are taking a terrible risk, you don’t need her there.
· Have a few back-up persons lined up in case your first choice of helper is not available, or you need more help than you expected, or in case you have to go to the hospital. Ask them ahead of time.


Preparations for the Home Birth


Stuff You Probably Have Already

· Lots of food stored away - so your birth attendant(s) can have something to eat, and so you have plenty for yourself after the baby is born.
· A firm bed, if bed is where you want to give birth.
· Some like to sit on an exercise ball during labor. Or soak in the bath.
· Plastic sheet - to protect the mattress (or carpet) from wetness. An old shower curtain or vinyl tablecloth will do.
· Old sheets and towels - to put over the plastic sheets and absorb fluids.
· Newspapers - also to protect floor if amniotic fluid is leaking.
· Tea Kettle - to make some raspberry-leaf tea, an herb which is known to help labour, childbirth, morning sickness, menstrual cramps, and mood swings. Boiling water is also for sterilizing the scissors and shoelace for the cord, and to have warm compresses for the perineum.
· Sharp scissors for cutting the cord.
· A dresser or table cleared off for doctor or midwife use.
· Large bowl or dishpan or ice cream tub for the placenta. You can line it with a plastic bag if you like. Or use newspaper.
· A roll of paper towels. Handy for any kind of messes.
· Large garbage bags to contain those messes.
· A shovel. Traditionally, Dad buries the placenta ceremoniously in the backyard, planting a tree over it.
· Camera, camcorder, or tape recorder for those who want to record the event.
· Heavy-flow menstrual pads. You’ll need them the first day or so.
· Clothes, washed and clean for the baby; clothes for mom to wear after the birth, too. Something with easy access for breastfeeding.
· Thermometer - a good idea to check mom’s temp daily - a rise in temperature could indicate an infection.
· A list of emergency phone numbers, posted by the phone.
· Olive oil - often used for perineal massage. You can put it in a squirt bottle from the dollar store for better aim. Warm it in hot water.
· Soft washcloths or old diapers - for hot compresses.
· Flashlight - in case of a power failure.

Things You Might Not Have and Might Want to Get
· A shoelace for tying the cord. Shoelaces are soft and pliable like babies, unlike the hard plastic clamps used in maternity wards.
· Germ-killing soap like Betadine or Phisoderm for hand-washing.
· Infant Ear syringe - to suction mucous if necessary.
· Baby Scale – you can borrow one. Many midwives use a simple fish scale. Babies don’t cry when weighed this way (suspended from the scale in a cloth sling) like they do when laid out naked on a metal scale.



“What about The Mess?”

When you prepare the birth bed, make the bed with clean sheets, twice. On top of the clean sheets, put a plastic sheet, and then another set of clean sheets. After the birth, your helper simply strips the top layer off. Wash out blood in cold water, not hot, or it will stain. If you use old towels and newspapers, you could simply stuff everything — even the placenta — into a large trash bag.


In some places the placenta must be buried by law, as it is human tissue. In winter, wrap it up and put in the freezer until the ground thaws. Label it to avoid surprises!


Notes

i Ontario Ministry of Health, p. 109.

ii Lewis E. Mehl, MD., “Statistical Outcomes of Homebirths in the US: Current Status,” in Safe Alternatives in Childbirth, ed. by David & Lee Stewart, (N.A.P.S.A.C. [National Association of Parents and Professionals for Safe Alternatives in Childbirth,] 1976) p.81.

iii Nancy W. Cohen and Lois J. Estner, Silent Knife, (Bergin & Garvey 1983), p. 180.

iv Robert S. Mendelsohn, MD, Confessions of a Medical Heretic , (Warner, 1979), p.155.

v ibid. page 168-70.

vi ibid. p. 35 footnote.

© Sheila Stubbs 2005
Sheila Stubbs is a nurse, doula, childbirth educator, breastfeeding counselor, mother of six, and author of Birthing the Easy Way. Her first child was born by cesarean section due to a condition she calls “Physician Distress.” The rest of her children were born without medical intervention, four of them at home.

1 comment:

Danielle said...

Wonderful information!! I loved my home birth with my fourth child and can't imagine going back to the hospital!