Tuesday, June 29, 2010

The irrelevance of home vs. hospital

Ever since a conversation last night with my brother and sister-in-law, I've had this phrase going through my mind:  "It's not where you are, it's who you're with."  It seems to me that traumatic births often prompt couples to choose an alternative path for subsequent births.  For those who experience that trauma in the hospital, home birth often provides the healing they seek.  Because of the trauma my brother and his wife suffered following their home birth (and I do think my brother has some valid and genuine post-traumatic stress), they will likely have all of their subsequent children in hospitals.  I think it's just human nature to associate those intense frightening emotions with the place where they occurred regardless of whether the place contributed to their occurrence.

We can strive to reduce complications, we can keep our bodies healthy and strong, but we can't control everything that arises as we give birth.  Complications can and do arise in all birth locations.  As long as a laboring woman is within the standard "thirty minutes from decision to incision," what matters most in the midst of a birth complication is who is taking care of her and how do they respond?  Do they have the skills, experience, presence of mind, and knowledge of evidence-based practice to ensure her safety and well being?  Being five minutes from (or even inside of) a hospital doesn't guarantee that a care provider will advise the best possible solution to a problem.  Likewise, being at home with a midwife doesn't guarantee that a birth will be peaceful and empowering.  Midwives can degrade and doctors can earn the title "Wonderful." It's not where you are, it's who you're with. 

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13 comments:

Bridget said...

I totally agree. I had a great OB with my first daughter but because of moving had to transfer care, to mediocre midwives. With my second, I had totally unsatisfactory care at a freestanding birth center and ended up transferring (again because of moving) to an amazing hospital. This post is right on!

Liz Johnson said...

I agree as well. I think it's about finding a good 'fit' for what you want, and making it happen. Even if we end up moving two months before my due date, I am already trying to figure out how I can stick around and deliver with my current midwife and at my current hospital, because I feel like I've found such a perfect fit. I think that's the most important part.

Fig said...

The most surprising part of Viv's birth, for me, was how wonderful the hospital turned out to be.

Of course, there are environmental factors outside your home that you just can't control, and that's why we'll most likely go the home birth route next time, but hospitals are NOT always the cold, sterile, impersonal places that we often imagine them to be. Because of the great nurses, a doctor and doula I trusted, and because we did our homework on local hospitals and picked the one that fit our ideals best, it turned out really well.

With a little prep and trusted helpers, birth can be beautiful anywhere.

Sarah said...

I wish that location didn't matter, but sometimes it does. I live in an area where all 4 hospitals in a near radius have double to quadruple the WHO-recommended maximum cesarean rate. Here is a list of standard procedures at one local hospital, as taught in a hospital-sanctioned birth class:
* membranes will be ruptured by 4 cm
* confinement to bed after AROM, including bedpan (no getting up even for bathroom)
* internal continuous EFM
* directed pushing IN BED ONLY, never on a birth ball, in the shower, on a rocking chair, etc.
* after birth, expect immediate cord clamping and for baby to be taken to the other side of the room for 40 min of evaluations
* after that, mom may hold baby for 20 min, then baby will be taken to the nursery for 2 hours

Yes, moms can technically decline any recommended care, but it is made well known that if you rock the boat, the nurses and/or OBs will make your life miserable. I know ppl who have declined certain interventions only to have CPS called on them (fraudulently) by OBs or nurses.

It's not as simple as it sounds, to tell women that all they need is a good care provider (if one exists nearby, not just a bait-and-switch provider), a good birth plan, and the will to have a natural birth.

Buscando la Luz said...

Great points, Sarah. It's definitely an individual, personal decision and each couple has to weigh their options and choose what fits best for them. I'd definitely choose home birth if I were living in your area. Yikes.

kami said...

Awesome post. I think you're really right. Having a good care provider and good labor support is key. Obviously there are things in a hospital, like Sarah mentioned, that would make it more difficult and possibly more stressful, but it can be done. It is such a personal decision and one that should be made with prayer and education.

Jennifer said...

The point of this post is to make those of us who MUST birth in that setting feel comfortable. We know that hospitals can do some questionable things already hence the need for a blog post like that. Thanks for totally ruining the purpose of this post Sarah.

MeesterMama said...

I agree. Who is with you is HUGE. The only disagreance would be my first two births were c-sections so when I went to VBA2C no doctor or midwife in a hospital would take me on without rediculas stipulations that would leave me with another section...so in my case my only option was home. Which was fine with me I would have chose that anyway. But sometimes the options arent really options. Now that I have had a vaginal birth I could go to a hospital (stupid I know) I have a "proven pelvis" now. But I agree that it totally makes a difference who or who isnt with you.

Anonymous said...

I do believe who you have with you is SO important! I've had five homebirths with several different midwives. Compassion is a key quality to look for in a care provider.

Mother Earth said...

Great post. I'm sorry your sister-in-law's experience with her provider wasn't great. That truly makes all the difference. That's why unity with care providers is so important.

I think it is natural to want to change everything about the place where things went down wrong. After my divorce, my therapist gave me one of the only good pieces of advice she ever gave me and that was to redecorate my house (I kept the place) so that it felt nothing like it did before.


That might actually be advisable after a bad homebirth experience. Because there may be anchors all over. At least if there is trauma in the hospital, you can get away from it and avoid it after that.

TheFeministBreeder said...

I agree - it is who you're with. Unfortunately in a hospital you cannot control who you're with. OBs and hospital midwives are not the ones doing the bulk of the labor care - it's the L&D nurses, and you don't get to choose those (you can fire them, for sure, but something bad usually has to have happened first.)

In the two hospital births I've attended so far, it was the L&D nurses that made the mother feel terrible. Two different hospitals, and two different types of providers - yet neither could avoid the nurses. The provider they each had (one a medwife, one a real midwife) definitely impacted their final outcome, but again, the midwives weren't there the whole time.

That, unfortunately, is one thing that simply cannot be avoided in a hospital setting.

Anonymous said...
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Anonymous said...

"I agree - it is who you're with. Unfortunately in a hospital you cannot control who you're with."

And very sadly in some homes you cannot control who you're with either. :( Like if you and your husband live with his parents and your parent-in-laws want to keep managing your lives like they managed his when he was a boy. Or like if you're an unmarried teenager living with your parents (married teens are more likely to live with their husbands' parents than their own) and sharing a bedroom with your younger sister or brother because your parents can't afford a 3-bedroom home. :(