Labor at home as long as possible??

I’m in a rather spunky mood today, ready to ask some challenging questions for my fellow obstetrical care providers (as well as hopefully getting a couple of wheels spinning in the minds of expectant parents contemplating birth in the near future).  This post isn’t going to entertain you with beautiful pictures, or clever images to illustrate a point…..just a few questions that make me go “hmmm….”

I’m about to point out what is, to me, a huge obstetrical contradiction. I don’t hear people talking about this contradiction – not yet anyways – and I am rather excited about reading responses to these questions from any nurses or doctors or people in the mainstream obstetrical field.

As a homebirth midwife, I am used to the question, “what if something goes wrong.” I always answer, “then we either fix it…or we go to the hospital to get it fixed.” To that, ACOG and so many others seemingly roll their eyes and give an exacerbated sigh and say, “Women need to be in a hospital because things can happen in a MOMENTS NOTICE – emergency situations where you need an OR right up the hallway to save the mother and baby from imminent death!! Things can happen quickly so you need to be continuously monitored in a hospital!!”

These same people will also (in another conversation) say things like, “You should labor at home as long as possible”….”You are only 3cm dilated, go home until you are in active labor.” … “You aren’t progressing fast enough so we will do X to you….you shouldn’t have come to the hospital so early.”

Here is the thing that I wonder: how can you say that it’s an emergency waiting to happen and therefore you need to be continuously monitored and ready with an OR up the hallway (even though the surgical team isn’t waiting there and the doctor is out to dinner with her family) – and at the same time say that it’s safe to labor at home until transition and feeling pushy with NO monitoring and no medical professionals anywhere near you?

I’m seriously trying to understand your position here. Is it labor that’s dangerous…or just birth? Why is it a 4cm mother doesn’t need monitoring if laboring at home, but needs monitoring if laboring in a hospital? How can you say with a straight face that she is safer laboring at home without anyone and then arriving only in time to birth her baby – than she would be laboring at home with me overseeing everything and just staying home to birth?

You encourage a woman to labor at home as long as possible (so long as there aren’t big warning signs)….but, um, isn’t that the DEFINITION of a homebirth?  Laboring at home as long as possible (with a trained medical professional) watching for warning signs; transferring to the hospital if there are problems that come up?

You have an OR right up the hallway and we do not, that is true…but how many times have you seen a normal healthy woman have an obstetrical emergency happen without warning DURING DELIVERY (since you’ve already said that labor is safe to do without any assistance) in which your decisions-to-incision time is notably faster and makes a difference (because everyone is in place and ready to perform the cesarean the moment the emergency occurs)?  How often do you see emergencies occur without warning (and without us causing it), identified immediately,  and with a surgical team scrubbed and already ready and waiting?  Seriously.

I know you like to advertise yourself as being ready for an emergency at any moment…you say that being 15-30 minutes away from a hospital can be the difference between life and death! And yet….you ban VBAC’s because you don’t feel you are capable of dealing with the 0.1% chance of a uterine rupture since you don’t have an anesthesiologist as well as surgeon standing by immediately? If that’s the case…how are you prepared for ANY obstetrical emergency?? And if you have to assemble the team and prepare for the cesarean – then can’t you do that while I am transporting my client to the hospital? Since I called to warn you we are coming – shouldn’t *MY* homebirthing client with an emergency be able to get her necessary cesarean because we are having an emergency at about the same time as your hospital birthing patient could get hers?

What I mean is….either you are prepared for an emergency (and thus why it’s so important to be IN THE HOSPITAL in the first place) or you aren’t and need to assemble a team (in which case you can be doing that while we’re on our way)

How can it possibly be safe to labor unsupervised and unmonitored when planning a hospital birth….but not safe to plan a homebirth with a trained midwife? Safe to “labor at home as long as possible” but not safe to plan a homebirth…? Is it the labor or the birth that you have a problem with? Or is it just me?

If it’s just the birth you have a problem with….why monitor and poke and prod during LABOR if she’s in the hospital?? If she can be left alone without supervision while at home and call it safe….why can’t she be left alone without intervention while at the hospital and call it safe?

I think we know the answer to that…I’m just curious to hear what you’re going to say.