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.

28 Comments

  1. Diana J. wrote:

    Stephanie, I’ve actually been wondering that very same thing for a couple of years now. I’m looking forward to seeing the conversation – hopefully some OBs will jump in!

    Tuesday, November 30, 2010 at 4:33 pm | Permalink
  2. Crystal Pena wrote:

    One of the many reasons I love your blog Stephanie is that you raise points or questions that many of have in mind but either have a hard time articulating or simply just don’t have the guts to raise. You are right, there are many contradictions to be found when you look at the societal norms surrounding birth which are, unfortunately, not doing women in the United States any favors!

    Tuesday, November 30, 2010 at 4:40 pm | Permalink
  3. Angela Horn wrote:

    One word:
    L I A B I L I T Y.

    If your baby is harmed or dies at home, you are at fault. If it happens under our nose and in our facility you’re gonna sue US.

    Why is midwifery more risky = $$$$$. You (midwives) will give far better and higher quality care, leaving the OB/GYNs to do just GYN and only emergency births. Now, we can’t have that, can we?

    (DISCLAIMER: There are some wonderful OBs out there who have a midwife’s heart. I’m not talking about them above.)

    Tuesday, November 30, 2010 at 5:21 pm | Permalink
  4. Denise wrote:

    I’m naive when it comes to hospital procedure with respect to emergency c-sections. Let’s say something happens at home and we need to transport. Once at the hospital, won’t it take extra time to get a team of people up to speed and on-board with the situation vs amassing docs who have immediate access to the case/labs/vitals etc and transporting to an OR down the hall?

    Tuesday, November 30, 2010 at 5:58 pm | Permalink
  5. So so so true. Also, why on earth is someone who is at 4cm considered when they’re or in latent labour at 2cm even if the baby is obviously soon? It’s a weird system, that’s for sure.

    Tuesday, November 30, 2010 at 6:15 pm | Permalink
  6. Amy Hatch wrote:

    Wow, good one Stephanie!

    I came to realize the value of a home birth team and midwife two years ago now. I feel that having a doula and midwife(s) during labor watching and caring and monitoring was far ‘safer’ and more effective than some silly electric monitor never placed right to catch contractions and a distracted nurse trying to ‘watch’ many laboring women at a time, with the doctor no where in sight.

    Fear and money are the great architects of the system we have now…

    Tuesday, November 30, 2010 at 6:27 pm | Permalink
  7. elfanie wrote:

    Denise:
    I have a transfer sheet I fill out on the way with all of the pertinent medical information with regards to the mother….and I give report to the hospital when we call it in. They are usually up to speed well before we get to the hospital – and if it’s an emergency, I apprise them of the situation so that they can have the OR ready when we get there (as ready and it would have been in that period of time anyways)

    Tuesday, November 30, 2010 at 8:51 pm | Permalink
  8. I love it, Stephanie! I have long wondered this same thing. Hmm…hours of no monitoring or a PLAN of monitoring and support at home? However, this is the same mentality that many states have openly adopted with not acknowledging midwives. They’d rather that women labor and birth alone than have a (licensed) attendant!

    Tuesday, November 30, 2010 at 10:49 pm | Permalink
  9. Jespren wrote:

    silly people, it’s not the labor, deliver, or attendant that makes home or hospital labor/birth safe, it’s wether an OB knows you’re in labor. As long as no one knows (labor at home as long as possible) you went into labor you’re safe! But the second you call someone the labor is dangerous, why it’s downright deadly! (Your water just broke but your contractions are irregular and 20-30 min apart? Better come in so we can monitor you. You called your midwife? Better come in to the hospital so we can make sure there isn’t some infinately rare disorder she might have missed) So, it’s access to a phone that makes labor safe or unsafe! Humm..maybe that’s why they make us turn our cells off in the hospital, they know how dangerous those darn phones are! 😉

    Wednesday, December 1, 2010 at 11:40 am | Permalink
  10. Sheridan wrote:

    I have actually thought and written about this before. I work with a lot of VBAC moms and some of their OBs say, “Stay home as long as possible, it is your best chance for a VBAC.” I think this is true and I am glad their OBs say so.

    But personally I would rather be at home with a midwife who is checking on the baby while I am laboring and know I can transfer to the hospital if anything comes up during the birth.

    Staying home alone un-monitored and showing up just to push seems more risky to me then having support at home and birthing there!

    Wednesday, December 1, 2010 at 12:40 pm | Permalink
  11. Shelby wrote:

    I am a “worst case scenario” kind of girl so, to me, it doesn’t matter how unlikely a healthy woman is to have a medical emergency during her child’s birth. I know, given history and the fact that childbirth USED TO be the #1 killer of women, that there still is a chance. Therefore, I will be having all of my children in a hospital. I am more concerned with my child’s safety than the “Experience.”

    Wednesday, December 1, 2010 at 1:48 pm | Permalink
  12. elfanie wrote:

    Shelby:
    That would make PERFECT sense if…
    1. hospital outcomes were better than homebirth outcomes (and they are not)
    2. if hospital births are what lowers the mortality rates…they aren’t (as other countries with midwifery care as the norm have MUCH better outcomes than the US)
    3. if hospital births eliminated those “worst case scenario” risks…they do not. (in fact, when births moved into hospitals the mortality rate DRAMATICALLY INCREASED – then, as we learned about germs and gloves, ALL mortality rates decreased at the same time)
    4. if those who choose homebirths were choosing an experience over safety…and they are not.

    And going off of the topic of this blog post….so are you saying that you believe that you should go to the hospital as soon as labor begins? should you or should you not labor at home?

    Wednesday, December 1, 2010 at 2:45 pm | Permalink
  13. Rachel wrote:

    It’s funny you should mention this because just the other night we had a lady come into the hospital who was 6cm dilated but her contractions had died out. Everyone was upset because she didn’t want pitocin or have her water broken. Most of the nurses were in agreement that she should go home because what was she doing here if she didn’t want anything done to her.

    I just laughed and told myself…well that’s why women do homebirths…at the hospital we can’t stand not doing anything:)

    Wednesday, December 1, 2010 at 3:48 pm | Permalink
  14. Sharon wrote:

    Maybe I’m weird. With five children I have spent a combined total of slightly less than 14 hours in labor. For most of them the hospital where I delivered was over an hour away. I never go past 4 cm dilation until transition and from that point it has never been more than 20 minutes until I was holding my child in my arms.

    The only time I have had any complication with the actual birthing was with my fourth child – the one time I used a midwife. So many people had raved about the “midwife experience” I thought I would give it a try. Because of state law she was required to do the delivery in the hospital, so it was not much different than my three previous deliveries where I had been attended by my doctor. However, I experienced some very heavy hemorrhaging after this fourth delivery which continued for several days. I remember them pulling the placenta back out to look at to be sure they had it all because they couldn’t figure out why I was bleeding so heavily. They kept me a couple of extra days in the hospital because I was so weak and my iron level dropped very low. Anyway, when I became pregnant with my fifth child, and returned to my good old family doctor, his first comment on examining me was “When did you tear your cervix? There is quite a bit of scar tissue here.”

    My only guess was that it was when I delivered my fourth child; that might have explained the unusual bleeding.

    BTW, all of the previous births had been natural. My husband and I did crossword puzzles at the hospital until I hit transition, just like we would have at home. And I didn’t have to wash the sheets afterwards.

    Thursday, December 2, 2010 at 5:41 am | Permalink
  15. rachel wrote:

    the kinds of things that used to cause women to die of in child birth are largely irrelevant these days.

    there are the the complications that would be screened for ahead of time. Placenta previa would not go unnoticed in a pregnancy, and if discovered, would indicate a scheduled cesarean. Conditions like pre eclampsia, a midwife knows how to detect, and when to transfer to hospital if necessary. Neither of these.

    infection was a common cause of death. These days, pharmacies give out antibiotics for free. Excessive bleeding, again, home birth midwives carry the exact same drugs to control bleeding as the hospital.

    i’m sure that very rarely, women would die because labor went on and on and for whatever reason, the baby just isn’t coming. That is irrelevant today, because at some point in that labor, the decision wouldbe made to go to the hospital.

    except maybe in freak circumstances, birth just doesn’t go from ”just fine/normal” to ”OMG!!! Get a scalpel NOW!!!!” in seconds. There are warning signs, or emergencies where it is prudent to transfer quickly to the hospital, but no, emergencies don’t just fly out of nowhere and kill you before you realize what’s happening. That’s now what killed women hundreds of years ago. It’s that we have the option to go to the hospital at any time that makes planned home births really, REALLY safe!

    and my midwife did all birth related laundry and clean up before she left.

    Thursday, December 2, 2010 at 12:34 pm | Permalink
  16. Mama&Ellie wrote:

    I didn’t choose to birth at home for the experience…I chose it for the safety of my baby and myself. There are many interventions that can take place in a hospital setting that can potentially cause the baby harm. Pitocin, epidurals, premature rupture of membranes, laying on back, EFM, use of IV and nothing by mouth, premature cord cutting…

    I don’t like it when people assume I chose my comfort of my baby’s safety, because it simply isn’t true.

    And my midwife did my birth laundry, cleaned up, made us breakfast and helped me shower. She was spectacular.

    Thursday, December 2, 2010 at 4:22 pm | Permalink
  17. sara wrote:

    Yes it is quite a contradiction! My doc suggested staying home until the end and that’s just what I did. Looking back I could have stayed home- the doc didn’t even catch!it does kind of seem like birth is only an emergency when and if they are aware of it.

    Thursday, December 2, 2010 at 10:16 pm | Permalink
  18. Ditto Mama&Ellie! I chose home for safety “and” comfort. Not only for me, but my husband and my children.

    No sheets to wash here, midwives and doulas do all that. Had my babies in water as well. One bag for garbage one load of towels 🙂

    Saturday, December 4, 2010 at 10:17 am | Permalink
  19. Anon wrote:

    Shelby, pregnancy is also really dangerous. It would probably be best to stay in the hospital for the duration just in case something goes wrong.

    But don’t take the car to get there. Driving is really really dangerous.

    Saturday, December 4, 2010 at 5:38 pm | Permalink
  20. Thank you for a thought provoking post! You are quite right of course. While something can always go wrong, the definition of what is safe and what is not seems to be largely based on the financial satisfaction of medical professionals (as well as their ego!). The discussion is also interesting. I, too, opted to have homebirths because of the safety (and comfort) of my baby as well as myself. When your choices are a homebirth of a 1950s style East European hospital, where complications of some kind crop up during the hospital stay for almost every mom and baby pair, the choice is quite obvious. The same can be said in more developed countries, though.

    Olivia

    Monday, December 6, 2010 at 12:59 pm | Permalink
  21. Oh, and of course, life itself is dangerous. Instead of jumping to the conclusion that we should “only” spend our entire pregnancies in hospital, why not just move there permanently? I once had this discussion with a doctor, who replied that “apartments near hospitals tend to be more expensive”. Perhaps so :). But I don’t want to live in constant fear!

    Monday, December 6, 2010 at 1:01 pm | Permalink
  22. Brittany wrote:

    Another contradiction not covered here is the fact that for a woman’s entire pregnancy she is told not to take anything other than Tylenol because other drugs will cause harm, yet the second labor starts it’s DRUG CITY! I’d love to see this covered eventually!

    Monday, December 6, 2010 at 6:50 pm | Permalink
  23. Amy Farr wrote:

    What an excellent post. I think I’ve said all the same things at one time or another. We had a client transfer at 6 cms from a homebirth to the hospital and the nurses were freaking out about getting the baby on the monitor. The baby had been monitored at home. If she came in at 6 cms and had been laboring at home alone nobody would have panicked.

    And the whole immediate availability of an OR for a VBAC drives me nuts. If you can’t be ready for that then you shouldn’t see ER patients who might come off with a traumatic amputation or massive injuries from an auto accident either. I’m sure those things happen more frequently than uterine rupture.

    Stepping off my soapbox now. Thanks for an awesome post!

    Tuesday, December 7, 2010 at 11:35 am | Permalink
  24. Avani wrote:

    I loved this post and I actually love all your blogs you so clearly address and answer.

    I am planning a VBAC and I love the part..

    “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??” Soo true and yes how can they handle any other emergency if they can’t handle that.

    Homebirths with midwives are wonderful and a midwife is there for the momma and baby and they really do have all the same tools that a hospital birth would have!

    Thanks for all your blog you do great work!

    Sunday, February 6, 2011 at 2:50 am | Permalink
  25. Holly wrote:

    Homebirths are the smart way to go. When you get into a hospital you cannot relax. Laboring at home unattended or attended is fine. You know that if you start bleeding, have hypertension, or spike a fever that it is in your best interest to get to a hospital but remember, homebirths were a lot bigger than came along modernized medicine. Your body is able to handle birthing and in the majority of the situations are low risk that you could labor without help. That is what your body is meant to do. The major concern for doctors is the possibility of hemmoraging. Yet most cannot give you the actual risks. Research go with a midwife and birth at home.

    Friday, March 18, 2011 at 9:11 pm | Permalink
  26. Shay wrote:

    I am grinning ear to ear. I have never thought of this before and I want to carry a copy of this around just to shove in somones face if they back talk against homebirths. I am aiming for a HBAC this time and I am looking forward to it. I am 37 wks and with all the materials ready to go. 🙂

    Sunday, October 16, 2011 at 3:14 pm | Permalink
  27. mamacash wrote:

    i have had two previous delivers in the hospital. i had my first when i was 19yrs old. that labor was easy, well perfect. i went into labor naturally i was given pitocin when i arrived at the hospital they had eventually broke my water and things just seemed to move together seemsly. however with my second birth i was completely induced i was nieve and told to come in by a dr. that was not my primary. and at that point of my pregnancy i had been extermly uncomfortable for a while and i just wanted it to be over and to have my baby. However that day was like a nightmare. when my dr showed up in the morning she didn’t know why i was there. then they just cranked up the Pitocin and forced labor. by the time i was 5cm my contractions were like a minute apart and they felt unnatural. they broke my water and continued with the pitocin. by the time i reached 8cm i had to push the pressure was so unbearable. the nurses kept telling not to push. It was like they weren’t listening to me. i had to push. They had to use the forceps to deliver him he had marks on his face and head from them. i tore horribly because of the forceps. it was a traumatic expercience to say the least. I blame the hospital for this i was rushed through labor when in fact i should have been told to go home. i am now pregnant with my third child i will go to the hospital to birth but i will labor at home as long as possible i will be more forceful with my wishes and what i expect of them. they do after all work for me right? i pay for the insurance that pays them. if i had my own home and not a tiny apartment i would birth at home in water. I think hospitals take everything natural out of child birth. They turn it into a big medical show and try to squeeze every cent out of it. I am sure there are some doctors out there who actually listen to moms and respect their wishes. I think this is an awesome question and would love to here what OBs have to say about it.

    Tuesday, May 15, 2012 at 10:06 am | Permalink
  28. Edilberto wrote:

    about a year ago I took Staci’s maternity pohots.a0 I love when customers come back and I just get to see how much they have grown and changed.a0 I

    Thursday, December 3, 2015 at 2:00 am | Permalink

Post a Comment

Your email is never published nor shared. Required fields are marked *
*
*