Wednesday, April 28, 2010

The Whole Truth and Nothing but the Truth


Matt and I started watching Pregnant in America last night. I'm not a huge fan of the movie (I much prefer The Business of Being Born). However, I do agree with the concepts. I love analyzing the ways in which profit-making affects what becomes culturally acceptable in our society (obviously, this relates to weddings, too!).

As much as I'm leaning toward the birthing center or home birth option because I don't think it's necessary to pathologize or overly medicalize the birthing experience, I do want to get my hands on unbiased information that compares home birth to hospital birth. I know home birth advocates argue that it's safer, but I'm sure the other side argues the same thing about the hospital option. I don't want propaganda from either side; I just want legitimate, sound data!

Can any of you point me in the right direction?



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22 comments:

Katie/John said...

I do not have any data but I have experience. Both of my daughters were born in a regular ol' hospital. It was a wonderful experience both times. We live in a very rural area and it would have been unrealistic for me to go for any other option. You need to do what feels right for you but just remember as you are getting caught up in all the birthing hype that as important as it seems now in the long run the birth and weather or not you follwed your plan is so insignificant. What matters is that you have a happy, healthy baby and no one is going to remember how that baby got here. Enjoy the experience but don't get your heart set on a particular birth experience, things change and labor is unpredictable. Congratulations and enjoy your baby!!!!

Randa said...

I can't lead you towards information but I do have some insight on this debate because I study it all the time [I'm a human development major, just FYI].

The only difference bettwen a birthing center and a hospital is that hospitals have medicine. Period. End of story.

C-sections and stuff have been on the rise in the past few decades because doctors are afriad of malpractice cases - if they do a c-section, then it shows that they've done "all that they can" to save the baby. This goes for all the medical things that doctors do - inducing early, putting the mother on pain medicine, etc. They do have some good intentions towards the mother and baby - they are doctors after all - but a bulk of their practices are because they don't want to take the risk of getting sued.

Home birthing centers are a great option but remember that they are just as much about making money as hospitals. They'll offer you tons of options to "personalize" your birthing experience - in my opinion, the fact that a baby is going to becoming out of your vagina makes it "personal" enough.

The best bet is to go with a birthing center that is connected to a hospital. That way, if anything goes wrong, there are medical professionals who can administer medicine near by to help.

Hope this helps a little!

rebecca leigh said...

It seems to me that the individual caregiver(s) might even be more important than the setting. I've heard stories of pushy midwives as well as OBs. For example, inductions can happen in the hospital or at home, so if you don't want one, you need to find someone who will support you in that, but also let you know whatever risks are involved. So I'd start with finding someone who gets you and is willing to work with you and your partner and your needs.
From my perspective, the main benefit of birthing at home is that I'd be in comfortable surroundings and could move, vocalize, etc. however I needed to without feeling restricted, or like I was being disruptive to anyone else. Also, there's not so much time pressure. So many unnecessary cesareans are done because of "failure to progress," which could be a valid concern, but if I'd prefer to move through the labor on my own schedule and have limited exams (to prevent risk of infection).
So, sources... Here are some blogs I read: Gloria Lemay, Science & Sensibility, and The Unnecesaren.

(All this from someone who isn't even planning on getting pregnant for another five or six years! I bet some people with more experience than I have will share.)

Vee said...

Blogger That Wife (www.thatwifeblog.com) just had a home birth and birthed the most beautiful baby boy. She hasn't written her birth story yet, but in the months of her pregnancy did a LOT of hard research on the birth process/home birthing/etc., so you might look to her for some resources. Hope that helps =)

Jessica said...

I am several years away from pregnancy, but really enjoy reading Rixa Freeze's blog:
http://rixarixa.blogspot.com/
She presents information in a very rational way, presenting lots of data/research, as well as feel good birth stories and links!

Elisabeth said...

I think finding unbiased info on such an emotional topic will be tricky. However, I do have some experience, despite the fact that I haven't been pregnant yet!

Last year, both of my sisters-in-law gave birth. I visited them both at the hospital. The first was our local hospital. It was cold, there was one chair, the door was open constantly, and they whisked that baby in and out as if he belonged to the nurses, not the parents. They didn't even know where he was or what they were doing to him. I left telling my Husband I would never, ever undergo a hospital birth!
But then, my other SIL gave birth in a hospital 45 minutes away. It was warm and quiet. The nurses were very attentive, the room was spacious and inviting with plenty of seating. The tub was big enough for birthing. The baby was right by her momma constantly. And I realized that it wasn't a hospital I was against, just my local hospital. There is a birthing center close to me as well, and when the time comes, I want to check things out myself before I decide. (And to the above commenter, at least my local birthing center is not money-driven. It's run by Mennonites.)

meandthedoor said...

I'm not sure what the role of midwives is in the States, or what their training etc. is, but if it's similar to Canada that's who I'd get my information from. Here, they give you all the information and lay out all your options in a very straightforward, factual way and then help you make a decision based on what makes sense to you. Their job isn't to "sell" you a specific kind of birth, it's to educate & support you in your decision making processes.

From what previous commenters have said, it does seem like there are a few differences in options in the States. I think what I'm happiest about with being under the care of a midwife (in Canada) is that any decisions I make aren't permanent. Right now, we are planning on doing the majority of labouring at home, but moving to the hospital for the birth. However, if I'm comfortable at home and decide last minute that I don't want to get in the car I can change my mind.

Karuna said...

I found this book by Naomi Wolf to be very interesting. It is full of data though I am ALWAYS wary that there is "propaganda" as you say surrounding birth and the choices we make. It is so emotionally charged and everyone has a story simply due to the fact that they were once born. Anyway, Ms Wolf does (in my opinion) her due diligance with the facts and figures in this book while telling a beautiful, sharp and at times, heartbreaking story of women and birth in America and around the world. I am currently recomending it to all of my not yet pregnant buddies.

http://www.amazon.com/Misconceptions-Truth-Unexpected-Journey-Motherhood/dp/0385497458

Best of luck. And thank for the "premester" posts. I find a lot of resonence in my own life and efforts right now.

Anna

Elizabeth said...

I don't have any information, either - but I am so glad you posted this call for help! I think I've said this before - my mom has been an ob/gyn for 25 years, and is the most strident anti-homebirth person I know. She will 100% for sure stop speaking to me if I choose a homebirth, she feels they are that dangerous and irresponsible.

I certainly don't agree with her, but I do see her point that while, yes women have been giving birth since the beginning of time, 1 in 4 women used to die in childbirth, and that is certainly not the case anymore.

I'm excited to check out these resources you all have posted - thanks to Sara for getting these discussions going!!

Andrew and Cara said...

I recently came across this website and subsequent blog, which are very inspiring and non-judgemental in celebrating all birthing options, no matter what a parent chooses - http://bringbirthhome.com/

stef said...

The other thing to consider is that pregnancy and birth is so unpredictable. One of my good friends had her heart set on a drug free birthing centre birth however her baby was a footling breech so instead she felt the best course of action was an elective c-section after the OB her midwife referred her to couldn't turn the baby.

I guess before finding out where you give birth is to find a great carer who you trust. Here in New Zealand we get funding for our care. All midwives are free and they can refer you onto an OB if you run into troubles. You can also pay for your own OB if you don't want to go the midwife route.

C├ęcy said...

I'm going to say like Vee, check out those posts from thatwifeblog.com
Regarding ressources she read and enjoyed. She choose to have a home birth
http://thatwifeblog.com/2010/01/pregnancybirthlabor-self-education/

http://thatwifeblog.com/2009/11/pregtastic/

Allison said...

Hi Sara,

I was born in my parent's house and my mom was very happy with the experience. I will say, however, that on of her midwives had a dream a few nights before I was born that I wouldn't be breathing, so she brought in a tank of oxygen. It turned out I WAS born not breathing. It's scary to think that if it hadn't been for a midwife's premonition I might not be here.

It also makes me ridiculously emotionally attached to my parent's house. They're thinking of moving and I feel a little weary of losing my birth space.

Just my 2 cents :)

Laura said...

I have a pdf article from the Canadian Medical Journal entitled "Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician." Lots of stats in it. You can look for it, or just let me know if you want to see it and I can email it to ya.

Sara E. Cotner said...

You all are so helpful! The blog links are super-interesting.

@ Laura: I was able to find the the article you mentioned. Thanks! Here's an excerpt for everyone else: "The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician." Here's a link to the full article: http://www.bmj.com/cgi/content/full/330/7505/1416

rebecca leigh said...

@ stef--

Not that this can help your friend, but I've read that they just recently changed the official position on breech birth in Canada. Women are offered the chance to birth vaginally, as studies have found there isn't any more risk to it... but they're having to teach doctors who never learned how to deal with a vaginal breech birth. I read an interview with a doctor who was very supportive of the shift and impressed with the breech births he attended.
Now, I don't know what you mean by "footling." What is that?

V. Wetlaufer said...

I would check out this book:

Gentle Birth Choices: A Guide to Making Informed Decisions About Birth Centers, Birth Attendants, Water Birth, Home Birth, Hospital Births, By Barbara Harper

It might be slightly skewed toward home birth, but that also might just be my reading of it, because I would want to avoid the hospital at all costs, because I don't want any interventions unless absolutely necessary, so I read the information as a clear cut decision for me (not that I'm anywhere near ready to have a baby myself.)

Anyway, it's a great book, as is The Birth Book by bill & Martha Sears.

FM said...

Sara, you might also want to search for references to that article on the internet. I don't think I've ever read the article itself (although I will now!), but I've read posts on medical blogs that refer to it and the discussions in the comments are interesting to me, as a person who doesn't know enough about medical studies to analyze them. Those comments (and blog posts) get inflamatory, but still there is interesting info and criticism in them. Wish I could remember those links for you.

stef said...

@ Rebecca Footling breach = feet (or in this case foot) first which is the worst breech position to be in to attempt a vaginal birth. He was looking like a cossack dancer in there!

But interestingly homebirth is quite common in europe. But I think the key is to find a great carer. I'm all about midwives, but if you find a great doc then that's fabulous too.

Maya said...

I'm pregnant and planning on a birthing center. I don't want the restrictions or cost of a hospital birth and love the rich tradition of midwifery. I haven't found one that has it all but I've been balancing out the Mayo Clinic baby book and Ina May's Guide to Childbirth. I have to say, I have thoroughly enjoyed Ina May's guide.

Onnie said...

Personal opinion: I have to say, while there can certainly be pushy midwives as well as holistic, open-minded OBs, I'm definitely for contacting a Certified Nurse Midwife or Certified Lay Midwife if you want to know more about home births. They're the ones who perform them, so they have the best experiences of what goes on in homebirths for low-risk pregnancies. (Of course, I'm in nursing school right now with several wonderful women who are planning to go on to nurse midwifery, and I used to see a nurse-midwife for gynecological care & women's health when I was a teen, so I'm definitely prejudiced in that direction). Also, many nurse-midwives also perform low-risk hospital births in addition to or instead of home births or birth-center births, so that may be an option if you're interested in an approach rooted in the midwifery tradition of viewing birth as a normal process, not an illness (something many OBs, MDs, and DOs agree with too - but it's part of the history of midwifery, while medicine's still debating this idea).

Besides deciding on a provider (who of course will be your partner in prenatal care - first things first!), if you are considering delivering in a hospital, you should really check on their Baby-Friendly status. Baby Friendly hospitals encourage rooming-in (no nursery, only a NICU if your baby's sick) and do not give out pacifiers, artifical nipples or free formula samples, in order to give optimal support in establishing breastfeeding. The Baby-Friendly initiative IS evidence-based practice (not just my own opinion): it's based on protocols set by UNICEF and the WHO.

http://www.babyfriendlyusa.org/

galfromaway said...

I'm torn between the home birth vs birthing centre vs hospital birth. Mind you, we're not pregnant yet, and as far as I know there aren't birthing centres in the community where I live.

At my last job, there was a lot of discussion about midwifery and homebirths. The physician I was working with at the time worked in a rural setting and saw first-hand what happens when things go seriously wrong during a home birth and the midwife doesn't get the woman to the hospital ASAP. Because of that, he's not supportive of home births at all. There aren't a lot of midwives in the province I live, though, because the closest university offering midwifery is in Ontario, and certification of existing midwives is just starting.

I think as long as you're going into this with as much information as possible, and are prepared to make changes if the birth isn't happening in a safe, healthy way, whatever you decide will be best for you and your husband. Me, I'm hoping that when we get pregnant that I'll be able to make use of a midwife (hopefully they'll have space to fit me in, the busy folks that they are).

Hope that helps a little bit - I've been jumping back and forth between here and work, so I'm not sure how much sense I've been making. ;)

@Laura: Thanks for posting that article. I'm going to read the whole thing.

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