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OB Docs and Nurses Scoff at Homebirth

My community hospital’s views have never been in favor of any type of home-birth… whether it’s with a skilled professional  practitioner or a skilled lay midwife. There could have been some free unassisted births going on but we were not aware….  As I grew-up in this profession, I learned first from my experienced counterparts…then I began to educate myself and learned a lot from mothers and babies.  The doctors and nurses I worked with were all stagnant in their knowledge in my early years. They were satisfied with how things were.  I was young, I had an open-minded philosophy and an eager quest for knowledge.

In the later 70’s, just when we began to have mothers speak out and request a more natural childbirth, I had a few friends who enlisted the aid of some lay midwife in the region and arranged for homebirths. They all had a really nice birth experience without a single complication. Perhaps that was why I was open to the idea even though I was not personally involved. Besides some of the truly prepared couples who came in and had incredibly beautiful births….. that had been my first exposure as an alternative option to the knock’em out–pull’em out births I had been working with on the job. I knew my friends were very low-risk and had done their homework. 

   However, the hospital’s exposure to a homebirth in those days was only if the homebirth went awry for some reason or another and they came in our doors seeking help…  here’s what the docs and nurses would say to one another :

  • “Can you believe she planned to deliver at home???”
  • “How could she take take a chance like that with her baby?”
  • “The reason people started coming to hospitals to give birth was because mothers and babies were dieing at home….she must be crazy or totally insane!!”

   We’ve had planned homebirths come in for various reasons, as I am sure other facilities did…. (keep in mind that in my area, the usual birth attendant was a lay midwife). The situations bringing the mother to the hospital were often scary and upsetting for her. The most common were:

  • Fetal heart rate decels with or without meconium stained fluid 
  • Lack of progress with pushing mostly after many hours..
  • Higher than normal bloody show or bleeding–possibly abrupting
  • Breech, brow or face presentation
  • Retained placenta

Often the OB’s didn’t handle themselves well.. certainly not professionally. We had this one OB who would call for the OR to be opened before he even examined the patient or evaluated the situation…..regardless of why they came in.  And he often actually yelled at the mother, in the middle of her scary situation.

“Your baby will die if we don’t do an emergency C/S right now, why did you let this happen!”

Most often the backlash was directed at the midwife who cowered in the hallway- uninvited by the staff, left alone detached from her patient. She never left the unit though until she was afforded the opportunity to visit and speak to her patient. 

The two significant situations I remember which would fall in to statistical data for morbidity were:

  1.  An abruption which resulted in a crash C/S upon admission and a neonatal resuscitation with good response….(final apgars 3@one min then 7@ five min) positive overall outcome, no long term sequelae.
  2. A birth where the father (a chiropractor) was the birth attendant for his wife, a multip, encountered a shoulder dystocia and the baby ended up with a displaced fractured left humerus. That baby was in a crib with traction to realign the bone. The child went on to be an honor student at a local university after homeschool.

I feel that instead of the midwife or mother receiving hostility (or even the mother being wisked away to the OR without a trial of something if the baby was deemed stable..)~ the staff should have behaved in a compassionate professional manner, acting on any urgent situation with consideration that this mother is now experiencing not only labor but fear and grief over the loss of her beautiful planned birth.

Despite all the negativity from the staff, we never had a seriously bad outcome from attempted homebirths arriving on our doorstep.  We still have attitude problems, probably always will~ just as we do with breastfeeding.  I wish they could  look at it from my perspective. Those who choose homebirth today have better information to hopefully make an educated informed decision about their birth options and choose wisely. I really like Ricki Lake’s “The Business of being Born” among other’s. I hope those choosing homebirth are truly investigating all these options, deciding what is best for them and not making any decisions out of “anger at the system” or any sort of revolutionary zeal.  

  There is so much out there for medical professionals to be aware of other than what goes on in their tiny little realm, their little part of the world. My co-workers and doctors need to be better informed.  

Any one bad outcome (which most certainly happens in the hospital)  does not mean that every homebirth is a bad idea.

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21 Comments Post a comment
  1. Great post! Things sadly have not changed much. There are reports from many home birth transfers that they were treated with condescension and scorn upon arrival, and in some cases, actually “punished” by having some procedure done on them with extreme malice (one story comes to mind of a UC transfer in which the OB applied traction to the placenta despite mother’s pleas to stop, with no bleeding or indication for emergency, and caused a complete uterine inversion, requiring surgical intervention.)

    I also am very concerned about OB motivations with shadow care. I know of many home birthers, planned with a midwife or UC, who use OBs for prenatals and back-up care, where the OB will find any lame excuse to get them into the hospital for some imagined obstetric “emergency.”

    I wish the atmosphere between HCPs were not so antagonistic. Midwives and OBs have completely different spheres of influence – one’s job need not threaten the other’s. If they would realize this, work in tandem to provide optimal care for every woman, and recognize each other’s strengths, I believe we would be in position The Netherlands is in – on top of the world for positive pregnancy outcomes.

    May 28, 2009
    • Birth_Lactation #

      Thanks Emily. Very good points and I too wish the relationships were better. The experience I’ve had with the shadows in my community..at least in that era between late 70’s to late 80’s– was different, The shadow was NOT one of our docs but worked at a hosp about an hour from here. He’s an awesome human being who did everything to preserve the mother’s wishes for a safe home birth. (He is retired, no longer practicing.) At the time these pts came in, it was sometimes at his suggestion and sometimes because he was somewhere else at a homebirth. My doc’s where miserable to these women. So very sad.

      I’d like the Netherlands 🙂

      May 29, 2009
  2. I had a bad experience with doctors against homebirth as well when I had my baby back in October last year. I was laboring at home as long as possible and my contractions were coming irregularly, and before I knew it I accidentally gave birth at home (luckily I had a great doula who arrived a few minutes before our baby who helped us figure out what to do!). We called the paramedics right before my daughter was born since we didn’t know if there would be any problems (everything was totally fine thankfully), but the paramedics were unfortunately pretty clueless about birth. One of them was actually trying to pull the placenta out of me with the umbilical cord, and thank God the doula made him stop. They would only take us to the hospital closest to our house and the doctors there treated me like a criminal. They kept lecturing me about how I shouldn’t have given birth at home, it’s unsafe, the baby ws big (just under 9 pounds) so there could have been horrible complications, etc. And I hadn’t even had the home birth on purpose! The thing that upset me the most happened when they were stitching me up from some minor tearing. I told them I didn’t want any drugs (I had the baby without them after all!), but the next thing I know I looked down and a nurse was putting stadol in my IV line after I had just explicitly told her no. Of course then I was totally out of it for about 6 hours and couldn’t nurse or anything. Not that it mattered too much anyway since they would not allow my baby to leave the nursery for 24 hours because they considered her birth to have been unhealthy. It was ridiculous, and I really feel like it did put a damper on our initial bonding and nursing. Luckily I did resolve those issues over time, but it was still not a good experience. I had been planning on having my baby in a birthing center where we could have gone home 18 hours later, but instead I ended up in this hospital getting lectured for 2 days. I think if I have another baby, next time I’ll just plan for a home birth because the birth experience itself was great and very uncomplicated.

    May 29, 2009
    • Birth_Lactation #

      Erin! I don’t know how I missed this story! So Sorry! It is a travesty and quite appalling that you were medicated against your will! Unbelievable— and then how awful that the effects of the drug lasted so long for you. It is as if you were being punished. We, unfortunately, also USED to have a policy that if a baby was born on the “outside”…they would need to be kept “isolated” but we at least “allowed” the mother and baby to be together! Thanks for sharing, I am so sorry this happened to you. To the staff at that hospital..Shame on you! I hope you do good research if you have another baby and pick the best option for you at the time.

      June 3, 2009
  3. I know that there is this attitude, but I feel that it is also changing…slowly. My family doctor, who attended the first 2/3 of my recent pregnancy, home-birthed her 2 children. She was very supportive of unmedicated childbirth, breastfeeding, etc. However, we had a conflict in that I did not want continuous EFM for my VBAC labour, but the hospital policy required it. We see-sawed back & forth on it until it got to the point where I felt it was destroying our relationship and stressing me out too much. So I switched to m/w for the last 1/3 of my pg & ended up with a happy homebirth.

    When I saw my doctor for my son’s first appointment outside of m/w care, she was very warm and happy that things had worked out the way they did. While I was disappointed that I hadn’t had the support I wanted from her, I can empathize to a certain extent in that the overarching policies & most of the hospital environment runs contrary to it.

    I wonder how many of the younger generation of doctors and nurses feel trapped within these policies?

    May 29, 2009
    • Birth_Lactation #

      Hi Gayle– I would bet that most new practitioners and older ones do because of the fact that most facilities where they practice must follow a framework recommended by ACOG and other recognized experts. We do live in a medico-legal society. People have lawyers and use them..believe me. Many hospitals have the policy of continous EFM for a VBAC. We do for VBAC’s and for Pitocin administration.
      That doesn’t mean that they do EVERYTHING as recommended by those experts. Unfortunately, many of their practices like the inductions, C/S for example seem to be for practitioner’s CPD… (Choice or Personal Decision). This is why I support a women’s right to her own educated informed decsion of childbirth choice…one that is right for her…recognizing any limitations of her choice. If she chooses to deliver in a hospital…please know what the policies are etc… I am so glad the decision you chose for yourself worked out for you. I love that!! I hope your relationship with your family doctor remains intact because she sounds like a good resource. Thanks

      June 2, 2009
  4. Love your blog! I’m coming back to read more later.

    June 2, 2009
    • Birth_Lactation #

      WELCOME!! Please do come back and let me know when you do…. Thanks!

      June 2, 2009
  5. This is great Melissa! Are homebirth midwives in PA licensed to do hospital deliveries too or is it an either or thing? Just wondering the difference between ours here (priviledges in hospitals and licensed to do home birth too, all services covered by provincial medical care).
    @Erin – how horrible that you were given drugs after explicitly requesting them not to!
    @Melissa – how often do hospitals get sued for that kind of thing?

    June 3, 2009
    • Birth_Lactation #

      Hi Mel~ You ask a very good question! Laws governing the practice of midwifery vary from state to state. It is important that every midwife or midwifery practice be familiar with the state laws and regulations as well as their own hospital policy. That is what can determine whether an individual practitioner (CNM and CPM) can practice independently. JCAHO’s definition of a Licensed Independent Practioner ) was revised in 2004 as “any individual who is permitted by law and by the organization to provide care, treatment, and services, without direction and supervision.” (JCAHO, 2004) So IF I am correct …(and someone please feel free to let me know if I’m not)~ any Midwife who can be an LIP could have a practice for homebirths…whether or not they are required by PA law to have an MD back up..I couldn’t find that info… If that same practioner also has hospital privledges as above, I think there may be language with-in their by-laws as to whether they can have their own practice for home births and work in the hospital. Each state will be different from what i can find. There may still be some direct entry midwifes who may practice outside the hospital and their services may not be covered under insurance. There is a lot of info out there on ACNM and PA state legislation. I was having some trouble finding that specific peice of info. As far as how often does a hospital get sued for administering drugs like that against the express wishes of the patient! I hope everytime!! No I don’t know for sure. In this day and age, people are quick to sue if they have a feeling of poor outcome for anything…valid or not. We have very strict patient rights now and all those I work with are at least good about that.. If patient refuses a med…. it is documented as such and and the doctor is informed.. So WHY CAN’T I GET THESE SAME NURSES to UNDERSTAND it is the SAME for FORMULA and BREASTFEEDING….if mom refuses formula???? That’s another day…

      June 3, 2009
      • I want to come back to this blog when I am on my computer and not my phone to shed some light from my 35 years of professional RN and home birth midwife experience, as well as my position of having researched for years to write Gentle Birth Choices book and video.
        My current research on Waterbirth and the emotional intelligence of newborns continues to take me into hospitals and deal with hospitals on a daily basis. I love educatiing medical professionals and seeing the veritable light bulbs go off so that there is an understanding of the divine plan for human reproduction and procreation. By focusing on what goes on for the baby physically, neurologically, emotionally and spiritually a totally different picture of birth emerges. One which enables the provider and parent alike to see the importance of not disturbing the birth unless absolutely necessary. My educational work and research on birth has taken me to 44 countries thus far and I have a LOT to say about our North American maternity care system both here and in Canada and Mexico.
        That’s for later-index finger giving out!!
        Barbara Harper, RN
        Founder/Director Waterbirth International
        Author Gentle Birth Choices, The Complete Guide to Waterbirth
        & out next year Embracing the Miracle: How Pregnancy, Birth and the First Hour Influence Human Potential

        March 1, 2010
  6. thefeministshopper #

    Thanks for this post. I desperately want to avoid the “system” I was put through the last two times, and I feel like homebirth is the way to do that, but it’s certainly feels like I have no choice in the matter. I’d definitely much *rather* have a birth right down the hall from a team of people who could intervene if something went horribly wrong, but the problem is, they’re never “down the hall.” Instead, they’re all up in your grill from the second you walk in the door trying to make you miserable (or whatever *they* call it, all I know is I was miserable.)

    And since almost 0 midwives in the northern part of Il will attend VBACS (even secondary, which my next one will be) I have almost no choice but to deliver at home unassisted. That is NOT my ideal situation, but I really do feel like my hands are tied.

    I feel like vomiting every time I see gynecological equipment, so I just don’t think I could ever willingly go back into a hospital environment again – for any reason.

    June 11, 2009
  7. I’m surprised by this! I’m originally from New York, and homebirths are not a big deal. While most people I know took the traditional hospital route, I’ve known some who’ve had their babies at home. Of course, midwives and doulas are plentiful in New York City.

    Home birth was never an option for me because I have a blood clotting disorder and labor of itself is dangerous for me.

    June 16, 2009
    • Birth_Lactation #

      I wish home birth wasn’t such a big deal here too… well, this is a perspective from over the years… mostly years ago. We haven’t had many lately. We have only a few doulas in the area. I wish there were more. We had a homebirth transfer this week which was so beautiful and most all involved were very good professionally. A few nurses and one doc were judgemental and had trouble relinquishing control… but most of all…. the mother felt her experience was positive! This is the most important after all.. 😉 Thanks for reading!

      June 16, 2009
  8. Heather #

    Here’s a reasonably quick and easy suggestion…maybe. Have a few of the current edition of The Womanly Art of Breastfeeding available for reference. If you can, get it made required reading, but at least encourage using it as reference. The La Leche League at least mostly knows what they’re doing. There is also a document available on the web called 101 Reasons to Breastfeed Your Baby. I have used this to impress pregnant girls who otherwise would have little access to pro-breastfeeding info.
    Also, I am starting to see an online movement to emphasize that breastfeeding is the NORMAL thing for human mamas to do, & formula feeding is both abnormal and inferior. Can you make changes in procedures/paperwork from that angle that will help?

    I’m not any sort of a health professional…just a breastfeeding mama who has been active in her state’s (successful!) movement to legalize CPM’s. My one hospital birth experience was definitely pro-breastfeeding, thankfully, although the pediatrician I saw after, well, let’s say I switched pediatricians rather quickly, and my next baby was born at home–and is still breastfeeding at 20 months)

    June 21, 2010
  9. katrn #

    I wish with all my heart that I could view a homebirth as a good thing. As a natural process, laboring, bonding, listening to what my body told me to do during birth. As a NICU nurse, my vision of the whole process is skewed by the many births I have attended in a hospital that were troublesome. I was so nervous during my pregnancy with my first child that something would go wrong, my body never even went into labor-I was 42 wks when I was induced. What an awful, horrible experience it was. I wish I had supportive people around me to assure me everything was going to be OK.

    January 3, 2012
    • StorkStories #

      I do understand how you think. I also attend many crazy births and we are often called STAT for unforeseen issues. I am also leary of all the what can go wrong scenarios. I don’t know about where you work,but my place has multiple birth interventions already in place when I get to a room. As I look around, I see a mom on her back, Others holding her legs in unnatural positioning, IV fluids, often IV Pitocin, sometimes MgSO4, Epidural anesthesia. fetal monitor straps, vacuum ready and people telling a mom to push with all her might when she can’t feel an urge or feel how to push. I think having witnessed the beauty of natural birth in my years of life in L and D… I can see that all so clearly. I know home birth isn’t for everyone and some mothers with certain health concerns truly need certain interventions. I feel the most important thing is that a mother pregnant or considering pregnancy become educated and understand what birth options are available to her. Empowered to make informed decisions. Thanks for reading!!!

      January 3, 2012

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