Posted by My OB said WHAT?!?.
Jun
25
Posted by My OB said WHAT?!?.
“I Get Nervous When People Have Home Births…”
“I get nervous when people have home births because so many babies in the hospital have to be resuscitated.” -Pediatrician to mother at her son’s two week newborn check up.
There are 63 comments to this post.
Once again, prevailing doctor-wisdom:
Problems in the hospital happen DESPITE being in the hospital.
Problems at home happen BECAUSE you were at home.
BTW, a trained midwife carries all the equipment needed to resuscitate a baby. They’re doing more than carrying twinkle lights.
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Sarah Dorrance-Minch Reply:
June 25th, 2010 at 6:20 am (Quote)
Ooh! Ooh! I got it! The twinkle lights are for tying the umbilical cord after it’s stopped pulsing with blood, just before somebody cuts it! Pretty, soothing, and provides direct lighting!
Wait, no, that can’t be right.
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Kasondra Reply:
June 25th, 2010 at 6:36 am (Quote)
So, my midwife is going to show up with more than crystals and ripped up sheets? Wow…learn something new every day… *rolls eyes*
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Jane Reply:
June 25th, 2010 at 6:37 am (Quote)
Yeah! She’ll have incense and a celtic harp, too!
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Aron Reply:
June 25th, 2010 at 7:09 am (Quote)
and a knife to tuck under the mattress, you know, to cut the pain. She’ll also open every window, door and cupboard so your body will open for the baby, and she’ll untie every shoelace so the cord won’t have a knot in it.
Oh wait, I forgot: this isn’t the middle ages, it’s the 21st century.
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StaudtCJ Reply:
June 25th, 2010 at 9:56 am (Quote)
Hee old midwives tales! I always figured that the knife under the mattress was to cut the pain… the pain in the *ahem* “neck” OB, the pain in the neck Father To Be, the pain in the neck Person-who-won’t-leave-me-alone…
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Sarah Dorrance-Minch Reply:
June 25th, 2010 at 12:04 pm (Quote)
I like the one about keeping a cat in the birthing room, because cats are “easy birthers” as evidenced by the fact that they purr when they queen.
Whoever came up with this particular superstition probably didn’t know that cats frequently purr when they are in pain.
OTOH, even if they are in pain, they do seem to have an easier time of it than humans do. For me they’re kind of a birthing role model. I must be part cat – I also like to be alone in a cool, dark, boxed-in place when I’m in labour, going by the last labour I had, anyway. Okay, so I also yowl instead of purr, but so what?
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VW Reply:
June 25th, 2010 at 3:44 pm (Quote)
My MW told me a story about one of her clients whose cat was always inseparable from her when she was in labor…when she was having her 4th baby, she had some prodromal labor, and finally the MW figured out that the best way to figure out whether it was the real thing was to watch the cat…sure enough, the one time the cat stuck by her owner, she was actually in labor 
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Kit Reply:
June 26th, 2010 at 6:57 pm (Quote)
Geeze, now I feel stupid. (well, I knew it was stupid before, but this is the first time I realized OTHER people think its stupid)
Our family does untie knots during labors… I never thought it was such an outdated superstition.
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Aron Reply:
June 28th, 2010 at 6:38 am (Quote)
Truly? Well, it was honestly never my intention to offend – I’ve never heard of anyone carrying on those rituals in the modern world. What I was actually alluding to was the fact that many, many uninformed people genuinely believe that a midwife is not much different from a witch doctor, that she would stand over a bleeding woman or non-responsive baby muttering incantations and waving burning sage rather than bagging/masking babe with O2 and giving mom a shot of methargine before calling 911, as needed. It was a commentary on the general ignorance of what midwives actually DO, not a dig at people who like superstitions.
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” And WHY do you think babies born in the hospital need to be resuscitated, Doc? Could it be all the medication pumped into the moms system? Hmm, Women having homebirths don’t get drugs pushed on them. maybe that’s why so many fewer homebirht babioes NEED resuscitation.Something to think about,eh?”
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Sherry Reply:
June 25th, 2010 at 4:59 am (Quote)
Gee- pardon my typos. This one royally pissed me off. I guess critical thinking skills aren’t needed in medical school when the subject is ob/gyn or newborn pediatrics.
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anon Reply:
June 25th, 2010 at 5:23 am (Quote)
because they are either dead or braindamaged, not resuscitated. Babies at home, along with mothers, either die or do well…there isn’t an inbetween
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Tara Reply:
June 25th, 2010 at 8:58 am (Quote)
Dr. Amy, is that you?
I think anon here forgot to read the posts preceding hers. Homebirth midwives are trained in neonatal rescuscitation. So in the few cases its needed (far less frequenty than in the hospital) it’s available at home.
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Kat Reply:
June 25th, 2010 at 9:37 am (Quote)
It seems inevitable that when a blog starts finding a wider audience, they also pick up a “troll” or two along the way. We have discovered ours. I think this is the third or fourth incident involving this same cowardly “anon” ID.
Midwives who attend homebirths receive training in neonatal resuscitation. They carry an oxygen tank to use for this purpose. Many also carry certain medications to use if the mother seems to be bleeding more than normal.
What you have presented here is a logical fallacy known as a false dichotomy.
The statement that babies who are born at home are “not resuscitated” is patently false. The two alternatives presented “They either die or do well” are NOT the only two possible outcomes, your statement is not evidence based, and is designed to provoke an emotional response. By responding with logic and rational thought, I hope to encourage others who read this blog to also use logic and common sense when encountering the phenomenon commonly referred to as “internet troll.”
I realize the most likely response of the troll will be either to ignore this, or continue to post statements devoid of logic or reason, but hopefully we can continue to present information calmly and rationally, which will minimize the disruption caused by this attempt to troll the site.
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K Reply:
June 25th, 2010 at 10:28 am (Quote)
Perhaps you should see the article in the BMJ, 2004, demonstrating comparable safety, but decreased interventions in a comparison of low-risk pregnancies with either planned home (CPM attended) or hospital birth in the U.S.
The safety to mom and baby was the SAME.
The differences: hospitals had higher c-section rates, episiotomy rates, and infection rates.
Check the evidence.
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FRS Reply:
June 26th, 2010 at 9:06 pm (Quote)
That’s not really true. My baby was born at home and needed some extra help breathing on his own from the midwife. She did some chest compressions and gave him some oxygen and then he was able to take a deep breath and was fine. My baby was an in between and my midwife handled it calmly and professionally. I would expect nothing less of her.
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So, I initially read this as “I get nervous when people HAVE BIRTHS.” Sadly, it didn’t really susrprise me that someone would say THAT. LOL
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JulietsButterfly Reply:
June 25th, 2010 at 6:26 am (Quote)
Yeah, that’s how I read it too. I thought “Yeah, birth can be nerve wracking for some people.” So far, I haven’t seen any difference between my hospital born “just to be safe” kids and my friends’ home birth kids. It’s like home birth is actually safe!! Low risk moms have no need to be in the hospital unless they really feel like they want to be there.
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Sarah Dorrance-Minch had this to say,
Jun 25, 2010 @ 6:18 am (Quote)
Let’s play Spot The Syntax Error. Glaring grammatical ambiguity reveals the obvious:
Hospital = resuscitation (what routine procedures could possibly lead to low Apgars and overall need for extra help for the newborn? Let’s see: aggressive use of pitocin causing foetal distress; suspected “macrosomia” leads to early induction or prophylactic c-section, but baby is not only not a massive fifteen pound blimp, it’s only thirty six weeks old and not ready to come out yet; malpositioning of the mother in the cockroach position caused loss of oxygen to the baby due to compression of the vena cava, and she pushed for three hours because it was hard to push a baby in this position; cord cut early wound up haemorrhaging; I’m sure we can brainstorm other possibilities)
Home = pediatrician hasn’t seen any homebirthed babies, at least none that have reassured him, so hard to say what he’s afraid of, aside from nebulous complications of birth that take place in the hospital and presumably will almost certainly take place at home. Because every home is equipped with a pit drip, operating theatre, nurses who coach the mother in Valsalva-style pushing technique, and people who think life and health depend on the mother staying on her back and pushing in the cockroach position.
Riiiiiiiiight.
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Jane Reply:
June 25th, 2010 at 6:36 am (Quote)
But you do raise an interesting point: 100% of the homebirthed babies that end up in the hospital are there either because the mother or the baby had a problem with the birth. The vast majority of homebirthed babies where mom and baby did just fine are not represented in the sample the pediatrician sees.
ALSO, the pediatrician is not rousted out of bed at two o’clock in the morning by a phone call from the hospital saying that a baby was born and is totally fine. The on-call pediatrician would only be called because a baby needed help and needed it NOW. Over time, that probably creates the illusion that the vast majority of babies need some sort of help immediately after the birth.
That’s got to change your perception of normal birth, when all you see is abnormal outcomes.
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Jane Reply:
June 25th, 2010 at 6:39 am (Quote)
Amending the above: the pediatricians do come in and do normal rounds in the mornings on the healthy babies, but the ones that are going to stand out for them are the emergencies because of the hormonal stress-responses that burn emergency situations into our memories. Doctors in general (according to Jerome Groopman’s book How Doctors Think) remember bad outcomes much more strongly than they remember good outcomes.
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The Deranged Housewife Reply:
June 25th, 2010 at 7:11 am (Quote)
I used this analogy with my OB when he (actually both) were trying to sway me from attempting a VBAC. I asked him how many of those ruptures were because of a Pitocin-induced labor and he said he “couldn’t remember,” which I think is absolute BS. Of course you’ll remember something like that.
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Jane Reply:
June 25th, 2010 at 7:44 am (Quote)
They can’t remember most likely because they don’t keep track of things like that. Since they don’t think of it as a factor (since VBAC is inherently life-threatening to begin with in their minds) they don’t make note of it, the same way they don’t make note of whether mothers whose names begin with J are more likely to experience a uterine rupture or mothers who choose to have a pedicure are more likely to experience a uterine rupture.
In their minds, Pitocin = safe = totally necessary, and therefore it CANNOT be dangerous because some doctors don’t know any longer how to manage a birth without it.
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CCindy Reply:
June 25th, 2010 at 6:59 pm (Quote)
And yet Pitocin was not recommended 15 years ago when the only doctors willing to try VBAC were the ones who used evidence based medicine. Now it is a marketing ploy followed att the last minute by a bait-and -switch routine. If you want to know if a doctor is really qualified to “oversee” a VBAC ask if what he/she would do if you went past your due date. If he/she says induce you have your answer. Even though they have apparently lighten up on the use of Pitocin for augmentation. I think there is still pretty clear evidence the induction is a no-no.
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Sheva had this to say,
Jun 25, 2010 @ 6:18 am (Quote)
Sooooo, you get nervous. And your point is….?
Take a pill, honey.
My ped wouldn’t sign a paper that my midwife has peds sign, saying that they’re going to be the baby’s PCP (another term I hate – I’M the baby’s primary care provider, thank you!). He said, “If I don’t sign it, will you still have a home birth?” He was hoping that if he didn’t sign I wouldn’t be allowed to birth at home. I told him if he didn’t, I’d find someone who would! He did some research and thought about it, and signed it a week or two later. Guess if I switched practices.
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I know this is a silly comment for a ped to make, but to me it sounds like s/he was trying to open up a conversation about home birth because s/he had little knowledge about it and s/he was talking to someone who just did it! We often start conversations by bringing up our own fears or misconceptions so that they can be refuted. Not the best way to frame it I know but at least it was the doctor’s own fears not a dismissive comment meant only to insult or demean the Mom.
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Jane Reply:
June 25th, 2010 at 6:40 am (Quote)
I like that interpretation. Many doctors (maybe even most doctors) do want to learn, and home birthers are something of a cypher to many of them primarily because we’re operating to some extent outside the hospital system.
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Cmat Reply:
June 25th, 2010 at 7:57 am (Quote)
I think that might have been a way to look at it. Ignorance breeds fear, the only way to get rid of that fear is through education and what better way to do it than to talk to someone who’s been there!
I hope it was that and not the pedi trying to scare mom out of subsequent home births.
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cheeks023 Reply:
June 25th, 2010 at 1:06 pm (Quote)
I guess I am just a pessimist! I see this as an absolutely passive/aggressive statement. The baby is 2 weeks old, is obviously in great health, with no need for resuscitation. This is his way of chastising her for her decision without coming right out and telling her she was bad.
Even if the doctor was trying to start up a conversation to increase his own knowledge, he would not have had to bring up resuscitation. In fact, likely as not all we would have had to say was “Homebirth? Really? tell me about it.” That probably would have opened the flood gates sufficiently.
I have a hard time buying that this was just fear-based curiosity. But it would be nice!!
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Heather Reply:
June 25th, 2010 at 3:26 pm (Quote)
I was involved in Missouri’s effort (successful, 2 years ago yesterday!) to legalize midwives. There are plenty of OB’s who are total @sses, & you would not BELIEVE the things those human beings will say in front of a legislative committee–some of it was so bad that the senators on the committee, who were NOT on our side, told the doctors that they should produce some documentation for their claims or shut up.
But there are also OB’s who haven’t really researched the matter & simply don’t have knowledge of just how midwives are equipped or what goes into a midwife’s training. This is a systemic fault, and it MUST be changed if we are going to have a first-class maternity care system in this country.
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Cynthia Reply:
July 2nd, 2010 at 8:29 am (Quote)
That’s exactly how it came across to me. However, I wasn’t mad about that, I probably come across the same way when I’m trying to be polite with people I totally disagree with. It was the lack of acknowledgement that the interventions at hospital births, particularly the drugs, contribute substantially. (Now that I’ve been reading this site, things like that don’t surprise me as much). I was already on edge, because I had been planning to switch to a family doctor anyway, didn’t even plan to let her know that I had another child. Then the health department called and said they needed to rescreen my son right away and said my midwife couldn’t do it. (He’s fine, btw. And my midwife was miffed, because she said they always called her with other clients when there was a problem)
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Heather Reply:
June 25th, 2010 at 3:20 pm (Quote)
Yeah, honestly, this dr. sounds like potentially one of the “good guys”. He needs education–maybe an invitation to come and sit on his hands and see a homebirth. And he needs to know that midwives DO carry the needful to resuscitate a newborn.
ALL Ob’s should be required to observe at least 1 homebirth. Then, there would be no problem!
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I get nervous every time I head to the hospital with a doula client. Despite having my own low intervention and drug free hospital birth I have seen far too many clients manipulated into unnecessary medical interventions.
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Jen Reply:
June 26th, 2010 at 5:23 pm (Quote)
This was almost exactly what I was thinking. I get knots in my stomach anytime I head to a birth at a location I’ve seen bad things happen at before. Would I go so far as to tell someone that is most comfortable with a hospital birth that I don’t think it’s safe because of those experiences? Never.
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Could that possibly be because birth attendants in the hospital are the ones causing the resuscitations? That the variable to prevent so many instances is actually being in the hospital? Someone needs to tell that ped that there is a lesser need for dramatic rescues at home.
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I am SO THANKFUL for my local ped practice.
The main doctor has 4-5 children. At least one was born at home, I don’t recall exactly. My 4th child was born at home, not only did none of the office staff bat an eyelash, they brought me a notarized piece of paper I didn’t know I would need to get his birth certificate, without me having to ask for it.
When my youngest was born at the hospital, and we came in for her to have a checkup, the nurses asked if she was born at home, not in a “You aren’t one of THOSE crazy people are you?” tone, more in the same tone one would ask “So how much did she weigh? Does she look more like her brother or her sister?”
They also let parents make their own decisions about vaccinations, but that’s another hot-button issue entirely.
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Cmat Reply:
June 25th, 2010 at 1:47 pm (Quote)
Oh man, jealous!
I think my son’s old pediatrician that we left behind when we moved would have been like that. He was just very casual, low key, generally happy. He never got hyper about anything and respected the parent’s decisions while trying to help us understand both sides. I don’t think I’ll ever find one of those again!
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Cedar had this to say,
Jun 25, 2010 @ 8:35 am (Quote)
I had a pediatrician say almost this exact same thing to me when I was pregnant and interviewing possible pediatricians, and I asked him his opinion of home birth. This same guy also said he didn’t think water birth was safe because “the baby might swallow some meconium.” I was like, “Um, I don’t think the baby is supposed to breathe or swallow till he touches air–never mind.” He didn’t make the cut.
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I expected to need to find a new pediatrican when I announced my intentions to have my third baby at home, but I was pleasantly suprised. Although I don’t think it’s something she would choose for herself, she was fine with my decision. She was unfamiliar with midwives and asked me about our midwife’s qualifications, but once I explained it all to her, she was pretty relaxed about it. I think I’m one of her “weirder” parents, but we get along fine. ;0)
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My baby needed resuscitation at birth. Thank GOODNESS we were at home! His cord stayed attached and pulsing while he worked on the whole transition to breathing thing And he never left my side. And you should have seen him a half hour or so later! Perfectly pink and alert, bright eyed, nursing like a champ, didn’t want to let go of that boob for anything! I’m so happy he was born at home.
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alyssa Reply:
July 10th, 2010 at 10:14 pm (Quote)
thats awesome rachel! i had a mild hemmorage at home and i was having a shower at the time with my midwife sitting on the bath chatting to me. she noticed a fair bit of bleeding and asked me to step out, really casual she was lol! so i stepped out and promptly fainted! she was sooo calm, gave me an injection, my husband and sister were the only ones who knew what was happening and were coming in and out with towels and other things my midwife needed. i was in there for about an hour, there were about 20 ppl in the house, and none knew anything was wrong. when i was ok, i came out and they had taken out the pool, cleaned my room and gotten my bed ready for me to just relax with my bub, he meanwhile, had had a lovely time getting to know his extended family while alert and bright eyed!
The cord thing is my biggest bugbear. the blood in the cord is supposed to be in the baby! not clamped and cut and thrown out or given to the cord blood bank, its part of my babys circulatory system!!!
Home birth is the best!!!
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LeedleFishy had this to say,
Jun 25, 2010 @ 2:00 pm (Quote)
I misread it at first, thinking it said “I get nervous when people have birth plans.” In response I was thinking something along the lines of “I get nervous without a birth plan, or at least feeling confident that you’ll acknowledge my desires.”
…now that I’m reading it correctly! I like what Lori said about the possibility that the doctor actually wanted to learn more about home birth. I also like hearing that some of you ladies have totally pro-home birth doctors!
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Michelle Potter had this to say,
Jun 27, 2010 @ 4:04 pm (Quote)
I get nervous when people have hospital births because so many babies in the hospital have to be resuscitated.
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CCindy Reply:
June 28th, 2010 at 4:42 am (Quote)
THIS
Except is resuscitate the right word. suctioned, given oxygen, send to NICU, but truly resuscitated??? Not breathing, no heart beat, brought back from the dead resuscitated. I have to check the dictionary for an exact definition. Okay also applies to consciousness. But still a big term for something every midwife is prepared to handle.
I think this Ped is a nervous superstitious doctor rather than an evidence based man (or woman) of medical science. Most of them are.
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Jane Reply:
June 28th, 2010 at 6:24 am (Quote)
When my baby’s oxygen saturation levels dropped to about 65% due to a suck-swallow dyscoordination, they went to work on her and a minute later when she’d started breathing again, the nurse said to me, “She resuscitates real well.”
So apparently that term can be used for more than just bringing someone back from the dead, since the baby still had a heartbeat the whole time. She just wasn’t breathing.
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Lindsey Carr-Ruck had this to say,
Jun 27, 2010 @ 5:04 pm (Quote)
Babies born at home don’t have their lifeline (cord) clamped immediately after they come out, thereby cutting off the oxygen coming from mom. As long as the baby is being profused by the mom and has a good heart rate, everything is cool. The hospital resus happens even more when there’s a cord wrap because docs don’t know how to deliver somersault, so they clamp/cut on the perineum. Stupid.
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Sounds to me like yet another doc who has no idea what goes on at a homebirth, what equipment and training a midwife (or educated unassisted birthing mother and her partner) has, or what causes babies to need resuscitation in the first place!
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I have a friend who is an OB nurse, used to be an L&D nurse. When I told her the birthing center I was going to use, she said they see a lot of babies rushed to ER after being born there. Do you think that is what they meant?
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Jane Reply:
July 6th, 2010 at 8:47 am (Quote)
Ask her how often they see a baby rushed to the ER.
Ask the birth center approximately how many babies are born there per month. Compare your friend’s answer to the birth center’s.
Ask your friend how many babies born in the hospital need serious medical attention, and ask what percentage that is of the whole.
Ask the birth center what their newborn transfer rate is.
Most likely you’re dealing with an observer bias. She remembers the bad outcomes from the birth center but doesn’t see the bad outcomes that take place in L&D because those babies are whisked down the hallway to the NICU right away.
Remember that their basic assumption is that problems happen BECAUSE the mother wasn’t in the hospital. And problems that happen within the hospital happen DESPITE being in the hospital.
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Gem Reply:
July 6th, 2010 at 9:09 am (Quote)
Oh, I know it is probably observer bias. The pregnancy I was going to go with the birthing center/midwives on actually ended up with a miscarriage, and against my arguing it wouldn’t have made a difference, my dh was really nervous about a BC birth so I went with an OB. I went to the OB this nurse worked for, but she is a personal friend, so she was my doula. As medically-minded as she may have been as an OB nurse and a former L&D nurse, she was an awesome doula and fought for ALL of my birth plan requests (even after telling me that most birthplans come from first-time moms who don’t know any better and they just laugh over them). She even came to my house to check how dilated I was when I was at 2 minute contx but not a lot of pain. She probably could have just delivered the baby right there on my bed, as I was at a 9!!!
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alyssa Reply:
July 10th, 2010 at 10:24 pm (Quote)
you know this really annoys me when you say theat most birthplans come from first time moms who dont know any better so they just laugh over them… im sorry, its almost like you have to have a crap first birth so you gain some cred, figure out what you want, even tho its quite often similar to what you wanted in the first place, in order to get what you want for the second birth. its soooo wrong!!! just because you are a first time mum it doesnt mean you know nothing and your wishes arent worth trying for. if you have a horrible first birth, you are forever dealing with those issues for all your other births and completely opens you up for pnd. i hate hate hate the hospital/medical system, with their holier than thou attitude, treating us mums like scum who know nothing. meh!
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alyssa Reply:
July 10th, 2010 at 10:28 pm (Quote)
i wasnt saying that you were saying that gem, just quoting what you said in your post.
Its also really wrong that we feel the need to “fight” for our birthplans. its our body, our birth, our baby, we’ve just spent 9 months growing this precious baby, obviously we want whats best for the baby but that doesnt mean throwing away everything thats important to us, even if it ends in a c section, there are ways to make it still a birth and still special, but a lot of the time, these so called professionals forget this is special for us and treat it like another number thats just gotta get done. they’ve lost their wonder for it and completely de humanise it. ok im done ranting!
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So let the moms with no complications have their babies at home and the doctors will be free to focus on the ones that NEED recesitation.
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