Posted by My OB said WHAT?!?.
Posted by My OB said WHAT?!?.
“I Don’t Think You Should Have A Home Birth…”
“I don’t think you should have a home birth. My daughter has spina bifida and they didn’t catch it on our ultrasound. If that happened to you what would become of your baby?” – Pediatrician during a well child visit, speaking to the pregnant mother.
I actually know of a case where a baby was born with spina bifida, and the hospital swaddled her up and sent her home without telling the mother about it. It wasn’t until she tried to give the baby a bath that she discovered it. Granted, this was a few decades ago, but still.
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Um. Take her to the doctor after birth, same as if she was born in a hospital?
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I think there are certain forms of spina bifida in which the spinal cord or a bunch of nerves from it, are exposed, or outside the body in a very delicate sack of membranes, and if that is broken, infection, paralysis and even death can follow. Great care is needed in such cases to avoid infection before surgery is done. BUT-it would seem that these cases would most likely be caught on ultrasound.
I had my home births without even having any ultrasounds. (Nine babies, and I never had one.) Had my baby been born with any defect, I would have called my family practice doctor, who was always “on call” for me during my births, and he would have met us at the hospital. He also would have found me the right specialist to deal with the problem, probably by the time I got there.
I suppose there are some conditions which require absolutely immediate intervention. They are not common. To me it was worth some degree of risk in order to have freedom and self determination in birth.
Susan Peterson
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Kristy Reply:
January 28th, 2012 at 3:40 pm (Quote)
I have a friend who had seven at home… then she had to go to the hospital for number eight or claim to have an ‘oops’ baby. Apparently it is illegal to have an eighth or higher numbered child at home in our state. Bizarre.
She was wondering if they expected the mother to be insane in her old age and accidently eat the baby or something. I mean… it isn’t like she hasn’t proven she can do this just fine.
Of course she happened to like the hospital birth too. She said it was so *quiet* and peaceful compared to her house… lol. She and hubby threatened to take advantage of being away from the kids to start work on number nine. Nothing more fun than freaking out the hospital staff with comments like that.
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Lexi Reply:
January 28th, 2012 at 3:57 pm (Quote)
Is it illegal for the mother to have an out of hospital birth or illegal for someone to attend her? These are very different but often presented as the same. Would you mind telling me the state, so I can look it up? I’m intrigued now. Thanks!
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Kristy Reply:
January 28th, 2012 at 4:52 pm (Quote)
The state is Arkansas… as I explained in more detail below I’m not really sure which it is since I ‘do’ hospital births myself and never bothered to fully research the law. But the way she talked she couldn’t have her regular midwife there *and* would have to ‘oops’ have the baby unassisted so she didn’t get ‘in trouble’ for doing it intentionally. She didn’t want to lie so they went to the hospital.
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Susan Peterson Reply:
January 28th, 2012 at 4:04 pm (Quote)
There is no state where it is illegal to HAVE an eighth or higher baby at home. Perhaps in your state it is illegal for licensed midwives to assist in such a birth?
I had women with some training (not sure how much) at my first two home births, with my fourth and fifth babies. My husband and I did numbers 6,7, and 8 on our own. (I got prenatal and after the birth care from my FP). Number nine was the only one caught by a “legal” medical person, a CNM. (She was a nurse working as a “lay” midwife first, then went to school to become a CNM. There were no CPMs in those days.)
I really liked the births best where no one outside my family was around. I would do this again if I were young enough. Not suggesting that anyone do this because I said so, though.
Susan Peterson
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Kristy Reply:
January 28th, 2012 at 4:28 pm (Quote)
Well, yes… I think that is what she meant. It was illegal for her regular midwife to assist and she would have to ‘oops’ have the baby unassisted because she didn’t make it to the hospital. She was personally fine with not having anyone ‘trained’ there after seven babies… but she said she was not comfortable with lying to keep out of ‘trouble’. So I guess unassisted birthing is a ‘no-no’ with DHS or some such if she felt she’d have to lie about it.
I don’t really know the full details of our law (Arkansas) since I prefer hospital births. If I *did* homebirth I could see it best as you describe (family only)… cause my only real ‘concern’ is my own tendency to ‘tense up’ when anyone other than family is in the house. At home I’d feel like a hostess… at the hospital I feel like the customer. However, I think my hubby would veto unassisted birthing and if it is a case where we would have to lie about it anyway here to keep DHS off our case… I would not be comfortable with that.
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Susan Peterson Reply:
January 28th, 2012 at 4:43 pm (Quote)
Is DHS the same as CPS-Child Protective Services? If so, why would they be involved? There was no one I had to lie to. My FP doctor was both my doctor and my children’s doctor, and he encouraged me. The pediatrician I had before I started going to him would not have had a problem with it either. And when we moved from Maryland to NY, my kids doctor there didn’t seem phased by it. That was over 20 years ago though. I am so sorry that the state (as in, the government) has become so very intrusive into private affairs, that a woman can’t commit the simple physiological act of giving birth in her own home without government agencies having something to say about it.
There was a time when governments punished sexual improprieties. Now anything goes sexually, but giving birth is highly regulated, which is every bit as intrusive.
Susan Peterson
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Heidi Reply:
January 28th, 2012 at 6:22 pm (Quote)
I can totally relate to feeling comfortable with hospital birth. I am the customer, and the hospital where my babies were born is very friendly to natural childbirth. Out of four births, I have never had someone offer me an epidural or pitocin for labor, and only had one idiot nurse suggest a C-section.
At home I would probably be trying to show everybody where everything was or get it or do it myself. The kids, the dogs, the mess, gah. The hospital works for me. Oh, also, I have twice had postpartum hemorrhages, so I think I may not qualify as low risk, technically.
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Brige Reply:
January 29th, 2012 at 7:11 am (Quote)
I think maybe its because grand multips have a higher chance of hemorrhaging? Apparently on Tri-Care… thank you awful horrible military insurance… you are not allowed to have a CNM attend a birth of any baby higher than #5… they won’t cover it… I heard this from a mama who just had baby #8… havn’t researched it myself, but I wouldn’t put it past them… that being said… the state probably feels that its “too high of a risk” or “beyond the scope of practice” for a midwife… I call BS
every case is different… but yeah…
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Carolyn Runnells Reply:
January 28th, 2012 at 4:30 pm (Quote)
Susan you are correct their are different forms of Spina Bifida, there are three types. The worst being where the sack and nerves are outside the body. Both my boys had this type of SB (one birth, one adopted, see story below). Think of your spinal cord as a rope. Some ropes are nice and smooth, but a old rope may have splits and be frayed. Not all old ropes are the same, so the level the defect. But the more frayed the “rope” the worse the defect.
BTW let me say a word on testing. After my first son’s birth I became the liaison for the hospital and the Spina Bifida association. I’ve been to the hospital and visited the family “where we had tests and ultrasounds and everything was ok” to a family who had a baby who was fine/normal but were told he had Spina Bifida. The ultrasound showed a large sac – it was his scrotum that was enlarged and between his legs, not an opening on the spine.
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How hilarious to me.
It was my friend’s homebirth of a baby with the worse case of spina bifida in our state to live that gave me the courage to have my first homebirth! Because he’d born at home, he got to bond with all his siblings. He got to nurse right away while they waited on the ambulance. He was considered “dirty” by the hospital, so he couldn’t go into the nursery and mom and dad could stay with him until he was transported to a hospital out of state where they could do the (many) complex surgeries he ended up needing.
He went on to be a fine young man.
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Carolyn Runnells Reply:
January 28th, 2012 at 4:13 pm (Quote)
I’m the mom of that fine young man. I always said that if we had another child and I found out that I would be having a another born with Spina Bifida (or any other birth defect) I would go to the hospital parking lot in our beautiful RV have the baby in peace and quiet. Then go in.
Seriously our birth experience compared to many families of Spina Bifida kids was calm and reassuring. When he was born our mid wife said “oh he has Spina Bifida, Carolyn talk to him, don’t touch the back” as she laid a couple of sterile 4X4 on the opening – 6×8 cm opening on a newborns back. She then presided to tell the other mid-wife to call the hospital and tell them we need a transport for a baby with SB. I asked, “What is this Spina Bifida?”. She calmly replied, “it is a condition at birth, you will be making several medical decisions over the next few hours, but right now we need to get him breathing good and you fixed up. Keep him on your stomach and talk to him”. Because she was so calm, we were calm, I could tell it was a serious situation but not alarmed.
Compare this to many stories at Spina Bifida support meetings and conferences. Where no ideal the baby was born with Spina Bifida and the whole delivery room erupts into people running here and there to get everything fixed up for this baby. Mom laying there and Dad standing nearby panic setting in by what is happening. You ask a question and you are ignored or worse a nurse runs by pats you on the shoulder and says “Don’t worry dear, it’s not your fault” Can you imagine the kind of gut wrenching fear that would produce in you? I’m thankful for my birth experience.
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IF Survivor Reply:
January 28th, 2012 at 5:19 pm (Quote)
Oh Carolyn, thank you for telling your story! I rarely cry good tears when reading birth stories and I’m having a hard time typing due to the good tears. What a blessing for both you and your son and what an amazing gift you had in your midwife!
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Carolyn Runnells Reply:
January 28th, 2012 at 7:49 pm (Quote)
Ludie’s calm demeanor set the tone and I was so thankful. I am still thankful to this day for her. Several months later I was thanking her and she told me that didn’t feel that calm, but your right she was an amazing gift.She gave to us by taking calm control and a sincere honesty but not minimizing the danger. But carrying onward with the task at hand, When transport showed up (ambulance) my former husband went with to the hospital with Daniel. Ludie then proceeded to sew me up. She said your going to be up and on your feet and sitting at the hospital for long hours, we’re going do do this right. I remember her seriousness and the need to be through but hurry so I could go to the hospital.
When I arrived they were talking about surgery, I called a friend got a crash course over a pay phone on Spina Bifida–ahh the days before cell phones and computers, The next day we were air vac to San Diego where I spent 2 mo living in neonatal ICU. What do I remember about that time?Besides the seriousness of Daniels surgeries, which overall for a SB kid were fairly straightforward and few glitches. There was a light side to all of this– I was hooked up to the milking machine every 4 hours like ole Bessie the cow so Daniel and several other babies could have milk-I produced lots. And setting on a donut Ludie told me to get, bless her heart!
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I agree with the first commenter in the sense that this comment could come out of genuine concern. The problem I see with it is that the Mom wasn’t consulting the pediatrician about her home birth. She was there for a well baby visit with her older child. So while I appreciate his concern, I’m not sure he went about saying it in the best way. Maybe “Have you talked with an OB about your decision to have a home birth? I wonder about the possible ramifications of it if your child were to be born with a birth defect. For example, my daughter was born with spina bifida.” Something along those lines.
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Well, according to my midwife, who (a) had children with extremely deep sacral dimples and so studied the topic in depth and (b) does not believe in PUSH PUSH PUUUUUUUSHHHH!, you first get the baby out as gently as possible, then pad the lesion, immobilize the baby on a backboard, and call emergency services. She even had a tiny custom-made backboard.
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Jenny Islander Reply:
January 28th, 2012 at 9:17 pm (Quote)
Forgot to mention–The first line, of course, was prevention: high-quality food* plus vitamins formulated for maximum absorption.
*By which she meant, frex, homemade refried beans with corn tortillas and local fruit vs. canned precooked refried beans with flour tortillas and Sunny D. She did her apprenticeship in the south of Texas.
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I believe I saw a study several years ago that didn’t show any benefit to babies with spina bifida being born via c-section. According to the study I read, it’s one of those “common sense” things that doesn’t seem to pan out.
Anyone have access to pub med so they can get an actual study rather than “I remember reading something five years ago”?
BTW, the chance of having SB is something like 1 in 1000 in the general population. So the pediatrician wants EVERYONE to give birth in the hospital because there’s a tenth of a percent chance of spina bifida.
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Petra Reply:
January 28th, 2012 at 6:22 pm (Quote)
I don’t have access to the full article, but I think this is the abstract: http://journals.lww.com/co-obgyn/Abstract/2005/04000/Management_of_pregnancy_and_labour_in_cases.7.aspx
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Petra Reply:
January 28th, 2012 at 6:29 pm (Quote)
Oops. This one is probably the one you mean:
http://journals.lww.com/greenjournal/abstract/1988/04000/open_spina_bifida__does_cesarean_section_delivery.5.aspx
Though evidence refuting this finding was published a few years later:
http://www.nejm.org/doi/full/10.1056/NEJM199103073241004
And it remains in dispute:
https://www.thieme-connect.com/ejournals/abstract/ejps/doi/10.1055/s-2008-1066151
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Petra Reply:
January 28th, 2012 at 6:34 pm (Quote)
Couple more:
http://www.springerlink.com/content/j8614000mg24r006/
http://www.sciencedirect.com/science/article/pii/S0301211502000337
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This is mine.
It was not a well child visit, We were there because my 3 year old tested for high lead levels in a screening at a baby fair and we were following up on that with a blood draw. So we were a bit worried about that. She seemed really irritated with us (them?) that they would send her in for a follow up with 11 (not sure the measure) lead level. Her follow up levels were fine.
Anyway, she comes up with this out of the blue. I really didn’t know much about spina bifida at all. I told her I guessed we’d just go to the hospital that was 2 minutes away if there were any issues. For some reason she seemed to think that we were incapable of doing that.
I did follow up with my midwives after this and asked them what would happen with SB. Yep, go to hospital. For the record, she was a healthy baby, easy birth.
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Kathryn Reply:
January 29th, 2012 at 5:28 pm (Quote)
Unwanted/unneeded birthing advice aside, the lead level thing makes me angry! My little boy’s finger-prick test at 1 year was a 12…normal is below 10. Lead poisoning doesn’t happen until something ridiculously high, 60 if I remember right (and I could be wrong, but it was a very high number compared to my son’s 12). His follow-up blood draw was 10, and they freaked about that too. The health department was calling and wanting to come test our house; it got to be quite ridiculous. The lady’s tone always implied that it was somehow my fault and I had done it on purpose and that I was knowingly endangering my child and that he was going to have all sorts of learning disabilities and such. A second follow-up test was fine (4), but the other day I got a call from the health department about it, and it’s been a year and a half! My pediatrician said it wasn’t a big deal but the health department was awful about it all. Blah.
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I am not downing anyone for the choices they make for their families. And I like to think that I’m at least a relatively honest person. But… I wouldn’t lose a milisecond’s peace over lying about my birth plans. If home birth was illegal, I’d say, “Whoops!”
Yes, I think it’s sad that the medical and social services “establishment” forces a decision between lying and slavish obedience. But I would absolutely lie.
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Kristy Reply:
January 28th, 2012 at 6:21 pm (Quote)
Oh, I don’t for a second look down on those that feel like they need to do that either! It just isn’t something I could pull off personally. I tend to have an overactive conscience when it comes to things like this… rules haunt me.
*But* when it comes to my rights… I’m just as sure I know them and fight for what is important to me! I’ve also gotten good with finding a way to *technically* be following the rules and still be doing things my way… lol If I hadn’t worked on those things I’d be the world’s worst pushover in the hospital. I was with my first baby.
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My SIL was born with SB 30 years ago in a hospital and she was still sent somewhere else almost immediately. My MIL was still being taken care of when SIL was in an ambulance bound for a Children’s Hospital (she is now a reasonably healthy 30 year old that my kids consider lucky because she gets a fancy chair and a van with a ramp in it). How could that be better than having the baby born at home and calmly waiting for an ambulance there to take the baby to the big fancy hospital? I think this is one of those big risks that you have to accept to have children at all, no matter how you have them. Life is dangerous and unpredictable but if you live it in constant fear of the things that can go wrong, you miss the point. OP, I’m glad you didn’t do that and went on to have a healthy baby.
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Jane Reply:
January 29th, 2012 at 4:42 am (Quote)
THis is a very good point. Unless you give birth at a hospital with the highest level NICU and an ECMO machine, any baby with a really bad health problem is going to get transferred anyhow.
I believe all homebirth midwives carry enough equipment to resuscitate a baby and get the baby stabilized — oxygen, etc — and it’s pretty much the same stuff a hospital is going to do if they don’t have a high-level NICU.
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My baby was born at home after I had had two healthy hospital babies. I had a healthy pregnancy, carefully monitored by my midwife. I opted out of an ultrasound, which the midwife was okay with. In retrospect, I should have gotten one, but I’m glad I did not.
My daughter was born seemingly healthy. The only funny thing about her was that her ears were bent out of shape, but I was certain that was from the way she way lying in the womb.
She grew and her differences became more pronounced. She is not three and a physically healthy little girl. No major health issues. She does have some sort of chromosomal or genetic disorder that we are still trying to find.
I’m very happy that we had a home birth. If I had an ultrasound, I probably would have had to go to the hospital and would not have seen my baby for hours after birth. I’m thinking ahead, though- if I have another child, I will definitely have an ultrasound. I realize how badly my 3 year old daughter’s birth could have turned out because I didn’t have one. But all the same, I’d be scared that the ultrasound would risk me out of a home birth. A lot to think about.
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teapot Reply:
January 29th, 2012 at 10:38 pm (Quote)
GMAZu, you’ve probably thought about this, but just in case….. You may want to consider getting a referral to a perinatologist for your u/s. They generally have much more experience in finding smaller defects that less experienced persons might miss. All the best to you as you search for proper diagnosis and treatment for your little one. Sometimes the search seems to cause more questions than it answers. Hang in there!!!
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GAMZu Reply:
January 29th, 2012 at 11:37 pm (Quote)
Thank you for your kind words, teapot! I will definitely keep it in mind if the situation arises again.
Can a perinatologist see a three year old?
One reason I sometimes wish I had an u/s is that they seem to find the littlest defects, so maybe they’d find my daughter’s diagnosis right away, instead of years of testing which is our reality now. I must say, though, everything turned out perfectly. Not that I could choose, but I’m not sure if I would have wanted a diagnosis if that meant risking out of a HB.
Bottom line, anything can happen to anyone. You can’t live in fear that your child may have an undetected case of something or other which may or may not require immediate hospitalization. If so, spend your last trimester in the hospital, in case you go into labor. Heck, spend the whole pregnancy there. What, are you going to choose comfort and normal life at the risk of having something go wrong while you are out of the hospital?
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teapot Reply:
February 1st, 2012 at 9:56 pm (Quote)
GMAZu, perinatalogists are specialists in high-risk pregnancies, so I don’t think they would see a 3yo. If you have a medical school near you, their pediatrics department might be a good place to start.
You are right, anything can happen to anyone and we can’t live in fear or constantly think about the “what ifs,” either those in the past or those in the future. All you can do is the best you know how and when you learn more, well, then, maybe you do things differently from then on.
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GAMZu Reply:
February 2nd, 2012 at 6:50 am (Quote)
I was joking about the perinatalogist. I take my daughter to a geneticist and a neurologist at NYU. What I meant is that doctors are so good at picking out every little thing that can go wrong before birth… but after the child is born, no one really cares all that much to help you get to the bottom of an issue.
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teapot Reply:
February 2nd, 2012 at 4:36 pm (Quote)
OK, now I get it!! You never know, even though most of the women who are here are extremely educated, some aren’t. And yeah, you’re right: any little blip during pg, and they’re all over it. Afterwards, not so much. My sister was told that her 3mo’s seizures were gas & startle reflex, so she got her the second round of DPT/OPV, back in 1980. The result was quite unpretty. That pedi left the group shortly afterward. If you’d like to continue this privately my addy is Tennessee (TN) d o u l a at g m a i l dot c o m You seem like you’re smart enough to figure that out & it ought to deter any one who is up to no good.
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At least this one could actually be out of concern unlike most posted.
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Telula Reply:
January 29th, 2012 at 6:48 pm Telula(Quote)
I agree.
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