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This is a big part of why homebirth is gaining popularity. It's just family and maybe a midwife. Nobody is going to do a meth test. The doors don't lock you ins

by burfog 10y ago

This is a big part of why homebirth is gaining popularity. It's just family and maybe a midwife. Nobody is going to do a meth test. The doors don't lock you inside, unable to escape without permission. (that security is NOT to protect the baby from strangers; it's so CPS can take your baby) Also: There is no need to drive madly to the hospital. There will be no incentive to keep you for exactly how long your insurance will pay, nor to perform surgery. You get to sleep in your own bed, without constant beeping and light from the hallway. You can have as many visitors as you want. You will never be separated from your baby, not even for a moment. You won't be treated like a potential criminal. You get respect.

masklinn 10y ago
And if there's trouble and the kid[0] dies[1] you can just say that was "their journey" and wash your hands from it. Hell, you might even "get respect" and praises for having killed your kid, go you. But hey, CPS didn't get to take your kid[2], so there's that. [0] or the mother, or both [1] which is anything but rare, even in the UK under obstetric care[3] > The risk of dying on the day of birth (0.43 per 1000, or 430 micromorts) exceeds that of any other average day of life until the 92nd year. and matches the risks of major surgery. Homebirth, especially with completely unqualified midwives (which is the rule in the US) is almost an order of magnitude more risky[4]. [2] the coroner did, to check for foul play [3] http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12544/full http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12544/f... [4] https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585 https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeM...
- Domenic_S 10y ago
  That's just an ignorant response. There are plenty of board-certified midwives, birthing centers, etc. Importantly, a great deal of risk can be ascertained before labor, and like any other medical procedure you're either a good candidate for non-hospital birth or you're not.
  - jmcgough 10y ago
    It depends heavily on the quality of the midwife and how well they can recognize complications. If they miss something (which very likely would turn from from a required test in a hospital), by the time the baby has stopped breathing, it might be too late to save them. "Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P=0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth." [1] "Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births." [2] [1] http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 [2] http://www.ajog.org/article/S0002-9378(14)00275-0/abstract http://www.ajog.org/article/S0002-9378(14)00275-0/abstract
    - ThrustVectoring 10y ago
      Rounding up your first statistic slightly, that's a difference of two severe incidents per thousand births. That's a reasonably big risk factor in absolute terms, but small enough that it's not unreasonable to take in order to get other things that you care about. Like, these are "am I willing to make this tradeoff" numbers similar to choosing to drive to work daily, rather than "fuck no, go to the hospital" numbers.
- MustardTiger 10y ago
  If you have to deliberately compare to the worst case scenario "with completely unqualified midwives" to try to make your point, then it is not a good point.
  - FireBeyond 10y ago
    True. Though as an EMS provider, I'll definitely say that I've run the gamut of calls to midwifes/birthing centers/home births from "completely competent professional I'd have no issue managing my partner's birth" to "I really need to call the DOH after this". Situations where, upon handing us a cyanotic baby with severely deficient APGAR score (https://en.wikipedia.org/wiki/Apgar_score https://en.wikipedia.org/wiki/Apgar_score) the midwife's primary care was 'respect for the process and the environment', wanting us to take off boots and "try not to be too loud or overactive".
    - tropo 10y ago
      If you've already been handed the baby, your boots should be on their way to the emergency room as fast as your truck can go. It really isn't right how you people turn every call into an excuse for searching without a warrant. Unrelated stuff going on in the home or birth center is none of your business.
      - FireBeyond 10y ago
        What on earth are you talking about? "You people"? Unrelated stuff going on in the birthing center? I am describing a situation where the midwife/ doula was MORE CONCERNED with maintaining a "positive and serene energy in the birthing space" (her words) than she was about what we would do to take care of a critically ill neonate. I can assure you, my methodology on such a call is not to "stay and play" but to "stabilize, ideally while transporting". Let alone a fishing trip. To wit, I could not care less what else is going on in the home, be it legal or illegal, unless it directly affects the care I am or need to provide. My reference to DOH was not a "fishing trip", but in regards to a provider who, in my professional opinion, was being actively negligent in caring for what was their patient, until transferred to me. I think your biases are showing.
LeifCarrotson 10y ago
The baby's heart rate dropped during contractions, as monitored by the hospital equipment. The mother was put on oxygen to help. Later, they chose to do an emergency C-section because the heart rate dropped too low. In a hospital, all that was easy to access. If this had been a home birth, it may have been catastrophic. Driving to the hospital and not being in your own home is an unfortunate reality. We do not live in hospitals. Disrespect, misalignment of insurance incentives, and inflexible criminal treatment are all bad things. But their damage is amplified because the alternative - homebirth - lacks the medical advantages of being in a hospital. Draconian policies like this literally kill children at the margins.
- tropo 10y ago
  "The baby's heart rate dropped during contractions, as monitored by the hospital equipment." That's about as reliable as: "The dog moved funny, indicating it found drugs, so we have to search your car." (it's totally normal for the heart rate to drop) The sad reality is that the facility for C-section is not financially viable unless you use it on a regular basis. There is an incentive to use it. When used, it is profitable. Doctors who push back on profitability find themselves replaced. In any case, those who have trouble at home can get emergency C-sections. Since prepping takes time anyway, there is no added delay if you call ahead. Situations where mere minutes matter are rare to the point of being pretty much non-existent.
  - JshWright 10y ago
    A baby's heartrate (as measured by either an external transducer, or a probe hooked into the baby's scalp) is an objective measurement. Comparing it to the completely subjective "signaling" of a police dog is absolutely absurd. Much of the 'prepping' requires the mother to be present (administration of anesthesia, monitoring, etc). The prep of the OR is generally done in parallel with those tasks. If it takes you 30 minutes to the to the hospital, you are delaying a c-section by at least 30 minutes. Additionally, measure that can be taken to reduce fetal stress (while waiting for the OR to be prepped, in the event that is delayed) are _much_ easier to accomplish in a hospital, rather than in a car, or the back of an ambulance.
strictnein 10y ago
> "(that security is NOT to protect the baby from strangers; it's so CPS can take your baby)" Uh no, it's really not.
- EdHominem 10y ago
  It's not to protect the baby, thefts of children (etc) are rarer than lightning strikes.
  - strictnein 10y ago
    Actual thefts? Sure. Related issues (family disputes, unwanted guests, etc)? Far more common.
    - EdHominem 10y ago
      Keep the guests out with a door that's locked from the outside, sure. But lock people in? Recipe for disaster! I trust my smoke alarm - to probably give me extra warning. I don't trust it to unlock the door and let me out.
  - pm24601 10y ago
    it is also there to prevent unmonitored/uncontrolled access to babies. Prevent things like babies being mixed up. Aides taking wrong child for testing etc.
  - dragonwriter 10y ago
    > It's not to protect the baby, thefts of children (etc) are rarer than lightning strikes. Maternity ward infant abduction is an ongoing thing, though now fairly rare (and even more rarely successful, with dozens of attempts stopped within the ward for each successful abduction) because of the security measures that have been instituted by hospitals in the last few decades. But that's a success of the security measures, not an indicator that they aren't necessary.
    - EdHominem 10y ago

by burfog 10y ago

masklinn 10y ago

And if there's trouble and the kid[0] dies[1] you can just say that was "their journey" and wash your hands from it. Hell, you might even "get respect" and praises for having killed your kid, go you. But hey, CPS didn't get to take your kid[2], so there's that. [0] or the mother, or both [1] which is anything but rare, even in the UK under obstetric care[3] > The risk of dying on the day of birth (0.43 per 1000, or 430 micromorts) exceeds that of any other average day of life until the 92nd year. and matches the risks of major surgery. Homebirth, especially with completely unqualified midwives (which is the rule in the US) is almost an order of magnitude more risky[4]. [2] the coroner did, to check for foul play [3] http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12544/full http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12544/f... [4] https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585 https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeM...

Domenic_S 10y ago
That's just an ignorant response. There are plenty of board-certified midwives, birthing centers, etc. Importantly, a great deal of risk can be ascertained before labor, and like any other medical procedure you're either a good candidate for non-hospital birth or you're not.
- jmcgough 10y ago
  It depends heavily on the quality of the midwife and how well they can recognize complications. If they miss something (which very likely would turn from from a required test in a hospital), by the time the baby has stopped breathing, it might be too late to save them. "Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P=0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth." [1] "Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births." [2] [1] http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 [2] http://www.ajog.org/article/S0002-9378(14)00275-0/abstract http://www.ajog.org/article/S0002-9378(14)00275-0/abstract
  - ThrustVectoring 10y ago
    Rounding up your first statistic slightly, that's a difference of two severe incidents per thousand births. That's a reasonably big risk factor in absolute terms, but small enough that it's not unreasonable to take in order to get other things that you care about. Like, these are "am I willing to make this tradeoff" numbers similar to choosing to drive to work daily, rather than "fuck no, go to the hospital" numbers.
MustardTiger 10y ago
If you have to deliberately compare to the worst case scenario "with completely unqualified midwives" to try to make your point, then it is not a good point.
- FireBeyond 10y ago
  True. Though as an EMS provider, I'll definitely say that I've run the gamut of calls to midwifes/birthing centers/home births from "completely competent professional I'd have no issue managing my partner's birth" to "I really need to call the DOH after this". Situations where, upon handing us a cyanotic baby with severely deficient APGAR score (https://en.wikipedia.org/wiki/Apgar_score https://en.wikipedia.org/wiki/Apgar_score) the midwife's primary care was 'respect for the process and the environment', wanting us to take off boots and "try not to be too loud or overactive".
  - tropo 10y ago
    If you've already been handed the baby, your boots should be on their way to the emergency room as fast as your truck can go. It really isn't right how you people turn every call into an excuse for searching without a warrant. Unrelated stuff going on in the home or birth center is none of your business.
    - FireBeyond 10y ago
      What on earth are you talking about? "You people"? Unrelated stuff going on in the birthing center? I am describing a situation where the midwife/ doula was MORE CONCERNED with maintaining a "positive and serene energy in the birthing space" (her words) than she was about what we would do to take care of a critically ill neonate. I can assure you, my methodology on such a call is not to "stay and play" but to "stabilize, ideally while transporting". Let alone a fishing trip. To wit, I could not care less what else is going on in the home, be it legal or illegal, unless it directly affects the care I am or need to provide. My reference to DOH was not a "fishing trip", but in regards to a provider who, in my professional opinion, was being actively negligent in caring for what was their patient, until transferred to me. I think your biases are showing.

LeifCarrotson 10y ago

The baby's heart rate dropped during contractions, as monitored by the hospital equipment. The mother was put on oxygen to help. Later, they chose to do an emergency C-section because the heart rate dropped too low. In a hospital, all that was easy to access. If this had been a home birth, it may have been catastrophic. Driving to the hospital and not being in your own home is an unfortunate reality. We do not live in hospitals. Disrespect, misalignment of insurance incentives, and inflexible criminal treatment are all bad things. But their damage is amplified because the alternative - homebirth - lacks the medical advantages of being in a hospital. Draconian policies like this literally kill children at the margins.

tropo 10y ago
"The baby's heart rate dropped during contractions, as monitored by the hospital equipment." That's about as reliable as: "The dog moved funny, indicating it found drugs, so we have to search your car." (it's totally normal for the heart rate to drop) The sad reality is that the facility for C-section is not financially viable unless you use it on a regular basis. There is an incentive to use it. When used, it is profitable. Doctors who push back on profitability find themselves replaced. In any case, those who have trouble at home can get emergency C-sections. Since prepping takes time anyway, there is no added delay if you call ahead. Situations where mere minutes matter are rare to the point of being pretty much non-existent.
- JshWright 10y ago
  A baby's heartrate (as measured by either an external transducer, or a probe hooked into the baby's scalp) is an objective measurement. Comparing it to the completely subjective "signaling" of a police dog is absolutely absurd. Much of the 'prepping' requires the mother to be present (administration of anesthesia, monitoring, etc). The prep of the OR is generally done in parallel with those tasks. If it takes you 30 minutes to the to the hospital, you are delaying a c-section by at least 30 minutes. Additionally, measure that can be taken to reduce fetal stress (while waiting for the OR to be prepped, in the event that is delayed) are _much_ easier to accomplish in a hospital, rather than in a car, or the back of an ambulance.

strictnein 10y ago

> "(that security is NOT to protect the baby from strangers; it's so CPS can take your baby)" Uh no, it's really not.

EdHominem 10y ago
It's not to protect the baby, thefts of children (etc) are rarer than lightning strikes.
- strictnein 10y ago
  Actual thefts? Sure. Related issues (family disputes, unwanted guests, etc)? Far more common.
  - EdHominem 10y ago
    Keep the guests out with a door that's locked from the outside, sure. But lock people in? Recipe for disaster! I trust my smoke alarm - to probably give me extra warning. I don't trust it to unlock the door and let me out.
- pm24601 10y ago
  it is also there to prevent unmonitored/uncontrolled access to babies. Prevent things like babies being mixed up. Aides taking wrong child for testing etc.
- dragonwriter 10y ago
  > It's not to protect the baby, thefts of children (etc) are rarer than lightning strikes. Maternity ward infant abduction is an ongoing thing, though now fairly rare (and even more rarely successful, with dozens of attempts stopped within the ward for each successful abduction) because of the security measures that have been instituted by hospitals in the last few decades. But that's a success of the security measures, not an indicator that they aren't necessary.
  - EdHominem 10y ago