5 ms·

A free-standing birth center, without a financial incentive to divert you into an associated hospital, could run you $700 out of $3000. (you pay $700, insurance

by burfog 9y ago

A free-standing birth center, without a financial incentive to divert you into an associated hospital, could run you $700 out of $3000. (you pay $700, insurance pays $2300) Some of these places are very nice, feeling far less like a prison or mental institution than a hospital. I know one where the laboring mother can open the door to her room, then step out on to a patio that is separated from the street only by some large bushes. There is no feeling that the place is ready to lock you in and call social workers over a bit of dark humor. A midwife at home would be perhaps $1000 out of $5000. (you pay $1000, insurance pays $4000) Residents of California may have trouble finding this; the obstetricians got their competition mostly outlawed. Doing things by yourself is of course free. I did that with twins and with a 10-pound (4.5 kg) kid. With all of the above, you are far less likely to be subjected to time pressures that will lead to drugs and ultimately to major surgery. Surgery is not just an expense; it is a hazard to both mother and babies because it impairs the ability to maintain and deliver future pregnancies. Surgery rates in the USA are improperly high because of how an uneducated jury is thought to respond; death and injury from surgery ("at least they tried everything") looks better than death and injury from non-action. Except for the do-it-yourself option, there is emergency equipment. People greatly overestimate the chance of having a fast-developing problem, and they overestimate the ability of a standard hospital to respond effectively. If you truly need surgery, the time to travel for it can overlap nicely with the time it takes a hospital to prepare.

encoderer 9y ago
> Residents of California may have trouble finding this; the obstetricians got their competition mostly outlawed. I live in Berkeley. In our recent birthing class, of 9 couples, 3 had home births. YMMV in more far flung places of California but I've not heard of any problems here having talked in detail about birth stories with these families. (We were not one of them, we opted for Hospital birth and it cost around $12k)
- burfog 9y ago
  Indeed, "mostly". There are ways to make it work, most obviously by the "midwife" actually being an obstetrician. There are a large number of midwifes practicing illegally in California, and I would bet that Berkeley is a hotbed of this. There are a few other ways too, but generally is it sort of banned.
  - encoderer 9y ago
    Oh, fascinating, having chatted with these couples I was left with no impression it was a grey area. First rule of fight club?
    - burfog 9y ago
      A popular strategy is for the midwife to claim to be just a birth coach. They will not admit to actually helping to ease the baby out, whether they do or not. They claim to show up, maybe give suggestions, and then perhaps do some limited care afterward. Often these midwives require the family to take care of filing for the birth certificate. It's like how the slightly older profession often claims to be just an escort service.
      - pacaro 9y ago
        We had a homebirth in San Francisco, it was all on the up and up. The Midwife was notionally under the supervision of an Obstetrician, but the reality was that my wife’s obstetrician simply recommended a midwifery practice when we asked about home birth. It probably helped that the Obstetrician in question had her own children at home. A lot of the scare tactics about homebirth are ill founded. The whole “what if something goes wrong?” question is predicated on the idea that a situation will develop extremely quickly, more quickly than a hospital transfer can happen. The reality is that (for the most part) childbirth is a relatively slow process, midwives are typically highly risk averse and recommend a transfer at the slightest sign of a complication (e.g. any evidence of meconium in the water). The advantages for us included: knowing everyone in the room (only 3 in total, 2 midwives and a student); after the delivery the midwives cleaned up and were gone within 2 hours; a rich level of support before and after the birth (in reality a life long relationship with the midwives); during early transition my wife was hungry so I made chimichangas; nearly 48 hours between water breaking and delivery but no pressure to induce; family dog could provide nose to nose licking support during pushing phase Cost was $4000, of which insurance paid (eventually 70%)
marcell 9y ago
> Doing things by yourself is of course free. I did that with twins and with a 10-pound (4.5 kg) kid. Do not attempt this at home... Sure, 95% of the time you'll be fine and have no complications (for mom or baby), but do you really want to risk it for that 5%? I suspect this will be one of those trends that seems very appealing until we get a few headlines of home births gone wrong. Especially dangerous if it is your first baby, or if you have other risk factors.
- burfog 9y ago
  For the first couple births, I really recommend a midwife at either a free-standing birth center (no financial incentive to do a bait-and-switch) or at home. With the experience of a midwife, you are less likely to panic or do something dumb, and you'll have somebody to tell you if there actually is a serious issue. By being away from pressure for intervention, you will avoid life-altering surgery. If it turns out that you like having kids, you might want more... but this can turn out badly if there are big nasty scars from surgery. To properly consider the hazards of surgery, it is important to consider not merely the present birth, but also all future births.
- manmal 9y ago
  The idea that at home birth is so much more dangerous is controversial. Look at this very lengthy review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399594/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399594/ (search for death and mortality to find the interesting sections).
  - GordonS 9y ago
    Most home births involve a midwife though - I'd guess the figures were rather different for 'DIY' home births like the parent refers to (I don't have any evidence to back that up tho)
  - zxcmx 9y ago
    My son had cord wrapped around neck and SO glad I was around people who knew what they were doing with medical support. It might be only a few % different but if its your few % you might come to feel differently in the end. I suspect homebirth statistics in the west suffer heavily from selection bias since sensible antenatal care will direct complicated births to hospitals. They do mention this in the intro to the study you linked - homebirths in western countries tend to be experienced mothers from advantaged backgrounds having second or further children.
Brendinooo 9y ago
>I know one where the laboring mother can open the door to her room, then step out on to a patio that is separated from the street only by some large bushes. Oh man, I'm trying to picture walking by those bushes and hearing the screams behind them. >There is no feeling that the place is ready to lock you in and call social workers over a bit of dark humor. Not all hospitals, I guess. Ours has a really nice maternity ward and we got along well with the staff, and we had already met all of the doctors prior to delivery. Had one incident where they didn't want to admit us and sent us home for a few hours, but apart from that it was a positive experience.
- burfog 9y ago
  I don't think it normally is screaming, especially since labor would not be induced. (that creates extra-strong contractions when the tissue hasn't yet softened up) Typically it would be weird patterned breathing and loud statements like "GET THIS BABY OUT OF ME" or "I WANT THIS OVER WITH". Lots of my friends have had horrid hospital experiences. One had a doctor brutally cut her with a scissors, from her vagina almost to her anus, cutting across all sorts of tendons and meaty bits. (this can cause anal incontinence) She later learned that he was trying to get out of there to not miss his golf tee time. My wife had a similar situation due to the doctor wanting to deal with his flooding house; thus we did our later births elsewhere. Doctors are definitely humans with their own priorities.
- giarc 9y ago
  Hollywood has perpetuated the stereotype of screaming mothers. I work in a hospital and visit the labour and delivery ward quite frequently. Have never heard screaming.
giarc 9y ago
>With all of the above, you are far less likely to be subjected to time pressures that will lead to drugs and ultimately to major surgery. See here's the problem with the American system. You feel like the 'better choice' is a private birthing centre rather than a hospital because of the issues you outlined. The better option is single payer health. In Canada, where I live, there's no pressures to get it over with. If you have a 3 day labour, you have a 3 day labour. If you need an extra day stay, you stay an extra day. Not once does someone bring up cost... not the doctors, not the patient, not the family, nobody. We have birthing centres for those who want them. You can deliver at home with a midwife if you want. When I had my two kids, my cost was $14.95 for parking and ~$20 for my lunch/dinner.
- Consultant32452 9y ago
  Birthing centers, statistically, offer better outcomes for both mother and child than hospitals. This is even after you adjust for everything like if you have a high risk situation you would always wind up at the hospital.
  - the_mitsuhiko 9y ago
    Depends on where i suppose. State hospitals have a sigificantly better outcome rate than private hospitals in Austria and they generally need to send mothers and the newborns to a state hospital in emergency reasons. Why? Because they are too small relatively speaking and don’t have enoughs births.
    - Consultant32452 9y ago
      The general rule of thumb is that birthing centers are less likely to interfere with the natural birthing process. For example, babies are more likely to be born on weekends at birthing center than hospitals. This is because births at the hospital are less "convenient" for staffing reasons. Hospitals are less likely to force labor to go faster with drugs, and obviously birthing centers don't perform any c-sections, so mothers giving birth there will be less likely to get unnecessary c-sections which increase risk to mother and baby.
shadowbantruth 9y ago
Are you counting caesarean as normal or surgery? (or neither?) my understanding is that hospitals only do caesarean nowadays. Is that not true?

by burfog 9y ago

encoderer 9y ago

> Residents of California may have trouble finding this; the obstetricians got their competition mostly outlawed. I live in Berkeley. In our recent birthing class, of 9 couples, 3 had home births. YMMV in more far flung places of California but I've not heard of any problems here having talked in detail about birth stories with these families. (We were not one of them, we opted for Hospital birth and it cost around $12k)

burfog 9y ago
Indeed, "mostly". There are ways to make it work, most obviously by the "midwife" actually being an obstetrician. There are a large number of midwifes practicing illegally in California, and I would bet that Berkeley is a hotbed of this. There are a few other ways too, but generally is it sort of banned.
- encoderer 9y ago
  Oh, fascinating, having chatted with these couples I was left with no impression it was a grey area. First rule of fight club?
  - burfog 9y ago
    A popular strategy is for the midwife to claim to be just a birth coach. They will not admit to actually helping to ease the baby out, whether they do or not. They claim to show up, maybe give suggestions, and then perhaps do some limited care afterward. Often these midwives require the family to take care of filing for the birth certificate. It's like how the slightly older profession often claims to be just an escort service.
    - pacaro 9y ago
      We had a homebirth in San Francisco, it was all on the up and up. The Midwife was notionally under the supervision of an Obstetrician, but the reality was that my wife’s obstetrician simply recommended a midwifery practice when we asked about home birth. It probably helped that the Obstetrician in question had her own children at home. A lot of the scare tactics about homebirth are ill founded. The whole “what if something goes wrong?” question is predicated on the idea that a situation will develop extremely quickly, more quickly than a hospital transfer can happen. The reality is that (for the most part) childbirth is a relatively slow process, midwives are typically highly risk averse and recommend a transfer at the slightest sign of a complication (e.g. any evidence of meconium in the water). The advantages for us included: knowing everyone in the room (only 3 in total, 2 midwives and a student); after the delivery the midwives cleaned up and were gone within 2 hours; a rich level of support before and after the birth (in reality a life long relationship with the midwives); during early transition my wife was hungry so I made chimichangas; nearly 48 hours between water breaking and delivery but no pressure to induce; family dog could provide nose to nose licking support during pushing phase Cost was $4000, of which insurance paid (eventually 70%)

marcell 9y ago

> Doing things by yourself is of course free. I did that with twins and with a 10-pound (4.5 kg) kid. Do not attempt this at home... Sure, 95% of the time you'll be fine and have no complications (for mom or baby), but do you really want to risk it for that 5%? I suspect this will be one of those trends that seems very appealing until we get a few headlines of home births gone wrong. Especially dangerous if it is your first baby, or if you have other risk factors.

burfog 9y ago
For the first couple births, I really recommend a midwife at either a free-standing birth center (no financial incentive to do a bait-and-switch) or at home. With the experience of a midwife, you are less likely to panic or do something dumb, and you'll have somebody to tell you if there actually is a serious issue. By being away from pressure for intervention, you will avoid life-altering surgery. If it turns out that you like having kids, you might want more... but this can turn out badly if there are big nasty scars from surgery. To properly consider the hazards of surgery, it is important to consider not merely the present birth, but also all future births.
manmal 9y ago
The idea that at home birth is so much more dangerous is controversial. Look at this very lengthy review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399594/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399594/ (search for death and mortality to find the interesting sections).
- GordonS 9y ago
  Most home births involve a midwife though - I'd guess the figures were rather different for 'DIY' home births like the parent refers to (I don't have any evidence to back that up tho)
- zxcmx 9y ago
  My son had cord wrapped around neck and SO glad I was around people who knew what they were doing with medical support. It might be only a few % different but if its your few % you might come to feel differently in the end. I suspect homebirth statistics in the west suffer heavily from selection bias since sensible antenatal care will direct complicated births to hospitals. They do mention this in the intro to the study you linked - homebirths in western countries tend to be experienced mothers from advantaged backgrounds having second or further children.

Brendinooo 9y ago

>I know one where the laboring mother can open the door to her room, then step out on to a patio that is separated from the street only by some large bushes. Oh man, I'm trying to picture walking by those bushes and hearing the screams behind them. >There is no feeling that the place is ready to lock you in and call social workers over a bit of dark humor. Not all hospitals, I guess. Ours has a really nice maternity ward and we got along well with the staff, and we had already met all of the doctors prior to delivery. Had one incident where they didn't want to admit us and sent us home for a few hours, but apart from that it was a positive experience.

burfog 9y ago
I don't think it normally is screaming, especially since labor would not be induced. (that creates extra-strong contractions when the tissue hasn't yet softened up) Typically it would be weird patterned breathing and loud statements like "GET THIS BABY OUT OF ME" or "I WANT THIS OVER WITH". Lots of my friends have had horrid hospital experiences. One had a doctor brutally cut her with a scissors, from her vagina almost to her anus, cutting across all sorts of tendons and meaty bits. (this can cause anal incontinence) She later learned that he was trying to get out of there to not miss his golf tee time. My wife had a similar situation due to the doctor wanting to deal with his flooding house; thus we did our later births elsewhere. Doctors are definitely humans with their own priorities.
giarc 9y ago
Hollywood has perpetuated the stereotype of screaming mothers. I work in a hospital and visit the labour and delivery ward quite frequently. Have never heard screaming.

giarc 9y ago

>With all of the above, you are far less likely to be subjected to time pressures that will lead to drugs and ultimately to major surgery. See here's the problem with the American system. You feel like the 'better choice' is a private birthing centre rather than a hospital because of the issues you outlined. The better option is single payer health. In Canada, where I live, there's no pressures to get it over with. If you have a 3 day labour, you have a 3 day labour. If you need an extra day stay, you stay an extra day. Not once does someone bring up cost... not the doctors, not the patient, not the family, nobody. We have birthing centres for those who want them. You can deliver at home with a midwife if you want. When I had my two kids, my cost was $14.95 for parking and ~$20 for my lunch/dinner.

Consultant32452 9y ago
Birthing centers, statistically, offer better outcomes for both mother and child than hospitals. This is even after you adjust for everything like if you have a high risk situation you would always wind up at the hospital.
- the_mitsuhiko 9y ago
  Depends on where i suppose. State hospitals have a sigificantly better outcome rate than private hospitals in Austria and they generally need to send mothers and the newborns to a state hospital in emergency reasons. Why? Because they are too small relatively speaking and don’t have enoughs births.
  - Consultant32452 9y ago
    The general rule of thumb is that birthing centers are less likely to interfere with the natural birthing process. For example, babies are more likely to be born on weekends at birthing center than hospitals. This is because births at the hospital are less "convenient" for staffing reasons. Hospitals are less likely to force labor to go faster with drugs, and obviously birthing centers don't perform any c-sections, so mothers giving birth there will be less likely to get unnecessary c-sections which increase risk to mother and baby.

shadowbantruth 9y ago

Are you counting caesarean as normal or surgery? (or neither?) my understanding is that hospitals only do caesarean nowadays. Is that not true?