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Home birthing and health insurance costs


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  #21  
October 12th, 2009, 06:12 PM
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Quote:
Originally Posted by AMDG View Post
I prefer the idea of birth centers over home births - would there be a reason why you advocate home births and not birth centers as an equally viable option?
No, birth centers would be fine too. From a strictly financial perspective, any low-cost, low-intervention form of birth would be preferable to a hospital. I'm not well-versed in the relative costs of birth centers v. home births, but I would imagine that they're fairly comparable.

Quote:
Originally Posted by TheOtherMichelle View Post
Insurance companies should pay for homebirths and birthing centers, but no woman should be denied care in a hospital if that is what she is comfortable with or forced to pay out of pocket for an epidural.
Why not? They're nice, but they're elective -- not medically necessary. I have to pay out-of-pocket, if, say, I want the nice big comfy private room at the hospital to give birth rather than the small, tacky, shared room, because this is an issue of comfort and not of health. Aren't epidurals the same thing?
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  #22  
October 12th, 2009, 06:26 PM
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Originally Posted by (.Y.)mom2dd(.Y.) View Post
^ I agree with this.

I'm a huge advocate for homebirth, and midwifery because of my birth experience. However first and foremost, I advocate for the mothers. Too many moms out there are like BabyBird and truly think the hospital is the best place for them to give birth. Birthing moms need to be respected and feel comfortable. If they feel comfortable in a sterile hospital on a bed with drugs and surgeons close by, that's their choice.
Sure, it's their choice, and no one is denying them that choice. What I am suggesting is that insurance companies should deny them coverage for that choice. Just like insurance companies would deny me coverage for most types of plastic surgery -- or for teeth whitening -- or for a full x-ray scan of my retina, like I was offered at the eye doctor the other day. At some point, we do have to take financial issues into consideration and make a decision about which types of medical procedures give us the most "bang for our buck." Otherwise, why shouldn't insurance companies pay for every single one of us to have our DNA fully mapped, so that we can all better avoid/prepare for any possible inherited diseases? It would be nice, but it's not cost-efficient. I am suggesting that hospital births may be the same way.
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  #23  
October 12th, 2009, 06:33 PM
(.Y.)mom2dd(.Y.)
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Originally Posted by brui77 View Post
Sure, it's their choice, and no one is denying them that choice. What I am suggesting is that insurance companies should deny them coverage for that choice. Just like insurance companies would deny me coverage for most types of plastic surgery -- or for teeth whitening -- or for a full x-ray scan of my retina, like I was offered at the eye doctor the other day. At some point, we do have to take financial issues into consideration and make a decision about which types of medical procedures give us the most "bang for our buck." Otherwise, why shouldn't insurance companies pay for every single one of us to have our DNA fully mapped, so that we can all better avoid/prepare for any possible inherited diseases? It would be nice, but it's not cost-efficient. I am suggesting that hospital births may be the same way.
I do understand what you're proposing. I wish all people took control of their personal health by not smoking, eating right and working out/playing for health reasons. While in principle I totally understand why you're wanting that, I just can't agree with you fully. I think all birthing moms should have all coverage paid for by their insurance company or in my case, socialized medical care. I had to fight to get midwifery covered by my province's socialized health care structure. From that experience alone, I think it would hypocritical to say one thing is covered but another one isn't. We even free abortions here. I can't deny health care coverage of any kind to any person ~ to me, that should be a human right.
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  #24  
October 12th, 2009, 06:37 PM
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Originally Posted by (.Y.)mom2dd(.Y.) View Post
I think that's the entire problem here. You're assuming that the hospital avoids birth accidents when statically it's the hospitals that cause the birth accidents.
How exactly does a hospital cause a prolapsed cord or placental abruption...or other things that have nothing to do with where they are? These things happen without warning.

Quote:
I'm a huge advocate for homebirth, and midwifery because of my birth experience. However first and foremost, I advocate for the mothers. Too many moms out there are like BabyBird and truly think the hospital is the best place for them to give birth.

You are an advocate for homebirth because of your experiences just as I am an advocate of delivering in hospital because of MY experiences. I agree there are some Ob's who jump to interventions when it might not be nessesary but I have also witnessed midwives who don't know when to say when...and the ones who suffer are the babies.

Quote:
Birthing moms need to be respected and feel comfortable. If they feel comfortable in a sterile hospital on a bed with drugs and surgeons close by, that's their choice
.

And just the same for women who choose to deliver at home...if they are comfortable with the possibility that something may happen during delivery that might put their baby in danger then that is their choice. I personally couldn't live with myself if I didn't provide a safe environment for my baby.

Quote:
Midwives are trained to deal with these "accidents."


You can be "trained" all you want but if you don't have the proper equipment available there isn't much you can do.

We are sort of straying from the original question though.
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  #25  
October 12th, 2009, 06:41 PM
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Midwives not only are trained but also have equipment. Assuming it's not a fully safe environment only speaks of your lack of knowledge of the training midwives have.
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  #26  
October 12th, 2009, 06:47 PM
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Originally Posted by BabyBird View Post
How exactly does a hospital cause a prolapsed cord or placental abruption...or other things that have nothing to do with where they are? These things happen without warning.
I am not sure about these issues specifically, but I am pretty sure that a hospital can cause a birth to take longer than it would at home. They can do this by (a) electively inducing for spurious reasons, rather than waiting for the baby to be born naturally (note that inductions accounted for 22% of all labors in 2004! Systematic Review: Elective Induction of Labor Versus Expectant Management of Pregnancy -- Caughey et al. 151 (4): 252 -- Annals of Internal Medicine), (b) forcing the mother to lie on her back with her feet in the stirrups rather than moving around naturally (this happened to me, and I know I could have birthed Charlie faster had I been permitted to crouch the way I wanted to), and, (c) generally being cold, sterile, and scientific instead of coaching/encouraging the mother and serving as her advocate. To me, it is common sense that if a birth is prolonged unnecessarily, there is a higher risk of complications developing simply because there is more time for them to develop.

Would you agree, at the very least, that insurance companies should not provide coverage for elective inductions before full-term?
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  #27  
October 12th, 2009, 06:58 PM
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Originally Posted by brui77 View Post
Would you agree, at the very least, that insurance companies should not provide coverage for elective inductions before full-term?
I don't know but I'm leaning to no.. you see, I've read about military moms doing this because dh's deployment date was on her EDD. If they are aware of the risks and are willing to do that, why not? It's their health care and they truly feel they are doing what's best for their family.
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  #28  
October 12th, 2009, 07:07 PM
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Originally Posted by (.Y.)mom2dd(.Y.) View Post
Midwives not only are trained but also have equipment. Assuming it's not a fully safe environment only speaks of your lack of knowledge of the training midwives have.

Having had an "uncomplicated pregnancy" that became a "complicated birth" (breech baby) resulting in an unplanned, unwanted section, things are not always as easy or simple as they look. I'm sure we can agree on that much.

Yes midwives are trained for many of these situations. HOWEVER, when these situations arrise there is a hospital transfer so that equitment is nearby. Midwifes have a lot of training and equitment, they train just as long as doctors really. They're also trained to know when to stop. Sometimes they choose not too, or the mother chooses not too. When these situations come up then its tragic.

I was lucky I had pre-natal care or I and my children wouldn't be here.

When you look at states of midwives vs OB's it must also be noted that midwifes take ONLY low risk uncomplicated pregnancies. So of course they run a lower number of complications on average.

There was a pannal who met to decide if I was even eligable do to my first section and my chance of having a second breech baby. They eccepted me.

When my baby was found to be breech an OB was one again involved and I was under the care of both an OB and a Midwife.

I live in Ontario. Midwives are covered by our provincial healthcare. For homebirth or for Hospital. There are not birthing centers in my city, we're too small. Interesting to note when you have a midwife and a transfer of care is done (to the OB) the OB is NOT paid for his services. The midwife is. So my OB didn't push for the second section for the money, he didn't get a dime of it. He and the midwife both fought to get me my VBAC. Since I am now "high risk" I no longer qualify for a midwife, the OB told me to go to him if I have anymore kids and he will try once again to get me a vaginal birth.

So while I support a womens right to have a homebirth, that right goes both ways. After all if I had not had the right for me sections, and had to pay, I would not be able too. I pay into the healthcare system just like every other Canadian, I have a right to use it. I know many women who, the only time they've used a hospital is when they gave birth.

Last edited by KimberlyD0; October 12th, 2009 at 07:12 PM.
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  #29  
October 12th, 2009, 07:12 PM
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I always find it interesting how when someone has to pay for something if they want to choose it, suddenly that becomes being "forced" to do something. If I got food assistance that offered cheese & I didn't like cheese, that isn't like I am "forced" to eat cheese, just because cheese is covered. Is it fair to say then that I am forced to have a hospital birth since a midwife isn't covered? I don't think I am being forced. I think it is nuts they don't cover it, but that is a different story.
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  #30  
October 12th, 2009, 07:15 PM
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Originally Posted by brui77 View Post
Because the government has a public interest in reducing health care costs for everyone, in order to improve the general standard of living. It's the same reason the government sponsors programs encouraging us to quit smoking, start exercising, and eat healthy. Not really their business, strictly speaking, but beneficial nonetheless.
But you are talking about two totally different things. I am all for the government offering programs to teach people about these different topics, but so far, as far as I know, the government doesn't cut you a check if you quit smoking. I think offering a childbirth class, maybe even a naturally birthing class such as Bradley or Hypno is a great idea, but I can't get behind the government cutting a check or issuing a tax credit for everyone that births at home. Another reason? We all know not everyone is a good candidate for home births, such as those in high risk pregnancies. But I could see a woman hiding facts from her midwife that would warrant a hospital birth, just so she could get the $$$ from birthing at home. It could be disastrous.

Quote:
Originally Posted by brui77 View Post
Sure, it's their choice, and no one is denying them that choice. What I am suggesting is that insurance companies should deny them coverage for that choice.
You are talking about taking major steps backwards. Women all over this country are fighting to give birth the way they are comfortable with (mainly home birthers) and have their insurance cover it. To go 180 the other way and deny coverage for hospital birth is just as wrong as denying coverage for a home or birthing center birth.
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  #31  
October 12th, 2009, 07:21 PM
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Originally Posted by beck12 View Post

After all, historically, almost all births happened at home, and there's no reason that women are biologically any different today from what they were in the 1700's or 1800's.


And before anyone says women & babies died by the hoards BEFORE hospitalized birth became the norm:

Corroborating Citations on the Safety of Homebirth
Oo you are reading a lot into that. The 1950s? Ok yeah our ranking among nations changed but mother and infant mortality over all in the US continued to decrease. Then over the course of the next 30-40 years mortality continued to decrease, our ranking among nations just isn't so hot...

Also... women are biologically different, sorta. Our nutrition is better... makes us healthier, right? Well it also means BIGGER BABIES and MORE FULL TERM BABIES. Bigger, more full terms babies, and women with the same sized hips.

Quote:
Originally Posted by (.Y.)mom2dd(.Y.) View Post
I think that's the entire problem here. You're assuming that the hospital avoids birth accidents when statically it's the hospitals that cause the birth accidents.
Depends on what you mean by accident. YEs, minor problems are caused, but accidents that kill mommy or baby are rare. Major things can go wrong during a birth that could cause a woman to die in minutes. You may think midwives are equipped to deal with these issues, but a midwife can't perform surgery and in some cases real medical attention is required to stop the bleeding quickly.

Yeah maybe at the hospital you have an episiotomy or the baby ends up with a broken clavacle, but at least your chances of bleeding to death are greatly reduced.




Quote:

Midwives are trained to deal with these "accidents." I think you're assuming that only hospitals are equipped to deal with these senerios.
No they really aren't. Not the bad accidents. YEah simple things like breech baby, cord around the neck, meconium. There are major things that can go wrong in an uncomplicated pregnancy. My first pregnancy was beyond uncomplicated and I'd be dead if I had expected to give birth at home. Dead as a door nail sorry to say.

Quote:
Originally Posted by brui77 View Post
Sure, it's their choice, and no one is denying them that choice. What I am suggesting is that insurance companies should deny them coverage for that choice. Just like insurance companies would deny me coverage for most types of plastic surgery -- or for teeth whitening -- or for a full x-ray scan of my retina, like I was offered at the eye doctor the other day. At some point, we do have to take financial issues into consideration and make a decision about which types of medical procedures give us the most "bang for our buck." Otherwise, why shouldn't insurance companies pay for every single one of us to have our DNA fully mapped, so that we can all better avoid/prepare for any possible inherited diseases? It would be nice, but it's not cost-efficient. I am suggesting that hospital births may be the same way.
If you take away insurance coverage for it, you are taking away the choice. If my insurance didn't cover a hospital birth there is no way I could pay for it and we both make decent salaries really. I would be forced to have a home birth and I'd probably be dead. Truly.
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  #32  
October 12th, 2009, 07:22 PM
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Originally Posted by KimberlyD0 View Post
Having had an "uncomplicated pregnancy" that became a "complicated birth" (breech baby) resulting in an unplanned, unwanted section, things are not always as easy or simple as they look. I'm sure we can agree on that much..
Breech babies can be delivered by a midwife. I was at a high risk of having a breech baby so I looked into it throughly. I was devastated to find out that all breech babies here in Calgary were c-section babies. (I prayed and visualized having a head down baby. I was stoked when we learned she was in a head down position.) I remember very specifically the recent thread here that annouced the guidelines of breech baby protocol changing here in Canada so that not all breech babies are forced to have c-sections immediately. I also remember you being very upset because it was suddenly possible that you didn't need to have a c-section based off of the change of this regulation. So I'm not too sure why you would use a breech baby as an example of a complication during birth that would result in an unplanned, unwanted c-section when the dynamics of this have changed so much since both of us had births?

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Originally Posted by Lilmom View Post
Depends on what you mean by accident. YEs, minor problems are caused, but accidents that kill mommy or baby are rare. Major things can go wrong during a birth that could cause a woman to die in minutes. You may think midwives are equipped to deal with these issues, but a midwife can't perform surgery and in some cases real medical attention is required to stop the bleeding quickly.

Yeah maybe at the hospital you have an episiotomy or the baby ends up with a broken clavacle, but at least your chances of bleeding to death are greatly reduced.


No they really aren't. Not the bad accidents. YEah simple things like breech baby, cord around the neck, meconium. There are major things that can go wrong in an uncomplicated pregnancy. My first pregnancy was beyond uncomplicated and I'd be dead if I had expected to give birth at home. Dead as a door nail sorry to say..
Again, there is a huge underestimation of what a midwife can do. They know when things are getting too complicated to handle and when a birthing mom needs a transfer to an OB/GYN. I don't disagree that a relative easy pregnancy can change in birth but that doesn't mean a midwife isn't equipped with knowledge on how to handle that with change with the right protocol.

Last edited by (.Y.)mom2dd(.Y.); October 12th, 2009 at 07:27 PM.
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  #33  
October 12th, 2009, 07:33 PM
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Originally Posted by (.Y.)mom2dd(.Y.) View Post
Midwives not only are trained but also have equipment. Assuming it's not a fully safe environment only speaks of your lack of knowledge of the training midwives have.
You are right, maybe I don't know exactly what equipment your midwife will bring but I can pretty much bet it isn't everything that is available at a level III NICU.

All I am saying is you never know what will happen. Personally, I would want to be prepared for the sake of my baby.

Quote:
Originally Posted by brui77 View Post
Would you agree, at the very least, that insurance companies should not provide coverage for elective inductions before full-term?
Depends on the reason. I had an elective induction at 39 weeks. Technically I was term but it was an induction regardless. I was induced because it would have been dangerous for me to go into labor on my own given the meds I was on to keep my placenta from forming a clot. I would hope my insurance wouldn't deny me of coverage because doing the induction kept me and my baby safe. I think you are assuming that elective inductions before term happen often? I don't know of any OB that will induce BEFORE term (term being 37 weeks...more are leaning toward not doing them before 39 weeks) just for fun. I know there are some OBs who are happy to induce but I doubt they will do it before term for no medical reason.
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  #34  
October 12th, 2009, 07:41 PM
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Originally Posted by (.Y.)mom2dd(.Y.) View Post
Again, there is a huge underestimation of what a midwife can do. They know when things are getting too complicated to handle and when a birthing mom needs a transfer to an OB/GYN. I don't disagree that a relative easy pregnancy can change in birth but that doesn't mean a midwife isn't equipped with knowledge on how to handle that with change with the right protocol.
It isn't nessesarily the skill level of the midwife I am concerned with. Lack of resources like I mentioned before but also lack of support. I have resuscitated many newborns and I don't care how skilled you are you cant do it alone. There are at least 3 sets of hands on the baby at once and sometimes that isn't enough.
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  #35  
October 12th, 2009, 07:42 PM
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You are right, maybe I don't know exactly what equipment your midwife will bring but I can pretty much bet it isn't everything that is available at a level III NICU.

All I am saying is you never know what will happen. Personally, I would want to be prepared for the sake of my baby..
I get you have complete confidence and faith in hospital births and I support your right to have one there. I just wanted to point out that your last statement is a bit condescending because moms who have homebirths are prepared for the sake of their babies. Deaths happen in the hospital as well as at home. Having a homebirth or a hospital birth isn't a reflection of how much a birthing mom loves her child or her ability to know what's best. Every mom who has a less than perfect outcome questions what they did wrong.

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Originally Posted by BabyBird View Post
It isn't nessesarily the skill level of the midwife I am concerned with. Lack of resources like I mentioned before but also lack of support. I have resuscitated many newborns and I don't care how skilled you are you cant do it alone. There are at least 3 sets of hands on the baby at once and sometimes that isn't enough.
You experience worse case senerios because you're at a level 3 NICU.. I can't express to you enough that a midwife isn't some layperson.

Last edited by (.Y.)mom2dd(.Y.); October 12th, 2009 at 07:45 PM.
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  #36  
October 12th, 2009, 07:49 PM
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Originally Posted by BabyBird View Post
It isn't nessesarily the skill level of the midwife I am concerned with. Lack of resources like I mentioned before but also lack of support. I have resuscitated many newborns and I don't care how skilled you are you cant do it alone. There are at least 3 sets of hands on the baby at once and sometimes that isn't enough.
I agree with this. Ironically, I was supposed to have a midwife birth in the hospital, and it was a nurse who ended up causing my unplanned section, so I see Michelle's point, too.
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  #37  
October 12th, 2009, 07:52 PM
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Oo you are reading a lot into that. The 1950s? Ok yeah our ranking among nations changed but mother and infant mortality over all in the US continued to decrease. Then over the course of the next 30-40 years mortality continued to decrease, our ranking among nations just isn't so hot...

Also... women are biologically different, sorta. Our nutrition is better... makes us healthier, right? Well it also means BIGGER BABIES and MORE FULL TERM BABIES. Bigger, more full terms babies, and women with the same sized hips.
I think you are reading into it - I am just quoting stats.... Our ranking is WELL below countries where home birth rates are much higher & women are no different biologically than we are..such as some countries in Europe.
Quote:
"In The five European countries with the lowest infant mortality rates, midwives preside at more than 70 percent of all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland's maternal and infant mortality rates are far lower than in the United States..." ("Midwives Still Hassled by Medical Establishment," Caroline Hall Otis, Utne Reader, Nov./Dec. 1990, pp. 32-34)
Last I knew our nutrition & hips are no different than the Dutch??? I have been there (Holland), it didn't seem any different in that regard at all. If you took those women & plopped them here, they looked pretty American to me.

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Originally Posted by BabyBird View Post
You are right, maybe I don't know exactly what equipment your midwife will bring but I can pretty much bet it isn't everything that is available at a level III NICU.

All I am saying is you never know what will happen. Personally, I would want to be prepared for the sake of my baby.


Depends on the reason. I had an elective induction at 39 weeks. Technically I was term but it was an induction regardless. I was induced because it would have been dangerous for me to go into labor on my own given the meds I was on to keep my placenta from forming a clot. I would hope my insurance wouldn't deny me of coverage because doing the induction kept me and my baby safe. I think you are assuming that elective inductions before term happen often? I don't know of any OB that will induce BEFORE term (term being 37 weeks...more are leaning toward not doing them before 39 weeks) just for fun. I know there are some OBs who are happy to induce but I doubt they will do it before term for no medical reason.
If you were not medically a candidate to go into labor naturally then you are likely not a candidate for a homebirth anyway - so the insurance thing would be an issue where you would be someone who would require a hospital delivery. Most women aren't on meds their whole pg or monitored as closely as you were.

I don't think I would have been seen as a likely candidate either since they thought my risk of c-section was high initially. This time around my own Ob has said I could be a good candidate...but there are no midwives in my area that do homebirths.
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  #38  
October 12th, 2009, 08:12 PM
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Originally Posted by (.Y.)mom2dd(.Y.) View Post
I get you have complete confidence and faith in hospital births and I support your right to have one there. I just wanted to point out that your last statement is a bit condescending because moms who have homebirths are prepared for the sake of their babies. Deaths happen in the hospital as well as at home. Having a homebirth or a hospital birth isn't a reflection of how much a birthing mom loves her child or her ability to know what's best. Every mom who has a less than perfect outcome questions what they did wrong.


I totally did not mean to say that women who have a homebirth don't care about their babies. Everyone has a right to do what they think is best...that is why I said I PERSONALLY would want to be more prepared. Say I had an abruption in the hosptial, the outcome would be completely different if the same happened at home. Of course I would wonder if I did something wrong but I would know my baby had a better chance at survival having the resources available to take care of the situation. Of course no one WANTS an emergency c/section but I would rather be cut open than bleed out on my own bed.


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You experience worse case senerios because you're at a level 3 NICU.. I can't express to you enough that a midwife isn't some layperson.
I realize a midwife isn't a layperson. I know they have training...I can't express to you enough that even with training you don't have 8 hands or a ventilator strapped to your back! Again, you can't predict when an emergency will happen. Yes, i work at a level III NICU but I take care of babies whose mothers had "normal" uneventful pregnancies...not just high risk deliveries. It just so happens that they deliver in the hospital and can be taken care of. I have also taken care of babies who were brought in from home or a birthing center in respiratory distress and shocky because they had a stressful delivery.
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  #39  
October 12th, 2009, 08:16 PM
Tofu Bacon
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Originally Posted by KimberlyD0 View Post
When you look at states of midwives vs OB's it must also be noted that midwifes take ONLY low risk uncomplicated pregnancies. So of course they run a lower number of complications on average.
Not so. Suppose I were under the care of a midwife, but complications arose that resulted in me having to be under the care of an OB for the delivery, I could still see the midwife for all of my remaining prenatal care and the outcome of my birth would still be tallied under the midwife, not the OB.
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  #40  
October 12th, 2009, 08:20 PM
KimberlyD0
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Originally Posted by (.Y.)mom2dd(.Y.) View Post
Breech babies can be delivered by a midwife. I was at a high risk of having a breech baby so I looked into it throughly. I was devastated to find out that all breech babies here in Calgary were c-section babies. (I prayed and visualized having a head down baby. I was stoked when we learned she was in a head down position.) I remember very specifically the recent thread here that annouced the guidelines of breech baby protocol changing here in Canada so that not all breech babies are forced to have c-sections immediately. I also remember you being very upset because it was suddenly possible that you didn't need to have a c-section based off of the change of this regulation. So I'm not too sure why you would use a breech baby as an example of a complication during birth that would result in an unplanned, unwanted c-section when the dynamics of this have changed so much since both of us had births?


Again, there is a huge underestimation of what a midwife can do. They know when things are getting too complicated to handle and when a birthing mom needs a transfer to an OB/GYN. I don't disagree that a relative easy pregnancy can change in birth but that doesn't mean a midwife isn't equipped with knowledge on how to handle that with change with the right protocol.

Thats dependent one the TYPE of breech.

Frank Breech or bum down is the safest, but still has a high rish of the head becomeing stuck.

Footling Breech extrealy high chance of baby becomeing stuck

Transveres (sideways baby) can't be delivered saftly. Leads to infant and mothers death.

Even the midwives can't do a breech delivery ALL the time.

Believe me when I say we tried everything to turn the babies.

DD#1 I hemeraged 2 days after the section, saved because I was in the hospital.

With DD#2 she turned when I got the spinal, no one checked. Turns out that saved my life and hers. She had the cord around her neck 4 times and leg once. Apgars very low. Plesenta was stuck, hemeraged on the table. Plesenta had to be removed forceably, no idications of problems before the birth.

If they had allowed me to birth her naturally, she might have been ok because the cords could be most likly delt with. However I would have needed emergency sergery.

I credit both the midwife and the OB with saveing my life. Him for doing what he needed to, and her for supporting me though it.
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