How considering out of hospital births can help educate the next generation of labor and delivery nurses.
Last weekend I hung out with a student just beginning her journey through nursing school. She's planning on working in labor and delivery when she graduates and had a few questions. Not surprisingly, her questions are ones I'm asked a lot.
What do I think of home birth?
My young friend thought I'd say they're dangerous and stupid and all women should deliver in hospitals. I actually shocked her when I said, "They can be some of the best, safest and most lovely births, especially if the mother is well-prepared, has a really experienced midwife and an excellent emergency back-up plan."
"But," she said, "the nurses at the hospital say it's too risky and when labor goes wrong and mothers have to be transferred to the hospital, it's a mess and mothers and babies are in deep trouble."
I asked her to consider why women might not want to deliver in the hospital in the first place and to imagine how they're treated at the hospital when laboring at home doesn't work out. We talked about how high rates of unnecessary interventions and c-sections make some women feel safer at home where the natural course of labor is respected. When a 'home-birther' is transferred to the hospital, frightened mothers and fathers are too often treated like idiots or bad parents. They're scolded, bullied and guilt-jerked when they question hospital procedures. Eyes are rolled, judgments are made and parents are left feeling defensive and wounded.
I asked my friend to consider that the only home birth patients most nurses and doctors see are the ones where something's gone wrong and they're expected to rescue a sick mom and baby. It's stressful for healthcare providers to take care of patients they don't know in emergency situations. Is it any wonder there's not a lot of love lost between the home birth and hospital birth cultures. Most home births work out just fine and most hospital transfers go smoothly when a home birth is no longer a good plan go smoothly. But if all you see are the disasters; that's going to put a sour taste in your mouth.
See more: The perks of home birth >>
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What do I think of midwives practicing without a Certified Nurse Midwifery license?
Again, I surprised the heck out of my young friend. Several avenues of education and training produce top-notch midwives. Certified Practical Midwives become experts in out-of-hospital births like at home or in birth centers. Certified Nurse Midwives have RN licenses as well as midwifery training, which helps them become experts in hospital births (though many practice at home or in birth centers). Many practical midwives (AKA lay midwives) who receive their training through apprenticeships are great too. The problem with lay midwifery though is that there's no specific educational pathway, curriculum or licensing process that determines they know what they're doing. Many are great. Some aren't, but the same can be said for all types of health providers.
See more: How to choose a midwife >>
Am I pro-home birth?
I think for some healthy mothers who have great, well-trained and careful midwives who know when and how to get patients to the hospital if complications arise, home birth can be a safe option and the data supports me on this one.
Do I think most women should use midwives?
Yeah, I kind of do, but not necessarily at home. Midwives are the experts at normal physiologic birth, whereas obstetricians are the experts for medically complicated ones. Most women don't have significant medical problems and are fully capable of having normal labors and births. The problem we're seeing in the US is too many normal mothers are being treated as if they have medical complications. Ironically, it's that over-medicalization of normal pregnancy and labor that's leading to increased complications.
At the end of our conversation I recommended this young student educate herself in all the options available to mothers, not just the ones presented by the hospital. I also hoped that as a brand new nurse, she'll be part of the revolution that makes hospital birth less intervention-oriented and more welcoming and respectful to all mothers.
Jeanne Faulkner, R.N., lives in Portland, Ore., with her husband and children. And co-author of, The Complete Illustrated Birthing Companion: A Step-by-Step Guide to Creating the Best Birthing Plan for a Safe, Less Painful, and Successful Delivery for You and Your Baby. Got a question for Jeanne? Email it to firstname.lastname@example.org and it may be answered in a future blog post.
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