I'm a new DAD!; I've got Questions!

[Heart_of_Dorkness]

Okay, first and foremost… CONGRATULATIONS! YIPPEE! HUZZAH!

Now:

Home birth vs. hospital -

If you’re low-risk, and very close to the birthing center, I think you’re probably fine to do it at home. Me, I had my baby 5 months ago, and I went to a hospital, and was thrilled with the experience. My cousin gave birth a month before me, and she did it at home, and also had a great experience - though not without complications. (She lives in a part of the world where home births are the norm, and hospitals don’t really have maternity wards, though.) I can tell you the details of both births if you like, but the *most *important thing, in my opinion, is that, whatever you choose, you don’t get too attached to having a specific kind of experience in a specific way in a specific place, because childbirth has a habit of going pear-shaped. Tell yourselves this every day, and let it really sink in: if you come out the other side with a healthy mom and a healthy baby, you’ve had a “good” birth experience.

I stress this because I know a lot of women who wanted to have home births, or drug-free births, or whathaveyou, and wound up having to have a heavily medicated C-Section in the hospital… and they were incredibly disappointed. They felt like failures, like they had compromised their ideals. They’re glad to have healthy, happy babies, but they still have regrets about the birth itself. And there’s absolutely no reason to feel that way. In my mind, they should be proud of themselves for putting the needs of their baby ahead of their own hopes and plans. That’s what good parents do.

My “stuff happens” anecdote: I had always planned to go to the hospital, but I would have been a great candidate for home birth: both the baby and I were very healthy, and I’d had an incredibly easy pregnancy. We’re also just a few minutes from the hospital. But - as happens about 10% of the time - my water broke before I had really started labor. I wasn’t dilated at all. This meant that I basically had to be induced. But the labor went really smoothly, and I still got to use my birthing ball and stuff, and watched the whole thing happen in a mirror, which was awesome. I had hoped not to need an epidural, but in retrospect, I should have had it sooner. It allowed me to relax, which helped me dilate quickly, and I was calm and comfortable during the actual delivery. The point is just that things went very well, even though they didn’t go according to my plans.

Incidentally, I think this is another reason doctors are sometimes anti-home birth: they have to treat women who tried to give birth at home, who are having complications that require intervention, but who are still trying to make things happen according to plan. They question everything the doctor does, and refuse or delay treatments, not for any medical reason, but simply because it’s not what they had imagined or hoped for. If you try a home birth and need intervention, understand that it is an emergency, and time is of the essence. I’m not saying you shouldn’t ask questions or be actively involved in your care and treatment, but just don’t prevent the doctor from helping you.

And a few other thoughts, in no particular order:

As much reading and preparation as you do for the birth, triple it for the baby. And do it NOW. Once the baby comes, you will have no time to read. At best, you’ll have a moment to refer quickly back to something you saw before. So get to know those baby books now.

That said, take all the books and advice with a grain of salt. They can certainly be useful, especially when, for example, your baby has vomited up everything it just ate, partly via its nose, with tremendous force, and is now smiling at you without a care in the world, or when it suddenly decides to stop pooping for a week, and you’re wondering if these things are normal (they are). But it’s really true that every baby is different, and what works for you is what works for you.

If your wife plans to breastfeed, find a lactation support group. I love breastfeeding, but it was incredibly painful and difficult for the first few weeks, and there are a host of issues (thrush, mastitis, “latch” problems, blocked ducts, engorgement) that are pretty common. If I hadn’t had support, I might not have stuck with it. Now, at 5 months, I’m pumping at work and nursing at home, and it’s all going swimmingly.

And possibly most important of all - be as involved as you can. You’ll be a hero to your wife, and a better dad to your baby. Change diapers, give bottles, give baths, run errands, and hold and hug that baby. Your wife will likely need more time to recover than either of you realize. Make sure she gets enough to eat and drink, especially if she’s breastfeeding, try to let her sleep/rest as much as possible, and make sure she gets a chance to shower at least every other day. Take as much time off as you can at the very beginning, but also consider doing part-time or modified hours or some other arrangement. Under FMLA, both dad and mom get 12 weeks of leave. My husband didn’t feel comfortable taking the full leave (especially in the current economy), but he took a few weeks off when I went back to work. It was a huge adjustment for me, after having cared for the kid 24/7 for months, and it made it so much easier to know that our baby was with someone he knew and loved, rather than having to go right into daycare. And my husband says he’s incredibly glad he had the chance to spend time getting to know him and bonding with him.

[Little_Bird]

@Phlosphr

There are numerous things that can go wrong in the hospital as well. I would think the with the advent of hospitals infant mortality went waaay down, but millions of children were delivered without a hospital for thousands of years, some in the dirt…

Yep, and squillions of them died.

Look, I’m not going to judge you if you have a home birth, as long as you have a qualified medical-trained professional right there and are prepared to hie thee to a hospital in minutes. It’s your choice and have at it. But to say that birth is natural and has been done for millions of years in sub-optimal conditions as reasons for not taking precautions is at best ignorant and at worst deadly.

I have seen the studies on homebirth being just as safe as hospital births and to me they seem sketchy. I wonder how they are controlling for the perceived riskiness of the birth? As I see it there are certain categories of births:
[ol]
[li]Low Perceived Risk, planned to birth at home, birthed at home[/li][li]Low Perceived Risk, planned to birth at home, ended up at hospital due to complications[/li][li]Low Perceived Risk, planned to birth at hospital[/li][li]High Perceived Risk, planned to birth at hospital[/li][/ol]
(this is weeding out any “High Perceived Risk, planned to birth at home” crazies and "Planned to birth at hospital, got stuck on the highway and birthed in a taxi oopsies.)

I can easily see Home Births looking as safe or safer than Hospital Births if you put item 1 in the “Home Birth” category and items 2-4 in the “Hospital Birth” category. But that’s not really fair, is it? Not apples to apples.

The way to compare the two should be using 1 and 2 as “Home Birth” and 3 as “Hospital” and disregarding 4 in the comparison entirely since a high risk birth should absolutely not be attempted at home. Looked at that way I’m sure Hospital Birth will look safer than Home Birth by miles.

[Jimson_Jim]

@Palo_Verde

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02175.x/abstract
Here’s another large study which looked at over 500,000 women.
…
Conclusions  This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

Have your baby wherever you want. I have nothing against hospital births. But in the spirit of fighting ignorance, but studies don’t show that they are safer.

Three things:
• That this study is based in the Netherlands of “low risk women” it is not a study of US home births.
• The abstract shows that over 60% of the mothers in the study planned to have home births. This may be a cultural preference for home births. If there is a cultural preference to home births there may be better or more efficient medical care supplied for the home birth. For all we know midwifes in the Netherlands may park a trauma ready ambulance in the driveway.
• Lastly consider the infant mortality rate in the Netherlands is is 4.7 deaths per 1000 births. By contrast the US rate is 6.3 per 1000 births (both numbers are from UN studies via Wiki). Thus something in either the health of the population or the health care system gives a baby a better chance to start with.

This study does not convince me that US home births are safer.

Oh and my wife was whisked into emergency C section after 11 hours of labor. Had we been doing home birth there is a very good chance our little one could have suffered brain damage from oxygen deprivation.

[needscoffee]

@Phlosphr

There are numerous things that can go wrong in the hospital as well. I would think the with the advent of hospitals infant mortality went waaay down, but millions of children were delivered without a hospital for thousands of years, some in the dirt…

So, it is the choice that matters, my wife’s safety and that of the infant are premier on my mind, the fact that some [not you] think that a home birth is looking away from safety speaks to just how far we have come in a society concerned with germs, vaccinations and taking the choice away from the family.

If you think that infant and mother mortality hasn’t changed since the advent of hospitals, you are vastly uninformed. I can’t remember the exact figure, but in a piece in The New Yorker, it was something like 1 in 135 births resulted in the death of the mother in the 1800s in the U.S.

[Smeghead]

@Palo_Verde

Repeat: scientific studies show it to be no more riskier to give birth at home than in the hospital. NO RISKIER. NO MORE DANGEROUS.

You know what they say about anecdotes and data. Well the data shows it is equally safe either way.

As Atrael pointed out, you’re glossing over some extremely important caveats there. However, this is not the statement against which I was arguing. I was arguing against your statement earlier that “If you get someone qualified and take the normal precautions, it will certainly be fine.” I provided a counterexample, which proves your sweeping generalization incorrect. When you state an absolute, it only takes one example to invalidate it.

[needscoffee]

Something else to consider is that there is a large range between healthy infant birth and infant death. Such as any degree of preventable brain damage due to slight delays in medical procedures which can’t be performed at home. I know two adults who are moderately retarded due to lack of oxygen during birth. Brain damage occurs after only a few minutes. Death can occur after only 5 minutes. The cord can wrap around the neck during the birth, as happened to one of the people I mentioned.

The hospitals out here have had birthing suites with low lighting, etc. for over 20 years. Visit some ahead of time and see how you like them.

[raspberry_hunter]

@Heart_of_Dorkness

I stress this because I know a lot of women who wanted to have home births, or drug-free births, or whathaveyou, and wound up having to have a heavily medicated C-Section in the hospital… and they were incredibly disappointed. They felt like failures, like they had compromised their ideals. They’re glad to have healthy, happy babies, but they still have regrets about the birth itself. And there’s absolutely no reason to feel that way. In my mind, they should be proud of themselves for putting the needs of their baby ahead of their own hopes and plans. That’s what good parents do.

This! This! This! I was trying to say this in my post, but HoD says it far better.

And double this for breastfeeding.

[elfkin477]

@Jimson_Jim

• Lastly consider the infant mortality rate in the Netherlands is is 4.7 deaths per 1000 births. By contrast the US rate is 6.3 per 1000 births (both numbers are from UN studies via Wiki). Thus something in either the health of the population or the health care system gives a baby a better chance to start with.

One of the reasons that the US infant mortality rate looks the way it does in the US is because our numbers include micropremies who couldn’t be saved, while some other counties count those babies as stillbirths; when we talk about only full-term infants, the US mortality rate is 2.4 per 1000, which is less than one birth per thousand more than countries in the Netherlands. For reasons not fully understood, we also have more preemies than other countries too (I thought that it was established that it was mostly due to the rate of obesity, high blood pressure and diabetes, but…).

[Girl_From_Mars]

@Jimson_Jim

Three things:
• That this study is based in the Netherlands of “low risk women” it is not a study of US home births.
• The abstract shows that over 60% of the mothers in the study planned to have home births. This may be a cultural preference for home births. If there is a cultural preference to home births there may be better or more efficient medical care supplied for the home birth. For all we know midwifes in the Netherlands may park a trauma ready ambulance in the driveway.

The home birth debate rages here in AUstralia, with The Netherlands often quoted as an example that home births are safe. The thing is, that the medical system in The Netherlands is well set up to support home births - there is a well oiled process to transport home birthees to hospital, and the teams often work in conjuction. Here in Australia (and also likely in the US) - home birth is seen as a real opt out of the medical system, and there is often reluctance by the parents and midwives to acknowledge when the time has come to go to hospital, and often it is a car ride of more than just a few minutes with mum and or baby in distress - and that is where the difference seems to lie to a great extent. We’re just not set up to have an effective transfer mechanism.

The thing is, home births are great when everything goes well. If someone had guaranteed me that I could have birthed at home and we’d have no complications, it would have been great. But there are very small, but incredibly serious risks that something bad could happen, and at the end as someone above has said, the goal here is a healthy baby at the end.

The birth experience you mention is completely you’re wife’s choice, and her experience. The baby will have no memory of it. The question for me was not, what is the best experience for me, but what will the best outcome for the baby be.

I laboured at home for 38 hours with no medication and no doula (but Boy From Mars and my Mum, which was helpful), and when I felt I was almost there we drove 10 minutes to hospital, and my daughter was born half an hour later under the care of my midwife and OB.

Seriously consider options like that, or a birthing centre - my OB accepted my no drugs, no episiotomy, no induction etc birth plan without issue, although I had the caveat - unless it was really medically necessary. Find a doctor and a birthing centre who will support what you want.

[overlyverbose]

I almost forgot - Congratulations!

I hope that, whatever you decide, you and your wife have a great experience. For what it’s worth, here’s my advice: no one likes to think of what could go wrong, especially the first time around. I know I didn’t, and I wish to God I’d done more research on potential complications beforehand as well as what to expect if it did.

The crappy thing is that, when you read about what could happen, you think that it’s a wonder anyone’s born healthy at all. But at the same time, knowing what could go wrong and being able to react wherever you are can really improve whatever experience you might have, even if it’s just by empowering you with knowledge so you know what’s going on and can answer and ask the right questions.

And like raspberry said, your wife should not feel guilty at all if her birth doesn’t go the way she wants. And she shouldn’t feel bad if she can’t breastfeed for whatever reason. I promised myself the first time around that I’d never subject my poor baby to drugs and that he would never ingest the awful chemical soup that was formula. Unfortunately, a 2.5 day labor, lack of nutrition (wasn’t allowed to eat for 4 days after eclampsia and couldn’t stomach it for 7 days after) and 2-week long migraine after eclampsia made changing my mind a necessity.

[Lamar_Mundane]

Phlosphr, IIRC you are in the Boulder area. If you are, you should be able to get tons of support for what you are looking to do, and it will be very professional.

Still, I think it is part of a Dr’s professional duty to tell you the facts about the process, and giving birth is going to be safest in a hospital. Keep in mind that virtually all of the highest risk births are going to be done in a hospital, so that skews the statistics. If you compare only healthy, young mothers with no complications, the hospital births are going to have better outcomes than home births.

That said, if you’re having issues with your OB/GYN, look into The Boulder Women’s Clinic on Arapahoe. The Dr.s are a married couple, the McSalkas, and they are very friendly to non-traditional requests. They probably wouldn’t participate in a home birth, but they would advise you and give referrals to make it the safest and best delivery.

Both of my kids were delivered by them (actually, they were delivered by me. At the right moment, he, and she the other time, pointed at me and said “get over here” and had me pull my kids out of the birth canal), in a birthing facility adjacent to the hospital. Mine were at the old office next to Boulder Community Hospital on Broadway, but it seems they have moved to the new hospital. The birthing rooms were like a bedroom with comfy furniture and regular lighting, etc. It was about as non-hospitally as you can be, but the hospital was yards away if things went wrong.

It sounds as if you are looking for something a little more basic, but as I said, they would probably guide you through the process most professionally, while providing pre-natal care.

Just a thought.

[PeskiPiksi]

@raspberry_hunter

This! This! This! I was trying to say this in my post, but HoD says it far better.

And double this for breastfeeding.

Hear Hear!

[Phlosphr]

@Lamar_Mundane

Phlosphr, IIRC you are in the Boulder area. If you are, you should be able to get tons of support for what you are looking to do, and it will be very professional.

That said, if you’re having issues with your OB/GYN, look into The Boulder Women’s Clinic on Arapahoe. The Dr.s are a married couple, the McSalkas, and they are very friendly to non-traditional requests. They probably wouldn’t participate in a home birth, but they would advise you and give referrals to make it the safest and best delivery.

It sounds as if you are looking for something a little more basic, but as I said, they would probably guide you through the process most professionally, while providing pre-natal care.

Just a thought.

Yes we are, and that is exactly the birthing center I am talking about. They have been incredibly helpful and the midwife can certainly be in the room, all things I am very happy about.

We are simply covering all the bases and it’s not really a back to basics thing, but more of a wanting a choice thing. So far Boulder has been very good at hosting us, as a matter of fact, there are so many midwives and dulas around it’s hard to make a choice. And we are not opposed to the birthing center, we just want to have all our bases covered. And I was informed of the "husband and wife OBGYN team just the other day by a really cool midwife - I am assuming she was talking about the same people.

[Lamar_Mundane]

@Phlosphr

Yes we are, and that is exactly the birthing center I am talking about. They have been incredibly helpful and the midwife can certainly be in the room, all things I am very happy about.

We are simply covering all the bases and it’s not really a back to basics thing, but more of a wanting a choice thing. So far Boulder has been very good at hosting us, as a matter of fact, there are so many midwives and dulas around it’s hard to make a choice. And we are not opposed to the birthing center, we just want to have all our bases covered. And I was informed of the "husband and wife OBGYN team just the other day by a really cool midwife - I am assuming she was talking about the same people.

Almost certainly they were, they’re pretty famous around here.

If that’s the direction you are going, then you are in good hands. The people at the clinic are true professionals, just with an “earthy” twist. They also have a nutritionist on staff who would be able to consult with your wife on her diet.

Anecdote: While wife was pregnant with my first daughter, we were taking Lamaze classes in the clinic. One of the nurses came downstairs with a placenta from just-completed birth to show us. She said we couldn’t touch it because she had to take it back to the mother, who was going to eat it.

[Phlosphr]

@Lamar_Mundane

Anecdote: While wife was pregnant with my first daughter, we were taking Lamaze classes in the clinic. One of the nurses came downstairs with a placenta from just-completed birth to show us. She said we couldn’t touch it because she had to take it back to the mother, who was going to eat it.

Mmmmm

[Lasciel]

@Lamar_Mundane

Almost certainly they were, they’re pretty famous around here.

If that’s the direction you are going, then you are in good hands. The people at the clinic are true professionals, just with an “earthy” twist. They also have a nutritionist on staff who would be able to consult with your wife on her diet.

Anecdote: While wife was pregnant with my first daughter, we were taking Lamaze classes in the clinic. One of the nurses came downstairs with a placenta from just-completed birth to show us. She said we couldn’t touch it because she had to take it back to the mother, who was going to eat it.

Erk. And I thought burying it under a new-planted tree was a little on the hippy side.

[Drain_Bead]

What’s crazy is that if I’d followed the adage of “labor as long as you can at home before heading to the hospital,” my daughter almost certainly wouldn’t be here today. And before I decided to homebirth, that’s what my hospital midwives suggested I should do. It was only because I had my exceptionally trained midwives there with me at home that everything went fine when it all went tits-up.

[Voyager]

Congrats. Another anecdote.

My wife, who had a very easy pregnancy, no morning sickness, started throwing up with every contraction when she went into labor. We drove to the hospital with a basin. At 1 am or so. I discover that you get very good service as far as getting a room when you are about to barf on the floor of the ER. During her fairly long labor she spewed things from every orifice. We were quite happy to not be the ones cleaning this up.
At the very end of the labor they discovered that our daughter had a heart irregularity, and they did a forceps delivery, in an OR. It fixed itself, and I’m not sure she was in any danger, but those doctors moved! The heart irregularity, happily, cleared up by itself.

This was almost 30 years ago, and the birthing room was quite pleasant. Today, certainly in Boulder, I suspect you can have company and all sorts of stuff you want. My wife thinks that women who want their sisters and their cousins and their aunts in the room with them are nuts, but it seems to be possible.
The birthing process can be a spiritual experience, or it could be a bloody mess. What is a spiritual experience is holding your child for the first time. I did it once in an OR, and the second time in the birthing room, and the surroundings made no difference to how wonderful it was.

[Voyager]

@Palo_Verde

Repeat: scientific studies show it to be no more riskier to give birth at home than in the hospital. NO RISKIER. NO MORE DANGEROUS.

You know what they say about anecdotes and data. Well the data shows it is equally safe either way.

You have been given several examples of babies who would have died in a home environment, but who survived in a hospital environment. Can you give us examples, or even scenarios, of babies who would have lived at home and died in the hospital? If not, your conclusion is suspect, and there must be self-selection going on. I wonder how a baby born at home, has problems, and eventually dies in a hospital is counted.

[Drain_Bead]

How about looking two posts up? When I was planning a hospital birth, the midwives at my GYN practice said “Labor as long as you want at home, then go to the hospital when you feel ready.” Had I done that, I would have been completely alone (well, other than my husband) when my daughter’s cord prolapsed, and she would have died.