Homebirth vs. Hospital

Now really, I don’t like to face them off like that, but for the purposes of this post maybe I will.

I’ve had a few people ask which I prefer now that I’ve done both.  A few people assume that I preferred the hospital (an assumption I kind of resent) and a few people were completely baffled as to why I wouldn’t have had a second homebirth (which makes me feel like I owe some kind of apology).

Since I addressed some of my concerns in a post prior to birth I’m going to address it now:

I do not think that one is always going to be better than the other.  First, it totally depends on who is involved in each (not only the mother, but the support people and the midwives/doctors/nurses) as to which is a better option.  Second, there are so many different elements over the course of almost a year to consider that I don’t think you can flatly say one is always better in every category than the other.

I think the best way is to break it down by category:

Prenatal Care:

This is actually a tie for me.   Each time I got the type of care that I wanted and needed.  With my first pregnancy I really wanted very minimal testing and I got that.  We checked vitals at each appointment, but I did not do any ultrasounds or blood testing.  I really didn’t want them or feel I needed them.  With my second pregnancy I did more, but it was still pretty minimal.  I had routine blood testing (not a big deal) but I passed on other testing that was available.  We had three ultrasounds: one at 10 weeks (and I did feel I needed that because I was very nervous about the pregnancy being viable- being able to see a little embryo and hear the heartbeat put me at ease), one at 18 weeks (and this time I did want to know the sex, plus it was another relief to see that the basic anatomy was as it should be), and a final one at 36 weeks (that one I didn’t really feel was necessary but I didn’t really think there was a need to fight it at that point either.)

The other testing I did the second time that I did not do the first was the glucose tolerance screening (otherwise known as the 1-hr test).  I failed.  Rather than do the 3-hr test, my OB agreed to me meeting with the dietitians to discuss the GD diet and then having me test my blood sugar four times a day.  I did this for a few weeks and my numbers were great and all within the appropriate range, so after a few weeks I was able to stop doing that although he advised that I continue following the GD for the remainder of my pregnancy.  That wasn’t a big deal to me because it wasn’t too far off from how I was eating anyway.  I actually did continue to test my sugar just to hold myself accountable.   I was really thrilled with the way we were able to handle this.  I understand the importance of blood sugar being under control, but I feel that the screening test isn’t very reliable.  After all, when do I ever put 50 g of pure glucose into my body on an empty stomach without any protein to balance it out and then sit around for an hour.  No wonder my body didn’t know what to do with that sugar load, you know?  Plus I loved being able to monitor my blood sugar myself.  It was one more thing I could keep an eye on and I could see what my body was actually doing.  It turns out I was handling sugar just fine, so I didn’t get stuck with a GD diagnosis.  If  I had taken the 3-hr test and failed (and I very well might have) I would have been stuck with that GD label.

Another element is the personal connection factor.  One of the things I loved about having a midwife the first time was just the way my prenatal visits were.  I would go to my midwife’s house and sit on the couch in her living room for an hour.  She would check everything and then we could sit around and talk.  It was very relaxed, I was never rushed, I knew who I was seeing (obviously) and developed a relationship with her.  I was never sitting around in a waiting room for an hour.  I had a friend who was pregnant the same time as I was and I knew her experience with her OB was very different.

This is one of those “it depends on the doctor and the office” sort of things.  One of the reasons I can say that this category is a tie is specifically because of who I saw for my second pregnancy.  My OB has a solo practice, so I was never going to go in and get some other doctor, it was always him.  In fact, it was also always the same nurse.  I got to know everyone who works in that office.  Plus, I already knew my OB’s wife (who also works there) because she leads our local LLL.  I felt like I was me, and known for being me,  not just another pregnant woman being churned through the system.  Plus, the longest I ever had to wait was 10 minutes, and that was in part because I arrived early that particular day.  Normally I came in, checked in, stopped into the bathroom and by the time I came out they were ready for me.

I should probably add here that both my pregnancies were free of complications and that we (myself and my babies) were blessed with good health.  If the need for medical intervention had arisen during my first pregnancy, I was aware that my midwife had a back-up OB that she would have sent me to.  Not all midwives use a back-up OB.  This time I was afraid that I would have some complications and although I didn’t, starting out seeing an OB was a relief to me because I knew he would be able to help me if something came up.

Labor

Homebirth wins hands down for this one.  (Once again, both my labors were spontaneous so I didn’t need any interventions.  It think that makes a difference since  I didn’t need an induction.)  I would always want to labor at  home if I could.  Sure, you have to protect your floors and mattress, but laboring at home is SO.MUCH.BETTER.

At home I was free to move around as needed, I could drink and eat as I pleased.   I felt comfortable being on the floor to kneel and lean against the ball or the bed.  Probably most importantly, my husband was much more relaxed and comfortable supporting me at home.

The hospital scores negative points for automatically insisting I lay in bed hooked up to an IV of fluid and tied to the EFM.  I get why they do it, but blech!  It was very uncomfortable to labor like that.  Even though I was taken off the IV and allowed to move around, I still had to periodically be hooked back up to the monitor…or I would have if I had labored longer.  As it was there wasn’t much time for a second monitoring period.  Also, trying to answer questions and have blood drawn as well as an IV started while having major contractions just plain sucks.  Not to mention that M wasn’t anywhere near me during all this, instead he had to get out of the way and so I had less physical support from him once at the hospital.

Birth/Immediately After

The home experience wins here too.  Basically as soon as he was out I got to hold my baby.  He was there for us to cradle he had to be taken away so that I could get the attention I needed.

As for the hospital experience: I am still a little perturbed that they took him right away instead of giving him to me and then it was a good 10-15 before I finally got to hold him.  To be clear, he didn’t need any special attention, I think the nurses flipped out because the doctor wasn’t there when I delivered.  At least M went over there and when little I opened his eyes for the first time he saw his daddy.  When I did finally get him he latched on right away and we had a good long time together and it was good, which despite getting E right away at birth we kind of missed that at home with him.  So I guess it all evens out.  Home was much calmer, much more affirming though.  My midwife was encouraging and there was such excitement in the room, especially when M could see E’s head.  In contrast, at the hospital they were flipping out and telling me not to push (yeah, right!) and M was actually freaked out by all the flurry.  I was fine and wanted to touch him as he came out (and did actually) and the one nurse (same one who took I away right away) pushed my hand away and snapped at me.  Please!  It was my body and my baby!

I did find that my body was given more care and attention at the hospital.  I really appreciated that because I kind of feel that was lacking at home.  We were trying to spread the good news and then I was getting instructions for myself that only half registered and since it was my first birth I didn’t know exactly what to expect or how to care for myself.  I mean I figured it out ok, but I certainly feel it could have been better.

First 24-36 hours Post-Partum

Hospital wins on this one.  Despite the lack of sleep because of the constant interruptions in the hospital, the truth is we didn’t sleep the night after E was born either.  I think we were terrified for one thing because there we were all alone with a newborn who was only a few hours old(!!!) and for another I know that I was really keyed up from everything that had happened and kept replaying it in my head.  Basically I don’t think the adrenaline had died down enough to let me sleep.

I say the hospital wins because it was such a relief to be able to send little I to the nursery once he was asleep and know he was being watched.  They were really good about bringing him back to me to nurse (see the lack of sleep I was able to get).  I didn’t need it this time so much, but there was all kinds of little how-to videos that were at least a good refresher and something to watch when I was bored.  A nurse came in and spend a good amount of time just reviewing basic care things with us.  She had great bedside manor, so it was mostly like “I’m sure you know this, we just go over this with everyone” and not condescending at all.  Even M remarked to me that it would have been nice to have had that the first time.

I already touched on my care, but as much as I hated being hooked up to the pitocin drip for 12 hours after birth, I definitely felt like I was being monitored and cared for at the hospital too.

I guess the truth is I felt a little overwhelmed and abandoned even after the home birth.  I will take some responsibility for that because maybe I needed to be clearer about what I needed, however, I don’t think I even knew what I needed.  It would probably have been different too if I had a doula and really I probably should have looked into that more, but I don’t think there are too many around us.

Conclusion

So all in all I really had good experiences with both pregnancies and births.  There were elements I really liked in with each experience and each experience had negatives too.  What will I do again?   I’ll do OB/hospital.  It isn’t that I wouldn’t want another homebirth, I wish I had the option of seeing my OB but having a midwife be there for a homebirth as long as everything was ok.  That isn’t how it works here, I suppose I could try to set something like that up but it would be a lot of extra appointments, extra money, and a little difficult to navigate considering the midwife/homebirth vs. OB/hospital culture that exists here.

At this point even though I’ve not had major pregnancy complications, I have had some things come up that make me feel that I’m not really low-risk enough to be completely confident in staying home or at the very least not be under the care of someone who can actually write me prescriptions if I need them.  I don’t think homebirth is dangerous when you honestly access a situation and the woman is really low-risk, but I do think that it requires you to be really honest and not deny reality so that you can have a homebirth.  In order for it be safe we need to be honest with ourselves and with out providers.

Another big issue for me is that it is really hard to have to travel half an hour to an hour away for an appointment that will last at least an hour when you have other small children.  It wasn’t a big deal when it was our first, but with one or two kids…it gets complicated, and even if they are welcome at the visit, do you really want them there every time?  I really didn’t.  I wanted my prenatals visits to be about me and the baby and how we were doing.  I didn’t want to worry about corralling a 2-year old.  It just isn’t good for those blood pressure readings.

The last thing is that I find that I really do need to have an OB/GYN for my own health concerns and even for the breastfeeding support (as in help with breast issues, not baby feeding issues) and I didn’t have that connection when I used a midwife.  When I was about 5 weeks post-partum with E and got mastitis I had to go to Urgent Care instead of calling a doctor I knew.  Thankfully I didn’t have those issues the second time around, but it was reassuring to know help was only a phone call away.  If I were to go back to the homebirth/midwife route I would kind be severing those ties and I really don’t want to do that!

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