Are Home Deliveries Safe?

I'm pleased to host Tanya Cunningham today as she discusses the safety of home deliveries. I think this is another one of those instances where some important information is not as prominent as what is portrayed by celebrities and others.

What do you think? Welcome, Tanya!

The birth of a new baby is a life changing, exciting event in the lives of the expecting mother and father to be. The number of decisions to be made are numerous and often overwhelming. One question many expecting parents ask is whether to give birth in a hospital setting or at home with the aid of a certified nurse midwife (CNM).

Although there are benefits to both hospital and home births, the American College of Obstetricians and Gynecologists does not recommend home births due to a concern for safety and a need for much more research according to Dr. Joseph R. Wax of Maine Medical Center in Portland.

The benefits of home births that appeal to expectant mothers include a more relaxed or therapeutic setting, decreased risk of tearing and episiotomies, decreased risk of hemorrhage, decreased risk of infections, and a sense of autonomy concerning her birth plan.

In a systematic review of literature by Laurie Barclay, MD and Hien T. Nghiem, MD, they found that planned home births have a worrisome neonatal mortality rate triple that of hospital births, despite similar perinatal mortality rates. So while an actual delivery may go as planned, triple the number of newborns die in the first month of life after a planned home birth.  Barclay and Nghiem also found the 9% of parous (repeat mothers) and 37% of nulliparous (first time mothers) had to be transported to the hospital during planned home labor.

Other safety concerns I personally cannot ignore is the “what if” factor. Hopefully everything does go as planned whether delivering at home or at a hospital, but what if the new mother does hemorrhage in the postpartum period? The amount of blood loss in minutes can be catastrophic, and if it's me, I want to be in a hospital setting where quick and timely interventions such as an emergent blood transfusion can save my life.

Another example is fetal distress. If severe or prolonged enough, an emergent or “crash” c-section may be a necessity. Again, if it's me in the delivery room, I take comfort knowing an OR is seconds away if needed.

I love the idea of the home delivery, but I don't love the realities. The reality is, even in the most straightforward, low risk pregnancies, unforeseen and even emergent complications can occur during labor and delivery. I do feel the OB hospital setting and staff have been vilified a bit, as time driven, heartless wardens chaining the laboring woman to a hospital bed with fetal monitoring against her will.

As a postpartum RN, I can assure you our first interest is the health of the mother and baby. As long as their well being isn't compromised, mothers are encouraged to labor as they wish. At the hospital where I work, women are free to roam the halls and utilize birthing balls and birthing tubs. There are many women who deliver naturally, and their birth plans are respected and followed.

If you've had a negative experience in a hospital setting delivering a baby, feeling rushed by medical interventions or that a c-section might have been premature, remember, that may be more of an issue with your health care provider or the staff working at the time. I'd encourage you to research doctors who are more flexible and work with expectant/laboring mothers to follow their birth plans as closely as possible.

We who are in the business of delivering and caring for new mothers and babies seek to be as therapeutic as possible, but there are times when medical interventions are necessary to protect the health and well being of either the mother or baby. While delivering a baby at home might be more desirable to an expectant mother as far preserving her autonomy, the truth is hospital deliveries are safer. If you're expecting or planning to have a child in the future, be sure you make an informed decision when considering where to deliver your precious little one.

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Tanya Cunningham is a mother/baby RN and lives in Missouri with her husband and two small children. She has been caring for mothers and their newborns for almost four years, before which she was a RN in the USAF. During that time, Tanya worked on a multipurpose inpatient unit for two and a half years (taking care of ortho, neuro, medical, general surgical, and tele) and a family practice residency clinic for a year and a half. Tanya earned her BSN at Oral Roberts University.

Tanya has been writing children's stories for almost 2 years now and is working towards being published. She enjoys raising her children, cooking, and reading medical suspense/mysteries, especially those in Christian Fiction. You can find out more about Tanya by visiting her website.

Up and Coming

Hello Redwood's Fans! How's the week been treating you? Seemingly, I am not as immune as I thought to all those pediatric patients I've been caring for in the ER. Darn respiratory season!
Hope all of you are well...

This week:

Monday: Are home deliveries safe? Welcoming guest blogger/OB nurse Tanya Cunningham as she presents some eye opening information.

Wednesday and Friday: James Pence stops by with the truly amazing story of Nate Lytle who survived a serious traumatic brain injury. His story inspired me and I know it will inspire you, too.

What are your plans for the weekend? Me, getting to know the two main characters of my third novel, Tyler and Morgan.

Jordyn

Forensic Issues: Maintaining the Chain of Evidence

I can remember when I'd been in nursing about two years and became involved with a patient who'd been the victim of a sexual assault. I was tasked with the job of collecting most of the evidence for her rape kit and when I was done, I had about three large paper (grocery size) bags of evidence.

Photo by Todd Wiseman

Taking care of a sexual assault victim takes a lot of time. It can easily tie up one nurse for several hours. What becomes paramount is maintaining the Chain of Evidence or Chain of Custody. You may find that these terms are used interchangeably but essentially mean the same thing.


Chain of custody is a record of who was accountable for the evidence from the time it is collected to the time it is disposed of. It's a chronological record of signatures of who possessed the evidence when. If the chain of custody is broken, the item may be inadmissible in a court of law.

The envelope is designed to reflect this. It may look something like this:

Jordyn Redwood, RN
Steven Lee-- Denver PD

Steven Lee-- Denver PD
Luke Simmons-- Denver Crime Lab

Etc...etc.

From the point in time where I collect the evidence, it should be locked up where few people have access. For instance, a locker where there is only one key. It could come into play who has access to the locker so it should only be a small group of people. If the evidence cannot be locked up, then it must stay in the possession of the person who collected it until it is handed off to the next responsible person-- typically someone in law enforcement.

In my case, there wasn't a place to lock it up. The police took about an hour to claim it. So, as I continued to care for patients, I literally carried those bags with me from room to room.

Can you think of a plot where chain of evidence could come in to play? My thought was... what if someone was an impostor and signed on the chain of custody log. What would happen when that was found out?

Mark Young: Heroes Among Us 2/2

Today, we're continuing with Mark Young's posts that reflects how a personal experience provided fodder for the opening scene of his latest novel, Off the Grid. A great read for a great price!

Welcome back, Mark!

They seemed to vanish as we neared where I last saw them. We followed the trail they made for quite a ways without any further sightings. Finally, orders came through to break off and head toward our main camp. Just as we veered off, enemy soldiers opened up. Our machine gunner was the first man hit. My adrenaline kicked in. As I reached for another magazine of ammunition, I realized that I had been hit. Someone yelled “medic” as the jungle around us seemed riddled with enemy fire. I saw a lone corpsman crawling through the brush, working his way toward our position amidst heavy enemy fire. With little regard for his own safety, I watched this man move forward and began to treat each of us who had been hit.

He worked with speed and compassion in what seemed like an impossible situation. Nightfall soon descended and we pulled back a short distance. We could hear movement all around us that night as we waited for morning light. Air support could not reach us until daybreak, and for the moment we were cut off from the rest of our troops. The machine gunner lay mortally wounded, but it took most of the night for him to die. That corpsman stayed with the dying Marine, trying to comfort the injured man at great risk to himself. The dying man occasionally screamed out in pain, and the noise threatened to give our position away. The enemy might have easily lobbed a grenade or fired a shot in our direction, using the howls of pain to locate our position. That brave medic, however, stayed by the dying man’s side until the very end risking his own life.

That corpsman was my idea of a hero.

As I came back into the present and began to write, I tried to remember those moments and make the memory of that corpsman, and others I met on the battle field, a part of what my main character would become—a hero. In this world, we need to witness the courage and bravery lived out in the lives of those around us. We need to find those heroes among us. We saw it in the lives of others when the events of 9/11 changed us forever. Today, there are heroes living among us, normal everyday folk whose bravery might never be known—a nurse comforting the injured, a doctor easing the pain of others. And a corpsman braving a foreign battle field to provide aid and comfort.

Our world needs to see that there are more heroes. That is why readers will always find a hero somewhere in my novels. These main characters will not always be perfect—but they always come through in the end regardless of the cost.

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Mark Young is an American novelist. His second novel, Off the Grid, is his first international thriller. Mark was a police officer with the Santa Rosa Police Department in California for twenty-six years; an award-winning journalist; and a Vietnam combat veteran. He served with several law enforcement task force operations, including the presidential Organized Crime and Drug Enforcement Task Force targeting major drug traffickers, and the federal Organized Crime Task Force charged with identifying and prosecuting prison gang leaders. He lives in the Pacific Northwest with his family. Visit Mark’s blogs for further information at Mark Young: Arresting Fiction… or at his mystery blog site Hook’em & Book’em.