Home Birth vs. Hospital Birth

EverydayFamily.Com
By: Phylana Stowers, RN, BSN

There are many different opinions and sides to this subject; I think we should all just agree that everyone is looking for the best pregnancy experience they can get, and that means different things to different people. Every woman should have the opportunity to choose what kind of delivery they would like, but those facing complicated or high risk pregnancies should take into consideration the health and safety of herself and her unborn child and think about additional services that may be needed. There are pros and cons to both sides, and even the pros and cons are relative, depending on which side of the fence you sit.

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“When it comes to hospital births, they are more controlled. The environment is pretty sterile although delivery of a baby is considered to be a “clean” procedure.”

When you are admitted to the hospital for labor, whether it is induced or natural timing, intravenous IV access is obtained, and you are placed on fetal monitors and a transducer that monitors your contractions.

You are usually confined to a bed, especially if the membrane of your amniotic sack has been ruptured (this can happen naturally or the doctor can “break your water” with an amniotic hook), and you are then limited to ice chips. Your food and fluid intake is limited, in case you have to have a Cesarean Section or another emergency that would require anesthesia.

If you would like, pain medication is readily available in two forms. The first is Nubain, a short acting narcotic that lessens pain perception and makes the pain more tolerable. Second is a longer acting epidural that is administered by an anesthesiologist through the space between the spinal cord and the outer membranes, this space being called the epidural space. The epidural, when working properly, dulls the sensations from your stomach to your legs or feet. These are all pretty standard features that come with the hospital.

Another thing that seem to be standard is the administration of Pitocen, which is a medication that is started to help your contractions become strong and regular. Pitocen is made to simulate Oxytocin, which is a hormone that causes muscles to contract in the uterus. The use of this medication is one of the causes of debate. Sure, if a woman needs help getting contractions started, a little help is wonderful, but rarely in the hospital setting is the need for this medication assessed. It seems to be more about time management, and that is one of the problems with hospital births (in my opinion). Instead of letting the birth happen naturally, they want to speed up the process or make it happen at a desirable time for the doctor or mother.

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Home births with midwifes or at birthing centers (BC) are different in that you are able to walk around without intravenous access or monitoring of the baby or contractions, and you’re able to eat and drink. With home births or BC births, you can have as many people involved in your delivery as you would like, as opposed to the limit of two or three in the hospital.

Having an experienced person there will also make it run a bit smoother because they know what is needed and how to help comfort you during contractions and throughout the process.

The home delivery can be a quiet and private experience, or a celebration. This all depends on your desires and expectations. Focus is on how you are tolerating the contractions, and keeping you comfortable seems to be the key.

There is also no time constraint – real or assumed. We all need to remember that birth is a natural occurrence; and you don’t need a hospital, a nurse, or any other personnel for it to happen. It happens on elevators, in the backs of cabs, and other inopportune times. The use of midwives or medical personnel makes it safer in the event your baby needs some help at delivery. Having experienced people there will also make it run a bit smoother, because they know what is needed and how to help comfort you during contractions and throughout the process. This being said, one of the cons of home births would be if there were problems that were unforeseen. A newborn that is in distress needs immediate attention, and a wait for the emergency medical service could make a big difference in the outcome of your baby and his or her health.

Of course, this is just the tip of the iceberg; there are several differences between the two settings. If you are being care for by accredited professionals, you should be able to tell them your idea of how you would like your birthing experience to go, and a plan should be prepared that will help you have the experience you desire. Just keep in mind that the most important thing is the outcome of a healthy baby; if that is your goal, everything else should either fall into place or be adjusted to suit. Keep asking questions, keep informed, and keep your options open.

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How Will the Affordable Care Act Affect the Nursing Profession?

NurseTogether.Com
By: Renée Keats

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Now that the State and Federal Health Exchange websites are fully operational, millions of previously uninsured Americans will be able to access affordable healthcare, perhaps for the first time. As demand rises, there will also be job growth for healthcare workers, and in particular the nursing profession. Some analysts predict that there will be as many as 250,000 to 400,000 healthcare jobs created annually over the next ten years. There will also be an increase in the scope and location of those jobs.

So what will the anticipated growth in the demand for healthcare and the Affordable Care Act’s (ACA) newly mandated requirements mean for the profession? Two words: tremendous opportunities.

Increased funding for nursing education, especially for advanced degrees and specialties

Currently, it is estimated that the United States has a deficit of over 9,000 primary care physicians. As a result of the Minimum Essential Coverage provision (MEC), the demand for primary care providers will increase. A greater number of patients will seek services from Advanced Practice Nurses (APRNs) for preventive and wellness care, as well as other, more routine forms of care.

Knowing that there is already a nationwide shortage of primary care providers, $30 million dollars has been allocated via the ACA to support the Advanced Nursing Education Expansion Program. It is an academic training program for nurse practitioners and certified nurse midwives. The funds will help pay for instructors and for students’ housing and living expenses.

Additional voids in the healthcare system are developing. The American Association of Colleges of Nursing (AACN) projects that there will be 1.2 million job openings for licensed practical and registered nurses by 2020. As these positions are filled, there will be a decrease in the number of other critical, licensed medical support staff. These include medical assistants, physician assistants, and other patient care technicians. The opportunity to pursue and enhance one’s medical training and expertise has never been greater.

Increased demand for geriatric nurses

Doctors and hospitals want nurses who specialize in geriatric and hospice care. According to the National Council on Aging in Washington, D.C.: “With baby boomers approaching their retirement years, the number of Americans age 55 and older will soar from 60 million (21 percent of the population) to more than 107 million (31 percent) by 2030.”  

Some of the most significant components of the ACA are the financial incentives offered to primary care providers treating Medicare patients. Physicians, hospitals and outpatient centers will be rewarded for the coordination and quality of care versus the quantity. There will be a greater demand for geriatric and hospice nursing services to provide these services.

The provision of care moves from inpatient to outpatient

While hospitals focus more on acute care, the Affordable Care Act calls for routine care to be provided in outpatient or ambulatory settings. Additional funding has been allocated to increase the quality of preventive care and routine well-health exams for the general population. Many of the sites providing this type of care will be nurse-centric. These include the following:

•Community health centers
•National health service corps
•School-based health centers
•Nurse-managed health clinics

New standards mean new specialties

In its Nurse Role Exploration Project, the California Institute for Nursing and Health Care identified five new roles in the nursing profession to address the expanding demand for healthcare services:

•Care coordinator
•Faculty team leader
•Informatics specialist
•Nurse/family cooperative facilitator
•Primary care provider

To meet the increased demand for healthcare information and access, it is forecasted that expanded telehealth applications will be a key resource for the general public. There will be an increased demand for nurses who have both clinical and technological expertise.

There is also a growing demand for the adherence to complex clinical measures (i.e. increased paperwork) to meet the pay-for-performance incentives. Much of this work falls on the nursing staff’s shoulders.

Insurance companies have historically tied financial incentives with clinical performance measures. Now that the ACA has followed suit, comprehensive and complete record keeping will be even more imperative for clinical care centers. As such, increasing workloads may result in new opportunities for nurses.

If there was ever a time to consider the nursing career or seeking an advanced degree in nursing, it is now. Highly specialized programs offer opportunities for nurses currently working in the industry and looking to expand their career prospects. These include the Family Nurse Practitioner Certification from schools like Olivet Nazarene University in Illinois, to broader graduate study like the Master of Science in Nursing from the University of South Carolina.

As more people access affordable care, the demand for nurses will increase exponentially over the next few years. While the Affordable Care Act may not change the way that we treat patients one-on-one, it may change how we see them. Greater emphasis is being placed on preventive and wellness care. This is good news for the nursing profession that has always known importance of preventing medical crises. Clearly, it is an exciting time to enter this well-respected industry and grow one’s skills.