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Homebirth in the Hospital: Integrating Natural Childbirth with Modern Medicine Paperback – Feb 16 2009


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If you’re pregnant or planning to be, read this book! Dr. Kerr’s wise embrace of nature and technology demonstrates that the best births have the right mix of midwifery and medicine. --Ricki Lake and Abby Epstein, creators of the film The Business of Being Born

A must read for the expectant parents who want a natural birth but also want to have the security of a safe and happy delivery. Dr. Kerr is an impassioned advocate of patient empowerment in the birthing process. She has always practiced what she so eloquently believes. Congratulations to Dr. Kerr for writing this very timely and much needed book on natural childbirth in a hospital setting. --Bob G. Field, M.D., former Director of High Risk Obstetrics, Sutter Medical Center, Santa Rosa, CA

Women who want a natural childbirth often feel compelled to choose between a home birth and a hospital birth. They want the warmth and comfort of home, but they also desire the security of the medical support available in the hospital. Kerr, a family physician who provides family-centered childbirths, tells families how they can have the best of both worlds. She had two children, one in a birthing center and one at home, and trained with Ina May Gaskin at The Farm before going to medical school at the University of California, Davis. Her book offers clear guidelines for integrative childbirth, emphasizing the "Five C's": choice, communication, continuity, confidence, and control. Parents learn how to choose a health-care provider and hospital that will partner with them for a fulfilling birth experience. Physicians learn how to work with patients and their families to make sure this happens. The stories of 15 families who have had "homebirth in the hospital" illustrate that it does work. This is an excellent book for public, health sciences, and consumer health libraries. --Library Journal

Homebirth in the Hospital is an outstanding book and a must read for all expectant parents as well as the providers who care for them. Dr. Kerr has truly integrated concerns for safety and the use of appropriate technology of the medical model with the skills and comprehensive wisdom of the midwifery model, thereby using medical interventions only when truly necessary. Dr. Kerr clearly illustrates with detailed examples how women and their clinicians can work through the challenges that are unique to each woman's individual birth. Caregivers and women will benefit by seeing how empowering and healthy normal and natural childbirth can be when using skillful hands-on maneuvers, instilling confidence and facilitating the woman's own ability to understand what her body can do, the choices she has, and the confidence to communicate her needs. This book is a significant contribution to modern and normal childbirth. --Phyllis Klaus, MFT, LCSW co-author of The Doula Book

A much-needed book showing that women can have real choices in hospital childbirth, and that the key ingredient in their ability to give birth as they wish is the ideology, the wisdom, and the heart of the practitioner. In this case, that practitioner is Stacey Kerr MD, who, like the best of midwives, is there to guard, guide, and inspire the women she attends to help them achieve their desires. A must-read for any woman interested in giving birth normally in the hospital setting—usually very difficult to achieve, but entirely doable, as this book beautifully demonstrates, when the doctor is truly on and by your side. --Robbie Davis-Floyd PhD, author, Birth as an American Rite of Passage

Homebirth in the Hospital is a wonderful breath of fresh air! Dr. Kerr’s balanced approach to childbirth is inspiring and very helpful. I highly recommend this book. --Christiane Northrup, MD, author of Women’s Bodies, Women’s Wisdom

Dr. Stacey Kerr's wonderful book of birth stories shows how the midwifery model of care can be provided within a hospital setting. I hope that Homebirth in the Hospital reaches a wide audience of parents-to-be and physicians, as it's just what the midwife ordered! It should be required reading for all obstetric and family practice residents. --Ina May Gaskin, author of Spiritual Midwifery

About the Author

Stacey Marie Kerr, MD, is a family physician who has provided family-centered childbirth experiences for her patients for over fifteen years. In 1989, at the age of 39, she received her MD from the University of California, Davis, Medical School. She completed her residency and earned her Board Certification in Family Medicine in 1992, probably the first grandmother to graduate from the Santa Rosa UCSF residency program. Dr. Kerr writes about current issues in medical practice and has published extensively in medical journals, including JAMA, California Family Physician, and Sonoma Medicine. She writes a monthly health column for the Santa Rosa Press Democrat. She currently lives in Santa Rosa, California.

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Amazon.com: 23 reviews
24 of 25 people found the following review helpful
The benefits of integrative medicine Dec 5 2008
By Ann Spencer - Published on Amazon.com
Format: Paperback
I just finished reading Homebirth in the Hospital: Integrating Natural Childbirth with Modern Medicine by Stacey Marie Kerr, a family practice physician. Kerr has an unusual background for a medical doctor; she lived for several years on The Farm, gave birth to her first baby in a birthing clinic and her second at home, and then entered medical school in her mid-30s. She strongly supports the midwifery model of care in a hospital setting. Her book explains more about her approach to birth, which she calls "integrative childbirth." She argues that by integrating the midwifery model of care with the best that modern medicine has to offer, a woman can have the "best of both worlds."

Dr. Kerr's book begins with a brief explanation of her childbirth philosophies. Next, chapter 2 explains what she means by "homebirth in the hospital." Written specifically for expectant parents, she outlines five essential elements for a successful integrative childbirth: choice, communication, continuity, confidence and trust, and control of protocols. Dr. Kerr supports natural childbirth and encourages women to birth at home or in birth centers if that is what they desire. However, she acknowledges that most women feel safer and more comfortable in a hospital setting and that the empowerment of a home birth can still be experienced in a hospital setting. She writes:

"If we combine the two styles, basing our initial care plan on the midwifery model and using the medical technology only when necessary to save lives and to serve the needs of laboring women, we have a true integration: the best of both worlds."

After these two introductory chapters, the bulk of the book contains fifteen different birth stories, including those of Kerr's two children. Each story is told through the words of the parents. Kerr also offers a brief introduction and commentary to each birth story. Some of these births were with Dr. Kerr, while others were with other integrative family physicians.

Kerr concludes with a chapter written specifically for physicians on how to practice integrative childbirth. This chapter largely repeats what was written in chapter 2. She stresses the same key elements--communication, continuity, confidence and trust, and control of protocols--from a health care provider's point of view.

I would recommend this book for pregnant women who are seeking mainstream medical care or who, due to certain circumstances, cannot choose an out-of-hospital birth. It explains how the judicious, rather than routine, use of medical technology is appropriate. For those women already immersed in natural childbirth/midwifery/home birth/unassisted ways of thinking, the book will be less useful.

Now for some nit-picking: I do have issues with the phrase "homebirth in the hospital" and with the idea that a hospital birth with an integrative physician is "the best of both worlds." Kerr argues that the key elements of home birth are "satisfaction and empowerment." However, there are other elements of giving birth at home that cannot be transposed to an institutional setting. One could certainly argue that, however satisfying or empowering, a hospital birth can never be a home birth. Not to say that one is inherently superior--just that they are inherently different, and to respect that difference. Some of the best elements of a home birth cannot really exist in a hospital setting, and likewise some of the best parts of modern medicine--especially its strengths at responding to life-threatening emergencies--cannot exist at home. The idea that there is a "best of both worlds" implies that there is an ideal way to approach childbirth, rather than acknowledging that what is best for one woman might be terrible for another.

I also worry that women who read this book may become lulled into a false sense of security that they can "have it all" when, in fact, most physicians do not practice like Dr. Kerr. I know some fabulous family doctors who do, but they are usually rarities in their communities.

Despite these concerns, I am glad that Dr. Kerr has written Homebirth in the Hospital and hope that it will inspire more physicians to adopt integrative medicine. I also hope that it will spur women into thinking more critically and carefully about their maternity care choices.
34 of 39 people found the following review helpful
Dr. Stacey is no Ina May June 15 2009
By Ashley Price - Published on Amazon.com
Format: Paperback
I'm a homebirther and homebirth advocate who was hoping to see some positive stories of "homebirth" in the hospital; unfortunately this book simply does not deliver. Despite the fact that Dr. Stacey, as she calls herself, lived on The Farm and had two homebirths herself, she is a poor advocate for natural childbirth or the 'integrative medicine' that this book is ostensibly based on.

The first two chapters can be boiled down to "Doctors, listen to your patients and treat them with respect," and "Patients, learn to be flexible." Of course, the first one should be a given (though it's not, as almost any homebirther can tell you), and the second is used to disparage birth plans repeatedly throughout the book. So much for that first maxim.

The bulk of the book is 15 birth stories which I found got increasingly disturbing. There were several positive accounts of women who planned a natural birth getting pitocin or an epidural, which I had no problem with. It wasn't until the "positive" account of the admittedly unnecessary episiotomy followed by a story about a neonatal death that I had to put the book down.

As a disclaimer, I picked this book up when I was 41 weeks pregnant, and perhaps the hormones heightened my response to these rather horrific experiences. Because of this, I can not state strongly enough that this book SHOULD NOT be read in late pregnancy.

I was hoping for a more medically-minded Ina May Gaskin, and was sorely disappointed. If you want to read positive birth stories, pick up Spiritual Midwifery; even the few that wind up in the hospital are far more positive than the ones here.
16 of 19 people found the following review helpful
EVERY story includes interventions of some sort- thats not "natural" Feb. 2 2011
By hypnomama - Published on Amazon.com
Format: Paperback Verified Purchase
I bought this for a friend who was planning a hospital birth, after having my own very calm satisfying birth at a birthcenter. The section of advice for doctors and patients was good. HOWEVER the bulk of the book is stories and they were far from natural and even farther from home births. Purhaps a better title would be Integrating "Vaginal" Childbirth with Modern Medicine. Im so lucky I read the book before gifting it to my friend.

Every story included some sort of medical intervention. One story even says 'this is as simple as it gets' and still had an intervention!!!!! Very disappointed that there were no "natural" birth stories in here. I know they are possible but this book almost makes me believe its not. I expect these stories represent the hospital setting from the late 90's, just beginning to integrate less medicalized births as routine for every women. The stories are far from what true natural birth advocates dream about for the future. The hospital settings still have ways to improve in many communities. (there's no reason to screen EVERY women for pregnancy diabetes without warning signs, babies can be born without vaginal exams, why do ALL women get ultrasounds when there's no family history or warning signs to warrent more info, etc.) We've come a long way from using ether and leather straps, but still this book by no means represents natural birth in the hospital
5 of 5 people found the following review helpful
Misleading title, but I give her credit for promoting Integrative Care April 21 2011
By Tsu - Published on Amazon.com
Format: Paperback
Homebirth in the hospital? Yeah, right, good luck with that. I was also annoyed to keep reading birth stories with interventions--while I support the moms' rights to choose interventions, and am not judging them for their choices, if these had been homebirths, would the interventions have happened? Women who plan homebirths usually want to have totally natural, unmedicated births, and are fine with not having medical options for pain relief, for example. That's one reason why I think the title is misleading.

As far as the "experience," I agree with the reviewers that discuss how some aspects of homebirth cannot be duplicated in a hospital--the privacy, calm setting, and lack of protocols, for example--and I hope that moms whose goal is to have these things for their birth, but don't want to stay home, realize that they are setting themselves up for disappointment by going to the hospital. It's true, as another reviewer stated, very few doctors and hospital staffs practice the type of care mentioned by Dr. Kerr in this book, it's the exception rather than the rule, and especially first-time moms shouldn't expect to easily "have it their way" at the hospital--it's sad, and not right, but they should expect to have to fight for it. They should realize this is one of the main reasons WHY the women who choose homebirth do so.

That's why I also hate that the book repeatedly disparages birth plans, "Burn the Birth Plan..." I understand labor and birth are unpredictable, and you have to be "flexible," blah blah blah, but it's really important that the new mom, her care provide and the hospital staff have an initial idea of the mom's wishes. Dr. Kerr should be more careful when she says that, in my opinion, it really undermines her credibility, and contradicts the whole point of the book. It makes her sound just like every other OB who pays lip service to a mom's wishes before labor starts, but then once it gets going, for whatever reason things change, and none of it is supposed to matter anymore--she and the moms in these stories keep saying that the changes are okay because the care was integrative, and the moms let go of their expectations. I hope that's sincerely true, and no one was manipulated here. Even with the stories that had what could be considered negative outcomes/situations (loss, C-section), the book tries to paint them in a positive light, which annoyed me as well. It's okay to have certain expectations for your birth, and realistic to feel disappointment when it goes differently than you had hoped. Dr. Kerr needs to acknowledge that, too. Every woman's feelings are valid and should never be dismissed.

I do give Dr. Kerr credit for promoting Integrative Care, and wish more OB's would be as considerate. I wish all OB's had experience like she did with natural birth, homebirth, and midwives...I wish many things for our broken maternity care system, which in desperate need of change. But until real change happens, I am planning to stay home the next time I give birth.
6 of 7 people found the following review helpful
Disappointed March 4 2009
By Wendyrful - Published on Amazon.com
Format: Paperback
As a homebirth mother and advocate, and a certified labor doula, I always love a good birth story. I attend a lot of Hospital Births. I understand some mom's do not feel comfortable outside of the hospital, and there are many places that homebirth with a midwife is unavailable to mom's who would choose that were it an option. I was excited to get this book and hoped to read how to integrate Homebirth and the Midwifery Model of Care, into the Hospital setting.
I was disappointed however in this book. To me integrating Homebirth into the hospital would be working with moms while they labor to help them achieve a non interventive, non medicated, holistic birth in a hospital... I guess more of a birth center type birth, in areas of the country that also don't have a birth center available to them either.
The birth stories I read in this book did have communication and continuity of care going for them, and some of those things have been studied and do make for better outcomes, and mom's seem to have a better sense of satisfaction with the outcomes when those things are in place, but that in itself does not make a homebirth in a hospital.
I felt like there were a lot of interventions in the birth stories in the book. There were a lot of medicated births and to me that took it completely out of the realm of having a homebirth experience in the hospital.
I had hoped to like this book, and planned to buy it for a few of my favorite practitioners to help them understand more of what mom's are looking for when they want a homebirth type of experience in a hospital setting. I did not find any of this information in this book. I would be worried that reading this book would just encourage the practitioners who read it to think that using all the medical technology they are used to, and medicating moms, is just fine and why work to try to avoid interventions.
I think the author tries hard to help moms, and I appreciate that, and I'm sure I would appreciate working with her as a care provider for my doula clients, but... I think she misses the mark on the way she practices, and thinking that makes a home birth in a hospital.


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