Hospital vs. Homebirth

The Babble Staff

Believe it or not, babies can be born outside of hospitals. Some women find hospital deliveries too medical and choose to give birth at home instead. Homebirth advocates claim that artificial rupturing of membranes, augmentation of labor and even C-sections happen needlessly in hospitals. But complications can arise fast during labor, and in that event fantasies of cocooning with your newborn on the couch may be thwarted by an emergency trip to the hospital. Birthing centers offer a home-like environment, less medical intervention and the security of having a professional staff on hand. Some professionals, including many doctors, advocate hospital births as safer, while others, including many midwives, recommend birth at home or at a birthing center for low-risk pregnancies. In the end, most concede that stress can make labor longer and more painful, so it's better to give birth wherever you will feel the most comfortable.

Giving birth at home in familiar surroundings, in the company of your loved ones, in your own way and in your own time can be an experience that enriches and strengthens the growing family.

As one group of GPs who have been attending home births in the UK for 12 years comment, "Birth at home may seem to be an interest of the eccentric middle class, but our experience is that an appreciable number of working class women will opt for home birth if the service is available."

A pioneering group of midwives in South East London with a 75% home birth rate (as opposed to 1.8% nationally) note that "A third of our clients are on benefits and many more are grappling with heavy socio-economic pressures." Yet in addition to a high home birth rate these mothers go on to achieve a rate of spontaneous vaginal delivery in 87% of cases, a caesarean rate which is less than half the national average and 74% need no pain relief during labor. In addition, the rates for breastfeeding 28 days after birth stand at 96% as compared with the national average of 25%.

Birth at home is an option available to any woman. A recent NCT survey concluded that "the home birth rate is increasing where women are given a real choice." Yet because home birth is still the exception, you may find that making your choice will require a great deal more thought as you process fact, opinion and feeling, to arrive at a choice which is right for you.

Hospital birth also increases the risk of the emotional/psychological disruption of being in an unfamiliar institution. It is well documented that other mammals, when disturbed in their nests in labor or moved to unfamiliar surroundings, have longer labors with more complications. Entering hospital undermines a woman's need to feel safe, secure and in familiar surroundings. This in turn interferes with her ability to relax and ultimately give herself up to the experience of birth. This 'letting go' - the ability to respond to a deep, instinctive knowledge of how to give birth to your baby - is an important part of letting the birth process unfold a smoothly and safely as possible

These include your own level of health, being well-nourished throughout your pregnancy, the practical as well as emotional and psychological support and care available to you during pregnancy, labor and beyond, the skills of your midwife and your own intuitive sense of where your baby should be born.

Many parents will anxiously sort through the pros and cons, but once they have chosen home birth, they discover a growing excitement and confidence in the rightness of their decision.

One of the reasons that people have opted for (or perhaps never questioned) having a child in a hospital was because of the belief that it is safer. For a time, this was true. However, women today are healthier, receive better care throughout their pregnancies and have better living standards than in the past. All of this, along with improvements in technology, has contributed to making home births just as safe, if not safer than hospital births.

Even the World Health Organization has said that there is no proof that hospital births are safer than home births in the developed world. Most of the research on home births in the developed world has found that infant and maternal mortality rates are the same, if not better, than hospital rates. There is also less chance of a woman having a cesarean, induced labor, or of a midwife needing to use forceps.

Your whole family is welcome to be there with you (if you want), which many women find to be one of the best advantages to a home birth. While some hospitals are changing, most still have restrictions on who can be in the delivery room with you. Having your partner, children and other family members or friends there with you can allow you to have more support throughout your labor and generally allows your birth to be a more positive experience.

One complaint some women have about giving birth in a hospital is that it makes them feel like a patient who is ill rather than a person who is experiencing a special, natural moment in their life. Often, women choose a home birth because they see it as a much more natural environment to give birth in. Women who have had children before and were disappointed or even angry about their experience in a hospital may also decide to have a home birth.

If you like the sound of a home birth but do not feel entirely comfortable with the idea of giving birth in your home, you may want to consider giving birth in a birthing center.

Birthing centers are places where women can give birth in a more relaxed atmosphere. Rooms are often set up like a bedroom, rather than a hospital room. The large rooms allow for women to try various positions and often have birthing pools available. Birthing centers are staffed by midwives, but they also have obstetricians on hand.

Some hospitals also offer birthing rooms. These are rooms that are designed with the laboring woman's comfort in mind. They come equipped with different types of chairs and rails to give you the freedom to adopt different positions throughout the labor process. Some hospitals are even equipped for water births. If you prefer to give birth in a hospital, check to see if the hospital has a birthing room.

The birthing option we recommend for most parents is an LDR facility, meaning mother labors, delivers, and recovers in the same room. This birthing room is more than just a physical facility. It is an atmosphere conducive to giving birth and an attitude that birth is a normal process. This type of birthing room portrays a homelike environment, conveying a "relax while you're here" message. The lighting is soft and adjustable. The windows are large, the lounge chair inviting, and the medical and surgical equipment is efficiently but unobtrusively placed. The bed is adjustable to make birth easier. Visit the birthing room and spend a few moments envisioning labor and birth. Interview the nursing staff, your supporting cast. Does the room give you a nesting feeling? But don't be oversold by the designer showroom appearance of the room. The skills and mind-set of your birth attendants are more important to the well-being of you and your baby. Birthing rooms are best for mother — best for baby. The LDR birthing environment can minimize pain, help labor progress, and increase your chances of having an uncomplicated birth. (Delivering in the traditional surgical style promotes fear and tension, contributes to that dreaded malady of the laboring mother — failure to progress — and often results in agonizing labors and surgical births.) As an added attraction, baby stays right where he or she belongs — nesting in the room. If your local hospitals do not offer this birthing option, ask for it. — Another option: water labor.

The Baby Book, p.22, 26

At a time when women are encouraged to embrace the birth process that is right for them, more and more hospitals, obstetricians, and midwives are providing women with the option of a birthing center. For women who are having a low risk pregnancy and want a more natural birth experience, a birthing center might be just the right fit.

What can you expect from a birthing center?

Relaxed and warm setting

You can return home shortly after the birth if you wish

Health care providers include nurse-midwives, direct-entry midwives, or nurses working with an obstetrician

May be free-standing, on hospital grounds or inside a hospital building

Birthing centers can vary significantly, so you will want to investigate carefully their philosophy of care; review mission statements, objectives and interview personnel to find the one that fits your birth plan.

A true birth center holds to the following:

No Induction

No augmentation of labor with Pitocin (oxytocin)

No electronic fetal monitoring except Doppler ultrasound

No drugs for pain relief except local analgesia to suture tears in the perineum

Very few episiotomies

No operative deliveries

In many birth centers, the only equipment is oxygen and catheters to clear a baby's airways, if necessary.

If the birth center is connected to a hospital, medical intervention can be a routine part of their care. If you are choosing a birth center connected to a hospital, ask if it has it's own staff or is staffed by hospital personnel. You may also want to know in which situations the birthing center would obtain the assistance of hospital personnel and how often this occurs.

Experience and history demonstrate that a women's body is made for birthing. For some women it is important that labor not be viewed as a medical condition, but as the culmination of the most beautiful, natural 9-month process. Birthing centers are committed to prenatal care and education to empower women to direct their personal birth experiences.

Because most caregivers have privileges only at a particular hospital or birth center, [. . .] the majority are unwilling to attend home births at all . . . Most doctors and midwives agree that a hospital is the safest place to give birth if your pregnancy is considered high-risk because of a pre-existing medical condition, complications of pregnancy, or previous birth-related complications. There's just one small caveat: complications can develop--sometimes within a matter of minutes. When one of these unanticipated emergencies arises, the best place to be is in a hospital. That's why most doctors argue that the safest place to give birth is in a hospital, period.

If the technology is there, it may be used, whether you need it or not. Studies have shown that women giving birth in a hospital can be subjected needlessly to such interventions as artificial rupture of membranes (AROM), fetal monitoring, augmentation of labor, and cesarean sections.
A hospital delivery is more expensive than a birth-center delivery or home birth, averaging $8,000 for an uncomplicated birth.

You're less likely to end up with a C-section if you deliver in a birth center. According to the National Birth Center Study, the cesarean rate for mothers using birth centers is 4.4% as opposed to the national average of 25%. Although most of the low rate can be explained by the fact that women with high-risk pregnancies are not permitted to use birth centers, it's an impressive statistic nonetheless.

The time you lose in transit could adversely affect the well-being of you or your baby, which explains why many caregivers believe that birth centers don't provide as safe an option as hospitals.

Assuming that you're fortunate enough to have the option of giving birth in a birth center, you will want to conduct a tour of the facility before settling on this particular birthing environment.

If you are in the care of a qualified doctor or midwife and you are able to get to a hospital quickly, a home birth is no more dangerous than a birth-center delivery, but it isn't as safe as a hospital delivery, given the fact that unexpected complications can and do arise.