Maybe Home Birth Vs Hospital Birth is the Wrong Question?

Lots of home birth in the news this week. First we learn from the CDC that since 2004 it’s gone up 29% in the US. Then over in Australia a home birth advocate dies after her own home birth. We don’t know what happened but of course speculation ensued. Perhaps she could have been saved in a hospital setting, but maybe not.

The debate over where to give birth has been revived and the usual arguments are being made from both sides of the issue.

I’ve been reading them all but there’s one article at that caught my eye.

It’s by Emily Willingham a developmental biologist/science writer who given birth in a hospital and at home. Though the piece is called, “There’s No Place Like Home… To Give Birth,” Willingham– who writes with a refreshingly clear-headed logic–points out the flaws in both the hospital and home birth scenarios as they are played out in the US.

“What choices do women in the U.S. have that empower the woman and offer a safe, stress-reduced birthing environment? Harriet Hall, a doctor who is a considerate and calm proponent of hospital birth, has noted that integrating a ‘kinder, gentler, less-interventionist midwife approach into a home-like hospital birthing facility’ would increase patient satisfaction without sacrificing safety… Hall also has said, ‘We need to figure out (with science)’ what is ‘beneficial, to improve the safety of both homebirths and hospital births.'”

Yes! I’ve been saying this for years. Even if home birth was a real option for a segment of the population in the US, we still need to work on improving hospital care and outcomes! Fewer women would be opting out of hospital births if they didn’t feel their births would be overly medically managed to the point of introducing new risks from medications and surgery. Hospitals have much to offer in terms of emergency care, and a lot less to offer a low-risk mom who would prefer a birth with few interventions.

But Willingham also points out that home births in the US could use some improving too. There are various levels of midwives in the US and when we lump together data about poorly trained assistants and highly trained certified nurse midwives, we get skewed results. And without more focus on the training of home birth midwives, we will see adverse outcomes.  She concludes:

“The obvious solution to the controversy is to offer choices that reduce perinatal stress, minimize interventions, and personalize birth—the great appeal of home birth and midwives—while ensuring a safe outcome with well-trained attendants and access to emergency facilities. The absence of options in the United States leaves this solution elusive, especially where hospitals lack a homey, low-stress environment and local midwifery care fails to meet the gold standard. Strange, isn’t it, that our nation, in the 21st century, can’t offer more uniformly safe choices for a low-risk pregnant woman seeking a healthy, low-stress birth for her child … and herself?”

How we can move forward in terms of safety in BOTH settings. Too often the home vs hospital debate gets mired in which (flawed) side is right? We could all use some help, frankly.

What do you think? Do you feel you have real choices?


Ceridwen is the co-author of  From The Hips: A Comprehensive, Open-Minded, Uncensored, Totally Honest Guide To Pregnancy, Birth and Becoming a Parent.

Follow Ceridwen’s pregnancy and birth blogging on Facebook.

Photo courtesy of Rachel Zucker

Article Posted 5 years Ago

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