Choosing a Birthplace for your Baby
Hospital Births
Advantages: Insurance coverage available. Availability of epidural anesthesia for women who choose to use it. Immediate availability of emergency equipment. Safest environment for high risk pregnancies. Many women feel safest in a hospital, thus minimizing fear.
Disadvantages: Hospital policies may place restrictions on the choices laboring women can make; policies may affect mobility, eating and drinking while in labor, choice of position for birth, etc. Nursing staff may change throughout the labor, and are typically strangers to the family. Interventions such as I.V.’s, electronic fetal monitoring, medical induction and augmentation may be commonplace routines. Higher risk of c-section: 25 – 30%. Birth is viewed as a medical event, managed with medical interventions.
Additional considerations: Note that hospitals vary widely in their services, policies, attitudes about birth, and “homelike” atmospheres. Depending on your insurance coverage, and where you live, you may have several hospitals to choose from. Try to learn about your options through tours and other information sources, and choose the hospital which best suits your needs. (See Simkin for an excellent review of issues in choosing a hospital.)
An
example of the variance is intervention rates: one hospital in
Home Births
Advantages: Parents have more flexibility and control over choices regarding labor. Mother may feel more relaxed and secure in her own territory. Personalized care: caregivers are guests in the home, and no unfamiliar people are present. Older children can be present for as much of the birth as desired. Mother is able to avoid ‘routine’ interventions, such as I.V.s, monitoring, and augmentation. Intervention rates minimal, complication rates extremely low. Low risk of infection. Low cost. Birth is viewed as a natural event, and part of the on-going life experience of the family.
Disadvantages: Insurance coverage unlikely. Chance of transfer to hospital during labor: 15% overall, one in four first-time mothers are transferred. Home birth services are not available in all areas.
Additional considerations: Mother should be in good health. Choice of a well-trained and competent caregiver is essential; as is a clear plan for hospital transfer. The home should be located within a 10-15 minute drive to a hospital. Most transfers are for non-emergency situations, such as prolonged labor, meconium in amniotic fluid, or prolonged ruptured membranes. Hospital preparations for a non-emergency c-section take about a half hour; if the caregiver has called ahead, preparations can be underway before the mother arrives.
Childbirth centers are a compromise between home and hospital births. They provide a ‘home-like’ setting for labor, birth, and the first few hours after birth.
Advantages over homebirth: May feel safer than homebirth for some women. Staff cleans up after the birth. May be closer to hospital than family’s home, in case transfer is needed. Often covered by insurance.
Advantages over hospital: Less expensive. Fewer restrictive policies. Non-interventive care, with lower chance of cesarean section. May result in a more positive birth experience. Positive environment centered on childbirth, not focused on treating illness. They are similar in philosophy to homebirth, with a focus on birth as a natural event, and on empowering the mother to make choices about how to give birth.
Where do American women give birth? Korte and Scaer estimate that 1% of all births are planned home births. Their rough estimate for out-of-hospital birth centers is 30,000 births a year, out of ‘millions of babies’ born each year in U.S. hospitals.
How do costs compare? Estimates of costs for births without complications are: hospital - $4,000 - 6,000; birth center - $2800. homebirth - $600 – 2000. Note that medical insurance may cover a majority of the costs of hospital birth, and are less likely to cover home birth.
What are the rates of medical interventions?
|
|
The Farm * |
Home ** |
Birth Center † |
Birth center‡ |
Hospital / Midwife ** |
Hospital / Doctor † |
Seattle hospitals |
|
Sample Size |
1700 |
471 |
500 |
11,814 |
369 |
500 |
N/A |
|
Induction/ Augment. % |
1 |
3.6 |
3.1 |
1.4 |
5.1 |
21.2 |
~25% |
|
Pain Meds % |
2 |
21.2 |
6 |
57 |
23.6 |
70 |
|
|
Episotomies % |
28 |
52.4 |
|
22 |
52.8 |
|
10-80 |
|
Instrumental Delivery % |
.5 |
13.8 |
|
|
15.7 |
|
|
|
C-section % |
1.8 |
3.0 |
2.8 |
4.4 |
4.1 |
9.2 |
12-22 |
* Duran, 1992. Summary in Korte. (The Farm is a spiritual community in Tennessee that trains their own midwives in assisting low-intervention birth.) ** Wiegers, 1996. Midwife-attended in Switzerland www.bmj.com/archive/7068pr3.htm † Goodlin, 1980. Summary in Korte. ‡Ernst, 1989. Summary in Korte.
How Safe Are the Different Options? When asked why they chose hospital birth, most women say “Safety.” Is the hospital the safest option for a low-risk pregnancy? Here’s some data. (I encourage readers to use the sources cited to find out more detailed information.)
· The American College of Obstetricians and Gynecologists issued a statement that birth “require[s] standards of safety which are provided in the hospital setting and cannot be matched in the home situation.” However, the statement was issued in 1975, and last amended in 1979. The citations below offer more recent evidence on the issue.
· Olsen (1997) examined several studies of planned homebirths with hospital backup compared to planned hospital births. Nearly 25,000 births in 5 countries were studied. Fewer home-born babies were born in poor condition. Mothers were less likely to have had labors induced or augmented, or to have had c-sections, forceps, or vacuum extractor deliveries. There was no difference in survival rates for babies born at home, and no maternal deaths in either group.
· An analysis of 4500 home births and 3300 hospital controls indicates that a woman who is appropriately screened for home birth is putting herself and her baby at no greater risk than similar mothers who deliver in a hospital. Chamberlain, et al, 1999.
· 976 planned home births were compared to 2928 planned hospital births in Australia. Planned home births appear to be associated with less overall maternal and neonatal morbidity and less intervention than hospital births. Woodcock, et al. 1987.
· Aidan McFarlane, a British physician, notes that while 68% of hospital mothers experience postpartum depression , only 16% of home birth mothers do.
· "It has never been scientifically proven that the hospital is a safer place than home for a woman who has had an uncomplicated pregnancy to have her baby. Studies of planned home births in developed countries… have shown sickness and death rates for mother and baby equal to or better than hospital birth statistics for women with uncomplicated pregnancies." World Health Organization.
· “No evidence exists to support the claim that a hospital is the safest place for women to have normal births.” National [U.K.] Perinatal Epidemiology Unit, 1994.
Sources: A Good Birth, A Safe Birth by Korte and Scaer, 1992. Alternative Birth: The Complete Guide by Carl Jones, 1991. Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, and Keppler, 2001. Recent research on homebirth safety is available on-line. For links, see www.aboundingjoy.com/insstats.htm; www.geocities.com/Wellesley/5510/studies.html; www.gentlebirth.org/ronnie/homesafe.html#safety; www.changesurfer.com/Hlth/homebirth.html.
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