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. Some women feel
safest in a hospital, so birthing in a hospital may minimize their fear, and
help labor to progress.
Disadvantages: Hospital policies
often 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.
Birth is viewed as a medical event, managed with
medical interventions to prevent possible complications.
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 et al for an
excellent review of issues in choosing a hospital.)
Reviews: Find consumer
reviews of local hospitals and information about local intervention rates at www.thebirthsurvey.com
Home Births
Advantages: Parents have more flexibility, control, and 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 are minimal, complication rates are typically
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 possible in some states, not in others. The
chance of transfer to hospital during labor: 6% for mothers who have birthed
before, 25% for first-time mothers. Most transfers (96.6%) are for
non-emergency situations, such as prolonged labor, exhaustion, meconium in amniotic fluid, prolonged ruptured membranes, or
a desire for pain medication. Pain medication is not available at home births.
Home birth services are not available in all areas.
Additional considerations: Mother should be in good health, and experiencing a low risk
pregnancy. Choice of a well-trained and competent caregiver is essential; as is
a clear plan for hospital transfer. The home should be within 10-20 minute
drive to a hospital.
Childbirth centers are a compromise between home and hospital
births. They provide a ‘home-like’ setting for active labor, birth, and the
first few hours after birth.
Advantages over
homebirth: May feel safer than
homebirth for some women. May be closer to hospital than family’s home, in case
transfer is needed. Often covered by insurance. (Note
that some families choose birth centers because they don’t want to worry about
cleaning up their home after the birth. It’s important to know that midwives
typically help clean up the birth space after the birth, whether it’s at home
or a birth center.)
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.
Disadvantages: Early labor may be affected by anxiety over when it will be time to go
to the birth center; active labor can be affected by anxiety about whether
transfer to the hospital will become necessary. This uncertainty or fear can
slow or disrupt labor progress. Most birth centers ask the parents to leave the
birth center a few hours after the birth; some parents are ready to leave at
that time, some wish they could stay and cocoon.
Finding a birth
center: search at http://www.birthcenters.org/find-a-birth-center
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 4 million babies born each year
in
How do costs compare? Estimates of costs for births without complications are: hospital - $5,000 - 7,000;
birth center - $1500 for birth center + 2500 for midwives’ services; homebirth
- $2000 - 2800. Note that medical insurance may cover a majority of the costs
of hospital birth, and are less likely to cover home
birth, depending on the state.
What are the rates of medical interventions?
|
|
The
Farm * |
Home
** |
Home*** |
|
Birth
center‡ |
Hospital
/ Midwife ** |
Hospital
/ Doctor † |
|
|
Sample Size |
1700 |
471 |
5418 |
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 |
40
– 90% |
|
Episotomies
% |
28 |
52.4 |
2.1 |
|
22 |
52.8 |
|
<
10% |
|
Instrumental Delivery % |
.5 |
13.8 |
.6 |
|
|
15.7 |
|
|
|
C-section % |
1.8 |
3.0 |
3.7 |
2.8 |
4.4 |
4.1 |
9.2 |
16
– 30+ |
* Duran, 1992. Summary in Korte. (The
Farm is a spiritual community in
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
·
Johnson (2005) examined 5418 planned home births in
·
Janssen, et al. (2002) examined planned home births vs. planned
hospital births in
·
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
·
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 [
For questions to ask when
learning about a possible birth place.
Compiled by