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.)
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.
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