Home Birth vs. Hospital Birth
It is strange how medical practices vary when it comes to childbirth. Many developed countries favor hospital delivery but in a few countries like the Netherlands for example delivery at home attended by a registered midwife or nurse has been the norm for quite a while. In Germany, the idea of home birth is catching on although other alternatives such as “maternity houses” are also becoming popular. A friend of mine had a hospital birth with her first born but opted for a home birth the second time round. Her first born made up her mind for her when the little girl asked with the unerring logic of a 4-year old. “Why do you have to go to the hospital, Mommy? You and the baby aren’t sick, are you?”
Indeed, we associate hospitals with illness and even death so that many people would rather celebrate the joy of childbirth outside the hospital walls. But there are still questions
Is Home Birth Safe?
The debate about the safety of home birth vs hospital birth has been going on for decades and is not likely to be settled anytime soon.
A recent study by Canadian researchers compared the outcomes of home birth vs. hospital birth in British Columbia. The study consisted of:
- 2889 home births attended by certified midwives
- 4752 planned hospital births attended by the same midwives
- 5331 hospital births attended by doctors
The researchers reported that women who planned a home birth had less maternity-related interventions but also less adverse outcomes. The interventions associated with hospital childbirth are induction of, electronic fetal monitoring, epidural anesthesia, assisted vaginal delivery, and cesarean section. The adverse outcomes reported were infection and hemorrhage. The risk of newborn mortality was similar for both home and hospital births.
So why are there fewer complications in home birth than in hospital birth? The researchers think it might have something to do with self-selection.
Caveat: this is just one study in one country. More data are needed to confirm these findings.
When is Home Birth Not Safe?
I delivered my twins in Frankfurt, Germany. I loved the idea of a home birth but I knew almost right from the beginning that it might not an option for me, mainly due to my advanced maternal age and multiple pregnancies. Even my choice of a hospital was rather limited. Whereas other moms had fun looking around which hospital or clinic they could go to, I had no choice but to opt for the only one in town with a neonatal clinic.
There are many reasons why a home birth may not be ideal for you, and your family, friends, even your midwife may have something to say about this. But are these reasons valid? Let us look at some of these reasons:
- First Delivery. The first time is said to be always difficult and slow. Truth or myth? We don’t know. At any rate, there’s no scientific evidence that supports any objection to home births for first-time moms.
- Maternal Age. People would say “you’re too young” or “you’re too old” for home birth. But what is the right age for home birth? No one can say. I think it’s something to do more with health status rather than age.
- Previous Delivery Complications. Those who had previous complications have a good reason to be wary of giving birth away from the hospital. However, not all complications would necessarily occur the next time around. Assisted delivery (e.g. forceps delivery) and episiotomy (tear) are less common in home births, according to Homebirth UK. There are life threatening complications, however, like preeclampsia and postpartum bleeding that may warrant more medical monitoring than what a home birth can provide.
- Underlying Medical Conditions. Women with underlying condition such as diabetes, high blood pressure, or obesity are usually advised against home birth.
- Breech delivery. Breech births are very tricky. Unless your midwife is highly experienced in breech delivery, a hospital birth might be the best option for you and your baby.
- Multiple Pregnancy. Having multiples is one very good reason to play it safe and opt for a hospital birth. I did. This doesn’t mean it’s not possible. It is simply too risky.
- Premature Labor. Premature delivery is usually unplanned but does not preclude home delivery if pregnancy has reached the 37th week. Very premature delivery, however, requires immediate medical attention and being close to a neonatal intensive care unit is advisable. This was foreseen in my case and I was glad of my decision to deliver in a hospital.
- Overdue Delivery. Many women who are overdue are referred to a hospital to induce labor. Health officials are divided when induction becomes a “must” and can range from 6 days to 2 weeks after the due date. Midwives, however, can also induce labor at home.
- Baby Problems. If it is known beforehand that the baby might have some health or genetic problems, a hospital birth is usually recommended.
But Who Makes the Decision? Please take note that the items in the abovementioned list are only my opinion. According to Homebirth UK, the decision between a home birth and a hospital birth lies on the woman alone. Her doctor or her midwife can only give recommendations. Nobody can force her to deliver in a specific location against her will unless nature takes the decision out of her hands. It is best, though, that she discusses the issue with her partner and together they make an informed decision.
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