Delivering Baby at Home or Hospital? – The Home Birthing Debate

June 16, 2016/Andrea Kay

The national debate on public breastfeeding and home births has spilled over onto Facebook where millions of mothers are discussing the pros and cons of each side. Public awareness of home birthing has grown as mothers have increasingly shared their experiences online. This has led to increased scrutiny that challenges conventional hospital birthing.

While awareness of home birthing is growing, the actual rate of home births is still quite low. Out-of-hospital births are only 1.36% of births nationally. In Idaho, the rate is higher at 3-6%* of statewide births annually. This is still a significant rise and warrants a serious look at the differences in birthing options for expectant mothers. With the national rate of C-section for hospital planned births at 32.2% we are seeing a polarizing divide between women who want to schedule their birth and those who are seeking alternatives like home birth and birth centers.

Hospital Births

Hospitals have rules and regulations that vary in each state and hospital. Expectant mothers are attended by nurses and either an OB/GYN or a midwife. Hospital birthing rules often require patients to use a IV and no food or drink during labor. They are generally faster to suggest interventions to ease pain or speed up labor than out of hospital midwives and options for these that are exclusive to hospitals are readily available. Some interventions in the hospital may increase the mother’s chances of complications. For example, it has been reported that an epidural roughly doubles your chances of a c-section. A baby can also present breech which, by policy, requires a c-section in many hospitals. Some doctors are still happy to deliver a breech baby vaginally but they are now rare as most doctors aren’t trained on a breech delivery anymore.

It is generally recommended that an expectant mother have a birth plan as well as understand the hospital’s policies and what the doctors or midwifes preferences and statistics are for things like c-section, episiotomy, etcetera. This helps avoid a lot of frustration and problems at the birth.

With increasing changes in what expectant mothers are wanting for their birth hospitals are largely adjusting to have more options and a homey atmosphere while still providing for all the possible emergencies that can come up during labor. For expectant mothers who are in a moderate to high risk pregnancy and may be concerned about the possibility of a sudden emergency or just want pain relief, the hospital is considered their best option.

Birth Centers

A Birth Center has far fewer rules and regulations, some of the emergency equipment that a hospital has and can handle the majority of complications that come up during a low risk birth. They are attended by midwives and assistants. Each center is different so they recommend asking a lot of questions to be sure you understand what your options are, including their rate of transferring mothers to the hospital. This is a good option for a mother who wants most of the benefits of a home birth away from home.

Home Births

A Home Birth has the least rules and regulations when attended by a midwife; however, there are still rules that the midwife has to abide by. Some states require that midwives transfer a home birthing mother to a hospital if there is breech presentation. Other regulations state conditions for which a newborn may need to be transferred if certain vital statistics are low. Other conditions include fever symptoms or excessive bleeding.

During a home birth, a mother does not have access to the powerful pain relievers available in the hospital. She is free to move around and utilize natural methods of coping with the discomfort of labor.

A midwife travels with much of the same equipment used at a birth center or hospital and can handle most complications that arise. The home birth allows for approved family members to be present during any part of the birth the mother allows. The home environment often makes for a more comfortable and relaxing experience.

The risk of complications are lower at home for low risk births, compared to births in the hospital. For example a 5.2% c-section rate of planned home births vs the 32.2% rate in hospital planned births.

Andrea, a local Idaho Falls resident shared with us her experience of both hospital births and home birthing,

“I’ve had an OB/GYN hospital birth, midwife hospital births and a home birth. I loved every one of my births for giving me a healthy baby but the home birth was my favorite. I had an epidural with my first and it nearly sent me into a panic attack, a possible side effect they don’t mention when you ask for one. While I was grateful for the pain relief I realized that it just wasn’t worth it for me. One hospital required an IV line put in, which was horrible since I really hate needles. ”

“The staff, doctors and midwives at the hospitals were all great and very kind I just found that the benefits of crawling into my own bed and being able to fully enjoy my baby and family without any unnecessary interruptions along with the relaxed atmosphere overall was really the best for me and my baby.”

In any setting a mother can choose to have the support of a labor doula. They do not assist with the birth itself but are rather there to support the mother and advocate for her when needed.

Choosing where to have a child is an important and personal decision. Each option has its own advantages and expectant mothers should research and decide which method is best for herself.

Do you have an opinion on home birthing? Please share in the comments below.

* “In 1900, almost all U.S. births occurred outside a hospital; however the proportion of out-of-hospital births fell to 44% by 1940 and to 1% by 1969, where it remained through the 1980s” CDC NCHS Data Brief No. 144, March, 2014 As of 2012 the CDC saw a rise in out of hospital births to 1.36% with 2004 seeing the lowest percentage at .84% However some states are seeing a much greater increase of 3% of births or more, particularly in the Northwest. 71% of out-of-hospital births are considered low-risk compared to 65% of births in hospital. 88% of out-of-hospital births were planned. source: cdc.gov