Tag Archives: Home Birth Versus Hospital Birth

Are Hospitals Really Safer?

The great majority of births are in hospitals. In 2007 in the United States, only .62% of all births were at home. While trends show an increase in both homebirths and birth center births, they are still remarkably low.

I get it. As is obvious by the fact that I had an accidental home birth, I wasn’t planning on a home birth when I was pregnant with Peanut. No matter how naturally minded I got and how good a home birth sounded, it was terrifying to me. I whole-heartedly supported the idea of women giving birth at home, but I decided it just wasn’t for me. I needed the hospital to feel safe and, as the numbers above suggest, so do a great majority of moms-to-be.

Image courtsey of http://www.nytimes.com/

I started off my maternity care with my regular OBGYN. During my third trimester, I moved to the team of midwives in the office because I thought they would be better support for my natural birth. I told myself that it wasn’t that I was afraid of a homebirth, but that it wasn’t financially possible or that it wasn’t really our home. Truth be told, I think I was afraid. I liked the idea of a homebirth, but I was afraid to bring in another aspect of the unknown when the whole thing was already such new territory. Then, of course, Peanut came at home.

 

It was hard. It was scary. It was exactly what I want for this birth.

In my lab safety class, we’ve gone over a concept called risk perception. Risk perception is how you view a risk yourself. It’s entirely subjective and changes drastically depending on the person, current events, society you live in, et cetera. My original risk perception was that homebirth was less safe. We are taught that hospitals are wonderful places that save lives. We are taught that homebirth is an a crude thing that women used to do on farms and would often die shortly afterwards. There’s a commercial I often hear on the radio for a local hospital. It talks about how birth happens so frequently that it could be considered unimportant, but at their hospital they treat it like the miracle it is. Most babies are fine when they come into this world, but some aren’t so don’t you want the best care immediately available for your baby? Well, according to them, their hospital has the best of both worlds.

Part of risk perception isn’t only what you experience, such as in my case, but also what you know. Educating yourself means you can make educated decisions, which is the most important thing you can do for your family. The more you know, the better decision you can make. So I seek, as I always do on this blog, to educate. I will present information and hope that it helps you in your decision making process, no matter the outcome.

Here is our question: Are hospitals really the best for your birth?

First off, let’s examine birth in the United States. We rank 42nd worldwide in neonatal mortality rate and worst in maternal mortality rate for industrialized nations (for a full comparison and rebuts to arguments against these numbers, watch this video). It is clear that there is something wrong with our maternity system. These numbers, not so surprisingly, correspond greatly with the increase in cesarean births that our country has experienced over the last decade. The cesarean section is a wonderful, life-saving surgery. The only problem is that it is used too often (a whopping 1 in 3 births in our country and rising). There is no reason our c-section rate should be this high and it is costing thousands of lives every year. Yes, costing lives. While c-sections are in some situations the best thing you can do to save either mom or baby’s life, they open a whole new area of complications. A cesarean section is major surgery and as any surgery does, comes with risks. Infection, injury to other organs, medication reactions, and even an increased risk of the placenta fusing with scar tissues in future pregnancies (which at very least means a hysterectomy if not death and increases in risk with every c-section) just to name a few.

So what does this have to do with homebirth? Giving birth at home means drastically decreased interventions. While that study is quite old, I’m certain that it still holds true for a comparison of home to hospital birth. If anything, with our changes to the maternity system in our country over the last couple of decades, I’d say that a more current comparison would fair even worse for the hospital. Interventions, even ones considered so common such as the epidural and pitocin, start the slippery slope towards a c-section, not to mention open a whole new range of possible complications.

But what about comparing death rates in the hospital and at home? A 2009 Canadian study did just that. They found that homebirth had comparable, if not better, outcomes than hospital births. Part of this was obviously perinatal (directly surrounding the time of birth, depending on the definition it can mean anywhere from 20-28 weeks gestation until 1-4 weeks postpartum) death rate. Homebirths were .35 (per 1000), hospital with a midwife was .57, and hospital with a doctor was .64. These are very small numbers, but there is still a significant difference between them. This study didn’t include women who were induced in the hospital, which is the traditional beginning of the slippery slope mentioned above.

There’s also the increased risk of infection presented in a hospital. No, hospitals are not sanitary. Hospitals are places where sick people go and germs spread. Hospitals contain high amounts of antibiotic resistant bacteria that can kill. Newborns have incredibly weak immune systems. Team this with the lack of support for breastfeeding in the hospital (and therefore less immunities for your little one) and you’re bound to get at least something minor, if not something more serious.

Now you take this information and do with it what you wish. I realize that even if I gave you a study that said that you were 10x more likely to die in a hospital birth, that you still may choose the hospital. Even with the knowledge of the slippery slope, many women will continue to choose an epidural because our society’s insistence that birth is pain that is worse than anything you can imagine and no one can or should have to endure it. These are ideas that are ingrained into our heads from a very early age and you can not change things overnight.

The difference now is that you know. You are given the knowledge that some of your preconceived notions about hospital births may not be what they seem. You can take this new knowledge and expand on it how you wish. You can do your own research and make an educated decision on what is best for you and your baby.

It’s Not Fair to Call Me Stupid

Peanut minutes after she was born in Daddy's arms (we still own that towel).

Many people think that we were stupid to have an accidental home birth. The first assumption is that our labor was so fast that we couldn’t get to the hospital in time. The second is that we were so stupid that we didn’t know it was time.

You weren’t there. You didn’t see the signs. You didn’t talk to the midwife on the phone and have her tell you that you still had a long time to go.

It’s not fair of anyone to judge our situation. Actually, from talking to other moms with posterior babies, the feelings I had were not unusual. I didn’t feel like the baby was coming because she was turned around and putting pressure on my bowel (the reason that the midwife and our Bradley teacher both thought I was constipated). The same thing causes my contractions that were anywhere from 2 to 10 minutes apart and very inconsistent. My water didn’t break. Given those signs and adding the fact that we didn’t want to go to the hospital until we absolutely had to, would you have gone in?

I’m guessing not.

Given the last 2 years to hear other people’s stories and process, I think I know what happened. It is my belief that my daughter was posterior for the majority of my labor. For a long time I was on the toilet “pushing” because the midwife said that once I was relieved of the constipation, the baby would come. Considering those two places are very close together, pushing in one place equates to at least some pushing in the other.

Then my daughter flipped around. I don’t know if she was in my birth canal or if all of the pushing before hand made her basically slip down into the birthing canal once she was in the right position. Either seems anatomically difficult, but it’s what makes the most sense for the sensations I was feeling. Suddenly, it felt like the pressure was in my vagina rather than my bowel. I thought myself crazy, but decided to check. Sure enough, she was just a few inches from crowning.

I immediately felt a strong urge to push her out. I don’t know if it was the sudden urgency of the situation if it was simply that she was finally in the correct position. Either way, it was the strongest urge I’ve ever felt. Just a few pushes and she was out. I can’t give a good idea of a time frame, but I know it was quick.

I’m sure that part of what we saw during labor could have pointed us in the right direction. Possibly I would have recognized transition if it wasn’t my first labor, but it was so short (I literally said to my husband once “I don’t think I can do this” and he said “Yes you can” and that was it) that we didn’t recognize it. Maybe if I wasn’t so afraid of going into the hospital and being stuck there and having all of these interventions, I would have gone in to get checked. If I would have had a planned home birth, maybe the midwife would have recognized the signs of a posterior labor and realized I was closer than we thought. Maybe if our midwife hadn’t had been so certain that I was just constipated, we would have seen the signs that it wasn’t constipation rather than ignoring them because the midwife must be right.

All in all, there were many things working against us making it to the hospital in time. Some simple things like not realizing that I was in transition. Some much more complex like my water not breaking.

I don’t regret birthing Peanut at home, with or without attendants. What I regret is going to the hospital afterward. What I regret is having to hear flack from people for missing the signs. What I regret is the resentment I feel towards the people in my life that think I’m stupid or ignorant for having an accidental home birth.