The Truth About Home Birth and Hospital Birth
By
Sheila Stubbs ©2008
In spite of all the childbirth education available today, women fear childbirth as much as they ever did – perhaps even more. In the media childbirth is portrayed as a risky event. The hospital is considered to be the safest place for both mother and child because of its modern technological equipment, so women are afraid of giving birth at home. And truly, if a woman feels safer in the hospital, she will labor better in the hospital. But is it safer to give birth in a hospital?
What do the Statistics Say?
No study has ever proven that hospital birth is safer.
When hospital birth has been defended as safer than home births, all out-of-hospital births were used in the statistical data, including births which occurred in taxi cabs and newborns found in trash cans. For a realistic, truly fair representation of the homebirth population, well-informed healthy women who planned homebirths should not be equated with teenaged drug addicts who gave birth in toilets. A reliable comparison between home and hospital births would include parents who were matched - by age, number of pregnancies, education, socio-economic status, and risk factors. This has been done.
The first of such studies was done in 1976 by Dr. Lewis Mehl, MD, and included over 1000 couples.
This study clearly shows that home births resulted in much less difficulty and intervention than their hospital-birthing counterparts.
................................Hospital Birth.......Home Birth
1st Stage of Labour........8 hours average.......12 hours average
2nd Stage of Labour......42 minutes avg.........72 min. average
3rd Stage of Labour.......5 minutes avg...........22 min. average
birth injuries.................30..........................0
elective induction..........22..........................0
amniotomy...................56..........................6
episiotomy...................87.4%......................9.8%
pain medication............75%.........................5%
oxytocin - 3rd stage......95%........................24%
forceps.......................35%........................1.6%
oxygen required............8.9%.......................1.2%
Cesarean required .........8.2% .......................2.7%
• Note that all three stages of labour took less time in the hospital. This seems to be a benefit, but labor is shortened by amniotomy, episiotomy, oxytocin and forceps used.
• Homebirths required very little medication in spite of long labors.
• The cesarean rate in the hospital was only 8.2%. It’s now over 30% in most hospitals. But even in 1976, the rate was three times higher for couples who chose hospital deliveries.
As for complications, in the hospital births,
Resuscitation was required 3.7 times more than home births
Newborn infection occurred 4 times more
Meconium aspiration pneumonia 2.5 times more
Newborn respiratory distress 17 times more
Fetal distress 6 times more
Meconium staining 3.5 times more
Shoulder dystocia 8 times more
Maternal high blood pressure 5 times more
Maternal hemorrhage 3 times more
3rd degree tears 5.5 times more
4th degree tears (into the rectum) 14.6 times more
A more recent study in 2006 shows a similar contrast :
Intervention........Homebirths Hospital
Fetal monitor.......9.6%.........84.3%
Induction............9.6%.........41%
Augmentation......9.2%.........18.9
Episiotomy..........2.1%..........33%
Forceps..............1%............2.2%
Vacuum Extraction.6%...........5.2%
Cesarean.............3.7%.........19%
Questions to ask yourself:
Why are there more cases of shoulder dystocia in the hospital? Why are there more cases of maternal hemorrhage where more technology is available to ensure your safety? Why should there be a greater likelihood of 3rd- and 4th-degree tears dependent upon the location where a woman gives birth? What causes a five times as many women to require a cesarean section when they leave their homes to give birth? Does this make sense?
Is there something about being in the hospital which makes it more dangerous to give birth there?
How Routine Interventions Can Cause Problems
1. If you arrive in early labor in the evening a sedative is usually ordered to help you sleep through those early contractions, so you (and the doctor) will be well-rested for the birth.
Risks: -Your baby may be adversely affected by the drug.
- Sedatives are not prescribed during pregnancy because of the risks to the baby, yet doctors deem them safe during labor.
- Sedatives can slow baby’s heart rate to the point of distress, necessitating cesarean.
- Baby more likely to require resuscitation.
2. Electronic Fetal Monitoring is a standard requirement
Risks: - When hospitals began using fetal monitors, cesarean rates increased.
- There has no improvement in mortality and morbidity rates with the increase in cesarean rates.
3. Bed Rest is recommended to get as much rest as possible and avoid infection.
Risks: Labor is slowed increasing need for augmentation
- When mother is upright and moving freely, it helps move the fetus into optimal position for delivery.
- Confined to bed, the fetus may become wedged into an awkward position increasing the need for forceps delivery or cesarean section.
4. Rupturing Membranes to “help speed things up.”
Risks: - Increases your infection risk.
- The cord may prolapse making a cesarean necessary.
- Your contractions will become more intense and painful.
- You now have a time limit, and may require augmentation
5. Augmentation: The use of artificial hormones to increase and/or regulate contractions.
Risks: - Powerful contractions can cause uterine rupture
- Too long/too strong contractions can cause fetal distress.
- Substantially more painful than natural contractions.
- More likely to need pain medication.
6. Pain Medication
Risks: - Can cause respiratory difficulties for the baby.
- Baby may be lethargic and have trouble breastfeeding.
- Some drugs have an adverse affect on intellectual and motor development of the child
- May make the mother feel “drunk” and less in control.
7. Epidural Anesthesia:
Risks: - Epidural use is related to an increase in neonatal jaundice.
- Some women develop a backache that may last several months.
- Occasionally the numbing effect of the drug accidentally goes up instead of down, causing maternal breathing difficulty.
- Increased risk of hypotension
- Slows down labor, increasing the need for further augmentation.
- You can’t feel the pushing urge.
- Forceps delivery is more likely, because your ability to push is affected.
- Adversely affects the hormonal surge following birth that aids bonding.
8. Lithotomy or semi-sitting position for delivery
Risks: - Lying on your back makes your uterus work harder.
- When on your back, the baby presses on large blood vessels causes pain, increasing the need for medication.
- Increases the need for forceps.
- Increases the risk of tearing as it puts more pressure on the perineal tissues.
- The weight of the uterus rests on major blood vessels, possibly making you lightheaded and also...
- Reduces the oxygen supply to the baby, causing fetal distress.
- One of the main reasons for lithotomy position is so the doctor can do an episiotomy, but the main reason you need the episiotomy is because you are in lithotomy position!
9. The Episiotomy – believed to prevent a perineal tear that would be difficult to repair.
Risks: - Increases the risk of infection.
- It will be painful to sit on those stitches for days at best, weeks sometimes. Some women have painful intercourse for months after an episiotomy.
- The birth may occur sooner but repairing the incision takes up to an hour.
- Studies showed a higher risk of second- and third-degree tears with an episiotomy, than without one.
But isn’t it Safer for the Baby in the hospital?
- Both you and your baby have a much higher risk of acquiring an infection in the hospital.
- You are immune to the germs in your own home your baby receives immunities by breastfeeding.
- A cord around the baby’s neck is not uncommon, occurring in about 30% of births, and not inherently dangerous.
- The widespread practice of putting alcohol on the cord to help it heal was proven in one study to be useless.
- Hospital nurseries were necessary when mothers were rendered unconscious for delivery. Healthy mothers are very capable of caring for their own babies.
- Nurseries undermine a woman’s ability to care for her child. Many feel inadequate in contrast to the medical experts who keep her baby under observation.
- Mothers may pattern themselves after these “experts” and ignore their baby’s fussing and crying.
- Separating mom and baby interrupts an important learning period in which mother learns to interpret baby’s signals. This can affect breastfeeding success.
- Love is missing! Babies should be in their mother’s arms, not isolated in a box, nor watched over by strangers!
The Move to the Hospital
It’s commonly believed that women stopped giving birth at home because hospital birth was safer. The truth is that the early 1900’s studies showed mortality rates were higher in doctor-attended births than midwife-attended births, and highest in hospitals. Today, there is still no statistical data to prove hospitals are safer. Countries using midwives as primary maternity caregivers have the best mortality statistics.
Why did hospital births become so popular?
1. Convenience. It was easier for the doctor to have the patient come to him, than for him to have to travel to the patient. Thus, while the woman was laboring in the hospital under the watchful eyes of the nurses, the doctor could continue to see other patients. This brings us to the second reason:
2. Money. The doctor could earn more money managing several patients at one location.
3. Control. In the hospital, the doctor was in his own domain. He could dictate how he wanted things done. At home, doctor was not the manager, but the helpful visitor.
Home Birth: Not only safe, but easier!
 You don’t have to go anywhere. No bags to pack, no arrangements made to feed the dog. Your midwife comes to you.
 There is little to do in the hospital but wait, so boredom and discouragement can make augmentation more appealing. At home, you can continue to do whatever you normally do.
 Preparing your home for the baby – “Feathering your nest” – is an emotionally satisfying way to pass the time.
 No coping with admission procedures and paperwork during contractions. No asking permission or arguing policy.
 Eat and drink whatever you desire, do as you like. Sing, dance, or take a shower. Talk on the phone or take it off the hook. Cry if you want to, scream if it feels good. You write your own rules.
 Invite whoever you want at the birth, as many as you want. Or don’t tell anyone.
 You don’t have to worry about strangers walking in at any time. Your privacy is respected.
 You can do whatever you like with that privacy. Kissing and lovemaking stimulates hormones which can actually help labour.
What If Something Goes wrong”?
• If something goes wrong, go to the hospital of course!
• Because midwives provide personal care to you, not to the entire maternity ward, problems are detected well in advance of disaster.
• If the umbilical cord prolapses into the birth canal, call the hospital to prepare for an emergency C-Section. Kneel with your head down and bottom up to protect the cord from compression. Being in the hospital would not have avoided this complication.
• Some blood is normal in labor, but too much would be worrisome. Go to the hospital to be checked out.
• Hemorrhage after the birth. (3x more likely in hospital) Nursing the baby and massaging your belly will help your uterus contract. Go to the hospital if the bleeding is profuse.
• A cord around the baby’s neck can usually be slipped over the baby’s head. If it can’t be slipped off, tie it and cut it and deliver the baby as quickly as possible.
• Baby’s shoulders get stuck in the birth canal eight times more often in hospital births. At home a change of position will help: standing; on all fours; squatting; a lunge. A midwife may need to reach in a finger and gently pull the shoulder from under the pubic bone.
• Baby doesn’t breathe: (17 times more likely in the hospital!) Do infant CPR as described in any First Aid Book.
• If a long, difficult labor exhausts you, the hospital has relief.
• If you simply have a “gut feeling” that something is not right, trust your instincts.
Handling the Pain
 Just as common pains like menstrual cramps or headaches are easier to cope with in your own home, the same is true with labor. When you feel more at ease in the comfort of your own home, this relaxation leads to an easier, less painful labor.
 Pain is worse when accompanied by fear. At home, the fear of the unknown is reduced because of your familiar surroundings.
 When you feel like you can’t handle the pain it’s usually because you are only a few contractions away from delivery.
Birth Attendants
Usually two midwives attend home births, so there’s one pair of hands for mom and one for baby. You might want another attendant too. There are several things to consider when you decide who you would like at the birth.
• What do you want them to do? Housecleaning? Childcare? Backrubs? It’s nice to have someone clean up while you enjoy the new baby. Pick someone who won’t mind doing a little housework.
• Hire a “doula” - a woman with training in labour support. Or just ask a caring, supportive neighbor to be your doula.
• How many people do you want? Some enjoy the support of many close friends. Others like to keep it private and intimate.
• With older children, you may wish to have a person who knows your child(ren) well, whether to reassure them as they watch the birth, or to entertain them elsewhere in the house.
• Don’t invite a friend to your birth because it would be a good experience for her. You don’t need the pressure of performing for someone else’s benefit.
• This is your day, and anyone present should be there to serve you. If your very best friend in the world thinks you are taking a terrible risk, you don’t want her negativity at your birth.
• Have back-up persons planned in case your first choice of helper is not available, or you need more help than you expected, or in case you have to go to the hospital. Ask them ahead of time.
Preparations for the Home Birth
Stuff You Probably Have Already
• Lots of food - so your birth attendant(s) can find something to eat, and so you have plenty for yourself after the baby is born.
• A firm bed, if bed is where you want to give birth.
• Some like to sit on an exercise ball during labor. Or soak in the bath.
• Plastic sheet - to protect the mattress (or carpet) from wetness. An old shower curtain or vinyl tablecloth will do.
• Old sheets and towels - to absorb fluids.
• Newspapers - also to protect floor if amniotic fluid is leaking.
• Tea Kettle - to make some raspberry-leaf tea, an herb which is known to help labour, childbirth, morning sickness, menstrual cramps, and mood swings. Boiling water is also for sterilizing the scissors and string for the cord, and to have warm compresses for the perineum.
• Sharp scissors for cutting the cord.
• A dresser or table cleared off for doctor or midwife use.
• Large bowl, dishpan or ice cream tub for the placenta. You can line it with a plastic bag if you like. Or use newspaper.
• A roll of paper towels. Handy for any kind of messes.
• Large garbage bags to contain those messes.
• A shovel. Traditionally, Dad buries the placenta ceremoniously in the backyard, planting a tree over it.
• Camera, camcorder, or tape recorder if you want to record the event.
• Heavy-flow menstrual pads. You’ll need them the first day or so.
• Clothes, washed and clean for the baby; clothes for mom to wear after the birth, too. Choose something with easy breastfeeding access.
• Thermometer - a good idea to check mom’s temp daily - a rise in temperature could indicate an infection.
• A list of emergency phone numbers, posted by the phone.
• Olive oil - sometimes used for perineal massage. You can put it in a squirt bottle from the dollar store for better aim. Warm it in hot water.
• Soft washcloths or old diapers - for hot compresses.
• Flashlight - in case of a power failure.
Things You Might Not Have and Might Want to Get
• A shoelace for tying the cord. Shoelaces are soft and pliable, unlike the hard plastic clamps used in maternity wards.
• Germ-killing soap like Betadine or Phisoderm for hand-washing.
• Infant Ear/Nose syringe - to suction mucous if necessary.
• Baby Scale. Borrow one. Midwives often use a simple fish scale. Babies don’t mind being suspended from the scale in a cloth sling, but they hate to be laid naked on the metal scale.
• A bottle of champagne and a cake for the party afterward!
• Birth Day Party gifts for other children, wrapped and ready. (Some find a video is a good gift, using it to allow for mom/baby rest time.) Surprise your helper with a gift for her too.
Other Things Some Couples Like to Have
• a large mirror - to watch the birth
• hot water bottle or heating pad
• talc or lotion for back massage
• bendable drinking straws, ice chips
• rocking chair
• your favorite laboring music
• disposable diapers
• petroleum jelly – helps clean off those first black baby poops.
Other preparations
• Be prepared to meet with negative reactions. Some people may think you have just taken a terrible risk for selfish reasons!
• Be prepared to prove the baby is legally yours! A camera with date- stamp the date might be a good idea.
• Be prepared to limit visitors. They forget that even though you aren’t a hospital patient, you still need your rest.
• Be prepared to accept help. If someone offers, they will be happy to know exactly what will help you. “How nice of you to offer! There’s a load of laundry in the dryer that needs folded, and could you sweep the kitchen floor please?”
“What about The Mess?”
When you prepare the birth bed, make the bed with clean sheets, twice. On top of the clean sheets, put a plastic sheet, and then another set of clean sheets. After the birth, your helper simply strips the top layer off. If you use old towels, sheets and newspapers, you could simply stuff everything — even the placenta — into a large trash bag.
In some places the placenta must be buried by law, as it is human tissue. In winter, wrap it up and put in the freezer until the ground thaws. Label it to avoid surprises!
