Hospital Vs Birth Center Vs Homebirth
by: Kimberly Ambrose
of Open To Birth
Usually, when you are going to a hospital or doctor’s office, it’s because something is wrong, but with the birth of your child, you seek care because everything is going just as it should. In childbirth, you’re looking forward to when it’s finally time to call the midwife or go to the hospital. In most countries women are under the care of a midwife throughout their pregnancy, birth, and postpartum year. In the U.S., most women are under the care of an obstetrician, a trained surgeon. In the last 25 years, we have seen a rise in not only births by cesarean surgery, but also the cost of childbirth. This has led to a growing mistrust of maternity care policies and has created a swing back to home-birthing in order to both save money and avoid the increased possibility of unnecessary medical intervention. Some people have a mistrust of doctors and may be uncomfortable with the invasive technology of modern medical care. On the other hand, some other people would feel just as uncomfortable with not being able to get to a hospital and having to go through an unplanned delivery at their home. Where you give birth should feel safe to you, wherever that is and for whatever reason. Pregnancy can bring out a lot of opinions from the people around you, and where you choose to give birth can raise passions, but as long as you are the one doing the birthing then you get to decide what feels safest for you.
Determine where a woman gives birth is an important part of her birthing plan, and it is crucial that she feels safe in order for her to give birth. Oxytocin is the naturally occurring hormone that is responsible for causing labor contractions. As oxytocin increases, two other hormones are increased: adrenaline and endorphins. Endorphins are the hormones that provide a sense of calm, well-being and act as a natural anesthesia, providing pain-relief. Adrenaline gives the Mother the power and stamina to cope through contractions, endure a marathon of intense physical changes, and finally push the baby out. When a woman experiences fear, anxiety, or trauma, her adrenaline levels can become too high, which slows and can shut off the flow of oxytocin. This hormonal mechanism is present in all mammals. If a tiger is giving birth in the wilderness, and there are predators near by, ready to eat her vulnerable young, her adrenaline will peak and stop her labor long enough for her to move to safe area and deliver there. If a woman does not feel secure in her surroundings, it can make labor longer and more difficult for her to cope through. This also applies to the way she feels about her doctor and/or midwife. The Mother’s hormones need to find their perfect balance in order for labor to begin, progress, and then for her to deliver safely.
You feel most comfortable birthing in a hospital. You like the security of having technology close-by if needed. Most babies in America have been born in a hospital since the 1940’s. Hospital birth has changed quite a lot since then. Men are now allowed in the delivery room, routine episiotomies are beginning to phase out, breastfeeding was the normal way to feed an infant, then formula feeding was encouraged, and now we’re going back to breastfeeding. The use of stirrups during pushing is now an option instead of the routine set-up for delivery. Through all of these changes, some hospitals have been quick to change, while others continue the use of unnecessary routine interventions. Shopping around for a hospital birth has many factors, such as varying policies, locations in proximity to your home, and what they will allow. The good thing is that modern hospital birthing offers more options now than it ever has before. Couples are bringing in birth plans, some delivery rooms include a shower or tub for a water birth, many hospitals offer a midwife or doula option for maternal care, nurses are maneuvering around birth balls and women are getting up out of the bed, free to move and cope as they need to. With the convenience of having technology close-by, comes the increased chance of having unnecessary medical interventions. It’s good to ask questions to clarify your options. By asking your nurse or doctor, “Can I have time to think about it?” or “What are our alternative options?”, you can play a more active role in your medical care and decision making. Making your preferences known is an important part of planning a hospital birth. There is also hospital policy. Hospital policies might discourage some families from wanting to go through labor and delivery in their establishment. Common hospital policies include no eating or drinking of anything other than water, ice chips, juice or popsicles, getting out of bed when you are hooked up to the fetal monitor, mandatory fetal monitoring, mandatory intravenous infusion of fluids, etc. Knowing the policies of the hospital you’re going to give birth at can help you and your family prepare.
Having your baby at home is a great option if your health and your baby’s health permits it. The danger of a home birth is that, if complications arise, you may increase risks by not having immediate access to medical care. The benefits of home birth include a decreased risk of infection, no time limit placed on your birth process (before interventions like Pitocin is suggested), control over your settings, what you wear, what and when you eat, and control over the room temperature. You can bring in a pool for a water-birth. Not to mention the convenience of being in your home and not having to make a trip during labor or after in postpartum. You have to be medically approved by your midwife to give birth at home. The midwife brings supplies with her if any treatments she is capable of doing become necessary. She should bring everything she needs with her, and she will also ask you to prepare your home and provide additional supplies as well. Homebirth.org.uk offers some insight from midwife Mary Cronk, who provides a list of what she brings with her:
- “4 Cylinders of Entonox and the Entonox Head with mouthpieces and a mask.
- 1 Cylinder of Oxygen, a bag and mask for helping a baby and a bag and mask for an adult.
- Baby resuscitation equipment
- An IV giving set and IV fluids.
- Lots of inco pads (large absorbent pads)
- A TENS machine
- Pethidine and the antidote Narcan
- Syntometrine, Ergometrine, and Syntocinon
- Blood bottles and blood-taking syringes
- Syringes and needles
- A sphygnomanometer (for reading blood pressure) and a stethoscope
- Baby weighing scales
- Cord scissors cord clamps and cord ligatures
- Episiotomy scissors.
- Suturing materials and local anesthetics
- Baby drugs – konakion (vitamin K)
- A nice electric warm pad
Most of this lot I rarely use; my episiotomy scissors have been used twice in ten years. The warm pad is often used.”
If complications arise during pregnancy or early labor, your midwife will advise you to go to the hospital in order to use their monitoring technology, intravenous fluids, or to get a second opinion. Home birth is dangerous for a Mother and her Baby if she is experiencing a high-risk pregnancy or if there are medical reasons for her to require medical interventions or special monitoring. On the other hand, due to the rise in unnecessary medical interventions and questionable cesarean surgeries, it may be dangerous to give birth in a hospital if you are having a pregnancy that is without medical problems. A home birth is a healthy option if you medically qualify to do it. A lot of preparation goes into a home birth, and all precautions taken are a routine part of a safe and healthy home birth.
Some birthing centers are free standing and others are attached to hospitals. Free standing birth centers are not hard to come by, but they are comparatively few. They usually offer the care of a midwife or several midwives and may even allow you to bring an independent midwife that you’ve hired. Most birth centers have a private room for each birthing family that is set up just like a home bedroom with a working bathroom that includes a bathtub. You will have to ask what their policy is on how long you are allowed to stay postpartum. You will also have to factor in planning a route to a hospital in case complications arise. Birth centers also usually have a shared kitchen where you can bring snacks and beverages from home to store and eat throughout your labor as needed.