Home Birth vs Hospital Birth isn’t about location

January 18, 2011 · 8 comments

Porking out while being breastfed“Isn’t the obvious answer somewhere in the middle — … that [birth] should happen in a homelike environment within a hospital?” ~Lisa Belkin, Motherlode


Saying the middle ground of the home birth/hospital birth debate is a “homelike environment within a hospital” is like saying the middle ground of the feminist debate is for all women to work outside the home as teachers and daycare providers.

Where and how a woman chooses to give birth shouldn’t be a matter of public debate.

Home birth is safe. Even if you use the infant mortality numbers from the widely discredited Wax paper, the chance of a negative outcome with a home birth is less than 1%.

Hospital birth is safe. Most women give birth in hospitals, and most do just fine.

Both choices have risk.

For some women, giving birth at home is safer than a hospital. For others, the opposite is true. Each person should be able to evaluate their own situation with their family and maternal health provider and decide what’s best for them.

Unfortunately, because in the United States there generally isn’t easy access to qualified, trained, licensed midwives, the public feels compelled to weigh in to declare a “best” choice for everyone.

Access, Access, Access

In countries with the best maternal and neonatal outcomes, maternity care isn’t a matter of either/or. Midwifery and home birth is an integral part of the system, and low-risk women are free to make an informed choice about their place of birth.

They are then free to spend their pregnancies preparing for their unborn child, instead of on the phone with their insurance company, writing their legislatures, or taking out a loan to pay out-of-pocket for a midwife to avoid laboring in a hospital where 40% of the women give birth through their abdomen instead of their vagina.

Yes, that really happens.

Risky business?

Stop pretending that home birth is the only risky way to give birth.

Induction introduces risk.

Epidurals introduce risk.

C-sections introduce risk.

Yet the public hardly blinks an eye when women choose those options.

Scented Candles and Soft Music?

Do we really need to keep explaining why laboring in an unfamiliar environment with strangers sticking their hands in our vaginas and needles in our arms isn’t an ideal physiological condition for many women to give birth?

ACOG and The Lancet purport women want to give birth at home so they can have scented candles and soft music, and that hospitals have surgical teams at the ready for split-second emergency rescues in normal births. These two myths combine to form the conclusion that women who give birth at home trade “the birth experience” for “safety”.

Licensed homebirth midwives have skills, equipment, and training to deal with the vast majority of labor emergencies either at home or with enough time for safe transport. The answer to making homebirth safer isn’t to banish it, but to incorporate it into the continuum of maternity care so when emergencies do arise, midwives and physicians can be on the same page and transported women aren’t treated as lepers when they arrive at the hospital.

Money matters.

I’m also baffled as to how a home-like environment in a hospital is financially feasible. Hospital workers readily admit that labors are managed and sped along with medications and other interventions because hospital beds are limited and expensive. If that’s the case now, how will hospitals provide more comfortable, more private labor accomodations that approximate the physiological security of giving birth at home?

The reason celebrities famously give birth at home isn’t because they’re being trendy. It’s because they can afford it, because home birth attended by a licensed midwife often isn’t covered by insurance. Even though the cost of a home birth with a licensed midwife is usually about half the total cost of a vaginal hospital birth, the out-of-pocket cost after insurance payments makes hosptial birth more affordable for most women.

How long will insurance companies be willing to shell out more and more money for more comfortable home-like hospital accomodations, when safe, comfortable, home births are already available and affordable? Why aren’t they doing it now?

There is no “best” way.

It’s impossible to generalize about the “best” way to give birth in the same way it’s impossible to say there is a “best” way to live a life.

It’s not a matter of finding a middle ground that will work for everyone. Home birth advocates aren’t fighting for everyone to give birth at home. We’re fighting for access, and fighting for choice. 

Pregnant women can understand the risk factors. Pregnant women don’t need to be scared, bullied, or talked-down to. Pregnant women can make informed choices, when given the chance, that are of the most benefit to themselves, their children, their families, and ultimately, society.

It’s not a one-size-fits all kind of thing.

Photo Credit: Porking out while being breastfed by shellorz, on Flickr

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