In the last 80 years, a dramatic shift has taken place in the minds of most people in developed countries. From the 1920's birth has viewed as a natural and normal part of life. A family doctor or more commonly a midwife would arrive to the parents' home and assist in childbirth. When mothers began to hear that pain medication was available in a hospital, a huge shift in birth occurred. Birth was now looked at as a "medical event" that required medical intervention.
As a result, the changing perception of homebirth is that it is a choice to "go backwards" or that it is "not safe". Parents who choose homebirth are often asked "Why would you choose to give birth at home when the hospital is so much safer?" Let's examine this phenomenon of homebirth safety to see if there is any truth to the perception that hospital are safer than homebirth.
Medical Advances in Health Care
It is undeniable that the medical advances in health care in the last 80 years have greatly benefited both mothers and their babies. The use of antibiotics has decreased the number of mothers and babies who might have died as a result of infection years ago. Medications such as pitocin and methergan that can be used to prevent or treat postpartum hemorrhage have also been life-saving developments. Mothers today who need a cesarean have the option of an epidural or a spinal as opposed to risking complications from general anesthesia. So it is clear that the medical advances available in hospital in the last 80 years have brought about some positive changes for childbirth.
However it is important to point out that several of these medical advances in health care, including antibiotics and post-delivery pitocin are also now available to mothers choosing homebirth.
The Risks of Hospital Births
Undoubtedly one of the biggest risks in hospital today, no matter what type of procedure or surgery you are having, is from hospital-acquired infection (HAI). Every year over 2 million people become infected in hospitals in the US. This translates to about 70,000 people each year who die as a result of HAI's and over $4 billion dollars in additional medical costs.
The truth is that babies may be at greater risk than adults in contracting an HAI. One study showed that the neonatal ICU is one of the departments in hospitals with the highest rates of infection. The biggest risk of an HAI appears to affect male babies who are born preterm.
Studies also show that if the mother labors and gives birth in a hospital, she has a much higher chance of having a cesarean, as well as other medical intervention such as episiotomies, forceps and vacuum extraction than a mother who has planned a homebirth.
Homebirth Safety
A large North American study published in the BMJ of planned homebirths attended by certified professional midwives demonstrated that medical intervention was much less in the planned homebirth group and that the risks to mother and baby were no different in the homebirth group versus those who planned to give birth in a hospital.
While this study is not overwhelmingly positive toward homebirth, the fact that outcomes for mother and babies were the same disputes the perception that homebirth carries more risk.
Experts Disagree about the Safety of Hospital birth versus Homebirth
A Cochrane review states that there may no clear front runner in the battle for safest place of birth. In fact, their summary from review of research looking at both homebirth and hospital births indicates that "in some countries almost all births happen in hospital, whereas in other countries home birth is considered the first choice for healthy and otherwise low-risk women. The change to planned hospital birth for low-risk pregnant women in many countries during this century was not supported by good evidence. Planned hospital birth may even increase unnecessary interventions and complications without any benefit for low-risk women."
Similar to the BMJ study, the review found no clear evidence that hospital birth was superior to that of planned home birth for low-risk pregnant women and vice versa.
On the other hand, in 2008 the AMA has come out with a strong statement supporting the safety of hospital birth over homebirth. In fact, the official AMA statement supports legislation to oppose homebirth as a option for parents.
What Parents Need to Know about Homebirth versus Hospital Birth
In the end, parents should take a number of factors into consideration when deciding between a homebirth and a hospital birth.
- Do you have qualified staff who know how to handle complications should they occur in your homebirth?
- If you are considering homebirth, do you live a close distance to a hospital?
- If you are planning homebirth, is your pregnancy low-risk?
- If you have chosen a hospital birth, is your care provider patient with your questions in the prenatal period? This can help give you a window to know if she/he will be attentive and not rush to unnecessary intervention.
- Does your care provider have a personal cesarean rate that is lower than the national average?
- Do you have options for additional support in a hospital such as using a doula?
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