Family Planning: Hospital Birth or Home Birth?

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Table of Contents

Introduction
Background
Arguments for Home Birth
Arguments for Hospital Birth
Counter Arguments
Conclusion
Works Cited

Introduction

Visiting different forums on the internet, related to the issue of giving birth, a question that frequently a person might see is “Should I consider a home birth”. Analyzing such a question, one might remember the films on television and the novels of the old times, and come to the conclusion that the modern families have the alternatives to choose from, a luxury that the families in the past did not have. In that regard, the recent rise in such issues might have been caused by the fact that women initially tended to give birth in the natural setting to which they are used to, while hospital birth as a decision was guided by the safety first rule. In that regard, if the argument of safety was followed at home, does that mean that home birth will be the preferred method. Considering the controversy of the issue, the home birth is not so unambiguous, in terms of the existence of many factors that should be taken in mind. Nevertheless, this paper takes the position that home birth is a valid alternative to hospital birth, which in case of following the recommended measures will be the preferred choice, and which have many advantages.

Background

The wrong assumptions that can be made are that, in modern times there is a prevalence of hospital births over home births. In that regard, analyzing the history of midwifery, it can be seen that despite some shifts through the twentieth century, home birth was and still is the most common way of giving birth in the world. Skipping the older times, where for known reasons women gave birth at homes throughout history in most cultures, the shift toward hospitals started from the beginning of the 1900s. (O’MARA 1) The exact date is unknown, where until 1900s “midwives were the primary healers and birth attendants in the US” (O’MARA 1).

The shift started from physician attendance from the late 1800s, and up until the mid 1900s, where hospital birth was the norm, except in the most isolated and rural parts of the country. (O’MARA 1) For that period, it should be noted that giving birth in the hospital was not safer. On the contrary, it was even more dangerous than home birth, where the infection rates were higher in the hospital than in the home setting (O’MARA 1). In that regard, it was not until 1940, where the introduction of the sulfur antibiotics resulted in the mortality rates in hospital births drop below that of home births.

The following decades witnessed shifts from the idea of natural childbirth in the 1950s and 1960s, as a response to the medicalization of birth and infant feeding, to the emphasis on medical technologies and techniques starting from the late 1970s. Since that time, the introduction of medical technologies, and the private insurance, which made hospital birth affordable, increased the rate of hospital deliveries. In that regard, it should be noted that despite the fact that the natural birth movement was also continuously growing, home birth statistics remained low, where as of 2006, “99 percent of all births were delivered in hospitals; this level has been stable over the past several decades” (Martin et al.), and only 65.4 percent of that number were births given in residences, with the rest being in freestanding birthing centers.

Arguments for Home Birth

The arguments for home birth can be started with mentioning the most recent study published in the British Journal of Obstetrics and Gynecology in Mid-April, in which more than 500,000 women participated. In the course of the study, the researchers examined during seven years the information of birth of all low-risk women. Among these women 321,307 planned to give birth at home, 163,261 in the hospital, while the information of the preferences of 45,120 was not available.

The researchers considered such information as the number of deaths of the babies born in hospitals, born at homes, died during birth, during the twenty four hours after the birth and during the following week. Additionally, the researchers analyzed the information of the numbers of times the babies were placed in resuscitation. The study found that in home births, as well as in hospital births, the risk of babies’ death with low-risk women, and who had a normal flow of pregnancy, was almost equal. Accordingly, the study indicated that the following was true if an experienced obstetrician was present (Gordon).

The results of such study eliminate the factor of safety when arguing for the hospital birth, and although previous studies might have indicated similar results (Duran), the latest can be considered as the largest in scale, as almost 30 percent of women in the Netherlands give birth at home. Other researches with a smaller sample, indicated that home birth was also similar to hospital birth in safety and even safer, where “women in the home birth group were less likely to have epidural analgesia …[and] had fewer procedures during labour” (Janssen et al.).

In that regard, when equalizing the factor of safety as an argument, the benefits of the home birth over the hospital birth include the ability to deliver in a familiar and comfortable surroundings, having more control over the birth experience, and skipping the enduring routine medical interventions (BabyCenter Medical Advisory Board). Additionally, the aforementioned factors can be added to the ability to share such experience with family members, where their presence as well as the convenient setting might be relaxing to the mother, eliminating the fear from the procedure which can be usually associated with hospitals.

Arguments for Hospital Birth

Refuting the arguments of safety through the studies mentioned in the previous section, it should be stated that the main argument against home birth is only …safety. According to the press release of the American College of Obstetricians and Gynecologists (ACOG), the main argument of safety emphasizes that delivery in hospital is an essential process. In that regard, ACOG argues that complications can arise “with little or no warning even among women with low-risk pregnancies” (ACOG NEWS RELEASE).

ACOG also emphasizes the fact that a normal delivery can quickly become life-threatening, where the mother and the baby might face catastrophic consequences in case an emergency arises, and which needs professional medical intervention. In that regard, hospital is not only the best solution to handle possible complications, it is also the safest setting for the immediate postpartum period (ACOG NEWS RELEASE).

Additionally, according to the statistics of linked birth infant statistics, it was shown that home birth increases the risk of neonatal death to double or triple the neonatal death rate at hospital birth (Tuteur). The comparison includes home births with Direct Entry Midwives (MED), and hospital births with an MD. The lowest statistics were for hospital births with Certified Nurse Midwives (CNM), which can be explained in the fact that they do not care for high risk patients.

Counter Arguments

The best answer for the arguments of ACOG is that their representation of the birth experience contradicts the view on child birth as a naturally occurring experience. Their position on child birth turns the procedure into a potential medical emergency. In that regard, the exception can be seen in the occurrence of a problem that requires medical intervention, and in that regard, the arguments for home birth are supporting such a position.

It should be noted that all of the arguments supporting home birth in all of the literature and supporting studies, emphasize the low-risk factor, the normal flow of pregnancy, and the presence of a certified personnel. None of the arguments were supporting the unassisted birth, or the so-called free birth (Shanley). Accordingly, such a position can be accepted when there is a necessity and factors of risk in the process. Otherwise, promoting hospital birth using the arguments of what could happen is an intimidation.

Conclusion

It can be concluded that home birth is a natural experience that, in case each rule and consideration was followed, would be a safe experience. The results showing the same mortality rates indicate that, with similar safety factors, the usual setting can be more convenient for the mother and the baby. Nevertheless, it should be stated that the hospital is a necessity in case there is a slight factor of risk present, so the process will be monitored by a professional in a medical setting.

Works Cited

“Dutch Study Finds Home Birth Is Safe“. 2009. NCT Watch. Web.

ACOG NEWS RELEASE. “Acog Statement on Home Births”. 2008. American College of Obstetricians and Gynecologists. Web.

BabyCenter Medical Advisory Board. “Planned Home Birth”. 2008. BabyCenter. Web.

Duran, A. M. “The Safety of Home Birth: The Farm Study.” American Journal of Public Health 82 3 (1992): 450-53. Print.

Gordon, Wendy. “The Netherlands Home Birth Study”. 2009. Midwives’ Association of Washington State. Web.

Janssen, Patricia A., et al. “Outcomes of Planned Home Births Versus Planned Hospital Births after Regulation of Midwifery in British Columbia”. 2002. Canadian Medical Association. 2009. Web.

Martin, Joyce A., et al. “Births: Final Data for 2005 “. 2007. National Vital Statistics Report. 2009. Web.

O’MARA, PEGGY. “We’ve Come a Long Way, Babies.” Mothering.92 (1999): 56 pp. 2009. Web.

Shanley, Laura. “What Is Unassisted Childbirth?”. Unassissted Child Birth. 2009. Web.

Tuteur, Amy. “New National Statistics: Homebirth Increases Neonatal Death.” Homebirth Debate, 2008. Vol. 2009. Print.

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