Tuesday, November 10, 2009

Hospital Birth vs. Home Birth

My friend sent me a link to this article from the L.A. Times this morning.

Look, I know that home birth isn't for everyone. There are women who wouldn't dream of giving birth anywhere except in a hospital where the most advanced technology and pain relief is at their fingertips. Fine. I get it, only to the extent that there was a time, long, long ago, when I was one of those women. But knowing what I know now, and having experienced births on both sides of the technology spectrum, I want to make these points in response to the article:

  • "Many doctors are, to put it mildly, not supportive of this approach. Calling home delivery unsafe, they say that women who choose it are placing personal preferences about the birth process ahead of the health of their child.

    "Last year, the American College of Obstetrics and Gynecology issued a formal statement -- one supported by the American Medical Assn. -- detailing its opposition to home births. The organization acknowledged a woman's right to make her own decisions about delivery, but it drew the line at delivering at home."
Of course doctors aren't supportive of home births! Every home birth that occurs equals thousands of dollars that don't go to the doctors or hospitals. My understanding is that maternity units in hospitals are the number one revenue makers for hospitals. It all comes down to competition. Obstetricians have been resentful of home birth midwives since obstetricians took over Western maternity care early in the 20th century. Really. Go research it. This is nothing new.

Some other food for thought: the average uncomplicated vaginal hospital birth in the U.S. costs between $8,000 - $10,000 nowadays. The average c-section (which, don't forget, is occurring at the rate of approximately one in every three births in the U.S.) costs $10,000 - $15,000. Now, even if the mother and her family are not paying these amounts out-of-pocket, someone is: the insurance companies. And you know who really foots the bill for insurance premiums - all of us. The average home birth, on the other hand, costs between $3,000 - $5,000. Interesting, then, that insurance companies are generally loathe to cover home births.

  • "Most women who have home deliveries don't realize what can go wrong and how quickly it can go wrong," says Dr. Erin Tracy, an attending physician of obstetrics and gynecology at Massachusetts General Hospital."
See, this kind of statement just pisses me off. What a load of hooey. The truth is, women who choose home birth are generally extremely conscientious about risks and how to preserve the well-being of themselves, their babies, and their families. These are women who are much more likely to actually research all of their options, all the associated risks, and make a truly informed decision. These are women who actually take responsibility for their maternity care instead of just handing it over to the professionals.

  • "Babies can become trapped in the birth canal, for instance, or their oxygen supply can drop dangerously low, leading to brain damage. Women can experience life-threatening bleeding during labor or contractions so forceful that they rupture the uterus.

    "When these types of complications arise, immediate lifesaving interventions are required -- interventions that can be delivered only by a physician in a hospital or medical center. If a home birth takes an unexpected turn for the worse, both mother and baby must be transported to the hospital for treatment. Even under ideal circumstances -- when the problem is detected quickly, the ambulance arrives promptly and the transport time is short -- those inherent delays in treatment can have tragic consequences."
Midwives are trained to deal with complications such as dystocia (the baby becoming trapped in the birth canal). Dystocia, by the way, is almost always caused by malpositioning of the baby, and midwives are extremely knowledgeable about how to remedy dystocia by using various non-surgical methods to release the baby, such as having the mother assume certain positions during labor. In a hospital setting, dystocia will almost always result in a c-section.

Midwives are trained in life-saving techniques and carry drugs to stop excessive bleeding as well as oxygen and other emergency equipment. I think people have this image of a home birth midwife showing up with a pot of boiling water and some clean towels (which, truly, in most cases probably would be more than sufficient), and nothing more, but that's just not the case. My midwife brings a whole rolling suitcase full of instruments, medicines, and equipment, plus a big oxygen tank - just in case. Midwives are capable and qualified to perform just about every emergency procedure necessary during a birth except a c-section. And the truth is, the vast majority of c-sections performed in hospitals are not truly necessary (go ahead, get mad at me for saying that. It's the truth, and I stand by it).

  • The article repeatedly refers to nurse-midwives, as if that's the only kind of midwife. The truth is, there are a number of different kinds of midwives, and most home birth midwives, as far as I know, are not nurse midwives. Nurse midwives tend to work in hospitals (they are trained and licensed nurses with additional study and training in midwifery) with their obstetrician colleagues. Some people refer to them as "med-wives."
There are also:

~ Certified Professional Midwives - these midwives have passed rigorous competency testing by the North American Registry of Midwives (NARM) and is awarded a CPM certificate.
~ Direct Entry Midwives - these midwives learn midwifery through study, apprenticeship with experienced midwives, and attendance at midwifery school.
~ Licensed Midwives - licences by the state in which they practice; the requirements for licensing vary by state.

  • "Women may be surprised to learn that individual doctors and midwives are often willing to compromise, even collaborate, in a way that they are unwilling to do collectively.

    "Midwives can be asked to perform in-hospital births, and doctors can be asked to temper their use of technology. Some midwives and physicians willingly work together: The midwife assumes primary responsibility for providing prenatal care and attending to the delivery, while the physician provides backup and support should it become necessary."
Sadly, it's really not that easy to come by this type of scenario. No kind of midwife except a CNM (certified nurse midwife) can ever obtain hospital privileges - so even if a midwife is highly capable and qualified, if she isn't licensed as a nurse, she can't deliver in a hospital setting. And the truth is, most women who want a home birth, want a home birth - period. They don't want to "compromise."

  • "For women yearning for a homier birth experience, there's often no reason that the hospital can't be dressed to fit the part."
This is a joke. You can disguise a hospital room any way you want to - with cute, frilly curtains, a television, soft music, whatever. It's still a hospital room, and the procedures and protocols that will take place within those walls will still be those of a hospital. The bacteria one will be exposed to will still be foreign (as opposed to the bacteria in one's home which one has already built up a natural immunity to), exposing the mother and baby to risks of infection they would not be exposed to in their own home. My doula said something a long time ago that made sense and has stuck with me all these years: "If you want a home birth, don't go to a hospital looking for one."

Bottom line: home birth for low-risk mothers is extremely safe and usually far more satisfying. Midwives are very knowledgeable about screening out high-risk women and have no qualms about insisting those women give birth in a hospital setting. Even the World Health Organization endorses the midwifery model of care and out-of-hospital births, as opposed to the medical model of care.


Leigh Anne said...

i can't even read articles like that! they just piss me off! we're excited for our homebirth (provided i ever get pregnant again, lol).

ashamom said...

I know, I know. If it wasn't for the money ( I didn't have the $3,000), I would birth my last few babies peacefully on my own terms in my own time... No matter how nice they are to you- you always feel the pressure to "produce" progress.
Of course they want the $10,000 NCB- they don't even have to do anything!

heather said...

I do have to play devil's advocate here. :)

I had a unplanned home birth with Morgan and it was beautiful. Unfortunately since it was unplanned we didn't have a mid-wife to help with the delivery and my husband did it on his own with 911 on the phone. But with Morgan's delivery everything went smoothly and no complications.

Unfortunately I have two friends who did not have such favorable outcomes. One of them chose home birth to save money due to no insurance. The baby had delivery complications and had to be life flighted to the nearest hospital. They ended up with over $100,000 in medical bills because the baby was on life support and ended up with severe Cerebral Palsy.

My other friend also did a home birth with a mid-wife and had delivery complications. Her baby is now two years old and can't hold her head up, hold objects or focus her eyes, among numerous other complications. All things that could have been avoided if the baby would have been in the hospital and born via emergency c-section.

Personally my favorite deliveries were in the hospital with a midwife and my own delivery plan. I felt like it gave me the best of both worlds.

Angie said...

I'm one for wanting all the info I can on Home Birthing and Natural Birthing... would I home birth... No but that's a choice (plus I do live in a different country) Your views enlighten me to what is REALLY going on in hospitals and I love that Lisa.

I think Heather said it wonderfully

"in the hospital with a midwife and my own delivery plan. I felt like it gave me the best of both worlds."