Tuesday, March 27, 2012

Home Birth, Birthing Center, or Hospital?

This was one decision we had already talked about and planned on. Living in Rice Lake, WI, there are limited birthing options- but more than one would expect. Although I work with many of the obstetricians in the area on a professional level and I respect them greatly, my husband and I knew from research that your chances of an unmedicated and natural birth are much higher at home or in a birthing center. (I was not a fan of having my first child at home for purely opinion reasons and no evidence against it. For now I like the idea of going somewhere to have the baby and coming home with her. We’ll see how I feel about baby #2).

Both the mother and father must be very comfortable with where they’ve decided to give birth. It is very well known amongst midwives and obstetricians that fear can stall or create problems with a labor. If a mother decides to homebirth but is scared that she’s going to need medical interventions- it could very well be what causes a transfer to happen. But likewise, if a mother decides on a hospital birth, but is very scared of getting a c-section, she is increasing her chances just through that fear. A mother and father must be truly comfortable with their decision and be confident that they are at the location that will best reflect their birth plan.

Home Birth
Home birth is going to be a great option for the right candidates. If you are not considered a high risk pregnancy and know of a midwife who can attend your birth at home, then it is likely that home birth is an incredibly safe and rewarding option for you. In 1900, nearly half of births were done at home. By the mid 1900’s it was down to less than 25%, and currently is less than 1%. It is important to know that this shift has been largely due to a fear mentality that has arisen with birth, and not attributed to any studies that show it is unsafe. It is actually the contrary. Your chances of having a c-section go from about 30% in the hospital to less than 5% at home. Studies even show less chance of injury, death, or infection when birthing at home. Now that one shocked me and I had to re-read it when I learned that. How is it possible that birthing at home has less chance of infection and a lower rate of infant death? Yet after looking around at multiple sources, it appears to be true. The infant mortality rate at home is approximately between 1.1-2.2/1000 births. At a hospital the infant mortality rate is 5.7/ 1000 births. You are also not exposed to as many dangerous strains of bacteria at home that exist in hospitals despite their best attempts at being sterile. Respiratory resuscitation is 17 times more likely in the hospital than at home as well.

As the wife of an unofficial statistician, I should point out a very large “flaw” in most stats supporting home births. Much of the time, only women who do not have a high risk pregnancy are recommended to birth at home. If you are a “high risk pregnancy” or become one during the labor process- you are transferred to the hospital and are now included in the hospital’s stats. It could be concluded from that that the hospital has an “unfair” pool of women since they have many more high risk candidates than home births…. Just sayin.

If your wish is to have as natural and unmedicated birth as possible, and you are a healthy candidate, you should seriously consider looking into a home birth. It goes without saying that you are free to wear what you are comfortable in, eat or drink whatever you want, and do as you please at home. There are very few distractions that will occur at home that are likely to stall labor as well. One last note on home births… this can be a great option if you have no insurance as it is usually thousands of dollars less than a hospital birth.

Birthing Center
Birthing centers are wonderful for people who may be a little weary of the home birth idea, yet know they don’t want the “typical hospital birth”. This option may feel a lot safer to some than home birth because although many of the statistics of better mortality rate, less infection, and less interventions still apply, there are some medical interventions available at a birth center that wouldn’t be at home. Each birth center is going to be different on what they offer for medical advancements, but it is probably safe to say that none of them do major surgeries such as c-sections. If something unpredicted or more serious arises during birth, then you would transfer to a hospital at that time. Again with birth centers, you need to “qualify” to be a candidate for an out of hospital birth. Many of the benefits of a homebirth and birthing center birth are that you can cater your birth plan to your wants and needs. It is much easier to assure an environment that limits interventions like constant fetal monitoring, allows the mother to eat and drink during labor, walk around, and get into whatever position is most comfortable for her.

What should also be noted about midwife care versus many ob appointments is the amount of time they spend with you. Personally, I have an obstetrician who “signed off” on me being a safe out of hospital candidate, and she was amazing and wonderful- yet still my appointments were at best 15 minutes long. All of my prenatal appointments with the midwife have been between 40min to an hour and a half. During these appointments we discuss everything from nutrition, to the pros and cons of certain tests/interventions, to my emotional status.

Having a midwife so far in my pregnancy has been wonderful as she has also suggested many more natural approaches to “conditions” that have arisen during my pregnancy. Initially, I had higher blood pressure than ideal at my first few prenatal appointments. My midwife had 5-10 various suggestions for diet and lifestyle that were natural and noninvasive to me and my baby. Over the course of the next two months, my blood pressure dropped to a safe level. (Please note that many hospitals in the country have midwives available- there are none in my area, though.)

Hospital
Well this is obviously the much more common choice in America. This is a wonderful option for those that feel uncomfortable with the idea of birthing at home or in a center, or for some reason are considered a “high risk pregnancy”. If you are wondering if you are a high risk pregnancy, see this link by the National Institute of Child Health & Human Development. http://www.nichd.nih.gov/health/topics/high_risk_pregnancy.cfm

This is a good option for those that do not plan on “opting out” of any/many of the typical procedures and tests done around pregnancy, labor, and birth. Some of the procedures that may be standard at your hospital are: multiple ultrasounds, pelvic examination, STD testing, blood and urine testing, gestational diabetes test, use of the Doppler, triple screening, and group B strep test. There are also many things that are considered “standard” during labor, delivery, and neonatal care that will be discussed in the future birth plan blog.

In general, most people don’t need to be “talked into” a hospital birth, they just assume that is the safest and best place for them. If part of your birth plan is an epidural, then being at a hospital is kinda your only option. This blog is not to shame anyone for choices they make about their birth- so no one be offended if you raised your hand and said, “yes please!” to an epidural. This is not the “whether to get an epidural” blog… again that is in the future birth plan blog.

BUT, if you want a natural birth at a hospital, I will forewarn you of the “slippery slope of interventions”. This usually goes as follows… the use of Pitocin, which causes stronger contractions, which may require fetal monitoring. Stronger contractions usually mean more pain with less rest time, which requires the pain relief from an epidural.  Epidurals have side effects of longer labor and maternal fever. That usually requires antibiotics for the mother and baby. Some hospitals give what they call “walking epidurals” which allows the woman to be standing for birth. If your hospital does this- great! If yours doesn’t then you are on your back for labor which is the WORST position for labor. At this point it is common for either forceps, vacuum, or episiotomy for the baby to come out vaginally, or a c-section. That is the “slippery slope of interventions” in a nutshell. There are multiple studies out there to support that the slippery slope of interventions is true and common. If studies aren’t your gig… start asking around and you will hear it over and over again from your friends and family.

This blog will not answer all of your questions on where to birth, as there are many books that are completely dedicated to this subject. There are some links at the bottom of this blog, otherwise I suggest “Ina May’s Guide to Childbirth” as a great book to get you started. Good luck in your decision process, as this is the first “hard decision” of many.

Part 3 of this blog series will be on prenatal nutrition and exercise.


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