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Home birth vs hospital birth is something a lot of women consider while pregnant. There is a lot to consider even for low-risk women having low-risk pregnancies: cost, pro’s and con’s, as well as risks. Let’s talk about a few things you should consider.
This blog has been welling up for a while, but the last phone call I got from a midwife about a failed home delivery — I knew it was time to write it.
But I do want to give my initial thoughts on both types of birth — just like how they seem to someone who’s considering each one:
First off — home deliveries. Oh my goodness, do I love them! There are AMAZING stories about how your instincts kick in and what a loving thing it can be for your whole family. I have a labor and delivery nurse friend who did a home delivery and her story totally gives me chills. I realize how many times the hospital stops all that. It’s horrible. Out-of-hospital births are wonderful. Especially the stories of a planned home birth, where I already know the ending (hopefully that ending is cuddling with their mom at the time).
Hospital deliveries. They’re sterile, not at home, they’re in odd positions and you do it often with strangers. We make you do weird things, you wonder if the blood pressure cuff will actually dwell inside your arm soon. We’re always coming in, and typing. There’s 9 million questions, antibiotics, Pitocin, you feel like you’re out of control of the whole thing. Your health care provider doesn’t seem to give you many choices. They’re just not the sweet loving moment you would hope for. Even if they feel like the safest place it’s not the same as being at home in your own bed. There are definitely significant differences.
And then I read this study. I am well versed in how studies can be skewed and how it can certainly be read many ways. I’ve actually read worse studies, this one seems fairly even handed — especially for women who have had multiple children. But, there is a part I need you to hear if you’re considering at-home births:
“… researchers at New York-Presbyterian/Weill Cornell Medical Center found the absolute risk of neonatal mortality was 3.2/10,000 births in midwife hospital births, and 12.6/10,000 births in midwife home births, and it further increased in first-time mothers to 21.9/10,000 births in midwife home deliveries. Neonatal mortality was defined as neonatal deaths up to 28 days after delivery.”
That is a 4 times greater risk in general population, and a SEVEN TIMES greater risk in expectant mothers having their first baby.
Wow. I seriously had NO idea. The thing is, I’ve seen babies who would have died. So often the baby is doing amazing right through delivery and then comes out and is dead. Dead. Not breathing, heart barely going, and without all the equipment we have — it would most certainly have died. And while on many births we have a decent idea of how the baby is doing prior to delivery, sometime we don’t. Which means your midwife wouldn’t have a clue either.
However, the reality is that 21 out of 10k really isn’t a big number. It’s 2 tenths of a percent (compared to hospital births being 3 hundreds of a percent). It’s a VERY small number, but it IS there. Keeping in mind these deliveries were all done by a midwife, regardless of whether the planned place of birth was in the hospital setting or at home.
I also saw the official page of ACOG comparing planned home deliveries (which should not be confused with women who receive no prenatal care and just explode out a baby at home). It shows an almost 3 times great chance of death in nonanomalous (physical limitations not compatible with life) deliveries. I will also say there is a much larger chance of infection with a hospital delivery, cesarean sections and 3-4 degree lacerations. So, there are certainly potential risks associated with both of them. Expectant parents have to decide what is the best option and safest settings for them.
After that little review of literature, here are my thoughts on home deliveries vs in-hospital births:
If you believe that hospital births are too risky
If you REALLY want a home birth that doesn’t involve an IV or monitoring or people coming in and out of your room. You would be a good candidate to Deliver at home. I can’t be dragged into your fantasy. I’ll be dragged into the courthouse next. We have policies that we HAVE to follow. We leave ourselves open to limitless litigation if we don’t follow them.
For instance fetal monitoring. If I don’t get your baby on the monitor now and then I can be fired, and if there is a complication that case can go to court and you will likely win. Even though we talked about the risks and the benefits til’ I was blue in the face — what you wanted was outside the hospital policies and my standard of care.
And yes, I have seen informed consent given by several practitioners for patient’s wishes in the hospital, there was a poor outcome and then that patient sue us for not discussing the risks enough.
I WANT you to be happy and have a wonderful birth experience, but there are rules I HAVE to follow. Of course, if things are going naturally and the baby looks good there are ways I can accommodate you, but you can not plan on that.
If you believe that a hospital birth is too risky to consider, I would recommend talking to a healthcare provider about those concerns.
Cost of a Hospital Birth
The cost of a home birth is FAR less. Usually it’s one total fee for your home birth midwives vs the hospital where your OB plus the hospital (possibly plus anesthesia).
However, if you were to come to the hopistal in an emergency, that cost will be much more.
It’s important to choose your practitioner for a home birth or a hospital birth
Choose your practitioner. This goes for both ends. If you are having a home birth you need an experienced midwife who is certified and can tell you specific things she does to keep you safe. If you have chosen a hospital delivery you need a practitioner who will avoid the medical intervention you don’t want, unless it’s unsafe. Ask to see their statistics. I promise they have them, and I promise that they will try to skew them for you just like any good healthcare professional.
Ask around, if you know any labor nurses ask them. Tell them what you want. They can help you. I 100% promise that good bedside manners do not equate with a good physician, so if you can — ask someone who has an opinion of their actual skills as an OB.
There is some middle ground between a doctor and a lay midwife
Have you considered a midwife? I have delivered with midwives in the hospital. They are smart, they will be with you but also keep you so safe. Because they are with you much of the time, they are able to limit some of our policies in some regards, or at least answer all your questions more adequately. Still, find one you trust. Just like any other practitioner, there is a wide variance in their ability to practice well.
Delivery is very important when choosing where to have your baby
Consider your history to decide if a home birth is the right choice for you.
As noted above, first time moms have more to think about for a home birth. You just don’t have a tested pelvis, or any other information to go off of. Subsequent deliveries ARE safer in home. Also, what other risk factors do you have? Prior cesarean delivery? Someone came to my VBAC post (Vaginal birth after cesarean section) suggesting that TOLAC’s should consider a home birth. I can’t more strongly disagree with this statement, as does ACOG (American College of Obstetricians).
Risks of a home birth
Consider the outcome. Having a home delivery, to me, is like taking your baby, putting them in the car without buckling them and driving off. Almost ALL of the time, that is totally fine. Happy outcome and you get to your destination – it’s just the times it doesn’t. The outcome I wanted was an amazing family with a healthy mom and baby. I didn’t particularly care how we got to that end. I empathize people who really want that amazing delivery. It just wasn’t my concern.
If you’re planning a hospital delivery – don’t miss my beginning online prenatal class:
**I will entirely say that my viewpoint is skewed since I do this for a living. But I can’t help but clench my teeth when someone tells me they are delivering at home. I don’t need to know about how you prayed about it and how great you feel about it and your midwife. I still worry about it. But, I hope you have a wonderful story to tell me with a very happy ending, and most likely you will. I wish you luck in this decision. One of SO many important decisions you’ll make in your parenting life.
Hilary is a labor and delivery nurse who sometime writes about pregnancy and health. Please don't consider anything written here as advice that you should take over your doctor's recommendations. Talk to your doctor, you're paying him/her. Make them work for it!
Comments will inititally be open, but I reserve the right to close them, or delete them if I find them mean spirited towards me or any viewpoint. I think both decisions are valid. We should support women in what they want. Either way.
This post was originally written in 2014, but has been updated.
I go to a midwife group that delivers at the hospital. I love how midwives let you do it how you want it to, within certain parameters, and are with you the whole way through- mine even stayed a few hours past her end or call shift to finish my labor instead of transferring me to whomever was on call next. My insurance requires me to see their backup OB at some point in my pregnancy, and he’s always kind of disapproving because I consider a pregnancy a pregnancy, not a pathology, and I don’t feel I need appointments as often as he does and I always refuse the glucose test (seriously, the drink is so much worse than the blood draw, and waiting around in a LabCorp waiting room with 4- or any number of kids- for an hour is the worst of all), etc..
I think I’d be a good candidate for a home delivery (5 uncomplicated natural births), but as a nurse, I know just how much COULD go wrong, even if the chances are slim. I’m not so much worried about what might go wrong with me- I’m more worried about the baby, and I want to have a crash cart in the hallway, or in the room. And, as a mom, I just don’t want the mess of a home birth. “Cause I make big messes. And this last time around, I was glad I was in the hospital for me, since I burst a varicose vein in my lady parts and lost a fair amount of blood. I didn’t end up receiving a unit of blood, though it was considered, but I did get sutured up by the hospitalist, and my blood pressure, at one point was 70’s over 30’s.
I think a birthing center, right next to a hospital, would be ideal, but that’s not offered around here 🙁 I am always thankful for my L&D course in nursing school, so I know what’s going on, what they’re doing, why they’re doing it, and whether I should worry about it. And so I know what’s negotiable and what to ask for.
Yeah, I think hospital midwives are a great mid-point. I think a good midwife is worth their weight in gold, they know when they’re over their head, and otherwise they’re a wonderful support. We actually aren’t attached to the hospital where I work. It’s nice (except if you have to transport to the ICU).
Very nicely said. I personally had no desire to baby-up Dugger style. I got myself to the hospital well in advance and parked it in the hospital waiting room until the contractions were close enough to sign-in. There’s something soothing about having modern medical technology at your disposal.
Angela, that’s so funny that you hung out in the waiting room. I love it! 🙂
I like the idea of having a baby at home. It’s comfortable and you can be surrounded by whomever you want as long as you want, whenever you want. But at the same time, modern medicine is a lovely thing, and it seems like there are so many things that can go wrong with giving birth, I would rather be in the hospital. I was born via C-Section because I had the umbilical cord around my neck. How would that be worked around in a home birth? Would there even be a way to check that? To me, it’s not worth that risk.
Thank you for sharing your thoughts on the subject. It sounds like heartbreaking work, honestly. When you described how everything can seem fine to only end up delivering a dead baby? That would be heartbreaking.
I think you do get a bit calloused, but it can be hard. Most days are wonderful though. 🙂 Also, having the umbilical cord around the neck isn’t a reason for a c-section. 🙂 I’m guessing it was making your heart rate go down, so that shouldn’t affect your ability to have your babies the old fashioned way (but, you never know!). 🙂
Thanks for sharing your perspective. A question about the study: How did they define “midwife”? Did they look at home births with CNMs only? Or did they include CPMs, direct entry midwives, licensed midwives, etc.?
Theresa, I don’t know. I think the benefit is knowing that these were all planned, attended births, rather than unplanned and no prenatal care type births. That would go for both Hospital (because a Midwife would not be able to take care of a no-prenatal care patient at a hospital) and home births. As far as the studies I read, this one did seem to be the most even.
Thanks again for your response. I still think the background of the midwives in the study would be important. Are they nurse midwives (the same as those who attend hospital births) or are they direct entry (apprentice, non-medical midwives)? I guess I’m just hoping to really see a fair, apples-to-apples comparison one day. For example, I would love to know if in the U.S., CNM attended home births have better/worse/equal outcomes as CNM hospital attended births.
Anyhoooo… If you find the study, I would love to see it. I’ve been digging, but coming up short.
I do think that would help…. but I have nada for you. 🙂
This is terribly one-side, where all the statistics stating the negatives of hospital births? The forced c-sections, the higher risk of tearing, coaxing women into taking drugs, the fact that there are so little studies that show the full effect on both mom and baby of the combination of drugs offered while in labour. Sure, there are studies on what each individual drug does, but not the combination of the plethora of drugs offered to moms. Why are birth defects so much higher in drug assisted, hospital births?. Not to mention that, in your “study” you included home births WITHOUT midwives or any other professionals as well as with (and who even knows the classification of midwives is appropriate) – no wonder there are going to be a higher mortality rate.
Sarah, did you read the post? I very specifically say ” I will also say there is a much larger chance of infection with a hospital delivery, cesarean sections and 3-4 degree lacerations. So, there are certainly risks associated with both of them.” Also, it would be impossible for something we gave a woman in labor to cause a birth defect. Those would have to happen early in pregnancy while the fetus is forming. That study included included births with midwives, both hospital and home. I’m sorry you didn’t agree.
I would say that hospital births “result” in higher birth defect rates because if you’ve had pre-natal screening and a birth defect is suspected or detected, you will be giving birth in a hospital (and your midwife will hand over car to an OB/GYN). Midwives won’t do home births for high risk pregnancy. So that accounts for those rates…
Well, no GOOD midwife would do a high risk birth. 🙂
As a fellow L&D nurse, I share SO many of your same feelings! There is a time and place for both home and hospital deliveries…. And being on the receiving end of home deliveries gone wrong (including fetal deaths), I can’t help but hold my breath when I hear women talk about their home birth plans.
Thank you for sharing this!!!
Hollie, thanks — I’m getting a lot of haters on this today. I think most of these people (thank goodness) have not seen poor outcomes. 🙁
There is a lot of misinformation floating around out there from both sides… most often painting hospital deliveries as evil and unnatural and unnecessary. Popular opinion is not kind to our profession, despite so many changes to our standards of care that promote many of the “goals” the home birthing moms desire!
In the end, even for completely healthy, uncomplicated pregnancies, there can be unforseen dangers that creep up during the labor process — even when the labor is spontaneous.
My hope is that the culture will shift. One patient at a time (but mostly 2 at a time and sometimes even more…. eek!), each day I work hard to ensure my patients have a safe and happy delivery. 🙂
Thanks again! I appreciate your words!
I think my BIGGEST bug is that we’re ALL out to get you, we’re out to make it unsafe for you and your baby, like we have a vendetta and we’re just in this for the money. I want NOTHING more than a perfect birth experience. It’s just people coming unprepared for what they will face, or never discussing with their physician what they want. Then the upheaval comes. 🙂
I so understand your points! I also agree by and large. But I don’t think nurses or medical profs are “out to get me” or make it unsafe for me. My mother and brother are nurses and I know most nurses truely want their Pts to be happy, healthy, and have choices in their care (nurses are flipping awesome IMO!). I do think hospital is safer (and I don’t like the idea of giving birth in my home where it dosn’t feel as “clean” as a hospital, even though infection is higher at the hosp) I get nervous about the hosp b/c I truly WANT to try to do it unmedicated and/or use medication that wouldn’t leave me flat on my back. I want to be able to walk around, move, give birth in whatever position feels right. I don’t want to be treated like my pregnancy is a pathology or be over controlled by staff, I don’t want to be on some arbitrary “clock” that means once my time runs out I’m pressured or forced into a non medically needed c-section (I’m all for actually medically needed c-sections but I don’t want to be pressured to get one because my labour is taking longer than 10-12hrs.) I work in the medical field and I SO understand having policies you HAVE to follow, I truly understand that but I also know that sometimes Pts are pressured to just get the cookie cutter treatments even if they are not wanted or needed just so the staff have it easier, which is not cool IMO. So I feel stuck between really wanting the safety and backup of a hosp but wanting a team that will allow me and my body to birth on my body’s own time and in ways that feel right for me (assuming everything and everyone is doing well and safe) and to be treated as a smart person able to make my own choices and not like a sick person (eg pregnancy as pathology) who can’t make rational choices. It seems like it’s truly hard to get both worlds, at least where I live. I just want a safe supported birth with a team that will only give me intervention I request or when they because ABSOLUTELY needed for my or my baby’s life to be safe (not a “oh maybe” or ‘gosh I want to get off work on time, lets schedule a c-section” or “we give everyone pit after 3hrs” intervention). *sigh* I really do respect nurses and the bind’s they’re in a lot of the time, my frustration is more with the medical culture in the states, not the actual ppl. Thanks so much for your insights!
I actually think your home is cleaner than the hospital. I mostly just like leaving the mess there. I can’t imagine how my mattress woudl survive a delivery! I think your #1 is finding a doctor who is on board. Being honest with what you want and finding that doctor would give you the birth you want and the safety you desire. I know just which doctor I’d pick for you at my hospital. 🙂 It’s just so hard to find that actual information out unless you’re in a position like myself. 🙂
Laura @ Little Bits of Granola says
I don’t get the whole “hospitals are bad, sterile, cold, scary” mindset. For me, it is the PEOPLE who make the atmosphere during labor. I was fortunate to deliver both of my babies in a very nice hospital where the rooms are kept warm and the lights low, they play nice music for you if you want, that kind of thing. But I would deliver in a cinder block room if I could have the same doctor and especially the nurses. They were the ones who made me feel safe and cared for. And to top off their caring nature – they are trained experts who know how to handle things that can go wrong. The room or building I was in didn’t matter, it was the people.
I am currently planning my second home birth in February. My daughter was born in my old bedroom at my mom’s house with my very experienced midwife, who was also a L&D nurse for many years. When having a home birth, it is important to do your research and to trust your body. Does everything always go right? No, and thankfully my midwife is experienced enough to know when a transfer to a hospital is necessary. I totally see your point, and I can understand that by seeing what can potentially go wrong would deter you from a home birth. Everyone has a different opinion. Your article is very respectful though of women’s wishes…I’ve heard a lot of opposition to our decision to birth at home and it wasn’t as diplomatic as this lol.
HAha, Jackie — it sounds like you researched it out! 🙂
I have been on both sides of the coin, with a natural hospital birth for my first and a home birth for my second. Quite honestly, even though my home birth was amazing, everything went great, and i have a happy healthy 10 month old, I think I will go to the hospital if we have another one. I LOVE the ease and convenience of a home birth, and I trusted my midwife implicitly, but something’s bugged me ever since the birth and I think it was the realization that if something HAD gone wrong we would have almost certainly lost the baby, since we live more than an hour from the nearest NICU (basic hospital that doesn’t routinely deliver babies and ER in town). It scared me then and scares me now. I appreciate you taking the time to find a more balanced study since everything out there really seems very biased. Thank you for your clear-cut post on the topic.
Debbie, I can see why that would bother you, but it sounds like things worked out great. Thanks for the response. 🙂
I would love to hear your thoughts on giving birth in a birthing center with an experienced midwife! Both home births and hospitals make me nervous, and I feel like centers are a great compromise, but would love to hear opinions from an actual nurse.
I think a birthing center is great…. but not ALL that much different than a hospital. I guess you’d need to see their policies and procedures. I think they’re fairly safe. I think they are a great option if you’re stuck between the two. I think they are for extremely low risk deliveries and I would want to know exactly what they do when they notice distress by either the baby or the mom. 🙂
I had a hospital birth for my first child, and a home birth for my second child. My first was born at 29 weeks my second was 34 weeks. The home birth was completely unexpected as it was only 35 min from very first contraction (thought to be Braxton hicks since there wasn’t pain) to baby being out. My husband had to deliver her before paramedics could get to the house. It was an amazing experience, but I would much rather be at the hospital to deliver. So many things could have gone wrong, Especially with a 34 Weeker. Luckily, everything turned out ok, and Everyone is healthy.
If you’re in fear of what is going to go wrong, then that isn’t good for your baby either. However, usually fast deliveries are uncomplicated. Glad yours turned out well! 🙂
I had great hospital experiences and honestly it was like a vacation I felt pampered and my birth plan was …. Oh right get the baby out, that’s it, simply get the baby out. I loved my experience I only had one grouchy nurse and only for 10 minutes because she left haha I have never wanted to have a home birth I like the idea when I goes the right way and I have had zero complications with any of mine but I would never do it.
Lindsey, I am glad you had a great experience!
I had a midwife at the hospital for all of mine. I had pretty fast deliveries. my longest only being 6 hours and my shortest only an hour (my FIRST!) insane, my midwife almost missed it haha 🙂 I love having babies! Birth centers aren’t an option where i live,because there just isn’t an and the only people who do home births around here are Amish… So hospitals are really the only option where i live. With my last delivery they broke my water at 4am (since i was complete and it didn’t break on its own at that point… ) she was born at 4:08 and they they were cleaned up and out of the room and i was with my baby alone skin to skin by 4 15. it was amazing no one bugged us while we were there and other than them catching her coming out it was pretty much “unassisted” i got there at 1am and the said ok we will be back in to check on you at 4 came in done and done. I really like our hospital when it comes to baby deliveries. 🙂 i would have 10 more babies just like that!
Yeah, I wish our policies were more accommodating (nurses should be in every 15 minutes after delivery to rub your uterus)….
They actually did come in and rub after our minimum 1 hour skin to skin with baby but goodness i wish they wouldn’t it hurts so bad after about the 3rd time! and they would come in a few times a day after that and check bleeding and the belly rubbing and temp and blood pressure and so on so forth. still a vacation in my book! I loved it that was the best part of every delivery was the stay at the hospital being pampered for 3 days!!
Our policy is every 15 minutes that first hour. Actually, that’s Awhonn’s policy, but it is annoying (for both of us). 🙂
Melanie Wilson says
I had five healthy babies in the hospital, but had a horrible experience with my fourth. The epidural was done incorrectly and the nurses left me alone for an hour when I was complete. It took another hour for the doctor to arrive. Meanwhile I was paralyzed, but in excruciating pain. Had the spinal headache after and it was a miserable time. I had mild paralysis for eight weeks after.
I decided to have my fifth naturally in a different, small hospital and it was an amazing experience. Unfortunately, that hospital had closed when I was expecting my sixth. I decided to have a home birth with a doctor who only did home births. I had an ultrasound and consistent prenatal care. The doctor had emergency medical equipment with him. I got so much more sleep after my home birth and my husband absolutely loved being involved in the birth and the care of the baby.
You might think I would be a huge advocate of home births. While I had a good experience overall, my good friend is a labor and delivery nurse (I didn’t know her when I had my sixth). She recently told me about a woman who had a home birth with a breech baby and a midwife who agreed to deliver her. The baby died. Of course, I would never have agreed to a home birth in that situation. But I realize how very much can go wrong now. If I had made a choice that ended up in the death of my baby, I would have had a hard time living with that. If I had another baby (I’m too old :-), but I would look for another great hospital like I had with my fifth.
Oh Melanie, that does NOT sound fun. As far as I know doctors in any urban setting are prohibited from attending home births by their malpractice insurance…. it’s nice that you got it!
Melanie Wilson says
He was a DO and it was 9 years ago. He has since died.
I bet older doctors can kind of do whatever they want if they have a good track record. 🙂
This is very timely as my son and daughter in law are making their birthing plan! I would love for you to share this with us over at Country Fair Blog Party. It is a month long link up and you would be a perfect fit ! http://www.thetipgarden.com/2015/04/country-fair-blog-hop-april-15.htm
Thanks, just shared it! Good lukc to your son and daughter in law!
Just sent them your post! THanks again for linking up with us!
Thank you for sharing this very educated, well worded post. I am a NICU nurse who also cringes at the idea of home births because, similarly to you, I have seen horrible outcomes from them. I cannot wrap my mind around why people are willing to jeopardize their safety or the wellbeing of their unborn children in order to have an “experience” or because they refuse to debunk the myth that hospitals are out to “drug them up” or get them in some way. As healthcare workers, we need to relay that we have no ill intentions and only want the best for the mother and baby in every situation. Thank you for doing this!
I think anyone in the medical field has a slightly biased negative view of home births, and I don’t mean that in a nasty or accusatory way. I just think when the only side of it you see is the times when things go wrong it can leave a bad taste in your mouth. I’m not a home-birther, but I admire the women who do it. I do think, however, it is critical to have an experienced midwife who can quickly determine when it is time to go to the hospital if things are going wrong and one who has a relationship with the nearby hospital. I think that seems to be a big problem is when a patient comes in and the hospital has no medical history on that person and just has to respond to an emergency situation. As I type this I’m thinking of Ina May (I just finished her book) who has a good relationship with the nearby hospital to her birthing center and where the doctors are alerted that she’s on her way with a patient, the situation, and they know that it’s urgent because she couldn’t solve it.
Hilary Erickson says
I agree — and I try to make that VERY clear in the article.
I think, no matter who your provider is, you need to know they have a plan for when things go awry….