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.