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In an age of rising C-section rates, dangerous hospital infections, and increasing newborn and maternal mortality rates, expecting families are seeking alternatives to traditional hospital birth. The two main alternatives to hospital birth are birth centers and homebirth.
Safety
Birth centers have consistently proven to be very safe places to give birth. Their rates of intervention (which includes those clients who ultimately receive C-sections) are much lower than in a traditional hospital setting. Likewise, numerous studies have demonstrated that a planned home birth with a trained professional midwife is as safe as or safer for low-risk mothers and babies than birth in a hospital. Homebirth midwives carry most of the same emergency supplies found in a birth center setting, including neonatal resuscitation equipment, oxygen and medications to treat abnormal postpartum bleeding.
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Cost
The cost of a hospital birth includes a fee for the hospital stay for mother and baby as well as the charges for the doctor or midwife. Birth center births also involve a facility and practitioner fee, but these combined fees are usually significantly less than that of a hospital birth. Homebirth is generally much less expensive than either hospital or birth center, as the “facility” is your home.
When considering cost, keep in mind that additional services may be recommended or required by the birth center or homebirth midwife, but not included as part of the primary fee. Examples include:
- Doctor visits
- Lab work
- Prenatal testing
- Ultrasounds
It is important to be clear on these fees. You also need to discuss the consequences of various tests, and be aware that the results of some tests could serve to “risk” you out of your preferred birth site. This should include information on what kind of refund you are entitled to if you are risked out.
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Birth Center Pros
- A birth center may be a good option for you if you live with other people or in an apartment building with thin walls. Families determined to have a homebirth have solved these problems by borrowing a friend’s home for labor, or warning neighbors in advance of their homebirth plans. Your comfort is a key component in birthing success, however, so if you think you may feel self-conscious in labor…
- As most birth centers are within minutes of a hospital, a birth center can be a good option for people who would prefer a homebirth but live a long distance from a hospital and feel uncomfortable with the amount of time it would take to transport in case of that rare emergency.
- Although children usually do great at births, some mothers feel uncomfortable with laboring in front of, or even in the same building as their children. Birth centers are generally very supportive of children at birth, but are also a great option for natural birth outside of the home, and away from your kids.
- There is often a higher rate of transport from birth centers than from homebirths, but Certified Nurse Midwives (CNMs) who practice in birth centers usually have hospital privileges that make hospital transports smoother.
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Birth Center Cons
- Birth centers run by a CNM in most states are heavily influenced by the CNM’s supervising doctors and their protocol and prenatal testing requirements. This often leads to a higher rate of transfer out of the birth center practice during pregnancy or labor.
- While children are generally welcome at birth centers, most children are much more comfortable in their own homes. As well, they are easier to care for, especially in the event of a long labor.
- Families have to pack up and leave, commonly within hours of the birth. While this is a great benefit compared to hospitals that want to keep you for observation 24 to 48 hours or longer, it is far less comfortable and convenient than being in your home the whole time.
- The rate of infection is much lower in a birth center than in a hospital, but only your home has the germs/flora to which you (and therefore your baby) have already developed immunity.
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Homebirth Pros
- The continuum of being in labor, giving birth, and snuggling down with your newborn baby in your own environment creates an incredibly peaceful event.
- Your midwife comes to you. She is a guest in your home, so you are more in control of your environment, and ultimately your birth.
- Your children feel very welcome at a homebirth. They are comfortable because they are in their own environment, and it is easy for them to “take a break from the action” by going to their own rooms to play or sleep. Families who share birth with their children report improved bonding and less incidence of sibling rivalry.
- Labor is Hard! Avoiding drugs is much easier when:
- #1) there aren’t any immediately available,
- #2) you aren’t hooked up to an IV, monitors and blood pressure cuffs, and
- #3) you’re in your own environment where you feel free to sing, yell, cry or laugh as loud as you want, walk around totally naked, smell your own home’s smells, and eat your own food.
Why do you want to avoid drugs? Because it is better for you and your baby!
The vast majority of people who have had a hospital, birth center, and homebirth (a not uncommon progression) state that homebirth was by far the most intimate, wonderful experience of the three, and they would choose homebirth for their next birth.
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Homebirth Cons
- Although many homebirth midwives have very low transport rate, if it happens to you, it’s 100%. In reality it does occur and hospitals and doctors may be hostile towards people who attempt homebirth. The midwife generally receives the brunt of the criticism, but some of it can spill over to the birthing family.
- In our society, a family must be prepared take responsibility for the outcome of their homebirth. Seldom will you hear someone say, “That would have never happened if they were at home!” in response to a bad outcome at the hospital. Unfortunately, even if a problem at a homebirth is due to something like an unavoidable genetic defect, people will say, “That would have never happened at the hospital!”
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Questions to Ask Potential Care Providers
- Who will be my main care provider and how likely is it that he/she will attend me in labor?
Just because you see one doctor or midwife for all your prenatal visits doesn’t guarantee that he or she will be at your birth. Discuss the practice’s on-call policy up front.
- If my normal care provider is not available, who will care for me during labor?
This is important to know, especially if the people in the practice you are using have very different ways of approaching labor and birth.
- What are your transport rates? What are the transport rates of anyone that might attend me during my labor or birth?
This is hard to reliably determine, and your practitioner may not even know her back-up’s statistics, but it is worth asking.
- What could risk me out for a birth center or homebirth?
There are a number of legitimate reasons to transfer care to a hospital-based practice, but some care providers are much more conservative in their guidelines than others. Do your best to ascertain where your care provider stands, and assess your own comfort level with their practices.
- What are your C-section rates?
It is almost impossible to accurately know most care provider or even hospital c-section rates unless you happen to have a friend in labor and delivery at the facility you are investigating. But considering that the 2006 national section rate was 33%, a physician who claims a 10% surgical birth rate is suspect. A recent call to SC DHEC requesting individual hospital C-section rates was answered with, “At the recommendation of our lawyer, we do not give out that information…[because] the public can’t interpret that information.”
In addition to the questions that any pregnant mom should ask a potential care provider, there is another set of questions that should be asked concerning potential birth sites.
- Does my baby normally need to leave me at any time? Can we refuse routine separations?
Most hospitals prefer (and have policies to “require”) that your baby be observed in the nursery for a period of about two to four hours. In general, birth centers and homebirth midwives encourage continuous contact between mother and baby to encourage bonding and breastfeeding success.
- How soon do I get to go home?
Unless there is a true problem with you or your baby, it is best to be home in your own bed as soon as possible. This reduces newborn weight loss and the chance of maternal or newborn infection. Depending on your GBS status, most hospitals require that mom and baby stay for up to 48 hours after a vaginal birth to observe the baby for possible GBS infection.
- What are the routine procedures during pregnancy, labor and postpartum for mother and baby in your facility/practice, and which of these procedures can be refused? What happens if we want to refuse a procedure?
The answers to these questions indicate the level of intervention to be expected during your pregnancy and birth.
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