By the second half of the 20th century, hospital birth had become the norm in most Western countries. Hospital birth offers monitoring and interventions, many of which saved the lives of mothers and babies. At the same time, births became increasingly — and some would say unnecessarily — medicalized.
Many would also argue that the pendulum of intervention has swung too far. For example, from 1970 to 2010, the rate of U.S. cesarean delivery doubled — but (although both are low) the risk of a baby dying during the course of delivery remained unchanged, and the risk of a mother’s dying slightly rose. In an effort to avoid seemingly unnecessary intervention, and seeking an alternative to the environment of the hospital ward, it is not surprising that some women have turned again to home birth.
What are the advantages of a home birth?
According to the National Center for Health Statistics, home births account for only 1% of births in the United States. And the American College of Obstetricians and Gynecologists (ACOG) estimates about a quarter of those home births are unplanned. But the pandemic seems to have sparked a renewed interest in delivering at home. Why?
“Many families feel safest giving birth in their own space where there are fewer policies and restrictions,” Ranney says. “There is also a high level of intimacy in a home birth.”
Essentially, home births allow you to have more control over your birth environment, including how many support people are with you as well as how the general labor, delivery and recovery process develops. Studies also show that planned home births lead to fewer interventions than traditional hospital births, something that can be appealing if you’re hoping to have an unmedicated birth.
What are the disadvantages of a home birth?
While a well-planned home birth works well for some, it’s not for everyone. In general, home births are best for those who experience low-risk pregnancies, when you’re expecting only one child and have no additional health concerns. That’s because if complications arise, like if your baby’s heart rate drops or your labor isn’t progressing as it should, you’ll want to receive emergency care as soon as possible.
“If complications arise, then transport to a hospital will be required,” Ranney says. “It can be by personal vehicle or by ambulance, and this can be very traumatic.”
While many home birth midwives will have emergency medical equipment on hand just in case, they won’t be able to perform certain procedures that can only be done at a hospital. For that reason, it’s important to have a back-up hospital in mind that’s within reasonable driving distance. ACOG estimates up to 37% of first-time mothers who opt for a home birth are eventually transferred to a hospital. Another potential drawback is the time, energy and cost involved in preparing for a home birth.
Along with finding and hiring the right birth team — everyone from your midwife to your doula — you’ll also need to educate yourself about giving birth at home, gather the needed supplies and prepare yourself mentally and physically for the task. “Many families rent birth tubs to labor and deliver in, and others purchase a kit that has basic required items,” Ranney says. Unfortunately, some insurance providers do not cover the cost of a home birth, so it’s important to check with yours before you start planning.
What are the advantages of a hospital birth?
Although the COVID-19 pandemic might make you nervous about going to certain places, hospitals and accredited birth centers are still considered the safest place to deliver a baby and receive medical care. According to ACOG, a newborn’s risk of death is cut in half when born in a hospital compared to at home.
“At hospitals, you have immediate access to resources in an emergency,” Ranney notes. “Many women feel safer in an environment that can manage labor or infants when complications occur.”
Along with the safety factor, hospitals also provide additional resources you may need before, during and after you have your baby. “You have access to nonemergent resources, such as nursing and lactation support during your stay,” Ranney says. “There are pain management options as well as trained support for labor and postpartum.” And while every hospital is different, many healthcare organizations — including UW Medicine — offer a combination of obstetrician-gynecologists and certified nurse-midwives to align with your individual values and offer a personalized birth experience. “Hospitals vary in their birth culture, and finding the right fit in provider and hospital is important,” Ranney says.
What are the disadvantages of a hospital birth?
While hospitals are considered the safest birth option, they can lack the same level of intimacy and familiarity you might get from a home birth. Another consideration brought on by the COVID-19 pandemic are the visitor limitations some hospitals have implemented for the safety of you and your baby.
“There are policies surrounding visitors, length of stay and general guidelines in place,” Ranney explains.
That’s not to say that you’re not allowed anyone in the room with you when you give birth — UW Medicine currently allows two support people for labor and delivery — but you may need to adjust your expectations.
The bottom line
Figuring out where and how you want to give birth is an overwhelmingly personal decision that only you can make. Whatever your preference, though, Ranney encourages you to have an open and honest conversation with your maternity expert so you can make an informed decision.
“Having a strong relationship with your midwife and birth team is key to success in all environments,” she says. “Many times, that relationship will guide where you feel safest having your baby.”