Hospitals vs Home Births

     In the United States, there is a growing controversy about the way that children are born.  The main conundrum is whether it is safer for a baby to be born in a hospital with a surgeon, or in the mother's home with a midwife.

    One major concern that has brought this issue to light is that the United States has a higher infant mortality rate than any other developed nation, and a higher maternal death rate than any other developed nation but Lithuania.  Some argue that the reason for this is that women in the United States give birth differently than in other countries.

    Until the 1950s or 1960s, women gave birth at home unless there was a problem, in which case they were brought to a hospital.  However, several pain reducing drugs were introduced to the market and women began to go directly to hospitals to give birth.  Another drug that came out a bit later was the inducer.  This is the drug that makes the delivery of the baby happen faster.   Therefore, people decided to have their babies in hospitals because they thought that it would be less painful, faster, and cleaner than having the baby at home.  The problem, for some, is that the inducer and the anesthetic and the inducer work against each other and cancel eachother out.  Thus, when the birthing process ends, the mother could have a lot more drugs in her system than she intended when she walked in.  The anesthetic stops the pain by blocking the serotonin receptors in the brain.  These are the same parts of the brain that are supposed to have a chemical explosion the first time that the mother sees her new baby.  However, because these receptors are blocked, the chemicals do not work the way that they normally would.  There is no proof that this would in any way harm the mother or the child, though.   

The argument for a return to home birth did not truly start until later, though, with the introduction of the safe, modern caesarean section.  Once women realized that they did not have to wait for the baby to come out, they began to schedule c-sections.  This method was faster and more convenient, because mothers could schedule for them to take the baby out on a day that fit her schedule at a time that was easiest for her.  It was simply a matter of comfort and convenience.  However, some would argue that giving birth before the baby is ready to come out is not a good idea.  “ Women are three times more likely to die during or from complications associated with cesarean sections than with vaginal births, according to the American College of Obstetrics and Gynecology” (Weiner).

    Yet, these mortality rates continued to climb and people began to look for the answers as to why.  They found some when they looked to other developed nations.  In almost every other country with a lower infant mortality rate than ours has a lot more women still giving birth at home with a registered midwife.  The reasoning behind this is that women would be more comfortable in their own homes with a midwife that they have gotten to know, and they can easily get to a hospital if something goes wrong.  Actually, Ina May Gaskin, a registered midwife has said, “at first, we brought breech pregnancies to the hospital, but we found after a while that we could deliver them here just fine. Footling breeches, which are thought to be the most difficult, in our experience, they often just slid right out” (Shapiro, 1).  Breech means that the baby is being born upside down.  There is also an argument that a hospital is a business.  What they really want is for women to give birth quickly so that they can empty another bed and fill it with another patient.  Quickly is not always the best way to give birth.  It is also very difficult to have a natural birth in a hospital.  The obstetricians that help women give birth are surgeons and they want their patient to be anesthetized.  “Currently about one-third of all American babies are delivered surgically. Most U.S. hospitals require labor to be artificially induced if a woman goes one to two weeks past her due date. There are also often deadlines for the length of time a woman may be in labor before surgery is required, and many doctors will not perform a vaginal delivery after a previous Caesarean” (Shapiro, 2).  

    One of the main problems with hospital births is the immobility of the mother during the whole process.  She is made to lie on her back with her legs in the air.  This is not because this position is more comfortable, easier, or even safer for the child.  This position simply makes it easier and more uniform for doctors.  In fact, studies have shown that being upright and walking around can shorten labor.  There are health risks to giving birth in a hospital.  It is required in most hospitals to give the expecting mother an IV needle in case they need to move into surgery or if the veins collapse and they cannot get one in later, which almost never happens.  The sugar glucose chemicals that the IV needle puts in the body have been known to hurt babies who cannot handle those products in their systems.  Also, if the doctor uses forceps or a vacuum to pull the baby out of the birth canal, then there is an increased risk for shoulder dystocia.  This is a condition where the baby turns and its shoulder becomes lodged in the birth canal.

    Others say that having a home birth is four times riskier to the baby than giving birth in a hospital.  With 25,000 home births per year in the United States, this means about 23 additional neonatal deaths annually.  This risk is also increased if the mother is a first time mom, because she is at risk for preeclampsia, which condition found in first time mothers also called toxemia, or if the pregnancy has lasted for more than 41 weeks.

If a mother felt more comfortable getting induced and anesthetized, then it is difficult to find a midwife who will do that.  While it does not take too terribly long for an ambulance to take a problem pregnancy to the hospital if the mother needs surgery, like an emergency caesarian section, how much time can anyone truly afford to waste?  The consensus is that the hospital is the best place to deal with an emergency, and, when dealing with childbirth, problems are often emergencies.  Compared with midwife-attended births in hospitals, doctor-attended births had higher mortality, almost certainly because the most complicated births are generally handled by physicians.  “In a retrospective study of babies born in 2008, researchers found that having a home birth almost doubled the relative risk of a five-minute Apgar score of four or lower (scores above seven are generally considered normal), and more than tripled the risk of neonatal seizure” (Bakalar, 1).  Even when people defend midwives, it is noted that they are a good choice for a woman who has a low-risk pregnancy and does not have serious health problems.  “It’s the location of the delivery and it’s the quality of the person who delivers the baby,” said Dr. Amos Grunebaum, a professor of clinical obstetrics and gynecology at Cornell University's Weill Cornell Medical College, director of obstetrics at New York-Presbyterian Hospital/Weill Cornell and co-author of the study. “Women and their partners need to understand that there are more risks if you do it at home.”

Hospitals also have a device called the EMF, which is short for Electronic Fetal Monitoring.  This machine makes sure that nothing is going wrong with the baby and the heartbeat stays normal and well adjusted. If the heartbeat speeds up, then the baby is distressed in some way and the doctors know whether to move into the caesarian section.  However, the frequencies on the EMFs can be misread, and studies tend to show that most babies that have brain damage as a result of distress receive it in an incident before the birth, not during.  Still, the EMF has proved useful in the past and it does not hurt the mothers or babies that use it.  It is also far more accurate than a pinard horn or stethoscope that would be used by a midwife.

The simplest, most common problem of this controversy is that women feel more comfortable in their own homes.  They have their family around them and a midwife that they have gotten to know and whom they trust.  Dr. Amos Grünebaum says that the solution is “to make hospitals more like homes instead of making homes more like hospitals.”