Shalynn Hoffman 1-27-2017 Doula Certification Course [email protected] Paper Home Births vs. Hospital BirthsFor some women and their partners, choosing where to deliver there baby is very important, wether at home or a certain hospital. This may be a high priority because of safety, comfort, specific care provider, or aligns with their general philosophies. Throughout history, the attitude toward pregnancy and birth was, and still is by many around the world, a natural, healthy, normal life event, not a problem for which to seek medical care, which has grown more common since the development of modern western medicine. There are many reasons why individual parents make the choice to have their baby at home. The majority of couples who consider home birthing do so by becoming informed and educated about their options. It is generally not a decision which is taken lightly or apathetically. Home birth has been the natural choice of delivery since the beginning of humankind. It has only been in the last century that out-of-home birthing became the norm. With the Suffragette movement came a call to action for the early feminists in America. The National Twilight Sleep Association was formed, and began a concerted campaign, demanding that doctors in the US adopt the practice of Twilight Sleep during birth. Birth took a drastic turn from women being in charge of their birth to handing all control to a doctor. What resulted in the birthing world was a surge into the hospital. With it came the inevitable spiral of cause and effect: the more intervention was introduced, the more it was needed, until birth was no longer considered a natural process but rather a medical emergency. It has been changed into an assembly line procedure complete with time constraints, quotas, indifferent workers, procedure manuals, and loss of individual rights. Over time a new attitude developed that women did not have the power and ability to birth a baby naturally. Instead of women’s bodies doing what they were designed to do doctors began saying baby was too big, mothers pelvis was too small, or carrying too long past the guessed due date and interference was necessary. Man’s technology, it seemed, was better than God’s design. The truth is that a woman’s body is designed to procreate and give birth. It produces hormones that act as pain relievers, contractions that come and go at intervals to offer respite, and many other perfect physiological responses that ensure a normal birth. Pregnancy and birth are natural bodily functions that work best without interference. In the Journal of Midwifery & Women’s Health (JMWH) a study confirms that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies. (Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009)This study, which had nearly 17,000 participants of midwife-led care, is the largest analysis of planned home birth in the U.S. ever published.The cesarean rate is 5.2% for women who are attempting a home birth, a remarkably low rate when compared to the U.S. national average of 31% for full-term pregnancies. When we consider the well-known health consequences of a cesarean, for example; infection, hemorrhage, injury to organs, and long term side effects such as urinary incontinence and pelvic organ prolapse in the mother, and increased odds of asthma and obesity in the child, it serves to highlight the benefits of midwife-led care out side of the hospital system. Not to mention the exponentially higher costs of cesareans. There’s also little question that the intervention-heavy approach to birthing favored in most hospitals contributes directly to our nation’s unsettling birth safety statistics (we trail behind countless other countries when it comes to maternal death). Ninety-seven percent of the midwife-led care babies were carried to full-term, weighing an average of eight pounds at birth, and nearly 98% were being breastfed at the six-week postpartum visit with their midwife. Only 1% of babies required transfer to the hospital after birth, most for non-urgent conditions.The lack of disturbance associated with giving birth at home allows the full expression of the laboring woman’s “ecstatic hormones”. These four critical hormone systems — oxytocin, beta-endorphins, epinephrine/norepinephrine and prolactin — act to enhance ease, pleasure and safety for mother and baby in labour and birth, and give mothers and newborns an optimal start to breastfeeding and bonding. Successful breastfeeding and mother-infant attachment give irreplaceable and life-long health advantages to both mother and baby. These statistics show that home birth care is beneficial to both mother and baby. The fact is that there’s no such thing as completely safe or risk-free birth in any setting, be it hospital, birthing center, or home. For each of us, “safety” and “risk” are complicated decisions made within limitations of our individual circumstances and the options at hand. For mothers and families making these important decisions, statistics are helpful, but statistics only spotlight the corners of our own unique sets of certainties and uncertainties. Insisting that one location is always safe and another location never is, is ridiculous. Home birth has been around since humans have been, and it doesn’t look like it’s going anywhere. Hospital birth is where 99% of American birth takes place, and I doubt it’s going anywhere, either. There’s no denying it. “Some emergencies can be deadly in the absence of immediate hospital care. Cord prolapse is one of these. Placenta abruption may be another. But these complications are very unlikely to happen. Best estimates are that cord prolapse and placenta abruption each occurs in about 1 in 10,000 home births. That’s very low risk indeed. From a low-risk woman’s once-in-a-lifetime perspective, the risk of encountering such a complication is less than the risk of an average person being killed in a traffic accident during one year. Other complications, like shoulder dystocia, are more common. But such complications might be handled at home by a suitably trained midwife. ” (CMAJ : Canadian Medical Association Journal Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. pg. 3)For real people making real choices, let’s open up the discussion with compassion. Trying to look at this from both sides and see the pros and cons from a personal place was a bit harder than just looking at statistics. I definitely had my favorite when having my babies but I tried to be unbiased in making these lists. Here are some talking points. Home birthPros:– You are able to labor and deliver in the comfort of your own home. – There are no restrictions on how many family members or friends that can be present.– You can eat or drink as you wish during labor.– You are able to walk around freely without monitors or IVs.– When birthing at home, you are able to have a natural birth without intervention.– You can choose the delivery position that’s right for you.– There are little to no time constraints for labor and delivery.– You may be able to avoid unnecessary medical interventions common in hospital births such as c-sections, induction, and early rupture of membranes. – Low risk of outside exposure to viruses or bacteria.– After delivery, you can rest in your own bed with your baby.– You have optional in-home follow-up care and lactation support available from midwife and doula. – You will not be disturbed by doctors or nurses throughout the night. – Lower delivery costs.-You can have a water birth!-You don’t have to worry about a hospital bag.Cons:-Most insurance policies will not cover home birth expenses.-There is no pain medication or epidural available if birthing at home although a midwife or doula may assist in pain relief. -There are potential risks if your midwife or caregiver is unsure of what to do in an emergency situation. Carefully choosing a well trained and educated midwife is important. -You may need to be transported to the hospital if complications arise. Having a plan in place is helpful. -In case of emergency, there will be a delay in you and your baby receiving care, while in transit to the nearest hospital. -You will need to arrange for your own postpartum care. Family, friends, or a postpartum doula are all good options. -You will need to file your infant’s birth certificate. This is not hard and the midwife will usually tell you what to do. Hospital Pros:-When admitted to the hospital, you’ll be placed in a hospital bed with fetal monitoring, IVs, and a transducer to measure contractions to make sure everything is running smoothly from start to finish. (This could also be put on the con list depending on your mind set.) -Pain medication is readily available for those who desire it. -It is possible to achieve a natural birth in a hospital setting.-Most hospitals allow you to use a doula throughout labor and delivery.-You have assistance from trained nurses to help care for your baby, while you heal and rest after giving birth.-There is on-site lactation help.-If complications should arise, you have immediate medical assistance with the most advanced technology.Cons:-Your food and fluid intake will be limited to ice chips.-Hospitals often set a time limit on how long they will allow a woman to labor before using intervention.-Hospitals have a high C-section rate, some higher than others.-Not all hospitals allow or can accommodate the desire for a water birth.-If intervention is determined, doctors may administer Pitocin (a medication to help speed up contractions), which some view as “rushing” the body’s natural process and can cause adverse reactions for both mother and baby. -Privacy is minimal, as doctors and nurses are walking in constantly to check statuses, take vitals, etc. Rest is not easy to get in this setting. -You may be separated from your baby throughout your stay due to bathing, screenings, and vitals.-Hospitals have strict policies, protocols, and procedures that they must follow, which means you will, too.-High hospital costs if uninsured. (From what I could find the average birth at the hospital with insurance was $3000 out of pocket versus around $1500 for a home birth.) As you can see, if you are debating about whether to have your baby inside a hospital or inside your home, you have a lot of things to consider. I chose to write this paper because, as a doula, I often get asked the pros and cons of each side. Either way you decide, the most important thing is to provide the best possible outcome for yourself and your newborn child. It is a big responsibility that should not be taken lightly, so educate yourself with as much information as you can in order to make the right decision for your own situation. Some good books to read on home birth: Spiritual Midwifery by Ina May GaskinsThe Home Birth Book by Charlotte WardThe Home Birth Handbook by Annie FrancisAlso some good books for preparing big brother or sister for new baby:We’re having a home birth! By Kelly Mochel Baby on the way but William and Martha Sears and Christie Watts KellySources:Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Melissa Cheyney PhD, CPM, LDM, Corresponding author Melissa Cheyney, PhD, CPM, LDM, Marit Bovbjerg PhD, MS, Courtney Everson MA, Wendy Gordon MPH, CPM, LM, Darcy Hannibal PhD,?Saraswathi Vedam CNM, MSN, CMAJ : Canadian Medical Association Journal Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physicianPatricia A. Janssen, PhD, Lee Saxell, MA, …, and Shoo K. Lee, MBBS PhDShalynn Hoffman is a wife, mother of eight beautiful, loud, funny, sometimes obnoxious children, doula, and professional soccer and football parent. Shalynn received her training through Birth Arts International. She has been attending births for 24 years and has developed a love and passion for helping birthing mothers. Shalynn Hoffman lives in the great state of Ohio where she cheers on her Buckeyes and her children.