Home or hospital?

Even early in your pregnancy you will be faced with a range of choices and asked to make decisions. In order to help you decide what is right for you and your baby, you need information about any potential advantages or disadvantages that there might be in the services available. The following information is designed to give you up- to-date information based on what is known to be effective, so that you can make the right choices for you and your baby. It will hopefully help you decide which place is best for you and your baby – hospital or home.

 

The general assumption is that women, especially women who are pregnant for the first time, will have their baby in hospital. However, you have a choice between giving birth at home or in a hospital environment. There are important factors that need to be thought through when you are making your decision. The main one is that of safety – for you and your baby. But alongside this is your own preference, where you will feel more comfortable, more relaxed and more in control.

 

Safety first

 

At the same time that hospital births became more common, fewer babies were dying. It’s not surprising people linked the two and concluded that having babies in hospital was safer. Recent studies have not, however, shown any link, and it is probable that the number of babies dying would have fallen anyway due to the use of antibiotics, hand-hygiene, better education, and improved living standards. Research is ongoing, however, and when pregnancy is straightforward or ‘low risk,’ Canadian and international studies indicate that home birth is as safe as hospital births for women and their babies who have registered midwives. Also, women who plan home births are less likely to experience medical interventions in their labours (e.g., epidurals, vacuum or forceps deliveries) than women who plan hospital births with registered midwives. Therefore, even if this is your first baby, if you have had a normal pregnancy, you can plan a home birth. There is no evidence to suggest it is unwise.

 

Midwives have to adhere to guidance given by the College of Midwives standard ‘Indication for Discussion, Consultation and Transfer of care.’ This guides midwives’ decisions in practice in order to determine a woman’s level of risk. There are some situations when your midwife will advise against home birth because of safety. Examples include labour before 37 weeks, breech presentation, high blood pressure in pregnancy, or twins. Regular care and screening helps to detect most of these situations.

 

Home birth is safe because midwives have ready access to hospital back up in case of emergency.

A safe time/ distance to the nearest hospital has never been determined, but 30 minutes travel time to the nearest hospital is a common standard.

 

Feeling comfortable

 

Being as relaxed as possible when you are in labour is more likely to help you and help your labour. If anything is making you anxious or upset, you will become tense and may feel more pain. Women who choose to give birth in their own homes are more likely to feel in control as they have familiar things around them and can wander around freely and do as they please. A home birth may be right for you if you have strong feelings about how you want your labour to be; for example if you:

  • don’t like hospitals
  • want more privacy

 

Only you know the kinds of things that will help you feel relaxed. Some women may feel safer in hospital, and may feel reassured by having experts and a range of services on hand to help them if needed.

 

The choices Hospital

Advantages

  • Medical pain relief, including the epidural, is available should you want or need it
  • All women have a private room for their labour and birth
  • There are showers in all labour rooms with unlimited hot water
  • Most hospitals provide expert emergency care including cesaerian section
  • Everything is on hand if there are problems – you don’t have to move

 

 

Disadvantages

  • There are hospital policies and procedures that must be followed when birthing in hospital
  • There may be a limit to the number of people allowed in the birth room
  • Unfamiliar surroundings and caregivers can affect a woman’s confidence and ability to labour. Women may feel restricted and/ or inhibited. This can make it more difficult to feel in control of your birth experience
  • You are more likely to: use medications for pain relief during your labour, have an episiotomy (a cut in the opening of the vagina), to have your labour augmented, to need a forceps or vacuum delivery or a cesaerian section
  • Mother and baby must stay for a few hours after the birth before they can go home
  • Separations between mum and baby for routine hospital procedures may occur (this does not happen often)
  • There are no bathtubs in the labour rooms
  • Following the birth, mum and baby are moved to the postpartum ward, where rooms are often shared
  • Most women do not enjoy the food at the hospital

 

Home birth

 

Advantages

  • You are less likely to: use medications for pain relief during your labour, have an episiotomy (a cut in the opening of the vagina), to have your labour augmented, to need a forceps or vacuum delivery or a cesaerian section – this is true even for women who plan a home birth but transfer to hospital in labour
  • Studies have found that women who have had both a home birth and a hospital birth, say they much prefer home
  • Only the people you have invited to share in your experience will be
  • You can use your bathtub or rent a birth pool – many women find water imersion is an effective form of pain control in labour, and water birth is an option at home
  • The comfort of being in familiar surroundings is relaxing and helps to connect the experience of labour to normal life
  • You may feel more relaxed and in control when you’re in your own
  • Relaxing helps women to labour more effectively
  • Women may be less inhibited and able to move and make sounds as they feel the need to
  • Mother and baby experience less separation and interruption which helps breastfeeding and bonding

 

Disadvantages

  • You can’t have an epidural or other pain relieving drugs at home
  • You may have to transfer to hospital if there are any
  • It is the responsibility of the family to gather and purchase birth supplies
  • The postpartum mother may have less support than that available in the hospital (for example; 24-hour breastfeeding support and meals).

 

What we don’t know

 

All of life involves some measure of risk, and this applies to giving birth, wherever the birth takes place. When considering home birth, one must therefore accept that there is always the possibility, no matter how small, of a tragic complication which could have been more effectively dealt with in hospital.

 

This risk, however, is small, and midwives are trained to handle obstetric emergencies. Midwives update their skills regularly and they carry equipment and drugs that would be necessary in such an event. Midwives are also trained in infant resuscitation in the same way that doctors and nurses are. It is also important to note that unnecessary interventions are more likely to occur in hospital, and these interventions come with their own set of risks. This is why home and hospital birth are considered equally safe.

 

Occasionally, women develop complications during pregnancy and/or labour where they need access to specific care that is usually only available within a hospital environment. Therefore even if you have chosen to have your baby at home, if complications arise, you may be advised to transfer to a hospital.

 

 

Transfer

 

A few women having their first baby have to be transferred from home to hospital during labour.

Women who have already had a baby are much less likely to transfer. The most common reasons for transferring to hospital are a labour that is not progressing, meconium (baby’s bowel movement) in the amniotic fluid before the birth, or concern about the baby’s condition. Most transfers to hospital from home births are not urgent, and   do not require an ambulance. Even if your baby is born at home, there’s a small chance you or the baby may need to go to hospital after the birth. Studies suggest that women who transfer with a continuous carer (for example; a midwife) do not regret their original decision to have a home birth.

 

Your choice

 

Choosing where to give birth to your baby is an important decision. You have plenty of time to make your decision and you can change your mind at any time during your pregnancy. If you are advised not to give birth in the place you want, ask the midwife to explain the benefits and risks for you and your baby.

 

How to find out more

 

If you want to talk more about where to give birth, you can discuss this with your midwife.

 

Questions you may want to ask

 

After reading this leaflet there may be some things you are still not sure about. You can write down any questions you have and any things you would like to discuss further.