Goshen News, Goshen, IN

May 22, 2013

FIT FAMILIES: Hospital or home, which setting is best for delivering a baby?

By TERRY NEUFELD
IU Goshen Health

— It would be difficult to find a birth topic more emotionally charged than home delivery. Women and men of all socio-economic, educational and professional backgrounds tend to have strong ideas about home birth vs. hospital birth. Often there is also tension among delivering providers regarding the safest place for a baby to be born.

Although the rate of home births in the United States has grown in the past decade, home delivery continues to represent less than 1 percent of all births in America.

Women who choose home birth do so for a variety of reasons. Avoiding unnecessary medical interventions, a previous negative hospital experience, a desire to have more control, and giving birth in a familiar environment are just a few reasons that women give for opting for a home birth.

Home birth in the United States has not been widely supported by the medical community primarily for safety reasons and few insurance plans will pay for a home delivery. Without support from these two groups, many women feel that a hospital delivery is their only option.

Pregnancies are frequently categorized as “no or low risk” or “high risk” for purposes of evaluation and assessment. Diabetes, high blood pressure, pre-term contractions, previous cesarean section, breech presentation and a pregnancy of multiples (twins, triplets, etc.) are just a few examples of what might cause a pregnancy to be deemed high risk.

The research surrounding the safety of planned home deliveries for those at low risk is inconclusive. While some studies show that infants born at home are at increased risk for more difficulty in the transition to life outside of the womb, neonatal seizures, and even death, other studies have found no difference in health safety and actually show a decreased incidence of medical interventions as compared to hospital deliveries.

One significant challenge, however, is that even with careful screening for low risk, it is impossible to predict which birth will become a maternal and/or fetal emergency and require transport to the hospital. For every planned home birth, a transport plan must be devised prior to delivery which configures travel time to the hospital as short as possible. Expectant parents must also be advised that 10 to 40 percent of women and/or babies may need to be transported during the labor, delivery or immediate postpartum period. Should the need for transport arise for emergency reasons, any delay can prove devastating.

The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have agreed that “hospitals and birthing centers are the safest settings for birth in the United States while respecting the right of women to make a medically informed decision about delivery.”

Should a planned home birth be chosen, the delivery should be attended by at least two persons, one of whom is proficient in neonatal resuscitation, a type of CPR specific to newborns. It is also recommended that care be provided by a midwife certified by the American Midwifery Certification Board.

While it is true that labor and delivery is a natural process, it is complicated and the unanticipated is always possible. Those familiar with labor and delivery know all too well the number of things that can cause the miracle of birth to turn into tragedy. No matter the setting, the goal for each birth is a healthy mom and baby.