Planned Home Birth Versus Planned Hospital Birth

Introduction

Back home, birth was a usual process. But today, hospital birth has become a cultural norm, especially in developed countries. In most developed countries, a dramatic shift was seen from home birth to hospital birth during the 20th century. In the United States, a major shift occurred from 50 percent home births in 1938 to less than one percent home births in 1955.

Though the home birth rate remains low, there has been a significantly small increase in the home birth rate during the last few decades. Planned home birth is when the baby is delivered at home rather than in a hospital setting or a birthing center. However, a planned home birth is assisted by a trained, experienced professional, such as a certified midwife.

What Are the Benefits of Home Birth When Compared to Hospital Birth?

The potential benefits of home birth are:

• One feels more comfortable, safe, and supported. The familiar, supportive environment makes one more relaxed and allows one to labor effectively.

• Provides control over one’s choices. The assistance trained midwife professionals provide helps one make the right choices and, in turn, provides more emotional support.

• Some studies suggest that women who planned home birth exclusively breastfed their babies compared to those who underwent planned hospital birth.

• More positive birth outcomes and the need for fewer medical interventions. Studies suggest that about 97 percent of women who undergo hospital births will have some form of intervention used during labor. These interventions include labor induction, cesarean section, instrumental birth, and open vaginal delivery. These interventions may pose a risk to both the infant and the mother, increasing the risk of surgical birth.

• There is no need to interrupt labor to go to the hospital.

• Provides more skin-to-skin time with baby after birth. Further, if they are present, there is no need to leave other kids. Home birth also provides an opportunity for more support from the partner.

• Reduced cost.

• A greater chance that one will have a vaginal birth. Some studies that compared women who planned home births with those who planned hospital births found that the cesarean rate was higher in those who planned hospital births.

• Some studies suggest the risk of developing maternal complications like postpartum bleeding, retained placenta, endometritis, and perineal lacerations was lower in women who planned home birth.

• Freedom to choose one’s labor position.

• Religious or cultural considerations.

What Are the Advantages of a Planned Hospital Birth Over a Planned Home Birth?

The benefits of a planned hospital birth over a planned home birth are:

• Immediate access to medications and all resources in case of an emergency.

• Pain management options, including epidurals, are available. Hospitals offer pain control options like IV medications, epidurals, etc., which are unavailable in case of home birth.

• Trained nursing professionals and healthcare professionals are available for support.

• In cases of complications or emergencies, interventions, and medical support are available.

When to Go for Hospital Care in the Case of a Planned Home Birth?

During a planned home birth, one is advised to go to the hospital in the following situations:

• If the fetus is not in the headfirst position.

• If severe bleeding is experienced.

• If pain relief is needed.

• Delayed labor or if labor is not progressing.

• In case of premature membrane rupture.

• The mother feels exhausted and cannot continue delivery.

• If one develops a fever.

• If the baby shows signs of fetal distress.

• The mother feels exhausted and cannot continue delivery.

• If the mother has high blood pressure.

• In cases of umbilical cord prolapse, a condition in which the umbilical cord slips through the cervix and may even protrude out from the vagina. It is a medical emergency as blood flow from the umbilical cord gets blocked.

Which Is Safer?

The United Kingdom’s birthplace cohort study concluded the following, taking into consideration healthy, low-risk pregnancies:

• In the case of women having their first childbirth, a planned home birth increased the risk of serious complications for the infant from five in a thousand for a hospital birth to nine in a thousand for a home birth.

• For a woman having a second childbirth, a planned home birth was almost as safe as a hospital birth.

The safety and favorability of homebirth outcomes depend on various factors like the appropriate selection of trained midwives, accessibility to hospital care, immediate access to consultation, etc. Some observational studies found that planned home birth with trained midwives and a collaborative medical backup was as safe as planned hospital birth for women with a low risk of complications. Planned home birth in such cases was found to have fewer interventions and other unnecessary complications.

What Are the Reasons Why Women May Choose Home Birth Over Hospital Birth?

The main reasons are:

• Previous Hospital Birth Experience: events related to a previous hospital birth may motivate a woman to choose home birth in subsequent pregnancies. Two main factors contributing to this were using too many interventions and avoiding pharmacological pain relief. Another reason was dissatisfaction with the care received from the healthcare providers.

• Home Environment: The women can get all the emotional support and care they need at home.

What Are the Risks Associated With Home Birth?

Studies suggest that, though fewer interventions are required, homebirth increases the risk of perinatal death (about a twofold increase) and the risk of developing neonatal seizures. Planned homebirth may also increase the risk of uterine rupture, in which the uterus breaks open into the abdominal cavity.

Home birth should not be considered in the following cases to reduce the risks associated:

• The mother's age exceeds 42 years.

• The mother is younger than 17 years.

• In the case of first-time pregnancies.

• In cases of multiple gestations (more than one child).

• If under some medications, that may increase the risk for complications.

• In the case of pregnancies that are supported by assisted reproductive technologies.

• In the case of obstetric complications that include gestational diabetes, pre-eclampsia, and placenta previa.

• One who has not done a pregnancy screening test.

• Previous history of preterm labor.

• The partner is not supportive of the home birth option.

• If one needs an epidural for pain control.

• The baby’s position does not allow headfirst delivery.

Conclusion

Planned home birth has benefits like a homely, safe environment, fewer interventions, more emotional support, and more. However, it can only be performed in second pregnancies with low risk. Even then, there is a significantly low risk of complications, as the labor process can sometimes be unpredictable.