Hospital Birth versus Home Birth

Unexpected Risk Factors Leave Little Room for Managing Home Births Safely

The debate about the safety of home birth versus hospital birth has been going on for decades and is not likely to be settled anytime soon.

Go to a delivery room at a hospital or birthing center and you'll find a large amount of equipment and supplies that are supposed to provide the safest environment for a mother to give birth to her baby. Giving birth in a hospital has many advantages, yet some women are fearful. They have sometimes heard negative stories relating to certain medical interventions that cause them concern, and some have concerns about mom and baby not being able to bond right away.

"As doctors, we want the same thing that our patients and their families want: a safe delivery for mom and a healthy baby," says Dr. David Adler, D.O., a Board Certified OBGYN of Comprehensive OB-GYN of the Palm Beaches in Loxahatchee (www.comprehensiveobgyn.net). "While home births with a midwife can be fine if nothing goes wrong, the problem is how do you see into the future and know nothing will, in fact, go wrong? If there is a complication, we have the tools readily available in the hospital to get the baby out in less than 5 minutes if need be. New babies can take 10-15 minutes of strenuous conditions, but not an hour or two while you figure out whether you need to get to a hospital, and then actually travel there."

Dr. Greg Latchaw, also of Comprehensive OB-GYN of the Palm Beaches, stresses the importance of being in a hospital for childbirth to manage any unexpected complications during delivery. A Board Certified OBGYN as well, Dr. Latchaw has witnessed firsthand the tragedy of home births gone awry.

"In one case of a home birth that resulted in disaster, I was called emergently from one of the hospitals where I was on call and had to perform an emergency cesarean section where there was a complication known as a cord prolapse. Unfortunately, they arrived at the hospital when it was already too late," said Dr. Latchaw. "The tragedy is that the situation went unrecognized initially and by the time it was recognized, an ambulance called, the patient brought in, and the baby delivered, the baby had been oxygen deprived for a long enough time period that there was severe brain damage from oxygen deprivation. The baby only made it three days."

Dr. Adler and Dr. Latchaw have outlined several complications of childbirth that necessitate a rapid response as well as four myths about giving birth in a hospital. They believe educating women and dispelling myths is very important in our community and it will ultimately lead to healthier moms and babies.

Complications of Childbirth

Prolapsed cord

This is a condition where the cord protrudes through the cervix in front of the baby's head. In this situation, the cord is compressed because of the baby's head pressing down, made worse with each contraction. Hence, the oxygen supply to the baby becomes restricted and likely even completely cut off. This condition is dangerous and requires an emergency cesarean.

Long second stage of labor (pushing stage)

Lack of progress of second stage of labor can be an indication for measures only available at a hospital. At the hospital, an obstetrician may assist by using forceps or vacuum. Alternatively, an emergency c-section might take place if it gets too difficult or takes too much time, as this can compromise the baby's condition.

Hemorrhage

Post-partum hemorrhage is one of the more common complications of childbirth. In case of hemorrhage in which placenta is not detaching, there are medications that can be administered to stimulate contraction of the uterus and detachment of the placenta. Being in a hospital will allow for drug administration via an IV, blood transfusion or even operation in the case of non-detaching placenta.

Baby needs resuscitation

In case of the baby needing resuscitation, hospitals have tools necessary for advanced treatment, and the baby can be hooked up to a ventilator in the most serious situations.

Cord around baby's neck (nuchal cord)

The baby having a nuchal cord is a common occurrence which occasionally creates a complicated situation. In most cases, the cord is not tight, thus enabling the baby to be born vaginally. However, if the cord is very tight, the baby may have restricted blood flow through the cord, particularly with contractions,. In this situation, a baby may show signs of distress as indicated by a decrease in the heartbeat. If the distress continues, then the mom may need to be in a hospital for an emergency c-section.

Shoulder dystocia

Shoulder dystocia is a condition where the one of the shoulders may get stuck behind the pubic bone after the head is delivered. This situation is dangerous because the baby cannot breathe with the lungs until it's completely delivered and the cord clamped. At the same time, it may not get oxygen from the cord because the cord can be compressed in this situation.

Below are 4 common myths about giving birth in a hospital

A woman will not be allowed to walk around during labor. This is usually not the case in most hospitals. In fact women are encouraged to walk to speed up labor. It is true that many facilities will want to check the baby's heart rate by hooking mom up to a fetal monitor. However this can be done intermittently. If a patient chooses an epidural they would most likely not have enough feeling in their legs to walk safely. Some hospitals do offer a walking epidural that allows more feeling and the ability to walk around. This may be an option. Women who do not have any type of epidural are usually free to walk around, use a birthing ball, and use a tub if available.

A woman will be pressured to receive pain medication such as an epidural. It is true that a woman giving birth in a hospital will be offered pain medication but will not be pressured to accept any. A woman decides for herself what level of pain she can tolerate without getting pain medications. If she wants to go through the entire labor and delivery without any pain medication, the hospital will certainly not stop her. However, many moms-to-be decide they do want an epidural after feeling how severe the pain can be. The good news is when giving birth in a hospital, pain medication is available if a woman does have a change of heart.

A woman will give up all control when giving birth in a hospital.  Avoid this by opening up communication with your doctor and talking about your concerns. Perhaps discuss putting a birth plan together with your OB-GYN in advance. Hospitals will try their best to accommodate a woman. It is important to remember patients have rights. A patient can refuse a procedure. A woman still has a great deal of control over her labor and delivery. Occasionally unexpected things happen during labor that make following a birth plan not possible. Changes take place to ensure the health and safety of mom and baby.

A new mom will be separated from her baby after giving birth. With a vaginal delivery, some hospitals immediately place baby on mom. Other hospitals may do so for a few moments but then assess the baby on the other side of the room while the doctor finishes with mom.  Assessing the baby includes weighing and measuring length, making sure the baby is warm and dry, and making sure the baby is breathing well. Once the baby is quickly accessed and everything is fine, the baby is given back to mom. Many hospitals have the baby stay in the same room as mom for the entire hospital stay. The baby may be taken to the nursery for brief periods of time for assessments. Mom and dad can accompany the baby if they wish and ask that this be limited.

Hospitals vary, as do their polices. When a woman is deciding if she should give birth in a hospital, she should research her options and learn the facts. Things have changed in the medical community.

Hospitals have a strong focus on patient rights and satisfaction. The most important thing to remember is that obstetricians, hospitals and women want the same outcome, which is a safe delivery for mom and a healthy baby.

About Comprehensive OB-GYN of the Palm Beaches 

Comprehensive OB-GYN of the Palm Beaches (http://www.comprehensiveobgyn.net/) specializes in the complete, comprehensive care of women of all ages. From the very first gynecological visit, to a smooth and healthy transition into menopause and beyond, our experienced physicians are able to meet a woman's needs, offering the most up to date, expert women's health care in gynecology and obstetrics, with an added special touch.