Freedom of Choice: For those who believe in women’s freedom of choice about pregnancy, it’s time to think about women’s freedom of choice in birth. Though there are more birthing choices are available than ever before (hospital, birth center, midwives, home birth), there are 11 states where it is illegal for a midwife to attend a home birth and everywhere women are still regularly pressured into birthing in the hospital by partners, mothers, friends who do not trust that a woman can make the right individual choice for her body and her baby. Though a mother might feel more comfortable and in control at home, the prevailing ignorant thought is that if you don’t birth at a hospital, you are a bad mother putting your child at risk for the sake of your own comfort and preferences.

Health Benefits:
The medical community has a lot to say about why a hospital birth is safer but they have not officially published any comparative studies as to why it might be safer. Hospital birth is definitely safer for mothers who have had before-birth pregnancy complications and are considered High-Risk. However, there is no known added risk of birth complication if a normal low-risk mother births at home, and in fact many studies show that the risks decrease at home.

Compared to home births:
Episiotomy at a hospital is 9 times greater.
Maternal hemorrhage at hospital is 3 times greater.
Newborn infection at a hospital is 4 times greater.
Emergency C-section at hospital is 9 times greater.
Maternal death at a hospital is 3 times greater.
Postpartum depression after hospital is 4 times greater.
– (due to mothers who may have had unwanted hospital interventions and hospital policy not allowing early bonding.)

There aren’t numbers for differences in rate of perineal tears, but the rate of tearing is much higher in the hospital if the mother lays on her back, has an epidural (can’t feel how hard and fast she pushes) or when the doctor uses forceps.

As soon as a mother enters the hospital, her C-section rate increases 25% on average. The eventual emergency C-section rate after attempted home births is about 5 percent in the U.S. As with any major surgery, C-section carries a greater risk to mom and baby than a vaginal birth. A C-section increases the risk to mother’s body including excessive uterine bleeding, removal of uterus, injury to bowel and bladder, infection, complication from medications, and higher incidence of death.

The average C-section rate, should you labor in a hospital from the beginning, is 30 percent in the U.S.

Financial Benefits:
Many people who don’t have health insurance or have minimal insurance will be left with debilitating debt after a hospital birth, especially those without health insurance who do not qualify for Medicaid. Most families who have a hospital birth covered 80 percent by insurance will still have some debt. For low income women, 46% of home births are covered by Medicaid. The same percentage of hospital births are covered by Medicaid. Home birth is an economical alternative for low-risk women who have Medicaid.

Vaginal Birth with a physician: $8,000-$25,000 before insurance depending on interventions and stay length.

Cesarean Birth with surgeon: $15,000-$35,000 before insurance, depending on complications and stay length.

Prenatal care with a physician: 1,500-$3000 before insurance.

The average cost to an American family for prenatal care and hospital birth is $9000 out of pocket.

Yet the total of prenatal, homebirth and newborn care with a Midwife $3,000-$5,500 before insurance. Most insurance now covers 30% to 100% of midwifery care.

The Risks:
What if there is a small problem at home?

Along with midwifery techniques that can fix many minor problems including minor hemorrhage, certified midwives bring everything used at the hospital for a normal birth (with the exception of some narcotics, pitocin drip and epidural anesthesia). This includes oxygen for mom and baby if needed; stitching supplies, Doppler fetal heartbeat monitor and some even bring continuous heartbeat monitoring equipment and sometimes forceps. She also brings neonatal resuscitation items like heating pad, Res-Q-Vac suction pump w/sterile tubes and mucous trap, other suction devices and emergency baby fluids and glucose. Minor to moderate postpartum hemorrhage can be dealt with at home in the same way as at the hospital: the midwife administers pitocin injection and uterine compression.

What if there is a major problem at home?

In birth, immediate emergencies are rare.  If you must have an emergency C-section in a hospital, the rule is “30 minutes decision to incision” to prepare the doctors, room and patient. If a mother needs to be transferred to a hospital after and attempted home birth, the hospital can be called and prepared to have the baby out in the same amount of time as if she were already in the hospital- as long as she lives 20 minutes or less from the hospital.

In the rare occurrence the mother has a postpartum hemorrhage that doesn’t respond to regular treatment, the midwife can administer IV fluids and continue uterine compression until the mother makes it to the hospital to receive blood products or have a hysterectomy (But severe postpartum bleeding happens in less than 1 percent of mothers and is more likely during a c-section.)

In the very unlikely case that the baby has a breathing issue that does not respond to suction treatment, extra oxygen can be ventilated to the baby via “bag and mask” on the trip to the hospital to check for abnormalities that cause the breathing issue. The rate of home birth babies that transfer to the hospital is 7%-10% with no known added risk associated with the time it takes to transfer as long as she is born no more than 30 min. from the hospital.

The American College of Obstetrics and Gynecology’s own official statement against home births is incredibly vague stating only the unusual circumstance of a possible uterine rupture in a vaginal birth after cesarian (V-Bac) and though they state that they recognize there is something wrong with this country’s high C-section rate and it needs to be fixed, their main warning against home births is that midwives can’t provide you with a C-section.

The most disturbing part is ACOG’s ending statement:

“Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.”

This position obviously blames and shames mothers for caring about their own birth experience and reminds us that the hospital does not care at all that a birthing mother is having a profound life-changing emotional and bodily experience that effects her for the rest of her life. I can only help but think of the anti-choice position that abortion is wrong even if the pregnancy will mame, scar or torture the mother.

I am due in March. For me, my birth choice is about being well educated on birth, cost and my health. It is about owning the rights to my body and the right to bring my child into the world however I choose. Though doctors often have the best of intentions; the institution of medicine functions like any other- taking away the individual’s sense of agency and negating a woman’s sense of intuition. If I wind up having a major complication, I will be glad there are emergency hospital services to save me and my baby. However, I have been convinced by my research that normal birth is best at home-not that I’d wish to take away any woman’s right to choose a hospital birth if she so pleased.

Study numbers and statistics come from information gathered at the sites below:

http://www.gentlebirth.org/ronnie/homejjg.html

http://www.gentlebirth.org/ronnie/hospitalDangers.html

http://www.storknet.com/cubbies/homebirth/homebirthsafety.htm

http://www.womensenews.org/article.cfm/dyn/aid/2435

http://www.feministing.com/archives/015394.html

http://www.babygooroo.com/index.php/2009/05/28/is-home-birth-as-safe-as-a-hospital-birth/

http://www.thebusinessofbeingborn.com/

http://www.allacademic.com/meta/p_mla_apa_research_citation/2/3/7/0/1/p237018_index.html

Photo credit: stock.xchng.