Choosing a Birth Location – Hospital Vs. Home

The process of delivering babies has changed over the years. We have gone from delivering in caves and huts to midwives to the “medicalization” of childbirth, back to a push for more “natural” childbirth. For many years, dads were left out of the whole process. Moms were given drugs so they didn’t remember much of anything. Things have definitely changed!

Women are requesting more education and involvement about what is going on with the labor and childbirth process. Most obstetricians are willing to participate, within reason. It is important to work as a team. Discuss your birth plan during your OB visits. It is important that your doctor is aware of what you want. You can also make visits to your hospital or birthing center.

Women who are defined as “high risk” should definitely deliver in a hospital. This is not a complete list, but high risk includes:

Multiple pregnancy (twins or more) Placental problems (placenta previa, etc) Bleeding during pregnancy – talk to your doctor Cervical incompetence Previous preterm delivery, premature labor Baby who is not growing well (Intrauterine growth retardation – IUGR) Maternal medical disease – check with your doctor Hypertension or diabetes that develops during the pregnancy

If you have any of these problems, the potential for serious problems for mom or baby outweighs any benefit of trying to deliver outside the hospital. You may still have a vaginal delivery, but you and your baby need to be closely monitored for your health.

Most pregnancies are perfectly normal. It is hard to predict when or if there is going to be a problem. If you are seeing a provider who has promised to do your delivery outside the hospital, make sure you have asked about arrangements in case there are problems before or during labor. Some states do not license midwives; others require that they have a physician to back them up. Some require a certain amount of training, others do not. Remember, you are placing two lives into this person’s hands. Ask questions about qualifications, backup, and emergencies.

Check about what your non-physician provider is licensed to do. Most are not allowed to do any sort of stitching if you have any tearing. They are not allowed to give you any medications for pain. If you have problems, you need a physician to accept your care.

In Great Britain, where home deliveries are more common, 45% of first-time moms who attempt it are transferred to “obstetrical units”. The risk of “adverse outcomes” was double at 9.4%. They also state “These findings ….do not tell us how many babies died or were brain damaged in each group.” *

Remember that everyone should be concerned about a healthy mom and baby. Over the years, I have been surprised at the way things change towards the end of a pregnancy or during labor.

I had one mom who was on baby number 4. She just couldn’t understand this “fetal monitor and all that garbage”. When the baby started coming down during pushing, the heartbeat dropped dangerously low. And it stayed there. I was trained in the old days where we used forceps. I slid them on, slid the baby out, cut the cord that was around that baby’s neck four times, and then delivered the rest of the baby. The cord was getting pulled as the baby came down. How much brain damage would she have had if we had let that go on for a while? Who knows? I prefer not to find out.


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