Home Birth or Hospital?

my niece, Sophia

Never having given birth myself, I hadn’t considered how many factors there are when deciding where to give birth. Doesn’t everyone just give birth in a hospital? That may be the perception of many Americans considering close to 100% of U.S. births take place in a controlled and/or clinical setting.

When my Grandmama was born in 1932, there was no question that she would be born at home. When I spoke with her tonight, I asked her if she considered giving birth to my mom (in 1956) at her home. Grandmama chuckled and said “No way.” My mom gave birth to me (in 1985) at Methodist Hospital in Rochester, MN.

 

March 10, 1985

I only know of three women who have given birth at home. I asked my friend, Abby, about her experiences giving birth to her now 18-month-old daughter.

Abby hadn’t thought much about where she would give birth until she spoke with two of her friends who had both done home births. Abby wanted to know more about it and began asking them questions and doing some research. Abby and her husband, Aaron, had their initial appointment at a doctor’s office. Right away, they felt as though the doctor had no time for them.

The following day, Abby and Aaron met with Marcy, a licensed midwife. Marcy spent an hour with them asking them what their ideal birth would be like and encouraged them to think through what they did and didn’t want. Abby and Aaron decided that having Marcy be with them through the entire pregnancy was the best decision for them.

Abby listed some of the reasons why she chose a home birth over a hospital birth. She wanted:

• to be in a peaceful place where she felt calm. At her home Abby was able to move from room to room, go up and down stairs, lay in a bed, take a shower etc. Abby’s dog, Bauer, was also there to comfort her.
•  to be the one to make decisions about her body. Abby liked that she could eat if she was hungry and move when or where she wanted to. She also liked that no one would be poking and prodding her throughout labor.
• no one coming in and out as they pleased. At the start of labor, Aaron texted family to say “Abby is in labor” He then turned off their phones for the next 20 hours. There were no outside distractions.
•  to give birth naturally, the way God designed our bodies to do. Abby knew she didn’t want to have an epidural or be hooked up to monitors.
• someone to be with them every step of the way. Marcy met with them numerous times before and after delivery. When Abby was in labor, Marcy was with them from 8:30 a.m. until 4 a.m. the following morning.

Abby, Aaron and baby Hazel

I asked Abby what it was like telling her family she was going to have a home birth. She responded:

“It was hard. People had lots of questions especially our moms. My mom was silent and didn’t say anything to me about it for a long time. Aaron’s mom had lots of questions. After Hazel’s birth they said several times, 'We were so worried!' I felt bad because I don’t like when people are upset.”

Abby is now pregnant with her second child and is looking forward to giving birth at home again.

My older sister, Sarah, is a nurse at Mayo Clinic in Rochester. Sarah gave birth to my niece, Sophia, at the hospital in 2004. While I wasn’t there for the birth, I did get to come to the hospital right after Sophia was born.

meeting my niece for the first time

 I recently asked my sister why she choose to give birth in a hospital.  She responded, “It’s a piece of mind knowing you’re going to give birth in a hospital. You know you have care right there. If there’s a problem, everything you need is there.”

Before giving birth, Sarah didn’t feel strongly one way or the other about getting an epidural. However, 18 hours into labor, she was given one. “Personally, I loved the epidural,” she said. She went on to explain that she was a completely different person before and after the epidural. “It was terrible. I was in such pain. It was so awful. After the epidural, I was kind and relaxed.” Sarah said that if she were to ever give birth again she would choose to be back at the hospital because of the epidural.

So what’s going on outside of the United States? When compared to the U.S., planned home births are much more common in other developed countries. I had the opportunity to speak with an expert on this topic.

Rachael Kulick is another one of the few women I know who has had a home birth. Her delightful son was one of my former students. Rachael has almost completed her PhD from the University of Minnesota. Her dissertation compares home births in the U.S. to home births in the Netherlands.

While in graduate school, Rachael became a certified doula. She did massage during labor and prenatally helped women decide what kind of birth they wanted. When I asked her about her experiences, she said, “I was so disappointed in what I was seeing in Minneapolis hospitals, so I just started thinking there has to be an example of someplace where they do it better. I wanted to find a maternity care system that I thought worked better.” Rachael came across the example of the Netherlands, where 30% of babies are born at home.

Rachael was heavily influenced by a few books she read about home births. These included “Labor Pains” by D. Sullivan and R. Weitz. She especially enjoyed “A Pleasing Birth” by R. De Vries. Rachael even had the opportunity to meet De Vries. He was the one who initially invited her to visit the Netherlands.

Rachael spent the next few years studying Dutch, making connections, and traveling between the Netherlands and the United States. As she conducted her research, she worked closely with women and their midwives in both the U.S. (Duluth and the Minneapolis area) and in the Netherlands.  Rachael did prenatal interviews with each woman in her study and attended the prenatal appointments. Rachael was also there for the births and the postpartum visits. A number of weeks after the baby was born, Rachael did a final interview listening to each woman’s birth story from their perspective. Rachael found that every woman in her study wanted to have another home birth for the next child.

The following are some reasons why the Netherlands teach home birth when other developed countries do not…

• the Dutch developed the concept of the nuclear family (parents and biological children) before other countries in Europe. They started living in single family homes before other societies did.
• midwives were trained really early on – 100 years before they were trained anywhere else. Midwives have a lot of power in the Netherlands. In the U.S., midwives got pushed out of practice by physicians.
•  the Dutch people are relatively wealthy. Homes are clean and well lit; very pleasant places to give birth.

Unfortunately, there has not been very much data collected regarding home births in the United States. It wasn’t until the 1990s that the National Center for Health Statistics began even collecting data. One of the problems of having such little data about home births is that people tend to share all sorts of opinions about the dangers of giving birth at home even though there is no research that supports that belief. It is important for research to continue in this area to help fill the knowledge gap.

Now that Rachael is practically finished with her PhD (she defends her dissertation in December), she has some big decisions to make about where to go from here. One thing she mentioned she’d like to do is start a home birth research organization. I’m sure my friend, Abby, would’ve loved to have an organization like that when doing her own research about home births.

Rachael has learned that women in the U.S. are commonly told that giving birth at home is irresponsible and is putting their baby's life at risk. In the Netherlands, women are treated like normal human beings when they choose a home birth. Rachael hopes that eventually women in the U.S. could plan a home birth without being judged or viewed negatively.

If you'd like to read Rachael Kulick's dissertation it will be available on Proquest sometime after February 2014. For more information, you can e-mail Rachael at kuli0015@umn.edu. 

I forgot to mention one thing. In one of my readings for this week, it said that in the Netherlands, they have special ambulances called “flying storks” that speed mothers and their newborns to a hospital if needed. Crazy! Dutch research shows that home births can be better for mothers and are no worse for infants than hospital births.

So there you have it. Home births vs. hospital births in a nutshell. Which will you choose? Why do you prefer one or the other?