Running head: HOME V.

HOSPITAL BIRTH

Home V. Hospital Birth

Amanda McKellar
Ferris State University

HOME V. HOSPITAL BIRTH

Abstract
Thousands of babies are born in the United States on a daily basis. Traditionally, trained health
care professionals deliver these babies in a hospital setting under careful supervision. However,
some thought has arisen as of late about the practice of home birth as a holistic approach to
childbirth. A comparative analysis was done on home birthing versus hospital birthing processes
in expectant mothers. In order to gather the best information, journals were studied to analyze the
results. The two approaches in this tender issue were compared and contrasted to determine
which process would be the most beneficial for expectant parents.

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Introduction
Generally speaking, there comes a time in nearly every womans life when the idea of
procreating sounds like the most amazing experience in the entire world. Some women even wait
their whole life to go through the process of raising children. Unfortunately, not all women are
able to go about this dream of birthing biological children. However, the ones that do take the
step to create new life in the world have various options of how to go about the process. As is
true with many other controversial issues, nobody can come up with a universal right or wrong
answer. Every decision that is made reflects the mother and/or fathers personal preferences. The
decision made is whether to go through the birthing process in a hospital setting or in the comfort
of your own home. In each of the processes, ideally, a healthy baby is born. The only real visible
difference between the two choices is the location in which new life is brought into the world.
One may ask why this information is relevant in their life. Quite simply, at some point or
another, we will all be involved with pregnancy or know someone who is. Individuals who have
an understanding of the process fare much better than those who do not. A baby is the most
precious gift that one can be given. The heath of the unborn child and the prospective mother are
of the utmost importance under all circumstances. Parents should understand all the benefits and
risks of delivery methods to insure the health of all parties involved.
Some may also ask why this information is relevant in my own personal life. I am taking
a career path of nursing with an aspiration of working in labor and delivery. For me to fully
understand womens reproductive concerns, I knew I needed to look into some research to
understand how and why they make their birthing decisions. I do not have any children of my

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own, but I plan on creating a family at some point in my life. I am very knowledgeable in the
area of pregnancy due to previous research, job-shadowing, and various documentaries, but I
wanted to dive in even deeper.

Birthing Process
In a perfect world, a woman is impregnated and carries the fetus to full term. According
to WebMD (2011), A full-term birth is considered 37 to 41 weeks, but a new study suggests it is
more of a continuum. To begin labor, a womans body releases hormones that will kick start
contractions of the uterus. The uterus is preparing to expel the baby that has been developing for
the previous nine months. The hormones continue to contract the uterus until the mother
successfully delivers the little bundle of joy.
In a hospital, it is a rule of thumb that a physician or the near-equivalent is to delivery
each and every baby. A physician is an individual who has gone to med school and received a
doctorate degree. They may or may not specialize in birthing babies, but it is more likely that
they specialize in women or family health.
Most men and even many women have never heard of a midwife. For the women out
there that have delivered children before, they are usually very familiar with various midwives.
A midwife is a health care professional the aids the mother through delivery and often times
provides the necessary emotional support. The qualifications to be a certified nurse midwife vary
by state. In Michigan, certified nurse midwives must complete a masters degree along with
specialization in labor and delivery.

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In a home birth, it is rare that a physician attends. As stated above, the physician is almost
always present during the entire duration of the hospital birth. At home, a midwife is essential for
the health and even the sanity of the mother that is delivering. While in a hospital, midwives are
optional and mostly utilized by first time mothers who do not know what to expect with their
childs birth. In figure 4 at the end of this this analysis, a graph from the Centers for Disease
Control and Prevention (2009) is given to show the statistics of the health care workers present in
a home birth setting.
Delivery Methods
The American tradition is to deliver in a hospital. Movies depict child delivery as the
hectic experience of jumping into the car in the wee-hours of the morning en route to deliver at
the hospital. Think about it for a second, how many movies show woman peacefully, naturally
delivering in the comfort of their own home? The chances are that you have not seen many of
those kinds of movies.

In a home birth, a woman gives birth in her home, or wherever previously designated.
Health care professionals such as physicians, nurses, or midwives may be present during the
process just to stay on the safe side of things. Although having professionals in the home during
delivery is suggested, there is no law stating that you must have assistance. The staff can simply
sit on the sidelines as precautionary help. Instead of keeping continuous monitors on the mother
and baby, the personnel tend to maintain as little intervention as they possibly can.
The CDC shows that home births are more common among women aged 35 and over,
and among women with several previous children as shown in Figure 5 below (2012). Many
other variables go into the decision for the location to deliver a baby, but age and experience

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have proved to be contributing factors in the decision to birth in a hospital or at home. The older
a woman is, the more likely she is to deliver at home. Women who have delivered children
before feel as though the process will go smoothly and that they will have a safe home birth. This
decision may not be the smartest because pregnancy risk significantly increases as the womans
age increases.
A newer birthing method that has shown some controversy as of late is water birthing.
People have said that water birthing is a more natural way of bringing life into the world, but I
think that statement is debatable. The biggest issue arising with this form of delivery is that many
hospitals dont offer this kind of option. They prefer to use the traditional supine hospital bed
positioning for the ease of the delivery crew. Insurance companies may not cover this process as
it is not the traditional way to birth.
Pregnancy Risks
Every pregnancy carries some amount of risk. Although the process of being pregnant
and delivering a baby is completely natural, it is still a huge trauma to a females body. Certain
risk factors contribute to the health of the woman and child. For example, when a woman treats
her body badly before and/or during pregnancy, the fetus is at extreme risk for birth defects.
When a women smokes tobacco, drinks alcohol, does illegal drugs, is overweight or obese, or
stresses too much, the development of the unborn child can be severely stunted.

High blood pressure is a huge risk in all pregnant women. Preeclampsia is a condition
onset by pregnancy characterized by high blood pressure and fluid retention. Also, gestational
diabetes is a prominent problem in pregnant women. These women show no signs of diabetes
until pregnancy. As soon as the baby is born, the womans body will return to its normal state.

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To test for this threat, women in the early months of pregnancy are given sugar drinks and have
their blood drawn at regular intervals to test how their body throws off the excess sugar. If there
is an adverse reaction, the women will possibly be retested in the same way or given different
arrays of tests for a final diagnosis.

The Office of Womens Health (2010) reports many problems that can occur during
pregnancy other than just preeclampsia and gestational diabetes. One of these complications is
anemia. Anemia is a deficiency in the number of red blood cells in the body. Anyone, male or
female, can come down with anemia at any time but the problem is heavily present in pregnant
females. Depression can occur for a multitude of reasons during pregnancy or even after the
childs birth. Some unfortunate women come down with hyperemesis gravidarum, or sever
persistent nausea and vomiting during pregnancy. If any of these issues present themselves,
medical intervention is essential immediately for the safety of mother and baby. When any of
these complications are suspected and/or diagnosed, it is probably a good idea to deliver your
baby under careful supervision in a hospital.

Hospital Advantages
For the most proactive approach, women choose a hospital birth. Especially for first time
mothers, the most common decision is to deliver under careful supervision of trained
professionals. When giving birth for the first time, the possibilities are endless as to what could
go wrong. Women are aware of this and actually, very paranoid of this. Generally speaking, most
women will choose to give birth in the hospital with their first born to make sure that everything
with the process goes smoothly. Janssen, Saxell, Page, Klein, Liston, and Lee (2009) explain that

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planned home birth attended by a registered midwife was associated with very low and
comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse
perinatal outcomes compared with planned hospital birth attended by a midwife or physician.
Nobody wants to think about what could happen if their unborn childs health began to
deteriorate. If a woman were delivering in the home and things started to take a turn for the
worst, it could go unnoticed. For example, an acquaintance of mine went into labor in the end of
February this year. She had a perfectly healthy pregnancy without any sort of complications
throughout. While lying in the bed in the hospital, she started noticing that things were taking a
serious turn. Her labor was not progressing as it should have been. She birthed a daughter four
years previous so she knew what to expect in the process. She begged and begged the doctors
and nurses for an emergency Caesarian-Section until finally they gave in and gave it to her and
removed the infant. Because of this emergency procedure, the little boy was removed just in time
to provide him with the care that he needed. Had she been in a home without the help she
needed, the story may not have had a happy ending.
Especially for first time mothers, education is extremely important. In many cases,
mothers deliver their infants without any prior experience. In a hospital, generally staff is on site
24 hours a day, seven days a week, to insure that the new parents can adequately care for their
newborn. These individuals teach the parents how to swaddle the baby, change the diapers, burp
the baby, and many more. Breast feeding education is very important to new mothers. During
pregnancy, a lot of prospective mothers dont know everything that they thought they did about
breast feeding. In the hospital, the nurses are readily available to answer all possible questions
regarding anything pertaining to breast feeding, or anything else. Even if the mothers opt to
bottle feed, the nurses are first in line to explain how to do everything the right way. This

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education keeps womens minds at ease and calms the jitters of leaving the hospital to care for
the baby on their own. Although this kind of education can be provided in a home setting as well,
the helpers are not as readily available through all hours of the night with all of the proper
resources.
Disadvantages
The most prominent reason that women give for avoiding hospital delivery is the strict
regulation of processes. All women are treated the same way by the employees of the hospital
and the process can be rather impersonal. When in labor, the women are not allowed to eat, use
the restroom, or even get out of bed to walk around without careful assistance.

Health care workers are extremely paranoid of the safety of everyone involved in the
birth. This overbearing supervision can contribute to early stress of the delivering mother, as if
the process is not already stressful enough. Labor is a high stress time in itself, but additional
stress to the mother and unborn is extremely detrimental to their health. When a woman becomes
stressed, her blood pressure is likely to rise which can inversely affect the fetus causing their
heart-rate to drop. When the childs heart rate begins to drop, a snowball effect can result.
Everything begins to fall apart and it is extremely likely that the mother will need to be rushed
into the operating room for an emergency Caesarian Section to successfully deliver the child.

When in labor, specifically after your water breaks, women are essentially bed-ridden.
Health care personnel do not want women to get up out of bed in fear that they may faint or even
fall. Women are outfitted with fall-risk wrist bands and advised not to move too much in bed

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without assistance. If the ladies feel as though they need to use the restroom, the aides will put
them on a bed pan, or they will be catheterized by a nurse.

In my anatomy class, we were taught that at one time, humans walked the earth on four
legs. Whether you believe this or not is strictly up to you, but shockingly enough, it makes sense
when you look at the evidence. The most natural way for a woman to deliver her child is on her
hands and knees. The hands and knees are the best because of the angle of the birth canal being
aided by gravitational forces. However, with the advancements in medical technologies, a supine
(lying down) position is most favorable by physicians. The female laying has the easiest access
to the birth canal and therefore is the easiest way for the doctor to aid the delivery. While this
may be convenient for the professional, it is often not so enjoyable by the women who want to
make decisions about how they would prefer to deliver.

Home Advantages
The choice of birthing a child in the home has been steadily growing. In fact, the
percentage of all U.S. births that occurred at home increased by 29% from 2004 to 2009, as seen
in figure 1 (CDC, 2012). Many women opt to take the home birth route. These expectant mothers
often view childbirth as a natural process that should have no medical intervention. There are
several other reasons as to why one would choose to give birth in a home setting. As explained
by the Mayo Clinic, women often have the desire to give birth in a comfortable place with
familiar people, wear their own clothes, bathe, eat, and move freely throughout labor.

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No matter who you talk to, it seems like everyone in this day and age is having some
form of financial crisis. Adding children to the mix raises the cost of living exponentially. In
fact, when my sister recently gave birth, her labor bills in total were almost 10,000 dollars before
insurance. Shes one of the lucky ones; not everyone holds good health insurance. The cost of
birthing a baby is so expensive due to all of the pricy equipment used, not to mention the highly
trained staff and round the clock care. Giving birth in a home alleviates a lot of this pressure.
You can choose who to have around, at what price, and the duration of time they will be there.

At home, women report higher satisfaction when they are able to make choices regarding
minimal medical intervention. In Janssen, Lee, Ryan, Etches, Farquharson, Peacock, and Kleins
(2002) study, the experimenters explain that women who gave birth at home attended by a
midwife had fewer procedures during labor compared with women who gave birth in hospital
attended by a physician. One of these procedures is having an epidural. An epidural is a spinal
analgesic (pain killer) given to block the pain of delivery. This procedure is extremely
meticulous and must be executed by a certified anesthesiologist. Another thing women wished
against was hormonal intervention such as oxytocin or prostaglandins that would speed up the
natural process of labor. In hospitals, oxytocin is given in the majority of birthing to shorten the
length of the hospital stay so as to make room for the next patient. In home settings, women
usually opt against having an episiotomy. People that have an awareness of what this term entails
tend to cringe when they think about it. An episiotomy is a small incision made to the womans
reproductive organs during labor to help the baby be expelled and to disallow any possible
tearing.

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Disadvantages
The most important part of the birthing process whether at home or in a hospital is the safety of
the mother and child. In a home birth, the risks raise significantly. The Mayo Clinic says that you
should not consider a home birth if you have diabetes, chronic hypertension, seizure disorder,
previous Cesarean-section, use tobacco or illegal drugs, develop pregnancy complications,
pregnant with multiples, or are giving birth early or late. Basically, the smallest of risks should
not be handed at home for the simple fact that if something were to go wrong, the right
assistance or tools may not be available. While most pregnant women who choose to have
planned home births are at lower risk of complications due to careful screening, planned home
births are associated with double to triple risk of infant death than are planned hospital births
(Mayo Clinic).
Women must honestly consider their health and the health of their child before deciding
to birth at home. For example, if a mother chose a home birth without health care professionals
present and were to go into labor, she would be all on her own, with the possible exception of her
family. In the worst case scenario, the mother may be trying to pass the fetus through the birth
canal without realizing that the child has the umbilical cord wrapped around its neck. To family
members that have no prior knowledge of the circumstance or no idea how to alleviate the
situation, the fetus may suffocate during birth.

Another scary complication that could arise during labor is a breech baby. A breech baby is

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when the fetus being delivered has not come down into the birth canal in the proper position. The
proper position would be for the head and shoulders of the fetus to be delivered first. In a breech
birth, the babys legs attempt to pass through the birth canal prior to the head and shoulders. It is
extremely challenging and unnatural for a mother to pass a baby through the birth canal in an
upside-down position without any serious complication or fatality of the child or mother.

Conclusion
When considering the tender subject of bringing a child into the world, many parties
should be included in the decision. For example, a mother cannot make a reliable decision
regarding the birth of her unborn child without the aid of a registered professional. The mother
must first sit down with the childs father, if applicable, to see what his views are about birth.
After all, the baby is his as well and he should have a valid opinion. The woman should also
consult with her primary care physician regarding her overall health. After getting an okay from
the doctor, the woman may then look into a midwife if she wishes. The process is all
circumstantial and every female is different. Child birthing is a moral issue and all individuals
are entitled to their own decisions in the process.

In my own personal opinion, I think it would be extremely cool to deliver a baby in my

home. That being said, I do not have any children yet and I dont think that I would be able to
deliver my first child in my own home. It would be fantastic to go through such a special time in
the exact way that I would select, but whats easy isnt always the best. Delivering in the comfort
of my home would be an exhilarating experience. That being said, I would rather have the
security of knowing that my baby has the health care it will need as soon as it is born. What we

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want isnt always what we need. I would not be able to put myself or my unborn child in a
position that could result in harm. If I wanted to deliver at home and something began to go
wrong, I would not be able to live with the consequences of that decision.

In my professional health care view, I think that delivering at home is a terrible idea. I
am going to be a labor and delivery nurse in a few years, and I simply cannot condone any
unsafe behavior on anyones part. If I were to give a universal answer in the home versus
hospital debate, I would have to go with hospital birth. I think that health care should be on hand
for precaution no matter how many children the woman has previously birthed. There are way
too many risks with the process and possible things that can go wrong when the specifics or
birthing a child are not monitored.

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Helpful Visuals

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References
Mann, D. (2011, May 23). Study Gives New View of 'Full-Term' Pregnancy. In WebMD.
Retrieved November 15, 2013, from http://www.webmd.com/baby/news/20110523/studygives-new-view-of-full-term-pregnancy
Janssen, P. A., Saxell, L., Page, L. A., Klein, M. C., Liston, R. M., & Lee, S. K. (2009, August
31). Outcomes of planned home birth with registered midwife versus planned hospital birth
with midwife or physician. Canadian Medical Association Journal, 181, 6-7. Retrieved
November 7, 2013, from http://www.cmaj.ca/content/181/6-7/377.short
Janssen, P. A., Lee, S. K., Ryan, E. M., Etches, D. J., Farquharson, D. F., Peacock, D., & Klein,
M. C. (2002, February 5). Outcomes of planned home births versus planned hospital births
after regulation of midwifery in British Columbia.Canadian Medical Association
Journal, 166(3), 315-323. Retrieved November 7, 2013, from
http://www.cmaj.ca/content/166/3/315.short
MacDorman, M. F., Mathews, T., & Declercq, E. (2012, January). Home Births in the United
States, 1990-2009. In The Centers for Disease Control and Prevention. Retrieved
November 7, 2013, from http://www.cdc.gov/nchs/data/databriefs/db84.htm
Mayo Clinic Staff. (n.d.). Labor and delivery, postpartum care. In Mayo Clinic. Retrieved
November 7, 2013, from http://www.mayoclinic.com/health/home-birth/MY01713
Pregnancy. (2010, September 27). In Office on Women's Health. Retrieved November 22, 2013,
from http://www.womenshealth.gov/pregnancy/you-are-pregnant/pregnancycomplications.html

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