The right place to deliver: home or hospital?

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I think it's important to emphasise comtinuity of carer over place of birth. With the right care provider, the place of birth can be adjusted to suit the clinical needs of the woman.

All three of my children were delivered in a hospital under an obstetrician's care. Fetal monitors tracked the babies' heart rates, and an EKG machine measured mine. When it came to discomfort, I opted out and embraced every pain-relieving intervention that was offered. For me, each of the experiences was blissful -- pain-free deliveries with beautiful, healthy outcomes ...

This type of birthing experience isn't right for every woman. Some pregnant women believe very strongly in a more natural birth process ... Somw choose to give birth at home, opting to have a midwife oversee their care and delivery.

Many doctors are, to put it mildly, not supportive of this approach. Calling home delivery unsafe, they say that women who choose it are placing personal preferences about the birth process ahead of the health of their child.

... "Most women who have home deliveries don't realize what can go wrong and how quickly it can go wrong," ...

When these types of complications arise, immediate lifesaving interventions are required -- interventions that can be delivered only by a physician in a hospital or medical center. If a home birth takes an unexpected turn for the worse, both mother and baby must be transported to the hospital for treatment. Even under ideal circumstances ... those inherent delays in treatment can have tragic consequences.

Midwives respond

... Midwives ... point out that the interventions and procedures doctors use to ostensibly keep babies safe carry their own set of risks ...

Evidence to support either side's case is spotty at best. The National Center for Health Statistics tracks the number of home births that are performed annually (24,970 in 2006), but it doesn't closely analyze outcomes of these deliveries.

"Assessing the safety of home birth is very complicated," ... The population of women delivering in the hospital is fundamentally different from those who have their babies at home. Only healthy women with low-risk pregnancies typically attempt home birth; hospital-based deliveries, however, include a large number of high-risk women. "It's like comparing apples and oranges."

Home benefits?

Several studies conducted outside the U.S., however, have produced fairly consistent results: Home births performed on healthy women by highly qualified midwives appear to be as safe as physician-attended, in-hospital deliveries ...

No firm answers

... convincing evidence to support either the obstetricians or the midwives simply isn't there. Doctors believe that the burden of proof rests on those advocating delivery outside of the hospital; midwives put physicians on the defensive by pointing out that childbirth is a natural process that historically hasn't required hospitalization.

Until the question of home birth safety is answered, women can't make truly informed decisions about their childbirth experiences.

A third way

Women may be surprised to learn that individual doctors and midwives are often willing to compromise, even collaborate ...

Midwives can be asked to perform in-hospital births, and doctors can be asked to temper their use of technology. Some midwives and physicians willingly work together: The midwife assumes primary responsibility for providing prenatal care and attending to the delivery, while the physician provides backup and support should it become necessary ...

Melissa Maimann, Essential Birth Consulting 0400 418 448