Why is a low-risk woman safer giving birth at home?

Research supports the notion that a low-risk woman is safer giving birth at home, rather than in hospital.  This sounds counter-intuitive, given all the machines that go ping in the hospital, as well as the proximity to theatres and intensive care if those facilities are needed.  Could it be that hospital birth actually creates some risks that make it a riskier birth place for a low-risk woman? A planned hospital birth sometimes indicates that the woman is fearful of something going wrong, and therefore she prefers to be in a hospital environment.  Fear in itself can increase the amount of adrenaline that circulates in a woman’s body.  This can prevent labour from starting, or result in a slow labour if it begins naturally.

Hospitals are often unfamiliar environments for women, where they are usually cared for by midwives and obstetricians they have not met before, rotating through different shifts, with unfamiliar sounds and no comforts of home.

All of this can increase the amount of pain a woman feels, and therefore increase the chance that she will request pain relief.

It is also possible that hospital policy / practice will dictate that the woman will have a short period of continuous monitoring of the baby on arrival to the delivery suite.  This will usually mean limited movement for a short period of time, increased pain and a greater likelihood that the monitor will remain on for the duration of the labour.

Continuous monitoring increases pain due to the woman’s inability to move freely without disrupting the monitoring.  Some hospitals provide a form of monitoring that means that the woman can mobilise freely and use the bath or the shower, but these are not yet commonplace.

Assuming the woman uses pain relief (and we know that requests for pain relief are more common in women planning a hospital birth compared to women planning a homebirth), epidurals can result in a slower labour and an inability to feel to push.  This can mean that forceps or a vacuum is needed to deliver the baby.  Sometimes an episiotomy is made at the same time.  And sometimes all of this intervention increases the chance of a woman losing too much blood after the birth.

So it would seem that there is some risk in birthing in hospital that is not present when birthing at home.  But is this the end of the story?  We know that when women are supported by their own midwife, who has worked with them throughout the pregnancy, lower rates of interventions and complications occur.  So the moral of the story is that if you’re a low-risk woman, and you’d prefer to give birth in hospital, engage a midwife to care for you.

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