Home birth vs. hospital birth

Posted by Saraline , Monday, September 1, 2008 4:26 PM

I plan on having a natural birth. That means no cesarean, no forceps, and no epidural. At first I wanted to have an epidural, but then I read in Henci Goer's The Thinking Woman's Guide to a Better Birth that an epidural, which numbs you from the waist down, interferes with pushing, and a woman who has one is more likely to need a cesarean or an episiotomy.


This book and a natural birth forum that I have been following give the impression that you cannot have a natural birth in a hospital. They give the message that a hospital will not respect a pregnant woman's wishes while a mid-wife who assists with a home birth is more focused on the woman's needs. The doctors and nurses in hospitals are mean and will bombard you with pro-epidural propaganda and try to "save you" from having a baby. They will not even inform you first if they give you an episiotomy and they will do their best to convince to you that you should have a cesarean. They will even sneak formula to your exclusively breastfed newborn when you are not looking.

I am wondering if this view is more American than Canadian. When I went for my first appointment at the Royal Victoria Hospital here in Montreal, the nurse asked me if I wanted to have a natural birth. I said "Yes" and she made a check mark on her clipboard. Now that I have read Henci Goer's book I will have a lot more questions to ask at my next appointment, but since they asked me first if I want to have a natural birth, I am assuming that it will not be a problem when the time comes.

The cesarean rate in Canada is lower than that of the U.S. although it is still quite high. (In 2005, the cesarean rate was 26.3% compared to 30.2% in the U.S. although the rates in Canada varied drastically between different regions.) Goer mentioned in her book that hospitals are paid more money for a cesarean than they are for a natural birth. I doubt that this is true for Canadian hospitals since our health care system is significantly different from health care in the States.

I wonder if the high cesarean rate in Canada has something to do with the mentality of the women as much as the mentality of the people who work in hospitals. Some women are scared of childbirth. The hospitals do not have to convince every woman who comes in to have an epidural. Some women really do want them. As I mentioned before, a woman who has an epidural is more likely to have a cesarean, and some women do not take much convincing to have a cesarean either. Maybe some hospitals try to convince women to have procedures while giving birth that they do not want, but I do not think that it is to the same extent as what happens in the U.S.

You may wonder why I would want to give birth in a hospital if I want to have a natural birth. Why not just stick with a mid-wife who I know will respect my wishes to have a natural birth? I have my own reasons for not wanting to give birth at home.

First of all, at one of my appointments I was told that I tested positive for Group B Strep. The nurse explained to me that this is bacteria similar to that which causes strep throat, but it is located in your vagina instead of your throat. She told me that it is very common and that you can catch it from a swimming pool. The only time it causes anyone any harm is when a woman gives birth to a baby. The bacteria can be transferred to the infant, and it is very dangerous for a newborn infant.

The doctor prescribed antibiotics for me for a week, and while the antibiotics will kill the Group B Strep, there is no guarantee that they will get rid of it permanently. Most likely I will need to be hooked up to an IV with antibiotics while I am in labour. I do not want an IV for fluids, but this Group B Strep sounds like something not to fool around with, and I would rather have the IV with antibiotics than risk the bacteria being transferred to my child. I feel that this problem will be cleared up more efficiently and more effectively at the hospital than it would be at home.

Also, I live by myself. Who will clean up the mess afterwards if I give birth at home? My cat?

6 Response to "Home birth vs. hospital birth"

hajen Says:

Hello! Richer is someone I've known online for a few years now and he referred me to your blog - since you are talking pregnancy/birth and are feminist as well, I suppose he thought these are things I talk about too much. ;)

I do think it's a USian vs. Canadian thing. I had my first in a US hospital and my other two in Canadian hospitals, all under midwifery care. It's my opinion that having a midwife (if you're low-risk and can have one) goes a long way to helping you have the kind of birth you hope to have. Midwives give more woman-centered care in my experience.

In the US it was not possible to have a homebirth (it wasn't covered by insurance) so I had a hospital birth with nurse-midwives. The birth itself went well - my problem with the hospital care was the recovery - the nursing care was rather nightmarish - I didn't get any rest, they fed the baby formula, breastfeeding got off to a rocky start because of these things... (it did work out after a couple weeks thankfully but it was not a pleasant first birth experience).

Here in Canada I tried to have homebirths with my other two deliveries but both times I needed to go to the hospital - which I like about using a midwife - the flexibility - you can be at home or in the hospital, and they assist you through the labor at home until you're ready to go to the hospital as well. I needed an IV throughout my deliveries, not for Group B strep, but for antibiotics because I have a minor heart condition. They can provide the IV at home for a homebirth, by the way - but I don't think it matters - my personal opinion is that a hospital birth or a homebirth, neither is superior really in the end - it's whatever you are most comfortable with. (Oh, and the midwives help clean up after you deliver. But are you planning to be all alone?)

Episiotomies are not common practice here and I have never had one. Forceps are not common practice either. C-sections are unfortunately getting more common, but there are a lot of factors going into that... I was determined to avoid a C-section if possible. Epidurals CAN make C-sections more likely especially if administered too early in the labor. So I said with my first, I won't have one, then I was in labor a very long time and the baby was facing up instead of down... I have ended up having epidurals with all three deliveries. My body seems to clamp down in labor and everything goes very slowly and painfully until I have one, then it all goes very fast! I am a bit sensitive to the "natural birth" push that epidurals are just bad, bad, bad. After all, a hundred years ago it was a feminist stance to provide the choice of pain relief to the mother in labor! I think they could be used less, and better, probably...

My experience in Canadian hospitals is that, sadly, epidurals DO make labor easier for the nurses - the nurses have such long shifts and it's easier for them if the patients are quiet and undemanding. They will not force you to have one however. Plenty of women don't need one and there are other pain relief options you can use, like Nubain. One thing I found out is that here, if you get an epidural in some hospitals it is their policy to transfer your care from your midwife to whoever the OB/GYN on call is. I don't like this policy at all and neither do the midwives... It seems more common in middle-size cities rather than large or small cities.

I do prefer the Canadian model where you can go home after you have your baby if everything is fine, should you want to! In the US they forced us to stay 48 hours and I was miserable. Here I have only stayed 12-18 hours.

Anyway, sorry for the long comment, nice to meet you. =)

Saraline Says:

It's nice to meet you too, and your comment is very interesting since you've given birth in the U.S. and in Canada. Did you find that the hospital staff in Canada were more open to breastfeeding? Did they let you breastfeed right away?

hajen Says:

Yes, the hospital staff in Canada were more open to breastfeeding. There is a lot of lip service given to breastfeeding in the US but at the hospital I was given little real assistance and a lot of bad "rules" and advice that made the breastfeeding experience quite hard to begin with. In Canada it was much easier. Also the midwives do home visits with you a few times after the baby is born and check on your breastfeeding as well which I think is so smart and useful, that way you can have the baby weighed to make sure everything is going well and they check the baby's latch and so on.

In both countries I was allowed to breastfeed right away. The baby was placed on my belly directly after birth, the cord was cut, then the baby taken to be wiped off and checked and made sure everything was okay, then given back to me to breastfeed. The baby was only away from me a couple of minutes, right where I could see, they have the scale and so on in the corner of the birthing room. The babies stayed with us the entire time we were in the hospital as well, in Canada we were in the hospital such a short time we never left the birthing room, actually.

sasha Says:

love you for this blog
here is a blog about women health
pregnancy tubal reversal and vaginal
issues
http://www.mybabydoc.com/blog/
tubal reversal

Tubal Ligation Reversal Says:

From my side,Hospital birth is more secure with respect to home birth...
i really enjoyed to see this amazing information...
i like your way of thinking about pregnancy...

Language Courses for Adults Says:

Hello,
I would love to give birth at home, but there is no way I can find a midwife. I called 4 birth centers in and around Montreal and they put me on their waiting lists, all midwives being taken up until February 2012!!! I am 18 weeks pregnant now and they told me if they don't call me by the 30th week, I will have to give birth at the hospital. I wish there were enough midwives for all the wishing mothers to give birth at home if they are low-risk.

I've been reading some amazing books on natural birth, like Gentle Birth Choices, Ina May's Guide to Childbirth, The Hypnobirthing Method, and what I see is that birthing happens completely differently at home just because the woman feels relaxed, in tune with her little world, supported by the people she loves, and taking as much time as she needs.