Childbirth: Home or hospital?

Part of the nesting period a woman experiences towards the end of her pregnancy involves a choice of where to deliver the baby.

Until the advent of modern medicine, childbirth at home was the de facto method of delivery. In the 20th century, however, home births in the developed world declined rapidly to as low as 1% of total live births, as women opted for the safer hospital births. However, home births are experiencing a comeback in some parts of Europe and the USA, as more women now opt for a more natural, family-centred approach to childbirth.

Medical experts however warn that there may be risks involved. One study showed the infant mortality rate to treble in home births, questioning the safety of this option.

Published by the American Journal of Obstetrics and Gynaecology, the study revealing home births, though less traumatic for the mother, increase the risk of infant mortality three times as opposed to hospital births.

The study included data from various studies in the US and Europe considering 342,056 planned home births and 207,551 planned hospital births.

Dr Simon Attard Montalto, Head of Pediatrics at Mater Dei Hospital is against home births, declaring them “unsafe for both baby and mother.”

“Problems occurring as a result of birth asphyxia, cord prolapse, abruption, arrested or obstructed labour cannot be tackled with the same efficiency as at a hospital.” Dr Attard Montalto said.

In developed countries such as the US and Europe, oxygen deprivation during birth is the number two cause of infant death after birth defects. If the baby is delivered at home rather than in hospital, resuscitation is not likely to occur.

In the US study, deaths during home births were double those of hospital births – treble, removing babies with congenital deformities from the equation.

But despite the increased risk to the child, home births are steadily increasing in popularity in the US and Western Europe. The thought of a drug free, doctor free birth in familiar surroundings is appealing to many, including celebrities such as Cindy Crawford, Demi Moore and Erykah Badu, who all gave birth to their children at home.

On the plus side, home births are reputed to have a shorter recovery time and fewer lacerations than hospital births. Satisfaction from the experience of childbirth at home is said to be greater than at a hospital, according to the UK’s National Institute for Health and Clinical Excellence (NICE) report.

Dr Attard Montalto says that Malta has yet to follow suit in the madness that is home birth, as only a handful of home births occur every year. He would not recommend this style of birthing to anyone. High-risk pregnancies should always be delivered in a hospital, though even low-risk pregnancies could present medical emergencies.

The decrease in mortality rates of children born in hospitals in the last few years can be attributed to more liberal use of ultrasounds, electronic foetal heart rate monitoring, foetal acid-based assessment, labour induction and Caesarean section all of which can only be done at a hospital.

Misleading stats

However, the Royal College of Midwives in the UK claims that worries about safety of home births are mainly due to the collection of statistics. The statistics available refer to births occurring at home, not those that were actually planned to take place at home.

A 32-week pregnant woman who goes into labour prematurely, teenagers who refuse to acknowledge they are pregnant, women who experience very fast labour where transfer to a hospital is impossible, and women who choose to give birth without medical assistance – all are put in the same category as those who plan to give birth at home, thus skewing statistics.

Planned home births include all necessary antenatal care, vital signs of both mother and baby are checked and the assistance of qualified midwives, who are equipped with some basic resuscitation equipment, is available. Ambulance services are always available should complications arise, and the mother either wants or needs to go to the hospital.

Dr Josie Muscat, Chairman of St James Hospital claims that because of this, a home birth is just as safe as one in a hospital or clinic. He believes a woman should be entitled to a choice of where to deliver her baby.

“Of the hundreds of home births I have attended, only one had an unfavourable outcome,” he said. “I see no increased risks for mothers choosing to deliver at home as opposed to in a clinic or hospital. It is up to the doctor to ensure the mother is experiencing a low risk pregnancy, and not suffering from conditions that could lead to complications during childbirth such as diabetes. In this case I would always recommend a hospital birth.”

Delivery of the first child often presents more complications than that of a second or third child. A study in Scotland showed that one in three planned deliveries of the first child at home were transferred to a hospital, while the ratio was reduced to one in 10 for subsequent children.

Still, Muscat sees the criticism homebirths have received over the years as unfounded, saying that the people who slam homebirths have not had any experience of them. “How can you criticize something you have had never experienced?”

Dr Muscat is also concerned about the future of child bearing in general. “A worrying fact about childbirth today is that with all the technology that has become available, the explosion of Caesarian deliveries is coming at the expense of natural childbirth. Today women do not say ‘I delivered a baby’ but ‘They delivered my baby’”.

Going Dutch

The Dutch have a very natural approach to childbirth, with 30% of all births occurring at home – the highest in Western Europe. Pain relief is extremely rare. This is based on the premise that pregnancy is not an illness and should not be treated as one unless complications arise. It is not a doctor who delivers a baby in Holland, but a qualified midwife. Financial aid is granted by the government to encourage home births though women can still opt for a hospital birth.