Please note that I have scientific data backing up every claim marked with an *. Please contact me for references where you can read these studies and papers for yourself. All quotes and statistics are taken from a fabulous book titled Obstetric Myths Versus Research Realities by Henci Goer.
I’m about to make lots o’ people real nervous (namely my grandma and family who have no experience with or frame of reference for any type of birth other than hopsital birth) by declaring that this baby isn’t going to be born in a hospital unless absolutely medically necessary. Please note that I do believe high-risk pregnancies should be taken care of by a qualified OBGYN and labor should happen in a hospital where they can address the emergencies than can arise because of this classification. According to OBGYN Catherine Buerchner 15-20% of pregnancies are considered high-risk. Ina May Gaskin, arguably the most famous midwife in America, thinks that percentage is closer to 5%. Barring a diagnosis that places me in the high-risk category or a medical reason necessitating transfer during labor, I’m having the baby outside of a hospital.
Are you someone who would never consider out of hospital birth because you believe it to be incredibly dangerous? In 1992 Fullerton and Severino did a study titled “In-hopsital care for low-risk childbirth: comparison with results from the National Birth Center Study,” which compared outcomes for women from 15 hospital-based midwifery services with women in the National Birth Center Study to examine the function that site of birth plays in labor outcomes. To quote from that study:
[Low risk] women in hospital were more likely to receive an interventive style of labor and birth management [than similar women in birth centers]. Neonatal outcomes were … similar, although the incidence of sustained fetal distress, prolapsed cord, and difficulty in establishing respirations were significantly greater in the hospital sample. Hospital care did not offer any advantage .. and it was associated with increased intervention. The results of this study provide support for the National Birth Center Study’s conclusion that birth centers offer a safe and acceptable alternative for selected pregnant women.
Study after study shows the same thing*. Most of those who insist that choosing to birth outside of a hospital is more dangerous than giving birth inside of a hospital are not speaking against this choice based on facts and statistics they have spent time researching and learning. They are using cultural bias, personal belief systems, anecdotal evidence, or emotions (specifically fear) to back their statements, and the data doesn’t prove that this approach is best for mother or baby*.
I don’t want to give birth in the hospital because I want the least amount of interventions possible, which just isn’t a possibility in a hospital without putting up a huge fight against the system. The hospital really doesn’t want me there either. Would you want someone coming in to your work environment and telling you how to best do your job? Although some of the policies and practices listed below may be different than what you might have experienced or heard of, I believe them to be the standard, not the exception.
Reasons I’m Not Planning a Hospital Birth
- Hospital c-section rates are on average around 30% nationally*, and for some doctors and hospitals those numbers are much, much higher. According to studies average birth center cesarean section rates are less than 5%*. I’ll write a later post about why I’m so passionate about avoiding a c-section in the first place, but I’m far less likely to have one just by staying out of the hospital.
- I want to be as relaxed as possible, laboring in a quiet, dark room with the least amount of interruptions possible.
- I want to choose who is present at the birth. If I want mom, sister, grandma, photographer, husband, best friend, and a whole host of other visitors talking and laughing with me at any time, that wouldn’t be possible at a hospital. I also want to be able to kick EVERYONE out at a moments notice, even the midwife if I need some time to myself.
- I want the fewest amount of vaginal exams possible, and I don’t want to be told how far along I am. I believe there is a strong connection between the mind and body during labor, and I’d like to labor under the assumption that I’m doing well. My body knows when and how to push, and I’ll get there when I get there.
- I do not want to labor on my back, feet in stirrups. Upright positions improve quality of contractions and promote progress of labor*. Upright positions reduce the need for pain medication and oxytocin*. Upright positions for pushing make pushing more comfortable, help limit damage to the perineum, and shorten the second stage of labor*. Moving around and avoiding laboring on the back also improve labor progress by rotating posterior presentations*. I want to labor in the position of my choice. (Even on the toilet if I so choose!)
- I want option of a water birth. Though this is available in some, it is not available in all hospitals. Some hospitals allow patients to labor in the water, but force them to get out when the baby is born. I do not know of any studies to date that suggest maternal or fetal outcomes are worse when birth in water is permitted.
- I want to eat and drink whatever I want throughout labor. Why are women in hospitals forced to have an IV and told no eating or drinking during labor? Fear of aspiration (vomiting and inhaling the vomitus into the lungs) and the belief that forbidding anything by mouth prevents aspiration. Both untrue*. In 1988 McKay and Mahan concluded that eating and drinking during labor is generally a “safe, healthy, and natural practice”*. You know what does increase the risk of vomiting and aspiration? Policies that forbid food or drink during labor, narcotics, IVs, etc*.
- I don’t want continuous EFM (electronic fetal monitoring). EFM prevents mothers from moving around and changing positions during labor (remember all the studies above that show that laboring on the back without moving around is not the best?) EFM increases the odds of cesarean or instrumental delivery*. In 1987 Prentice and Lind said “On the basis of evidence there is no justification for a policy of routine monitoring for all women in labor. Indeed such a policy will probably expose mothers and their babies to a higher rate of morbidity because of the increased operative intervention*.” Hospitals don’t use EFM because the evidence suggests it, they use it because they don’t have the staff to replace EFM with regular intermittent auscultation (using a doppler to listen through the belly)*. I don’t want to birth in a setting where they make policies based on what is best for them, not what is best for me or my baby.
- NO EPISIOTOMY! You keep those surgical instruments away from my perineum mister. I’ll write a whole post about this one, but the belief that episiotomies are better than tearing naturally is false, false, false, false, false, false, false*. I can’t say it enough. Episiotomies are not easier to repair than tears, do not heal better than tears, are not less painful than tears, and do not prevent birth injuries or fetal brain damage*. Women giving birth outside the hospital are less likely to have an episiotomy and more likely to have an intact perineum*. Intact perineum is very important to both husband and myself.
- I believe oxytocin is overused in hospitals. The overuse of oxytocin can harm the baby*. Using oxytocin increases the risk of cesarean*. Oxytocin makes labor more painful*.
- As with all other interventions, the use of instruments such as forceps or vacuum during labor are lower outside of a hospital setting*. Use of these instruments increases the risk of having an episiotomy, something I’ve already said quite clearly I want to avoid if at all possible.
- Neonatal and maternal mortality rates are similar for both in hospital and out of hospital births*. Both the baby and I are statistically as likely to die both in and out of the hospital. Even better, maternal and fetal morbidity rates are lower outside of the hospital*. I choose out of hospital birth because it means my baby and I have a much higher chance of coming out of the experience intact, both physically and emotionally. It’s what is best for both of us.
I think I could keep going but I’ll stop there, as I think these address the most common policies and interventions present in hospital births. Note that all of the reasons on this list cannot be addressed simply by switching to a different OB/GYN or switching hospitals. Some, like the water birth, are hospital policy. Others, like episiotomy, are based on OB/GYN practices and beliefs. Therefore, the best way to get everything I want is to birth outside of a hospital. So I am.P.S.-Some of you are thinking “You don’t know how your birth will go! You might need a c-section! The cord could prolapse! You could hemorrhage! You could develop gestational diabetes! You could have placenta previa! Your baby could be breech!” As with all major life decisions we realize there are risks involved with every decision, and we are doing the best we can to prepare for incidences would would create a departure from the plan. By educating ourselves (meaning TH and I) we feel we have collected enough data to weigh the risks of our decisions against other possibilities and that our education gives us the necessary means to develop alternative plans.