Choosing a Hospital or Home Birth

Home or hospital? The question of where to give birth is a topic of ongoing discussion among expectant moms, doctors, midwives, and home birth advocates. As the number of women who give birth at home increases, the sometimes heated debate about which is safer for women, babies, and families will surely continue. The author of a recent New York Times Magazine article wrote “It is unfortunate that the choices and the rhetoric around birth—like many of the choices and rhetoric around motherhood in general—are so polarized.” It’s a big decision.

A woman’s health and risk factors should be central considerations in deciding on a birth venue. Although studies have shown that absolute risks of planned home birth are low, home births don’t always go as planned. Planned home birth is associated with increased risk of neonatal death when compared with planned hospital birth. Risks also increase in women with certain medical conditions such as hypertension, breech presentation, or prior cesarean deliveries, or in births where there are inadequately trained attendants. It is important for any woman choosing home birth to have a certified nurse-midwife, certified midwife, or physician practicing within an integrated and regulated health system with ready access to consultation and a plan for safe and quick transportation to a hospital in case of an emergency.

While ACOG believes that hospitals and birthing centers are the safest place for labor and delivery, we respect a woman’s right to make a medically informed decision about her birth experience. ACOG also continues to support collaborative practices between physicians and certified nurse-midwives/certified midwives to further improve outcomes for pregnant women and their babies.

Ultimately, women have a choice in where to give birth. As ob-gyns, it’s our job to educate our patients on the risks and benefits of hospital vs. home delivery and help them make the best decision for themselves and their families.

7 thoughts on “Choosing a Hospital or Home Birth

  1. Drs did not like birth centers either in the 1990-2010
    So they are learning .
    Home birth is just as safe with knowledgeable professional home birth trained midwives
    It is stil – money , power and control .
    Not wisdom – low risk births are not what ob/gyns are trained for ‘ they do not even know what a natural birth looks like because it does not happen under their watch in a hospital
    We know
    Gail Johnson CPM

  2. I am a licensed midwife in Texas. Petite to that I was a registered midwife in the UK, where, by the way, all babies are delivered by midwives.

    I have lived here for the last 15 years and overall I have seen midwives practice safely and sensibly. You mention above that more risky situations like hypertension (we always Transport to a doctor for that,btw, breeches, many missives are very skilled at delivering breeches at home, and VBAC’s are performed at home with midwives who are experienced with these situations. it is getting remarkably difficult to found a doctor who will agree to a vbac our vaginal breech since more often than not they out for the knife instead. It is their comfort zone.

  3. How can OB/Gyn’s be the best source for risk information regarding home vs. hospital birth when the vast majority have never attended or witnessed a homebirth? They have never witnessed the skill of a well trained homebirth midwife. I am also quite disappointed that certified professional midwives were completely left out of the discussion. It is a national certification and is recognized by most states.

  4. Until Doctors begin attending home births as a spectator to LEARN what a home birth really is, I cannot take any of their criticism seriously. They simply do not understand the dynamic of home birth. They know all the parts of the body, they know the diseases, the risks, the surgery and that is wonderful for those times when women NEED them. But most of the time they don’t.

    Women who trust their bodies and the birth process will do much better at home.

    However the brainwashing has been so complete that most women in the USA (for instance) are trained in fear and uncertainty. They honestly believe that a doctor can do it for them. And of course more than a third of birthing mothers allow their babies to be cut from their wombs, by a doctor who is a surgeon, after all. Birth is much more than that, but women must take control of their own births in order to find out exactly what it is to have a self directed birth.

    I will spend the rest of my life trying to help women educate themselves about birth and its power. That power is greatly diminished in a hospital birth no matter how well intentioned the staff may be. Do your own research. Do NOT do this by asking your doctor because the chances are enormous that he or she has never seen a natural birth at home.

    Instead I recommend going to sites online that are pro-homebirth. Watch the hundreds of videos that show natural births, water births, and midwives who support these so well. The information is out there.

    Home birth is NOT for everyone. But if it resonates with you, allow yourself time to research and learn about it. You won’t be sorry.

  5. If you are referring the Wax paper – you are grossly ignoring how it has been debunked as propaganda for OB’s. A planned homebirth, with a skilled attendant, is just as safe, and if not safer, than a planned hospital birth.

  6. We have a system in the USA which standardizes a high level of specialty care to 80 % of women who will have an essentially normal pregancy, labor, birth, and postpartum. The majority of our population can be easily cared for by mid-level practitioners following evidence based maternity care protocols in any setting. I tell my patients this metaphor; in our current system we are providing neurosurgeon level care to the majority of women that suffer from simple tension headaches! OB/GYN’s are specialists in grossly high risk obstetrics and skilled in surgery, we should appropriately assign them this group of women which we midwives have referred. Home birth works very well in a medically supportive, consultory, and
    transport friendly paradigm. It becomes unsafe on many levels when hostility and physician vendetta against home site birth and midwives prevail. Kathryn Newburn CNM, RNP, PHN

  7. Until we recognize that all people have the right for fully informed choice, and until we acknowledge that a fully informed choice is not possible in the current healthcare setting, this debate will continue. The only thing you are guaranteed when you are conceived is that one day you will die. Just because we are medically able to keep an infant alive (or any other person for that matter) does not mean that is the best thing to do. Personally, I think BioMedical ethics should be a requirement to graduate from high school, as well as a host of other classes. Instead it looks like we are going to continue to dumb down our population, expect people to do what they are told because doctors, government, etc knows what is best, and discourage individual thought processes. Remember, we each are able to deduce that just because we CAN do something, doesn’t mean we SHOULD do something. Same applies to all the interventions currently seen as normal and appropriate in the hospital setting. Until OB’s and CNM’s are required to disclose all the risks with inductions and epidurals, women and children will actually be safer at homebirths.

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