If you are considering giving birth in a setting other than the hospital, find out what services are available in your community. Are there competent people offering home-birth care? Is there a licensed birthing center in your area?
Out-of-hospital birth is a choice only for women who are in good health and who have had normal pregnancies. Interventions are often not necessary for healthy women having normal labors, but if the need arises, the woman is transferred to the hospital.
Those planning out-of-hospital births, therefore, expect to labor without pain medication and without medical intervention. It must be remembered that caregivers in out-of-hospital settings have fewer facilities (and possibly less skill) should emergency situations arise. Minutes count. How long will it take to receive adequate care?
Many women, of course, are not comfortable giving birth away from the emergency medical facilities available in hospitals. This disadvantage of out-of-hospital births should be carefully considered by all women contemplating birth outside the hospital.
Risks of Out-of-Hospital Births
Just what are the risks in giving birth outside the hospital? There are two classifications of risk: true obstetric emergencies, and other conditions that might require a less critical transfer to the hospital for assistance with the birth.
Even though true emergency conditions are uncommon, they are factors that must be considered by anyone who is contemplating an out-of-hospital birth.
You should also remember that even in a normal pregnancy and labor, unexpected situations could arise after delivery, making it necessary to transfer mother or baby to a hospital. For example, respiratory distress or cardiovascular problems of the newborn infant are true emergencies that can best be dealt with in a hospital setting.
Nonemergencies Requiring Transfer to the Hospital
Women are also transferred to the hospital for conditions that are not considered emergencies. Sometimes, if a complication (such as anemia, high blood pressure, diabetes, placenta previa, twin pregnancy, or breech presentation) is discovered during pregnancy, the woman is no longer a candidate for out-of-hospital birth.
If labor is prolonged or if it looks as though the mother will need pain medication, forceps or vacuum assistance, or other intervention, she is transferred to the hospital. Under these circumstances, the transfer is not an emergency, and there is usually time to try various solutions and, if necessary, decide whether and when to go to the hospital.
While it is never pleasant to have to give up plans for an out-of-hospital birth, and transfer is uncomfortable and worrisome for the parents, it does not usually present any danger to either mother or baby. A study of planned home births attended by certified professional midwives showed that approximately 15 percent of women were transferred to the hospital during labor or after delivery. First-time mothers were four times as likely to be transferred as mothers who had previously given birth. The possibility of transfer should be considered when parents are deciding on the merits of an out-of-hospital birth.
When inquiring about out-of-hospital birth services, find out what drugs and technology they use in their birth practices, such as pain medications, intravenous fluids, oxytocin, and fetal monitoring. Ask what emergency equipment they have available for all births. You will want to know about the backup hospital and the backup or consultant physicians. You should also know about transfer arrangements. For example, is an ambulance available at all times in case an emergency transfer becomes necessary? Or are the automobiles of the staff and clients the usual transportation in case of transfer? How far away is the backup hospital?
Advantages of Out-of-Hospital Birth
The advantages of out-of-hospital birth are that parents may have more control over the birthing experience. There are few routines that must be followed. In a home birth, for example, parents have the freedom to move around, visit with friends, go outside the home, and do household activities and other things during labor as much as they like. In addition, few interventions are used. Contact with the baby after the birth is unlimited and in accordance with the parents' wishes.
Women who choose birthing centers often find a sense of community and fellowship. Classes and social gatherings are often held at the birthing center, contributing to a sense of security and friendliness. Women who choose home births tend to find great appeal in the complete familiarity of their own surroundings.
The costs associated with home birth are by far the lowest of the three environments, and birthing centers usually cost less than hospitals. Those parents for whom finances are an important issue need to investigate thoroughly the actual costs involved in all three of these options.
Many uninsured people with low incomes find home birth to be the only affordable option. But if a planned home birth winds up as a transfer to the hospital, it may turn out to be more expensive than a planned hospital birth.
Some health insurance policies do not cover home-birth or birthing-center care, even though it is much less expensive. If you have insurance, make sure to investigate ahead of time the possibility of reimbursement for those expenses.
Disadvantages of Out-of-Hospital Birth
The major disadvantages of out-of-hospital birth are primarily related to the lack of available appropriate medical care should emergencies occur. Such situations can arise quickly (for example, hemorrhage, seizures, meconium aspiration, or any severe fetal or maternal complication that might place either baby or mother in jeopardy). The value of proximity to the full range of modern medical care should not be underestimated.
Once you've completed the important steps of choosing a caregiver and deciding where to give birth, you still need to prepare for the blessed event. Go to the next page to find out how to choose a childbirth class that's right for you.