One of the benefits of birthing in the United States today is the number of places a mother can choose to birth her baby: home, hospital or birthing center. And one of the first things that comes to mind, should an expectant mother ponder her choices, is "Where do I feel safest birthing my baby?" But what does that mean- "safest"? How do you determine why a place is safe or unsafe? In looking at the options of birthing at home or in a hospital (for sake of time I'll be discussing these two options only), you can see that safety has a different meaning for all mothers.
Safety in Technology?
It is a long standing myth that birthing in hospitals as opposed to home is "safer." In fact, depending on your perspective, the hospital may feel the least safe place to birth. In selecting a place, the big What If question comes up. "What if I suddenly need a cesarean section? If I'm in a hospital then the doctor can whisk me away to the operating room and deliver my baby safely."
There is much validity to feeling this way. Hospitals contain a large amount of wonderful technology that allows for many women- high risk or not- the chance to safely birth a healthy baby. There is absolutely a necessity for cesareans in some situations where the life of the child or the mother is at stake or could be if a cesarean is not performed.
But what about what is occurring in the hospital that leads up to such an emergency cesarean? Or worse yet, what is occurring that leads up to an unnecessary cesarean section (meaning one that could have been prevented)? From the moment a woman walks into the hospital amidst labor she is bombarded by technological interventions. True, these are the very interventions that allow for some women to feel safer. But for some women, it makes birthing uncomfortable and invokes a feeling of loss of control over their bodies and their birth experience. Furthermore, they can be the cause of an originally unnecessary cesarean.
Childbirth.org reports that the most common medical causes contributing to the increase in cesarean section rates in North America include non-progressive labor (aka dystocia) and fetal distress. It says, "some reports suggest that more careful diagnosis and management of dystocia could halve the primary section rate."
Examining a hospital's routine procedures one can see these procedures as contributing factors to a non-progressive labor. These procedures include: continuous electronic fetal monitoring, use of an IV instead of allowing a mother to eat or drink, limiting movement during labor, use of an epidural, inductions, and hospital- or doctor-imposed timelines. This doesn't include what the environment alone within a hospital can invoke purely by its nature. It can feel like a pretty unsafe place to surrender to your body's natural rhythms when there are doctors or nurses constantly moving in and out of the room to check your dilation, effacement, fetal monitors, etc.
Fetal distress, detected by a fetal heart monitor, can be misdiagnosed during continuous monitoring. According to childbirth.org it is "a benefit for the high risk mother but of questionable benefit to the low risk mother." Electronic fetal monitors use ultrasound, thus, leaving room for mechanical error and "may cause incorrect interpretation, unnecessary interventions etc." There is also a "loss of maternal mobility (when in use), which may slow labor; and may switch attention from the mother to the machine."
Cesarean section rates in America are some of the highest in the world. According to the World Health Organization, the rate of cesareans in the US is at 29%- double the maximum they recommend as a safe level (10-15%). Their leading concern is that maternal death can be linked to rates of cesarean, which means there is double the amount of maternal deaths linked to cesareans occurring in the US.
Think you may not be the type to be included in those statistics because you aren't high risk, see a private doctor regularly or have private health insurance? Think again. Cesarean rates are "higher for women who have private medical insurance, are private rather than public clinic patients, are older, are married, have higher levels of education and are in a higher socio-economic bracket."
But What about Home Birth?
True, the operating table is a lot closer in the hospital than it is in my home...But more and more physicians are acknowledging the safety of home birth. Dr. Mehmet Oz and Dr. Michael Roizen advocate the option of home birth in their new book, YOU Having a Baby. It states, "home birth is a viable choice for low-risk moms, and the rate of complications appears to be about the same when comparing home and hospital births among low risk cases. home births are still very uncommon, but they're a reasonable option for many." (p. 229)
If a woman chooses a home birth, a midwife attends to her labor and delivery. Midwives individualize their care and come without the hospital interventions, giving women the flexibility in labor they need to be comfortable. A midwife, for example, can't give an epidural, but encourages women to labor in different positions, allows them to eat or drink what they need, often encourages water birth to ease the pain, etc. A midwife will often allow a mother to labor for longer or push for longer than a hospital will, giving each woman's body the time to go through its natural birthing process. In result, studies site that less than 5% of home births lead to cesarean sections. Even midwife assisted hospital births (including some moderate to high risk mothers) have been revealed to have less than 12% births ending in a cesarean.
Results in multiple studies conclude like one conducted in 2000 by the Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada. The study included 5000 women planning a home birth with a Certified Professional Midwife in the US and Canada. The results found that "outcomes for mothers and babies were the same as for low-risk mothers birth in hospitals, but with a fraction of the interventions." Specifically the results explained that 12% of women transferred to hospitals with less than 5% epidurals, 2% episiotomies, 1% forceps, less than 1% vacuum extractions, and less than 5% cesareans.
Making the Decision
Now, all of this information about hospital interventions and the possibility of a cesarean, definitely does not feel safe to me. Nor did it feel safest when my son, Everett was born. But... that's my feeling of safety. It may be different for the next woman. She may be willing to take that risk to have the interventions at the ready were something to occur and that emergency cesarean becomes necessary. She may be too uncomfortable knowing that were something to go undetected with a midwife, she isn't equipped or trained to provide and epidural or perform a cesarean.
The point is that a pregnant mother has to be present to herself and her baby. She must educate herself throughout pregnancy and reflect deeply, after having gained all the necessary knowledge, to intuitively decide what feels safest. This is where she will have the best chance to have the birthing experience she desires with a healthy baby in her arms at the end.
Sources
- Fetal Monitoring FAQ, http://www.childbirth.org/articles/efmfaq.html, 1995-1998
- ICEA Cesarean Options Committee, Cesarean Section Fact Sheet, http://www.childbirth.org/section/CSFact.html, 1995-1998
- The Safety of Home Birth http://www.changesurfer.com/Hlth/homebirth.html
- Johnson, Kenneth and Daviss, Betty-Anne, Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America, http://www.bmj.com/cgi/content/full/330/7505/1416?ehom, 2005
- Debora Pascali-Bonaro (Director), Orgasmic Birth: The Best Kept Secret, Seedsman Group, Inc., 2008
- Oz, Mehmet, M.D., and Roizen, Michael, M.D., YOU Having a Baby: The Owner's Manual to a Happy and Healthy Pregnancy, Free Press, 2009
