Where Should I Give Birth? Home or hospital? (part 1)

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Do I have options for where I can give birth?

Yes you do. Choosing where to have your baby is a personal choice and knowing all the relevant facts can help you to make an informed decision. You can call International Association of Parents and Professionals for Safe Alternatives in Childbirth (NAPSAC) more information and talk to your midwife and other mothers in your area to widen your perspective. Where you live will affect your choice, since only a hospital birth may be available in your community. If your pregnancy has been normal with a normal medical and obstetric history, talk to your doctor or midwife about local options. Home birth or a birthing center might be available to you.

Is it safe to have my baby at home?

Research has shown that for healthy women who have had a normal pregnancy, a planned home birth attended by an experienced caregiver is as safe as giving birth in a hospital. There are similar findings for birth centers. Statistically, women who have home births are less likely to use drugs to cope with the pain and less likely to have an assisted delivery or cesarean, even if they have to be transferred to hospital during labor. They are also more likely to use upright positions for giving birth compared to hospital births. Likewise, women who give birth in a birthing center are less likely to use drugs for pain relief and less likely to have their labor speeded up artificially. They are also more likely to be satisfied with the care they receive.

Can I choose which hospital to give birth in or does it have to be the one closest to me?

Although, technically, you have a right to choose any hospital in which to give birth, you will have to consider what your insurance policy will cover, which hospitals your doctor has privileges at, as well as thinking about how far you want to travel while in labor. A local facility is therefore probably the most sensible choice. You may have a variety of services nearby, including public or private hospitals and birthing centers. Discuss all your options with your midwife and doctor and try to talk to other mothers locally to see if they have recommendations.

My pregnancy hasn't been straightforward. Will I have to give birth in hospital?

There are several reasons why you may be advised to deliver in hospital. If this is a second baby and there were complications before, such as bleeding in preterm labor or a cesarean, your care provider will recommend you deliver in the hospital. If this is your first baby and there are complications, such as diabetes or high blood pressure, or it is a multiple pregnancy, you may be advised to see an obstetrician or perinatologist and give birth at a perinatal center within a hospital.

What additional things do I need to think about if I'm having a home birth?

It may be worth having all the items you need for the labor and birth gathered in the place you intend to deliver, and it can also be helpful to organize your items separately from the baby's items. As well as practical items, such as clothing, toiletries, and sanitary pads, you may also want to have on hand music, phone numbers, and a camera. It's a good idea to have a well-stocked fridge to ensure that you have nutritious snacks on hand during labor, as well as helping you and your partner in the first few days after the birth. Your baby will need diapers, cotton balls, clothing, sheets, and blankets. If you have other children, you may need to make arrangements for them with family, friends, or neighbors, or have meals planned for them in advance and plenty of activities to occupy them.

Even though you are planning a home birth, there are occasions when things don't go quite as you want and you need to be transferred to hospital. This can happen before, during, or after labor and so, even though you may not want to contemplate this outcome, it's a good idea to have an emergency bag packed for such an occasion.

Do I have a right to give birth at home?

There is no federal or state law that prohibits a woman from delivering her baby at home. The care provider you choose needs to be licensed by the state however, or they can be charged with practicing medicine without a license. Check the credentials of your midwife carefully and ask what plans would be in place if a physician consultation or emergency transportation is needed. The home birth practice you choose should assess your suitability for home birth and conduct complete prenatal care.

What's the difference between a birthing center and a maternity department in a big hospital?

Birthing centers are staffed by midwives and the emphasis is on a natural birth. They can be situated next to a hospital maternity unit or on a completely separate site. Some hospitals have a birthing unit facility in the actual maternity unit, known as a hospital birthing unit , where midwives provide total care in a dedicated area of the maternity unit.

Since the majority of women give birth without needing medical intervention, these units provide a good alternative to a more medicalized hospital environment. The environment in a birthing unit tends to be more relaxed and flexible, which may appeal if you want a home birth atmosphere with added support. You will also have continuous support from nurse midwives and may even be attended by the same midwife throughout your labor and birth. Furthermore, the midwives in these units are very experienced at handling a birth without medical intervention. All of these factors therefore increase your chances of having a normal birth.

To be eligible to give birth in such a facility, you would need to have had an uncomplicated pregnancy and be unlikely to require specialized medical care or monitoring in labor and birth. If complications do occur in labor or birth at a birthing unit, you would need to be transferred to the nearest maternity unit, although this is a rare occurrence since most women in birthing units have been identified as being “low risk.”

If you labor in a standard maternity unit, you can be subject to a range of policies and not enjoy the same degree of flexibility. However, you will have access to an epidural and, if emergency intervention is needed, doctors will be close at hand.

I've arranged a cesarean since my baby is breech, but I want a natural birth. Is this possible?

You need to discuss this with your midwife and obstetrician and express your preference, since your feelings are an important factor when deciding how to manage your birth. You may be able to have a procedure called external cephalic version (which is usually done around 37 weeks) to try to turn your baby to a head-first position. However, if you have this procedure and your baby still remains in a breech position, you may be advised to have a cesarean, although some obstetricians will support you if you want to try for a vaginal birth .

I don't want to be monitored in labor. Will the midwives and doctors listen to me?

Unless there is a medical or obstetric complication, such a previous cesarean section or high blood pressure, you don't need to be strapped continually to a monitor to listen to the baby's heartbeat. Instead, a procedure called “intermittent auscultation,” which means listening in regularly to the baby's heartbeat with a doppler, should be sufficient to monitor the baby's well-being. Ultimately, the choice of monitoring or listening in, if all is well, is yours. If a midwife or obstetrician wants to monitor the baby's heartbeat continuously, they will explain why.

It's a good idea to make a note of your wishes during pregnancy in a birth plan and discuss this with your midwife before you go into labor. If you don't have a chance to discuss this before labor, when you do go into labor, the doctor or midwife will first take a medical and obstetric history and ensure that you and your baby are well, and will then ask if you have a birth plan, or you can show her the plan.

Will I be allowed to have a water birth?

You can use a birthing pool at home or in hospital if you have had a uncomplicated pregnancy and had no problems in any previous pregnancies. If you want a water birth, and you are in the hospital and are going to be induced or there are other complications with the pregnancy, you may need to negotiate this with your doctor or midwife. Your care provider can explain why you may not be a good candidate for water birth.

Is it possible to have a water birth in hospital?

This depends on the hospital maternity care unit. Some units have their own birthing pool; some have facilities for you to rent a pool and bring it in; some units have only room enough for a pool to labor in, not for delivery; and others do not have the facilities for you to bring one in or the structural ability to have one in the unit. Each maternity center also has its own guidelines regarding appropriate candidates for a water birth. For example, if you have a raised temperature or if you need an epidural, or if your baby's status is not reassuring, or he has passed meconium into the fluid, then a water birth would not be an option.

Can I use the birthing pool for labor and birth if I've had a previous cesarean?

Unfortunately, it is recommended that if you have had a previous cesarean section, your baby's heartbeat and your contractions will need to be continuously monitored throughout a subsequent labor and delivery, and this cannot be done in a birthing pool. The reason for continuous monitoring in this situation is that there is a chance, although quite a small one, that your uterus may rupture during labor. This often causes no pain and the only indication may be a change in your baby's heartbeat. If you decide you do want to labor and deliver in water after a cesarean section, this is your choice, but you should be fully aware of the risks.

When can I get into the birthing pool?

You can get into the pool whenever you want, but some midwives suggest that you wait until you are 2 in (4–5 cm) dilated or in established labor. This is because some people are concerned that the water can be so relaxing that it may cause the contractions to slow down or even stop, although there is little evidence to support this. However, if this does happen, getting out of the pool and walking around for a while is likely to increase the strength of the contractions. You will need to get out of the pool if your baby passes meconium or if the midwife has any concerns about you or your baby.

The water temperature can be whatever you find comfortable, although 98.6° F (37° C) body temperature is usual, especially if you are giving birth in the pool, since babies can get cold quickly once they are born. Most units have guidelines on this.

Can I deliver my baby in a birthing pool, or are these just for labor?

You should ask your midwife to find out if the hospital that you have chosen to deliver at provides facilities for you to deliver in the water, or just use a tub for most of your labor. This often depends on whether the pool is big enough for the delivery. Occasionally, there may not be a midwife available who has been trained in delivering births under water, in which case you may only be able to labor in water and will have to get out for the delivery.

Can I bring food and drinks to the labor room?

Most midwives and some doctors encourage women to eat and drink lightly in labor. Water may be refreshing, but isotonic drinks may be more beneficial, since they contain energy-boosting ingredients. If established labor is progressing well and you and your baby are well, you can eat light snacks to give you energy and help labor progress. However, if you require narcotic analgesics, which can make you nauseous or sick, or need an epidural, or other risk factors develop, you may be advised to drink sips of water only. You may also be offered an antacid to reduce acid buildup in your stomach. This precaution is in case you need an emergency cesarean.

Who will be with me while I'm in labor?

If you have a home birth, your midwife will stay with you throughout your established labor. As you near delivery, she will contact a second midwife or nurse who will support her and you throughout the birth. Whoever else you have at your home delivery, is up to you. Things may be different in the hospital, but inquire ahead to make sure that the support people you choose will be able to attend you in labor. Once in active labor, the nursing staff will be your primary support with the physician coming in to assess progress periodically and assure your well being and that of your baby. If you have chosen care through a midwifery service, the midwife will be with you through active labor with nurses assuming support responsibilities. Some maternity care centers have a doula program, or you may contract for doula services prior to your birth. Doulas are certified birth attendants who offer prenatal, labor support and postpartum assistance.

I've heard about hospitals being understaffed and women not getting a bed. Is this true?

Because of the nature of childbirth, on rare occasions, your hospital may be “on divert” for labor patients. This means that staffing may be inadequate to provide safe care or all the available rooms are full. Every hospital has a back-up facility that agrees to take these patients. It is important that you always call your care provider or hospital prior to coming in. The nursing staff can discuss whether or not it is advisable to come in and they can also inform you if they are not taking patients and where you should go. Your midwife group may not be able to “follow you” to the new hospital but only in rare circumstances.

I keep reading about infections like MRSA and now I'm worried about having my baby in hospital.

Although there is a great deal of media coverage of “superbugs” such as MRSA, most people have no problems at all with hospital infections. Infections are caused by germs, of which there are four major types: bacteria; viruses; fungi, molds, and mildew; and protozoa. Hospital infections are bacterial. Some bacteria are friendly or good bacteria, which aid the digestion and absorption of food in the gut. Others can cause infection and illness, methicillin-resistant staphylococcus aureus (MRSA) and Clostridium difficile (C. Difficile) being two notable ones of concern in hospital.

MRSA is a bacterium that can live completely harmlessly on the skin of healthy people, but can lead to serious infection in vulnerable individuals. Good hygiene, particularly in the form precautions such as hand washing, is an effective method in the prevention of MRSA infection and your chances of acquiring this in hospital are low. Even healthy relatives and friends of patients with MRSA carry no risk. If cutlery and plates are washed using soap and hot water MRSA is removed, and the risk of acquiring it through contact with curtains, sheets, and pillows is very low. Health-care workers use antiseptic solutions, such as alcohol hand rubs, and many hospitals have alcohol gels for hand cleaning door of patient rooms.

C. Difficile is another type of bacterium mentioned frequently in the media. Hospitals prevent and control the spread of C. Difficile with antibiotics, general hygiene measures such as hand washing, and by detecting cases early so that they can isolate affected patients to prevent it spreading further.

What measures can I take to prevent my baby or myself from getting an infection in the hospital?

Regular hand washing by yourself, staff, and visitors are likely to be adequate measures to prevent infection. You can use a hand purifier and ask your guests to do the same. Always wash your hands after using the toilet and always wash your hands or clean them with a hand wipe immediately before and after eating a meal. Make sure your bed area is regularly cleaned and report any unclean toilet or bathroom facilities to staff. Breast-feeding will provide your baby with protection against infection. Hospital staff is acutely aware of the dangers of hospital transmitted infection and attends regular education sessions to help you and your baby be protected and safe. Hopefully these measures will help you feel in control. You are unlikely to be in hospital for very long, and you and your baby should be safe.

My partner can't drive. Can I take an ambulance to the hospital?

An ambulance can transport you to hospital in an emergency, for example if you are bleeding heavily. Since this is an emergency vehicle staffed by trained paramedics, it is expensive. If you call an ambulance for a nonemergency, you could be taking it away from an emergency situation and putting others' lives at risk. Could a friend or relative be on call when you go into labor? or can you call a taxi in early labor? if you can't arrange transportation, discuss this prenatally with your midwife or, once in labor, call the maternity center at your hospital for advice.

What is a doula and where do I find one?

Doulas are specially educated women who offer pregnancy, labor, birth and postpartum support and comfort measures to women and couples. Dona international provides training and certification opportunities for doulas. International doulas are educated and experienced in childbirth and the postpartum period. They provide physical (nonmedical), emotional and informational support to women and their partners during labor and birth, as well as to families in the weeks following childbirth. Doulas nurture the woman and family by offering loving touch, positioning and comfort measures.

Research confirms the value of this support. Parents who receive doula support are more secure in parenting and adapting to a new baby in the family.