Hospital Birth vs Home Birth - Essay Example

?Running Head: HOSPITAL BIRTH VS. HOME BIRTH Hospital Birth vs. Home Birth Introduction Pregnant women may prefer different settings for delivery depending on which they are most comfortable with and which provides minimum risk to them and the unborn children. In addition, cost of facilities and availability of medical personnel/ midwives may play an important role in the decision making. This paper will critique the attributes, advantages and disadvantages of hospital births as well as home births. Hospital birth is more desirable since it is more efficient, poses less risk and accords the mother medical facilities otherwise unavailable with home birth. Discussion NCT (2008) states that, “In the 1950’s the majority of pregnant women in United Kingdom delivered their babies at home” (p.2). The ratio of midwives and women who were knowledgeable in midwifery to the general population was higher compared to the past decade. Most middle aged women had experience in midwifery having assisted in child delivery of a family member of a friend. At the time, home birth was considered reasonably safe and without concerns of overcrowding and fatigue. NCT (2008) continues to state that, “Trends gradually changed in the 1970’s towards the 80’s as hospital births increased in frequency and numbers. By the 1990’s home births had reduced significantly to about 1% (p.2).” In recent times this percentage has increased to 2.68% as popularity and campaigns for home births have increased. ACOG (2011) notes that “Most governments require that recommendations be made to pregnant women to have a choice of their desired place of birthing.” A medical professional can evaluate and examine a pregnant woman and suggest a place of birth for the woman explaining his or her recommendation based on medical grounds to her. The key factors to be considered when choosing between home birth and hospital birth are the safety of the procedure, the sense of security of the mother and the level or sense of control. According to ACOG (2011), “Women who inquire on planned home births at medical facilities should be adequately informed of its benefits and possible risks.” This information should be based on current and documented evidence. The advising party should clearly note to the mother that although the possible risks associated with home birth may be minimal, home birth is closely associated with increased risk of neo natal death. The risk of neo natal death is two to three fold that of hospital birth. To achieve a successful and reduced-risk planned home birth, the woman requires selecting suitable candidates for the home birth. “A nurse certified in midwifery, physician or midwife who is qualified and aptly practices within regulations set by the local medical body should be available” (ACOG, 2011). The intended candidate should also be available for consultations. Safe, easy and timely access to a hospital or medical facility should be possible at the slightest chance of complications occurring. An easy access to hospital should provide contingency in case complications develops and the mother and or infant require emergency medical attention. ACOG (2011) states, “At present, the United States records an approximate figure of 25,000 home births annually.” From this figure, a quarter of the births is not attended to and is unplanned due to the spontaneity or unexpected labor. On average, the fraction of women who initially plan and intend to deliver at a hospital, those women who fail to make provisions for the attendance of a certified medical professional in midwifery, and unplanned homebirths record high rates and instances of neo natal and pre natal deaths. Women should plan for any eventuality and sudden changes in original or intended plans. The lack of transport to the designated/ planned hospital may warrant a home birth. In case no provisions were made to equip the home or vicinity/ surrounding with equipment and tools of delivery, the woman runs the risk of infection to her or her infant. A midwife or certified person should also be within reach and able to be contacted. ACOG (2011) states that, “High quality and documented evidence on home births is limited. This is because clinical trials that can offer data on the topic are have not been adequately conducted.” In the case of developing countries which have more cases of home births, the attempts made to conduct such clinical trials are inhibited or prohibited by the unwillingness of women to participate. Women are reluctant to their randomization to home or hospital birth rather than their independent choice of the perceived better option. These studies have therefore been largely unsuccessful. Most of the data and evidence on home birth is currently drawn from observations made. Observational mythologies imply small sample sizes (ranging from 5 to 20) and these are inadequate to make accurate inferences and conclusions of the population. Home birth is associated with several advantages. The first of these is safety. Boucher et al. (2009) asserts that, “Studies show that with the presence of a midwife or qualified practitioner, the safety of a home birth is equal to that of hospital birth” (p. 121). There exists no apparent safety risk or hazard specific to home births. Interruptions and disturbances are fewer and can be controlled with relative ease at home as compared to the hospital where the attendants may be interrupted. Also the commotion in and around the hospital can unnerve the mother and cause psychological unease. Another advantage of home birth is the level of control availed to the mother and her family. The supporters and key assistants at the birth are your loved ones and friends. Personalized attention is accorded to the mother and the midwife is considerate to the needs of the mother. Furthermore, in home births, preparation of the environment to adequately suit the mother and the birth at hand is easier than at the hospital. “The mother can prepare the delivery room in a manner she is comfortable with her surroundings” (NCT 2008, p.3). Another important factor to be considered in home birth is cost. The cost of delivering a baby at home is reasonably less than that at home. This is primarily because overheads such as accommodation, necessary paperwork and logistics costs are not included at home. At home, the main costs are reimbursement of the midwife and purchase and preparation of equipment to be used. Additionally, hospital birth incurs transport costs of the mother to and from the hospital and any visitation trips made by family members from home to the hospital. One major disadvantage of home birth as stated by Wrightington, Wigan and Leigh (2010) is that, “if the need for epidural arises, it cannot be administered since it is only available in hospitals” (p. 3). The patient would therefore require to be transferred to a hospital and this may be risky for the mother and her unborn child if the distance between home and the hospital is prohibitive. It may be important to note that not all families are equipped with convenient modes of transport and therefore, it may be a tedious process to start arranging for the transfer of the mother to the hospital especially where urgent need arises. Another disadvantage of home birth is the credibility and qualification of the midwife or attending medical personnel. Hospitals bear the liability for the acts of unprofessionalism and or negligence of their employees. High standards and codes of conduct are therefore maintained to prevent malpractices amongst medical practitioners. Hospitals also ensure that their staff is well qualified and competent for the procedures they perform. Rogue midwifes, though required to be certified by law and medical boards, may fraudulently represent their qualifications and perform illegal and negligent procedures. It is therefore the duty of the expectant woman or her family to ascertain the suitability of the candidate the select to be their midwife. Hospital birth is the most preferred mode for deliveries. In case the mother desires or requires the services of an anesthetist, they are available. Vinicker (2012), “Most maternity units equip themselves with a contingent unit on stand near the labor environment.” Hospitals are equipped for almost any and all eventualities and complications that can arise during child birth. Equipment, surfaces and fabrics in the delivery room are sterilized and the procedure is carried out with utmost professionalism. Also, if concerns develop and an obstetrician is required, obstetric staff is available within the hospital. There are no restrictions to the duration of time the mother should remain under medical care and hospitalized provided that the overseeing physician has cleared her and deems her fit to go home. Hospital birth has the disadvantage that in many cases labor is expedited within obstetric units using intravenous drip. As a consequence, there is increased need for pain relief (Wrightington, Wigan and Leigh, 2010). Another disadvantage is that the mother and newly born have a high risk of contracting infections from the hospital from other patients. Also, the number of family members or companions allowed into the delivery room is restricted in most hospitals. Conclusion Medical practitioners and in particular obstetricians believe that hospitals and centers for birthing are the safest places for delivering/ births. With the choice of location and or facility of delivery solely on the woman or her close family, medical practitioners and pre natal care givers should provide the mother with adequate information as to the consequences and attributes of each setting to empower her to make an informed decision on the same. While conclusive data on home birth cannot be deduced, the suitability of home care as opposed to hospital care in the event of supervening medical needs clearly indicates that hospital birth is more favorable than home birth. References ACOG (2011). Planned Home Birth. Retrieved June 23, 2012, from http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Planned_Home_Birth Boucher, D., Bennett, C., McFarlin, B. & Freeze, R. (2009) Staying Home To Give Birth: Why Women In The United States Choose Home Birth. J Midwifery Women’s Health. 2009; 54:119–126 NCT (2008). NCT Briefing: Home Birth. Retrieved June 24, 2012, from http://www.nct.org.uk/sites/default/files/related_documents/B2%20Home%20Birth%20Briefing.pdf Vinicker, D. (2012). Home Birth: A Woman’s Choice for Natural Childbirth, Advantages and Risks. Retrieved June 24, 2012, from http://www.2womenshealth.com/Childbirth/Home-Birth.htm Wrightington, Wigan and Leigh (2010). Home or Hospital Birth Choices. Retrieved from http://www.wwl.nhs.uk/Library/All_New_PI_Docs/Audio_Leaflets/Obstetrics/Home_or_Hospital_Birth/Home_or_hospital_birth.pdf Read More