When choosing between a hospital or home birth, it’s important to realistically examine the benefits and disadvantageous of both. Deborah Flansburg, a Certified Nurse Midwife from Logan, Utah, explains, “Hospital births have pros and cons. Pain medication and emergency management are the two main reasons most women deliver in hospitals. The cons are increased interventions and increased risk of infection. Home births are a more familiar environment, and have less chance of infection, but they're not equipped to handle emergencies.”
Jo Olivarez, a mother of four who has experienced both hospital and home birth, wishes women could be empowered during pregnancy and labor, not afraid and dependent on a single group's opinion. "Not every birth should be at home and not every birth needs all the interventions provided at a hospital," she says. "Having professionals who understand how a normal uninterrupted birth should progress makes all the difference no matter where you are.”
For her, home birth is preferable. According to Olivarez, the best part of having a home birth was, “laying back against my husband with a fresh newborn still attached by a still pulsing umbilical cord, unwashed against my skin, in my bed where he was most likely created." She also said she enjoyed the quiet as everyone who was part of the labor gazed at her new baby.
Olivarez has some advice for mothers looking to find a qualified medical professional: “Just as you interview and require certain levels of education for your child's care, you must do the same for a midwife. You must know the different types, their education, their years of practice, what obstacles they have experienced during labor, what their attitude is during stress, and if you even like them.”
Choosing the Type of Birth for Your Baby
If you’re trying to decide between a home and hospital birth, an important question may be, “What kind of health care provider do I want with me when I deliver my child?”
Home Birth Care Providers
Direct Entry Midwives or Certified Professional Midwives (CPM) advocate a natural experience and deliver exclusively in homes or birth centers. They train under the supervision of other midwives by observing births and aiding in them while completing academic course work. They complete clinic time as well as a national skills test and a written exam in order to qualify as CPMs. They may or may not have a degree in this field.
Lay midwives also deliver at home and may be highly trained or self taught. Unlike other midwives, lay midwives learned their skills independent of a licensing agency or formal education.
Obstetricians (OB/GYN) are medical doctors who specialize in women’s health and delivering babies. They carry malpractice insurance, can perform cesarean sections (C-sections), and deliver exclusively in hospitals. Their greatest concern is aiding mother and baby safety by using any medical methods necessary. They often work with mothers who request pain medication during delivery or who have high-risk pregnancies.
Certified Nurse Midwives (CNM) earn Bachelor’s degrees in nursing and then continue on to receive their Master’s degrees as nurse practitioners with an emphasis in midwifery. CNMs, like all nurse practitioners, are able to prescribe medication including pain relief during labor. They usually work under an OB/GYN who can assist them if a C-section is needed. Flansburg explains that CNMs can deliver babies at home, but need their consulting physician in agreement with the labor and birth plan. Flansburg says, "Most CNM’s deliver in hospitals or birth centers, due to restrictions from malpractice insurance companies or because of conflict of interest with their employers,” the OB/GYNs.
Doulas are labor coaches who support mothers during birth. Doulas may work in either home or hospital settings to ease discomfort and aid the parents, but they provide no medical services. They create a more relaxing environment and help mothers cope with the journey of labor wherever they choose to deliver.
Nicki Hope, a monitrice doula and student midwife earning her CPM, admits that in the beginning of her training as a doula, homebirth, seemed extremely radical. "I had never met anyone that had a homebirth," she says, "and I didn't even consider it for myself. I was becoming very passionate about choice and education about birth options, though.”
But through her experiences as a doula and her current training as a CPM, her perspective of home birth and midwives has shifted. “Midwives are actually highly trained professionals and they bring emergency equipment with them, just in case," Hope explains. "We get to know our clients very well throughout the pregnancy, so most problems are solved or referred for physician care before labor ever begins. But for those rare occasions where something does happen, midwives are trained to handle things like ‘slow to breathe’ babies, hemorrhage, etc. Midwives also have a plan for transfer to the hospital if that becomes necessary.”
Flansburg became a CNM seventeen years ago. "I had delivered a few babies—unintentionally—while working as a labor and delivery RN. I enjoyed it. I liked being an advocate for women and infants.” However, she prefers hospital births. “I have seen babies die who could have been saved if they would have delivered in a hospital.”
While both hospital and home birth pose different challenges and different models of care, both also provide unique experiences and a once in a lifetime memory—the birth of your child. Regardless of what decision you make the most important part is to make a decision that's right for you.