People are so quick to judge women who choose to birth at home, but for some reason nobody talks about the "risks" of birthing in a hospital. And believe me, there are risks.

There aren't many absolutes in the world, but I've got one for you: If I post in a public forum that I had a homebirth, somebody will tell me I'm an idiot/terrible human for putting my baby and self at risk unnecessarily. They will cite this or that study confirming more babies die in homebirths. For every one of those studies, I can cite one that negates that claim, providing evidence that a planned homebirth with a licensed midwife for a low-risk birth has similar outcomes in terms of maternal/baby death and significantly reduced incidences of cesareans and interventions.

(FYI, many of the studies finding higher risk of death lump all homebirths together, including unplanned, unassisted ones. This of course gives us a skewed understanding of the actual safety of a planned homebirth.)

A woman should give birth in the place that she finds herself the most comfortable, supported and safe.

But I'm not really interested in defending my decision to birth at home, nor am I interested in attacking the decision of birthing in a hospital. A woman should give birth in the place that she finds herself the most comfortable, supported and safe.

Why aren't people talking about the "risks" of hospital birth?

What I'm really interested in talking about is that nobody seems to talk about the risks of delivering in a hospital. What? What's that you say? There's no risk? Huh. That's weird, because some hospitals have a 69 percent cesarean rate.

If I give birth in such a hospital, there's a 69 percent chance my abdomen will be sliced open. Sure. Maybe it will save my life, and that would be wonderful indeed, but when the World Health Organization states that no country can justify more than a 10 to 15 percent cesarean rate (source), there's a far greater chance I'll be cut open unnecessarily.

Call me crazy, but that sounds like a "risk" to me.

You know what the 2011 average cesarean rate was in America? Around 33 percent.

But this number varies significantly from hospital to hospital. A 2013 study found that hospital cesarean rates range from 7.1 percent to 69.9 percent. "Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent" (source).

Clearly not all cesareans are occurring out of medical necessity.

When you birth in a hospital, you are subject to the policies, positions and overall mentality supported by that institution.

So please don't tell me there's no "risk" when you birth in a hospital. First of all, there's an inherent risk involved in childbirth, no matter where you are. Secondly, when you birth in a hospital, you are subject to the policies, positions and overall mentality supported by that institution. Period.

Billed for an ER visit they never made?

Take this couple in Denver, for example. They were billed $6,600 for emergency room services at Rose Hospital even though they never stepped foot in the emergency room. At this hospital, if a mother doesn't schedule an induction or cesarean, she is subjected to this fee because spontaneous birth is considered an "emergency medical condition."

If a mother doesn't schedule an induction or cesarean, she is subjected to this fee because spontaneous birth is considered an "emergency medical condition."

There is no way this mentality doesn't trickle down into the care it provides patients. And indeed, though the Rose website claims "low cesarean rates" and an openness to VBACs, their cesarean rate in 2008 was actually the highest of any hospital in the area at 34 percent (source). Their VBAC rate was only eight percent, which was low among area hospitals (though kudos to them for allowing it all!), and their episiotomy rate was also eight percent, which was comparatively high (source).

The point I'm trying to make with this Denver couple is that when you birth in a hospital, you become subjected to their broader approaches, many of which you may know nothing about.

Though cesarean rates vary widely among physicians, all are part of our litigious society. They all face potential malpractice claims. It is a medical approach to childbirth. Birth is seen as an "emergency medical condition" to be managed and directed. In other words, it's something to be "treated." It's an inherently dangerous situation, or an illness.

The midwifery model sees childbirth as a safe, natural process until proven otherwise.

My choices

Personally, I don't want to be managed. I don't want a natural process that generally works just fine, especially when people stay the hell out of it, to be seen as an "emergency medical condition." I want to be awake, aware and empowered during my birth. I don't want medications, Pitocin or epidurals because they transfer to my baby, often inhibit pushing and increase my risk of cesarean.

These are my choices. These are not insane choices, are they? Or, is it any more "insane" than putting yourself in the care of a hospital that charges people ER fees simply because they can and "boasts" a cesarean rate three times higher than WHO's recommendation?

I had two hospital births. They were not traumatic. I am not a hospital hater. I was treated well at those births. One of them was 100 percent natural. I arrived at eight centimeters and gave birth to a 8.5 pound baby boy in the water about an hour later. The birth was attended by a midwife. It was the gentlest, loveliest birth I've had.

The second I stepped through those doors I was agreeing to their approaches and policies, and hospitals follow the medical model, which is good and right and life-saving when necessary, when they are in the genuine interest of the woman and her baby.

But I still had to argue for that birth. I had to yell to the nurse that I wanted to push (they didn't even believe I was in hard labor because I wasn't screaming). I had to fight them not to put a shunt in my hand. I didn't want to arrive and don their horrid white gown. They told me I must. I refused to lie down for their 20 minutes of continuous fetal monitoring. I said I would stand next to their machine, and I did.

This birth took place at a very liberal hospital in an affluent, highly educated area. But I still had to fight for the birth I wanted. Why? Because the second I stepped through those doors I was agreeing to their approaches and policies, and hospitals follow the medical model, which is good and right and life-saving when necessary, when they are in the genuine interest of the woman and her baby.

But what if those approaches and policies are not in the interest of the woman giving birth? What if they are in the interest of the doctor, or the hospital, or pharmaceutical companies? What if the hospital's focus is on protecting itself from lawsuits and milking insurance companies?

What then?

What kind of "risks" exist then?

Well, I think we already know the answer to that question. And for some of us, those are not risks we're willing to take.

More on birth

Planning a natural birth? Read these books.
What makes a birth good?
Prepare your mind for childbirth

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