Risks & Benefits of Hospital Birth vs. Birthing Center

[chanelagonzalez]

I would like to hear more opinions on the matter of hospital deliveries vs home births or birthing centers. As a L&D RN, I believe hospitals are the safest place to deliver since the staff and facility are well prepared to deal with emergent situations. Am I biased since I am a L&D nurse? I am also a new nurse and rather young, and truely do not know exactly what birthing centers have to offer. Any opinions on the matter?

[RadBSN]

For a normal healthy mom with a normal healthy pregnancy I would argue that birthing centers are safer than hospitals. In a birth center you are not exposed to the numerous interventions that put moms and babies at risk for the cascade of interventions and iatrogenic complications. Midwives and staff at birth centers are well trained to deal handle emergent complications during labor and birth (and less likely to cause them). They can handle the complications at the birth center or transfer to the nearest hospital if necessary.

[klone, MSN, RN]

There is plenty of research that has found that for low-risk women/babies, birthing at home with a qualified birth attendant is as safe as birthing in a hospital setting.

As far as FSBCs (free-standing birthing centers) go, they're generally very close to, if not right next door to, a hospital that has transport arrangements with them, so if the woman decides she wants an epidural, or the baby doesn't look good, or there are other complications that can't be handled by the BC, they can transport her within minutes.

For high-risk moms and babies, the hospital is the appropriate place to be. But if they're low risk, I fully support the decision to birth at home or at a FSBC if one is available. My own second child was born at home with a midwife. A qualified midwife, be it at home or in a FSBC, is also trained to deal with emergencies.

Many of the risks of childbirth are caused or made worse by the interventions done to women in the hospital setting.

As a new nurse, I urge you to expand your horizons beyond the unit at which you work. I would hate for you to develop the tunnel vision many OB nurses (and OBs) develop who have never been exposed to non-interventionist birth experiences. All you see are the interventions, so it becomes normalized, and "necessary". It's usually not. Maybe you should check out the film "The Business of Being Born"

[klone, MSN, RN]

One anecdotal observation I've made - the hospital I work at now keeps moms there longer than the hospital I used to work at. S/P C/S moms stay 3-4 days, as opposed to 2 days at the other hospital. And the rate of chorio/endometritis seems a LOT higher at this hospital that keeps women longer.

[Elvish, BSN, DNP, RN, NP]

I work in a hospital too and I support home/FSBC birth for low-risk women. The catch is that my state is one of the few that still does not allow CPMs to practice legally, and there are exactly two CNMs in this state that attend homebirths. It more or less takes away women's choice in the matter.

There are CPMs in my state who attend homebirths 'underground' but risk facing charges if they are found out. So if there is a transport situation, what does the CPM do? Dump her patient at the hospital? Stay with her and risk being found out? Neither paints homebirth in a good light, but it doesn't have to be that way.

I'm not against OBs. There are fantastic OBs and L&D nurses out there who believe women's bodies know what to do and when left alone, will do it well an overwhelming % of the time. But it's also amazing how many OBs have never seen a completely intervention-free birth. If you've never been exposed to it (or if all you see/hear are the horror stories), how can you know what it's like? Sorry, I get a bit passionate about this!! :)

The argument can be made that bad things can happen at home and mothers/babies can die, but I've also seen babies die and mothers almost die from things that happened to them in the hospital.

[CEG]

Research shows that for a low risk woman, maternal and neonatal mortality are equivalent in hospital vs out of hospital. However morbidity is lower for both out of hospital due to fewer infections, unnecessary interventions, c-sections, episiotomies, etc.

I'm glad you asked the question because many hospital based providers never even consider for a minute that it may not be safer.

I was an L & D nurse when I had my first homebirth. My colleagues were very unsupportive and spent a lot of time trying to scare me. Sadly the stories they had to tell me were all about mothers and babies who died as a result of hospital intervention: dead baby after cord prolapse after AROM, mom who coded during epidural placement, pulmonary emboli after c-section, fetal distress during inductions, placenta accreta after RCS #3. They just didn't get it. Not to mention that it was a little community hospital-- decision to incision time could often be 1 hour or more even in "emergencies". I was better off driving from my house to the next closest hospital than giving birth there if there was an emergency.

[chanelagonzalez]

"The argument can be made that bad things can happen at home and mothers/babies can die, but I've also seen babies die and mothers almost die from things that happened to them in the hospital."

If bad things happen at home, don't you think that they are better cared for at a hospital? Again, i'm not fully aware of how birthing centers are prepared. But, I have seen our staff in the unit work together and move quickly (decision to incision to birth in less than 10 min) to save a newborn via cesarean section after a tight nuchal cord and true knot along with a short cord was causing a placental abruption and prolonged deceleration, or to save a mom whose suffering from hemorrhage. I know the risks of delivering at home or in a BC have proven to be low, but just wondering, in case of a real emergency, is the hospital more prepared?

[klone, MSN, RN]

in case of a real emergency, is the hospital more prepared?

Sure, probably. But you have to ask yourself - what percentage of births are "real emergencies"? Of the "real emergencies," how many of them are caused, in part, by hospital interventions? Then you have to look at the rate of "real emergencies" that happen in a FSBC or home situation, as well as things that are directly CAUSED by birthing in a hospital (greater infection rates, greater C/S rates, etc), and look at those things that could have been prevented if they had not been in a hospital setting.

It's all about risks vs. benefits.

And the research has found that for low risk women, the the benefits of out-of-hospital birth outweigh the risks.

[JeanettePNP, MSN, RN, NP]

Tight nuchal cord--chances are that the heartrate wouldn't slow down all of a sudden. There would be clues well in advance that a midwife would pick up on and transport immediately. Postpartum hemorrhage--midwives do know how to treat it, either through fundal massage, pit or methergine injection, etc. Being pro homebirth does not mean that you absolutely will not consider transport under any circumstances. The hospital is there as backup during an emergency, with trained support available from the midwife the second that it looks like something is going wrong.

[klone, MSN, RN]

Also, midwives at home and at FSBCs usually spend the entire time with the mother. She's watching and assessing at all times, as opposed to OBs who pop in once in a while, glance at a strip, maybe AROM her, and then walk out to tend to other pts. There is a much higher level of attention given to the mother with out-of-hospital births, and they are much more likely to catch a problem sooner.

[JeanettePNP, MSN, RN, NP]

I also think that homebirthing mothers (and alternative birthers in general) are more tuned in to their bodies and more likely to pick up themselves that something is going wrong. This is not intended as a slam against hospital birthers, but the choice to have a home birth is usually well thought out and the mother does whatever preparation is needed for her own birth. It's not like a hospital birth where you just show up expecting the staff to take care of you.

[chanelagonzalez]

I don't think midwives could pick up on a tight nuchal cord too quickly since many do not use continuous fetal monitoring. I have assisted many deliveries to babies born with tight nuchal cords and the outcome was great. But, in this rare particular case, it was a combo. of the nuchal cord, a true knot and a short cord that was causing an abruption... Also, the hemorrhage i mentioned was from terrible lady partsl lacerations leading all the way to the lady partsl fornix which took a significant amount of time to repair and an EBL of 3000 cc. I know these instances are RARE, just glad that these patients were at my facility and not at home or in a BC. . I do admit that i am biased... and a bit naive when it comes to BCs... I appreciate all the opinions so far!