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Out-of-Hospital Births

Published October 24, 2007        by Nicole

Of course, it's safe to say that there is more to giving birth these days than just going into labor and then placing the child in a baby basket like in biblical times. But just what are the risks of giving birth outside the hospital? There are two classifications of risk: true obstetric emergencies, and other conditions that might require a less critical transfer to the hospital for assistance with the birth.

Even though true emergency conditions are uncommon, they are factors that must be considered by anyone who is contemplating an out-of hospital birth. It should also be remembered that even in a normal pregnancy and labor, unexpected situations could arise after delivery. For example, respiratory distress or cardiovascular problems of the newborn infant are true emergencies that can best be dealt with in a hospital setting.

Non-Emergencies Requiring Transfer to the Hospital

Women are also transferred to the hospital for conditions that are non-emergent in nature. Sometimes, if a complication [such as anemia, high blood pressure, diabetes, twin pregnancy, or breech presentation] is discovered during pregnancy, the woman is no longer a candidate for out-of hospital birth. If labor is prolonged, or if it looks as though the mother pain medication, forceps assistance, or other intervention, she is transferred to the hospital. Under these circumstances, the transfer is not an emergency, and there is usually time to try various solutions and, if necessary, decide whether and when to go to the hospital. While it is never pleasant to give up plans for an out-of-hospital birth, and transfer is uncomfortable and worrisome for the parents, it is not usually associated with danger to either mother or baby. Of women who choose out-of –hospital birth, approximately fifteen to twenty-five percent of first time mothers and five to fifteen percent of second time mothers are transferred to the hospital during labor or after delivery. The possibility should be considered when parents are deciding on the merits of out-of-hospital birth.

When inquiring about out-of-hospital birth services, find out what drugs and technology they use in their birth practices such as pain medications, intravenous fluids, oxygen, and fetal monitoring. Ask what emergency equipment they have with them for all births. You will want to know about the backup hospital and the backup or consultant physicians. You should know about transfer arrangements. For example, is an ambulance available? Or are the automobiles of the staff and clients the usual transportation in case of transfer? How far away is the backup hospital?

Advantages of Out-of-Hospital Births

The advantages of out-of-hospital births are that parents may have more control over their birthing experience. There are few routines that must be followed. Parents have the freedom to move around, visit with friends, or go outside the home, and do household activities and other things during labor as much as they like. In addition, few interventions are used. Contact with the baby after birth is unlimited and in accordance with the parent’s wishes.

Women who choose birthing centers often find a sense of community and fellowship. Classes and social gatherings are often held at the birthing center, contributing to a sense of security and friendliness. Women who choose home births tend to find great appeal in the familiarity of their own surroundings.

The costs associated with home births are by far the lowest of the tree environments, birthing centers cost less than hospitals. For those parents where finances are an important issue need to look into the actual costs involved in all three options.

Many uninsured people with low incomes find home births the only affordable option. But if a planned home birth winds up as a transfer to the hospital, it may turn out to be more expensive than a planned hospital birth.

Some health insurance policies do not cover home birth or birthing center care, even though it is much less expensive. If you have insurance, make sure to investigate ahead of time the possibility of being reimbursed for those expenses.

Disadvantages of Out-of Hospital Birth

The major disadvantages of out-of-hospital birth are primarily related to the lack of available appropriate medical care should emergencies occur. Such situations can arise quickly, for example, hemorrhage, seizures, mucous aspiration, or any severe fetal or maternal complication that might place either baby or mother in jeopardy. The value of proximity to the full range of modern medical care should not be underestimated.