Nicki Rosenbach
Pieplow- writing 1150
Literature review
Introduction:
When a woman is pregnant, she has the choice to decide between either hospital birth or home birth. Women are conflicted with this big and life changing decision every single day. There are a multitude benefits and disadvantages for each of these choices. There is much debate over the safety of homebirth versus hospital birth. The conflict over this issue stems from a long history and many people’s personal opinions about the subject. Birth is a natural and intricate process and problems could arise whether in the hospital or at home. This literature review will discuss the pros and cons of homebirth versus hospital birth, the difference between a midwife and a physician, whether home birth or hospital birth is more invasive, and which seems to be more popular.
Advantages of home birth:
The Royal College of Obstetricians and Gynecologists in the United Kingdom has issued a statement “supporting home birth as a viable choice for women with uncomplicated pregnancies” (Janssen et al, 2009). There are many evident appeals to home birth. “The cost is roughly a third of what the hospital charges. A planned home birth is five times less likely to end in a cesarean, and most other unnecessary medical interventions that are routine in hospital birth can be avoided at home” (Craig, 2011). In addition, Craig believes that home births are an over all positive thing for mothers; a birth that is less expensive and easier on both mother and baby. In addition, home birth provides a safe and comfortable environment for both the mother and child. It is soothing for a mother to give birth in her home because it is a familiar environment that poses no threat. “Of course, opponents to the bills claim that home birth is not safe, and they will often add some anecdotal horror story. The medical literature has clearly shown that home birth with a licensed midwife is just as safe as a hospital birth, with far fewer complications and costs” (Craig, 2011). In addition Craig states that opponents to home birth claim that training for CPM is insufficient, which is a common misconception. CPM’s must go through rigorous training and education in order to gain a license. A report which was done by the Disease Control and Prevention showed “a 5 percent increase in demand for out-of-hospital midwife births in 2005 across the United States. And home births in this state increased 32 percent from 2003-04 to 2005-06, according to the report, which was released in March” (Friedman, McClatchy, 2011 ). In Olsen’s study, A Meta-analysis of the Safety of Home Birth, he concluded that “home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions” (Olsen, 1997).
Advantages of hospital birth:
There are a multitude of benefits and positives to hospital birth as well. During “the period from 1930 to 1960 the proportion of births in hospitals increased from 36.9 percent (1935) to 88 percent (1950) to 96 percent (1960)” (Devitt, 1977). This was during a period where people felt being in a hospital was much safer and could provide much better care. According to Devitt, home births were quite risky during this time and hospitals seemed like a much more secured choice. “The campaign for hospitalized birth achieved support from obstetricians, public health officials, upper class women and insurance companies” (Devitt, 1977). Devitt who did a study about, the Transition from Home to Hospital Birth in the United States, 1930–1960, goes on to say that in 1946, the Hill-Burton Act provided funds for the construction of hospitals in rural areas, creating the possibility of hospital birth for populations, which previously had no choice, but to give birth in the home. In addition “the safety of planned home birth is controversial” and it has been claimed that hospital birth is safer for all women (Olsen, 1997).
Disadvantages of home birth:
The American College of Obstetricians and Gynecologists “reiterated its long standing opposition to home births, stating that the choice to deliver at home places the process of giving birth ahead of the goal of having a healthy baby” (Janssen et al, 2009). In Tuteur’s article, Stop pushing for home births, as an obstetrician herself, she is startled by both the RCOG claim that the home birth should be encouraged as safe in the absence of any data that shows it is safe. Tuteur has been writing about the dangers of home birth for over a decade. “There is no evidence that home birth is as safe as hospital birth or hospital care and there is absolutely no evidence that home birth saves money” (Tuteur, 2011). “In contrast to the hospital, where one midwife can care for multiple women in various stages of labor, home birth requires up to 2 midwives to care for one woman who may be in labor for many hours. And that’s only if there are no complications. If a low risk home birth suddenly turns high risk, the same costs of a hospital birth are incurred, plus the additional costs of transport to the hospital” (Tuteur, 2011).
Disadvantages of hospital birth:
Hospital birth is often much more invasive and sometimes more painful than home birth. A study by Morse and Park (1988) concluded “childbirth was perceived to be considerably more painful in the hospital birth group than the home birth group.” “Because homebirth mothers do not consider the option of receiving analgesics, the psychological preparation for labor includes minimizing the expected pain. We are suggesting that, after the homebirth, these mothers report lower pain ratings than their hospital counterparts” (Morse, Park, 1988). Pain management is much easier to control in homebirth than in hospital birth. In addition, hospital birth can also be extremely overwhelming to a mother and the idea of being in a hospital is much more intimidating and scary.
Difference between physicians and midwives:
There are many clear differences between physicians and midwives. “Midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulting in favorable outcomes for women planning both home or hospital births” (Reitsma et al, 2009). Both midwives and physicians handle the management of the third stage of labor in a different way. In Saxell’s study, How Do Physicians and Midwives Manage the Third Stage of Labor?. Birth: Issues in Perinatal Care, he states that physicians usually implemented active management of the third stage of labor. Midwives usually preferred expectant approaches, which are based on the women’s preference. “Data did now show any significance in problem for either way of managing the third stage of labor by practitioner type” (Saxell et al, 2009).
Craig defines CPM’s as “trained professionals who go through rigorous clinical training and education to earn their national certification.” There are laws in certain states that prohibit licensed professional who are specifically trained to attend home birth, these are Certified Professional Midwives (CPM). In Mclatchy’s article, Rallying cry to pass bill for legal midwives: Push! he speaks of dozens of mother and fathers who rallied in order to allow CPM’s to practice legally. The parents carried signs “including statements such as “my birth, my decision” and “RN’s love midwives” (Friedman, McClatchy, 2011). McClatchy’s article goes on to say that “a fully trained and credentialed certified professional midwife who can legally practice in Virginia, Tennessee and South Caroline and Florida is at risk for being arrested for providing the same quality of care in North Carolina.” McClatchy claims that, CPM’s are qualified and should be allowed to practice everywhere.
Invasiveness and deadliness:
In Reitsma’s study, “overall rates of intervention, and perinatal/nonatal morbidity and mortality were low for both the home birth group and the hospital birth group.” While “there was no increase risk of perinatal or neonatal outcomes in morbidity or mortality between groups, there were significantly lower rates of intervention and serious maternal morbidity in the planned home birth group in comparison with the planned hospital birth group” (Reitsma et al, 2009). Olsen’s study, Meta-analysis of the Safety of Home Birth. also showed that “perinatal mortality was not significantly different in the home and hospital birth groups.” Janssen’s study, Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician, was also similar. His study showed “that planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with planned hospital birth attended by a midwife or physician (Janssen et al, 2009).
More popular:
This is another study which showed in a sense which is more popular; home birth or hospital birth. MacDorman’s study, Trends and Characteristics of Home Births in the United States by Race and Ethnicity, 1990-2006. Birth: Issues in Perinatal Care, showed “that from 1990 to 2006, both the number and percentage of home births increased for non-Hispanic white women, but declined for all other race and ethnic groups. Then in 2006, non-Hispanic white women were three to four times more likely to have a home birth than women of other races and ethnic groups.” In addition, “for non-Hispanic white women, two thirds of home births were delivered by midwives. In contrast, for other race and ethnic groups, suggesting that a higher proportion of these births may be unplanned home births because of emergency situations” (MacDorman et al, 2011).
Conclusion:
I think that home births are going to become much more popular over hospital births in the coming decades. I think that research and public opinion seems to be going in favor of home births. I think there is still much more research that needs to be done about home birth and its safety but I think that people are on the right track.
Works Cited
Craig. Professional midwives are a key option for health care.(2011,May19). Herald Sun with Chapel Hill Herald,A.9. Retrieved October 11, 2011, from ProQuest Central. (Document ID:2378383531).
Devitt, N. (1977), The Transition from Home to Hospital Birth in the United States, 1930–1960. Birth, 4: 47–58. doi: 10.1111/j.1523-536X.1977.tb01207.x
Hutton, E. K., Reitsma, A. H., & Kaufman, K. (2009). Outcomes Associated with Planned Home and Planned Hospital Births in Low-Risk Women Attended by Midwives in Ontario, Canada, 2003–2006: A Retrospective Cohort Study. Birth: Issues in Perinatal Care, 36(3), 180-189. doi:10.1111/j.1523-536X.2009.00322.x
Janssen, P. A., Saxell, L., Page, L. A., Klein, M. C., Liston, R. M., & Lee, S. K. (2009). Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ: Canadian Medical Association Journal, 181(6/7), 377-383. doi:10.1503/cmaj.081869
Lead Friedman. (3 March). Rallying cry to pass bill for legal midwives: Push! McClatchy – Tribune Business News, Retrived October 11, 2011, ProQuest Central. (Document ID: 2281062271).
MacDorman, M. F., Declercq, E., & Menacker, F. (2011). Trends and Characteristics of Home Births in the United States by Race and Ethnicity, 1990-2006. Birth: Issues in Perinatal Care, 38(1), 17-23. doi:10.1111/j.1523-536X.2010.00444.x
Morse, J. M. and Park, C. (1988), Home birth and hospital deliveries: A comparison of the perceived painfulness of parturition. Research in Nursing & Health, 11: 175–181. doi: 10.1002/nur.4770110306
Olsen, O. (1997), Meta-analysis of the Safety of Home Birth. Birth, 24: 4–13. doi: 10.1111/j.1523-536X.1997.00004.pp.x
Tan, W. M., Klein, M. C., Saxell, L., Shirkoohy, S., & Asrat, G. (2008). How Do Physicians and Midwives Manage the Third Stage of Labor?. Birth: Issues in Perinatal Care, 35(3), 220-229. doi:10.1111/j.1523-536X.2008.00243.x
Tuteur, A. (2011,July15). Stop pushing for home births:Dr Amy Tuteur, aka the Skeptical Ob, can't believe The Royal College of Obstetricians and Gynaecologists is advocating more home births. She says it's time to acknowledge the truth -- hospital is safer.The Times,4. Retrieved October 11, 2011, from ProQuest Central. (Document ID:2398970401).