HW 42- Pregnancy and birth culminating project

The debate over hospital birth versus home birth is slowly increasing in popularity as midwives are beginning to gain more respect. Both sides seem to have made clear arguments for their case. The obstetricians and gynecologists that support hospital births would argue that superior technology and more available staff make the birthing process much more safe. On the other hand, those who support home births via midwives say that both women and babies are safer in a home birth, and most of the deaths that occur during childbirth are because of unnecessary OB/GYN intervention in the first place. However, there is no point in discussing the opinions of those who support either of these sides, the real question is how do certain factors that exist in both of these environments cause comfort and discomfort for the woman giving birth, for she is the one who will need to make the final decision on which type of birth to have. The most important aspect of giving birth is that both the woman and the child can be as safe as possible during labor and birth, but considering the fact that there is evidence that points to both the home and hospital birth sides of the debate, the second most important aspect should be considered highly. That aspect is the comfort of the woman in the environment that she chooses, which is what the remainder of this project will be exploring.

There is one huge factor that surprisingly seems to be more overlooked by most than expected which can cause a woman discomfort, and that is the issue of money. Our previous unit on illness and dying showed us that over 50 million people in America are currently not covered by health insurance, and sources suggest that, "For patients not covered by health insurance, the typical cost of a vaginal delivery without complications ranges from about $9,000 to $17,000 or more, depending on geographic location and whether there is a discount for uninsured patients." (Baby Delivery Cost) For an uninsured woman, knowing that there is a good possibility that you will need to pay thousands of dollars just to have a standard birth in a hospital would create a lot of discomfort and certainly be very stressful. Even patients with insurance are likely to pay somewhere between $500 and $3000 for their standard births. Cesarian sections cost even more for any patients without insurance, and can range from 14 to 25 thousand dollars. However, when considering all of the chemical and mechanical intervention that woman experience in hospital birth, it really is no surprise that they are able to charge so much money for the process. For some women, the much larger staff of trained professionals on scene while they are giving birth can provide a sense of safety and security, which are both factors that positively contribute to the mother's experience. To quote Dr. Moritz, "Obstetrics is 98% not exciting, and 2% sheer terror...but hospitals are good for when you have that terror." (Business of Being Born) The doctor seems to suggest that it is the emergency situations that hospitals are good at dealing with, which can be an attraction for women who are afraid that something will go wrong. However, if something only goes wrong two percent of the time, then why should obstetricians in hospitals be dealing with the other 98%? The film Business of Being Born also speaks about all the unnecessary treatment that women are given in hospitals, such as episiotomies without informed consent of the patient while they are paralyzed by an epidural.

In the year 1900, 95% of women were giving birth at home. Today, less than one percent of all women who give birth choose a home birth. (Business of Being Born) The reason for this is obviously that women of this generation are not necessarily comfortable giving birth at home, for various reasons that can range from safety to having to clean up the mess in their own home. However, the majority of sources that I have witnessed (including both Business of Being Born and Born in the USA by Marsden Wagner) have insisted that home birth offers much more choice for the women than hospital birth. "Final decisions about the place of birth can be left for the woman to make during labour, thereby ensuring that she keeps all her options open. Midwifery care will follow the woman regardless of whether she needs or wants to give birth in hospital." (Home Births Information) Not only are women given the ability to make their own decisions on the treatment they receive, it should be considered that hospitals are open 24 hours a day, and if something were to go wrong in a home birth, an ambulance could be called to take the mother to the hospital. Financially, to have a birth supervised by a midwife at a home birth is much cheaper than being at a hospital, although it will cost quite a bit of money either way. "Midwife fee which is usually between 1500-3000 dollars. This fee covers prenatal care, birth, postpartum check up, newborn check up and screening." (Home Birth Cost and How to Pay for it) Although this financial advantage over hospital births provides a comfort advantage for most women, there are certainly less people on staff in case of an emergency. Other than the attending midwife, typically the only other people the mother will have for support is the family, but this does mean that she has the option to pick and choose whoever she wants to be there. These two different perspectives of looking at the company that the woman chooses to have can be either comforting or discomforting, depending on the person.

After doing research online about the factors that women consider to be comforting and discomforting, I figured it was time to talk to someone that had been through both the home and hospital birth experiences. Fortunately, a friend of mine's mother happens to be a woman who gave birth in both situations. She has asked for her name to be kept anonymous, but she is the mother of three. Her first child (who was born in 1993) was born in the hospital, but both of her daughters (born 1996 and 1999) were born in her own apartment. When I asked about how her experience was in the hospital, she responded by saying, "Well, medically everything went well, but everything felt very mechanical and not personal. In the beginning, having all the nurses and doctors around me was actually more intimidating for me than reassuring, and none of them really seemed like they cared about how I was feeling in the moment. I did eventually get used to it, though, and once I held my son for the first time, nothing that had happened before mattered." Her description of what I had researched to be a typical, healthy hospital birth inspired me to ask why she had chosen to embark on the home birth journey for her last two children. "Hmm...I guess it was because I felt like there was an emotional part of the experience that was missing," she said. "It's like I felt like I was not involved enough in the experience, as strange as that may sound. But when I had [first daughter] and [second daughter] they felt even more like...they were all mine. Honestly, I was pretty paranoid that something would go wrong and we wouldn't be able to make it to the hospital in time at first for my first daughter, but for my last child everything went smoothly, medically and emotionally for me."

Ultimately, only the woman who is preparing to give birth will be able to determine which situation is best for her, because both hospital births and home births have different appealing aspects that might attract different types of people. However, the conclusion I have made about the reasons why less than 1% of woman do not feel comfortable having a home birth is that they are either because they are ignorant or afraid. When I asked my mother why she did not have a home birth, she said, “Home birth? Why would I have? I wanted to have a natural birth, but I’m not that radical, and thank God I didn’t, because everything  seemed to be going wrong when I gave birth.” My mother, along with millions of other women, seem to have chosen a hospital birth mainly because they are worried about (as Dr. Moritz describes) the two percent chance that a situation will turn into sheer terror. My mother also asked why she would have even considered a home birth, as if it was a completely foreign concept to her. This represents the extremely limited amount of knowledge that most people today have about home births, and therefore they often don't even consider them as an option. 

Citations
(All citations from homework 41 post were included as well)

"Baby Delivery Cost." CostHelper. N.p., n.d. Web. 5 Apr 2011. <http://www.costhelper.com/cost/child/baby-delivery.html>.

"Home Births Information." Birthjourney.com. N.p., 2010. Web. 5 Apr 2011. <http://www.birthjourney.com/homebirth.php>.

"Home Birth Cost and How to Pay for it." Home Birth Guide. N.p., 2009. Web. 5 Apr 2011. <http://www.home-birth-guide.com/homebirth-cost.html>.

Wagner, Marsden. Born in the USA. 1st. Los Angeles: University of California Press, 2006. Print.  

Lake, Ricki, Prod. Business of Being Born. Perf. Dr. Moritz, Julia Barnett Tracy. 2008, Film.