The Risks of Hospital Birth


Hospital births often come with intervention

Many women think that there is no reason to endure the “risks” involved in having a home birth when they can just deliver safely and conveniently in their nearby hospital and then head back to the comfort of their homes afterwards.

But the idea that a hospital is a great place for low risk women to deliver babies is a myth, as Dr. Mercola thoughtfully spelled out last week in this article The Myth of a Safer Hospital Birth for Low-Risk Pregnancies.

The whole article is worth reading but what I found of particular interest is the following table where he outlined exactly what makes hospital births more risky. It may prove useful for those who are on the fence about home birth.

Of course, where a mother delivers her baby is her choice. Some women are filled with fears about labor that they cannot easily overcome, and others believe hospitals to be the epitome of safety and cleanliness. But clean isn’t always a good thing, as I’ve written about before, and safety doesn’t necessarily come in the form of tests and equipment, as studies are beginning to show.

Planned delivery in hospital indicates women fear a bad outcome, which can be a self-fulfilling prophesy Increased fear releases adrenalin and other adrenergic neurotransmitters which can slow down or even stop the birth process Unfamiliar environment, strangers, people in uniform, unfamiliar smells during labor counter mammalian birth instinct Hospital staff are a reservoir of bacteria, which the mother/baby lacks immunity to Lower access to food, drink can cause hypoglycemia and dehydration
Car accidents on the way to hospital Fear and unfamiliar environment increase pain level, which sends stress signals to fetus, provoking negative influence on fetal heart rate Collusion among hospital workers takes precedence over commitment to client and safe protocol Lack of accountability of staff to patients contributes to poor outcomes Laying on back compresses the aorta and vena cava decreasing oxygen delivery to fetus
Continuous fetal monitoring increases pain, decreases oxygenation of fetus, decreases mobility and increases anxiety Hourly vaginal exams push bacteria up into uterus, causing increased rate of infection after 3 exams Overuse of antibiotics kills healthy flora, lowering immune system capability Artificial rupture of membranes (AROM) can cause cord prolapse, increased infection and pain Induction can cause cord prolapse, uterine rupture, amniotic fluid embolism, increased postpartum hemorrhage
Epidural causes fever in 15% of women, which increases neonatal seizures, which can cause brain damage Episiotomy can cause hemorrhage, third and fourth degree extensions, permanent disability. Vacuum increases rate of third and fourth degree tears, causing life long incontinence of urine and feces and sexual disability and increased hemorrhage and for the baby: intracranial hemorrhage, scull fractures, and, rarely, brain damage or fetal death Shoulder dystocia because of delivering in a hospital bed instead of on all 4s Cesarean can cause maternal and perinatal death, and increased maternal and fetal morbidity, lifelong scar pain, infertility, adhesions, decreased nursing success, increased stillbirth and placenta accreta on subsequent pregnancies.
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  1. Agreed, Sid. I am in a similar situation with #3. I have a midwife who has detailed instructions from me on how I want to deliver, and we are going to the hospital for the same reasons you mentioned: in the “big if” category, I want to know we are close to emergency care. The hospital is almost an hour from my home, too long to wait if the child or I need emergency care during or after the birth process.

    My first child was born in a room full of foreigners (sorry, I don’t begrudge any foreign person her American education, but having 9 Filipino student nurses yelling at you to breathe and breathe and breathe and push! was not fun). No one asked me if it would be OK to have them observe, they were just brought in to observe and couldn’t help themselves jumping in to get me up and pushing. I was pulled in so many directions that day it took hours for me to become coherent again. When my next child came, I explicitly told the staff that it was to be my husband, me, my OB, and a nurse. Period. No students, no one not medically necessary to the process. The hospital staff were very accommodating.

    Same thing this time around, the midwife, a nurse, me, and my husband. No epidural, no induction, no AROM, no fetal monitoring, birth in my own particular idiom, no vaccinations, 100% room-in with baby (they even give baths in the room if you want), and no formula. It’s a different hospital this time but my SIL delivered there and her experience was wonderful. I expect mine will be the same.

    Good luck on your birth process.

  2. Like many “debates” about pregnancy, birth and parenting, it bothers me the way the whole hospital versus home birth issue is conveyed as black-and-white. I had an amazing hospital birth with my first and am planning a second the same way. I had/will have: a brilliantly-trained midwife who lets me labour and deliver exactly the way I want to (with only intermitted heartrate checks and only 2 vaginal checks – same as a home birth); a full choice/supply of drugs if I need them (I didn’t the first time but it’s not a “I can survive the pain” contest); a hospital with excellent birthing facilities close to my house; an unlimited hot water supply and a giant bath tub; someone else cleans up the mess and; a “quick release” option where I can leave the hospital as soon as the babe and I have checked out as healthy (midwives do follow-up visits at home, last time I was home enjoying my own clean home within 3 hours of giving birth). My husband and I are also much more relaxed knowing that if anything goes wrong we will have immediate medical support. If women don’t have the option of this type of hospital birth, they should fight for it. Giving birth doesn’t have to be black-and-white.

    • You don’t generally know what kind of hospital birth you’re going to get until it’s over. I thought I was going to a hospital very tolerant of natural methods with a doctor who was the same. And I got none of that.

      Of course you can have a great hospital birth. You can have a great birth on the side of the road or in the car.

      I don’t think that presenting risks of hospital births in this country is calling birth black and white. Everyone is different and has their own reasons and needs. But the prevailing notion that hospital birth is the “only” way and the safest way is flawed.

      It’s wonderful to hear that you had a great experience. That’s the way it should be anywhere!

    • Wow, I’m jealous of your “quick release” option! I too had a wonderful, peaceful, medication and intervention-free hospital birth experience. I don’t think that these types of hospital births are so elusive if you choose the right medical team. My biggests complaints about the entire experience were a) the ride to the hospital (it sucked being in full blown labor in a car) and b) having to stay at the hospital for 24 hours before we were released (recovery rooms suck compared to home, especially if you have to share with another recovery mom). Should I choose hospital birth again in the future I will no doubt be asking about a quick release.

    • Sid~ I am not here to debate the “rightness” of where to give birth. I firmly believe it is an individual choice with the main concern being where mom feels safest. That said- it is inaccurate to say that you will have “intermittent monitoring and two vaginal checks- same as home birth” It is not the same. Most home births I attend there is only 1 vaginal check and it is just before the birth is eminent. I see upwards of 5 in the hospitals. There are drastic differences between the two and differences between hospital births around the world. We cannot begin to outline what a birth will include in one place or another. It sounds like you live in an area with very wonderful options for hospital births- most people cannot get what you have. So as long as we agree with your point that it isn’t black and white, maybe we should refrain from trying to outline the differences- thus making it black and white. Let’s leave it gray, accepting that birth is handled differently all over the world- home or hospital.

  3. I was not clearly in the low-risk category for a home-birth, but we thought through our options very carefully and decided that home was the place we felt safest. My high risk factors were: a gestational diabetes diagnosis (I was intolerant of 50 grams of glucose while fasting—-less than 3 % of my home test results over 120 mg/dL 1 hour post prandial over the course of 7.5 months of testing), along with wanting a VBAC (1st breech and no midwife here would support a breech home birth), and being over 35 (I had just turned 37). My OB sent in the pre-approval for a repeat cesarean at my 10 week visit, even though she clearly said she was supportive of me trying a VBAC. The lack of trust there was reason enough for me to change course since I initially *felt* safer having a VBAC in a hospital in case any of the scary possibilities happened. However, upon further reflection and upon finding a very supportive midwife, I felt very confident with my decision to birth at home. We are less than 10 minutes from a hospital (counting traffic lights and traffic), and our midwife was very much into being observant for any early cues that we might need to transfer.

    My daughter’s birth day came very uneventfully (as monumentally eventful as it was), and my older daughter (4.5 years old) and I took a walk to the library and she fed me snacks and made sure I had enough fluids throughout the day. It was very sweet for all of us to be in our own house. She had her special person to be with throughout the day–someone whom we love dearly who does not emit worry vibes under stress or new situations. My daughter was very comfortable. We watched lots of YouTube home water births (I was worried about this since my daughter doesn’t ever watch TV, but she doesn’t seem to traumatized! –so much for Sesame Street!). Anyhow, my second daughter arrived peacefully in our bedroom. She was so quiet and peaceful that I started to panic about her vital signs and I just remember my midwife repeating, “She is breathing and her heart rate is great! She’s fine! She’s here! She’s tired…” We thought she smiled at us first thing, and now that she’s nearly 7 months old and we know her so well, we’re sure she smiled!

    My midwife is in a bit of a hot seat right now for taking me on. My OB believes it was irresponsible to take on a VBAC client with “gestational diabetes.” I believe it is the responsibility of all of us women to do our own research, share our own stories and make our own choices. My midwife gave me the power to do that. If I wanted to head to a hospital, she was there to hold my hand the whole way.

    One of my dearest friends told me that giving birth is no walk in the park. She recalled our childhood times where I was less than graceful with pain and quite fearful of new things. Basically, she was trying to inject more fear into my decision making. She assumed that since she had a hard time handling the pain in a foreign place (the hospital) and needed pain meds, that I would want to be near them too. I never considered the pain so intense that I felt the need for pain meds. I was quite focused on the job at hand and I had good space between contractions to be chatty and cheerful. At one point, while leaving indentations in the side of the birth pool, I straight up told my midwife that I could not handle another 8 hours of *this* (7, maybe…. but not 8!). She smiled and assured me that the baby’s head was close and that I could likely think in minutes (maybe 57 minutes, but minutes nonetheless!). I would not have been able to let down my guard to get on with business had I been dealing with interruptions or strangers.

    If we decide to have a third baby, we will again look at the situation freshly, do research, and most importantly, follow our hearts. Without a doubt, home is where we will certainly be most comfortable!

  4. 10 years ago I had the ability to deliver my first child in my midwifes birth center. We are planning this with our second child due in January. As an RN I know the risks associated with both types of birthing situation, but I agree that you are more at risk for interventions in a hospital. We are lucky that we have the safety of the hospital if needed in this country. However considering that laboring is a very natural event a home birth or a home like environment it definitely better for many of us. Also the hospital in my area does not allow the quick release option. I might be more inclined to go there if it did. It is a great facility with amazing staff that I have worked with in the past. Maybe more hospitals need to explore this route for there patient population.

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