Saturday, June 2, 2012

Home Birth v. Hospital Birth

I'm a doctor.  I am not an OB/GYN, but I've delivered around 50 babies, so I know a little bit about the subject.  I've had friends do home births, use a mid-wife, bath tub, etc...  I've been in emergency C-sections, worked in the NICU, seen a true knot in the umbilical cord, seen cords wrapped around the babies neck, seen shoulder dislocations etc...
I've also have 4 children of my own, and delivered one of them myself.

My opinion may be valid, but if I were you, I'd want more than my opinion.  I'd want to know the results of thousands of births, in multiple states, with all different doctors, patients, circumstances, etc...

This post is not to tell you whether or not to have a home birth - this is to give good information so you can make an informed choice.

According to a study in "Nurse Midwifery" - If a birth is completely uncomplicated:

 - Home birth is 68% cheaper on average (no insurance)
      - Hospital average cost is $7,600 (with insurance you pay around $2000)
      - Mid-wife home birth cost is $2,500

Mom's who choose home birth are usually healthier, have less risk-factors, etc....

A Canadian study looked at around 10,000 births from 2001-2004.  It showed that home births had comparable mortality rates, and had far less complications.
HOME BIRTHS:
 - Less meconium aspiration
 - Less post-partum hemorrhage
 - Less obstetric interventions (fetal heart monitoring)

 A U.S. study was completed which looked at all studies done since 1947.  It included the results of 342,056 planned home and 207,551 planned hospital deliveries.  It showed:

HOME BIRTHS:
 - Less procedures: epidurals, fetal heart monitors
 - Less episiotomies and operative deliveries (both vaginal and cesarean)
 - Less infections, lacerations, hemorrahges, and retained placentas
However, there was one significant disadvantage to home birth
 - neonatal death rate DOUBLED with home birth.
 - neonatal death rate TRIPLED in home births where the baby had no genetic problems.

Granted - the death rate went up from .15% to .3%   - So the risk is still very small.

In summary:
 - Home births are cheaper, as long as you don't get transferred to the hospital.
 - Home births certainly have less interventions, lacerations, complications etc.
 - Home births may have a higher death rate in the US.

Around the globe:
The British OB/GYN association supports home births.  The US OB/GYN association does not.
Australia announced a major reform this year to support and promote midwife led births.  A review of 3 huge Cochrane meta-analyses showed no difference in outcomes for low-risk mothers.

2 comments:

Anonymous said...

Okay, so knowing all that, is your wife going to have baby #5 at home?

0.3% (3 in 1,000 or 1 in 333-- seems like an unacceptably high infant mortality rate.
What about maternal mortality rates? Early in the 20th century (so may 100 years ago) a quarter of women died in childbirth.

Dinah of Shrink Rap

Simple Citizen said...

You've got me there. Sometimes the research doesn't matter, because when the risk is your child's life, nothing else seems to matter.
My wife and I never considered home birth. There were some prenatal concerns from ultrasound and labs, plus I know how the hospital works, I know how to avoid a lot of the bad outcomes and get most of the benefit. Then you add in the cost difference because of insurance and it was a no-brainer.