Out-of-Hospital Births: Pros and Cons



With the emergence of COVID-19, more and more women are turning to out-of-hospital (OOH) births to decrease exposure to carriers of the virus. Women were certainly engaging in home and birth center births before, but with our hospital systems being overwhelmed by the pandemic, the lure of staying safe at home during labor and delivery has grown stronger. It is always best to consult with your healthcare provider to determine if you are a great candidate for delivering outside of the hospital. For women with high risk pregnancies due to pregnancy related issues or chronic conditions, the hospital is still the safest place to deliver. However, for those who are low risk and have had normal pregnancies thus far, it’s worth doing some research and consulting with your provider. I am not advocating for one place of delivery over another, but I wanted to provide a resource for those interested in OOH births and to discuss the pros and cons of doing so. Keep reading to find out more!


What exactly is an out-of-hospital birth?

Any birth that takes places outside of the hospital setting is considered an OOH birth. Many people believe that delivering in a birth center is similar to being in a hospital, but its actually just like being at home, except you are not at your individual home but a home like setting. So when someone uses this term, they are referring to births that occur at home AND a birthing center. A birth center may be preferred over a home due to the center already having a tub big enough for a water birth or your provider may only deliver at the birth center. There is a possibility that another woman or more, depending on the number of Midwives present, could be delivering at the same time as you. When you deliver at home, it is only you, your Midwife, family, doula, and whoever else you desire to be present.


Pros

  • You are in a familiar place when you choose to deliver at home. If you deliver in the birth center, it is still familiar because this is where you would have gone for prenatal visits. When something is familiar, you are more comfortable and at ease which helps labor to progress.

  • You will decrease your exposure to COVID-19 as you will encounter significantly less people delivering at home or in a birth center than the hospital. The hospital is not solely dedicated to OB and has all types of patients present. However, some hospitals have separate entrances for their maternity ward.

  • You are free to eat and drink. Many hospitals have a policy that labor patients cannot consume anything due to the risk of aspiration if an emergency C-section is needed. However, your provider can always order regular food for you, so ask them if this is something they support.

  • You can walk freely and avoid continuous monitoring when you are home or in a birth center. Walking around and moving allows labor to progress as your body works with gravity. Some hospitals will keep you strapped to the monitor because they are understaffed or don’t have the resources to do intermittent monitoring. When you are outside of the hospital, your provider is only focused on you and doesn’t have to worry about other patients. They are able to keep up with intermittent monitoring, which means you don’t have to be strapped to it.

  • Most women choose to birth outside of the hospital to avoid interventions. You don’t have to worry about anyone offering you pain medication or medication to induce your labor because it is not available. You can feel more in control and stick to your birth plan.

  • You can be surrounded by family. Before COVID-19, most hospitals already had a limit on how many people could be in the room when you actually delivery. This is because the rooms are only so big and there needs to be enough space in case an emergency occurs. Now, many hospitals are only allowing one person to be with you and some have even said none. It can be terrifying to go through labor alone without your support team.


Cons

  • You have no access to pain medication if you change your mind. You would have to be transferred to the hospital in order to have an epidural.

  • If an emergency occurs, the time that it will take you to receive care is delayed. One of the main benefits of delivering in the hospital is that care is immediately available when needed. There is usually an OBGYN who is on staff for the hospital and literally only a few seconds away. Anesthesia is also available if an emergent surgical procedure is needed. There is a unit of nurses who can run in and help at the call of a button. Unfortunately, by the time you call an ambulance or drive to the hospital, it could be too late. It’s important to have a Midwife who is experienced and trained to identify when labor is not following a normal pattern.

  • At home or a birth center, you do not have immediate access to a NICU or NICU team in case your baby is born in distress. Your provider should know basics on how to revive a baby, but sometimes it takes a team instead of just one person. What if you and your baby need the Midwife’s attention? In the hospital, there is a staff member who only focuses on your baby while the Midwife makes sure that you are okay.

  • If your labor is stalled and you require induction medications, you would have to be transferred to the hospital for this.

  • If you transfer to the hospital, you can have two bills. One for the services your Midwife provided outside of the hospital and one for everything that was done in the hospital. Make sure to discuss this with your Midwife during a prenatal visit to ensure you fully understand your financial responsibilities.


Tips when planning an OOH birth

  • Utilize a licensed professional to attend your delivery. Out of hospital birth and unattended birth are two very different things. Unattended means there is no medical professional present, and this is extremely dangerous. I do not recommend unattended births at all!

  • Ensure that your Midwife has an agreement with both an OB and a hospital. If you need to be transferred, you shouldn’t just be left on your own to go to the emergency room. Your Midwife should be able to give the hospital/OB your medical information and explanation of how labor has progressed so far. Even better if your Midwife also has privileges to deliver in the hospital and can be with you there.

  • Timing is everything in an emergency so make sure you are able to get to the hospital easily and efficiently. Some birth centers are even attached to the hospital or just across the street. If your home is too far, consider going to the birthing center so that you are closer to the hospital.

  • Make sure you fully understand the reasons for transfer before you are in labor. Have a plan with your Midwife in place so that the decision does not need to be made in the moment. Always discuss your birth plan during the prenatal time period.



I hope this resource provides some valuable information on things to consider when planning an out-of-hospital birth. Many women have successfully delivered at home and been happy with their decision. Remember, always consult with your individual healthcare provider and work together to come up with the best plan. As always, be strong.

xoxo, Global Midwife

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