Carrie Hook had her first two babies in a Minneapolis hospital, where she was surrounded by obstetricians, nurses, and cutting-edge technology. When she had her third baby, she was surrounded by a midwife, a house contractor (her husband, Joe), and a tarp to protect the living room carpet.
Home births aren't for everyone. But if Hook ever has another baby, she knows exactly where she wants to be: At home, not the hospital. She loved the privacy of being at home, she says. She could take a bath in her own tub, she could snack in her own kitchen, and, later, she could rock baby Julian on the exact spot where he was born.
Less than 1 percent of American babies are born at home. But that number is rising, and so is the controversy.
The American Congress of Obstetricians and Gynecologists officially opposes home birth. Its policy states that birth requires standards of safety that are provided in the hospital setting and cannot be matched in the home. The group published a study suggesting that babies born at home were twice as likely to die during delivery, and has noted that it is especially hazardous to attempt a vaginal delivery at home after having had a previous c-section.
But Susan Cassel, a certified nurse midwife in San Diego, says such fears are overblown. If a woman is at low risk for complications, home birth is as safe as a hospital birth, she says. A report from the British Medical Journal supports this assertion: The report concludes that planned home births by women in North America with low-risk pregnancies resulted in lower rates of medical intervention than their counterparts who had hospital births -- and no greater rate of poor outcomes or infant deaths. And a 2009 study from Canada found giving birth at home with a midwife present to be as safe as a hospital delivery by a doctor or midwife.
Every intervention possible
When Hook had her first baby, the whole event seemed far from normal. She was a healthy young woman going through a natural process, but she felt more like a patient in the emergency room. She had just about every intervention possible, she says. She received Pitocin to speed up contractions and morphine to ease the pain. The doctor used a vacuum to suck Madison out of the birth canal. And because Madison had breathed in some meconium -- essentially, baby feces -- the nurses whisked her away before Hook had a chance to hold or to nurse her.
Several hours later, Hook walked to the hospital nursery and got her first good look at her baby: red-faced, screaming, soaking wet, and alone.
For Hook, giving birth at home was a completely different experience. She may have missed her pain medication, but she didn't miss the beeping monitors and the IV in her arm. No one took Julian away after he was born. Hook held him close while the midwife cleared his airway.
Hook's first delivery was the kind of experience that turns many women off from hospitals. In a British survey of women who chose home birth, the most popular rationale was a desire to avoid unnecessary intervention. Looking back, there was only one intervention that Hook really appreciated. Pain medication is not a bad thing, and you don't get that at home, she says.
Of course, some women really need interventions and the constant support of doctors while giving birth. According to the American Pregnancy Association, women shouldn't even consider a home birth if they have high blood pressure or diabetes or if they're at risk for preterm labor.
Even if a woman is completely healthy, she should never completely rule out the possibility of a hospital delivery. If the labor isn't going smoothly or the baby seems to be in distress, both she and the midwife must be prepared to go to the hospital, Cassel says. There are absolutely no guarantees, she says. Everyone's goal is a healthy baby, not a home birth at all costs.
Indeed, doctors advise women planning a home birth to work with midwives who have a relationship with a medical practice that agrees to back up the midwife in an emergency. They also note that there certainly can be a middle ground between Hook's high-intervention delivery and a home birth. In most communities there are obstetricians, family physicians or nurse midwives who are committed to family-centered maternity care in the hospital. These people are willing to honor a woman's birth plan to the fullest extent possible. The outcome really depends on who's on your team and how well you communicate.
More perks, greater cost
Morphine wasn't the only hospital perk that Hook appreciated. The birthing bed was comfortable -- at least more comfortable than her living room floor. She also was glad to have constant labor support from nurses. They told her when to breathe and gave her plenty of other tips for getting through the ordeal.
But all of that support comes with a price. According to the American Pregnancy Association, a nonprofit pregnancy health education resource center in Texas, home births tend to cost about 60 percent less than hospital births. However, that doesn't necessarily hold true if you have comprehensive health insurance. In that case, a hospital birth that's fully covered could be less expensive than a home birth if you have trouble getting reimbursed for delivering at home.
The bottom line, Cassel says, is that a woman should give birth wherever she feels safest. If she doesn't feel safe, the hormones of birth won't flow well, and she won't have a good experience, she says. Women who opt for a home birth can enhance their feelings of safety by thoroughly interviewing their midwives ahead of time, she says.
Carrie Hook says she trusted her midwife, and she felt completely safe while giving birth at home. And if anything went wrong, the hospital was just down the street. It's a good hospital, too. It's just not home.
Interview with Carrie Hook
Interview with Susan Cassel
Janssen P.A., et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ.
Johnson K.C. et al. Outcomes of planned home births with certified professional midwives: large prospective study in North America. British Medical Journal. 330(7505):1416.
American College of Obstetricians and Gynecologists. News release: Frequently asked questions about having a baby in the 21st century.
American Pregnancy Association. Home birth. http://www.americanpregnancy.org/labornbirth/homebirth.html
American Academy of Family Physicians. Midwives. American Academy of Family Physicians. Birthing centers and hospital maternity services.