I am a homebirth doctor. I have attended many hospital and homebirths.

I had my baby at home before I worked and studied in hospitals. My homebirth experience was very different from what I was trained to do and practiced at the hospitals.

I encourage every women to research and ask around for all the information so she can make informed empowered decisions for her own personal needs. Some of these things listed may be done routinely in hospital BUT if bought to individual doctors attention can be discussed.

I was working in labour wards and antenatal clinics at a state hospital and the protocols were very different to what I thought was important in connecting with mothers and supporting physiological, even sacred births.

When I was working as a homebirth doctor with other independent midwives I noticed again – so many innate and important differences that happen at homebirths that are not done at hospitals births and others that are done routinely in hospital births but do not happen routinely in homebirths.


Photo credit: Natalia Roca fotografia of http://www.nataliaroca.com/Thank you Natalia for this beautiful photo and your work! 

Photo credit: Natalia Roca fotografia of http://www.nataliaroca.com/

Thank you Natalia for this beautiful photo and your work! 

 

Here are a few (based on my personal experience):

At a homebirth –

  1. A mother’s space is protected and the environment slowed down, lights dimmed, voices low, music chosen, delicate aromas – often.

     

  2. Midwives often sit around like they are doing nothing but they are exquisitely in tune and observing if not actively supporting the mother. They are fully alert and attentive to all the nuances of labour and the mother. They know what is normal and how to spot “abnormal” and what to do about it.

     

  3. Midwives know how to examine a mother (even hands-off!)– without serial and routine vaginal examinations. So there may not be routine vaginal examinations! And if done they are discussed with permission and awareness or information.

     

  4. Midwives have a different clock and may not use a partogram. This allows for a freedom within labour – with less “time” pressure! At the hospital everything happens depending on the clock.

     

  5. Midwives have all equipment they need should any emergency arise – like iv lines, fluids, ambubag for resuscitation even a suction machine and emergency drugs.

     

  6. No routine injections are necessarily given including routine syntocinon (injected into mother’s thigh) and Vitamin K (injected into the newborn baby’s thigh). This is an active and informed discussion between the parents and the midwife before the birth.

     

  7. Mothers can sip juice, eat snacks, or meals of their own choice – during and after labour.

     

  8. Mothers can wail, scream, grunt – be as loud as they need without anyone asking them to be any different.

     

  9. Midwives monitor baby’s heart rate intermittently with a handheld doppler after or during a contraction.

     

  10. If a mother say’s NO she will probably not be forced….

     

  11. Pharmaceutical pain medication is not used at a homebirth as each and every one has a side affect and therefore may need extra monitoring or resuscitation at birth. (It can make baby drowsy and slow to breathe). Therefore mothers have to find other ways to cope with pain or reinterpret it – and they do!

     

  12. Mothers can lie, stand, be in pretty much any position that is comfortable to THEM at any time during labour and even during the birth. (Us, midwives become adapted to very creative means of delivery in all kinds of positions too!)

     

  13. The baby comes immediately to the mothers chest and stays there skin to skin with no interruption and separation at all, as guided by mother or any medical need.

     

  14. According to the mothers desire and needs at the time – it is her choice who is at the birth – father, doula, photographer, mother, friend, midwife, midwive’s assistant….or not.

  15. Antibiotic ointment is not smeared over the baby’s eyes. 

     


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There are so many more as I consider it….

Another one I want to add:

16. Midwives have a backup. They always have a backup of someone who can offer more specialised services than them if there is a need of it. That is why the good and trusting relationship between gynaes and midwives is so important. Hospital doctors also have a backup. I worked alone in labour wards after hours and I had a backup of the specialist gynae – who could be there in 5 minutes if I needed him or was available for a phone consult. He also had a backup. We were at a secondary hospital – his backup was the next level hospital. We all have to have a backup. Its not humility. Its practical. Its co-operation. Team work. Mutual respect for each others role – none better or more.  

Please share with me here of the differences you may have noticed that have had an influence on your choice of where to birth?

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0 Comments

  1. Difference #17: Adequate pain relief like and epidural is unavailable at a home birth. Women laboring at home are deprived of that option. Their choices has been removed when laboring at home.

    1. Yes. As I noted in point 11. No pharmaceutical pain medication is available at home as there are side-effects for each one. Which could result in the need for resuscitation or help of the newborn. Epidurals contain pharmaceutical drugs injected into the epidura surrounding the spinal cord and contain substantial risk. Therefore require a qualified anaethetist to inject and monitor. So it is of course not available at a home birth. Interestingly in the state hospitals I worked at they were not offered there either…as there were insufficient anaethetists available. I would not say their choices have been removed. I would say they make that informed and aware choice when choosing a homebirth.

    2. You don’t think women who choose a home birth understand this and most likely have chosen home birth to avoid those options? I know its the reason I had a natural birth last time and will have a home birth this time. I was not "deprived" by birthing at home, if anything I was empowered.

    3. Most woman choose a homebirth anyway… There is always an option to transfer if it’s necessary? I have never had an epidural with my hospital births either. It isn’t the vital, be all and end all its made out to be…

    4. Deprived? No way. Women were made to give birth naturally and did for thousands of years. We also go into homebirth knowing that is not an option, and choose a natural birth. There was no time during either of my deliveries at home that I would have gotten an epidural if offered, and after my second baby I was walking around the house mere minutes after giving birth. Try doing that after an epidural.

  2. I had my first born in the hospital, filled with time restrictions ("you have 1 hour to progress or you’re going to c-section"), unexpected occurrences (the dr popped my bag of water without permission during a vaginally exam sending me into shock), and received everything but the c-section (zytotec, pitocin, ripping, episiotomy, forceps,and vacuum). Needless to say an unpleasant experience.

    My last two babies were homebirth. The extreme opposite. I went into labor naturally, labored at home, soft music, dim lights, eating, drinking until the last moment. My midwife was calm the entire time. She made me feel at ease, asked me permission with everything, warm birthing pool… the best empowering experience of my life. (And I’ve ran 4 marathons!) Thank you for posting this article. More people need to be aware of how much control we as women have over our births. Truly a miracle and a gift!

    1. Thank you, Yes. I feel there are some basic difference that DO matter to mothers that they are not aware of and therefore not making fully informed decisions. With more information they can choose and discuss and have open negotiations with awareness with their care provider.

  3. As a birth photographer and doula the biggest difference I see is the laboring mother being the boss. She tells everyone what she wants, needs, or prefers. There are no nurses or doctors coming into her labor space to tell her what to do or when to do it.

    There is also something to be said for a woman that gives birth in the place she feels most physically and mentally comfortable.

  4. I had two great hospital births (public hospital) and literally all the advantages of homebirth listed above happenned there, too, without special "negotiations". Maybe I am lucky to live in Belgium…

  5. I am a Doula and opted to have a hospital birth with midwives and a Doula present. My hospital birth was wonderfully empowering, and I had literally every single one of the benefits listed above. Women should know that while home birth is a beautiful and amazing choice for many, for those of us that don’t have that option it IS possible to have a beautiful, empowering hospital birth where you are fully in control of the experience.

  6. My primary reason for choosing home births after an emotionally traumatic hospital delivery was the emphasis on birthing being mother-led at home rather than Doctor led at a hospital.

  7. This article is so defensive it is alarming. I had 2 natural childbirths- in a hospital. And could have done whatever I wanted. Just choose a doc who is supportive of you and the rest will fall into place. No need to start a war

    1. Interesting you find it defensive? Please let me know which parts as that is never my intention. I am hoping to be assertive and pass on information so people can make their own informed choices.
      Thank you for your comment and for reading it.

  8. In the US standards of care vary WIDELY. Some women have empowered hospital births with great support while others are literally abused and assaulted. Most of the hospital births I’ve attended mom is not allowed to eat and beyond that rules on movement, positioning, lighting, people in the room IVs, etc. all varies. If you live in a place where supportive, mother-led care is the norm, you’re lucky. I’m a doula who chose homebirth because after attending multiple births at multiple hospitals (over 10 different hospitals) I knew home was the place for me. I unequivocally defend each mother’s right to choose to birth where she feels safe and supported. For many that’s the hospital, for some it’s a birth center, for some it’s home. I advocate for informed choice and more choices.
    In the US our disaster of health insurance creates circumstances where insurance companies are making or manipulating policies, not doctors or hospitals, and not based on best practices or even evidence. Racism plays a heavy role in quality of care as well, sadly. We have a lot of work to do here.

  9. With three hospital births only one of the doctors who had given me prenatal care actually attended the birth. The last two homebirths I had exactly who I had planned on being there.

  10. We should be encouraging others to be like Christ, not like ourselves! Gods word is silent on this subject.
    One cannot measure a spiritual experience. I would not have survived a home birth. After my 8th child was born doctors discovered a 3/4" hole in my heart. You don’t know what you don’t know. The epidural that I tried every time to avoid, to avoid the condemnation of the evangelical all naturals, saved my life! Midwives cannot see and are not prepared for such emergencies. The life of a child or mother is at stake. There are horror stories on both sides as well as blessed ones. Just because a decision is right for you doesn’t mean it is what others should do. On other topics that Gods word is silent on we shouldn’t need the approval of our own choices. (Homeschooling, immunizations, organic, etc. we are so enamored with our choices) Lets give God praise for whatever path He leads each of us to such amazing blessings!!

    1. Thanks Karen. I completelty agree with you. I am hoping my article could provide information for people to make informed choices. Not that everyone would choose the same way! I too, am facing many choices and situations that remind me that what is my best choice at one time for one child is not necessarily best for every child and every family at everytime. My wish is that each mother and family can make their own empowered and informed choice of their own.
      God Bless!

  11. I got 15 out of 16 in my hospital birth, the only difference was that I wanted to have apidoral and I got it (but I wasn’t forced to….) plus the security that if anything goes wrong me and my baby can get an immediate care!

  12. I got 16/16 for both of my births in a hospital. with the 1st one….the midwife needed backup very quick so 2 doctors arrived in less than a minute…..

    1. Wonderful to hear! Amazing how there is so much variety between institutions around the world. It shows what is possible.

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