You may have seen our recent blog post that talked about the benefits of home births. As promised, this post is a follow-up from our previous one, and this time we’ll be discussing the risks of a hospital birth.
Please remember that the aim of these posts isn’t to encourage or discourage parents from looking at particular options – we are not pushing one choice over the other! As always, our aim is to empower parents and parents-to-be with unbiased information, so they can make the right choices for their circumstances and their families.
As stated in our previous blog post, when it comes to safety considerations, we all tend to think that hospitals are the safest place we could give birth in. While home births continue to have this reputation of not being as safe. So to debunk some myths, we thought we’d flip this argument on its head and have a deep dive into the benefits of a home birth and the risks of a hospital one.
It goes without saying that this is NOT a blog post against hospital births – appropriate intervention, when necessary, saves the lives of mothers and babies, and as a society we can only be extremely grateful for the availability and accessibility of this service!
Whilst a couple of generations ago, people would happily give birth at home, hospitals are now the obvious choice to give birth in – they have become the cultural norm. But if it’s true that in the absence of particular medical conditions and complications home births can be considered safe, could hospital births carry potential risks that we tend not to be as aware of?
What are these risks?
In hospital labour might take longer or even slow down and stop
Something that we cover in our MummyNatal classes for expectant mums is that labour requires a fantastic cocktail of hormones to work together to allow for the cervix to soften and open, and for the baby to descend into the birth canal.
Women will almost always start labouring at home. And it’s no coincidence that labour often starts in the middle of the night – the place is dark, quiet and feels safe. In this environment, labour can progress quite quickly for some women, and leaving the house to go to the hospital could disrupt and interfere with the process. With the cocktail of hormones we talked about.
If you have given birth before or have spoken to someone who has, you may find this scenario familiar. Contractions feel quite intense and close apart at home. Mum rushes to hospital just to be told that her cervix isn’t dilated enough. Contractions have slowed down. Or stopped, even.
If this happens, this could be the body’s way of saying: “Hang on. Things have changed. I’m not in a dark, quiet environment where I feel safe. Baby is staying put for now”. At this point, Mum might be sent home. Or admitted to hospital, but the environment is no longer as familiar as home. There are people walking in and out of your room, examining you. The place is often bright, bustling, full of unfamiliar smells, and not very private.
You may consciously know you’re safe. But subconsciously, you may be feeling vulnerable, a little anxious, and perhaps even scared. Your birth instincts pick up on these subtle signals, and your body starts releasing adrenalin. Adrenalin is quite possibly the worst enemy of early labour and has the power to slow it down and even stop it completely.
Interventions are more frequent in hospital births
The NHS Choices website states:
“The proportions of women who received epidural or spinal analgesia were lower in non-obstetric units than in a hospital. For example, 30% of women attending a hospital, 8% of women with a home birth, 11% in women attending a free-standing midwife unit and 15% of women attending an alongside midwifery unit received epidural or spinal analgesia.”
The following piece from The Guardian from 2014 also summarises some of the findings: “Women who give birth under midwife-led care have less chance of being asked to undergo medical interventions such as episiotomies, caesareans and use of forceps or ventouse.”
These numbers support a phenomenon known to birth professionals as the ‘cascade of interventions’ – once an intervention is carried out, there is a higher chance that more intervention might be required or recommended.
It’s worth remembering that all interventions should always be positioned as suggestions and recommendations, and parents should always discuss pro’s and con’s with professionals before making a choice.
These are just a few examples that might illustrate the cascade of intervention:
- An artificial induction may cause contractions so strong that an epidural might be offered or requested to manage the pain.
- Artificial rupture of membranes to kick start labour could cause cord prolapse, increase the risk of infection and of pain, which would then need to be further managed.
- An epidural, especially if the hospital procedure calls for continuous fetal monitoring, might affect a mum’s ability to walk around/be upright or get into a squat (which can increase space in the pelvis by 20-30%). This could affect how easily the baby is descending into the birth canal and through the pelvis. This scenario might lead to a vaginal birth where forceps or a ventouse are used (and therefore an episiotomy is required).
- An epidural may lower the mother’s blood pressure – the baby is at an increased risk of not getting enough oxygen through the placenta, and this could lead to fetal distress, which could require further intervention in the shape of an emergency c-section.
You’ll see we’ve highlighted words like ‘could’ and ‘might’ to show that these are just examples of potential outcomes. By no means have these examples showed that every mother in the situations above will have the same outcome – that is simply not true!
Each birth is unique, and specific interventions will be offered based on the individual circumstances. But the fact remains that statistics show that in hospital births interventions are more frequent, and when one is used, others may follow.
A mum giving birth in hospital may not receive consistent and individual care
Hospitals are busy places. And because midwives are often looking after a few labouring mums simultaneously, they might be called to attend another mum while they’re in the room assisting you. It’s not unusual to be looked after by a few midwives, who come and go in and out of your room depending on their shifts and on wherever else they might be needed.
As ‘innocent’ as this might seem, it can lead to additional anxiety and fear building up in Mum, who subconsciously might not feel safe. With adrenalin increasing in Mum’s system, oxytocin struggles to get the right muscles to co-operate – while oxytocin helps the uterus contract and the cervix to soften and stretch to allow the baby to leave the uterus and move down into the birth canal, adrenalin can cause the muscles to tense up. So more adrenalin in Mum’s system (for whatever reason) can lead to a more ‘difficult’ (from a physical point of view) labour. This could mean increased perception of pain or a slower labour.
Having several health professionals looking after you could also potentially increase the risk of miscommunication between them.
A hospital birth can become a heavily medicalised birth
We all know that hospitals follow strict protocols and procedures. These are fundamental, of course, because patients’ lives depend on them. And sometimes birth requires life-saving interventions. Other times though birth could be straightforward if not interfered with.
We touched on this when talking about the cascade of interventions, but when birth becomes medicalised there is potential for undesired side-effects to be created. For example, an episiotomy or a c-section scar can affect a mother’s ability to sit up comfortably when feeding her baby. Or even achieve good positioning and a good latch if she is breastfeeding. Equally, routine checks and examinations that require the separation (even for short periods) of mum and baby, may adversely affect the breastfeeding relationship.
Essentially, when birth is treated like a medical procedure, hospital staff (who, according to their different roles look after a particular aspect of care) inadvertently interfere with a very delicate time in a new baby’s life.
Medical interventions can impact the course of a mother’s future pregnancies and births
Some medical interventions, like an episiotomy or a c-section, may not only impact the mum’s recovery and postnatal period (and potentially some of the choices she might make during that time) but may impact any future pregnancies and births as well. During pregnancy and labour, she might be considered at a higher risk, and she may then require further monitoring and interventions in the future. This can have a huge impact not only on a woman’s physical health but on her mental and emotional health too.
Hospital births carry an increased risk of infections
And last but not least, hospital-acquired infections can become a real risk for any mothers with a compromised immune system. Babies are also susceptible to infections, as their immune system is obviously very immature. A newborn baby’s skin and gut are meant to be colonised by direct contact with the mother’s skin flora (another great reason why skin-to-skin straight after birth is highly recommended). If the baby’s skin and gut are colonised with antibiotic-resistant hospital germs instead, a baby may be at risk of becoming sick from infections that are hard to treat. According to research*, the rate of infections for babies born in hospital is 4 times that of babies born at home.
It’s over to you now. Did you have a hospital birth? What was your experience?
*Outcome of elective home births: A series of 1146 cases. Mehl-Madrona, L.E., Peterson, G., et al. J. Reproductive Med., 1977 (5), 281-290.