Advantages and disadvantages of hospital birth

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Congratulations! You’re pregnant. Chances are when finding out the big news there were a wide range of emotions that came with it including excitement, elation, and nerves. Becoming a parent is a wonderful thing, but along with the baby carriage comes a lot of important decision making, including how and where to give birth. We thought we’d break down two popular options of both at-home and in-hospital births by listing out some of the potential pros and cons, so you can make the right choice for you and your growing family.

Home Birth

A home birth means just that—delivering your baby outside of a hospital, and in your own home. Choosing this route still requires the assistance of a qualified professional, whether it be a CPM, certified professional midwife, a CNP, certified nurse midwife, a registered or legally licensed midwife, or an obstetrician. Many expecting mothers choose to birth at home for a more intimate experience and to have more control over their bodies and their birth plan. Not all women are able to or recommended to have a home birth, especially if it is determined a high-risk pregnancy due to a number of factors, so make sure to check with your healthcare provider to see if it’s an option for you.

Pros:
– You are able to labor and deliver in the comfort of your own home.
– There are no restrictions on how many family members or friends that can be present.
– You can eat or drink as you wish prior to delivery.
– You are able to walk around freely without monitors or IVs.
– When birthing at home, you are able to have a natural birth without intervention.
– You can choose the delivery position that’s right for you.
– There are little to no time constraints for labor and delivery.
– You may be able to avoid unnecessary medical interventions common in hospital births.
– Low risk of outside exposure to viruses or bacteria.
– After delivery, you can rest in your own bed with your baby.
– You have optional in-home follow-up care and lactation support available.
– You will not be disturbed by doctors or nurses throughout the night.
– Lower delivery costs.

Cons:
-Most insurance policies will not cover home birth expenses.
-There is usually no pain relief or epidural available if birthing at home.
-Birth is messy. You may be responsible for clean up and keeping things sanitary, especially if using a birth pool.
-There are potential risks if your midwife or caregiver is unsure of what to do in an emergency situation.
-You may need to be transported to the hospital if complications arise.
-In case of emergency, there will be a delay in you and your baby receiving care, while in transit to the nearest hospital.
-If immediate care is needed, there is a higher risk of injury or death.
-You are responsible for recording yours and your baby’s vitals throughout the day and night, postpartum.
-You will need to arrange for your own postpartum care.
-You will need to file you’re infant’s birth certificate.

Hospital Birth

Some people feel more comfortable in a hospital setting, knowing they are surrounded by medical professionals in the event of an emergency. Others can’t bare the thought of delivering a baby without pain medication to help them through it. At the same time, hospitals, especially larger ones, can seem impersonal, intimidating, and uncomfortable. Find a hospital has an updated, relaxing maternity wing with warm, soothing lights and rooms, and all the medical necessities at hand. Take a tour ahead of time, so that you’re familiar and comfortable with your decision.

In this article

• Do I have to give birth in hospital?
• What are the advantages of giving birth in hospital?
• What are the disadvantages of a hospital birth?
• What facilities will the hospital provide?
• Which hospital is right for me?
• Who will look after me when I give birth?

Do I have to give birth in hospital?

No, you do have other options. You can have your baby in a midwife-led birth unit, or, as long as you are well enough, at home.

Most women do have their babies in hospital, though. About 94 per cent of mums in England give birth in a hospital delivery suite (CQC 2010).

Hospitals have the expert staff and equipment to help you, whatever happens during the birth of your baby.

You'll probably be looked after by a midwife throughout labour and birth, although obstetricians are on hand to help if their expertise is needed (CQC 2010, Redshaw and Heikkila 2010).

Many mums-to-be like the option of having their baby in a midwife-led unit, or birth centre. These are a halfway house between hospital and home. If that's what you'd like, you'll need to check early on that you have the option. Only about three per cent to four per cent of women give birth in midwife-led units (CQC 2010, Redshaw and Heikkila 2010).

Even fewer mums have their baby at home, about two per cent or three per cent of women in England.

What are the advantages of giving birth in hospital?

You may feel safer and happier giving birth in hospital. It can be reassuring to know that medical help is at hand should you need it. If your doctor or midwife thinks that you will need extra care during labour and birth, they will advise you to give birth in hospital (Nice 2007).

Even if you choose to give birth at home, or in a birth centre, there is a chance you will be transferred to hospital if a complication arises during your labour Nice 2007). The advantage of already being in hospital is that you will have immediate access to specialist care if you need it. The same is true for your baby. A hospital is better equipped for all eventualities.

In hospital you can have all types of pain relief. Until you’re in labour it’s difficult to know you will cope with labour pain. If you want the option to have an epidural, you will need to have your baby in hospital, as you need an anaesthetist to administer it.

Another advantage of having your baby in hospital is that you can stay for a while, giving you a chance to recover from the birth. If you have other children, you may value this time alone with your new baby.

Midwives are also on hand to help you get started with breastfeeding your baby. They can give advice about bathing your baby, and caring for her umbilical stump.

What are the disadvantages of a hospital birth?

You may be intimidated, even frightened, by the hospital environment. If this is the case for you there are things you can do with your room to feel more relaxed. Find out how to make your environment more homely and comfortable.

You are more likely to receive some form of medical intervention in hospital, compared with giving birth at home, or in a birth centre (Nice 2007). For example, your midwife or obstetrician may advise you to have measures to speed up your labour. This is often because each hospital has its own policy about how long labour should take.

Some hospitals are better than others at encouraging an active birth, allowing you the time and space you need to get comfortable during labour. Talk to your midwife to find out what your hospital’s approach to labour is. 

You may be concerned about the lack of privacy in hospital. You may hear others, and they may hear you. Try not to worry about this, and focus on your own needs. You may find that when you're deep in labour, you forget about everyone and everything else.

Being in hospital means there is a small possibility of picking up a hospital-acquired infection such as MRSA, for example. But this risk is very low if you are healthy (NHS 2009). You can reduce your risk of infection by washing your hands regularly.

It is possible for an MRSA infection to pass from mum to baby during childbirth, but it is rare. It can happen if there is a wound in your perineum that is infected with MRSA. In the unlikely event that your baby does pick up an MRSA infection, she will be treated with antibiotics in the hospital’s special care unit.

What facilities will the hospital provide?

Facilities vary between hospitals. If you have questions about what your hospital provides, raise them with your midwife at one of your antenatal appointments.

Most hospitals have adjustable beds, a comfortable chair for your partner, and space for you to move around freely during labour (NCT 2005). Newer hospitals may have en-suite bathrooms. Some older ones have separate, and fewer, bathrooms. Some wards have showers, and some have baths (HC 2008: 69).

Some hospitals may have birth balls, mats and wall bars, to help you lean or squat. Some may look more homely than others. You may be able to bring things from home to make your room feel more comfortable. Again, ask your midwife what you can bring to your hospital.

If you want a water birth, check that a birth pool is available at your hospital. If you want to use it during labour, tell the midwives caring for you during pregnancy.

Some midwives are trained to use complementary therapies to ease labour. If you are interested in finding natural ways to cope with childbirth, ask your midwife if this is an option at your local hospital.

Which hospital is right for me?

Depending on where you live you may have a choice of hospitals. If so, think about your needs and which hospital will best meet them.

For example, if you're expecting twins or have a medical condition, you may want the reassurance of a big teaching hospital. On the other hand, if you are well and have a healthy, straightforward pregnancy, you may prefer a smaller hospital.

Smaller hospitals may not have a full-time obstetrician on the labour ward. This may be a deciding factor if you feel happier having all levels of expertise available at all times (RCOG 2007).

If your hospital doesn't offer tours, even via a website, explore the options in your area. Discover your local NHS maternity services.

A good way to find out about a hospital is to ask friends who have given birth there about their experiences. Try not to be too influenced if one of your friends feels she had a bad experience. Every labour and birth is different, so it's best to get a balance of opinions.

Depending on your circumstances, and maternity provision in your area, you can change your mind about where to give birth at any time during pregnancy. Your final choice can be made at the end of your pregnancy (Midirs 2008). You can even decide during early labour, although it’s not ideal to leave it this late.

Who will look after me when I give birth?

A midwife will care for you during labour and birth. You will only need to be seen by an obstetrician if a complication arises during your labour.

Although you may have seen the same midwife for all your antenatal appointments, you will be looked after by whoever is on shift when you arrive at hospital. That’s unless your hospital runs a caseload midwifery service.

You'll have one midwife at a time caring for you during your labour, although she may call a colleague to help her, when the time comes for you to give birth.

Depending on the length of your labour, it's likely that you will be cared for by more than one midwife as one shift ends and another begins. Or, your midwife may be changed to accommodate the changing demands being made on the labour ward in general.

If you're giving birth in a teaching hospital, student midwives may observe and participate in your care, depending on their stage of training. Medical students may also request to observe your labour and birth. If you are not comfortable with this, say so, or ask your partner to tell your midwife.

It’s important that you have confidence in the people caring for you during labour. If you don't get on with your midwife, or feel that you are not being treated with respect, ask for another midwife.

If all is well, you may be left with your birth partner for periods of time during your labour (CQC 2010). If, at any point, you feel your midwife should be there to help you, ask for her to return (Nice 2007). There'll be a buzzer next to your bed which will call your midwife to the room.

You may want more than one birth partner with you. If so, you'll need to check your hospital’s policy with your midwife so you can plan ahead. Some hospitals, because of space issues, will only allow you to have one birth partner.

If you're still exploring your options, find out all you need to know about home birth and giving birth in a birth centre.

References

Atkins L, Guderian J. 2005. Blooming birth. London: Collins.

Beake S, McCourt C, Bick D. 2005. Women's views of hospital and community-based postnatal care: the good, the bad and the indifferent Evidence Based Midwifery 3(2):80-86

CQC. 2010. National NHS patient survey programme: survey of women’s experiences of maternity services 2010. London: Care Quality Commission. www.cqc.org.uk [Accessed January 2011]

CQC. 2010. Maternity services 2010. www.cqc.org.uk

Chesterfield Royal Hospital NHS Foundation Trust. nd. Having a baby in...hospital www.chesterfieldroyal.nhs.uk [Accessed October 2010]

Elatter A, Selamat EM, Robson AA, et al. 2008. Factors influencing maternal length of stay after giving birth in a UK hospital and the impact of those factors on bed occupancy. J Obstetrics & Gynecol 28(1):73-6

Healthcare Commission. 2008. Towards better births: A review of maternity services in England. London: Commission for Healthcare Audit and Inspection www.cqc.org.uk [Accessed September 2010]

Midirs. 2008. Informed choice leaflet for professionals: hospital or home.

NCT. 2007. Happy birth day. 2nd ed. London: Mitchell Beazley.

Newburn M, Singh D. 2005. Are women getting the birth environment they need? Report of a national survey of women's experiences. London: NCT www.nct.org.uk

NHS. 2009. What are the risks of MRSA during pregnancy? www.nhs.uk [Accessed October 2010]

NHS. 2010. In hospital. www.nhs.uk

Nice. 2007. Intrapartum Care – care of healthy women and their babies during childbirth. National Institute of Health and Clinical Excellence. Clinical Guideline 55. London: NICE. www.nice.org.uk

Ockleford EM, Berryman JC. 2004. Postnatal care: what new mothers say. Brit J Midwifery 12(3):166-70.

RCOG, RCM, RCA, RCPCH, 2007. Safer childbirth: minimum standards for the organisation and delivery of care in labour. London: RCOG Press.

Redshaw M, Heikkila K. 2010. Delivered with care: a national survey of women's experience of maternity care 2010. National Perinatal Epidemiology Unit. Oxford: NPEU. www.npeu.ox.ac.uk [Accessed January 2011]

Williams. C. 2007. Arbitrary time limits for the second stage of labour — do they disempower women from achieving normal birth? MIDIRS midwifery digest. 17.4. www.midirs.org

Wray J. 2006. Seeking to explore what matters to women about postnatal care. Brit J Midwifery 14(5):246-54

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