15 differences between home and hospital births – that they don't tell you

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?