"Your Birth, Your Way: Doula and Birth Experience at Home vs. Hospital"

Cordelia Thompson
Oct 23, 2024
5 min read

Updated: Dec 4, 2024

Is having a Midwife and a Doula unnecessary or is it a complementary meshing of individual strengths to benefit a client?

Many midwives are grateful for knowledgeable and compatible doulas on the team, and some discount their services for clients who have a Doula or have taken an independent childbirth education class supportive of the homebirth environment. Some midwives practice in a way that they are present for early labor, and do not see the need for additional doula support. Like all things “doula,” it depends on what the woman wants, and on how informed she may be about the pros and cons as she makes her birth choices. Whether at home, in a birth center, or in a hospital, the birthing experience can be vastly different—but a doula’s support is typically considered essential in all settings. They help create a calm, empowered birth, wherever you decide to welcome your baby.

If you choose to have a home birth your midwife will most likely provide most of the supplies you need for a successful home birth. However, you might want to make sure that you have plenty of extra towels and blankets on hand. You will also need to prepare your home making sure you have a clean and comfortable area for the birth to take place. You may also want to make sure you have: light food for labor, a refillable water bottle, pillows, at least two, pail or bowl for vomiting, ice chips, ice cubes or Popsicles, Ice pack.

Here are some of the pros and cons of having a home birth, highlighting both the benefits and challenges of choosing to give birth at home: Having the comfort of your environment: you have control over the surroundings, including lighting, temperature, music, and the presence of family or friends. Increased control over your birth experience, natural birth, focus personalized care, fewer medical interventions (Home births tend to have lower rates of interventions like epidurals, forceps deliveries, episiotomies, and C-sections.) Bonding and immediate family involvement, postpartum comfort.

Having a water birth may be easier to accomplish during a home birth. Water births are considered safe for healthy babies and low-risk pregnancies in fact they are considered quite beneficial for natural pain relief. A water birth can also help lower blood pressure. There is a chance though that it can slow down contractions, but it would still be a helpful form of relief if the mom needs a rest. Unfortunately, most hospitals do not allow underwater births because of the potential risks to the mother and baby, and the added liability for the hospital.

Here are some Cons of a Home Birth you should consider: Increased Risk in Emergencies: Home births are generally safe for low-risk pregnancies, but sometimes complications can arise unexpectedly. There may be a delay in receiving emergency medical care since you’ll need to be transferred to a hospital if complications occur. There are no immediate medical interventions and potential for transfer to hospital (About 10-15% of first-time mothers and 5-10% of experienced mothers planning home births are transferred to hospitals during labor, often due to slow progression or desire for pain relief. While most transfers are non-emergency, they can still be disruptive.) there is also an increased responsibility for preparation and potential legal and insurance issues.

Here are some of the pros of a Hospital Birth. You have immediate access to medical care, pain relief options, emergency interventions, trained medical staff, postpartum support, neonatal intensive care unit (NICU), and insurance coverage.

Here are some cons that may come with a hospital birth. You may have limited autonomy and control over how freely you can move around during birth. Higher risk of interventions, you may feel more pressure to have medical intervention whether it is needed or not. You will have less personalized care, and the potential for a more clinical environment (The bright lights, equipment, and hospital routines can interfere with the calm, peaceful atmosphere some people prefer for labor.) Restricted birth plans, (hospitals may have policies that limit certain birth choices, like water births or delayed cord clamping, based on their protocols or the attending doctor’s preferences.) Higher Cost (Without Insurance), in today's time it is rare but occasionally there might still be Separation After Birth where the baby is put in the nursery while the mom recovers.

There are a few things that may disqualify you from having a home birth, Pre-existing Medical Conditions may include Hypertension, Diabetes, Heart Disease, Kidney Disease, Clotting Disorders, and Seizure Disorders. There are also a few pregnancy complications to take into consideration as well, Preeclampsia, Placenta Previa, Placental Abruption, and Severe Anemia. Here are a few fetal complications breach presentation Multiple Gestation (Twins or Triplets) Congenital Anomalies, and Fetal Distress. Labor and Delivery Complications might include Previous C-section (VBAC) Prolonged or Preterm Labor, Post-term Pregnancy (Over 42 Weeks) Failed Progression of Labor, and Shoulder Dystocia. Some of these conditions are not as serious as the others and it will ultimately come down to whether you can find a midwife to cover you in whichever type of pregnancy you might be in.

The maternal death rate in home birth is about 170 deaths per 100,000 births, In 2022, the maternal mortality rate in hospital births was about 22.3 deaths per 100,000 live births. The perinatal mortality rate for home births is about 3.9 per 1,000, compared to 1.8 per 1,000 for hospital births.

There are blood vessels in the baby’s lungs that adults don't have, that keep the lungs from being used the way that lungs are used to process oxygen. Because the baby doesn't use its lungs before birth; the lungs are filled with fluid. The fluid keeps pressure on the blood vessels so they don't open and aren't needed yet. During labor, the force of the baby being born through each contraction pushes the fluid out of the baby’s lungs. As there is less and less fluid the blood vessels start opening up. As the labor progresses one of the extra blood vessels the baby has will close, this vessel keeps the blood from going into the lungs, so when that happens there is less pressure on the other blood vessels. When the head is delivered the baby starts taking breaths in response to the lack of oxygen. The first few breaths allow the vessels to open up as much as possible. The baby takes the first breath within about 10 seconds after delivery.

sources:

Pregnancy, Childbirth, and the Newborn: The Complete Guide by Penny Simkin PT (Author), Janet Whalley BSN IBCLC (Author), Ann Keppler MN (Author),