Hospital Birth vs. Home Birth: A Debate on Choices

When my wife and I chose to have our second child be born at home (our first child was born in a community hospital, not Brigham & Women's or Mass General, with the assistance of a certified nurse midwife), we reflected upon the safety issues, both among ourselves and with our midwife. Had there been any indication that something was out of the ordinary with the pregnancy, long before my wife went into labor, we understood that our midwife would transfer care to an OB in a premier hospital so that our child would be well-attended. Had there been a hint of a problem at any point in labor, our midwife would have packed us up and gone to the nearest appropriate facility. We weighed the likelihood of the need for a Cesarean section, or other interventive care, with the psychological and physical benefits of my wife being able to labor at home, and came to the personal conclusion that the benefits of staying home far outweighed the risks, particularly given the skill and experience of our midwife.

You state the following: "I do not feel people choose to home deliver out of ignorance or stupidity. In fact, such persons usually are more thoughtful and knowledgable of the whole process than your average hospital delivery parents." You have the opportunity to reach, through both your book and your work online, people who are thoughtful and knowledgeable enough to be presented with the facts about home birth, rather than the fear that is so evident in your new book. Please take advantage of that opportunity. Contrary to what you might think, I do not consider myself an advocate solely of home birth, but of making that option truly available to parents around the country through accurate information about midwifery care. If a mother, having been given full and fair information, feels that she will be most comfortable and safer by laboring and birthing in a hospital, then that is where she should be. The worst thing one could do is to have a mother labor and birth in place in which she does not feel safe and comfortable; I believe that anxiety is probably the most prominent "risk" facing any mother.

As I hope you can see, I am far more interested in intelligent discourse than calling you names.

Dr. DiLeo's Response

Certainly those who choose home birth are more passionate about their decision, for the typical hospital birth woman is merely going with the flow. Therefore I expect many more letters in support of home birth than hospital birth. It is tempting to interpret the number of responses each way as a vote of sorts, but that would be unfair to this discussion. I would like to think of this as a qualitative discussion, not a quantitative one. That being said, there are some initial comments I'd like to make.

First of all, that birth is a natural event is not the argument here. What has been gained in modern obstetrics is a reduction in neonatal mortality and maternal mortality. Also, comfort in the way of pain relief for those who choose to bypass discomfort. But what has been lost in modern obstetrics is the fact that it's not just a baby being born, but a family being born. This is the whole point of home birth, it is a "back to the hearth" event of significant importance as a family event. In my book, The Anxious Parent's Guide to Pregnancy, this is one of the points I emphasize the birth of the family as the highest pinnacle of mammalian evolution. It is for this reason that I can easily see the value of home birth from a romantic, caring, humanistic, and loving point of view. But this doesn't mean that I accept it as just as safe as a hospital birth.

One of the misconceptions is that doctors who are anti-home birth are anti-midwife. I can't answer for all obstetricians, but I will say that I have absolutely no problem with midwifery. In fact, I respect the profession greatly. It was a midwife who trained me in the very first delivery I attended. I think that I still use her mindset and technique for deliveries today. Midwives are not saddled with competing responsibilities of post-operative patient care, waiting surgeries, and the myriad other things that obstetricians multitask while patients are in labor. This means midwives can be dedicated to a full labor participation. They are wizards at playing gravity to advantage, sensing the nuances of positioning so as to effect more efficient labor. I wish there were a midwife in every hospital OB delivery area, supervising the goings-on there.