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The Hospital and the Home: a Historical Duel

March 28, 2024
Ahma & Co Team
Image Credit: Olha Ruskykh
Image Credit: Olha Ruskykh

Think back to the images, videos, and films of women giving birth. The setting of one may be different from the next, and each woman will have a particular story about how they got there. But, the birth is likely taking place within a hospital, the mother laid on her back, feet in the air, with nurses and a doctor around her, possibly a partner or family member, too. There is likely bright, fluorescent lighting, white pillows, white sheets, white walls. This familiar, clinical scene will be the place that most women will give birth. However, this setting wasn’t always the case. Before doctors, there were midwives. Through a series of events, the practice of delivering children changed over time to what it is today.

From the colonial period until 1765, midwives would aid women in giving birth. Alongside the midwife, the female family members would also be present. Midwifery practice existed for hundreds of years--but just like any pregnancy, it is a daunting thing to give birth, and women and babies died--just like today. Consequently, in the mid-1700s, women launched the idea of having doctors present at their births. Formal pregnancy and birth training then began for doctors. Though midwives were well-versed in this practice, the official education and prestige of doctors catalyzed the shift from home to hospital. Margaret Marsh, a history professor at Rutgers University highlighted that, “over time, there developed a rivalry between doctors and midwives. Doctors would say ‘we know more about anatomy, we are better suited to do this.’ Midwives said ‘we are women, we have experience, we know how we do this.'”

By the end of the 1800s and early 1900s, half of births were accompanied by a doctor. Those who could not afford the expense continued to utilize midwives. In 1950, 80% of births occurred in the hospital; ten years later, 90% of births followed suit. While hospital births became popular, midwives obtained the ability to have a formal education. The second wave of feminism in the 1970s brought about a revival of midwifery, however, the eighties brought regulations to midwives that only allowed them to practice with physician supervision. Today, there are still regulations dependent on the state you are in. However, midwives are educated, highly trained individuals that aim at providing women with holistic care and a birth that they want.

Despite the historical rivalry, pregnant women today have the decision to give birth in a hospital or a home. Though both have their strengths and weaknesses, the choice comes down to what a woman wants out of her birth, what will make her feel most safe, and what will make the process as relaxed and stress-free as possible. Below, we will discuss birthing in a home and a hospital.

To Birth at Home

As described above, for hundreds of years, women gave birth in their home, with their female family members around and a midwife present. It was what you did. As doctors' expertise took over, the practice of midwifery became rare. Though becoming increasingly more common today, home births only account for 1% of all births in the United States.

There are many advantages to having a home birth. First and foremost, you will be in a familiar place: your home. You won’t be on a bed with unknown sheets, pillows and walls; you could give birth in your own bed, with the sheets that smell like your detergent, with the walls full of memories. You could give birth in your living room on the couch, on the floor, or set up a water birth. There could be candles lit, music playing softly, and a camera to document the moments. In any situation, you will be surrounded by the pieces of you and your family that you have curated so specially.

Alongside this, you can be in full control of what you do. In a hospital, you may be given ice chips to attempt to cure your hunger. However, at home, you can be free to make a smoothie, and eat or drink whatever you feel you need to get through the birth. You can walk around as much as you’d like, practice yoga, and give birth in any position that your body decides is best. In Jennifer Block’s book Pushed: The Painful Truth About Childbirth and Modern Maternity Care, midwife Linda tells a couple she is planning with,

“Neither a birth plan or a doula is really necessary at home, because I’m not going to do stuff that you don’t want. In the hospital, you don’t really have much say--your doula is a buffer between you and the hospital. Whereas at home, I view me and the couple as a team. We are cooperating to bring about a healthy birth.”

You have free range to do and feel whatever you please in your home, and your midwife will respect that. In a hospital, there are oftentimes measures doctors will take to speed up the birthing process, such as administering pitocin and oxytocin. Midwives will have these medicines and other remedies as well, however, they only use them if you so wish. In a hospital, you may not have a say in which medical items are used on you. At home, you will.

Though there are great benefits to giving birth at home, women should heavily discuss with their care provider whether this would be the best option. Birth can be a terrifying process and can result in complications. Though there are slightly higher infant risks at home, taking the necessary measures to be sure this is the best course of action for you and your baby will aid in delivery. Things can go wrong in any pregnancy, so being sure you have a midwife who is well equipped for any situation will be crucial. Alongside this, being close to a hospital will be necessary if anything would require medical assistance. All in all, take special note of the birth you want to have, and consider the options with your family, your doctor, and your midwife.

To Birth in a Hospital

Hospital births have become the most common method of birth. Doctors have been trained and educated on pregnancy and birth, and as such, it has become safer since the practice began in the mid-1700s. They have obtained advanced medication that tends to make birth go smoothly, quickly, and very often, pain-free. Alongside this, they have the medical tools to administer a c-section if planned for or need be.

A huge benefit to giving birth in a hospital is being surrounded by medical professionals of all kinds that could help if anything were to go wrong during labor and birth. Women who have diabetes, high blood pressure, are pregnant with multiples, or have had a c-section in the past are at risk for complicated delivery. There are other conditions that may complicate delivery, and as such, women should speak with their care provider about their best option. Dr. Neda Ghaffari, a perinatologist at the University of California, San Francisco, says:

“It's very hard to determine which patients are going to have an obstetric emergency.” In fact, somewhere between 23 and 37 percent of first-time moms attempting home birth end up transferring to a hospital, largely because the baby is unable to move through the birth canal.

As such, giving birth in a hospital may be the best option for many soon-to-be moms. However, because of the possible complications, and because of the access to advanced, modern medicine, women may be more likely to have episiotomies and c-sections in the hospital. 247 per 1,000 vaginal hospital births end up in cesarean sections, whereas with home births, only 53 per 1,000 births end in c-section. Judith Lothian, registered nurse and author of The Official Lamaze Guide: Giving Birth with Confidence talks about the woman’s control she has in the hospital in Pushed: The Painful Truth About Childbirth and Modern Maternity Care:

“It’s an illusion. No Matter what anybody tells you in prenatal classes, or what your friends say, or what you read in books, the bottom line is, you will follow the rules of the hospital, and you will do what your doctor wants you to do. No matter what you think going into it.”

Because of this, Block’s book recommends having a birth plan or a list of required things you want to happen during your hospital birth. Whether it be having low lighting, having music on, not having many people in the room, no surgical procedures, whatever it may be--being sure you feel safe and comfortable will aid in relaxation that will ultimately help with giving birth. With the list, it may also be recommended to have a doula available and with you. Many women have told stories where doctors or nurses administered medical drugs, or began episiotomies that were not wanted by the woman, and having a doula prevented those things from happening. Though sometimes necessary, having a doula there that has more say medically will be important to ensure you have the birth you wish to have.

Despite medical interference, giving birth in a hospital may be the best choice for many women due to the cost. Mother Leslie McClurg highlights that if she were to give birth in a hospital, her insurance would have paid all the bills. With a home birth, she would have to pay roughly $4,000-$8,000 out of pocket. Unfortunately, not everyone’s insurance covers all medical bills, and most insurance will not cover a home birth, so this decision may be more difficult, especially with someone who may have complications that would necessitate a hospital birth.

Dr. Robyn Lamar, an OB-GYN at UCSF notes the lack of reproductive justice that often comes with giving birth. She says, “One should be able to choose their place of birth based on preferences and risk level rather than financial means.” Absolutely. Whether you choose to give birth in a home or hospital, the choice should be up to you, the type of birth you wish to have, and the best option in terms of past pregnancies and possible risks and complications. Though the historical rivalry seems to remain, the bottom line is that in both cases, a beautiful, life-changing process is happening. In the home or in the hospital, a woman is bringing life into this world, and she should be respected and taken care of throughout.

Ahma & Co Team

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