Home vs. Medical Births: Comparative Analysis Term Paper

Introduction

The fact that homebirths could be an option for women with low risk pregnancies remains debatable and controversial. There is a need to explore this alternative and determine its likelihood as a safer option due to escalating costs of hospital births and general healthcare. Moreover, the alternative can help flourish midwives who are denied the ability to lead professionals in hospital, with admitting and discharge priorities (Declercq et al., 2005). The problem remains in the fact that most people hold the belief that hospital birth is safer and better, and it may be supported by state law in many countries. There is a need to rectify the laws in order to shift from pre-scientific dog-mass and take advantage of promoting home births.

Discussion

The decisions concerning birthplace are guided by a number of factors including legality, quality of care experience, freedom of choice, costs and prospects of safety. These decisions are made by consumers, policymakers and practitioners. State laws regarding birth are not necessarily guided by empirical research findings on child outcomes, whereas the policy and lay literature can be blamed in a way for having failed to provide balanced presentation of evidence which is also unemotional. The literature according to Hafner-Eaton and Pearce show that low-to moderate-risk home births attended by direct-entry midwives could be as safe as those at hospitals attended by midwives or physicians (1994; qtd. in Hughes, n.d.). The authors supports the idea of private and public health insurers to reimbursing the lower-cost birth option and the ramification of policy to have changes in the medical and alternative health personnel and allow home as medically acceptable and legal birth setting Hafner-Eaton (1994; qtd. in Hughes, n.d.).

The assertion by Drife that hospital birth may be as three times safer have been criticized is misleading on the basis that the study groups were dissimilar (Garvin & Edmund, 2000). Drife had compared data of deaths in two studies in the United States and one study in Australia with data from the confidential enquiry into stillbirths and deaths in infancy (CESDI) in Northern Ireland, Wales and England in 1994 and 1995 (Macfarlane, McCandlish & Campbell, 2000). Further more, the Drife’s study was criticized for having not defined the categories of deaths included in the groups of births in which the deaths were compared, content of available maternal care, or even on the type of birth attendants (Macfarlane, McCandlish & Campbell, 2000). Drife also missed in the likelihood of differences in the healthcare setting in various countries because he compared data for different countries as seen earlier. Drife’s conclusions that the safest policy is to champion for hospital births because he failed to mention any research on the subject in the UK published since 1994, prospective or retrospective studies in the former Northern Region, neither the National Birthday Trust Fund survey in the United States, according to Macfarlane, McCandlish & Campbell, 2000. Macfarlane, McCandlish & Campbell support the idea that there is need for continued audit. Submission of complete “maternal tail” data would be essential in order to advance the recommendations by the aforementioned authors that “denominator data” about planned and unplanned home births (reported as lacking by the CESDI) can be collected at the national level in England through the existing maternity episode statistics. In addition, auditing of home births at a regional level as was done in Northern region of England in other parts was also necessary. Other authors (Gavin & Edmund, 2000) of a BMJ article asserts that although a safety audit for homebirth has been running for 18 years in England before his study, the author went ahead and wrongly reported that no such audit had been carried. In England, among an estimated 3400 mothers who were booked for home birth when labor started, one neonatal (0-27 day) death and no intrapartum death were realized for about fifteen years (1984-1998) according to Gavin & Edmund (2000) in a BMJ article. According to the author, homebirth may have become statistically safer because high risk mothers also press for home delivery. The author points out the need for providing mothers with accurate and balanced information, and this can help them to make informed choices about the place of birth. the author is of the view that different women should be advised differently depending on the risk, but most of them should be told that it is possible to have as safe home births as the hospital as long as they can take professional precautions and that the risk for those experiencing post-term pregnancy, breech and twin. Women would be possibly better placed for believing what they are told during pregnancy and labor, if it was possible to offer individual specific advice to them if information needed for the advice was available.

With appropriate prenatal care and attendant personnel, home birth can be a better option and therefore the state law that support this option needs to be amended because it makes financial and medical sense. In addition, the insurers should be able to reimburse for home delivery and medical back-up need be provided by hospitals and obstetricians (Hughes; qtd. in Hughes, n.d.). The advantages that can be accrued from home delivery include cost-related benefits where the method is itself cheap and because of fewer processes, the procedure gets cheaper. It has already been reported that one would incur 68% less of birth costs in a home than in hospital for average uncomplicated vaginal birth. With the healthcare cost being high, and many women lacking insurance, it would be necessary for paying attention to one health service that every or many families need (Anderson & Anderson, 1999). Allowing for homebirth can allow the country to shift the resources utilized (such as the percentage used in the Medicaid for covering births) to other priorities by allowing for birth alternatives that make reduction of the cost possible according to Anderson & Anderson (1999). The authors support the findings of lower incidence of cesarean delivery, neonatal mortality, and lower combined rate of intrapartum. According to Olsen, homebirth for health pregnant women could be even safer, for all statistical comparisons relevant to Nordic (1994). Another advantage that has been associated with birth at home is that several of the elements that characterize home births make the births proceed much easier, as shown from randomized clinical trials (Olsen, 1994). In another study involving 862 planned home births attended by midwives and compared to hospital births (571 attended by midwives, 743 attended by physicians), fewer procedures were undergone by women who chose to have home births during labor than those were attended by a physician at a hospital. In this study, the group attended at hospital by a physician and that attended at home scored similarly in meconium aspiration, rates of prenatal mortality, five-minute Apgar scores and need for a transfer to a different hospital (Janssen et al., n.d.). The study found out that the group choosing to have home births had younger people than those I the group with planned hospital births.

A study in Western Australia involving 976 women who “booked” to have a home birth between 1981 and 1987, and 2928 women planning to have hospital births (singleton births only) found out less likelihood of women to having complications at labor for home births, although they were more likely to have a retained placenta and postpartum hemorrhage. In addition, these women were less likely to have any sort of operative delivery although they had a longer labor (Woodcock, Read, Bower, et al., 1994).

Planned homebirths that were attended by regulated midwives was found to have no increased risk as compared to the birth attended by either midwives or physicians in hospital, in a study by Janssen et al. (2002). The research however outlines that the expected complications (thick meconium in the amniotic fluid and hemorrhage) were likely to be more serious at home as compared to the hospital.

Another study carried out with an objective to evaluate the safety of home births in North America, found out low rates of intrapartum and neonatal mortality for women who chose to have a home birth right from the start of the labor, and under a certified professional midwife. These rates were similar to those of low risk hospital births, but with lower medical interventions. The study also found high degree of safety and maternal satisfaction. In addition, 87% of women involved did not require to be transferred to the hospital (Johnson & Daviss, 2005). This study involved 5418 women expecting to deliver in the year 2000 and chose to deliver at home. The rates for vacuum extraction (0.6%), episiotomy (2.1%), caesarean section (3.7%), forceps (1.0%) and epidural (4.7%) were found to be lower than those for low risk US women having hospital births.

The need for a situation that allows homebirth with possibility of transfer to the hospital when needed has been put forward. A study involving 1404 mothers intending homebirths (of whom 8.3% were transferred to hospital during labor and 14 infants transferred after birth) found an intrapartal fetal and neonatal mortality of 1.8 per 1000 for those delivering at home, while the rate was 2.5 per 1000 for women who were beginning labor and with an intention of delivering at home. The care of qualified practitioners and a system that allows for transfer of patients in hospital is necessary according to the finding of this study (Murphy & Fullerton, 1998; qtd. in Hughes, n.d.).

The choice of homebirth as a birth option must be explored well and nicely because it applies sometimes to specific cases in special ways. The factors that can be considered include the quality of the healthcare system of the country in question. The healthcare system may be as well cheaper such that the cost advantage is minimal. In other situation, the healthcare system may be a bit poor. For example, Australia had realized perinatal deaths of 6.4 per 1000 for planned home births according to World Health Organization definitions. The death rates for Australian home births were found to be higher than elsewhere. Lack of response to fetal distress and underestimation of the risks associated with post-term birth, breech presentation and twin pregnancy presented the largest contributors to the excess mortality in the Australian case (Bastian & Keirse, 1998). This may point to the fact that a system that allows for transfer to hospital in case of complications.

Conclusion

Home birth as a health option is advisable and needs to be supported by state laws in order to gain the accompanying advantages, including shifting extra-costs for involved medical arrangements such as Medicaid, to other issues of national priorities, since home birth is cheaper for normal pregnancies and births. Home birth may even be safer or equally safe compared to some arrangements for hospital delivery. To succeed, home birth arrangements will need assistance from the healthcare system through provision of necessary and accurate information to women to guide them make necessary decisions. In addition, women should be provided with insurance. The fact that proper qualification of midwives participating in home birth-whether direct entry or not-is important cannot be overemphasized. Some of the factors that may make exploration of home birth an option include cheap costs amid escalating healthcare costs, quicker processes and cultural benefits.

The exclusion of home birth as a choice to women, and continued emphasis on beliefs that support only hospital birth as the only safer option must be eliminated because they may lead to dangerous trends. One such trend is where the hospitals are not able to support the numbers of women admitted in them, and which in turn may lead to further complications as a result of late attendance by professionals. Thus the healthcare system in a given country may be worth considering when exploring home birth as an option.

One avenue that can be followed is supporting home birth by availing a system which allows for immediate transfer to hospital incase of any need, and which offers medical intervention. It may be therefore easier to note that the option will work well with support from the hospitals and other sectors in order to realize mutual benefits such as reduced costs and stress for hospital facilities. The government should work for the improvement of the current status on homebirth other than discouraging it. With the rising in the healthcare cost, a facility which ensures safety for birth at home will be a financially effective one. Cooperation between the healthcare staff and the midwife and the government is required to improve the situation.

There is need to harmonize the existing literature on home birth and the situation, for the benefits of countries and the world as whole to improve the current perception about the practice and present balanced and unbiased information that would be necessary for appropriate decisions. Furthermore, biased literature that is not supported by research should not be utilized in the formulation of policies that discourage homebirth as an option. In order to encourage participation of more women to making the related choices on the place of birth, proper information needs to be disseminated. There is also the need to recognize that extensive research may be necessary to guide state laws and planners, insurers and other stakeholders into formulating a good procedure and criteria that result into a good home birth arrangement.

Work Cited

1. Campbell, Robert, & Macfarlane, Aiden. Where to be born? The debate and the evidence. (2^nd Ed.). Oxford: National Perinatal Epidemiology Unit, 1994
2. Chamberlain, George, Wraight Ann & Crowley, Peter. Home births. Report of the 1994 confidential enquiry by the National Birthday Trust Fund. Carnforth: Parthenon: 107-113, 1997
3. “Confidential Enquiry into Stillbirths and Deaths in Infancy”. Fifth annual report. London: Maternal and Child Health Research Consortium, 1998:51-62
4. Davies, James, Hey, Elson, Reid, Whitelaw & Young, George. “Prospective regional study of planned home birth.” BMJ. (1996): 313: 1302-1306
5. Drife, Johnson. “Data on babies’ safety during hospital births is being ignored.” BMJ. (1999): 319: 1008
6. Gavin Young, & Edmund, Hung. “Choosing between home and hospital delivery”. BMJ 320 (7237):798. 2000.
7. Janssen Patricia, Shoo Lee, Elizabeth Ryan, Duncan Etches, Duncan Farquharson, Donlim Peacock, & Michael Klein. “Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia.” 2009. Web.
8. Macfarlane Alison, McCandlish & Campbell, Rona. “There is no evidence that hospital is the safest place to give birth.” 2000.
9. Northern Region Perinatal Mortality Survey Coordinating Group. “Collaborative study of perinatal loss in planned and unplanned home births.” BMJ. (1996): 313: 1306-1309