The home births vs hospital births debate
Category: Birth Injuries
Last Updated: 14th Nov 2020
About the Author
If you are welcoming a new addition to your family in the near future, you might have been pulled into the ‘home births vs hospital births’ debate.
Since the second-half of the 20th century, the overwhelming majority of births take place in hospitals. However, 1 in 50 births each year in England and Wales take place at home, with many soon-to-be mothers preferring the comfort and familiarity of these surroundings.
This begs the question: are home births as safe as hospital births? Do they carry a greater risk of birth injuries? As clinical negligence experts, we feel it is essential that any new mother feels informed and secure about where she chooses to give birth to minimise any risk to her or the baby.
That is why here we will cover the home births vs hospital births argument and the factors that expectant mothers need to consider.
What options do expectant mothers have when giving birth?
The NHS presents three primary options for delivering a child:
- Giving birth in hospital
- Giving birth at a midwife led unit/birth centre
- Giving birth at home
This decision is made by the family, but should be taken with the advice of medical professionals based on the nature of the pregnancy.
For a home birth, expectant mothers can also implement several measures to make the birth more comfortable, including:
- A home birthing pool
- Gas and air supplied by the midwives
- TENS machines (a method of pain relief that utilises mild electrical current)
Why do people choose home births?
There are several reasons why an expectant mother might prefer the option of giving birth at home, including:
- Wanting to be in a familiar, relaxing setting
- Avoiding the interruption of labour caused by travel to hospital
- Not wishing to be separated from their partner during or following the birth
- Being supported by a midwife they have gotten to know during their pregnancy
- Lowering the likelihood of medical intervention
- Regarding their cultural or religious beliefs
These advantages of home births should be weighed up by both the family and medical professionals against the advantages of hospital births, which include:
- Access to obstetricians if labour becomes complicated
- Access to anaesthetists to administer epidurals and general anaesthetic
- Access to neonatologists and special care units if there are any problems for your baby after birth
Are home births safe?
The simple answer to this question is yes. But, the full answer is a little more complex.
For women who have given birth before and who are considered low risk for complications during delivery, the safety of home births versus hospital births is pretty much the same. If your first birth was uncomplicated, then it may be considered unlikely that any subsequent births will require intervention such as delivery by forceps or ventouse or pain relief procedures such as an epidural anaesthetic.
But, every birth is different. Therefore, it is key that the healthcare professionals supporting you during your pregnancy advise you whether a home birth is appropriate. While the decision is for you to make, they have a duty to inform you of any potential risks which may make a hospital birth the safer option.
If this is a woman’s first child, the risk of complications during pregnancy rises from 0.5% to 0.9%, according to the landmark Birthplace Study of 2011. The change might feel insignificant, but it demonstrates that complications are nearly twice as likely, and this should be taken into account when taking steps to minimise the risk of birth injuries.
Furthermore, if the expectant mother has any underlying health conditions, or health professionals have identified any potential risk for the baby, then the risks of a home birth increase due to the lack of access to specialist medical professionals and equipment. In the rare circumstances that something does go seriously wrong during childbirth, it could be critical that this support is available.
Other circumstances where the risks of a home birth increase include:
- When the mother is expecting more than one baby
- When the baby will be born prematurely
- When the baby will not be able to have a headfirst delivery
- When the mother has previously had a Caesarean section
It is important to stress that, while the overwhelming majority of births are performed safely and involve no complications, all childbirth carries an element of risk. In 2018 there were 2,958 stillbirths recorded, as well as 2,131 neonatal deaths. Sadly no birth is 100% certain to avoid complications regardless of where it takes place, but medical professionals should lend their expertise to minimise the risks involved.
Some important home birth statistics
- 2% of births in the UK take place at home; in 1959, this was 34%
- 9 in 1000 home births for first-time mothers will face complications
- 45% of home births by first-time mothers involve a hospital transfer (the figure is 2% for previous mothers)
Are home births safer than hospital births?
As noted, for first-time mothers and those with underlying health conditions, the home births vs hospital births argument leans toward the latter.
However, there are instances where a home birth can actually be recommended over a hospital birth. That is because, in low-risk births, this will remove the possibility of unnecessary medical interventions, such as the use of forceps or ventouse, or procedures like epidurals and Caesarean sections, which carry their own risks.
Indeed, The Royal College of Obstetricians and Gynaecologists (RCOG) has argued that up to a third of births should take place “without a doctor going anywhere near them”, while The National Institute of Clinical Excellence (NICE) has argued that giving birth at home or in a midwife-led centre is preferable for up to 45% of mothers.
Although the vast majority of births that take place in hospitals are carried out safely, unneeded medical intervention during a birth may put the wellbeing of mother and baby at greater risk.
How many home births end up in hospital?
The Birthplace Study revealed that 45 out of 100 first-time mothers who give birth at home would be transferred to a hospital either before, during or after the birth, while this drops to 12 in 100 cases for mothers who have given birth before.
This stresses the importance that when preparing for a home birth, the family, midwives and other medical professionals need to have a plan of action in place for a hospital transfer if it is required. Delays in delivery can lead to significant complications for all involved, including the potential for the baby to be born with learning or movement disabilities such as Cerebral Palsy, or of a stillbirth.
Protection against negligence
We hope that this has provided you with more information on the ‘home birth vs hospital birth’ question. Childbirth should be a time for celebration, regardless of where it takes place.
However, in order to make that decision, it is vital that expectant mothers receive up-to-date information on the risks associated with their pregnancy from the midwives and doctors who are looking after them. A birth injury can have devastating long-term consequences for newborns, mothers and a family in general. While in many cases that outcome may be unavoidable, if it has occurred as a result of inadequate care, a lack of preparation if problems arise, or any other form of clinical negligence, those affected are entitled to justice.
If you have been affected by a preventable birth injury, we are there to support you at this emotional time and guide you towards securing answers, compensation, and a brighter future for you and your loved ones. Speak to us today to discuss your situation.
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Always consult your GP if you are concerned about your health and wellbeing, or speak to us if you require legal advice.