The irrelevance of home vs. hospital

July 18, 2010 at 9:36 pm

Ever since a conversation last night with my brother and sister-in-law, I’ve had this phrase going through my mind:  “It’s not where you are, it’s who you’re with.”  It seems to me that traumatic births often prompt couples to choose an alternative path for subsequent births.  For those who experience that trauma in the hospital, home birth often provides the healing they seek.  Because of the trauma my brother and his wife suffered following their home birth (and I do think my brother has some valid and genuine post-traumatic stress), they will likely have all of their subsequent children in hospitals [<—actually, 2015 update, they had another home birth].  I think it’s just human nature to associate those intense frightening emotions with the place where they occurred regardless of whether the place contributed to their occurrence.

We can strive to reduce complications, we can keep our bodies healthy and strong, but we can’t control everything that arises as we give birth.  Complications can and do arise in all birth locations.  As long as a laboring woman is within the standard “thirty minutes from decision to incision,” what matters most in the midst of a birth complication is who is taking care of her and how do they respond? Do they have the skills, experience, presence of mind, and knowledge of evidence-based practice to ensure her safety and well being?  Being five minutes from (or even inside of) a hospital doesn’t guarantee that a care provider will advise the best possible solution to a problem.  Likewise, being at home with a midwife doesn’t guarantee that a birth will be peaceful and empowering.  Midwives can degrade and doctors can earn the title “Wonderful.” It’s not where you are, it’s who you’re with.

I had my first two children in hospitals and my third at home, but it wasn’t trauma that pushed me home.  In fact, my two hospital births were positive and beautiful which is why I didn’t hesitate to tell my brother and his wife last night: “You can have a fabulous experience in the hospital.”  Some hospitals are more mother-friendly than others, of course, but a good birth attendant can serve as a powerful buffer to greatly improve an otherwise hostile birth environment.  Although I find many hospital policies annoyingly counter-productive, I also know that those small annoyances can recede into the background as couples and their care providers work together to create safe and positive birth experiences.  I have multiple friends who have given birth in hospitals unmedicated and empowered over the last several months.  Wonderful hospital births happen every day.

I’ve mentioned before that, according to Penny Simkin’s research, women with the highest long-term levels of satisfaction with their birth experiences were the women who had positive memories of the way they were treated by their care providers.  Regardless of the interventions women received, regardless of whether complications arose, the most important factor influencing their satisfaction was the behavior of the people taking care of them.  I will never forget the labor and delivery nurse who assisted me through my first hospital birth because she was unfailing in her doula-like support, help, and encouragement.

I feel sad that my sister-in-law’s first birth was not what I had hoped for her,  I feel sad that she has few memories of the first days of her daughter’s life and didn’t feel “herself” for months afterward, and I will support her and my brother whole-heartedly if they choose to give birth in hospitals from here on out.  Just like I will vehemently defend my personal decision to give birth at home, I would likewise vehemently defend their decision to give birth in the hospital.  When a couple takes into consideration all the factors and makes a decision based on their own health, finances, history, and personal circumstances, whether they choose home or hospital is irrelevant to me.   My only agenda for my sister-in-law (and for anyone else) is that they choose the birth location they feel safest and most comfortable with.

It’s not where you are, it’s who you’re with.