Pros and Cons of Hospital Birth

"Buy the hospital ticket, go for the hospital ride."*

The first thing you should know about hospital birth is that hospitals have their routines that you basically consent to when you decide to go to a hospital to have your baby. (And then you literally consent to them when you sign the papers when you are admitted.)

That's okay if you are familiar with and agree to their protocols, but it can be quite an unpleasant surprise if you go in with certain ideas, only to discover - in the middle of labor - that your ideas are not compatible with the hospital's.

The best analogy is this: if you really wanted Italian, would you walk into a Chinese place? And then get annoyed with them for not serving pizza and spaghetti?

So if you have your heart set on a natural birth with no interventions, then going to a hospital is like walking into a Chinese restaurant asking for lasagna.

So how do you know whether a hospital birth is for you?

Four things are very important.

• Know yourself. What do you want?
• Know your options. What's the difference between a hospital birth, home birth or a birth center birth?
• Know your hospital. What are the common practices at your particular hospital?
• Know your care provider. What are your care provider's common practices?

Common hospital procedures

It is worth noting here that there are enormous differences between hospitals and there are enormous differences between care providers within hospitals. Take the time to research your hospital's and your care provider's statistics. If your hospital has a 70% C-section rate (some do!), do not kid yourself that you will be the exception who gets out with a vaginal birth.

Below I will try to list some of the most common hospital interventions so you can familiarize yourself with them. Make sure you understand what each entails in terms of experience and your and your baby's well-being. Find out how likely it is that you'll have to undergo particular interventions at your hospital.

Starting labor artificially before it would start by itself

This is known as induction. Pros: if either your or your baby's health is in danger, sometimes the only solution is to get the baby out before labor would start by itself. If it weren't for induction, your only other choice would be a C-section. Cons: Sometimes induction doesn't work and you end up with a C-section anyway. Often an induction triggers a cascade of interventions that really limit your options for your birth. And too often an induction gets a baby out before a baby is ready to come out, and you will have a premature baby. Inductions have been implicated as a major factor in America's soaring prematurity rates.

Speeding up labor

This is known as augmentation. Pros: It can shorten your birth experience and help a slow, exhausting labor move along. Sometimes it can prevent a C-section due to maternal exhaustion. Cons: The methods and substances they use to speed up labor (such as artificial rupturing of the membranes aka AROM, or using pitocin aka artificial oxytocin) can have detrimental effects on your baby's well-being. Speeding up labor also means labor is usually more painful than a natural labor would be.

Hooking you up to machines and frequent examinations

This is known as monitoring. Pros: They can keep track of your and the baby's well-being and the dilation of your cervix during a hospital birth. Cons: Monitoring limits your movement, and moving around is one of the primary means of natural pain management during labor. And both monitoring and frequent vaginal exams during a hospital birth interrupt the flow of labor, which can slow or even halt it, necessitating further interventions. Everybody will be watching the machines' output instead of focusing on you.

Offering pain medication

A hospital is a place to treat illness and pain, so this is what they will be trying to do for you. The reality is that it is easier for the nurse on duty to monitor and care for several laboring women if they are "medicated and comfortable." Pros: If you know you will want painkillers such as an epidural for your labor, this is a good thing. Cons: If you are aiming for a natural birth, meaning no pain medication, then offers of pain medication while you are in labor is like offering someone on a diet a chocolate cupcake. It will be hard to resist and will make it more difficult for you to achieve your goal.

Directing pushing

This usually consists of your care provider determining when your cervix has achieved full dilation and instructing you in what position and how to push. During hospital births, doctors tend to favor the so-called lithotomy position, which means lying on your back or being propped up in a semi-sitting position, grasping your knees and pushing when being told. Pros: Some women find the directions helpful, especially if an epidural has deprived them of the sensation of the urge to push. The lithotomy position allows the care provider very good access to your vaginal opening. Cons: Most women actually report that they do better and feel better when they follow their body's urges to push. The lithotomy position tends to be the least effective position for pushing: it increases the effort required to push, it increases the time of the pushing stage, increases the length of the vaginal canal, and increases the chances of a perineal tear as well as an episiotomy. Very few women choose this position if they are allowed to follow their body's urges and choose their own position for pushing.

Episiotomy

This is a cut made on the vaginal opening to enlarge it. Often it is performed prophylactically, to prevent a more serious tear. Pros: If the baby's head is already pushing on the perineum and there is an emergency such that the baby needs to be born very quickly to save its life, this procedure can shave a few minutes off the pushing stage. Cons: It's a cut where there normally there wouldn't be one. Women report that it heals more painfully than a tear does. Suturing it is often remembered as the most unpleasant part of labor.

Early clamping of the cord

After the baby is born, often the cord is clamped immediately in hospital births. Pros: There are no advantages to this unless the baby or the mother needs to be whisked off for some emergency procedure without the other. Cons: The baby is deprived of much of the blood that is circulating through the cord and the placenta at the moment of birth. Makes the transition from being supported by oxygenated blood from mom to oxygenation through breathing much more sudden. Increases the chance of anemia in the first year of life. Deprives baby of its own stem cell supply in the cord blood.

Early newborn exams

Once the cord is cut, the baby is taken away to be examined, and to receive its first medications (such as the antibiotic eye ointment). Then the baby is washed and swaddled before being returned to its mother in a hospital birth. Pros: None, unless there is a medical emergency with the newborn that needs immediate attention. Cons: The baby is stressed by removal from its safe place, which is the body of the mother. The baby is deprived of the benefits of immediate skin to skin contact with its mother, which is physiologically normal and stabilizes all the newborn's vital signs, such as heart rate, breathing, stress hormone levels, body temperature, immune response, etc. Washes the pheromone-laden amniotic fluid off the baby that would promote bonding and help the baby find the breast. Swaddling prevents free movement which allows the baby to find the breast on its own and begin nursing. May introduce something other than mother's breast into the baby's mouth, and thus something other than friendly bacteria into the baby's body.

Mother-baby separation

After too many hospital births, babies are removed to a separate nursery for observation so the mother can rest. Pros: Some mothers do find this helpful and restful. Cons: Many mothers are so concerned for their babies, they cannot rest. Separation interferes with bonding. Separation is stressful for the baby. Separation interferes with the initiation of breastfeeding. It also interferes with good breastfeeding practices, and ultimately leads to lower rates of breastfeeding.

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I cannot emphasize enough that every hospital is different, and every care provider is different. And of course, every woman is different.

A woman births best where she feels the safest. This is why knowing yourself and understanding your hospital's procedures is so vitally important. Do the hospital routines make you feel safe or do they make you feel constrained? Do you feel like you have more options in the hospital, or you have more options at a birth center or at home for what you desire from your birth? Have you discussed with your care providers which procedures make you feel most uncomfortable and which procedures you can request to avoid?

A hospital birth may or may not be for you. Make sure you understand and consent to what a hospital birth usually includes at your hospital and with your provider before you make your choice!

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*I have to admit, I did not come up with that title. A midwife, doula and blogger I respect greatly, Navelgazing Midwife, wrote an article about hospital birth by the same title, and I found it so compelling, I had to use it here.

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