How do women who have given birth in both a hospital and a homebirth setting perceive their experiences giving birth?
In a February 2023 study published in the journal, Women and Birth, three Irish researchers sought to answer this question.
The study, “‘It could not have been more different.’ Comparing experiences of hospital-based birth and homebirth in Ireland: A mixed methods survey,” surveyed 141 women about their experiences over a ten-year period.
Comparing Home Birth and Hospital Birth Experiences
Published by Elsevier on behalf of the Australian College of Midwives, the study examined a group of women who have had the unique experience of delivering a baby both at home and in a hospital setting.
Study participants were all 18 years old or older and they had all experienced at least one homebirth and one hospital birth in the past ten years.
According to the researchers, Ireland has a particularly high number of hospital deliveries compared to the other industrialized nations of Europe. Yet no scientists had previously compared hospital versus home birth experiences from the birthing women’s point of view.
The scientists explained that two research questions guided their inquiry:
1. How do women who have received maternity care rate the prenatal and labor care they received in each setting?
2. How do women feel about and describe their home birth and hospital birthing experiences?
A Mixed-Methods Survey of Home Versus Hospital Birth
The Irish researchers gathered their data using what they called a “mixed-methods survey.” What that means is that they found participants via a private Facebook group that had nearly 2,000 members, as well as posting on Twitter. On each platform, they placed a link to the survey for participants to complete.
They then anonymized the data they collected, removing identifying personal information.
In addition to asking women 31 multiple-choice questions, the surveys included three open-essay style questions.
The data was then processed for statistical significance.
The authors worked to both “quantify the subjective comparative satisfaction of individuals home and hospital births while also providing qualitative data to explore participants experiences.”
Their task, essentially, was to take these women’s subjective experiences and package them so they could provide measurable scores to enable a meaningful comparison between the moms’ hospital and home birthing experiences.
Their “scoring system” allowed for a total score of ten points for any question. The closer to ten, the more positive the experience.
Natural, Safe, and Normal or an Accident Waiting to Happen?
The researchers highlighted two different birth models that Irish women experience.
What they called the “social model of birth,” posits that birth is natural, safe, and a normal physiological process that will not require any medical intervention for most people.
On the other hand, what they call the “medical model” of birth posits birth as a pathological process (essentially like a disease) that is full of potential risks. In the medical model, birth is inherently dangerous and must be managed.
In the medical model of birth, in order for the birthing woman and her baby to be safe, they must be in a hospital setting, with access to a full suite of medical equipment, under the supervision of a highly trained obstetrician.
The More Natural the Birth the Better the Experience, According to Moms
The majority of American mothers give birth under the medical model, according to the National Vital Statistics System, which provides the most complete data on births and deaths in the United States.
Indeed, over 98 percent of babies in the United States are born in the hospital.
Out-of-hospital births—which include home births and births at freestanding birth centers usually attended by midwives—make up less than two percent of the total number of births in America.
But the Irish researchers found that study participants’ feelings about their births aligned strongly with the social approach. Women had much more positive and empowering experiences giving birth at home than in the hospital.
“The further away care moved from the social model, the less positive participants’ perceptions became,” the researchers explained.
When they tabulated the data the Irish researchers identified several things that influenced whether the experience of birthing was remembered as positive or negative.
Women ranked their homebirth experiences as 9.9 out of 10, but their hospital experiences as only 5 out of 10.
Home births tended to happen in an environment where the mother was cared for by a midwife with whom she had an ongoing relationship. And this relationship helped the birthing mother feel seen, heard, and respected throughout her pregnancy and during her birth. In contrast, the hospital experience did not prioritize relationships, resulting in impersonal care.
Unwanted Procedures Make Birth Less Positive
Informed consent refers to the process of communication between a doctor or other healthcare provider and a patient.
The idea is that every patient has the right to information to help them make an informed decision. They must be told what the benefits, risks, and alternatives are to any given procedure (including the alternative of doing nothing).
But while informed consent is a central tenet in medicine, it often is not practiced. In the category of informed consent, home births ranked 9.9/10 while hospitals and obstetrician-led care ranked 4.2/10.
At least 27 of the study participants experienced unwanted procedures without their care providers giving them informed consent or asking for their explicit consent.
The hospital policies and regulations tended to push unwanted procedures which the mothers felt they had to repeatedly ward off, or felt victimized by.
Women felt that in the hospital things were happening to them and they were not an essential part of the process.
Hospital policies often took precedence over their own choices. Some reported being treated disrespectfully, and made to feel like they couldn’t be trusted to make decisions about their births.
In contrast, during home births, the mothers reported feeling empowered and trusted to make decisions.
Nearly every participant, during their home birth experience, expressed feelings of being safe, secure, relaxed, comfortable, or joyful.
They expressed feeling trusted and respected by the people attending their birth. In fact, home births ranked as a positive life experience for all but one participant.
This was also in sharp contrast to the participants’ hospital experience. The hospital experience was described using mostly negative terms: disgraceful, impersonal, not respected, and even traumatic.
When positive words were used to describe the hospital birth experience, those words were relatively unenthusiastic: “fine,” “good,” “standard,” and “meets expectations.”
Birthing at home was much more positive and empowering for the moms surveyed than birthing in the hospital. At best, their hospital experiences “met expectations” but were “impersonal.” At worst, birthing in the hospital was traumatizing and dehumanizing.
Dr. Collin Lynn is a family practice physician based in northern California who has delivered over a hundred babies within the Redding hospital system.
He believes that if doctors took the time to listen to mothers, give them true informed consent, and support them during pregnancy and childbirth, their birthing experiences inside the hospital system would be much more positive.
“The patient is the expert, always,” Lynn said. “Instead of discounting or ignoring her, we need to include her in every aspect of the birthing process. Very rarely will a doctor actually labor with a patient. We’ve created a system to try to prevent risk but we’ve lost sight of the human aspect.”
Lynn said he has been involved in both high-risk deliveries and natural childbirths. Once he walked into the labor room where a birthing woman, completely naked, was crouched in a warrior stance. As a young doctor, he had never seen a woman laboring like that.
“We’re taught to make them labor on their back,” Lynn said. “I was a little uncomfortable because that was not what I was trained to do. But looking back I realize that it was a good example of her laboring how she wanted to—literally making a stand.”
Lynn also said that labor does not need to be scary and can actually be euphoric. “Natural labor has an organic rhythm that leads to release and euphoria. With hospital labor, it’s often changed to just a surgical procedure, even vaginal deliveries.”
One way to improve care in the hospital setting, according to Lynn, who reviewed the study but was not involved in it, is for doctors and hospital midwives to work harder to build relationships between themselves and expectant mothers. Another is to improve the power imbalance between the institution and the expectant mothers by allowing birthing women more say in their own care.
“In light of these findings, it is evident that the maternity care system as a whole could be improved through better implementation of the social model to increase women and people’s satisfaction with their birthing experience in the hospital-setting,” the researchers wrote.
In other words, the researchers believe that if a more natural, more patient-centered model of birth were implemented more completely in the hospital setting, birthing women would have more positive experiences.
Women will continue to give birth in the hospital. And care providers who are respectful, responsive, and relational can increase their feelings of empowerment and joy during childbirth.
Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.