The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA


Hospital Safety/Advocacy

Easy Steps to a Safer Pregnancy - View e-book or Download PDF - FREE!
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.

Other excellent resources about avoiding toxins during pregnancy

These are easy to read and understand and are beautifully presented.

See also:

Subsections on this page:

Medical View of Homebirth

This excerpt from Frederick Wirth, M.D.'s book, Prenatal Parenting (pp. 204-205), is a great description of the medical view of homebirth:

Being a neonatologist who cares for high-risk newborn infants, I have treated infants damaged by home births.  In general I think it is best for a child to birth in a hospital or birthing center where unexpected emergencies can be handled expeditiously.  [ed. Notice the implication that infants are never "damaged" by hospital births.  There are techniques used ONLY in hospitals that are known to be dangerous to babies - vacuum deliveries can often cause brain damage, and 2% of babies born by cesarean suffer lacerations from the surgeon's knife.  There are antibiotic-resistant germs that kill babies in hospitals; these germs are very unlikely to be present in a normal home.  Many hospitals have routines that keep the mother and baby separated for hours each day, which exposes the baby to dangerous germs that the mother isn't exposed to, and so can't make antibodies for.  Notice also the implication that if a baby born at home has a problem, the baby was somehow "damaged BY" the birth, rather than allowing for the possibility that there was a problem that would have happened whether the baby was born at home or in the hospital.  If you follow these implications to their logical conclusion, the hospital nurseries would be empty except for babies damaged by homebirth.  Last time I looked, there were a lot of babies in the NICU who were born in the hospital - either they had problems that were caused directly by the hospital birth that would not have happened at a homebirth, or they had problems that would have happened regardless of where the baby was born.  And . . . since many hospitals do not have neonatologists present at the hospital at all hours of the day or night, the implication that a baby born at the hospital has access to immediate NICU care is false.  There is also an interesting suggestion that unexpected emergencies can be handled more expeditiously in a birthing center than at a homebirth; this is strange, because most homebirth midwives have the same equipment as a birthing center, and they have the same training; this is an example of the mystification surrounding the facility itself, as if it bestows some magical safety to the events that transpire there.  This is magical thinking, indeed!]

I recently had a nurse-midwife whom I deeply respect challenge my assertion that all births should occur in a medical facility.  She gave me three excellent articles published in well-accepted medical journals that compare the safety of home births, birthing center births, and hospital births.  These were large studies done by good researchers, and I was impressed with their study design, date, and conclusions.  I presented these papers to a departmental journal club where all the pediatricians read and discussed the articles in detail.  Like me, my colleagues in pediatrics were impressed with the quality of these research articles on this controversial issue.  These articles and the journal club changed my opinion about the safety of home births, so I asked my midwife colleague if I could attend a home birth.  [ed. - These doctors are somewhat unusual in that they were willing to read these articles and were willing to have an open mind that allowed them to change their opinion.  Kudos to them.]

I have attended thousands of births during my thirty-three years of clinical experience.  Not once did I feel the way I felt at my first home birth.  During the home birth I felt I was intruding into the family fabric of an important, intimate life event.  I was uncomfortable and wanted to leave so this intelligent, loving couple could have some privacy.  They worked beautifully together as a team.  They certainly were more comfortable, intimate, and open than the many couples I observed birthing in a hospital.  They had more power over decisions and were able to exercise all their desired options, such as bathing or walking while laboring.  Her husband was better able to comfort her with loving behaviors such as pillows, cuddle positions, back rubs, and requests for ice chips.  The birth was a beautiful, personal family milestone.  [ed. - The feelings of intrusion are much less when the family has developed a personal relationship with their midwife during the prenatal months - then it's almost as if she is part of the family.]

If you choose a home birth, be sure that you are doing it for the right reasons.  The guidelines in the clinical research articles for selecting a home birth were very strict.  The births were all attended by a licensed nurse-midwife.  Each patient was screened early in the pregnancy by an obstetrician who worked with the nurse-midwife and was familiar with the circumstances around birthing at home.  If there were problems with the pregnancy or labor, the women were immediately transported to a birth facility.  Such risk factors as preterm onset of labor, breech position, high blood pressure, poor growth in the unborn child, the presence of meconium (fetal fecal material) in the amniotic fluid, prolonged labor or membrane rupture, or fetal distress were all indications for a hospital birth.  [ed. There's an interesting use of the phrase, nurse-midwife, that occurs throughout the American medical language - it's almost as if the word, midwife, did not exist in the English language. In fact, obstetricians in the United States have been working very hard for about a hundred years now to eliminate actual midwives as well as the word, itself.  This is especially interesting, because it is likely that the studies mentioned here were British studies, which specifically use the term, midwife, because there is no such thing as a nurse-midwife in the United Kingdom; their midwives are specialists in normal birth and are no more required to become nurses first than are obstetricians or neonatologists.  Another note - meconium is not fecal material - yes, it comes out of the baby's bowels, but it is not feces in the sense that it is not the byproduct of digestion, and it is sterile; this is a subtle but important issue - the real concerns about meconium are that it contains bile, which is a caustic agent that can cause tissue damage if aspirated into the lungs, not that it is truly fecal.

Hospital Safety References

Leapfrog 2015 Survey Finds Few U.S. Hospitals Come Up to Snuff on Maternity Care [6/6/16] from childbirth-u.com

The Leapfrog Group, which collects data on a voluntary basis from hospitals and compares results with national standards in order to evaluate quality of care, opens its 2015 report on U.S. maternity care with: “[T]here is substantial evidence that U.S. hospitals overuse medical interventions, exposing mothers and babies to unnecessary health risks from C-Sections, episiotomies, and early elective deliveries.” With nearly half (1750) of U.S. hospitals responding:

The Take-Away: Hospitals and care providers are far from alike. Ask questions. Choose carefully.

How Safe is Your Local Hospital?

 Released 2013 - The latest update to the Hospital Safety Score - Errors and Infections Still a Serious Problem in American Hospitals

Medical Error Is Third Leading Cause of Death in US, after heart disease and cancer

Temporal trends in rates of patient harm resulting from medical care. [full text]
Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ.
N Engl J Med. 2010 Nov 25;363(22):2124-34.

BACKGROUND: In the 10 years since publication of the Institute of Medicine's report To Err Is Human, extensive efforts have been undertaken to improve patient safety. The success of these efforts remains unclear.

RESULTS: Among 2341 admissions, internal reviewers identified 588 harms (25.1 harms per 100 admissions; 95% confidence interval [CI], 23.1 to 27.2) [corrected]. Multivariate analyses of harms identified by internal reviewers showed no significant changes in the overall rate of harms per 1000 patient-days (reduction factor, 0.99 per year; 95% CI, 0.94 to 1.04; P=0.61) or the rate of preventable harms. There was a reduction in preventable harms identified by external reviewers that did not reach statistical significance (reduction factor, 0.92; 95% CI, 0.85 to 1.00; P=0.06), with no significant change in the overall rate of harms (reduction factor, 0.98; 95% CI, 0.93 to 1.04; P=0.47).

CONCLUSIONS: In a study of 10 North Carolina hospitals, we found that harms remain common, with little evidence of widespread improvement. Further efforts are needed to translate effective safety interventions into routine practice and to monitor health care safety over time. (Funded by the Rx Foundation.).

The New England Journal of Medicine has graciously made this article available free in smaller segments that are less daunting to the public.

Drug errors hurt 1 in 15 hospitalized kids [4/08] - Medicine mix-ups, accidental overdoses and bad drug reactions harm roughly one out of 15 hospitalized children, according to the first scientific test of a new detection method.

Medicine Mix-Ups Harm Hospitalized Kids by Lindsey Tanner [4/7/08]

Drug mistakes injure 1.5 million every year - Medication errors hurt 1.5 million people every year in the United States and cost at least $3.5 billion . . .
If hospitals, clinics and other providers owned up to each and every mistake, it would help to keep track of and eventually reduce them, and systems such as electronic prescribing would also help, the Institute of Medicine report said.

"Medication errors are among the most common medical errors, harming at least 1.5 million people every year," the Institute said in a statement. Such mistakes kill at least 7,000 people a year, according to the institute, an independent, non-profit organization that advises the federal government on health issues.

Place of birth
Luke Zander,  Geoffrey Chamberlain.
BMJ 1999;318:721-723 ( 13 March )

"No evidence exists to support the claim that a hospital is the safest place for women to have normal births "

Excerpt from the World Health Organization's Summary of Research on Place of Birth from Care in Normal Birth: A Practical Guide Report

I highly recommend the fourth edition of Five Standards for Safe Childbearing by David Stewart, Ph.D.  It contains a good discussion of the relative limitations of homebirth and hospital birth.

Excerpts from the chapter "Midwifery: Safe, Cost-Effective Maternity Care for All (from Faith Gibson's site)

The new, fourth edition costs $16.95, plus $3.00 shipping. The Midwifery Reprint costs $4.95, plus $1.50 shipping, and the Home Birth Chapter costs $3.95, plus $1.50 shipping. Quantity prices are available for these two reprints.
Send check payable to NAPSAC, Route 1, Box 646, Marble Hill, MO 63764

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands.
Wiegers TA, Keirse MJNC, van der Zee J, Berghs GAH.,
BMJ 1996;313:1309-13.

Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome.
Ackermann-Liebrich U, Voegeli T, Gunter-Witt K, Kunz I, Zullig M, Schindler C, Maurer M, Zurich Study Team
BMJ No 7068 Volume 313

Isle of Man Study Shows Medical Interventions Causes Problems - this study can provide valuable insights into how to reduce the dangers inherent in hospital births

Can Hospitals be Made Safe for Birth? from Homefirst® Health Services, under the leadership of founder and Medical Director Mayer Eisenstein, M.D., J.D., M.P.H

Could the hospital be changed and somehow become as safe as home for laboring women? The answer is “No.” There is something about just walking into a hospital that changes the dynamics of labor. The length of labor is significantly increased in the hospital. If you put any woman in the hospital, her labor will slow down or stop because her hormonal balance changes. Her energies have to go into dealing with her strange surroundings, not into the birth itself.

When the mother has been in labor for a “reasonable” amount of time at the hospital without delivering, the doctors believe they must now “actively manage” the labor. They do not realize that the hospital setting is the cause of this problem.  They will not believe that this wouldn’t have happened at home.

Many “routine interventions” such as drugs, intravenous fluids, electronic monitoring and forceps occur during the hours of labor that wouldn’t have existed at home. Hospitals that allow you to labor naturally for the first 10 hours won?t allow you to labor naturally for the next 10 hours. At home these next 10 are spent getting to know the already delivered baby, not trying to push the baby out. In other words, the hospital environment creates many of the problems of labor and then obstetricians have to try to solve them.     Home births occur before the miserable second half of hospital labor has a chance to start. Home births occur before problems happen. If women knew that most of them could have half as much labor and no complications, they would all be choosing home birth!     Prior to this century, birth always took place in the comfort of home with close friends and family surrounding the mother. Giving birth requires privacy and intimacy.  Birth is a very sexual and personal experience. A warm, intimate and supportive environment allows us to function as we were intended.

Hospital Special Circumstances - First-Time Moms, VBACs, Large/Heavy Women

Birthing women with special circumstances can take specific action to increase the safety of laboring and giving birth in the hospital.

First-time mothers can hire a midwife as their primary care provider, thus reducing their risk of cesarean by 50%.  They can also hire doulas to provide continuous labor support even if the midwife is not present at the labor or is called away to another birth.  The best way for a first-time mom to improve her labor and birth experience is to delay going to the hospital as long as possible, since the anxiety of being in an unfamiliar surrounding will increase her anxiety and adrenaline, thus slowing or stalling her labor.

Women planning a VBAC can also benefit from hiring a midwife and doula to provide support and advocacy.

Large/heavy women can choose a hospital that has birthing tubs - real birthing tubs, like jacuzzis, where moms can move around, not the small tubs reminiscent of Motel 6.  If the hospital doesn't have birth tub facilities, women can arrange to rent their own tubs and bring them in.

Is Hospital Birth Safe for VBACs?

Many birth attendants and lawyers have opined that it is unsafe for a woman with a previous cesarean scar to be laboring without constant monitoring.  Unfortunately, it is not financially feasible to provide constant monitoring in the hospital, so electronic monitoring is substituted, but it is a poor substitute that is insensitive to the mother's remarks about how she feels or about sudden movements of the baby, both of which provide much better advance warning of uterine rupture than electronic monitoring, which simply provides information that the baby is already in severe distress.

Misconceptions Surrounding the Safety of Home Birth and Hospital Birth by Misty Dawn Richard - a dissertation containing an excellent summary of midwifery history and current issues.

Hospital Advocacy

How to Get Good Hospital Care Wherever You Go from CheckBook

Hospital Checklist for a woman's eligibility for a hospital birth

The Cost Effectiveness of Home Birth by Rondi E. Anderson, M.S., C.N.M. and David A. Anderson, Ph.D.
Forthcoming in the Journal of Nurse-Midwifery, Vol. 44, No. 1, January/February 1999.

This article quantifies and compares birthing charges and safety figures among modalities.  The combined analysis permits rational decisions based on cost-effectiveness tradeoffs.

This article shows clearly that significantly more money is brought into the health-care system through hospital birth. The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, which is a huge chunk of money considering that childbirth is the primary reason for hospitalization in the United States.

Response to a Hospital Complication or Tragedy

What can you say to the parents of a baby who dies or suffers permanent damage because of a hospital-acquired infection or from the negligence that is an inherent problem of institutionalized birth?

It is essential to remain as compassionate as possible towards these parents.  Even if they were informed of the dangers of hospital birth, they may not have known how to arrange insurance coverage for a birth center or out-of-hospital birth.  Or perhaps they were too young to feel that they could make an "alternative" decision contrary to the wishes of their own parents or peer group.

It's a complicated situation to be in, and all you can really do is offer your sympathy.  Perhaps when they announce another pregnancy in the future, you could help to educate and support them about safer alternatives.


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