Before we focus on the risks of giving birth in a hospital, we must first acknowledge that when a rare but true high risk medical complication occurs that is outside of the scope of practice of a midwife, hospitals can play an important role for these women and babies. Additionally, when a rare emergency cesarean section is truly needed, we are grateful that hospitals are available to us. This is also true for purposes of natural childbirth under the care of Certified Professional Midwife (CPM, non-medical midwife). Hospitals can be a beneficial provision for midwife back-ups when they are truly needed. The same can be said for the availability of medical doctors who work in hospitals and private practices that care for high risk maternity issues.
To illustrate, if a pregnant woman or newborn under the care of a CPM midwife develops a true high risk condition that cannot be resolved within the scope of practice of the midwife, it would be necessary for the midwife to refer them to an appropriate high risk medical specialist for that condition. So it is in this case, that hospitals and medical doctors can play an important role in maternity care.
However, with that said, it must be noted that high risk medical conditions are rarely developed in most pregnant women and babies when under the careful supervision of a Certified Professional Midwife. This is because CPM midwives follow the Midwife Model of Care, which includes a non-interventive, holistic, proactive, natural, and preventative approach to maternity care. Nonetheless, in the extremely rare case that a true high risk medical condition does arise, then a collaborative consultation with a medical professional, specializing in that specific condition, would be appropriate. In some cases, this may subsequently lead to the specialist providing co-care with the midwife. In other cases, the symptom may be resolved over time and the midwife care can be resumed. Or, it may be that the symptom worsens or cannot be resolved, and may even mean a complete transfer of care to a high risk medical specialist. A transfer of this type typically results in an appropriate hospital based birth, and at which in our case, the midwife remains present as a support person.
Your Planned Birth Location
We are here specifically focusing on making the choice of a planned birthing location, not one based on an unexpected (but maybe necessary) birth location that was not planned, over which of course you may have little control. Currently, maternity care practitioners may legally delivery babies in three different planned birthing locations. Within this legal parameter, families may choose to plan their birth experience to take place either in a private home, at a birthing center, or at a hospital (Note: we will address the birth center option later under the question "What is the difference between a Homebirth and a birth center?" in our FAQ's page).
We know of course, that birth can occur anywhere at any time, and no law can prevent that. And this fact is the very reason why birthplace planning and preparation in advance are so important. It helps us to be prepared for (as much as reasonable possible) the intended successful birth at the planned location, and also for the potential unplanned birth location as well.
For example, if a pregnant couple were detained unexpectedly while in active labor, and had no advance knowledge on the natural birthing process, they would not be well prepared for what is commonly called 'emergency childbirth' (with no attendant present). In this case, it's only viewed as an 'emergency' because the parents are unprepared for it. The point is, for parents to be responsible for their own healthcare decisions, some advanced planning and preparation is necessary, which should be provided and supported by the chosen healthcare practitioner. Therefore, your planned birth location is one of the most important decisions to make, as it will usually determine the type and quality of health care provider you will have available for your birth.