What's the difference between homebirth and hospital birth?

Last night during an interview with potential clients the mother-to-be asked me what I see as the difference between a homebirth and a hospital birth. – A difficult and complex question to answer. I paused. And then I started with my best attempt at an answer.
A hospital birth is a finite medical event. A homebirth is a big experience that takes place in the midst of normal daily life with a few traces of medical paraphernalia.
During a hospital birth there is a moment when the couple arrives in the hospital and the medical records begin. People go to the hospital for medical care and this is where the orientation lies. Walking into a room full of equipment and the clients will negotiate themselves and their experience around this environment and equipment. They will meet some medical professionals they have never met before and some that they have. The nurses will be moving from one patient’s room to another, and if the doctor or midwife is there and becomes tired, he or she will go to another room in the hospital to sleep. The baby will be born, the placenta will be born, the doctor or midwife will leave, the baby will be weighed and measured (maybe in the same room as as the mother and the equipment brought in, maybe in the nursery), and they will be moved to a postpartum room. This may all happen in a great rush or it may happen more slowly but it’s a fairly set sequence of events in a somewhat fixed period of time. At the end they will leave the hospital to return to home, different than they entered.
A homebirth is less a finite event and more a broad experience. The home that the parents-to-be have built around their lives will transform somewhat to build itself around the experience; the birth attendants will similarly build themselves around the parents home environment and needs. The mother-to-be may wander in and out of her kitchen to get food and water, her bathroom to shower and brush her teeth, her bed to rest.... Small (ie. transportable) medical equipment will be set on a piano bench, a coffee table or a bedroom dresser. The midwife may become tired and lie down to sleep on the couch. The mom’s partner will probably be in and out of the kitchen to prepare food for him/herself and the mom. She may become cold and walk to her dresser to pull out a comfy socks. Maybe she becomes dehydrated at some point and lies in bed while her midwife gives her an IV which she then places on a hanger from the closet to hitch onto a nail in the wall or a shelf by the bed. The baby’s heart rate will be listened to on a regular basis but with a small doppler that disappears to the floor beside the couch (or the bed or the bath...). At some point the progress of labor will become intense enough that the focus will not travel far from the room the mom is in. Everyone may be in the same room, the piano bench with medical equipment moved closer but probably without much attention to it. After giving birth the process continues; the placenta in a bowl and carried to the sink for inspection, some quiet time alone while someone is in the kitchen cooking the new parents food and the midwife is at the dining room table taking notes. At some point maybe the new mother showers while her partner holds the baby, and the bed is freshly made. At some point when the parents are ready the baby will be weighed and measured on the bed while the parents lie in bed resting and watching. And eventually when things have settled enough, slowly people will leave so you can all sleep.

I’ve been hearing lately about a book called Homebirth In The Hospital and I’ve had many people say, “I want to have a homebirth experience in the hospital”. My response to both of these is the same; it is absolutely possible to have a beautiful natural birth in the hospital, but the experience will not be like a homebirth because you are not at home. You are not in the environment that you have built around your life and the environment on that day is not building itself around you. A hospital birth entails you leaving for the hospital and creating your experience within an environment created for medical purposes. If what you want a homebirth experience, the hospital is not the place to have that and if what you want is a hospital environment, home is not the place to have that.

I am writing about this because there seems to be such polarization between natural birth and medical birth, between homebirth and hospital birth. These are not mutually exclusive and neither one is right or wrong. It is really about what the individuals want and where the individuals (or couple, or family) feel most safe and comfortable. A home and a hospital, they are really different kinds of places.

So this is what I’m thinking about at the moment. I’m not sure I’m done thinking about it.