Thursday, May 2, 2013

Home Birth

Women who choose home birth should understand the risks. For low-risk women who are planning home births that are attended by registered midwives, the concept is not new and actually becoming more widely discussed and accepted. However, for women at high-risk or those who do not intend attendance by a registered midwife should examine their perceptions and wishes and acknowledge the statistically increased chances of a less than desired outcome.

Several well-educated, under advanced- maternal- age women who already had delivered in the hospital setting ( which was less than thirty minutes away ) reported similar beliefs and themes about why they chose home delivery as their best option for subsequent labors and deliveries. They were questioned about their perceptions about hospital and home delivery. Three commonly held themes emerged.

The women were all not naive to the risks of childbirth in general. They all believed that childbirth ( and pregnancy ) had inherent risks. They admitted to examining these risks, knew something could go wrong and that death was a possibility for mother or child in either setting.

They all concluded that the hospital is not the safest place to deliver. Stating that home births were less likely to present risks to their physical, mental and emotional well-being. They all agreed that exposure to infection was a great threat to their babies when delivered in the hospital.

All women felt that medical interventions and interruptions to the birth process were major risks to them in the hospital. They sited unnecessary testing and monitoring, labor induction and/ or augmentation, use of artificial extraction and increased possibility of cesarean section as being potentially the cause for a cascade of  spiraling interventions that would require even more interventions and more risk for the possibility that "something would go wrong."

Clearly there are increasing concerns among the populations that I encounter, that hospital births run a very high risk of cesarean section. Women and their partners are stating that labor and delivery is a natural and common occurrence that does not necessitate the amount of medical attention it receives. But they are very aware and concerned about  the risks of home delivery.

Thankfully, the American Academy of Pediatricians has released guidelines in favor of hospital deliveries, with consideration for recognizing and addressing maternal needs for emotional safety and security. They state that women do have the right  to make medically informed decisions about their deliveries. And that every newborn has the right to a high standard of care.

The American Association of Pediatricians and the American Heart Association both recommend one person dedicated only to the care of the infant, who is qualified to provide the baby with warmth, resuscitation and the assignment of Apgar scores.

The statement further explains that all women should be screened for group B strep and administered IV antibiotics if appropriate.  All newborns should have a detailed physical examination. Newborns should receive prophylaxis against gonococcal ophthalmia neonatorum with the administration of antibiotic eye drops and a dose of vitamin K to prevent hemorrhage. Stable babies should receive an early dose of hep B vaccine, if they weigh more than 2 kilograms at birth.

So as we recognize the need for reform and choice when we continue to examine and modify the old standards for childbirth, change will come. It is essential that we keep ourselves informed and proactive to protect our rights as medical consumers. We do quite a bit of research when purchasing a car or new washing machine; our healthcare deserves the same consideration.