Home Birth - Is It the Right Decision

Introduction

Long back, birth was a normal process. From the beginning of the 1900s, more women started delivering at hospitals. In the present day, with advancements in medical science and technology, more women are willing to choose home birth options. These are carried out as planned home births under the support of trained midwives and are indicated only in cases of low-risk healthy pregnancies. However, a properly planned home birth can sometimes be the best option. In simple terms, homebirth means giving birth to a baby at home.

How to Know If Home Birth Is the Right Decision for One?

Home birth may be considered in the following cases:

• Low-risk and healthy pregnancy.

• A safe and suitable environment at home.

• Has easy access to a maternity hospital in case of emergency.

A low-risk pregnancy is one in which:

• Singleton pregnancy (only one baby)

• Less than five previous births.

• Do not have any underlying medical conditions like obesity, diabetes, etc.

• No previous history of uterine surgery (including cesarean section).

• BMI (body mass index) is lower than 35.

• Have not encountered any severe complications during previous pregnancies or childbirth.

In What All Cases Home Birth Should Not Be Considered?

Home birth should not be considered in the following cases:

• Maternal age is more than 42 years.

• Mother is younger than 17 years old.

• In the case of first-time pregnancy.

• In case of multiple pregnancies (more than one child).

• If under some medications, that can increase the risk for complications.

• In the case of pregnancies supported by assisted reproductive technologies.

• In the case of obstetric complications like gestational diabetes, pre-eclampsia, and placenta previa.

• One who has not undergone a pregnancy screening test.

• Previous history of preterm labor.

• The partner is not supportive of the home birth option.

• If one needs an epidural for pain relief.

• The baby’s position does not allow headfirst delivery.

How Safe Is Home Birth?

The United Kingdom’s birthplace cohort study concluded the following results for healthy, low-risk pregnancies:

• In the case of women having their first childbirth, a planned home birth increased the risk of serious complications for the infant from five in thousand for a hospital birth to nine in thousand for a home birth.

• For a woman having her second childbirth, a planned home birth was almost as safe as a hospital birth.

Studies also suggest that, though fewer interventions are required, homebirth increases the risk of perinatal death (about a twofold increase) and the risk of developing neonatal seizures. The safety and favorability of homebirth outcomes depend on several factors, like the appropriate selection of trained midwives, accessibility to hospital care, immediate access to consultation, etc.

What Are the Potential Benefits of Home Birth?

The potential benefits of home birth are:

• One feels more comfortable, safe, and supported. The familiar, supportive environment makes one more relaxed and allows one to labor effectively.

• Provides control over one’s choices. The assistance trained midwife professionals provide helps one make the right choices and, in turn, provides more emotional support.

• More positive birth outcomes and the need for fewer medical interventions. Studies suggest that about 97 percent of women who undergo hospital births will have some form of intervention used during labor. These interventions may pose a risk to both the infant and the mother, increasing the risk of surgical birth.

• There is no need to interrupt labor to go to the hospital.

• Provides more skin-to-skin time with baby after birth. Further, if they are present, leaving other kids is unnecessary. Home birth also provides an opportunity for more support from the partner.

• Reduced cost.

• A greater chance that one will have a vaginal birth.

• Freedom to choose one’s labor position.

• Religious or cultural considerations.

When to Go for Hospital Care?

During a planned home birth, one is advised to go to the hospital in the following cases:

• If the fetus is in a position other than the headfirst position.

• Delayed labor or labor not progressing.

• If one needs pain relief.

• In case of high blood pressure.

• If one develops a fever.

• Premature membrane rupture.

• If the infant shows signs of distress.

• Bleeding is experienced.

• The mother feels exhausted and cannot continue delivery.

• In cases of umbilical cord prolapse, a condition in which the umbilical cord slips through the cervix and may even protrude out from the vagina. It is a medical emergency as blood flow from the umbilical cord gets blocked.

What Are All the Things to Consider While Planning a Home Birth?

The following should be considered while planning a home birth:

1. Assessing the Risk Factors:

The risk factors should be evaluated, and if home birth poses a risk to the mother or baby, it should be avoided. The maternal age, maternal medical conditions, fetal position, number of pregnancies, previous obstetric history, etc., should be considered.

2. Choosing the Appropriate Midwife:

Choosing the appropriate midwife is essential.

The following things should be assessed:

• The training and certification course the midwife has done.

• The midwife can handle all labor and delivery complications.

• Is the midwife equipped to provide postpartum care?

• How many previous births have the midwife-attended?

• Know her emergency plan.

3. Hospital Accessibility:

Sometimes, even in low-risk pregnancies, things may not go as planned, and complications can occur. In labor and delivery complications, immediate medical care is required, so easy accessibility to a maternity hospital is essential.

What Is Needed in a Home Birth Kit?

The homebirth kit the midwife brings contains the following:

• Absorbent pad.

• Birth pool, if available.

• Pain relief options other than epidural.

• Transcutaneous electrical nerve stimulation (TENS) uses low-voltage electric current to treat pain.

A home birth checklist includes the following:

• A maternity note containing details of each appointment.

• A directable light source that helps in the examination of the perineum and vaginal region.

• One’s birth plan.

• Other necessary items like maternity pads, blankets, and birth balls.

Conclusion

Home birth is to be considered only in cases of low-risk healthy pregnancies. Even in such cases, the risk for perinatal mortality and neonatal seizures is comparatively higher. In the uncomplicated healthy low-risk second or after pregnancies only home birth should be considered. That too only under the advice of a health care professional with the support of a trained certified midwife.