Home birth, how to deal with it safely
Home birth, which was once the rule, has been re-evaluated by many women who feel more comfortable at home than in the not always serene environments of a hospital. What are the pros and cons? How should we organize ourselves?
A woman who decides to plan a home birth needs to be made aware of the potential risks and benefits.
According to the Italian Society of Neonatology (SIN) but also according to ACOG and the American Academy of Pediatrics
The hospital is the safest place to give birth and giving birth at home exposes mother and newborn to greater and unpredictable risks
Although medical societies consider hospitals and accredited birth centers to be the safest birthing facilities, every woman has the right to make an informed decision about her birth.
The choice to give birth at home rather than in the hospital is often dictated by the fear of excessive medicalization, by the desire to give birth in a comfortable and familiar place surrounded by one’s family, by the desire for freedom and control in the birth process.
The reason why medical societies advise against it is that possible complications that can put the health of mother and child at risk cannot be ruled out with certainty.
These complications can only be dealt with with tools or skills that are not available at home and to obtain them an ambulance transfer becomes necessary, which lengthens the intervention times.
“ Childbirth is a natural event and as such it must be experienced. We share the reasons of those who would like to give birth at home, but the situation of our health system forces us to strongly advise against this choice. In fact, within the home, the necessary safety measures are not guaranteed in case of problems that may arise. For example, there isn’t a capillary network of ambulances and, when this is guaranteed, you have to deal with the proximity and accessibility of neonatal intensive care units.”
How to deal with a home birth safely
In the event that the woman, made aware of the risks and benefits of home birth, decides to opt for home birth, the SIN provides the indications for dealing with the birth in the conditions of greatest possible safety:
1. The woman must be correctly informed about the risks of home birth and about the organization of the same in the city where she intends to give birth
2. There must be an easily accessible equipped hospital facility
3. Rapid transport to the hospital for mother and newborn by expert personnel trained in resuscitation maneuvers must be guaranteed
4. The nearest Neonatal Intensive Care Hospital should be pre-alert
5. The expectant mother should consult a midwife with appropriate training in both hospital and home care and who has documented skills in neonatal resuscitation maneuvers
6. It is necessary to guarantee all the necessary and routine check-ups to the newborn and the mother in the hours immediately after delivery.
Main contraindications to home birth
The main ones are:
- Twin pregnancy
- Previous cesarean delivery
- non-cephalic presentation
- Previous placenta
- Presence of known fetal pathology
- Presence of maternal pathologies that require intensive surveillance during labour
- Great multiparity (more than 5 previous parties)
For all contraindications, we refer you to the guidelines for home births
Home birth and public health care
In Italy there is no national regulation in this area. Some regions have activated paths for home births for physiological pregnancies which are assisted within the public service or reimbursed.
This fragmentation of the right to free and quality assistance in the place of one’s choice for childbirth is, in fact, the origin of a territorial inequality in access to care.
Home birth and hospital birth: scientific studies
There are limited quality studies available. To date, no adequate randomized clinical trials of planned home birth have been conducted.
In developed countries where home birth is quite common, attempts to conduct such studies have not been successful, mainly because pregnant women are reluctant to participate in clinical trials. Consequently, most of the information on planned home births comes from observational studies.
Observational studies of planned home births are often limited by methodological problems, including small sample sizes, lack of an appropriate control group, lack of reliable data, limited ability to accurately distinguish between planned and unplanned home births, diversity in certification delivery and the inability to accurately explain and attribute adverse outcomes associated with antepartum or intrapartum transfers.
Some recent observational studies overcome many of these limitations, describing planned home deliveries within tightly regulated and integrated health care systems , attended by highly trained licensed midwives with immediate and timely access to nearby hospitals. However, these data may not be generalizable to the situation in the individual country.
Furthermore, no studies are large enough to compare maternal mortality between planned home and hospital births, and few, when taken alone, are large enough to compare rates of perinatal and neonatal mortality. Despite these limitations, when viewed collectively, recent reports clarify a number of important questions regarding the maternal and newborn outcomes of planned home births versus planned hospital births.
Recent studies conducted in the United States have shown that compared with planned hospital stays, planned home births are associated with fewer maternal interventions, including induction, local analgesia, and cesarean delivery (Table 1). Planned home births are also associated with fewer vaginal, perineal, and third-degree or fourth-degree lacerations and less maternal infectious morbidity.
Table 2 below shows data from the United States regarding single term pregnancies. Data demonstrate higher risk of 5-minute Apgar scores below 7, below 4 and 0, higher risk of perinatal death and neonatal seizures in case of planned home birth, although absolute risks remain low .
However, it should be noted that the studies that support a non-increased risk of neonatal and maternal adverse events in the case of home births were conducted on women with low-risk pregnancies and in countries where home births are well integrated into the system. sanitary.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.