Friday, May 14, 2021

Is it safe for you to give birth at home?

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The question of where and how to give birth is a relatively new question for women. Until the beginning of the 20th century, less than 5% of women gave birth in a hospital. In the 1950s, the birth of a baby, an event that was once a family affair and attended by a midwife, became more medicalized.1

Pregnancy and childbirth were seen more as a disease than a natural part of life. One mother described the birth of her first child in the 1960s as occurring without pain medication, with minimal interaction from medical staff and a forced hospital stay of two weeks.2

Fathers began attending births in the 1970s, and by the 1990s childbirth was becoming a natural part of life. More and more women are now being offered choices that respect their wishes, without repeating the horror stories of generations past. This is an important factor for the future health of mothers, children and families, as recognized by the World Health Organization.3

The outcome not only affects the mother, but can also be important in the development of the mother-child relationship and in the mother’s future reproductive experiences. Researchers have found that both positive and negative perceptions of a woman’s birth are related more to her ability to control the situation and have choices in her options than to specific details.

Low risk home birth as safe as hospital birth

The evidence does not support the long-held belief that low-risk deliveries are best served in the hospital where medical intervention can be used to expedite delivery.

The debate over safety around home births is not new. Almost 11 years ago, data showed that when a home birth was planned by a woman with a low-risk pregnancy and assisted by a midwife, there was:4

“… Very low and comparable perinatal mortality rates and reduced rates of obstetric interventions and other adverse perinatal outcomes compared to a planned hospital birth attended by a midwife or doctor.

In 2008, the American College of Obstetricians and Gynecologists (ACOG) issued a statement against home births, writing that “Choosing to give birth at home, however, is putting the birth process on the back burner. ” have a healthy baby. . “5

Despite evidence to the contrary, their statement released almost 10 years later has not changed: in 2017, they recommended that women be made aware of the risks, especially that there are fewer risks to the woman. but a higher rate of perinatal deaths.6

In another study of 530,000 births in the Netherlands,seven the researchers found no difference in the maternal or baby death rate between people born at home or in hospital. The study was triggered by the suggestion that the high rate of infant mortality could be due to the high number of home births. Examination of medical records did not confirm the hypothesis. Professor Simone Buitendijk commented to the BBC:8

“We have found that for mothers at low risk early in labor, it is just as safe to give birth at home with a midwife as it is in hospital with a midwife.” These findings should strengthen policies that encourage low-risk women early in labor to choose their own place of birth. “

Positive safety data with well-trained midwives

It should be noted that the data was released long before the 2017 ACOG policy statement mentioned above. In 2014, an assessment of 16,924 home births registered between 2004 and 2009 was examined. Researchers noted the 41% increase in home births between 2004 and 2010, writing that there is a9 “Need for an accurate assessment of the safety of planned home births.”

Scientists found that among participants who planned a home birth, 89.1% had. Most transfers to hospital during labor were due to failed progression. However, 93.6% had a spontaneous vaginal birth and 86% of infants breastfeeding exclusively at the age of 6 weeks. The overwhelming majority – 87% – of the 1,054 people who attempted a vaginal birth after a home Caesarean section were successful.

Researchers recently conducted an international meta-analysis to assess the safety of home and hospital deliveries with the measurement of the primary outcome of any perinatal or neonatal death. They chose 14 studies, including approximately 500,000 home births planned in the presence of a midwife.ten

The information was drawn from the results of eight Western countries, including the United States, in studies published since 1990.11 What they found matched most of the previous studies:12 “The risk of perinatal or neonatal mortality was no different when delivery was scheduled at home or in hospital.” Eileen Hutton of McMaster University, one of the researchers, commented:13

“More and more women in countries with sufficient resources are choosing to give birth at home, but concerns about their safety persist. This research clearly shows that the risk is no different when the birth is scheduled for home delivery. home or hospital. “

Conditions best treated in hospital

Of course, there are high risk pregnancies best served in hospital settings. According to the US Department of Health and Human Services, factors that can create a high-risk pregnancy include existing health problems and lifestyle choices. While this list is not exhaustive, they are factors that your midwife or doctor will consider when discussing your birth plan. Some include:14

High blood pressure – If this is the only risk factor and arterial pressure is only slightly raised, this may not be enough to stop a home delivery plan. However, uncontrolled blood pressure is dangerous for both mother and baby.

Polycystic ovary syndrome (PCOS) – PCOS can increase the risk of gestational diabetes, cesarean section, preeclampsia, and miscarriage before 20 weeks.

Diabetes – Moms who have Diabetes are more likely to have bigger babies than most their babies may also have low blood sugar after birth.

Kidney disease – Depending on the extent of the disease, it can impact fertility and the ability to carry a pregnancy to term. Almost 20% of women with preeclampsia during pregnancy are diagnosed kidney disease.

Autoimmune disease – Medicines used to treat autoimmune diseases can harm the baby; these conditions also increase the risk of pregnancy and childbirth.

Thyroid disease – Uncontrolled illness can increase stress in the baby and lead to poor weight gain, heart failure or problems with brain development.

Obesity – Obesity before becoming pregnant is associated with high risk and poor outcomes, including fat for gestational babies, difficult birth, and risk of heart defects.

Age – Adolescent girls and first-time mothers over 35 fall into high-risk categories.

Lifestyle factors – The use of alcohol, tobacco and drugs increases the risks to mother and baby during pregnancy and childbirth.

Pregnancy conditions – Women who are carriers of multiples, who have had a premature birth in the past or who have gestational diabetes, preeclampsia or eclampsia are at high risk.

Comparison of the risks of home and hospital births

The decision to give birth at home or in hospital is a personal decision. Although ACOG says hospital is the safest place, research data shows low risk pregnancies delivered at home or in a hospital with a trained midwife have the same risks and potential. results. Equally important are the risks to low-risk women giving birth in a hospital.

For example, while a home birth rarely, if ever, includes the use of drugs or interventions to speed up the birth, many hospitalized women may be given Pitocin, a synthetic form of oxytocin. The drug is used to induce labor or to trigger contractions and it can be used to intensify labor contractions to speed up the process.

However, the use of the drug should be weighed against the results, such as a higher rate of analgesia and cesarean section,15 which both affect the mother and the baby. In any pregnancy, oxytocin can also increase the risk of fever in women, low pH values ​​in the umbilical cord, and shorter first stage of labor.16

CDC data shows the Caesarean section rate in 2018 was 31.9% of all births.17 However, this includes a number of Cesarean sections that are considered medically unnecessary. The Nullipare, Term, Singleton, Vertex (NTSV) cesarean birth rate is 25.9%.18

This means that of all the women who had a Caesarean section, 25.9% had their first baby, beyond 39 weeks gestation and carried a normally presenting child, in the vertex position with the head down.19

Having a first C-section almost guarantees that subsequent births will also be C-sections as the repeat rate is 86.7%.20 As the American Pregnancy Association explains, a Caesarean section presents multiple risks for both mother and baby. For the mother, these are infections, bleeding, injuries, long hospital stays and emotional reactions as well as those related to medicine.

Moms can also have adhesions or scar tissue that causes a blockage in the stomach area. Babies can have low birth weight, low APGAR score, difficulty breathing, and even injury.21

The type of birth influences future health

As you probably know, the gut microbiome is a complex living base for your immune system that plays a role in your risk of chronic disease, weight management, and your body’s ability to absorb nutrition. As you can imagine, during a vaginal birth, a baby’s microbiome is first “seeded” and developed.

In the process, a baby receives the microbiome from the mother, which is why it is so important for a woman to have a healthy gut before, during and after pregnancy. The composition of the mother’s gut will influence the growth of the baby’s microbiome.

A cesarean bypasses this important step, which can be made worse by bottle-feeding, a lifespan of processed foods and overuse of antibiotics. These factors have all led to a great loss of biodiversity in the human gut, making many people vulnerable to disease. Skin-to-skin contact after birth and breastfeeding are two ways to pass on a healthy microbiome if you’ve had a cesarean section.

For more information on how to more effectively help seed your baby’s gut microbiome, see “How birth method can affect lifelong health. “



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