Home birth: Is it safe?

Dear Doctor,

I have watched videos of women having home births and I am confused. How safe is this? Can a woman actually arrange for this? What are the risks that women should be aware of before trying this out? Margaret

Dear Margaret,

Home birth is where a woman gives birth at home, at the end of full term pregnancy. It has several advantages, but some disadvantages as well.

If the pregnancy has been smoothly progressing, there are no real or potential complications, no history of complications during a previous pregnancy, home delivery is a good option. If home delivery is being planned, a lady should arrange everything needed before hand.

The greatest advantage of home delivery is that a pregnant mother delivers in the familiar environment at home. Hence, she is more relaxed. There is no compulsion, hence, mental pressure of taking any tablet or injection. There is no cost involved and the expenditure on hospitalisation and hospital delivery is saved. The family members are also relaxed and can take better care of the new-born and new mother, as nobody has to rush in and out of the hospital.

One of the disadvantages is that home delivery needs enough privacy.  The bed and bed sheets and surrounding area becomes messy, which needs thorough cleaning afterwards. One should ensure that the scissors, knife, and tools used to cut the umbilical cord should be very clean and if possible disinfected and sterilised. Otherwise it can be a potential source for tetanus and other infections in the woman, as well as in the new-born.

One should arrange for a qualified, skilled, midwife, nurse or obstetrician to assist the birth at home.  The person assisting birth should be aware of due aseptic precautions and follow those to prevent any post-delivery infection. These include, good hand washing and then using clean gloves, prior to examining the birth canal of the woman and assisting the child birth. He/she should be able to handle the new-born well, cut the umbilical cord neatly and take suitable decisions after assessing the situation, just immediately before and after the delivery.

Complications can still arise after delivery in a woman, even if she has had an event free uncomplicated pregnancy and smooth delivery, like excess bleeding after delivery. The new-born may aspirate some fluids from the birth canal and become cyanosed, he may cry poorly. These are situations, which can be potentially fatal. The midwife or nurse assisting the delivery should be able to recognise these and arrange for the mother and baby to be shifted to the hospital immediately.

However, in certain situations, a home delivery should never be attempted.  These are history of Caesarean section in a previous delivery, twin pregnancy, high blood pressure and or diabetes during pregnancy, malposition foetus as with a transverse lie, foetal distress during previous child birth, and etcetera.

Dr. Rachna   Pande is a specialist in internal medicine.

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