Home birth
My job is to provide clear and reliable information so that each mother/couple/family can make a responsible decision about the place they prefer for the birth of their child.
I accompany you in your home birth
Every woman should get the necessary support regardless of where she wishes to give birth, as birth will go best where she feels safest (ALPACC, 2018; Downe, 2007).
So far there is no scientific evidence that low-risk childbirth is safer in a hospital than at home.
Many women feel more secure in their own environment as they are more in control of what is going on around them, have more freedom of movement, more intimacy, more capacity for physical and emotional spontaneity, and have been able to build a family relationship of mutual trust with the midwife who accompanies them.
These women are more likely to have a physiological birth free of unnecessary interventions (NICE, 2014), and are therefore at less risk of having a caesarean birth or an instrumental delivery (Reitsma et al, 2020; Homer et al, 2019; Rossi and Prefumo, 2018; Scarf et al2018; Davies-Tuck et al, 2018; Wiegerinck et al2018; Hutton et al, 2016; Sandall et al, 2016; Halfdansdottir et al, 2015; Snowden et al, 2015; Homer et al, 2014; Offerhaus et al, 2014; Cheyney et al, 2014; NICE, 2014; Hollowell et al, 2011 Hodnett et al, 2012a; McIntyre, 2012; Miller and Skinner, 2012; Davis et al, 2011; Hutton et al2009; Janssen et al2009; Lindgren et al2008; Maassen et al, 2008) less risk of infection and less risk of having a postpartum haemorrhage (Reitsma et al, 2020; Homer et al, 2019; Rossi and Prefumo, 2018; Scarf et al2018; Hutton et al, 2016; Halfdansdottir et al, 2015; de Jonge et al, 2013; Davis et al, 2012; Miller and Skinner, 2012; Nove et al, 2012; Janssen et al, 2009). They are also less likely to have a 3rd or 4th degree tear when they go home (Reitsma et al, 2020; Homer et al, 2019; Scarf et al, 2018; Bolten et al, 2016; Hutton et al2016; Halfdansdottir et al, 2015; Janssen et al, 2009; Lindgren et al, 2008).
They tend to be women who ask for less pharmacological analgesia thanks to the continued support offered by someone they know and trust (Bohren, et al. et al2017; Hutton et al2016; Sandall et al, 2016; Halfdansdottir et al, 2015; Cheyney et al, 2014; Lida et al, 2014; Offerhaus et al2014; Hodnett et al, 2012a; Hodnett et al2012b; Miller and Skinner, 2012; Hollowell et al, 2011; Janssen et al, 2009 Heptinstall and Lee, 2004).
These are women who report having more satisfying experiences (Gregory et al2023; Sandall et al, 2016; Dahlberg and Aune, 2013; Hodnett et al, 2012a; Hollowell et al, 2011; Leap et al, 2010; RCOG and RCM, 2007), which allows them to feel strong and healthy to face motherhood (National Childbirth Trust (NCT), 2002), recovering quickly and less likely to suffer from Post Traumatic Stress Syndrome, which is often caused by negative experiences (Fairbrother and Woody, 2007; Paradice, 2002), emergency caesarean sections and instrumental births (Rouhe et al, 2008; Leeds and Hargreaves, 2008, Baston et al, 2008; Fairbrother and Woody, 2007; Lobel and DeLuca, 2007; Stadlmayr et al2006), and because of negative relationships with birth professionals and a sense of loss of control over the process (Morton, 2019; Larsson, 2019). et al, 2019; Perriman et al, 2018; Sosa et al ,2018; Hill, 2015; Holvey, 2014; Maggioni et al, 2006, Olde et al, 2006; Slade, 2006).
This syndrome can cause symptoms such as sweating, tremors, insomnia, irritability, flashbacks and nightmares, difficulty in bonding with the baby (Olde et al, 2006), as well as Fear of Childbirth in a subsequent pregnancy or secondary toco-phobia, a condition that has already been recognised in medical settings as an iatrogenic condition that needs to be treated and is the result of a biomedical model (Walsh, 2002). On the other hand, a positive birth experience can transform negative social misconceptions about a new birth, reducing fear (Larsson, 2002). et al2019) and may encourage other women to seek out options for a more enriching birth experience (Hill, 2015, Walsh, 2002).
The risk of perinatal morbidity and mortality at home is similar to that of hospital births, always in low-risk pregnancies and deliveries (Reitsma et al, 2020; Homer et al2019; Hutton et al, 2019; Rossi and Prefumo, 2018; Scarf et al, 2018; Li et al, 2015). In the long term, by the age of 7 years, these children are less likely to have asthma, allergic related diseases and infections (Ovaskainen et al, 2021).
All this implies lower economic costs in home birth than in hospital birth (Attansio et al, 2019; Janssen et al, 2015; Schroeder et al, 2011), but despite this the Catalan public and private healthcare system is still not willing to cover its costs.
The Royal College of Obstetricians & Gynaecologists (2007) stated that too many deliveries are taking place in hospitals, and the WHO insists that the number of caesarean sections without a justified medical indication has increased alarmingly in all countries (World Health Organisation, 2010) increasing the risks to the health of mother and baby in both the short and long term.
Objectives and Methodology
Every mother/partner/family is informed that home birth can only take place when the birth is considered low risk and the following conditions are met:
- the baby is presented cephalic (i.e. head down)
- labour starts spontaneously between 37 and 42 weeks of gestation
- the pregnancy is not multiple (there is only one baby)
- there is an absence of health complications for both the intrauterine baby and the mother.
Every mother/couple/family is offered a birth plan which is discussed point by point, signed by both the mother and the midwife, detailing the wishes of the mother/couple/family and the conditions under which some interventions might be necessary in my clinical judgement.
Every mother/partner/family should be informed of the possibility of transfer to a Health Centre (ALPACC 2018; NICE, 2014; MCWP, 2007) and various options for transfer to Health Centres will be planned in case this is necessary according to the urgency and/or priorities expressed by the mother.
The goal of planning a home birth is to make it safe for mother and baby, and a healthy experience for all involved, regardless of where the baby is born.
What do I offer as a professional?
- visits at 10, 16, 25, 25, 28, 28, 34, 34, 36, 38, 38, 40, 41 and 42 weeks (NICE, 2008)
- be on call 24 hours a day from week 37 to week 42
- telephone support, or physical support if it is not necessary, in the pre-delivery period.
- to be at home with the mother once labour has begun
- taking care of the ambient temperature
- ensure that there are no distractions or external stimuli
- promote high levels of oxytocin
- eliminate/avoid elements and situations that can cause stress, and therefore high levels of adrenaline and cortisol in the mother and baby.
- physical and emotional support
- monitoring the wellbeing of mother and baby
- monitoring the progress of labour
- promoting hydration and nutrition for the mother
- only if the mother requires it, offer the use of non-invasive analgesic methods such as: the use of water in the form of a bath, birthing pool or shower, mobilisation and change of positions, massage, the use of analgesic breathing, visualisations and aromatherapy.
- helping the mother to deliver her baby and assisting in the delivery of the placenta until the postpartum bleeding is controlled
- offer care of the mother's perineum to avoid tearing, avoiding routine episiotomy, and suturing only when necessary.
- not to cut the umbilical cord until delivery of the placenta if the mother/partner chooses physiological management of the delivery.
- monitor the wellbeing of mother and baby after birth by promoting skin-to-skin contact and breastfeeding, staying at home for at least 3-4 hours after birth.
- cleaning and tidying up after childbirth.
- be accessible by telephone for at least 10-15 days after the birth and until the final discharge on the 28th day.
- visit mother and baby at home, on days 1, 3, 5, 10 and/or until discharge. I adapt the visits according to the situation and if there are complications or specific needs.
- Assessment of the perineum before discharge with supervision of ergonomics, carrying and daily habits. Recommendation of personalised exercises according to each situation.
Testimonials
Home birth with midwife
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