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If you are considering a home birth…

Dear doctor, am slowly approaching the end of my first pregnancy. Am considering a home birth, is this a viable option for me?

Home births were the norm in aeons gone by. But by the turn of the 1900s, hospital births started becoming more common. It is estimated that nowadays, home births account for only one percent of all deliveries. However some developed countries have well-organized programs that support home births, recording slightly higher regional statistics.

There are several reasons why some women are attracted to the possibility of delivering at home. For starters, you deliver in familiar surroundings, and have a chance to share the experience with family and friends. Some want to avoid the medicalization of labor and delivery, which is inevitably associated with hospital births. Still others may think of the costs associated with hospital deliveries. Some studies estimate that home births can be up to 60% cheaper compared to hospital births.

Whatever your reasons for considering a home birth, there are several factors to consider. Your pregnancy must be considered low risk and uncomplicated. You must discuss the plan for home delivery with your midwife and obstetrician well in advance. You also need to identify the team that will supervise your home delivery. Such a team would ideally include two midwives, with an obstetrician readily available in case their presence is required. It’s also prudent to identify a paediatrician who should be on standby.

A plan B is also required in case things don’t turn out very well. You see, the process of labor is dynamic and unpredictable. Unforeseeable eventualities may happen, necessitating abandoning the previously well-laid plans for a home birth. Labor involves progressive uterine contractions, continued opening of the cervix, and ongoing descent of the baby into the birth canal. Sometimes these coordinated events may not progress optimally. Your baby may also go into distress, creating an emergency situation. All sorts of other labor -related complications may occur. Thus your plan B must be clear about how to respond to any emergencies that may arise, including rapid transfer to the hospital.

There is an inevitable debate about the safety of home deliveries. You will come across several scientific studies about the subject, and heated exchanges among professionals about the merits and demerits of home deliveries. It appears home births are associated with a slightly increased risk for the unborn baby, and even the mother as well. But it’s clear that carefully selected low risk women can safely delivery at home, so long as all precautions are put in place to take care of any eventualities.

Go ahead and review your plans for a home birth. Make sure you understand the complexities involved, and take care of even the minutest of details especially as relates to safety. If any doubts arise, delivering in hospital remains the safest option.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke

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