A home birth is any birth which takes place at home in the presence of a midwife, provided that the mother-to-be planned for this ahead during pregnancy.
The percentage of home births has historically been fairly small in Estonia. In many years, home births have accounted for less than 0.5% of all births. The percentage of home births is generally under 1% in most other European countries as well. In recent years, the number of home births has been on the rise: 65 planned home births took place in 2018, whereas that number was between 5-7 babies per year from 2000 to 2002.
With regard to the SARS-CoV-2 epidemic, most maternity hospitals have banned support partners from attending births. It is likely that this unpopular decision among pregnant women as well as fear of the virus have led to an increase in the number of home births as of the start of the emergency situation. Women may also choose in favour of a home birth for other reasons, for example, they may wish to avoid medical interference or feel more safe at home.
Progress in medicine and the living and hygiene conditions of people over the past 150 years has dramatically decreased the rate of mortality among mothers and newborn children. It has also established the idea that childbirth is a relatively safe event for both mother and child.
However, it is impossible to predict with absolute certainty potential birth-related complications based on risk assessments conducted during pregnancy. As much as 30% of low-risk pregnancies may experience unexpected complications. Chorioamnionitis and meconium stained amniotic fluid are some of the potential risks which require immediate action and hospitals are the best places to provide the necessary care. Placental abruption, umbilical cord prolapse and postpartum haemorrhage are rare emergencies, but tend to be unpredictable and require quick medical attention.
With home births it is also more difficult to monitor the condition of the baby, for example, the baby’s heart rate can be assessed by listening at certain intervals, but cardiotocography or CTG at the hospital gives a better overview of the baby’s health. Unfortunately, pregnancy anamnesis and the course of the delivery allow us to predict only around two-thirds of cases where a newborn may require resuscitation. It is true that home births have less medical interventions, which is one reason some women plan to have their baby at home.
A home birth is not recommended for first-time mothers – it is best to deliver your first baby at a hospital.
Compared with first-time mothers at hospitals, women who decide in favour of a home birth have a significantly higher risk of complications for the newborn child, for example, intrauterine foetal demise, brain damage, neonatal death, meconium aspiration syndrome, bone fractures, brachial plexus birth palsy. First-time mothers also experience more disruptions in the course of the pregnancy with almost 25-50% of women needing to be taken to a hospital.
Data from the United Kingdom indicates that if home births are well-integrated into the healthcare system, there are no significant differences in the risk of severe complications for the newborn child with low-risk women who are not first-time mothers, regardless of where the child is delivered. In this case, the risk to the newborn’s health is equal for a home birth and a hospital birth.
To be more specific, good integration means that the work of providers of obstetrical home care, for example, midwives, is set out and acknowledged in legislation. For example, providers of obstetrical home care must have appropriate training; they must have the option to continue the delivery/treatment at a hospital, know how to provide first aid and have the necessary equipment. Home births must include a well-functioning ambulance service to call for help in the event of complications.
Planning for a home birth should never be done without the help of a midwife, as this puts both mother and child at risk.
As gynaecologists, we accept that women have the right to a home birth, but at the same time we consider it safer to give birth at a hospital.
Authors:
Resident Doctor at East-Tallinn Central Hospital Dr Anu-Liis Laar and Head of the Maternity Department Dr Kristel Krunks