A home birth is a birth that occurs in residence rather than in a hospital or labor center. They may be attended by a midwife, or a lay clerk with experience in managing the birth of the home. Birth at home is, until the advent of modern medicine, the de facto delivery method. Since the beginning of the 20th century, home birth rates have declined in most developed countries, often less than 1% of all births. However, this varies considerably, with the Netherlands having higher home birth rates than many high-income countries and the UK has a planned home birth rate of 2-3%. The infant and maternal mortality rates have also dropped dramatically over the same time period and initially, assumptions are made that these findings are related, as reflected in the UK Government Peel Report (DoH 1970). Epidemiological work then identifies that there is no causal relationship, with an associated mortality increase primarily on increasing income and general health. Controlled analyzes for socioeconomic factors and for whether births were planned and attended or unplanned and unattended identified that the outcomes of planned births were positive. However, at this time, the view that birth should be done in the hospital has become more normal.
Women with access to high quality medical care may choose home births because they prefer home intimacy and family-centered experience, to avoid hospital-related risks, or a desire to avoid a typical medical-centered experience from home sick, among other reasons. Professionals attending home births may be obstetricians, certified or uncertified midwives, and doulas. In developing countries, where women may not be able to afford medical care or may be inaccessible to them, home births may be the only option available, and the woman may or may not be assisted by professional officers of any kind. In some cases, therefore, untreated home births may be unplanned (due to lack of access to care or lack of easy access to facilities for birth) or selected (often called [freebirth]). The latter tends to occur in women who want to avoid repetition of previous traumatic birth experiences at the facility.
Several studies have been conducted on home birth safety for children and mothers. Standard practices, licensing requirements and access to emergency hospital care vary between countries, and in countries such as the US, between regions, making it difficult to compare cross-country studies. The systematic review and meta-analysis of US studies 2014 concluded that the neonatal mortality rate was three times that of hospital birth (Wax et al 2010), but this methodology has been a critical review on the basis of inclusion of poorly controlled studies. A whole US cohort study of planned homes or hospital births from 2004-2009 concluded that there was no significant difference in perinatal outcome but lower intervention rates for mothers planning home births. A US-based registry study of all planned births in Oregon 2012-2013 (Snowden et al NEJM 2015) concluded that low-risk outcomes in low-risk women were low but home-planned births were associated with higher perinatal and neonatal mortality rates. seizures when compared with birth plan in hospital. However, this study relies on retrospective routine data and fails to control differences in service delivery, such as unlicensed midwives attending home birth proportions and lack of integration of midwifery services in the state of Oregon). In contrast, more recent studies on integration of midwifery services in the US found that mortality rates and rates of preterm delivery or low birth were lower in states with integrated obstetric care, in addition to lower rates of obstetric intervention and higher physiological birth rates.. A large-scale prospective cohort study of planned birth outcomes, midwifery hospital or midwifery arrangement in the UK found lower rates of intervention in all midwife-led settings and no difference in poor neonatal outcomes. However, despite its extremely low overall level, there is an increased risk of perinatal outcome harm for the first planned birth at home. The optimal results in this study were found with freestanding midwifery units, which are separate units of hospitals with midwifery units, which are administered by midwives and aimed primarily for the care of women with healthy pregnancies. Variations in study findings tend to be associated with an inability to offer timely assistance to women with emergency procedures in the event of complications during labor in settings with low levels of service integration or lack of universal access to care, as well as with various licensing and training standards for birth attendants between different states and countries.
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Home births are either attended or unattended, planned or unplanned. Women are attended when they are assisted through labor and birth by a professional, usually a midwife, and rarely a general practitioner. Women who are not helped or just attended by laypeople, may be their partner, family, friends, or an unprofessional birth attendant, sometimes called freebirths. A "planned" birth at home is a birth that happens at home with intention. Unplanned "home" births are what happen at home because of necessities but not with intent. The reasons for unplanned home birth include the inability to travel to a hospital or labor center due to conditions outside the mother's control such as weather or roadblocking or speed of birth development.
Factor
Many women choose a home birth because giving birth to babies in a familiar environment is important to them. Others choose home births because they do not like the hospital or maternity environment, dislike medical-centered birth experience, are concerned about exposing babies to hospital-carrying pathogens, or disliking the presence of strangers at the time of birth. Others prefer birth at home because they feel more natural and less stressed. In a study published in the Journal of Obstetrics and Women's Health, women were asked, Why do you choose birth at home? Five main reasons given are security, unnecessary evasion. general medical interventions in hospital births, previous negative hospital experiences, more control, and a comfortable and intimate environment. One study found that women experience pain inherent in births differently, and less negatively, in home settings. In developing countries, where women may not be able to afford medical care or may be inaccessible to them, home births may be the only option available, and the woman may or may not be assisted by professional officers of any kind. Some women may not be able to have safe birth at home, even with highly trained midwives. There are several medical conditions that can prevent a woman from qualifying for a home birth. These often include heart disease, kidney disease, diabetes, preeclampsia, placenta previa, placenta abruption, antepartum bleeding after 20 weeks of pregnancy, and active genital herpes. A previous cesarean can sometimes prevent a woman from qualifying for a home birth, though not always. It is important that a woman and her health care provider discuss the health risks of an individual before planning a home birth. Maps Home birth
Trends
Birth at home is, until the advent of modern medicine, the de facto delivery method . In many developed countries, home births declined rapidly during the 20th century. In the United States there was a major shift towards the birth of the hospital starting around 1900, when nearly 100% of births were at home. Prices fell to 50% in 1938 and to less than 1% in 1955. Since 2000, the transition back to birth at home has raised rates from 0.54% in 2004 to 0.72% in 2009. In the UK , a similar but slower trend occurs. with about 80% of births occurring at home in 1920 and only 1% in 1991. In Japan the birth-place change occurred much more slowly, but much faster: home births were 95% in 1950, but only 1.2 % in 1975. During the same time period, maternal mortality lasted from 1900 to 1997 from 6-9 deaths per thousand to 0.077 deaths per thousand, while infant mortality rates fell between 1915 and 1997 from about 100 deaths per thousand births 7.2 deaths per thousand.
A doctor describes a birth in a working class home in the 1920s:
You find a bed that has been slept by husband, wife and one or two children; already often soaked with urine, dirty sheets, and dirty patient clothes, she has not bathed. Instead of a sterile dressing you have some old cloth or dirt that is allowed to soak into a nightgown that does not change for days.
This experience contrasts with the birth of a 1920s hospital by Adolf Weber:
The mother lies in a well-disinfected room, light and uninterrupted sunlight flow through the high windows and you can make it light as an electric day as well. She was bathed well and freshly dressed in dazzling white sheets... You have a staff assistant who responds to every signal... Only those who have to fix the perineum at the cottar's house on a cottar bed with bad light. and help in hand can bring excitement.
Midwifery, the practice of supporting a natural approach to birth, enjoyed revival in the United States during the 1970s. Ina May Gaskin, for example, sometimes called the "mother of authentic obstetrics" helped open the Center for Midwifery in Summertown, Tennessee in 1971, which still operates. However, despite the sharp increase in birth attendant midwives between 1975 and 2002 (from less than 1.0% to 8.1%), most of these births occur in hospitals. Birth rates outside US hospitals remained stable at 1% of all deliveries since 1989, with data from 2007 showing that 27.3% of births since 1989 occurred in free standing birth centers and 65.4% in residence. Therefore, the birth rate of homes in the United States remained low (0.65%) for the twenty years prior to 2007.
Home births in the UK have also received the press since 2000. There is a movement, especially in Wales, to increase birth rates at home by 10% in 2007. Between 2005 and 2006, there was a 16% increase from births at home. level in Wales, but in 2007 the total home birth rate was still 3% even in Wales (twice the national rate). A 2001 report noted that there are different rates of birth at home in the UK, with some areas around 1% and others over 20%. In Australia, home births continued to decline for many years and 0.3% in 2008, ranging from nearly 1% in the Northern Territory to 0.1% in Queensland. In 2004, the New Zealand rate for home births almost tripled Australians by 2.5% and increased rates.
In the Netherlands, the trend is somewhat different from other industrialized countries: while in 1965, two-thirds of Dutch births occurred at home, that number has fallen to about 20% by 2013, which is still more than in other industrialized countries.. Less than 1% of South Korean babies are born at home.
Research on security
In 2014, a comprehensive review in the Journal of Medical Ethics from 12 previously published studies covering 500,000 planned home births in low-risk women concluded that the neonatal mortality rate for in-home births is three times that of births in the hospital. These findings echo that the American College of Obstetricians and Gynecologists. Because of the greater risk of perinatal mortality, the College suggests postterm women (pregnancies over 42 weeks), carrying twins, or having breech presentation not to attempt birth at home. The additional Journal of Medical Ethics review found that some studies conclude that home birth has a higher risk of Apgar scores that fail in newborns, as well as delays in diagnosing hypoxia, acidosis and asphyxia. This is contrary to a 2007 UK study study by the National Institute for Health and Clinical Excellence (NICE), a British government organization devoted to creating guidelines for coverage across the UK, expressing concern over the lack of quality evidence in studies comparing the potential risks and benefits the birthplace of homes and hospitals in England. Their report notes that intrapartum-related perinatal deaths are low all over the UK, but in the case of unexpected obstetric complications, the mortality rate is higher for in-home births because of the time it takes to transfer the mother to the midwifery unit.
Uncertain evidence suggests that intrapartum-related perinatal mortality (IPPM) for deliveries in ordered homes, regardless of birth place, equal to, or higher than births ordered in midwifery units. If IPPM is higher, this may occur in a group of women with intrapartum complications and who require transfer to midwifery units.
When unanticipated obstetric complications arise, either in the mother or infant, during home delivery, the outcomes of serious complications tend to be less favorable than when the same complications arise in the midwifery unit.
A 2002 study of planned home births in Washington state found that home births had jobs shorter than births in hospitals. In North America, a 2005 study found that about 12 percent of women who intend to give birth at home need to be transferred to a hospital for reasons such as difficult labor or pain relief. A 2014 survey of American births between 2004 and 2010 found that the percentage of women transferred to hospitals from premeditated births after birth to 10.9%.
The Journal of Medical Ethics and NICE report notes that the use of cesarean section was lower for women who gave birth at home, and both noted previous studies which determined that women who had larger home birth plans. satisfaction from experience when compared to women who have birth plans in hospital.
In 2009 a study of 500,000 hospitals and the birth of low-risk hospitals in the UK, where midwives have strong licensing requirements, is reported in the British Journal of Obstetrics and Gynecology. The study concluded that for low-risk women there is no increase in perinatal mortality, provided that the midwife is well trained and there is easy and quick access to the hospital. Furthermore, the study notes there is evidence that "low-risk women with planned home births are less likely to have referral to secondary care and subsequent obstetric interventions than those planning births in hospitals." The study has been criticized for several reasons, including that some data may be lost and that the findings may not be representative of other populations.
In 2012, Oregon undertook a study of all births in the state during this year as part of discussing the bill on licensing requirements for midwives in the state. They found that the intrapartum infant mortality rate was 0.6 deaths per thousand births for planned hospital births, and 4.8 deaths per thousand for planned home births. They further found that the mortality rate for planned home births attended by direct-entrance midwives was 5.6 per thousand. The study notes that statistics for Oregon differ for other regions, such as British Columbia, which have different licensing requirements. Oregon was recorded by the Centers for Disease Control and Prevention as having the second-highest home birth rate in the country in 2009, amounting to 1.96% compared with the national average of 0.72%. A 2014 survey of nearly 17,000 volunteer home births in the United States between 2004 and 2010 found an intrapartum infant mortality rate of 1.30 per thousand; early neonatal and neonatal mortality rates were 0.41 and 0.35 per thousand respectively. This survey excludes deaths associated with congenital anomalies, as well as births where mothers are transferred to the hospital before starting labor.
In October 2013, the largest such study was published in the American Journal of Obstetrics and Gynecology and included data on more than 13 million births in the United States, assessing delivery by doctors and midwives inside and outside the hospital from 2007 to 2010. This study showed that home-born infants were approximately 10 times more likely to have an Apgar score of 0 after 5 minutes and nearly four times more likely to have neonatal seizures or serious neurological dysfunction when compared to hospital-born infants. The study findings suggest that the risk of an Apgar 0 score is even greater in first-born babies - 14 times the risk of birth in hospital. The study results were confirmed by analyzing birth certificate files from the US Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics. Given the results of the study, Amos Grunebaum, professor of obstetrics and clinical gynecology at Weill Cornell Medical College and lead author of the study, states that the magnitude of risks associated with home delivery is so alarming that it requires the need for parents to -to know the risk factors. Other writers, Dr. Frank Chervenak, adding that the study was playing a risk of birth at home, since the data used calculated births in homes where mothers were transferred to the hospital during labor as a birth in hospital.
When it comes to the birth of a home vs. the birth of the hospital, the birth of a home is strongly associated with poor outcomes. The rate of increase in adverse outcomes of in-home births occurs despite the presence of a lower-risk home birth risk report. [...] We emphasize that the increased risk of poor outcomes from home birth arrangements, regardless of officer, is almost impossible to solve by transport. This is because the total time for transportation from home to hospital can not be realistically reduced to clinically satisfactory time to optimize outcomes when time is of the essence when unexpected setbacks of the good condition of the fetus patient or pregnant patient occur.
Study plan
Randomized controlled trials are the "gold standard" of the research methodology in relation to the application of findings to the population; However, such study designs are unfeasible or ethical for the location of births. Existing research, therefore, is a retrospective cohort study by selecting hospital records and midwife records. by pairing couples (by pairing study participants based on their background characteristics), In February 2011 Congress of Obstetricians and Gynecologists from America identified several factors that made quality research at home birth difficult. These include "lack of randomness, dependence on birth certificate data with inherent assurance issues, assurances depend on volunteer application submission or self-reporting, limited ability to distinguish between planned and unplanned births, variations in skills, training, and certification of birth attendants, and the inability to calculate and accurately relate the poor results associated with the transfer ". Therefore, quality studies need to take steps in their design to reduce these problems to produce meaningful results.
Available data on home birth safety in developed countries are often difficult to interpret due to problems such as differences in birth standard homes among different countries, and it is difficult to compare with other studies because of the various definitions of perinatal death. In addition, it is difficult to compare the births of homes and hospitals because only different risk profiles exist between the two groups, according to the CDC: people who choose to give birth at home are more likely to be healthy and at low risk for complications. There are also indistinguishable differences in home births, such as the mother's attitude toward medical involvement in birth.
Insurance and Licensing Issues
While a woman in a developed country may choose to have her child at home, at the birth center, or in the hospital, health coverage and legal issues affect the options available.
Australia
In April 2007, the West Australian Government expanded coverage for births at home across the State. Other state governments in Australia, including Northern Territory, New South Wales and South Australia, also provide government funding for the birth of independent and private homes.
The Federal Budget 2009 provides additional funding for Medicare to allow more midwives to work as private practitioners, allowing midwives to prescribe medications under the Medicare Benefits Schedule, and assisting them with medical compensation insurance. However, this plan covers only the birth of the hospital. There are no current plans to extend Medicare and PBS funding to home birth services in Australia.
Starting July 2012, all healthcare professionals must show proof of liability insurance.
In March 2016 the Coroner Victoria Court found against Gaye Demanuel's midwife in the case of Caroline Lovell's death.. "Coroner White also calls for a review of midwife regulations that care for women during childbirth at home, and for governments and health authorities to consider violations that prohibit unregistered health practitioners from taking money to attend home births."
Canada
The coverage of public health services at home varies from province to province such as the availability of doctors and midwives providing home birth services. The provinces of Ontario, British Columbia, Saskatchewan, Manitoba, Alberta and Quebec currently include home birth services.
United Kingdom
There are some legal issues with home births in the UK. Women can not be forced to go to the hospital. Support from various Health Authorities of the National Health Service may vary, but in general the NHS will include the birth of the home - Parliament Under the Minister of State for Health, Lord Hunt of King's Heath has declared "I turn to home birth issues, noble Lord, Lord Mancroft, make some useful statements. As I understand, although the NHS has a legal obligation to provide maternity services, there is no similar legal obligation to provide home delivery services for every woman who asks However, I really hope that when a woman wants a birth at home, and it's clinically appropriate, the NHS will do all it can to support the woman in her choice of home birth. "
United States
27 countries licens or regulate in several ways a direct-entrance midwife, or certified professional midwife (CPM). In the other 23 states there are no licensing laws, and practitioners can be arrested for practicing medicine without a license. It is legal in all 50 states to employ certified nurse midwives, or CNMs, who are trained nurses, although most CNMs work in hospitals.
References
External links
- The International Maternity Treatment Model A report on maternity care released in Scotland, 2002, includes a summary of how maternity care is handled in a country other than the UK.
- Common Aspects of World Health Organization Labor, Nursing in Normal Birth: Practical Guide , Chapter 2, 1997.
- American College of Obstetricians and Gynecologists Statement on Home Birth
- Home Birth Summit
- Why Not Home?
Source of the article : Wikipedia
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