Is Home Birth as Safe as Hospital Birth - Literature review Example

Is Home Birth as Safe as Hospital Birth? Introduction Child birth that occurs outside a hospital or the setting of a birth center, usually in the home of the mother is known a home birth. The delivery may or may not be attended by a midwife or any other health professional (Davis, p.45). When the delivery occurs without the assistance of a health professional, it is known as unassisted home birth. Home birth is not much in practice now especially in the urbanized cities and towns. Though in yester years, it was a much in vogue, it declined in the 20th century. This is because of the assumption that hospital based deliveries supervised by obstetricians and pediatricians are safer for both the mother and child. However, there again seems to be a rise in the home births even in industrialized nations. Midwifery care blossomed in the U.S. because of the home birth movement, as women who didn’t themselves want home births but who did want care that did not involve routine and unnecessary medical interventions and practices, such as pubic shaving, enemas, being forced to remain still while lying supine during labor (the painful position possible) and often mandatory pain medication, wanted to be able to choose the midwifery model of care in the hospitals where they would give birth (Home Birth Guide). Politically and academically home birth is a much debated topic. Though there are many studies conducted to evaluate home birth, the benefits remain unproved as yet. An ideal method of assessing the benefits of home birth would be to conduct a randomized control trail. However, this seems less practical in the event of need for large numbers to get enrolled in the study, and also to have a proper environment for home delivery. Currently, home birth is is being promoted in many parts of the world including Europe, Australia and the US (Gaskin, p.74). Incidence The incidence of home birth varies from country to country worldwide depending on the industrialization. It is lowest in developed countries. In Britain, the incidence of home birth is estimated to be 0.6% (Macfarlane, McCandlish, & Campbell, p.798). In the Netherlands, 30% of births are planned to be at home (Bastian, Keirse & Lancaster, p.384). Safety aspects of home birth Though hospital settings have more infrastructure and expertise to take care of complications occurring during and after delivery, since most of the deliveries are uncomplicated, home delivery is safe for uncomplicated pregnancies under the supervision of midwives or any other trained health personnel. Infact, most of the studies on the safety of home birth are on low-risk pregnancies. It is obvious that high-risk pregnancies need to be delivered in the hospitals under expertise supervision and monitoring. Also, high risk mothers seldom opt for home delivery (Davies et al, p.1302; quoted in Macfarlane, McCandlish, & Campbell, p.798). Olsen (p.4) did a meta-analysis of the safety of home birth in low-risk pregnant women. The study revealed that perinatal mortality and maternal death rates were actually similar to both home and hospital deliveries. Also, there was a lower frequency of low Apgar scores and severe lacerations and also fewer medical interventions in home deliveries. The author concluded that "it is at least as safe for healthy women to give birth at home as in hospital, and perhaps safer." He insisted that obstetricians should be encouraged to base their judgements on empirical evidence rather than pre-scientific dogmas. Johnson & Daviss (p.1416) evaluated the safety of home births in North America involving direct entry midwives. They concluded that planned home birth for low risk women using certified professional midwives was associated with lower rates of medical intervention. The researchers also reported that the intrapartum and neonatal mortality was similar to that of low risk hospital births in the United States. Similar reports were inferred from other studies (Weigers et al, p.1309; Ackermann-Liebrich, p.1313). Infact, Weiger et al (p.1309) opined that "there was no relation between the planned place of birth and perinatal outcome in primiparous women when controlling for a favorable or less favourable background, and in multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables." Davies et al (p.1302) studied the the experience and outcome of pregnancy, the indications for hospital transfer, and the attitudes of mothers, midwives, and general practitioners amongst women requesting a home birth. The study revealed that the women who delivered at home were at ease because of family setting. Most of the times, the care-givers were midwives. General practitioners were apprehensive about inability to handle complications arising during home birth. However, study by Bastian, Keirse & Lancaster (p.384) showed different results. In their study they found that home births in Australia carried a high death rate compared with both all Australian births and home births elsewhere. The cause of these high rates was accounted to "underestimation of the risks associated with post-term birth, twin pregnancy and breech presentation, and a lack of response to fetal distress". Benefits of home birth Since home birth occurs in the setting of the mothers house, she is naturally comfortable. The incidence of medical interventions like episiotomy, forceps application, cesearean section, vaccum application and epidural analgesia is reduced (Johnson & Daviss, p.1416). Also, home birth is cost effective. Childbirth makes up one-fifth of all health care expenditures and is also and is the most frequent cause for hospital admission. Costs in home birth are defined as charges to the mother for a routine birth. Hospital birth in the US costs about 6000-10,000 dollars for vaginal birth. But home birth costs between 1500-3000 dollars (Home birth guide). In the US only 40% of births are covered by medicaid. Anderson & Anderson (p.30) compared costs of hospital, home and birth center deliveries in the US. They concluded that "informed birthing decisions cannot be made without information on costs, success rates, and any necessary trade-offs between the two. The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery". Women who deliver in their homes are less likely to have painful perception of parturition. This is evident from the study by Morse & park (p.175). Perineal outcomes in home birth Aikins & Feinland (1998) studied the damage in the perineum in those women who delivered at home and compared with those who delivered n the hospital. Their study revealed that about 70% of the women had an intact perineum, in the sense, there were no tears, minor abrasions (grazes) or small tears that were not stitched. This is a very good rate when compared to the high rates of episiotomy in hospital-based deliveries. Episiotomy is actually equivalent to second degree perineal tear. Aikins & Feinland (p.226) concluded that it is indeed possible for or midwives to achieve a high rate of intact perineums and a low rate of episiotomy in a select setting and with a select population. Information to be given to woman about choosing between home birth and hospital- delivery The women should be given accurate and balanced information about the pros and cons of home delivery. The women must be told that home delivery is safe as long as they follow professional advice. Those with high risk pregnancies including twin, breech and post-term pregnancies have increased risk involved in home-births when compared to low-risk pregnancies (Macfarlane, McCandlish, & Campbell, p.798). The women must be given individualized specific advice. One important aspect during home birth that taunts most mothers while choosing between home and hospital delivery is, whether transfer during labor is safe, in case of any unexpected complications. Studies have shown that transfer during labour is safe ((Macfarlane, McCandlish, & Campbell, p.798). Role of the midwives and general practitioners during home delivery It is important for general practitioners to create the right circumstances for safe and satisfying home births (Springer & Van Weel, p.1276). The care deliverers have a responsibility to to select women who are not at high risk of complications and to establish an infrastructure for safe obstetric interventions. They need to provide basic obstetric infrastructure like elevated beds. They also need to provide support during labor and also after delivery. Maternity home care assistants have a pivotal role in taking care of the baby and the mother. The health care attendants must also allow access to hospital facilities in the rise of serious complications which need the immediate attention of expertise care. Hence there should be good coordination between the primary care health personnel and the obstetrician (Springer & Van Weel, p. 1277). Conclusion Home births are considerably safe, as much as birth-care center or hospital deliveries. They offer the comfort of family setting to the mother. Also, the incidence of medical interventions is drastically reduced contributing to low cost for health care. Meticulous selection of women at low risk of obstetric complications is the key to achieve good results in home birth. Works Cited Page Aikins Murphy P, Feinland JB. "Perineal outcomes in a home birth setting." Birth 1998 Dec;25(4):226-34. Anderson RE; Anderson DA. “Cost -Effectiveness of Home Birth.” J Nurse Midwifery 1999 44(1):30-5. Ackermann-Liebrich U, Voegli T, Guenther-Witt K, Kunz I, Zullig M, Schindler C, et al. “Home versus hospital deliveries: a prospective study on matched pairs.” BMJ 1996;313:1313-8. Bastian, H, Keirse, MJN, & Lancaster, L. “Perinatal death associated with planned home birth in Australia: population based study.” BMJ 1998;317:384-388. Davies J, Hey E, Reid W, Young G. “Prospective regional study of planned home birth.” BMJ 1996;313:1302-5. Davis, Elizebath. "Heart and hands: a midwives guide to pregnancy and birth" 2004. Berkeley, CA: Celestial Arts. Print. Gaskin, Ina. "Home birth-why its necessary" 2007. TN: Ina May Gaskin Productions. Print. Homebirth Guide. “Homebirth Cost.” 2007 Dec 4th 2010 Johnson, KC. & Daviss, BA. “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ 2005 330, 1416. Macfarlane A, McCandlish R, Campbell R. “Choosing between home and hospital delivery. There is no evidence that hospital is the safest place to give birth.” BMJ 2000;320: 798. Morse, P & Park, M. “Home birth and hospital deliveries: a comparison of the perceived painfulness of parturition.” Res Nurs Health 1988 Jun;11(3):175-81. Olsen O. “Meta-analysis of the safety of home birth.” Birth 1997;24: 4-13. Springer, NP, & Van Weel, C. “Home Birth.” BMJ, 313, 1276-7. Wiegers TA, Keirse MJNC, van der Zee J, Berghs GAH. “Outcome of planned home and planned hospital births in low risk pregnancies in the Netherlands.” BMJ 1996;313:1309-13. Read More