Many women contemplate giving birth at home because they want to avoid the high-tech atmosphere and interventions of a hospital. You're a good candidate for a home birth if you're in good health and have an uncomplicated pregnancy. Still, most expectant mothers don't get past the thinking stage -- home births account for less than 3 percent of all births. Here's what you need to consider if you're thinking about this option.
1. Research your options. It's extremely unlikely that you'll find an ob-gyn to be your birth attendant. By training, they're taught to treat birth as a medical event with potential complications. In some states naturopathic physicians do a lot of home births. But a midwife is your most likely candidate. Most home births are attended by direct-entry midwives, as opposed to certified nurse-midwives.
2. Pick a practitioner with solid experience. When interviewing, be sure to ask how many births she's attended, both as a primary (where she was in charge) and as an assistant. You want someone who's been the primary birth attendant in at least 100 births, says Chris Ann Beard, a certified nurse-midwife in Portland, Oregon. Make sure the midwife works with an assistant (most do).
3. Make sure the practitioner is comfortable handling emergencies and is bringing appropriate equipment. Ask specific questions about the range of complications she's handled. She should have the knowledge and equipment necessary to resuscitate a newborn, administer medication to stop a postpartum hemorrhage, and suture a severe laceration.
In case of such emergencies, she should bring IV fluids, an oxygen tank, and oxygen masks for various sizes of infants. She should also bring an oxygen delivery device suitable for adults (in case you need one) as well as suturing materials.
4. Have an emergency plan. Ideally, your midwife should have a relationship with a physician or hospital in case the home birth doesn't go as planned. If she doesn't have a doctor she can call to describe what's happened and warn of your arrival, you'll basically be treated as an ER patient, notes Beard. The doctor and staff won't know anything about your medical history, and they will likely be very worried about you and your baby. This often results in more tests and interventions, the very thing many women want to avoid.
5. Decide where you're going to give birth and who will attend. Depending on how far away you are from a hospital, you may choose to go to a friend's or relative's house once you go into labor. That way, if there's an emergency, you can get to a hospital quickly. There are no rules on how many people should be present at the birth. Whether to include children, family, and friends, or just yourself and your partner (plus the birth attendant and her assistant of course!) is up to you.
6. Consider having lab work and tests done through a clinic. Home birth patients sometimes have all of their prenatal lab work and ultrasounds done through a doctor's office, often on the midwife's recommendation. That way their insurance is put to some use. And if the patient ends up being transferred to the hospital, the medical records are already on file.
8. Understand there is risk. According to a recent study in the journal Obstetrics & Gynecology, the risk of death to newborns intended to being delivered at home is nearly twice that of babies intended to be delivered in hospitals. Even if there's a sound emergency plan in place, you could lose valuable time in transit to the hospital. Women who delivered at home were more likely to experience problems such as postpartum hemorrhage and prolonged labor.
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