DO YOU WANT A HOME BIRTH?
WHAT YOU NEED TO KNOW
I had my first child in hospital, and it was so quick and easy that we decided to have our second at home. The home delivery, in a birthing pool, was a fantastic experience, so when I got pregnant a third time, we didn’t even discuss the possibility of a hospital birth. But there were complications, and we were lucky we had a very experienced and competent midwife.” This sobering recollection of a mom who had three entirely different birth experiences is a salutary reminder that every pregnancy and delivery is unique, and that nature doesn’t necessarily always follow our rules. That said, a carefully planned home birth for “a healthy woman having a lowrisk singleton pregnancy” can be a calm and joyous experience, says midwife Heather Pieterse, whose Pretoria-based practice has been assisting with home births for 17 years.
WHAT ARE THE BENEFITS OF A HOME BIRTH?
“A sense of autonomy,” says midwife Ruth Erhardt, who’s been helping women deliver babies from her base in Muizenberg for three years and is the co-founder of Home Birth South Africa (homebirth.org.za). “Having control over your environment and procedures, and who’s present, and being able to call the shots, as well as the feeling of safety your own home gives you, are all extremely beneficial.” “A home birth enables you to move through labour doing everyday things: walking in your garden, chatting to your kids, folding washing, patting your pets; doing what comes naturally,” says Heather. “Then, when you feel your body is ready, you can just move to your birth space, and not have to drive anywhere. It’s all perfectly natural, with no triggers causing adrenaline to surge and hamper the birth process.” Then, adds Ruth, you can take your time, and not have to labour according to a clock or graph. “There’s also no change in staff during your labour, and you can choose the position you want to birth in.” After the delivery, your baby isn’t taken away from you and you can snuggle in bed as a family while life carries on. Another pro is that the baby is born into his or her own microbiome (the immediate environment, including all microorganisms in that environment), which makes him or her less likely to develop allergies and other related illnesses in later life, says Ruth. A 2006 study found that term infants born vaginally at home and then breastfed exclusively had the most beneficial gut microorganisms. Finally, “a home birth is far cheaper than giving birth in hospital,” Heather points out, but adds, ”Having a home birth just to save money is most certainly not the ideal reason to have one.”
WHAT DOES THE MIDWIFE DO?
“A midwife brings to a birth what you would find in most labour wards in a birthing clinic or hospital,” says Ruth. “She can monitor the foetal heart rate in labour. She can perform vaginal exams and measure blood pressure. She carries the equipment for and is trained in neonatal resuscitation (helping a baby to breathe) and postpartum haemorrhage (heavy bleeding after the birth). She can stitch you up if you tear, although she’ll work very hard to make sure you don’t. And she’ll weigh the baby and perform a basic newborn exam.” She doesn’t, however, perform C-sections or provide epidurals.
WHAT ARE THE RISKS OF A HOME BIRTH?
“Under the right conditions, the risks are limited to the odd obstetric complication which
is in reality very rare,” says Heather. She cites as some of the reasons why you would need to transfer to hospital: Slow progress in labour that requires further intervention – stimulating labour via medical augmentation isn’t recommended at home. Pain relief. “Some midwives do carry synthetic drugs to home births but personally I choose not to as this can lead to other complications,” Heather notes. Foetal distress – if the baby’s heart rate is “non-reassuring”. “This can be determined by listening to the foetal heart with a foetal Doppler regularly during and after a contraction,” Heather says. Slow second stage – battling to actually birth the baby. “If the head isn’t coming down effectively and progress isn’t obvious after trying various positions and giving enough time, we would rather transfer than wait until there’s foetal or maternal distress and a real emergency,” Heather says. The placenta gets retained, causing bleeding or postpartum haemorrhage. “This is possibly one of the greatest risks at home,” says Heather. “It’s considered a true obstetric emergency and a fast transfer is imperative.” The baby is battling to recover after birth. However, stresses Ruth, “The majority of healthy pregnancies do labour smoothly. Birth isn’t an illness or an emergency, it’s a normal physiological process.”
WHAT HAPPENS IN AN EMERGENCY?
“We insist on a rock-solid backup plan that entails knowing what hospital we would transfer to, understanding the ambulance transfer procedure, and having a backup obstetrician who’s seen the mom-to-be during the pregnancy at least twice,” Heather says. “In the case of a state hospital, we insist that the mom attends the antenatal clinic at least twice to get the clinic card and the necessary blood tests done. A hospital booking is also done – it costs nothing – and all forms are kept in the hospital bag, ready and completed.” Heather adds that it’s crucial the parents are aware of the full costs of a hospital admission for mother and baby, as if there isn’t medical aid or a hospital plan, the hospital will demand a large deposit. “In an emergency there’s no time to phone a family member to borrow money,” she points out. While a backup plan is obviously vital, “during the pregnancy, the midwife and mother work closely together, getting to know one another,” Ruth says. “The careful monitoring of the mother in pregnancy often eliminates emergencies in the labour because the reasons for them cropping up in the labour are dealt with in the pregnancy. All this preliminary stuff often eliminates true emergencies. Hospital transfers are usually quite slow, calm affairs that happen because the labour can no longer happen at home, or if the mother and baby need to be seen to by a doctor after the birth.” Heather adds, “The mom and the midwife need to have a very open and honest trust relationship in that if the midwife recommends moving to the hospital, it should be a smooth and efficient transfer, without argument or negotiation, with the mom knowing and trusting the midwife is using her good judgment.”