Why do people want to give birth at home
There are no official statistics on home births in Russia, but every year there are more and more groups and forums that gather supporters of this movement. Their main arguments are: pregnancy is not a disease, everyone has given birth for centuries and has not died out, the body knows what is best.
Of course, this is a survivor’s mistake: people who have experienced the death of their child in a home birth say less about it than those who have gone well.
However, there are reasons why mothers refuse medical care. Women
- want to give birth with a minimum of medical interventions in a familiar environment with loved ones;
- dissatisfied with medical care, experienced obstetric violence before;
- afraid of medical errors;
- believe representatives of alternative medicine.
It is beneficial for the latter to demonize medicine in order to maintain demand for their services and make money on it. The irony is that they speak loudest about the financial benefits of public hospitals.
In fact, giving birth with a doula in Russia will cost you at least 70-80 thousand rubles. And according to compulsory medical insurance, you can give birth in a hospital for free, even with a partner.
In the USA, for example, the situation is reversed: medical care is very expensive, home births with a midwife will cost less. That’s why some people choose them.
What are the dangers of home birth?
In some countries, such as England and the United States, home births are regulated by laws: there are specially trained midwives who are in touch with the maternity hospital in order to urgently hospitalize mother and child at any time. And even there the number of complications is higher than in specialized institutions.
In Russia, there is no such practice officially. But on the Internet there are various dubious centers and specialists who are ready to take birth even online. So the risks are even higher.
In 2019, WHO presented a major report on maternal mortality. According to him, in 2017, about 810 women died every day in the world from complications associated with pregnancy and childbirth. And the most common cause was bleeding.
Stopping them is incredibly difficult. Hospitals have entire protocols for these cases. And still, sometimes you have to go to extreme measures: ligate the vessels and remove the uterus. At home, without medicines and equipment, it is almost impossible to save the mother. A healthy woman can bleed out and die in less than 2 hours.
Massive bleeding can begin unnoticed by the woman in labor. Therefore, the woman remains under the supervision of doctors in the birth unit for another two hours, and does not go to the ward. It is very difficult to determine by eye how much blood a mother is losing, usually the real volume is underestimated by 30%. Therefore, the staff collects and measures the amount of blood, and monitors the symptoms closely so that treatment can be started immediately if the situation becomes dangerous.
No doula, no matter how experienced, can save you. And by the time you get to the hospital, you will miss time, which can count in seconds.
Women also die from infections and pre-eclampsia, an anomaly in the structure of the placenta that leads to increased pressure and the appearance of protein in the urine from the 20th week of pregnancy and can cause a stroke or other fatal complications. In the maternity hospital, they can make drug prevention of these conditions. In addition, on the 2nd or 3rd day, an ultrasound is done and they look at how the uterus contracts and if there are any parts of the placenta left inside. This helps prevent delayed bleeding and infection.
For a child
Planned home births are more likely than hospital births to end badly. For example, death during and after childbirth, severe neurological dysfunction, and low Apgar scores that indicate the state of the newborn.
Rarely, but it happens that mothers are even prosecuted for causing death by negligence, as in Magadan in 2022.
The child is threatened
- Asphyxia, that is, the newborn does not begin to breathe or suffocates immediately after.
- Entering the lungs of water, including with the original feces – meconium. This is called aspiration.
- Placental abruption or detachment of the umbilical cord during childbirth. This is dangerous because the blood flow from the mother stops abruptly and the child dies.
- Shoulder dystocia – this means that after the birth of the head, the baby gets stuck. If it is not correctly brought out, he can instantly die or remain paralyzed.
When you can’t give birth at home
You definitely need hospitalization if you have:
- multiple pregnancy;
- the child did not take a position upside down (transverse, oblique, foot or pelvic presentation);
- there was a caesarean section, especially if less than three years have passed after it;
- narrow pelvis, heart and other chronic diseases in which it is impossible to give birth naturally, severe preeclampsia and other indications for caesarean section;
- infections or congenital malformations of the fetus;
- placenta previa, when it completely or partially covers the pharynx;
- placenta accreta when it grows into the underlying layers of the uterus.
To know for sure if you can give birth at home, you need to be fully examined by an obstetrician-gynecologist and discuss this possibility with him. Neither doulas nor coaches will ever be able to objectively assess the risks and recommend something.
Do doulas and special courses reduce risks?
A doula is a birth assistant. She does not have a medical education, but she helps the woman in labor physically and mentally cope with childbirth. She can give a massage, follow the correct breathing, attach the child to the mother’s breast, give water.
Some studies have shown that her presence in the hospital reduces the frequency of medical interventions: anesthesia, episiotomy (perineal incision) and caesarean section, and also reduces the duration of labor and helps turn it into some kind of positive experience.
But since she’s not an OB/GYN, she won’t be able to help in some emergencies. Therefore, do not think that she somehow insures. In addition, she does not bear any responsibility for the woman in labor and the child and can leave them in danger and leave at any time if she feels the risk.
Courses on home births also do not guarantee that in the event of problems, the mother and baby will remain alive. Even doctors make mistakes, despite all the experience, and coaches promise to teach you in a couple of months.
In 2009, the court sentenced the creator of the Cradle Center to 5 years in prison. She taught classes for women who want to give birth at home, frightened them with the horrors of maternity hospitals and accompanied them in childbirth herself. Because of her actions, 6 children died and 2 more were seriously injured.
The court delayed her execution due to the age of her youngest child. Therefore, right now she continues to advise women and guide their pregnancy.
This is not the only high-profile case, the same thing happened to hundreds of other people.
Should you give birth at home?
No. The maternity hospital is much safer than your home. Even if you can quickly get to the hospital in case of an unforeseen situation, you will lose valuable time. Because of this, you or your child may die or remain disabled.
There are many stories that ended happily when a woman did not have the opportunity to go to the hospital and gave birth in the field. But it shouldn’t be an option.
Even though childbirth is most often successful, there is always a chance that something will go wrong. In the hospital, you will be next to specialists who can save you.
If you still want to give birth at home, choose a doctor who will manage your pregnancy in order to assess the risks with him and make a birth plan.
Make sure you have access to medical care as soon as possible. For example, there is a transport that will take you to the hospital, or it is possible to call an ambulance. Ideally, you should be sure that you can be in the hospital within 15 minutes.
In what situations you need to call an ambulance if you still give birth at home
Call an ambulance at the same second as soon as you suspect that:
- childbirth slowed down;
- the child’s condition worsened;
- the child does not move head first;
- you need pain relief;
- your blood pressure has risen;
- you started bleeding.
Do not try to verify these conditions yourself. Call an ambulance without wasting a minute, even if it only seems to you that something has gone wrong.
How to give birth safely, but with minimal medical intervention
Many maternity hospitals practice “soft delivery”. This means that you will be able to:
- give birth in an individual box, where it is quiet, warm, dark;
- choose non-drug ways to relieve pain (mats, fitballs, special chairs, transforming beds);
- walk, ride a fitball, be in the pool;
- do without obstetric aggression: all interventions are justified in detail before consent is taken, the woman is treated with respect;
- invite a partner, loved one or doula;
- to receive anesthesia at will;
- to spend the “golden hour” with the baby – the newborn will be placed on the mother’s stomach immediately after childbirth and will be helped to attach to the breast.
In some regions, “soft delivery” with minimal intervention is included in the compulsory health insurance program and is completely free for the patient.
Also, some maternity hospitals perform a “soft” caesarean section, when the mother is conscious and pushes the child herself after opening the uterine cavity.
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