November 18, 2008

Choice and Safety of Home Birth: An Ongoing Discussion

There was a flurry of e-mails in my inbox earlier this week as the teacher trainees were very excitedly passing on an article from the NY Times on home birth. The article, Baby, You’re Home, discusses the upward trend of home births, the practicality of it, the safety precautions, and the opposition.

I find it very exciting that people are being made aware of the different options there are for birthing. Just earlier today, a friend of mine asked me to recommend a care provider for his wife. They are starting to plan for a family and the wife’s doctor is up in Westchester. So, I asked him about their birth preferences: Do they want a particular hospital or birth center, or a home birth? Are they interested in natural birth? Are they opposed to routine intervention? My friend – who asked to remain anonymous – admitted he had no idea there were so many choices to be made. He thought you just chose a doctor and did as you were told. But isn’t it great that we can make choices about how we bring our children into this world?

My friend and co-teacher, Nikita, just gave birth to her second child last week at home with a home birth midwife. She was very open with her students about her plans for a home birth. Her first child was also born at home, as were she and her husband. What I found surprising were the misconceptions about home birth. Many people thought she and Noah, her husband, just stayed at home and did this by themselves. Ok- that is a choice some people make, but it is rather uncommon and is not what home birth necessarily means.

Also, many people didn’t realize that when a home birth midwife arrives she comes prepared with a great deal of equipment and various safety precautions. Since I have only attended a handful of home births I asked my friend Nancy, a Midwife Assistant, to provide me with a list of the equipment, instruments and materials that she brings to a home birth. The list is quite extensive!

When we arrive at a mom’s house, the first thing we do is take vital signs on mom and listen to the baby with a doppler. In active labor we listen to the baby every 15 minutes, when she’s pushing it’s every 5 minutes or after each push. Mom’s vitals are re-checked every 4 hours in labor. We bring 3 big bags of supplies with us to the birth, as well as a birth stool and birth ball.

In the first bag we have:
*doppler and gel for listening to baby’s heart rate
*sterile medical delivery instruments
*sterile suturing instruments
*lab vials for collecting cord blood to test for baby’s blood type and antibodies
*a medication bag – vitamin K, medications to stop hemorrhaging, antibiotics, Pitocin, etc.
*bag full of different size syringes
*different size needles for stitching up tears
*lidocaine gel to numb areas before stitching
*lidocaine for injecting into spots that need more than the gel can help
*stethoscope for mom
*stethoscope for baby
*blood pressure cuff
*baby scale
*heating pad and cutting board to have a warm, firm place if resuscitation of baby is needed
*IV equipment and fluids
*Delee suction tube for baby
*amnio-hooks for breaking water

In the second bag:
*homeopathic remedies, about 50 of them
*homeopathic reference book
*herbal tinctures
*music CD’s
*lab forms
*newborn care info
*postpartum care info
*sharps container
*extra gauze pads
*extra gloves
*extra everything!

In the third bag:
*oxygen tank
*different oxygen masks for mom and baby
*ambu-bag for giving positive pressure ventilation

For the birth, the mom is responsible for buying a birth kit which includes the following:
*10 23×24 underpads (chux)
*10 30×36 underpads (chux)
*1 tape measure
*1 cotton hat
*1 peri bottle
*12 Topper 4×4 gauze pads
*15 alcohol prep pads
*1 digital thermometer
*1 pt of alcohol
*1 pt of witch hazel
*1 postpartum pad system
*1 bulb syringe, 2 oz
*8 oz lube jelly
*1 4 oz Betadine
*10 pairs of latex small sterile gloves
*10 single latex small sterile gloves
*1 cord clamp, plastic
*1 betadine scrub brush
*2 peri cold pad
*1 box of exam gloves latex small (100)
*2 straws
*1 kleenprint footprinter and Home Birth Certificate

There is also another list of home supplies the family has to have ready for the birth which includes things like towels, baby blankets, baby diapers, a mirror, garbage bags, a laundry bag, olive oil, etc.

Nancy also reminded me It’s important for couples to know that the prenatal care is completely different than what they are used to. The midwife I work for schedules an hour for each visit. Most doctors’ offices schedule one patient every 10 minutes. The prenatal visits include the usual hands on – check blood pressure, weight, urine, position of baby (with hands, not an ultrasound machine!!), heart rate of baby. The visit also includes nutrition counseling, emotional preparation for pregnancy, birth and motherhood, suggestions and handouts for pregnancy issues, and care during the postpartum period. We also lend out DVD’s for mom and family to prepare by watching other birthing moms. Families can also rent a birthing tub if they would like to have a water birth, or even just to labor in.

How one chooses to birth is a very personal choice, but one that should be made with great consciousness. Where and with whom you give birth will greatly impact the experience and the outcome. Sometimes I feel people spend more time picking out a new flat screen TV than they do their OB/GYN or midwife. It is important to discuss with your partner what style of birth is right for your family and what is within your comfort zone. The choice is yours.



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