Home Birth, Prenatal, and Postpartum Care

Posted by on Nov 2, 2012 in Services | Comments Off on Home Birth, Prenatal, and Postpartum Care

Home Birth, Prenatal, and Postpartum Care

Home Birth and Maternity Services:

  • Comprehensive prenatal care, including all visits and laboratory tests, routine screening and counseling for low risk women seeking home birth.
  • Continuous care during labor, birth and several hours postpartum.
  • 2-3 postpartum visits for mom and baby in your home, including mom and baby 24 hour assessment.
  • NYS required newborn treatments, vaccinations and PKU testing done in your home per request.
  • Well newborn care until transfer to pediatrician for up to 28 days after birth.
  • 6 week office visit.

We have relationships with family and obstetrical physicians should the need for medical consultation, collaboration or care arise at any time during your pregnancy or birth.

Advantages for the Mother:

  • You are not subjected to routine procedures but seen and known as an individual.
  • You are much less likely to desire pain medication when you feel safe in your own surroundings, able to labor in privacy, and give birth in any location and position you choose, including waterbirth if desired.
  • Your needs and desires are not sacrificed to protocols or statistical averages.
  • No staffing changes, no “on- call rotation” of several healthcare providers (continuity of care).
  • No separation from the baby.
  • Continuous support from midwife and team after the birth.

 

Advantages for the Baby:

The baby’s experience of birth and transition is acknowledged and made as gentle as possible. Infection rates are reduced when a baby is at home with his/her mother. Routine hospital procedures such as suctioning, washing the baby and separation from parents are avoided. Breastfeeding is easier to establish when the baby can nurse on demand when ready.. Research indicates that babies of low risk women who plan home births under a supportive system with a qualified attendant are statistically no more likely to die or have serious injuries than babies of similar women who choose hospital birth (1, 2, 3, 4, 5, 6). Babies of mothers who plan home births also:

  • Are less likely to require resuscitation at birth (2, 3, 4)
  • Are less likely to take longer than 1 minute to establish respiration (4)
  • May have higher 5 minute APGAR scores (4, 6)
  • Are less likely to need oxygen therapy beyond 24 hours (2)
  • Are less likely to experience meconium aspiration (2)
  • May be less likely to be admitted to the NICU (1, 3) though in one study (1) this difference disappeared when the data was controlled for risk factors
  • Are less likely to be born by cesarean, forceps or vacuum extraction (4, 5)
  • Are less likely to have birth trauma (2)

 

Some possible explanations for the differences in neonatal outcomes:

  • Women who plan home births are less likely to have obstetric interventions, including electronic fetal monitoring, augmentation of labor, assisted vaginal delivery, cesarean section, and episiotomy. (2)
  • Women who give birth at home feel more free to move and be upright during labor, which can promote progress without the use of oxytocin augmentation (7), thereby avoiding pitocin’s potential side effects on the baby.
  • Women who give birth at home are not under any pressure (direct or subliminal) to push in a bed. Studies show that upright birth results in a shorter pushing phase (8), higher APGAR scores, and lower arterial pCO2 with unchanged pO2, which indicates less transient cord compression. (9)
  • Women who give birth at home are not given any pain medications that have effects on the newborn’s breathing or that increase the need for assisted delivery (10, 11). The vacuum extractor, the most common method of assisted delivery used today, is associated with slightly higher rates of neonatal cephalhaematomata and retinal haemorrhages. (12)
  • Babies born at home do not have their cords cut immediately. (14)
  • Babies born at home are almost never separated from their mothers. Most hospitals fail to implement immediate skin-to-skin contact as standard practice, despite the well-documented benefits for the newborn, including a positive impact on breastfeeding rates, breastfeeding duration, temperature regulation, cardio-respiratory stability, and infant crying. (13)

 

References:

  1. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births
  2. Outcomes of planned home birth with registered midwife vs. planned hospital birth with midwife or physician
  3. Ontario study, outcomes cited in this article
  4. A matched cohort study of planned home and hospital births in Western Australia 1981–1987
  5. The Farm Study
  6. Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome
  7. Ambulation vs. oxytocin in protracted labor: a pilot study
  8. The Squatting Position for the Second Stage of Labor: Effects on labor and on Maternal and Fetal Well-being
  9. A comparison of fetal outcome in birth chair and delivery table births
  10. Epidural vs Parenteral Opiod Anestheia on the Progress of Labor
  11. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid anesthesia: systematic review
  12. Vacuum extraction versus forceps for assisted vaginal delivery (Cochrane Review)
  13. Early skin-to-skin contact for mothers and their healthy newborn infants
  14. A Review of the Literature on Umbilical Cord Clamping

 

Advantages for the Family

Birth is an integral part of family life. Partners, friends, siblings and family members are welcome, not “allowed” to be present. Many families highly value this private and special way to birth.

Disadvantages

Having a home birth requires a higher level of effort and responsibility. While midwives bring emergency equipment with them to every birth, some complications may require transport to a hospital. Members of our birth team stay with you if you transport and resume care postpartum.

Sometimes, your decision to have a home birth may not be supported by friends, family, coworkers and the medical community. Many people are unaware of the evidence of safety inherent in the midwifery model of care. (See reference section)

Home birth is covered in part or in full by most insurance plans.

Email us for a consultation to see if home birth is right for you.

Home Birth Clients

The following is a list of forms and resources for our clients: (you must have the username and password to download these forms)