The walls do not help: What is dangerous home birth
Olga Lukinskaya
And science, and practice in medicine are rapidly going forward - and the number of fans of "all natural" miraculously does not change. In poor countries, women often do not have the opportunity to get into a normal maternity hospital, and the birth of a child at home remains the only option - but everyone understands how bad the inaccessibility of medical care is and what its consequences are. More surprising is the desire to give birth at home where all the achievements of obstetrics and gynecology are available. Together with the experts, we tried to figure out what was behind this desire and why we should not go on about it.
The reason for choosing home birth is mistrust of the medical staff and the certainty that "killer doctors" will surely harm the child, preventing him from being born "as naturally as possible"
According to the gynecologist Oksana Bogdashevskaya, home births are usually addressed for one of two reasons. The first is the reluctance to stay in the hospital, to hear the clinking of instruments, to smell, to be alone. On the one hand, this point of view is quite understandable, on the other - almost all the advantages of home furnishings have long been available in maternity hospitals, often even for free. This is a dim light, the ability to move or be in a comfortable posture, the presence of a loved one, immediate contact with the baby "skin to skin." At the same time, not everyone, even having access to options uncharacteristic for an ordinary hospital, strives to take advantage of them - according to the experience of the gynecologist Natalia Artikova, women often do not want to walk or swing on fitball to facilitate contractions, and the pose for births choose the most standard .
Another reason for choosing home delivery is mistrust of the medical staff and confidence that the "killer doctors" will surely harm the child, preventing him from being born "as naturally as possible." According to our experts, it is almost impossible to argue with adherents of this point of view, and by virtue of their conviction they resemble clergy - but, fortunately, the number of their supporters does not grow over the years. Dr. Artikova adds that patients with a normal attitude to medical care who accidentally gave birth at home (for example, they did not have time to get to the hospital during rapid delivery) do not usually want to repeat this experience.
Doctors have a sharply negative attitude to home birth for a simple reason: it is dangerous. Even with a completely healthy pregnancy during childbirth, unforeseen complications can occur - and, for example, obstetric hemorrhage can be fatal if not treated in minutes, but this is not possible at home. According to a recent study, the risk of death of a newborn in the first month of life after home birth is doubled compared with a birth in a medical facility. At the same time, for example, in caesarean section or other interventions, labor at home was needed less often - that is, initially the degree of risk associated with pregnancy was considered lower.
Even with a completely healthy pregnancy during childbirth, unforeseen complications can occur - and, for example, obstetric hemorrhage can be fatal.
After the publication of this study in The New York Times, the publication received a lot of feedback, including from doctors and obstetricians. According to Sarah D. Fox, a professor at the medical faculty at Brown University, she often faced tragic outcomes of home birth - and parents asked if it would be possible to save the child if he was born in a hospital. She notes that the answer to this question is always complicated, but in most cases it is positive - most likely, in a hospital or a specialized center, properly equipped, the child would have survived.
Doctor Artikova says that it is possible to allow a child to be born at home only if there is child resuscitation on duty under the windows - but this option does not guarantee complete security, and it is not clear from whose pocket he can or should be paid. In the US, there are, for example, instructions for the urgent transfer of a woman to the hospital from home birth conditions - but the emphasis is on transferring information from the midwife to doctors, maintaining documentation and joint (doctor and patient) decision making. Compliance with the instructions will not help if the car is in a deaf traffic jam or simply breaks down the road - and for obstetric complications, the expense goes for a minute, and the road to the hospital can cost the life of the newborn and the mother.
The Netherlands is often cited as an example of a country where “everybody gives birth to a house”. Indeed, there is a free choice for low-risk women in this country — to give birth in a hospital or at home, in both cases with a licensed midwife. In this case, the costs of home birth are covered by all insurance companies, and for deliveries at the maternity hospital, sometimes you need to pay a small amount (about 300 euros). The midwife who comes to the house brings everything you need, including equipment for resuscitation of the newborn, and in an emergency can cause an ambulance; An ambulance with a woman in labor is obliged to accept any hospital, and the journey takes on average ten minutes.
In 2010, it turned out that mortality was higher after home deliveries in women with a risk rated as low than in high-risk patients who gave birth in hospital
Nevertheless, the situation with pregnancy outcomes in the Netherlands is not so good - and the prevalence of home births over the past ten years has decreased from 30% to 13%. The reasons for the fall in their popularity are the desire to give birth without pain (and anesthesia at home is not available) and the availability of more truthful than before information about the risks and rates of infant mortality. In 2010, it turned out that mortality was higher after home deliveries in women with a risk that was assessed as low than in high-risk patients who gave birth in a hospital. These results call into question the whole obstetric care system in Holland in general - perhaps serious mistakes are made at the diagnostic stage, when the degree of risk is determined.
In Russia, licenses for home birth does not exist. According to Dr. Bogdashevskaya, organizations that offer such services (including some kind of "spiritual accompaniment in childbirth") act illegally. At the same time, official medicine is gradually taking the path of providing maximum comfort for the patient and the newborn - after all, the moment of birth of the child should be remembered as one of the happiest in life. Therefore, there is now a tendency to reduce the number of interventions; childbirth can proceed as naturally as possible, in the presence of a partner and without bright hospital light, but only, unlike home ones, they are practically safe in the hospital.