HOME BIRTHHOME BIRTH

Dr Muhammad El HennawyDr Muhammad El HennawyOb/gyn ConsultantOb/gyn ConsultantRass el barr central hospitalRass el barr central hospitalDumyatt Dumyatt –– EGYPT EGYPT www. Mmhennawy.co.nrwww. Mmhennawy.co.nr

Birthhospital homeemergency planned

assisted

unassisted

medicated

unmedicated

where birth happenswhere birth happens

unassisted home birthunassisted home birth midwife, or other medical personnel presentmidwife, or other medical personnel present In unassisted birth, there is no In unassisted birth, there is no

doctordoctor conception wasconception was birth should be as private and intimate as the birth should be as private and intimate as the thethe

They do own prenatal careThey do own prenatal care they don't go to anyone for they don't go to anyone for prenatal care prenatal care

1.1.   Listening to fetal heart beat with a fetoscope or stethoscope after 20 Listening to fetal heart beat with a fetoscope or stethoscope after 20 weeksweeks they belief that ultrasound is an unproven and possible unsafe technology, they belief that ultrasound is an unproven and possible unsafe technology, no electronic monitors or dopplers will be usedno electronic monitors or dopplers will be used. .

2. Measuring their fundal height of the uterus2. Measuring their fundal height of the uterus 3. Testing their urine for protein3. Testing their urine for protein 4.4.   Measuring their blood pressure Measuring their blood pressure 5.5.   Measuring their own maternal weight. Measuring their own maternal weight. 6.6.   Determining their fetal position inside the uterus Determining their fetal position inside the uterus the birthing woman to be the one to catch her own the birthing woman to be the one to catch her own babybaby Just Just trust that her body knows how to give birth Perineal massage with oil, hot compresses, and perineal support Perineal massage with oil, hot compresses, and perineal support

will be usedwill be used .she would prefer to allow the tissues to tear rather .she would prefer to allow the tissues to tear rather than be cut.than be cut.

No drugs of any kind will be administered during the laborNo drugs of any kind will be administered during the labor gives birth in the squatting position gives birth in the squatting position The umbilical cord will not be cut until it has stopped pulsating, The umbilical cord will not be cut until it has stopped pulsating,

usually 3 to 4 minutes or longer.usually 3 to 4 minutes or longer. no substance by mouth other than my breastmilk or colostrum no substance by mouth other than my breastmilk or colostrum

the assumptionthe assumption that hospital birth is safer for mother and baby has never been supported

Whether she is safer at home than in a hospital, however, is another question

Prenatal care, better nutrition, antibiotics and blood transfusion have played more of a part in the relative safety of birth now.

No one can tell a mother she is perfectly safe giving birth at home.

What are the drawbacks of a What are the drawbacks of a home deliveryhome delivery??

The most obvious drawback is that not The most obvious drawback is that not everythingeverything a hospital offers is available at a hospital offers is available at home home

You may need the You may need the expertiseexpertise of the hospital of the hospital staff staff

and certain and certain equipmentequipment at your disposal if at your disposal if something goes wrong. something goes wrong.

At home there is always the possibility, no matter how small, of a tragic complication which could have been more effectively dealt with in hospital. Parents choosing home birth will consider and come to terms with that risk,

HomebirthHomebirth • • Can anyone have a home birthCan anyone have a home birth? ? • • How do she organise oneHow do she organise one? ? • • What pain relief will be availableWhat pain relief will be available? ? • • Can she change my mindCan she change my mind? ? • • What happens if she need to go to What happens if she need to go to

hospital in labourhospital in labour? ? •• Who will be present at the birth? Who will be present at the birth? •• What equipment do she need? What equipment do she need? •• What happens after the birth?What happens after the birth?

Can anyone have a home Can anyone have a home birthbirth??

In theoryIn theory, any pregnant woman has the right , any pregnant woman has the right to give birth at home to give birth at home

In practiceIn practice, you may encounter obstacles. If you have a complicated medical history such as toxemia, diabetes, breech presentation, toxemia, diabetes, breech presentation, prematurityprematurity

. the birth . the birth in the hospitalin the hospital. Since safety is of . Since safety is of paramount importance, we bring IV fluids, paramount importance, we bring IV fluids, medications, oxygen, surgical instruments and medications, oxygen, surgical instruments and life support systems life support systems

At homeAt home there is always the possibility, no matter how small, of a tragic complication which could have been more effectively dealt with in hospital. Parents choosing home birth will consider and come to terms with that risk,

Homebirth is not for every Homebirth is not for every womanwoman

Only Only multiparous healthy women ( not nulliparous women which are more likely to require transfer to hospital during labour because of delay in labour).

with with . . a normal obstetrical (without pregnancy-a normal obstetrical (without pregnancy-

related problems ), related problems ), and normal medical history (without and normal medical history (without

chronic health problems ), chronic health problems ), who haven't had a previous cesarean who haven't had a previous cesarean

section 0r any operation in terussection 0r any operation in terus

How do she organise How do she organise oneone??

her obestetrition will contact you to make the her obestetrition will contact you to make the arrangements arrangements

Wherever you decide to give birth is up to you; just remember that you can make the decisions that need to be made when you have true information.

It is your body, your baby, your money, and your life on the line,

What pain relief will be What pain relief will be availableavailable??

Although in some cases pain medication is available Although in some cases pain medication is available to mothers birthing at home to mothers birthing at home pethidinepethidine if she want, in if she want, in most cases this option is most cases this option is not availablenot available. .

give her give her gas and airgas and air.. Alternative methods of pain relief Alternative methods of pain relief if contractions are

pretty strong, such as TENS machine,breathing such as TENS machine,breathing exercises, massage, and labouring in a birthing pool , exercises, massage, and labouring in a birthing pool , aromatherapy, homeopathic remedies, or aromatherapy, homeopathic remedies, or acupuncture. acupuncture.

It is well understood that sensations of pain in labour are regulated by hormones released by the woman's body relaxation can diminish maternal stress, improve oxygen flow to the baby and facilitate labor. 

. During the labour, oxytocin - the hormone which causes contractions and helps the baby to be born - works in harmony with endorphins - the body's own pain relieving hormone.

Preparing for LaborPreparing for Labor Take a birthingTake a birthing class. Some available types class. Some available types

of home birthof home birth ExerciseExercise. Regular exercise, such as yoga or . Regular exercise, such as yoga or

walking, can help prepare your body for walking, can help prepare your body for labor. labor.

Consider the atmosphere in your Consider the atmosphere in your homehome, and , and prepare it for optimum comfort once you go prepare it for optimum comfort once you go into labor. Make sure it is into labor. Make sure it is cleanclean and that the and that the surroundings are soothing to you. Also surroundings are soothing to you. Also prepare for such things as prepare for such things as musicmusic and and lightinglighting during the birth if you have preferences during the birth if you have preferences

Childbirth EducationChildbirth Education You need to prepare for birth. Make preparing You need to prepare for birth. Make preparing

for it special - these educational classes are an for it special - these educational classes are an excellent resource for you, or anyone who excellent resource for you, or anyone who might be with you during the birth process. might be with you during the birth process.

These classes usually include information on These classes usually include information on exercise, nutrition, breathing, position, exercise, nutrition, breathing, position, movement and relaxation methods for use in movement and relaxation methods for use in labor and delivery, information regarding labor and delivery, information regarding hospital procedures, medications, anesthesia, hospital procedures, medications, anesthesia, alternative complementary therapies, newborn alternative complementary therapies, newborn care and the postpartum period.care and the postpartum period.

gentle yoga postures (increase your repertoire of gentle yoga postures (increase your repertoire of comfortable positions during pregnancy), ease comfortable positions during pregnancy), ease low back pain, use vocal toning, visualization, low back pain, use vocal toning, visualization, meditation, massage and relaxation meditation, massage and relaxation Use gentle Use gentle deep breathing (not the fast pace)deep breathing (not the fast pace)..  

Obtain the necessary Obtain the necessary suppliessupplies

. . You may be able to provide you with You may be able to provide you with a birth kit, but here are some of the a birth kit, but here are some of the most important things you will need. most important things you will need.

Sanitary pads, large ones Sanitary pads, large ones Cracked ice Cracked ice Nursing bras Nursing bras Something to mist your face with Something to mist your face with Buckets-to sit on and for clean up Buckets-to sit on and for clean up New nail brush and clippers New nail brush and clippers Waterproof pads to sit on Waterproof pads to sit on Heavy plastic sheet for the bed Heavy plastic sheet for the bed Large towels Large towels

Can she change her mindCan she change her mind?? Yes — at any time you can change you can change

your mind about site of labouryour mind about site of labour

What happens if it her baby What happens if it her baby will arrive before she get to will arrive before she get to

the hospitalthe hospital??

Emergency home deliveriesEmergency home deliveries are are extremely unusual, especially with extremely unusual, especially with first babiesfirst babies

the baby arrive before or after the the baby arrive before or after the emergency medical team emergency medical team

Who will be present at the Who will be present at the birthbirth? ?

doctordoctor and and his nursehis nurse go to a woman's go to a woman's home when she starts labor. home when she starts labor.

Who else is present is up to her it's her home, after all. Anyone she Anyone she wish! her wish! her mothers, sisters, close mothers, sisters, close friends, neighbor, labor coach, or friends, neighbor, labor coach, or others, others,

What equipment does she What equipment does she needneed??

series of childbirth series of childbirth classes,classes, covering the major covering the major topics in prenatal nutrition and exercise, natural topics in prenatal nutrition and exercise, natural birthing methods, pain relief and breast feeding birthing methods, pain relief and breast feeding

sheshe will bring round a 'birth pack' containing all the will bring round a 'birth pack' containing all the bits and pieces they needbits and pieces they need

During labour, her baby's condition will be During labour, her baby's condition will be regularly monitored with regularly monitored with a sonic aida sonic aid

TheThe doctor doctor at a home birth will have all herat a home birth will have all her instrumentsinstruments laid out, readily accessiblelaid out, readily accessible, , and theand the oxygen tankoxygen tank turned onturned on

AllAll she she may be asked to provide is adequate may be asked to provide is adequate heatingheating, and a reading , and a reading lamp.lamp. However she did However she did arrange hire of a Tens machine, arrange hire of a Tens machine,

TheThe doctor doctor carries oxygen and carries oxygen and resuscitation resuscitation equipmentequipment to use while waiting for the ambulance to use while waiting for the ambulance

What happens if she need to go to hospital in labour?

her doctor will talk to her and her partner about why she believes a transfer to hospital would be a good idea and will then call an ambulance because her labour has slowed down slowed down or because there's a real emergency or because there's a real emergency ..

For this reason, it's wise to deliver at home only if you're within 20 minutes of the nearest hospital and her transportation there is fail-safe.

What happens after the What happens after the birthbirth??

Once the baby and placenta are safely delivered The doctor will check the baby over and The doctor will check the baby over and weigh him,the nurse help her with her first weigh him,the nurse help her with her first

breastfeedbreastfeed How long will doctor stay at How long will doctor stay at

her home after her baby is her home after her baby is born?born?

The doctor will stay until the mother is up, The doctor will stay until the mother is up, sitting in a chair, feeling well, drinking and sitting in a chair, feeling well, drinking and eating, and the baby is judged to be healthly eating, and the baby is judged to be healthly and is nursing satisfactorilyand is nursing satisfactorily.. (one hour) (one hour)

Within the hospital Within the hospital groupgroup,,..

o Maternal hemorrhageMaternal hemorrhage was higher.o The incidence of respiratory distress among among

newborns was greater in the hospital than in the newborns was greater in the hospital than in the home. home.

o Limp, unresponsive newbornsLimp, unresponsive newborns arrived more often..o The perinatal mortalityThe perinatal mortality rate was higher in the rate was higher in the

hospital birthshospital birthso Neonatal infectionsNeonatal infections were common. . o There were permanent birth injuriespermanent birth injuries caused by

doctorso moremore lacerations lacerations to the mother, to the mother, many

episiotomiesepisiotomieso a higher rate of forcepso a higher rate of C-section C-section delivery o much more likely to experience postpartum much more likely to experience postpartum

depressiondepression or even post traumatic stress or even post traumatic stress disorder.disorder.

doctor tend to allow time for the woman's tissues to stretch and to use perineal massage, warm compresses, and good head flexion to avoid both episiotomies and tearing;

doctor use include simple techniques for relaxation and breathing but may also include the use of massage, herbs, homeopathy and acupuncture.

doctor at a home birth will have all her instruments laid out, readily accessible, and the oxygen tank turned on, so that what might be an emergency becomes a matter of routine.

What are the advantages of a What are the advantages of a home birth over a typical hospital home birth over a typical hospital

deliverydelivery?? It respects It respects the natural processesthe natural processes of giving birth labor progresses more of giving birth labor progresses more rapidly in the rapidly in the familiar home environmentfamiliar home environment her own home, in her own bed her own home, in her own bed

their home is the most appropriate place for a new baby to enter their family circle.

a matter of acknowledging her needs for a matter of acknowledging her needs for privacy, security, comfort, privacy, security, comfort, safetysafety, control, freedom and respect for the emotional and spiritual , control, freedom and respect for the emotional and spiritual aspects of birth aspects of birth

She may have had a previous bad experience in hospital and wish to avoid another.

No Baby Mix-Ups No Baby Mix-Ups The dangerous The dangerous bacteria and virusesbacteria and viruses that commonly inhabit hospital that commonly inhabit hospital

environments are far less likely to inhabit her homeenvironments are far less likely to inhabit her home there are no there are no unnecessary medical interventionsunnecessary medical interventions performed at home, performed at home,

which themselves could create problems which themselves could create problems .. encourage laboring mothers to encourage laboring mothers to walk orwalk or to assume comfortable to assume comfortable positionspositions, ,

and to and to drinkdrink if thirsty and to if thirsty and to eateat if hungry if hungry relax in a warm tub of waterwarm tub of water, , have herhave her feet rubbedfeet rubbed by loving friends.

she chooses, sip on energizing juices, continue caring for other children as she is able. She can move about freely, wear what clothingclothing

wishing to minimise the wishing to minimise the disruption of the routinedisruption of the routine for their other children for their other children Decrease the risk of the Decrease the risk of the emotional/psychological disruptionemotional/psychological disruption of being in of being in

an unfamiliar institution an unfamiliar institution . . they want to deliver their babies without drugs and unnecessary

interventionsinterventionsthis this lower-costlower-cost costs 68% less in a home than in a hospital costs 68% less in a home than in a hospital

prenatalprenatal calmcalm people who are present at the birth. people who are present at the birth.

Tension in a room can slow down or stop a laborTension in a room can slow down or stop a labor. . Usually someone other than the mom or her Usually someone other than the mom or her

partner assumes partner assumes responsibility for any childrenresponsibility for any children who are present, freeing mom to focus on who are present, freeing mom to focus on birthing. birthing.

The birthing process is allowed to take its own The birthing process is allowed to take its own course and set its own pace. The general course and set its own pace. The general philosophy is that any interventions philosophy is that any interventions ((administering drugs or trying to hurry things administering drugs or trying to hurry things along) create more harm than good.along) create more harm than good.

the mom is likely to be less inhibited about the mom is likely to be less inhibited about trying different labor positions and locations. trying different labor positions and locations. She can She can sitsit on the toilet or go for a walk outside. on the toilet or go for a walk outside. She can She can eat eat or or drinkdrink whatever she wants whatever she wants

When it's time to deliverWhen it's time to deliver she can often try she can often try whatever positionwhatever position she she

wants: on her side, squatting, sitting or wants: on her side, squatting, sitting or kneeling many childbirth authorities feel the kneeling many childbirth authorities feel the motion of walking and changing positions can motion of walking and changing positions can enhance the effectiveness of the enhance the effectiveness of the contractions.contractions.   . .

When a doctor and mother build When a doctor and mother build a personal a personal relationshiprelationship, this trust helps women let go , this trust helps women let go and have their babies more easily. and have their babies more easily.

Homebirth allows for full participation of Homebirth allows for full participation of family membersfamily members

babies are usually immediately placed on the babies are usually immediately placed on the mom's breast, providing security, warmth and mom's breast, providing security, warmth and immediate bondingimmediate bonding between mom and baby between mom and baby

Home versus hospital birthHome versus hospital birth There is no strong evidence to favour either There is no strong evidence to favour either

planned hospital birth or planned home birth for planned hospital birth or planned home birth for low risk pregnantlow risk pregnant women. women.

Planned home births in appear to be associated Planned home births in appear to be associated with less overall maternal and neonatal morbidity with less overall maternal and neonatal morbidity and less intervention than hospital births.and less intervention than hospital births.

"Home birth is an acceptable alternative to "Home birth is an acceptable alternative to hospital confinement for hospital confinement for selected pregnant selected pregnant womenwomen, and leads to reduced medical , and leads to reduced medical interventions.interventions.””

Continuing evaluation of home birth practice and Continuing evaluation of home birth practice and outcome is essential.outcome is essential.

Home birth can be accomplished with good Home birth can be accomplished with good outcomes under the care of qualified outcomes under the care of qualified practitioners and within a system that facilitates practitioners and within a system that facilitates transfer to hospital care when necessary.transfer to hospital care when necessary.

Intrapartal mortality during intended home birth Intrapartal mortality during intended home birth is concentrated in postdates pregnancies with is concentrated in postdates pregnancies with evidence of meconium passage evidence of meconium passage

many mothers who have delivered in the hospital as

impossible confined to a hospital bed, denied food and water, separated from their other children and

supportive family members and friends, enduring frequent internal examinations

and vital sign checks, being transfered from one room to another

on a stretcher at the peak of labor's intensity

and having their legs strapped into stirrups. 

good result of home birth because good result of home birth because good selection of type of pregnant good selection of type of pregnant women to allow to deliver at home women to allow to deliver at home

Good health prenatal = low Good health prenatal = low complications natal and postnatalcomplications natal and postnatal

final judgment regarding the relative final judgment regarding the relative safety of home birth still cannot be safety of home birth still cannot be made.made.

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