While the debate on the safety of home birth continues, we have doubts about what are the requirements to have a planned birth at home. Gathering information about it, we talk about the conditions that professionals who attend this type of births and mothers must assume.
Undoubtedly, these are points that add to the conditions so that home birth is safe and, in principle, does not entail risks for mother and baby.
According to the first guide to home birth assistance, prepared by the Official College of Nursing of Barcelona, there are certain inclusion criteria for home birth.
Recall that the objective of this manual was to unify the criteria of performance during delivery and postpartum to improve the care practice of midwives dedicated to home care.
For them, it consensuates criteria of performance of midwives and establishes specific recommendations, based on scientific evidence, to assist women who choose this option.
To meet the request for home birth support it is necessary that:
- The birth plan is established before 28 weeks of gestation. From that date, it will be each professional who will assess whether or not to care for pregnant women who decide later.
- It is recommended that a minimum of four clinical visits be made before delivery assistance, one of them at the same address of the pregnant woman.
- Women will provide all the ultrasound and analytical controls and other necessary complementary tests that have been performed.
- Gestation will be nothing more than a baby and in cephalic presentation.
- The delivery will be attended at home when it happens between 37 and 42 weeks of gestation.
- It is necessary that the normality criteria be maintained throughout the process, that is, the pregnancy is low risk. Any deviation will be particularly valued and will be addressed as appropriate or will be derived in the necessary cases.
This point is the one that most questions me if I had to raise a home birth, remembering the difficulties of establishing what is a normal birth for WHO and the inability to predict "normal" during pregnancy and childbirth, because It is a condition that, although unusual, may suffer variations without notice.
- The choice to give birth at home must be an informed and free choice of women. Never convince or impose. It is crucial that the responsibility of the woman and her partner in choosing to give birth at home is established and assumed from the beginning.
- The pregnant woman and her partner, if any, will complement the medical history. This document will be confidential and will be filed and guarded by the professional.
- It is necessary signature of informed consent.
According to the document that I have been able to consult with informed consent for normal childbirth assistance, the woman and the couple, if any, accept that the Protocol of assistance for childbirth, puerperium and newborn care be applied. They also state that the midwife or obstreta has informed them about these protocols and that they have resolved all their doubts. Finally, in case of danger, they accept that professionals apply the measures they deem appropriate.
What happens if there are complications in a home birth?
As we have just seen, the informed consent delegates the responsibility for acting on professionals who attend delivery in situations of danger to the mother or the baby. In principle, midwives are prepared to deal with most complications, but a hospital transfer may be necessary.
In the previous points, focusing on women and their pregnancy, the need for the proximity of a hospital is not established. But in the section dedicated to the valuation of the address, they do indicate that there should be during the delivery a companion who knows the way to the nearest hospital and its entrance to obstetric emergencies, and who has a vehicle to carry out the transfer.
In the section entitled “Transfer and coordination with health centers”, the document states that in the hypothetical case of needing a transfer, the degree of urgency will first be assessed, and the priority center will be the nearest reference hospital, without establishing distances .
If complications are suspected, they indicate that the transfer to the hospital will always be better if the baby is not yet born. The transfer can be made by private vehicle if it is not urgent, or by ambulance, which will be requested by telephone, if it is urgent.
Undoubtedly, this last case is the one that can cause more fear and doubts in the mothers, because it is clear that if there are no ambulances nearby, because there are no health centers or hospitals nearby, the transfer must also be done by private car.
Although, I suppose, these cases are the least in our environment, both for the possibilities of complications in childbirth and for the remoteness to any hospital.
In short, these are the conditions to attend a home birth, which act as recommendations but do not appear to be arranged as standards and that leaves some loose ends.
A step that, in my opinion, would contribute to increase the security in this type of births and to follow in the path that at the present time they have already taken in our environment to be a good alternative to hospital birth and to present certain advantages over this.
Advantages linked to a warmer and more humanized birth which, by the way, we also fight to move to hospital delivery.
