At present, home births are becoming more and more relevant and are the subject of debate in our society. In Spain, this practice is increasing, generating a debate among health professionals and at a social level, but are they the safest option?
The American College of Nurses-Midwives has defined planned home birth as “ care for selected pregnant women, by qualified professionals, within a system that provides for hospitalization when necessary ”.
Linked to this definition, we must also highlight that the World Health Organization affirms that all women have the right to respectful and dignified care during pregnancy and childbirth.
Are there other factors to take into account? And here is the debate: it is not only about the wishes or beliefs of the woman and the couple. Human rights come into play, and, in particular, women’s rights, such as the right to dignity, privacy, physical integrity and autonomy.
What is obstetric violence? What happens when women’s rights are not respected?
It is called obstetric violence and constitutes gender discrimination, representing a violation of human rights.
Its first definition was made in Venezuela in 2007 as ” the appropriation of the body and reproductive processes of women by health personnel, which is expressed in a dehumanizing treatment, bringing with it a loss of autonomy and ability to freely decide on their bodies and sexuality , in an abuse of medicalization and pathologization of natural processes negatively impacting the quality of life of women” .
Obstetric violence refers to the practices and behaviors carried out by health professionals on women during pregnancy, childbirth and the postpartum period, both in the public and private spheres, which, by action or omission, are or may be perceived as violent.
In a qualitative study carried out in the province of Alicante between 2009 and 2014, the advantages and disadvantages of hospital birth and home birth were compared.
Some of the expressed disadvantages of childbirth in the hospital were the protocolization, the hostile environment, the loss of protagonism, the non-choice of the health professional, the non-respect of fundamental rights and even the difficulty for the partner to be present at times .
On the other hand, the advantages of home birth are defined as dignified treatment, respect for the rights of women and partners, freedom of decision, security, choice of health professional, peace of mind, etc.
When do we know if home birth is safe?
The safety of the pregnant woman and her baby, and the possible risks that a childbirth may entail should make us think that we have to evaluate which set of risks and benefits are more acceptable to her, and which are more consistent with her belief system. own values and interests.
If you are pregnant and you consider the option of giving birth at home, it is important that you have follow-up and control by a registered midwife or a team of specialized midwives to be able to evaluate all possible options.
Lidia Lestegás, midwife (@lidiaciguena), comments “asking your midwife for her collegiate number is to guarantee that you are being assisted by a professional with 6 years of university training, highly qualified, and specialized in assisting normal childbirth. It is important that home birth is assisted by accredited professionals for it in terms of safety “ .
We must think about the minimum requirements for home delivery: trained care and immediate care if there are complications.
The safety of home birth depends on many factors, such as the provision of resources , or the location and facilities of the home such as hot water, heating or even if you live in a fifth without promotion. All this is valued and evaluated jointly with the family.
There are important determinants for a good perinatal outcome in home births:
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The experience of the professionals who are caring for you.
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Adequate intrapartum fetal monitoring.
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Access to neonatal services.
In terms of experience, any accredited midwife in Spain must have attended at least 100 normal deliveries , which is why it is essential to look for registered professionals who have specific and advanced training in neonatal resuscitation.
Lidia Lestegás informs us that “ we also have specific and advanced training in neonatal resuscitation , although, of course, we work to prevent this possibility in any case. In a home birth in which everything has gone well, it is extremely rare that neonatal resuscitation has to be reached, and if there are difficulties adapting to extrauterine life that cannot be managed, there are clear circuits established to achieve a rapid transfer to advanced care units, as happens in regional hospitals with respect to their reference hospitals .”
From the Official College of Nursing of Barcelona they have prepared a guide for assistance to home birth with the criteria for inclusion and action during childbirth and postpartum. There are several recommendations but the main one is that the pregnancy is normal or low risk and that it happens between 37 and 42 weeks of gestation.
What does it mean to be a normal or low-risk pregnancy?
We speak of a low-risk pregnancy when it tends to be normal, in a woman who does not have risk factors that endanger her own health or that of her baby.
On the contrary, there are risk factors that do generate exposure or danger during pregnancy, such as:
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Women ‘s lifestyles such as smoking, drinking alcohol, or using drugs.
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Advanced age of the mother or in adolescents.
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Existing health problems such as high blood pressure, diabetes, thyroid disease, polycystic ovary syndrome, etc.
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Pregnancy conditions such as gestational diabetes, multiple pregnancy or preeclampsia and eclampsia.
However, not all of these conditions alone are going to make home birth no longer a reasonable option for many women. Although the pregnancy requires a more exhaustive control , the delivery may be low risk.
For example, in the previous list, if a woman has controlled hyperthyroidism, or polycystic ovary syndrome, it does not mean that it is not safe for her to give birth at home, if the rest of the variables fall within normal limits.
Similarly, even without any risk factors, the possibility that signs may be observed during labor that require transfer is never completely excluded.
In any case, it is important to maintain a healthy life and prenatal control with the midwife to be able to detect problems, promote health, and carry out adequate follow-up.
The health structure in our country does not currently cover home delivery assistance . Work must be carried out in a health system with spaces that are respectful of the pregnant woman and the birth process, offering guarantees of full safety for the mother and the child.
Other countries, such as Australia, the Netherlands, or Great Britain, have a more institutionalized culture of home birth care, where this type of care is not only allowed, but in specific cases is encouraged.
Bibliographic references
Eunice Kennedy Shriver National Institute. 2018. What are the factors that generate risk for pregnancy? https://espanol.nichd.nih.gov/salud/temas/high-risk/informacion/factoresMartínez-Mollá, T., Siles González, J., & Solano-Ruiz, M. 2019. Avoiding obstetric violence: reason for deciding to give birth at home.Ministry of Health. 2007. Normal birth care strategy. https://www.elpartoesnuestro.es/sites/default/files/recursos/documents/m_sanidad_-_estrategia_de_atencion_al_parto_normal_2007.pdf
Eunice Kennedy Shriver National Institute. 2018. What are the factors that generate risk for pregnancy? https://espanol.nichd.nih.gov/salud/temas/high-risk/informacion/factoresRodríguez Mir, J., & Martínez Gandolfi, A. 2022. Obstetric violence: an invisible practice in medical care in Spain. Sanitary Gazette, 35, 211-212.Sánchez-Redondo, MD, Cernada, M., Boix, H., Fernández, MGE, González-Pacheco, N., Martín, A., … & Couce, ML 2020. Home birth: a growing phenomenon with potential risks . In Anales de Pediatría (Vol. 93, No. 4, pp. 266-e1). Elsevier Doyma.
