As I was pondering what would be a suitable topic to write about as a farewell to 2015, I realized that this is the month in which the Christians worldwide celebrate the birth of baby Jesus. We all know the picture of the Nativity: no fancy delivery rooms, no midwife in attendance. Just the newborn Jesus surrounded by his mother, his father, the Three Kings, as well as a few of the usual dwellers of a stable. I was always taken by the Renaissance old master’s paintings and sculptures where a smiling Virgin Mary is looking with adoring eyes to her little newborn son.
Over 2000 years have passed since that time. Babies are still being born and mothers still look at their new baby with adoring eyes. The human touch associated with the arrival of a new baby has not changed. The surroundings, however, have changed dramatically. Pregnancies are safer and better taken care of, babies are healthier and while we are still not perfect, we look at this new century for progress that, not too long time ago, was considered science fiction.
Until 1900 prenatal care was unknown. One never went to the doctor because you were pregnant. Labor and delivery was always attended in the home. We improved maternal care and decreased maternal morbidity and mortality. The newborn care is the best in recorded time. Thanks to these advances, the public started having a sense of security and felt that women have given birth since time immemorial and the act of birth, after all, was a natural process. As a result many women started migrating back from hospital delivery to home delivery.
Mind you, in principle there is nothing wrong with home delivery. You are in your own environment, surrounded by family, and once delivered you can enjoy your new baby that does not have to be taken away to the nursery. Psychologically you do not feel that you are ill in the hospital. You are at home and well. As such, your recovery is faster and you can even make your own cup of coffee when you so desire.
Should you contemplate a home delivery?
The advocates of home delivery have some rules, like your pregnancy must be normal to the end, to qualify for home delivery. There is no question that this is a good rule. But does it assure you that labor and delivery will be normal?
Once labor starts many unpredictable events may happen, even if your pregnancy was absolutely wonderfully normal. Labor can stop progressing normally for a variety of reasons. The placenta may separate from the uterus before its time, with heavy bleeding, threatening the life of both mother and baby. The uterus can rupture, a life threatening situation when one only has minutes to intervene. Babies can get stuck in the lower pelvis. The baby may also come in an unfavorable position for normal delivery.
How does one handle such situations at home?
The story is that should anything go wrong, one can transfer the mother to a hospital. That’s all well and good if the situation allows for enough time to do that. Most serious delivery problems do not have the luxury of time. Like a sudden drop in the baby’s heart rate, or a cord prolapse, and many other catastrophic events.
Sure. If you decide for a home delivery what are the chances of that happening to you?
Not many. But do you want to play Russian roulette with your life and that of your baby? As usual, statistics do not help. A 1% risk is an acceptable risk. Otherwise no one would be driving or flying in a plane. But if it happens to you it’s not 1% anymore. It’s a 100%.
Fortunately, just like most pregnancies are normal so are most labor and deliveries. But that is not a statement you can depend on. Understand that when you decided to have a home delivery, you accepted its risks. If something does not go as you expected, do not blame others.
For every one of our grandmothers that had 7 children, all healthy, and delivered at home, there are others that were not so lucky. We just don’t hear about them, or don’t want to hear.
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so by email at: firstname.lastname@example.org
You can read more of Dr. Aladjem’s posts on Imperfect Women by clicking here. Dr Aladjem also answers questions of medical interest related to pregnancy in a recurring post here at Imperfect Women. You can read more details about this feature and ask a question by filling out the form here.