Can I Have a Homebirth? Common Complications

There are many reasons why homebirth is superior, and yet there are times when a mother and her child are better off in the hospital. There are some cases that are commonly considered reasons not to birth at home that do not necessarily require hospital care. There are also many situations where birth is better off beng done in a hospital that are not commonly listed.

Preeclampsia can be mild or severe. The condition is usually recognized during pregnancy but can only be treated by close monitoring and delivery of the child. If your caregiver notices that your condition is worsening, he or she will induce labor. Hospitals are likely to schedule a C-section. Mothers can begin having seizures during labor, which can be dangerous to the mother and the child. If this happens, she will need to transfer to the hospital for a C-section. Whether to birth at home or in the hospital is up to the mother, though having a hospital closeby is a good idea as well as having a midwife who has experience with preeclampsia.

Gestational diabetes often results in high birth weight babies, which raises the risk of shoulder dystocia. The accuracy of screening is questionable, just as is the accuracy of sonogram weight estimation. Midwives are capable of recognizing and treating gestational diabetes during pregnancy, and you can see a traditional ob/gyn while planning a homebirth with a midwife if you desire.

Macrosomia, or big baby syndrome, is often treated with an early induction or scheduled C-section, which often takes place early as well. You are at high risk of both of these if you chose to birth in a hospital. Ultrasound technology has been known to overestimate fetal weight, so one should get a second opinion via level II ultrasound or stomach palpitation before making any plans. Macrosomia makes shoulder dystocia more likely to occur.

A mother with a small pelvis is encouraged to birth in a hospital usually by scheduled C-section, which often occurs weeks before her due date putting a babe at a higher risk of preterm birth. Your pelvic size is no indication of whether or not you can birth, being that your pelvis expands to release a baby and is made even wider by assuming a squat position. Shoulder dystocia is considered more likely to occur in small patients, especially if macrosomia is expected as well.

The main concern with shoulder dystocia is fetal distress. Fetal injury may occur if the birth attendant's interference is inappropriate; forceps and vacuum delivery or tugging the baby out are very likely to cause injury to mother and child. Midwives are trained in many maneuvers that will help dislodge stuck babies with minimal injuries. Shoulder dystocia is less common at homebirth being that, in a hospital, a woman is expected to lie down to birth but at home a woman can chose any position. Squatting opens a woman's pelvis much wider. Fetal distress can occur if shoulder dystocia occurs, and the cord becomes compressed between the vaginal wall and the baby's body. Having a trained midwife who understands the manuevers for shoulder dystocia and can resuscitate an infant will maximize your chances of a good outcome. In the hospital the usual treatment is forceps or vacuum delivery, which can cause injuries, or immediate C-section, which comes with many risks.

One is perfectly capable of VBAC delivery at home, too. The risk of uterine rupture is 1 in 200 and is more likely when interventions take place. If this did occur at home or in a hospital an emergency C-section would be required, but a timely transfer to the hospital should guarantee a good outcome for mother and child. If you have a classical (T-cut) Cesarean scar, your chances of uterine rupture is much higher. While women have had successful VBACs in these cases before, you may be safer in the hospital especially if you live a good distance away.

Term delivery is generally considered anywhere from 37-42 weeks, though some hospitals say 38 weeks to be cautious despite the lack of evidence for that consideration. Many women have healthy babies at 35 or 36 weeks gestation at home, and those babies generally have less problems that babies born much more prematurely. Typically breathing problems are the biggest concern. While it is perfectly safe to birth after 37 weeks, the choice to birth at 35 or 36 weeks is one you should make with your midwife. Birthing before 35 weeks, however, comes with significant risks to the child. When labor begins before 35 weeks it is best to go to the hospital if the midwife cannot stop the labor.

Due dates are often off by a week or two, so being overdue is not any cause for concern. Post-term pregnancy is not considered dangerous until 42 weeks, and some wait until 43 weeks to induce. You do not have to enter a hospital to be induced. Midwives have the tools to induce labor at home, and their methods are no safer than in the hospital. Post-date pregnancy does increase the chances of meconium being passed and stillbirth, especially after 42-43 weeks. Birthing in the hospital won't reduce your chances of stillbirth in this instant, though inducing labor will. Macrosomia can also occur when birth goes postdate, but we have already discussed that and shoulder dystocia.

Meconium can be passed as a result of fetal distress or the baby's gut maturing. If the pregnancy is past 40 weeks and baby shows no heartrate irregularities, the latter is likely, and there is no emergency. Fetal distress can cause a baby to pass and aspirate meconium, which can cause him to become ill. If a child's heartrate persists in being irregular and the waters are stained with thick meconium, it may be a good idea to transfer to a hospital. When the meconium is heavily diluted by amniotic fluid it is rare that the child will breathe it in and develope Meconium Aspiration Syndrome, which mainly occurs with fetal distress. Midwives know how to handle situations where the waters are stained with meconium.

If ultrasound and palpitation reveal that the baby is small, under 5 1/2 lbs, the main concerns are fetal distress and stillbirth which can make hospital birth a better option especially if your home is far from one. Small babies may not be able to maintain their body temperature, but the child can be kept warm with thermal blankets, a heating pad or portable heater, warm clothing, and skin-to-skin contact. . Malnourishment can be a problem, especially if mother's milk takes time to come in. Supplementing with formula and pumping can help. Ultrasound estimates are often incorrect, so make sure to get a second opinion before making your choice. Requesting a level II ultrasound or asking a midwife to check your abdomen may ensure a better prediction of fetal weight.

Group B Streptococcus (GBS) affects 10-35% of pregnant women. When this bacteria colonizes the vaginal region, her baby is at risk of contracting GBS disease during birth. There is a high chance of infant death if infection occurs, and other medical problems are common. A mother with GBS can be given antibiotics, which carry their own set of risks, through an IV, which will limit the mother's movement during labor. This will reduce the chance of the baby becoming infected. Declining vaginal exams and amniotomy will also help decrease those risks. Birthing at home while taking oral antibiotics can lower the risk as well. Whether or not to birth at home is a choice to be discussed with your caregivers in this situation.

Doctors now advise anyone whose bag of waters has ruptured to deliver within 24 hours, but others feel that waiting up to 96 hours is perfectly safe. The risk of infection is minimal, and the risk of dry birth is zero. The placenta continues to manufacture amniotic fluid until after you have given birth. The fluid continuously trickles down the vagina, pushing bacteria down and out. If you have a vaginal infection such as Group B strep you may wish to induce labor which can be done at home, but a broken bag of waters is not a reason to birth in the hospital. Do not allow anymore vaginal exams if your water has broken. There are women whose waters break in the second trimester that eventually heal. Even in cases where they do not, the baby is fine because the body keeps making fluid. Risk of infection in those women is low, though they are given some advise to help prevent infection and are put on bedrest.

Low amniotic fluid can increase chances of birth complications, such as fetal distress caused by cord compression. Close monitoring during pregnancy can make sure everything is okay in your womb so if the child seems to be having difficulty you can take action, such as inducing if you are very close to termIf the baby isn't handling the labor you may wish to transfer to the hospital for a C-section. Drinking lots of fluids can help this problem. Some women may wish to birth in the hospital so they can have fluid pumped into their uterus to keep the baby cushioned, but the choice is yours. This does not have to be a reason to birth in the hospital, but it is up to the individual.

Some are told that their home is incompatible with homebirth. This may be because they rent, where a landlord may disapprove, or live in an apartment or townhome, where neighbors may hear. That has little to do with whether a woman should birth in a hospital. The structure of your home may be unsuitable to hold a birthing tub, but its condition overall has nothing to do with the decision. The distance of your home's location from the hospital is something to consider, especially if you are at a higher risk of birth complications. You do not need a spotless or spacious home to labor and safely deliver a child, especially considering the bacteria in one's own home is a lot less dangerous than the foreign contaminents found in a hospital environment where sick people gather. Your home is usually the safest and most comfortable place to birth!

While homebirth is safe in most situations, there is a chance that an emergency will occur or that the mother will want to transfer for some reason such as pain relief. Having an EMT team on standby and notifying the hospital that you are homebirthing can mean faster treatment in case of an emergency. Please make sure that medical care is available nearby if you decide to birth at home. While severe birth complications are not nearly as common as a normal birth experience, they can happen, so be prepared. Read as much as you can, and talk to health care providers about complications and treatment options. The birth experience is important, but ultimately a healthy baby and mother are the most important goals. If you feel something is not right or if your midwife advises you to transfer, please do so. Intervention may be overused but it can and does save lives, so keep your mind open to other options!

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