Home birth is right choice for some mothers

Press, 19 April 1982, Page 16

Home birth is right choice for some mothers

By

FELICITY PRICE

Planned home birth is safe and offers a viable alternative to hospital births in many cases, according to a review of home births in the Auckland area, published in the “New. Zealand Nursing Forum” this month. “There have been over 1000 home births in New Zealand, with a total of three deaths. This compares well with a perinatal mortality rate of 13 per 1000 live births for hospital deliveries.” says the author of the survey, Mrs Sian White, a domiciliary midwife in Auckland. In Christchurch, where until last year there has only been one practising domiciliary midwife available for home births, there have been a total of 450 home births, and no fatalities.-Last year, there were 50 home births in Christchurch and the neighbouring countryside. Of the 89 planned home births studied in Mrs White's review, 16 had. to be transferred to hospital to complete the delivery, and in two cases the baby had to be transferred to hospital for minor complications after the birth. Of the 16 transferred to hospital, five turned out to be normal deliveries after all. five required forceps deliveries. two were caesarian sections, and others required manual removal of the placenta. There were no fatalities.

The transfers to- hospital were taken as a precaution, and were carried out early, when the woman and foetus were in good condition and there was no need to hurry, Mrs White explains. All of the women transferred to hospital subsequently expressed the hope that with any future pregnancy home birth would remain the preferred option. Not all women are suitable candidates for home births. The basic criteria are: she must be a non-smoker; she must have a history of good health and nutrition: she must have no existing medical problems; she must have a low-risk pregnancy (that is no previous caesarian section. no toxaemia, and no maipresentation): she must be emotionally stable; she must have a willingness to prepare for the birth: and she must have regular antenatal care with a general practitioner who supports the home birth and is prepared to attend. Mrs Ursula Helem who. until this year has been the only domiciliary midwife in Christchurch, considers that this last factor is often the most difficult to satisfy. "At the moment, the hardest criterion is to find a doctor who will support the woman who wants to have a home birth." she says. "It’s not an option given to pregnant women by most

general practitioners. If a woman wants one. she is very dependent on finding the right doctor who will agree to attend the birth and be responsible tor the confinement." As a qualified domiciliary midwife. Mrs Helem is able to perform the delivery herself. without the presence of a doctor but Department of Health rules require that a doctor should agree to be responsible for the birth, even if he is not there. It is this I was told that seems to put off most doctors. In spite of- general reluctance by doctors to recommend or be responsible for home births, there has been a gradual increase in the number of such births since Mrs Helem started practising in 1974. In her first two years as a domiciliary midwife. Mrs Helem attended just five home births. In 1976. she attended 30. and since then, the numbers have kept going up. Last year, there were 50. Home births do not cost individuals anything. They are funded by medical health benefits. The midwife’s fees are paid by the Department of Health, and the doctors fees are paid in the same way as other medical bills incurred during pregnancy. This year, Mrs Pat Fuller has joined Mrs Helem as a registered domiciliary midwife in Christchurch.