Risks carefully monitored

Press, 19 April 1982, Page 16

Risks carefully monitored

Because so few people are involved in the care of the home birth mother, all possible risks can be easily identified. Mrs Sian White maintains in her article in “New Zealand Nursing Forum.” “She visits her general practitioner regularly, and routine checks are made on each visit. Communication between general practitioner, midwife, and the woman is established early." she said. In some places, she is able to go to home birth support groups, run by previous home birth mothers, and take part in a serie's of classes on topics such as the emotional and practical preparation for birth, breastfeeding, ante-natal exercises. and relaxation. A midwife will attend the sessions. as will the prospective

fathers. "The support group also provides a way for experiences to be shared. This goes a long way towards countering some of the negative feedback and criticism a lot of couples encounter when they announce their decision to .'have the baby at home." Mrs White said.' The midwife makes an ante-natal visit to the home about six weeks before the birth date. Logistics of the birth are discussed, as well as the setting up of furniture in the room where the birth will take place. Details are also worked out about other children and arrangements are made for contacting the midwife and doctor. “As soon as labour commences the midwife is contacted, and goes to the home. Routine observations of

blood pressure, temperature, abdominal palpation are made to establish a baseline at the onset of labour. The general practitioner is notified that the woman is in labour and details given. "At this point the antenatal history is evaluated and it is generally possible to predict whether' the labour will be normal, without the need for any outside interference and whether the condition of the baby will require care in hospital. "Each labour is a unique event and each woman is helped to experience it in her own way. She is usually up and about for most of the first stage of labour, she receives constant care and support, and regular observations are made to monitor her condition and that of the babv.

“The woman adopts whatever position she finds easiest for the second stage. Often she is helped to squat or goes on all fours. 'Alternatively she may sit between her partner's legs, so she can lean against him. “The head is delivered with the aid of gentle massage. Then the woman herself lifts the baby out and straight up onto her abdomen. Alternatively the father may do this with help from the midwife. “The cord is left until it stops pulsating and then the father is usually invited to cut it — a symbolic gesture. The placenta and membranes are delivered when they have separated, usually 1045 minutes after the birth* "The baby fixes and suckles at the breast for an hour

or more to get the maximum amount of colostrum. Routine examination of the newborn is performed by the doctor. "The baby is weighed and dressed by family ' and friends. "The woman is helped to shower and made comfortable. and the whole family celebrate the new baby. The midwife remains for several hours to ensure there are no problems. "Post-natal care is continued for 14 days. Visits are made 2 or 3 times a day at first, if help is required with breast feeding or extra support is needed. Daily visits are subsequently made. “If at any point the woman is transferred to hospital, the midwife stays with her and will continue postpartum care after discharge."