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Risks of Home Birth

11/15/2021

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I've been asked during interviews with prospective clients, and also by complete strangers who just learned I'm a midwife about the risks of having a home birth.  It's a good question that needs a straight answer.  However to understand the risks of home birth, you need to understand that birth in and of itself has an element of risk.  There are "low risk"  births but there is no such thing as a "zero risk" birth.  

What are the risks of birth?  There is a risk of baby being breech.  There is a risk of Mom tearing.  There is a risk Mom may have a hemorrhage.  There is a risk of shoulder dystocia. There is a risk baby may be in a posterior or other less than optimal position.  There is a risk baby may pass meconium before or during labor.  My list of risks is not complete, I decided to list the ones I have seen. These risks can be factors regardless of where birth happens.  I've seen shoulder dystocias in the hospital and in home births.  I've seen hemorrhages at the hospital and at home.  Births are not risk free.  Risks can be minimized or managed and for the majority of births, the risks are minimal.

Sometimes birth can be high risk.  For instance, a mother with a placenta covering all or part of the cervix is certainly dealing with more risk than a mother who does not have that issue.  A mother with high blood pressure has higher risks than someone who doesn't.  As a home birth midwife, I recognize I am not equipped or prepared to handle higher risk birth, so I monitor carefully to make sure pregnancy and birth remains normal to keep risk low.  I am particular about taking clients have low risk, healthy pregnancies.

The risks of home birth are exactly the same as at the hospital.  The biggest difference is that if there's a problem, care may be delayed due to needing to travel to the hospital.  In my midwifery practice, we discuss the risks and also have a plan if there is a need to get more help than I can provide.  During the birth I am constantly monitoring to ensure baby and mother are navigating labor well and that everything stays within the range of normal. Situations requiring immediate emergency care are thankfully uncommon. Usually we have time to arrange for a calm, orderly transfer of care.  I keep my training in emergency skills current and I practice them with my assistant on a regular basis so if there is ever a need to use them, we are ready.  I can't promise a risk free birth. I can promise that I will use my intuition, knowledge, and skills to the best of my ability to provide the best possible care and outcomes for my clients.  
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This isn't your grandmother's hospital, so why act like it is?

11/1/2021

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I recently had the privilege of attending a hospital birth.  It's been a while.  The hospital is in a large metropolitan area.  The hospital is among the few in Kansas that will support VBAC.  The hospital prides itself on presenting risks, benefits and the most current evidence.  Imagine my surprise when Mom was  told she could not have anything to eat during labor due to the risk of aspirating stomach contents if anesthesia was needed for an emergency c-section.  It was all I could do to not scream! This is such an outdated and no longer needed practice!  This is not your grandmother's hospital!  Anesthesia has come a long way from the days of dripping chloroform onto a cloth across your face and hoping to get the balance right.  It begs the questions in my mind of just how bad the anesthesiologists are at this hospital and if they are that bad, why they aren't taking steps to improve things.   

The recommendation to not let laboring mothers eat changed eight years ago.  In this day and age of instant news, and being able to pull up the most current research and recommendations in a second, why do so many hospitals continue to operate under such outdated guidance?  

When mothers are not able to eat during labor, labors can slow down,  and laboring women can just plain run out of the energy they need when it is time to push.  I've seen mothers in the hospital literally exhaust themselves while in labor and in my opinion, some food would have helped mothers end birth with some energy in reserve.  The body is expending enough calories during labor that ketosis is a risk if Mom doesn't eat.  Ketosis increases blood acidity for both mother and baby which contributes to labor slowing down. Don't count on any calories from that IV bag either, dextrose solution is not typically used during labor because of associated risks of electrolyte imbalance.

Attending the birth confirmed to me yet again why I am a Certified Professional Midwife serving families who wish to do a home birth.  My clients can eat and I insist on it during labor. I am not forced to adhere to protocols that have been changed for years. While it can take up to 17 years before a new recommendation is put into clinical practice, as a home birth midwife I can put the latest recommendations into practice as soon as they come out.  I can provide my clients the most current evidence based care and support during pregnancy and birth, one reason why I am happy to serve my clients as a home birth midwife.


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    Author

    Gail Webster, CPM

    Gail is a Certified Professional Midwife serving Manhattan, Junction City, Fort Riley and other areas in Kansas.  


    When Gail is not occupied with birth work, she enjoys reading, quilting, baking, riding her motorcycle and spending time with family.
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