Post natal care

Benefits of Homebirth Aftercare

You or your partner and other family members will be able to stay together with your baby.

You will be available to your other small children and so avoid the distress which can result from seperation if the mother is in hospital for a few days.

You and your baby will not have to make any traumatic adjustment from hospital to home life.

You will be free from the restrictions and routine of hospital.

You will be free to breastfeed whenever you and your baby want and you will have information and support on breastfeeding from your midwife.

All post-natal visits are done in the privacy of your own home i.e. paediatric checks and six week checks of mother and infant. Most midwives will stagger visits over a period of two weeks after the birth.

Safety aspects
These days, there is an assumption that hospital must be the safest place to have a baby because of the correlation of statistics between decreasing maternal and peri-natal mortality rates and increasing hospital births. However, the improvements in living standards, nutrition, general health and ante-natal care are likely to have had a much greater effect on these statistics than the trend to deliver in hospital. This is borne out by studies in the U.K., Holland and Australia where there are enough home births to make meaningful comparisons in maternal, peri-natal and infant mortality rates.

In the U.K. the peri-natal mortality rate for home birth compares very favourably with that of births in general:

Home births 4-5 in 1000

Hospital births 9-10 in 1000

It cannot be assumed that all of the women giving birth at home were "lucky" and/or so-called "low risk". For more statistics in this regard, Marjorie Tew's "Safer Childbirth?", is the best reference.

The following quote is from the U.K. Health Committee Second Report House of Commons: Maternity Services, Vol. 1 (The Winterton Report), published in March 1992

"On the basis of what we have heard, the committee must draw the conclusion that the policy of encouraging all women to give birth in hospital cannot be justified on grounds of safety." (Para. 33). The British Medical Journal of Nov. 23rd '96 published a Swiss study "Home vs. Hospital deliveries: follow up study of matched pairs for procedures and outcome".

Their key conclusions include:

"There are no obvious disadvantages of home delivery for mother or child when the mother opts for home delivery."

In some areas of Ireland, notably Co. Clare and West Cork, mothers-to-be have to make round trips of 100 miles to attend ante natal clinics in hospital. This is due to closures of smaller maternity units and the running down of domiciliary services.

Apart from the obvious inconvenience of travelling such distances, there are other risks involved - long and high speed car journeys to hospital,; giving birth unattended either at home or on the road side which is particularly applicable on second or subsequent babies, where labours can be very short and fast.

Given these risks, some women choose induction in order to avoid either of these scenarios. Induction itself is not without risk. In these cases, it would seem safer and more sensible to be attended at home by a local midwife/doctor.

There also seems to be less risk of infection for both mother and baby in the domiciliary setting than in the hospital environment.

The two specific risks which cause most anxiety are post-partum haemorrhage (PPH) in the mother and failure of the baby to breathe. As mentioned above, complications happen rarely in home birth situations

PPH - What would happen?

Ergometrine would be injected intravenously to contract your uterus and stop the bleeding. Your uterus would be massaged and bladder emptied by catheter. If required, the midwife would call an ambulance, though it is safer not to transport a woman in shock unless absolutely necessary.

Distressed baby What would happen?

Distress might be indicated by a change in the baby's heart rate, and if it happened in the first stage of labour you could be transferred to hospital. During the second stage the distressed baby would be delivered as quickly as possible.

Baby not breathing - What would happen? If the cord is still pulsating it will not be cut as this is an oxygen supply. It is important to keep the baby warm, possibly using massage as an extra stimulus. If required, the midwife would use an ambubag and/or mouth to mouth resuscitation. An ambulance might be called for transfer to hospital. If necessary, a tube might be placed down the baby's throat into its windpipe by the midwife.

Please remember, distressed babies are a rarity when mothers are not stressed. It is wise to discuss these eventualities, however unlikely, with your midwife and find out what steps she would take and what equipment or drugs she carries to cope with an emergency, i.e. Ambubag, Ergometrine or Syntometrine, I.V. drip, oxygen etc.