Home birth

from Wikipedia, the free encyclopedia

A home birth is a form of out-of-hospital birth . It takes place, as opposed to births in hospital or birthing center , in a private apartment instead.

history

Until around the middle of the 20th century, home births were the predominant form of birth in all parts of the world. Clinical birth only developed into the dominant type of delivery in industrialized countries thanks to the comprehensive supply of hospitals and health insurance companies, while home births are still predominant in developing countries , often due to a lack of alternatives. In the USA only 5% of all births took place in clinics in 1900, 50% in 1939, and almost all births in 1960. It was believed that a hospital would provide greater safety and better pain relief, and they wanted to take advantage of the longer rest that inpatient treatment offered. In the twenties and thirties of the 20th century, hospital births were no safer than home births: infant mortality from incorrectly performed operations rose by up to 50%; Maternal morbidity and mortality have also been linked to the increasing rate of hospital births. This should be counteracted by being more careful about infections in the clinics. Mortality and morbidity improved with the introduction of antibiotics and the use of caesarean sections instead of forceps extractions for complications with an incompletely opened cervix.

From the second half of the 20th century, home birth was considered exotic and unreasonable in many industrialized countries. This attitude changed again at the end of the last century. Nowadays it is up to the mother to decide which place of birth to choose. In some countries home births are subsidized again by the state, for example in the Netherlands . The home birth rate there is around 30%.

In 2012, of 675,944 children in Germany, 10,164 (planned and unplanned) were born out of hospital. This corresponds to a share of 1.5 percent. The statutory health insurances reimbursed an average of around 1,100 euros for each home birth.

Obstetric care

Midwives

As a rule, home births are accompanied by a responsible midwife . The costs for this care are covered by all health insurance companies in Germany. The on-call service charge, which varies from region to region and is charged to home birth and attending midwives, is payable by the parents. Some private insurance companies pay premiums to the policyholder concerned for home births; the amount of the premium depends on the company and the type of insurance, but usually covers the standby lump sum.

doctors

General practitioners and gynecologists are allowed to look after a home birth, but in Germany they are obliged to call in a midwife. These costs are also covered by the health insurance companies. In practice there is only very seldom medical care for a home birth.

Alone birth

As unassisted childbirth (German about: alone birth ) is defined as a home birth, in which neither the midwife nor other medical personnel are present. This form of birth is relatively unknown in Germany and is rarely practiced because of the risks involved. In Austria there is an obligation to call in a midwife during the birth. In Germany, a pregnant woman is generally allowed to give birth without having to seek professional help. However, should the child suffer damage during the birth that a midwife could have prevented, the mother may be guilty of negligent bodily harm or even negligent homicide (Sections 222 and 229 of the Criminal Code).

requirements

Legal responsibility

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.
Where are these responsibilities evidenced? Do these also apply in Tajikistan?

Whether a home birth is possible for a pregnant woman is primarily at the discretion of the accompanying midwife. A pregnant woman can also ask a gynecologist for her opinion, but she is not responsible for the choice of her birth wish. The gynecologist is not responsible for the choice of the place of birth.

Exclusion criteria

Exclusion criteria for a home birth exist when a spontaneous birth is not possible or involves particularly high risks. This includes positional anomalies of the child as the transverse position , abnormalities in function and location of the placenta as a placenta previa but also evidence of a pregnancy-related disease ( preeclampsia ) or in advance diagnosed organ damage of the child.

Also risk births as breech or multiple births are exclusion criteria for a home birth. For insurance reasons, you are not allowed to be accompanied at home by a midwife in Germany. If relocation is no longer possible, an ambulance will be called in case there are still complications.

Social criteria

In addition to medical aspects, social aspects must also be taken into account when giving birth at home. If the pregnant woman feels stressed by her home environment, due to poor hygiene, noise or family disputes, the decision to give birth at home makes little sense. Conversely, for a woman with a hospital phobia or for reasons of self-determination and the protection of privacy, the home birth can be an alternative.

Reasons, possibilities and limits

According to the surveys of the Society for Quality in Extra-Clinical Obstetrics (QUAG), most women cite the care provided by the midwife they trust and the possibility of self-determination as the decisive motivation for giving birth at home. The personal environment and the exclusive presence of trusted and desirable people are cited as further reasons. A home birth can be prepared individually in consultation with the midwife, so it is possible, for example, to discuss the intensity of the obstetric care with the midwife and thus offer a woman who would like to have her child largely without help, an alternative to a single birth. Siblings can be present at the birth or methods such as gentle birth in the sense of Frédérick Leboyer or Michel Odent can be given special consideration.

In 2006, QUAG recorded water births in 15.9% of out-of-hospital births . Water births are also possible at home in a standard bathtub. A birthing pool is a suitable option to increase the convenience for the parturient and the midwife. Such pools are rented, bought or made available by the midwife.

According to the US health authorities, to reduce the risk of Legionella infection , the water hose should be rinsed with hot water for three minutes before the water enters, and special tubs - never a whirlpool - should be used.

The use of strong pain relievers or anesthetic procedures such as the pudendus block or epidural anesthesia cannot be used in the context of a home birth, but they are rarely required due to the special situation of the home birth. Pain relief can be tried through procedures such as breathing techniques and relaxation baths. Also alternative medical treatments such as homeopathy or acupuncture are used.

safety

Meta-analyzes and systematic reviews

Home birth safety remains a controversial issue. A review published in the Journal of Medical Ethics in 2014 evaluated 12 published studies that recorded 500,000 planned low-risk home births. The authors reported a 3-fold higher mortality in home births compared to hospital births, as well as poorer Apgar scores and a delayed diagnosis of hypoxia , acidosis and asphyxia in the home birth setting. The review also concluded that cesarean sections were less common in planned home births.

The largest study on the subject was published in October 2013 in the American Journal of Obstetrics and Gynecology . The data from 13 million births were evaluated in it. The study found that newborns had a 10-fold increased risk of an Apgar score of 0 after 5 minutes and a 4-fold increased risk of neonatal cramps and neurological dysfunction after a home birth . In firstborn babies, the risk of an Apgar score of 0 after a home birth was 14 times higher than in a hospital birth. Frank Chervenak, an author of the study, noted that the actual risk of home births, due to the design of the study, must probably be even higher, since home births moved to a hospital were evaluated as hospital births.

A 2013 analysis by the Cochrane Collaboration compared planned home and hospital births for low-risk women. The data found that planned hospital births are no safer than planned home births, but the former have more interventions and complications. According to the authors, not enough studies of good quality have yet been found to be able to make more concrete statements. The authors of the Cochrane Collaboration also attribute the higher rate of interventions during hospital births to the greater range of medical options in hospitals, which, in combination with impatience, lead to escalating measures more frequently. This in turn could create new complications.

A US meta-analysis (2010) examined 12 observational studies from the period from 1976 to 2006 with data of 342,056 planned home and 207,551 hospital births from seven Western countries. She came to the conclusion that there is a two to three fold increased risk of neonatal death (between the 7th and 28th day after birth) in children born through a home birth. According to the study, the perinatal risk of death (up to the 7th day after birth) of a home birth compared to a hospital birth is the same, due to the fact that births that are expected to result in complications are generally planned in the hospital. The authors point out, however, that if the birth age and birth weight of the home births are matched, an increased risk also arises during this period, especially in cases that still had to be transferred to a hospital. The reactions to this study were very critical, as it violated internationally recognized standards for meta-analyzes. It contains numerical errors, improper study design and methodology (inclusion and exclusion of studies) and bias of cited papers.

Several studies and meta-analyzes have shown that the data for first-time mothers in particular (women giving birth to their first child) showed a worse outcome than for multiparous mothers (women who have already given birth): more often they are transferred to a clinic during childbirth, they get more Interventions (such as perineal cuts) or have more secondary caesarean sections than multiparous homebirths; one study shows a slightly worse outcome for newborns in home births to first-time mothers. Furthermore, for pregnancies with no evidence of complications at the beginning of labor, for home births it showed an overall increased complication rate in the child, which was particularly higher in primiparous women. WHO supports out-of-hospital births as an alternative for low-risk women.

Germany

The Society for Quality in Extra-Clinical Obstetrics (QUAG) has been conducting surveys in Germany every year since 2011. The figures are subject to slight fluctuations from year to year, but have not changed significantly in recent years. For example, data for 2012 showed:

  • Of 10,734 documented out-of-hospital births, 34.4% were home births (birth-house births, doctor's office births, etc. result in the remaining out-of-hospital births)
  • 40.9% first-time mothers
  • 90.8% spontaneous births;
    2.7% forceps / suction cup births;
    6.6% caesarean sections (after transfer to a clinic)
  • 62.5% with pregnancy results according to risk catalog A;
    8.2% with pregnancy results according to risk catalog B
  • 45.1% of all women who gave birth vaginally had no birth injury;
    4.9% of all women giving birth vaginally had a perineal incision;
    1.1% of all women with vaginal birth had a III or IV degree perineal tear
  • 33.4% without any intervention;
    23.7% with moderate interventions (naturopathy, massages, acupuncture, etc.);
    the rest with invasive interventions (perineal incision, medication including homeopathy, opening of the amniotic sac, etc.)
  • 11.2% with transfer to a clinic during childbirth (proportion of home births);
    92.4% of all transfers took place calmly, 7.5% in a hurry
  • 92.2% of all live births in good or very good condition
  • 0.18% infant mortality
  • No mother died in connection with childbirth.

The Federal Center for Health Education writes: "If all foreseeable complications can be ruled out, there is nothing wrong with giving birth in your own four walls."

The German Society for Gynecology and Obstetrics (DGGG) and the Professional Association of Gynecologists (BVF) issued a statement in 2011 on the safety of home births. They write that "the greatest possible safety for mother and child during childbirth can only be guaranteed in a maternity clinic, in which unforeseeable emergency situations can be responded to immediately and without time-consuming transport of the woman giving birth with the entire range of medically sensible treatments." Above all, the 10% transfer rate during childbirth and the higher perinatal mortality of newborns of 2.1 children per 1,000 births compared to 1.3 children per 1,000 births in births between the 37th and 40th week of pregnancy are criticized. You refer to a British study that compares the outcome of home and hospital births.

Switzerland

In a study by the Swiss Midwives Association presented in December 1993, 489 women with a planned home birth and 385 women with a planned hospital birth were examined within four years. Both groups were comparable in terms of age, number of children, social class, partner situation, state of health, birth risk assessment and nationality.

25% of first-time mothers were transferred to a hospital, and 4% of second and third-part mothers. Emergency transfers accounted for 4.1% of all home births. 38% of women who gave birth at home had no perineal injuries, compared to 9% of women who gave birth in a hospital. Furthermore, in the home birth were significantly less labor induction , caesarean sections or vacuum or forceps deliveries carried out and administered less frequently blow promoting and analgesic medications. No differences in the examined health characteristics were found in the newborns of both groups.

Other countries

The Netherlands: The Netherlands has a special position because it has a home birth rate of 30% - significantly more than in any other country in the western cultural area. A study published in the Netherlands in 2009 among women who had previously been certified as having a low risk of birth complications came to the conclusion that a planned home birth is just as safe as a planned hospital birth, whereby in both cases the supervision of an experienced midwife is required . It should be noted here that births at which there is an increased risk of complications are usually planned directly in the hospital. For this reason, in the study mentioned, hospital births to women with a low risk of complications are compared with corresponding home births. Another cohort study compares maternal outcomes with low risk: they suffered less morbidity and postpartum bleeding in home births, and the placenta had to be removed manually less often than in hospitals. Here, too, the value of well-trained midwives is emphasized, as well as clear documentation and a good system of relocation transports. According to the British health service NHS, however, the informative value of the work is limited in that mothers who had complications during or before the home birth and had to be transferred to hospital were not included in the analysis. There are also indications of poor data quality.

In the period from 1983 to 1992, while the home birth rate fell, maternal mortality rose from 9.7 to 12.1 per 100,000 live births between 1993 and 2005. In comparison with other European countries, it is noticeable that the Netherlands has poorer results in the perinatal statistics. Euro-Peristat is a project that collects comparative perinatal statistics from all EU countries. In the Peristat I study (European Perinatal Health Report 2004), the Netherlands had the highest fetal mortality rate (7.4 / 1,000 births) and, after Greece, the highest neonatal mortality rate (3.5 / 1,000 live births). In the Peristat II study (2010), after France, the Netherlands had the highest fetal mortality rate (7.0 / 1,000 births). Of all western European countries, the Netherlands had the highest neonatal mortality rate (3.0 / 1,000 live births). Perinatal mortality fell, but more slowly than in other countries, and the mortality rate is still high compared to the European standard (2006: 9.1 / 1,000 births). The Erasmus Medical Center investigated the causes on behalf of the Dutch government and came to the conclusion that the poor results are likely due to factors in the health care system: conservative and less invasive treatment of premature babies reduces their chances of survival; Prenatal screenings are carried out less frequently, which means that malformations are discovered less often. There are also more pregnant women at an older age, a higher number of multiple pregnancies and mothers from ethnic minorities. A connection with the high rate of home births is not established in the study.

Great Britain: The British Birthplace in England Collaborative Group published the results of their study on the place of birth in November 2011 (already quoted above). In the case of 64,538 women who were given birth to mature children between April 2008 and April 2010, there was no difference in the condition of the children born between the birthplaces if they were healthy multiparous women. However, the infant condition was worse in first-time women. The authors of the study conclude that women with low risk factors can be left free to choose where to give birth and that significantly fewer interventions take place in the case of out-of-hospital births. The National Institute for Health and Care Excellence (NICE), which produces guidelines for the UK National Health System (NHS), changed its guidelines in 2014 regarding the place of birth recommendation: Low-risk multiparous women should be shown that childbirth at home or with midwives managed institutions is particularly suitable for them; First-time births with a low risk are still advised to use facilities run by midwives. The recommendation is based on the fact that significantly fewer interventions are to be expected than in clinical settings, as well as more vaginally terminated births, while the quality of results ( outcome ) is equivalent to that of hospital births. It should be demonstrated to first-time mothers who want to give birth at home that there is a slightly higher risk of a worse outcome in the newborn. The women should be supported in making an informed choice; The information submitted should be based on evidence from scientific data.

United States. The American College of Obstetricians and Gynecologists does not recommend home births. An older study that compares home and hospital births under the same conditions comes from North America. She comes to the conclusion that there is no significant difference between the two birth variants from risk considerations. This contrasts with surveys by the state of Oregon in 2012, which found a child mortality of 4.8 per 1,000 planned home births compared to 0.6 per 1,000 planned hospital births.

Complication and emergency management

The limits of home birth care in the event of complications and emergencies, as well as the way to the clinic, are part of the antenatal discussions between parents and midwife. The handling of when a home birth is canceled can vary depending on the professional experience of the midwife and local conditions. Not every complication needs to be moved to a clinic. Many emergencies can be taken care of outside the clinic or bridged by midwives before they are transferred to the clinic: midwives always give births with an oxygen mask (in case of shortness of breath), emergency medication (e.g. synthetic oxytocin), electrolyte solution (in the case of slight blood loss from the mother) and other with; they are proficient in chest compressions and resuscitation. If complications arise during the course of a home birth that require clinical treatment, the patient is usually transferred to a nearby hospital.

According to QUAG, 11.2% of home births (16.6% of all births planned out of the hospital) were transferred to hospital during the course of the birth. 92.4% of all relocations (including birth centers) took place without rush, 73.1% of the relocations with their own car. Of the women who were transferred during childbirth, 39% had a caesarean section (that is 6.6% of all births started out of the hospital). In 5.4% of births, the mother and / or child had to be relocated after the birth. The main reasons for a transfer are very long births / birth arrests and abnormal childlike heartbeats.

literature

  • Anke Wiemer: Out-of-hospital birth in Germany, German Out-Of-Hospital Birth Study 2000–2004. Published by the Society for Quality in Extra-Clinical Obstetrics. V., 2007, ISBN 978-3-456-84427-5 .
  • Larissa Brodöhl: home birth. Reports by women for women. Weißensee Verlag, Berlin 2005, ISBN 3-89998-996-1 .
  • Frauke Lippens: home birth. Decision support and preparation. Heinrich Hugendubel Verlag, 2007, ISBN 978-3-7205-5021-5 .
  • Marjorie Tew: Safe Birth? Mabuse Verlag, 2007, ISBN 978-3-938304-06-8 .
  • Sheila Kitzinger : birth. The natural way. Dorling Kindersley Verlag, 2003, ISBN 3-8310-0432-3 .

Web links

Commons : home birth  - collection of pictures, videos and audio files
Wiktionary: home birth  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ a b J. R. Wertz, DC Wertz: Lying-In: A history of childbirth in America. Schocken Books, New York 1979.
  2. ↑ JW Leawitt: Brought to bed: Childbirth in America, 1750-1950. Oxford University Press, New York 1986.
  3. ↑ German Bundestag (Ed.): Answer of the Federal Government to the minor question from the MPs Cornelia Möhring, Birgit Wöllert, Sabine Zimmermann (Zwickau), other MPs and the DIE LINKE parliamentary group. - Printed matter 18/738 . No. 18/900 , March 21, 2014, ISSN  0722-8333 , p. 3 ( bundestag.de [PDF]).
  4. ↑ § 3 HebG ( Memento of September 27, 2007 in the Internet Archive ) - "Every pregnant woman has to call in a midwife for the birth and for the care of the child."
  5. ↑ Irene Berres: An Enigmatic Patient: Dangerous Birth. Spiegel online, August 27, 2017, accessed on August 27, 2017 .
  6. ^ Friedrich Wolff: Obstetrics. In: Jörg Baltzer, Klaus Friese , Michael Graf, Friedrich Wolff: Practice of Gynecology and Obstetrics: The complete practical knowledge in one volume. Thieme Verlag, 2006, ISBN 3-13-144261-1 , S. 188. .
  7. ^ Lachlan de Crespigny, Julian Savulescu: Homebirth and the Future Child . In: Journal of Medial Ethics . January 11, 2015.
  8. ↑ Birth Setting Study Signals Significant Risks in Planned Home Birth . In: American Journal of Obstetrics and Gynecology . American Journal of Obstetrics and Gynecology. September 17, 2013. Retrieved January 11, 2015.
  9. ↑ Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting . Retrieved January 15, 2015.
  10. ↑ O. Olsen, JA Clausen: Planned hospital birth versus planned home birth. In: Cochrane Database of Systematic Reviews. 2013, Issue 11. Art. No .: CD000352.
  11. ↑ O. Olsen, JA Clausen: Benefits and harms of planned hospital birth compared with planned home birth for low-risk pregnant women . Cochrane Summaries 2013.
  12. ^ Joseph R. Wax, F. Lee Lucas, Maryanne Lamont, Michael G. Pinette, Angelina Cartin, Jacquelyn Blackstone: Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. In: Am J Obstet Gynecol. 203 (2010), PMID 20598284 , doi: 10.1016 / j.ajog.2010.05.028 .
  13. ↑ Carl A. Michal, Patricia A. Janssen, Saraswathi Vedam a. a .: Planned Home vs Hospital Birth: A Meta-Analysis Gone Wrong. In: Medscape. Apr 01, 2011.
    BA Anderson, S. Stone: Best Practices in Midwifery: Using the Evidence to Implement Change. Springer Publishing Company, Aug. 24, 2012,
    M. J. Keirse: Home birth: Gone away, gone astray, and here to stay. In: Birth. 37 (4), pp. 341-346
    E.C. Hayden: Home-birth study investigated. Retrieved December 14, 2014 .
  14. ↑ a b c Out-of-hospital obstetrics in Germany - quality report 2012. On behalf of the “Society for Quality in Out-of-Clinical Obstetrics ”. V. ", quag.de (PDF; 2.4 MB)
  15. ↑ a b c Birthplace in England Collaborative Group: Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. In: BMJ. 343 (2011), doi: 10.1136 / bmj.d7400 .
  16. ^ World Health Organization (WHO): Care in normal birth: A practical guide. 1996, German (PDF; 4.21 MB)
  17. ↑ The home birth. Federal Center for Health Education, accessed on February 17, 2015 .
  18. ↑ Home birth - increased risks. Statement by the German Society for Gynecology and Obstetrics (DGGG) and the Professional Association of Gynecologists (BVF), dggg.de ( Memento from August 17, 2012 in the Internet Archive ) (PDF; 40 kB)
  19. ↑ National Fund Study “Home birth versus hospital birth” ( Memento from October 9, 2007 in the Internet Archive )
  20. ↑ No more risky home births than hospital delivery. April 17, 2009. Retrieved April 20, 2009 .
  21. ↑ a b c A. de Jonge, BY van der Goes u. a .: Perinatal mortality and morbidity in a nationwide cohort of 529688 low-risk planned home and hospital births. In: BJOG: An International Journal of Obstetrics & Gynaecology. 116, 2009, p. 1177, doi : 10.1111 / j.1471-0528.2009.02175.x .
  22. ↑ nhs.uk , last accessed on January 11, 2015
  23. ↑ cbs.nl
  24. ↑ J. Schutte, E. Steegers, N. Schuitemaker, J. Santema, K. de Boer, M. Pel, G. Vermeulen, W. Visser, J. van Roosmalen, the Netherlands Maternal Mortality Committee: Rise in maternal mortality in the Netherlands. In: BJOG . 117 (2009), pp. 399-406, PMID 19943828 , doi: 10.1111 / j.1471-0528.2009.02382.x .
  25. ↑ AD Mohangoo, SE Buitendijk, CW Hukkelhoven, AC Ravelli, GC Rijninks-van Driel, P. Tamminga, JG Nijhuis: Higher perinatal mortality in The Netherlands than in other European countries: the PERISTAT II study. In: Ned Tijdschr Geneeskd. 152 (2008), pp. 2718-2727, PMID 19192585 .
  26. ^ AC Ravelli, M. Tromp, M. van Huis, EA Steegers, P. Tamminga, M. Eskes, GJ Bonsel: Decreasing perinatal mortality in The Netherlands, 2000-2006: a record linkage study. In: J Epidemiol Community Health. 63 (2009), pp. 761-765, PMID 19416928
  27. ↑ GJ Bonsel, E. Birnie, S. Denktaş, J. Poeran; EAP Steegers: Lijnen in de perinatale sterfte, Signalementstudie Zwangerschap en geboorte 2010. Erasmus MC, Rotterdam 2010.
    Press release of the Erasmus Medical Center of July 5th, 2010
  28. ↑ National Institute for Health and Care Excellence (NICE): Guidelines for Intrapartum care - Key priorities for implementation ( Memento of December 16, 2014 in the Internet Archive ) - and - Guidelines for Intrapartum care - Recommendations. place of birth , NICE guidelines [CG190], December 2014.
  29. ^ The American College of Obstetricians and Gynecologists Issues Opinion on Planned Home Births ( January 30, 2011 memento in the Internet Archive ) American College of Obstetricians and Gynecologists: Planned Home Birth. Committee Opinion No. 476, Obstet Gynecol 117 (2011), pp. 425-428, doi: 10.1097 / AOG.0b013e31820eee20
  30. ↑ Kenneth C. Johnson and Betty-Anne Daviss: Outcomes of planned home births with certified professional midwives: large prospective study in North America. In: BMJ. 2005; 330, S. 1416 (18 June), doi: 10.1136 / bmj.330.7505.1416 (full text)
  31. ^ Committee Meeting Document 8585 . Oregon Legislative Assembly . March 15, 2013. Retrieved January 11, 2015.

other remarks

  1. ↑ The press release of the Erasmus Medical Center on July 5, 2010: “ The preliminary conclusion is that the unfavorable European position is probably mainly caused by factors in the care system while the differences within the Netherlands and the larger cities are linked to large risk differences between groups on the basis of ethnicity, social deprivation and the neighborhood in which people live. A research agenda has been formulated based on this. "