I know no one wants to think about possible complications, and some people even believe that if we talk about complications we will somehow invite them to happen. It seems reasonable, however, to consider this topic carefully when deciding and planning on a home birth. Preparing for something doesn’t assume it will happen, but it allows us the freedom to relax and release that worry, and also for us to feel confident if something unforeseen does happen. Key concepts here are prevention, management, and transfer.
Prevention: From your first prenatal visit, your midwife is thinking about who you are, what are your particular risk factors, and are you a good candidate for a home birth. We partner with you to have a healthy pregnancy and encourage you to eat well, exercise, relax and get good sleep. While we can’t control some outcomes, even if we “do everything right,” we can lower the chances that something will go wrong in the birth if we are mindful about our self-care. (This goes for pregnancy and all of life, including for midwives!). As a partner in your own care, you can assist this process by being honest with your care provider about your health and reproductive history, your lifestyle, and the things that you feel worried or concerned about. Appointments with home birth providers are typically scheduled for 45 minutes to an hour, so you should have plenty of time to share all of your concerns. It is absolutely to your benefit to learn all you can about natural childbirth, so that you can understand the process, and anticipate a likely course of events. Many families do this by reading books; I think an ideal companion to reading is attending an in-person childbirth class that is specifically focused on preparing for un-medicated births. Ask your midwife for local recommendations.
Midwives and other practitioners who work according to the Midwives Model of Care tend to avoid unnecessary intervention, which is another facet of preventing complications. Consumer Reports has recently done a nice job of summing up some of the biggest interventions that are high risk as well as high cost for mothers and babies. In short, interventions introduce additional risk. Sometimes that risk is warranted, as in the case of a mother or baby in distress, but many times that additional risk could be avoided.
Management: Home birth providers are trained in dealing with the typical complications that could happen during birth, including handling of hemorrhage, resolution of shoulder dystocia (baby being stuck after the birth of the head), stitching up perineal tears, and performing newborn resuscitation. Typically, midwives carry an array of supplies to assist in the management of these possible outcomes, such as anti-hemorrhagic medications, IV supplies, resuscitation equipment, and suturing supplies. Check with your midwife about her personal equipment, skills and supplies.
Transfer: Fully participating in prenatal care, having lab work and necessary ultrasounds performed can help to show that you continue to be a low-risk candidate, and that it is appropriate for you to plan to birth at home. Transfer of care to a higher level provider with more equipment and tools at their disposal may become necessary at any time in your pregnancy, during labor or in the postpartum. Again, your midwife is trained to continue to gather information and assess for potential risks that may be presenting. There may be something that comes up in your care that requires your midwife to consult with a hospital-based provider, or requires you to be seen by that provider. This may impact the decision to birth at home. Ultimately, everyone’s goal is to have a healthy outcome for mother and baby, so even if it has always been your dream to birth at home, a hospital birth may be the most reasonable option for you. Transfer during labor or in the immediate postpartum may also become necessary, and requires safe transport for mother and perhaps baby, if the birth has already been accomplished. Clients should consider this a possible outcome, and participate in the planning of potential transfer by identifying the closest hospital, and finding out what ambulance company serves your area.
What happens if the cord is around the baby’s neck? I really like this article about this topic. Long story short, a cord around the neck is very common, found in about 1/3 of babies. Dr. Rachel Reed has done a thorough review with thoughtful analysis of this topic. It may be that around the neck is a safe place for the cord to be, so that it doesn’t get compressed while the head is coming through the birth canal.
Hopefully, you feel reassured and confident in planning a home birth, as well as managing possible complications. Feel free to post questions in the comments.
Next: What about the mess?
~photo credit Fox Valley Birth & Baby