Home births carry risks
The incidence of home births in Singapore is less than 1 per cent (“More parents opting to give birth at home”; Monday).
It is important to distinguish between planned home births, which refer to home deliveries accompanied by a medical professional, and unassisted home births, where no medical or professional birth attendant is present.
Unassisted home births are unsafe and should be avoided, while the issue of planned home births is being keenly debated in many developed countries worldwide.
Labour and delivery, while being natural events, may present potential hazards to both the mother and foetus before, during and after birth. Unpredictable and potentially life-threatening complications such as post-partum haemorrhage, placental abruption and cord prolapse will require immediate access to hospital resources that are not readily available at home.
Indeed, the reported risk of the need for an intrapartum (during childbirth) transfer to hospital is 25 per cent to 37 per cent for women giving birth for the first time, and 4 per cent to 9 per cent for women who have given birth more than once.
Most of these transfers are for lack of progress in labour, non-reassuring foetal status, need for pain relief, hypertension, bleeding and foetal malposition.
In the most recent analysis of 12 studies, the overall neonatal death rate was almost three times higher for babies born without congenital anomalies in the home birth group.
Therefore, a decision to give birth at home must be made in the knowledge that there may be relatively few resources available for the management of sudden, unexpected complications that may affect any pregnancy or birth, even for those without any known obstetric risk factors.
Women contemplating planned home births need to understand these risks, and should seek information from their care provider about the provider’s experience and contingency arrangements in the event of an emergency, including options for a hospital transfer.
While the College of Obstetricians and Gynaecologists, Singapore supports a woman’s right to personal autonomy and decision-making in obstetrical care, the beneficence resulting from such a choice needs to be balanced carefully against any maleficence to the mother or her unborn child.
To quote an editorial in The Lancet in 2010: “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.”
In view of the absence of high-quality safety evidence, we do not support the practice of planned home births, owing to the inherent risks and the ready availability of safer options for labour and delivery in Singapore.
Source: Asia One
Published: 28 Feb 2014
Category: Features, Health alert
