Berlin (dpa) - Expectant parents face many decisions before the
birth of their child. How to furnish the nursery? What baby clothes
to buy? And, as the big day draws nigh, where to deliver?
The spontaneous answer to the last question is usually "in a
hospital." There are, however, alternatives. The right choice depends
in part on the woman's state of health.
When labour proceeds smoothly, home births and deliveries in
birthing centres are just as successful as birth in a hospital,
according to a German study that considered, among other things, the
health of newborns 10 minutes after delivery. The good showing for
non-hospital settings does not mean they are the right choice for
every woman, though.
"There are circumstances that make an out-of-hospital birth
inadvisable," noted Ruth Sichermann, deputy chairwoman of the Network
of Birthing Houses. They include, she said, illnesses of the
mother-to-be, such as epilepsy, high blood pressure and diabetes, as
well as diseases or organ damage detected in the foetus.
Due to the heightened risk of complications in such cases, the
baby should be delivered in a hospital, Sichermann said.
"The same goes for premature births or when the baby is
incorrectly positioned (in the womb)," she added.
If no risk factors are known, nothing stands in the way of an
out-of-hospital birth - "after all, birth per se isn't a morbid
condition, but a perfectly natural event. So why should it take place
in a hospital?" pointed out Susanne Schaefer, chairwoman of the
Federation of Independent Midwives of Germany.
But she said that many expectant mothers worry about medical care
for their baby outside a maternity ward in case of an emergency.
Complications can occur during any childbirth, "even when the
pregnant woman is completely healthy and has had a normal, easy
pregnancy," remarked Klaus Friese, deputy vice-president of the
German Society of Gynaecology and Obstetrics.
Those include: a failure to progress because labour contractions
are too weak; a lack of oxygen to the baby; and severe bleeding in
the mother due to premature placental separation or a ruptured
uterus.
There is little time to spare in such cases, "so emergency medical
care for mother and child must be available quickly," Friese said. He
questioned whether this was always fully ensured in out-of-hospital
births, particularly home births far from the nearest hospital.
According to the German midwives' associations, the safety of
mother and child is indeed ensured.
"Out-of-hospital midwifery care has very good risk management,"
Schaefer said.
"Midwives are trained to recognize problems during labour and
symptoms of anomalies in mother and child early," remarked
Sichermann. If something goes wrong, she said - for example, the
baby's heart tones are poor; the mother is in an extremely weakened
state; the mouth of the uterus is not properly opened - the woman is
transported to a hospital.
Many women decide to deliver outside a hospital because of the
relationship with their midwife.
"The woman and midwife get to know each other during the
pregnancy, the midwife does the screening and guides the pregnancy's
progress. This creates a relationship of trust," Schaefer noted. And
this, together with the more relaxed atmosphere outside a hospital
setting, supports the natural process of birth.
Copyright 2012 dpa Deutsche Presse-Agentur GmbH