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Bringing Out Baby ... at Home

Home Delivery

Home Birth Less 'Medical' for Most continued...

Shelton carries emergency equipment, including oxygen for babies not breathing well, but seldom has to use it.

Alice Bailes has the same experience.

"I throw out my IV bags because they're expired more often than I use them," says Bailes, CMW, co-director of BirthCare and Women's Health, a service of certified nurse-midwives in Alexandria, Va. Her delivery team often includes an RN or practitioner certified in neonatal advanced life support.

To make labor more comfortable and efficient, Bailes recommends "low-tech" interventions like changing position or taking a shower. Being able to move around free of a fetal monitor, IV, and other restraints typically used in a hospital is also a major advantage, she explains, as is not being pressured to deliver within a specified timeframe.

But Going to the Hospital Is Not 'Failure'

Despite these advantages, Bailes says that about 25% of first-time moms and about 4% of those who have already had children have to be transferred to a hospital for delivery. This happens mostly because of failure to progress, meaning that the woman becomes exhausted and feels that she can't deliver the baby on her own.

It's important not to refuse hospital help at this stage, says Ole Olsen, MSc, associate director of the Nordic Cochrane Centre in Copenhagen, Denmark. The Cochrane Centre has analyzed medical studies from around the world, including a study showing that if the mother refuses medical help despite problems with labor, home birth resulted in an increased death rate for both mothers and babies.

"If at any time you feel you need to abandon the home birth, trust yourself, and don't let someone else talk you out of it," says Hilda Bastian, a consumer advocate for home birth at the Flinders University of South Australia. "Going to the hospital is not failure -- if you think you or your baby need it, it's just being responsible."

"As long as the woman is followed by an experienced home birth practitioner who will transfer for hospital birth in case of any problems, home birth is not dangerous," Olsen says. He refers to two reviews showing that the infant death rate for planned home birth is very low and similar to that for planned hospital birth, provided the mother is healthy and the pregnancy is normal.

Low-risk pregnancies had infant death rates of 2.0 per 1,000 for home birth and 2.2 per 1,000 for hospital birth, says David Anderson, PhD, associate professor of economics at Centre College in Danville, Ky. Only 3% of low-risk mothers intending to deliver at home end up with C-sections, compared with 8-27% of low-risk mothers delivering in the hospital.

All experts interviewed stressed the importance of regular prenatal care in recognizing and preventing potential problems, and of having physician backup for in-hospital delivery in case something goes wrong. Arranging for a pediatrician to see the newborn within 24 hours is also essential, Bailes says.

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