Learn about natural birth and home delivery of babies and the risks involved.
Home Delivery of Babies: Rewards vs Risks
MOTHER EARTH NEWS worries at the thought of a reader trying to deliver her baby at home with nothing but a recommended book propped beside her and I do not, in any way, suggest or encourage such a foolhardy practice. On the other hand, I am increasingly aware that numerous readers of this publication have had — or are planning — "natural" or home deliveries . . . often with only the sketchiest information and large amounts of wishful thinking to guide them.
Perhaps this brief review of natural and home deliveries and the risks involved — while not to be interpreted as a guide to nor endorsement of the idea — will at least offer you some honest information on the subject. I suggest that — after you digest this feature and the books recommended by the various authors — you contact The American Society for Psychoprophylaxis in Obstetrics, 36 West 96th St., New York, N.Y. 10025
As recently as 1935, 65% of all babies born in the United States were delivered at home. At present, slightly less than 5% of this country's mothers deliver at home. Maternal deaths, during the same time interval, were cut from 60 per 10,000 to 5 per 10,000 and — as might be expected — the medical profession generally seems to feel that there's a direct correlation between the two sets of figures.
Some of us are not so easily persuaded by that reasoning, however. We know that much of this reduction in risk to a mother is due to the discovery of antibiotics and the widespread adoption of prenatal checkups (which detect and ward off complications of pregnancy before the actual delivery).
We also know that few medical people are apt to seek out and publicize the ways in which home deliveries actually reduce the risks involved in childbirth. For example, a mother at home will usually be watched and attended far more faithfully than she would if she were in a hospital; she will be less anxious in many cases; she will be much less likely to receive drugs which might poison the baby; her delivery will not be rushed by an obstetrician who is anxious to get on to something else; the baby will not be exposed to the virulent staphylococcus germs which breed in hospital nurseries.
On the other hand, serious complications can develop during any birth and such complications can definitely represent a larger danger to both mother and child in a wilderness cabin than when encountered in a hospital. If you decide to have your baby at home (after having gone through properly-supervised prenatal care) with an experienced nurse, midwife or M.D. in attendance, the odds are about one in 50 that something will happen during labor and delivery to send you to a hospital. Once in every 200 home deliveries that "something" will be potentially life-threatening.
Yes, this is entirely "natural". Even wild animals occasionally have trouble delivering and any farmer can tell you of complications he's had delivering a cow of her calf. It is pointless to deny — no matter how good your "vibes" — that problems can occur. It's much better if you know about these potential complications before than after they happen and the following description of some of the worst is not meant to scare, but to inform.
Home Birth: Twins, Triplets, Etc.
One in every 89 deliveries results in twins and only 60% of twin pregnancies are recognized as such prior to the actual birth . . . so they can be quite a surprise.
A mother may suspect that she's carrying twins if her abdomen is much bigger than seems normal and, if you have sensitive hands you can sometimes distinguish two hard, round baby heads instead of one when you touch the mother's abdomen. If you want to make a more professional check for twins, get a stethoscope at any physician's supply house and listen for the rapid tic-tac of the unborn baby's heart. If you hear two heart beats at different points over the abdomen (and particularly if there's more than 10 beats a minute difference in the pulse count) you can practically assume you have twins coming. The diagnosis can be confirmed by X-ray if there's any doubt.
Now twins, triplets and other multiple births are great to have in the family once they're delivered but, unfortunately, they frequently are born hind end first (breech birth) and that's a difficult form of delivery. They're also smaller in size (hence weaker for a time) and are more apt to get sick following delivery.
Twins could be delivered at home and everything might go OK but, if I was called upon to supervise the delivery, I would be jumpy until both babies were out and doing well. Any twin (any baby, in fact) weighing under four pounds would have a better chance if taken to a hospital nursery.
Home Birth: Mother's Pelvis Too Small
In about 1-2% of hospital deliveries the mother's pelvis is too small for the baby to be born. This is usually caused by rickets (vitamin D deficiency) which resulted in a misshapen pelvic as the mother's bone structure was being developed.
A doctor or midwife generally suspects this complication (called cephalopelvic disproportion) early in pregnancy and can advise against home delivery. In some cases, however, the condition is not noticed until labor has persisted longer than normal with no progress of the baby's head through the birth passageway.
The usual duration of labor for a first baby is about 12-14 hours. Labor lasts about 6-8 hours for subsequent children and, if a mother has already had one child, you can generally assume that her pelvis is of adequate size for a later pregnancy.
In the event that a mother's pelvis is too small (or the baby's head is too large), labor will simply continue for days and a Ceasarian section (the operation which removes a baby through a surgical incision into the abdomen) will have to be performed. A hospital is definitely the best place for such an operation.
Home Birth: Abnormal Presentations
When a part of the baby other than its head comes out first, the birth is known as an abnormal presentation and most knowledgeable people worry a great deal about delivering an abnormally presenting baby at home. The odds of such a birth are about one in 20 hospital deliveries. Get your M.D., nurse or midwife to show you how to feel the baby's head and wiggle it just above the pubic bone to make sure your baby is presenting its head first.
Home Birth: Bleeding From a Misplaced Placenta
This complication occurs in about one of every 200 hospital deliveries. Instead of growing on the side of the uterus where it should, the placenta grows over the mouth of the uterus, interfering with the passage of the baby. The symptom to watch for is continuous bleeding from the vagina either before labor or after labor begins. A "mucus plug" which is passed with a small amount of blood (called a "bloody show") early in labor is normal and should not cause alarm.
Misplaced placenta (placenta previa) is a very serious complication because of the rapid and severe bleeding which occurs. It is usually necessary to do a C-section to avoid catastrophe in the event of a misplaced placenta and, if bleeding occurs during labor, you've got some hard thinking to do in a hurry.
Home Birth: Bleeding After Delivery
At the time the placenta is expelled from the uterus, what seems like an amazing amount of blood is also expelled. This is normal but it's a good idea to have someone on hand who knows how much bleeding is OK and how much is too much.
Sometimes a fragment of placenta is retained in the uterus following delivery. When this happens, the uterus does not flex its muscles to stop bleeding and you will notice that instead of feeling like a firm orange when you massage it below the belly button — the uterus is large and flabby. Blood loss from this condition can be rapid.
If the complication develops, the baby should be placed at the mother's breast and her blood pressure checked frequently. If the bleeding continues, the mother's pulse becomes rapid and weak or her blood pressure starts to fall, you've got a problem. The mother needs qualified help immediately to evacuate the retained placental fragment and start a blood transfusion . . . and that means a hospital.
The average amount of blood lost during a normal delivery is about a cupful. Loss of over two cupfuls is worrisome and occurs in about one in 20 hospital deliveries.
Home Birth: Premature Labor
If labor begins a month or more before the baby is due to arrive, it can be predicted that the child will be small and weak (a premature infant). Such deliveries are tricky and should not be conducted at home. Certainly, any baby which weighs less than four pounds at birth is much more apt to get seriously sick in the days following delivery than is a baby of average weight. Low birth-weight babies also chill rapidly and should be put in a warm place as soon after birth as possible.
Home Birth: Compression Of The Umbilical Cord
If the umbilical cord (which carries blood to the baby) slips past the baby's head and into the vagina, the cord will be compressed during the passage of the baby. This causes a shutting off of the baby's blood supply and the complication is estimated to occur about once in every 300 hospital deliveries.
Although cord compression does not threaten the mother, it will frequently result in a dead baby unless a rapid delivery of the child (usually by C-section) can be performed.
A trained person would feel the cord by doing a vaginal examination, would place the mother in the knees-to-chest position (have nurse, midwife or M.D. show you how) to reduce pressure on the cord and would rush the mother to a hospital.
Compression of the umbilical cord is much more apt to occur during breech deliveries; less likely when the baby's head is presenting. The complication is one of several conditions which may make the baby's heart rate (listened to over the abdomen) drop below 100-per-minute and which may cause the passage of watery and greenish baby stool from the mother's vagina during labor. Another possible cause of such symptoms is medication which a doctor sometimes gives the mother for pain.
Home Birth: Infection of Baby After Delivery
If you run a test on any 100 women, 5 will probably have gonorrhea germs even though they have no symptoms. If a baby is infected with gonorrhea during delivery, that infection can cause blindness. This is prevented by putting either silver nitrate drops or penicillin drops in the baby's eyes immediately after birth. You should obtain these drops at the prenatal clinic and always apply them following a delivery at home.
In those instances where the bag of water breaks before labor pains begin (dry labor) there is increased risk of fever and infection in both the mother and baby. This is particularly true if the bag breaks and no labor pains begin for 24 hours or more (premature rupture of the membranes). In such cases (estimated to occur in about 1 in 80 hospital deliveries) the mother may develop a fever and the baby may be born covered with foul-smelling amniotic fluid. Such a baby must be watched carefully by experienced persons, since it may develop a life-threatening infection during the first week of life.
Home Birth: Childbed Fever and Kidney Infections
Both childbed fever and kidney infections can occur in the mother at any time during the eight days following delivery.
The symptoms of childbed fever are a high temperature, smelly vaginal discharge and abdominal pain. The condition is caused by germs getting into the uterus during or after delivery. Usually these germs are introduced into the vagina by the person doing the delivery. Always use sterile gloves (available from a physician's supply house)! Kidney infections are identified by a high fever and pain on one side of the mother's back.
In general, if significant fever occurs in the post-delivery period, you have reason to consult an M.D.
Home Birth: Other Birth Complications
Almost all other possible childbirth comiplications — including blood incompatibility, anemia, swelling of the feet, blood pressure elevation, diabetes and syphilis — can be detected by prenatal check-ups. Some of the complications I've mentioned — twins, small pelvic size and abnormal presentation — are also frequently detected in such examinations. Additionally, problems such as a bad heart or bad kidneys in the mother would probably be noted and home delivery properly discouraged.
I'm sold on regular prenatal examinations, in other words . . . don't wait until the last moment to sign up.
In England, where high risk deliveries are handled in hospitals and normal deliveries are performed either at home or in the hospital, a 1968 study done in the city of Wolverhampton produced this interesting comparison: Of 7,133 home deliveries under midwife supervision, there were 54 stillbirths (babies born dead) and no maternal deaths. Among 12,163 hospital deliveries, there were 369 stillbirths and four maternal deaths.
Although it would be unfair to take these figures as evidence of the greater safety of home deliveries — since, admittedly, the higher risk deliveries are shunted to the hospital — they do indicate that home delivery following adequate prenatal care and attended by experienced people is not as risky as our medical profession would have us believe.
Childbirth Suggested Reading:
Commonsense Childbirth, by Lester D. Hazell, Tower Publications, $5.95.
Emergency Childbirth Manual, by Gregory J. White
Available from the Police Training Foundation
3412 Ruby Street
Franklin Park, Illinois 60131.
Husband-Coached Childbirth, by Robert Bradley, Harper and Rowe, $4.95.
Painless Childbirth, by Marjorie Karmel, Dolphin Books.
Textbook for Midwives, by Margaret F. Myles. 6th edition,
1968, E. & M. Livingstone Ltd., Edinburgh, London.
Printed by Darien Press, Great Britain.
Other text books on Midwifery usually available at the library of any school of nursing.