Home delivery--beauty and the beast

I think it's about time I go out on a limb here.

I've been in private practice doing obstetrics and gynecology for over 15 years now, and I've seen many welcome changes. I've also seen many "fashionable" ideas about childbirth, many of which are lovely and befitting to this special event. Unfortunately, there's one that keeps surfacing from time to time that remains dangerous.

Home delivery still remains a baby's biggest threat. It poses significant risk to the mother as well. This is because obstetrics is a specialty in which a prospective mother can be normal one moment and bleeding to death the next. An unborn baby can be normal one moment and suffering devastating fetal distress the next. Even in the most modern private practices and best-equipped hospitals there are still isolated disastrous outcomes that no one could have averted. But there are also many more miracle stories that just wouldn't have been so if a patient didn't have a whole hospital wrapped around her.

Hemorrhage remains a major life-threatening complication in pregnancy. Unfortunately, it is usually sudden. In placental abruption, the afterbirth (placenta) separates away from the womb before delivery. Since the baby is dependent on the surface area of the placenta adhering to the mother so as to exchange oxygen and nutrients, fetal death can quickly ensue. Emergency cesarean section is life saving for the baby, and sometimes for the mother as well. Emergency release blood can keep a mother from undergoing cardiovascular collapse and shock. Anesthesia is there to make the whole thing painless as well as balance the tricky fluid balances during the melodrama. In a bedroom in her neighborhood, a mother doesn't stand much of a chance.

Seeking the beauty of home delivery possibly means accepting the ugliness of death.

I cannot overemphasize the importance of cesarean delivery as a life saving measure. Maligned as over-utilized, insurance companies and consumer groups have been successful in reducing the number of preventable C-sections. But this in no way takes away it's importance in getting a baby out in the most expeditious way when disaster strikes suddenly. I write this article on an evening when I managed the case of a baby with a prolapsed cord. This is when the umbilical cord--the baby's "lifeline"--falls past some presenting part of the baby and gets crimped, effectively cutting it off. Luckily, there was a wonderful baby born. But he was not only born healthy but also in minutes--all because it happened in a hospital.

Often a baby is born vaginally, every phase of labor and delivery having been completely normal. Yet within a moment the baby may not be breathing. A hospital has resuscitative equipment on hand, but your home does not. The riskiest time in a newborn's life is the first 24 hours, and except when your baby's with you, a hospital has a nurse watching him or her the entire time. Any abnormalities can be immediately assessed and pediatricians notified.

Some people still choose home deliveries and their reasons are many. Many see a certain beauty in the hearth. Others fear and distrust motives of doctors and hospitals. Still others do it to avoid the big hospital bills. As far as the beauty of the home for important events, save that beauty for important events like your baby's following birthdays, not THE birthday. You will want to stack the deck in your favor for taking part in the birthdays to come. As far as fear and distrust of doctors and hospitals, I never get tired of saying that I love what I do and I have nothing to gain in compromising a patient's well-being by unwarranted manipulation. As far as saving money by delivering at home, this is by far the saddest reason. Certainly a baby is more important than our car, so why don't we build our own cars at home? Is it because it can be done better elsewhere?

This article represents one author's opinion. If you would like to learn more about home births, please click here.