Tuesday, December 4, 2007

Where to birth and how long to wait before going home.

Where to birth? At home, in a primary birthing unit or in a hospital this is a question that many women have to consider during pregnancy. If choosing to birth in a facility, primary birthing unit or hospital, how long can they or should they stay before going home?

Photo from Sadalit's photostream http://www.flickr.com/photos/sadalit/123737076/

Research does little to help women decide when it is best to go home from a facility after birth. There has been quite a bit of research into early discharge, but the problem is that definition for early discharge varies so much. For some it means 2-3 hours after the birth of the baby and for others it means 1 or 2 days after birth of the baby. A Cochrane review of this topic found that the evidence was inconclusive but found that there was no evidence of adverse outcomes for the mother or baby with early discharge from a facility (Brown, Small, Faber, Krastev & Davis, 2002). If considering a home birth again the Cochrane review of this topic was inconclusive although they could find no evidence to state whether home or hospital was better for low risk women (Olsen & Jewell, 2007). A large American study found that there was less intervention when women planned to birth at home without any increased risks to the mother or her baby (Johnson & Daviss, 2005).

So what does this mean for women? If they have no health issues during pregnancy then women are less likely to have interference in the birth process if they plan to birth at home. Women have expressed increased satisfaction with birth when there is no intervention so it would tend to follow that satisfaction would also be greater with homebirth. The same is true if they birth in a unit which deals only with low risk births, (a primary birthing unit0. Of course if any problems arose then the woman would need to go to the hospital. Discharging from the hospital within hours of the birth also does not increase problems for women or their babies who are otherwise well.

There are two main issues here. One is being prepared for being at home, either early discharge or homebirth and the other is having the necessary support to be able to achieve this. One of the advantages of planning to birth at home is getting the support you will need prepared beforehand for this event. This might mean preparing meals before the baby is born so that there is no need to cook after or it might mean that a relative moves in with the new family. The woman will have prepared herself for early baby care, her midwife will cover the knowledge the woman and her partner need for those early days well before the baby is born. The home is ready for the new baby.

With hospital birth women often plan to stay in hospital for two or three days to learn how to care for baby and then go home. Many women seem to think that they will then pick up life as it was before, but this is not the case. They still need support as they learn how to become mothers and care for the new baby. It is not an instant process. We need to think of the first month after the baby is born as a continuation of the pregnancy-labour-birth process. It is a time when the woman's body is making enormous changes as well as the psychological adaption to new motherhood. The baby too is adapting to life outside the uterus and needs loving attention during this time. For the mother to be able to provide this to her baby she needs to be cared for and supported herself. Enormous changes and adaption occurs in the first month but there are those who would say that this continues, to a lesser degree, for at least first three months of the babies life. As a society we need to embrace the concept of mothering the new mother as she takes on her new role. It is an enormous life changing event and women need to be supported and nurtured as they adapt to this new identity.

Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002958. DOI: 10.1002/14651858.CD002958

Johnson KC. Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18; 330(7505): 1416-9.

Olsen O. Jewell MD. Home versus hospital birth. [Journal Article, Research, Systematic Review] Cochrane Database of Systematic Reviews. 2007;(4): (CD000352)


Sarah Stewart said...

Thank you very much for your comments, Carolyn. We are in agreement - you have just saved me the job of looking at the research. I have just caught up with the latest news about the baby's death - I thought your response to that was very thoughtful.

As I said in my blog post, there are problems with staying in hospital for days after birth, as well as advantages so I guess it is down to woman's choice and I would add that it is a decision that is not worth completing until after the baby is born to see what sort of birth you have had.

I remember when I had my second child. I had planned to have the baby and go home straight afterwards. But I had such an exhausting time (2 hour push with an OP baby) that I would go home - the staff had to threaten me to go home after 5 days - a very long time for a multip!! If they hadn't done that, I probably still would have been there!!

Carolyn McIntosh said...

My children were born during the time of week long stays for postnatal care. I still remember the lovely caring midwives who made me feel so special and mothered me, in the lovely rural unit I was in. None the less I was very eager to get home and left "early" at 6 days for both my children. I would have loved to have a homebirth but being so far from my own support network it was not a possibility for me at that time.

xlpharmacy said...

One thing for sure. Everybody would love to have your new baby born at home as soon as it can.

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