Home birth

A home birth is a form of non-hospital birth. You will find, as opposed to births in hospital or birthing center, in a private apartment instead.

• 3.1 Legal responsibility
• 3.2 Exclusion Criteria
• 3.3 Social criteria
• 3.4 reasons, possibilities and limits of a home birth

History

Until about the mid-20th century home births were the predominant form of birth in all parts of the world. Only through a comprehensive supply of hospitals and health insurance, the hospital birth in developed industrial countries the dominant mode of delivery, while in developing countries, currently the home birth prevails, often for lack of alternatives.

From the second half of the 20th century was a home birth in many industrialized countries as exotic and irrational. This setting has changed back to the end of the last century. Today, it is the mother deciding which place of birth she chooses. The sensitivity for hospital-specific risks grows. In some countries, home births are funded by the state again, as in the Netherlands. There, the home birth rate is approximately 30%.

The birth Alliance Austria, a citizens' initiative for a baby and mother friendly Obstetrics, 2010 appointed the year the year the house Obstetrics and below the period 2010-2020 the Decade of home birth.

In Germany were born (scheduled and planned) except clinically 2012 675 944 10 164 children. This corresponds to a share of 1.5 percent. The statutory health insurance reimbursed per home birth an average of around 1100 euros costs.

Obstetric care during the home birth

Midwives

In general, home births are accompanied by a responsible midwife. The cost of these services are covered by all health insurance companies. The regionally and individually varying call fee that is charged by home birth and midwives shall be paid by the parents. Some private insurance companies pay out premiums to the policyholder in question at home births; the amount of the premium is the company and the type of insurance dependent, but typically covers the readiness lump sum.

Doctors

GPs and gynecologists may attend a home birth, but are obliged to consult a midwife. These costs are covered by health insurance. In practice it is very rare to medical care of a home birth.

Alone birth

As an unassisted childbirth ( German about: Alone birth ) refers to a home birth, neither a midwife nor other medical staff are present at the. This form of birth is relatively unknown in Germany and is hardly practiced because of the associated risks. In Austria there is a duty to consult a midwife at birth. In Germany there is a pregnant woman, although it is basically to give birth without getting professional help. If the child, however, suffer during childbirth damage that a midwife could have prevented the mother may necessitate the negligent injury or even involuntary manslaughter (§ § 222 and 229 of the Criminal Code ) guilty.

Conditions for a home birth

Legal responsibility

Whether it is for a pregnant woman is the possibility of home birth into account, is primarily at the discretion of the attendant midwife who is fully responsible for their findings. A pregnant woman can also be a gynecologist ask for his opinion, but is it about the choice of their native desire not accountable. The gynecologist carries no responsibility for the choice of place of birth.

Exclusion criteria

Complete exclusion criteria for a home birth are when a vaginal delivery is impossible or fraught with particularly high risks. These include position anomalies of the child as the transverse position, abnormalities in function and location of the placenta previa as a placenta, but also evidence of a pregnancy-related illness ( toxemia ) or diagnosed prior to organ damage of the child.

While it is sometimes carried out a home birth in high-risk births and breech or multiple births, but is not recommended from a medical standpoint it.

Social criteria

In addition to medical aspects, but also social aspects are taken into account in the home birth. Feels the pregnant woman burdened by her home environment, due to poor hygiene conditions, noise or family disputes, the decision for a home birth makes little sense. Conversely may be the better alternative for a woman with a hospital phobia or from motives of self-determination and the protection of privacy, the home birth.

Reasons, possibilities and limits of a home birth

According to the surveys of the Society for Quality in non-clinical obstetrics ( quag ) give most women them to familiar midwife and the possibility of self-determination as a key motivation for home birth care by. The personal environment and the exclusive presence of familiar and desirable persons are cited as other reasons. A home birth can be individually prepared in consultation with the midwife, as it is for example possible to deny the intensity level of obstetric care with the midwife and as a woman who wants to get their child largely unaided, a sensible alternative for single birth has to offer. Siblings may be present or methods as the gentle birth for the purposes of Frederick Leboyer and Michel Odent will find a special account at birth.

The quag in 2006 recorded 15.9 % of non-hospital births water births. Water births are at home possible in a standard bathtub. In order to increase the convenience for the woman in labor and the midwife, a birth pool offers a suitable option. Such pools are rented, purchased or provided by the midwife available.

The use of strong painkillers or anesthetic procedures such as Pudendusblock or epidural anesthesia can not be used as part of a home birth, it will be because of the special situation of home birth but rarely required. Pain relief using naturopathic techniques such as breathing techniques and relaxation pools is available. Also alternative medical treatments such as homeopathy or acupuncture are used.

Studies and facts about the safety of home birth

Surveys, carried out by the Society for Quality in non-clinical obstetrics ( quag ) for over ten years in Germany each year, show that non-clinical births are similar safe as clinical births without risk. The numbers are subject to slight variations from year to year, but have not changed significantly in recent years. In 2006, for example, 93% of 9500 of the quag documented non-hospital births ( 41.5 % of home births ) spontaneous births. The proportion of first-time mothers was 36.4 %. 84.0 % of all women giving birth had no birth injury. An episiotomy was performed in 7.3 % of all vaginal births. No medical interventions, there were 31.6 % of all births, moderate interventions at 24.7%. The child's condition after birth was designated in 93% of cases as good or very good, the mortality rate of newborns was 0.12 %. No mother died in connection with childbirth.

In one presented in December 1993 study by the Swiss Association of Midwives 489 women were examined with planned home birth and 385 women with planned hospital birth within four years. Both groups were comparable with respect to age, number of children, social class, partner situation, health status, birth risk assessment and nationality. For first-time mothers 25 % were laid in the second and third parturient 4%. The emergency transfers amounted to 4.1% of all home births. 38% of women with home birth had no perineal injuries in women with hospital birth, there were 9%. Furthermore, in the home births significantly fewer discharges birth, caesarean sections or vacuum or forceps deliveries were conducted and administered less frequently blow promotional and analgesic drugs. In newborns of both groups, no differences in the studied health characteristics were found.

Another study comparing home and hospital births under the same conditions, native to North America. She comes to the conclusion that there are grounds of prudence no significant difference between the two Variants birth. The Federal Centre for Health Education writes: " Can all foreseeable complications are excluded, there is no objection to a birth in their own homes. " A 2009 study published in the Netherlands among women who had been attested at low risk for birth complications in advance, leads to the conclusion that a planned home birth is as safe as hospital delivery, in both cases, the supervision of an experienced midwife is required. It should be noted here that births where there is an increased risk of complications directly planned usually take place in the hospital. For this reason, hospital births by women be compared with a low risk of complications with appropriate home births in the mentioned studies.

The British Birthplace in England Collaborative Group, published in November 2011, the results of their study on the place of birth. It was found in 64 538 women who were delivered between April 2008 and April, 2010 by mature children, no difference in the status of children born between the birth places when it was healthy multipara. For first-time mothers, however, the child's condition was worse.

A U.S. meta-analysis examined 12 studies from the period 1976-2006 with data from 342 056 207 551 planned home and hospital births from seven Western countries. However, you came to the conclusion that a two - to threefold higher neonatal mortality risk is present ( between 7 to 28 days after birth) was entered into at a home birth for the children of the world. The perinatal mortality risk ( up to 7 days after birth ) of a home birth over a hospital birth is the study after the same, by the fact that cases in which complications are expected to generally scheduled to take place conditionally, in the hospital. However, the authors point out that an approximation of the birth age and birth weight of home births increased risk also occurs during this period, especially in cases which still had to be transferred to a hospital.

In the Netherlands, with about 30% of home births, a rise in the maternal mortality rate of 9.7 / 100,000 live births was observed to 12.1 in the period from 1993 to 2005, from 1983 to 1992 with a declining home birth rate. In the European PERISTAT I study the Netherlands had the highest fetal mortality rate (7.4 / 1,000 births) and to Greece the highest neonatal mortality rate ( 3.5 / 1,000 live births). In the PERISTAT II study (from 22 weeks ), the Netherlands, France, the highest fetal mortality rate (7.0 / 1,000 births) had. Of all the western European countries, the Netherlands had the highest neonatal mortality rate (3.0 / 1,000 live births). Although the perinatal mortality rate decreased, but more slowly than in other countries. (: 9.1 / 1,000 births in 2006 ) Nevertheless, the mortality rate is compared to the European standard high. The Erasmus Medical Center went on behalf of the Dutch government the causes and came to the conclusion that the poor results are probably due to factors in health care and is not related to the high rate of home births.

The German Society of Gynecology and Obstetrics ( DGGG ) and the Professional Association of Gynaecologists established in 2011 firmly in a statement that "the greatest possible safety for both mother and child may be granted during birth only in a maternity clinic in which to unforeseen emergencies immediately and without time-consuming transportation of women in labor can react with the entire spectrum of treatment medically meaningful. " A primary criticism, the 10% transfer rate during labor and the higher perinatal mortality of newborns of 2.1 children per 1,000 births compared to 1.3 children per 1,000 births for births between the 37th and 40th week of pregnancy. Also, the American College of Obstetricians and Gynecologists does not recommend home births.

Demolition of the home birth

The boundaries of the house perinatal care should be part of prenatal conversations between parents and midwife. They may vary depending on the experience of the midwife and the local conditions. If during the course of a home birth complications that require hospital treatment, laying usually takes place in a nearby hospital.

According to the quag 2006 12.3% of non- clinically planned births were laid before confinement in a hospital. 91.6 % of the transfers were without haste, 73.6 % of linings with your own car instead. In the case of 5.4% of births had to mother and / or child transferred after birth.