We all know about the most common complications of pregnancy, but what about those with pre-existing conditions or those rare circumstances that can interfere with birth? The information out there isn’t always readily accessible or clear, and deciding whether you can birth at home or not can be confusing. Hopefully, this information will help you understand when a homebirth is a possibility and when you are better off in the hospital.
Placenta previa, a rare emergency, is when the placenta is covering the cervix. This is not cause for alarm in early pregnancy as it may shift by the time labor begins. If the placenta is still in this position when birth is imminent, the mother must transfer to the hospital for a C-section.
Placenta abruption is the premature seperation of the placenta from the uterine wall, which causes maternal bleeding and a loss of oxygen to the child resulting in fetal distress. If this is suspected before labor, delivery should take place in the hospital. If it is suspected during labor, unless the mother is only moments away from delivering her child, she would be taken to the hospital for a Cesarean rescue immediately.
Gestational diabetes and preeclampsia are more common in overweight women, but this does not have to be a reason to birth in the hospital. Being overweight in and of itself is not a reason to give up on homebirth. However, certain health factors associated your weight may be, so you should talk to your doctor. If your doctor doesn’t recommend homebirth, ask why, and make sure it is a reason to do with something specific about your health!
If your baby may have an abnormality, the birth location decision must depend on the type and severity of the abnormality. If the abnormality will make your infant vulnerable or need immediate treatment after birth, the hospital is the best liocation. It is a decision you must make with your care provider, and opinions will vary from doctor to doctor. Cleft lip and palate are common and do not require a hospital birth, nor does Down’s Syndrome.
An abnormal uterus can increase your chances of having a baby in the breech position. Scar tissue from cervical surgery can slow dialation, making for a longer labor. Neither condition is a reason to turn away from homebirth.
If you are diagnosed with cervical cancer at less than 3 months gestation your doctor may advise you to end the pregnancy to receive treatment. Otherwise he will recommend delivering the child and then receiving treatment. The choice is yours, and it will not mean that you are incapable of vaginal delivery at home unless your cervix is misshapen.
For those with insulin-dependant diabetes, homebirth can be an option so long as blood sugar levels are carefully monitored. If your blood sugar begins to drop you should eat something high in sugar. If it continues to drop you should transfer to the hospital. Planning a homebirth may require a lot of persistance, especially in finding an approving caregiver, but is possible. Chances of blood sugar dropping dangerously during birth are unknown, but it is probably a good idea to make sure a hospital is closeby when planning a homebirth if you have this condition.
Low Haemoglobin, anemia and iron deficiency do not increase your chance of postpartum hemorrhage, but may make for a more difficult recovery if that does occur. It is no reason to mark homebirth off of your list of choices.
Multiple scelerosis, ME/Chronic Fatigue Syndrome, mental health problems, and asthma are not reasons to abandon hope of homebirth. Asthma increases chances of preterm birth, small baby, and high blood pressure, but those situations do not always guarantee hospital care. If the woman is at term when she goes into labor, hasn’t measured small for her due date, and has normal blood pressure, asthma should not be a reason to birth in a hospital. She needs to have her medication handy and be sure not to overexert herself if she has asthma, and that is true of those who suffer from fatigue as well. Asthma patients should be encouraged to keep their breathing steady and to breathe and push in the way that feels natural to them. One should probably be especially delicate when assisting someone with a mental disorder during their labor and delivery, simply because of the effects on their psyche.
Taking prescription anticoagulants will not result in postpartum hemorrhage because they are of a low prophylactic dose.
A prior tear or episiotomy is not a reason to birth in a hospital. Bad tears are less likely to occur at home, as most are the result of assisted deliveries. Those birthing subsequent children have a lower risk of tearing. Midwives are trained to handle tearing, even those of a severe degree, and can treat them in a number of ways. They are very adept at preventing this from even happening, making homebirth much safer for women who are worried about tearing.
Having suffered from postpartum hemorrhage before may be a reason to birth in a hospital depending on the likelihood of this recurring in your situation and the severity of the first instance. PPH does not occur at homebirths as often as hospital births because of the decreased occurance of intervention at home, and midwives have about the same equipment as hospitals do for treating this.
Low platelet levels can increase your blood loss, and high platelet levels may cause blood clots to occur during labor. Talk with your health provider to make a decision.
If a mother has a negative Rh factor, while her partner is positive, the infant may be positive as well which can cause the mother to produce antibodies that may attack the baby. The mother will need Rh immunoglobulin injections throughout her pregnancy and within 72 hours of birth if the child is Rh positive. If the baby has suffered severely he may need a blood transfusion. A homebirth is still possible if treatment has been effective, and there are no signs that the infant is not thriving. However, the decision to homebirth should be discussed with a doctor.
If you have an STD, you should birth in the hospital to reduce risk of the baby becoming infected and so the child can be tested and treated immediately.
Past assisted deliveries, as with forceps or a vacuum, are a very good reason to birth at home. Why would you want that to happen again, especially if you or the baby were injured? This is not an indication that you cannot birth vaginally even if the baby is larger than the one from the previous delivery. Your chances of vaginal birth after assisted delivery are 80%! There is a small chance you will need to transfer, but you will not be endangering yourself or your child.
If you have an unusual condition, homebirth can still be an option depending upon its severity, your comfort zone, and the type of condition. While some conditions require hospital attention and sometimes even a mandatory C-section, most will not inhibit you from having a safe vaginal delivery at home in the care of a skilled midwife. The choice to birth at home if you have one of these conditions is up to you. If you truly want to homebirth, do not be discouraged if you are not met with support initially. Keep searching until you find a caregiver that is supportive. Sometimes the right midwife is just around the corner!
Angela Horn, “You can’t have a homebirth, because…” Home Birth Reference. URL: http://www.homebirth.org.uk/