Childbirth is safest in the hands of skilled and trained birth attendants as mother and child receive the necessary care and attention.
MY grandmother delivered her first child in a dimly-lit room at her home in Perak towards the end of the Japanese occupation in 1945.
She only had her mother attending to her during the labour and delivery. And that was how most women of her generation had their babies. Home births were the norm and traditional midwives or women in the family assisted with the birth.
Fast forward to 2012 and as a 40-year-old woman with a high-risk pregnancy, I had my first and only child through a C-section at a private hospital in the Klang Valley where every kind of care and comfort was extended to mothers-to-be.
My grandmother and I may have had very different childbirth experiences but like all mothers, we wanted the same thing – a safe birth and a healthy baby.
Childbirth is not without risk and medical intervention has over the years prevented the possibility of mother and baby dying in many cases.
So why are there still women today who want to deliver their babies at home instead of going to a hospital?
These women, mainly from urban areas, choose to go through labour and childbirth at home with only a doula (birth companion/coach) in attendance and they often write glowing accounts of their experiences on gentle/home birthing websites or Facebook pages, describing the process as “more liberating” or“natural” than a hospital birth.
These stories and shared experiences tend to influence other pregnant women into thinking they too should opt for a home birth.
However, in Malaysia, in the last few years, there have been a few reported cases of mothers dying of complications after unattended home births.
A planned home birth in Malaysia without a skilled birth attendant in charge is not endorsed by the Health Ministry because it’s not a safe birth, says Professor Dr Imelda Balchin of the Department of Obstetrics and Gynaecology at University Malaya Medical Centre.
Dr Imelda explains that a safe birth means the mother is under the supervision of either a certified midwife or doctor during her labour and delivery.
The Health Ministry encourages women to have their babies at either hospitals or birthing centres led by midwives (for low-risk pregnancies) so the process is safe for mother and child and any emergency or complication can be quickly and effectively managed.
MAKING BIRTH SAFE
In the 1950s, a total of 500 out of 100,000 mothers in the country died during childbirth.
To tackle the problem, the Government made a concerted effort to reach out to traditional midwives and had them trained as skilled midwives.
Expectant mothers also made a shift from delivering at home to accepting hospital births.
As a result, by the 1970s, 30 per cent of Malaysian mothers were having their babies in hospital and by 2015, 99.4 per cent of births in Malaysia were supervised by skilled birth attendants.
“So when women asked why they could not deliver at home like their grandmothers did, they didn’t realise that their grandmothers and women of that generation actually made the transition to safer births,” says Dr Imelda.
She stresses that the majority of births are low-risk. It’s a normal physiological process but one cannot predict what will go wrong during labour or who will end up having problems.
The key to a safe home birth is patient selection. Only a woman with a low-risk pregnancy can be considered a potential candidate. She must also have a skilled birth attendant supervising the process and there must be quick and easy access to a hospital should complications arise.
In developed countries where home births are an option for expectant mothers, the process is well regulated and managed by trained and skilled birth attendants.
In the United Kingdom, for example, community midwives attend to low-risk pregnant mothers during labour in their homes if they have opted for a home birth.
When these women are nearing birth, not one but two midwives will be assigned to each mother, one midwife to deal with the needs of the mother and another to assist with the newborn.
“Certified midwives are trained to assess the mother and child. They carry equipment to monitor the mother’s blood pressure and baby’s heart rate. They are trained to identify problems during labour and births, to stop excessive bleeding, to resuscitate babies and they know when to transfer the mother and baby to a hospital should it become necessary.”
An untrained birth attendant would have no idea of the potential risks or how to identify them.
For example, if the baby’s shoulder becomes stuck during labour (shoulder dystocia), which happens in one in 200 births, the baby has to be delivered within seven minutes to prevent brain damage from oxygen deprivation and only doctors or trained midwives will be able to do it.
An untrained person would also not know when a mother is experiencing severe post-partum bleeding or whether she has developed an infection or when the baby is at risk and this can result in deadly consequences.
Dr Imelda says doulas/childbirth coaches can provide emotional support to expectant mothers, such as motivating them not to fear labour, teaching them how to handle the pain and overcome anxiety. They can also act as confinement ladies and provide support for breastfeeding after delivery.
“These women do have a role to play but they cannot take the place of a doctor or certified midwife during delivery.”
Know the facts
* Even with a planned home birth, the transfer rate to hospital is 60 per cent.
* Mothers are five times more likely to die during a home birth compared with a hospital birth if there’s no certified midwife in attendance.
* In the United Kingdom, 40 per cent of first-time mothers who have home births are transferred to hospitals.
* The American College of Obstetricians and Gynecologists and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists don’t support home births, even those attended by certified midwives.
* In America, data from over 300,000 home births shows that babies born at home have three times the risk of dying at birth. Half of these babies die due to asphyxiation.
* In the Netherlands, the country with the highest rate of home births in the world, 60 per cent of first time mothers end up being transferred to hospitals.
Home births can turn deadly
IN Nov 2013, Ang Lay Chin, 40, suffered excessive blood loss and passed away after a home birth at her house in Sri Kembangan, Selangor.
Ang initially had a smooth delivery but developed complications after the birth of her baby girl. Her husband and a friend who had prior experience with home births were by her side during the delivery. She was rushed to the hospital but it was too late to save her.
In December 2013, Amy Karmila, another Malaysian mum, died from post-natal complications following a home birth.
It was reported that she had been supervised by a doula during the birth and was rushed to the hospital following complications after delivery but passed away. Amy was said to have opted for a home birth after attending a series of seminars on the subject.
In 2014, it was reported that a popular Malaysian-British advocate for home births died after an unassisted home birth while delivering her sixth child.
Originally from Malaysia but based in the United Kingdom, she had apparently had unassisted births previously without problems.
In 2012, an Australian home birth campaigner and mother, Caroline Lovell, 36, passed away during the birth of her second child at her Melbourne home.
She was rushed to the hospital after suffering cardiac arrest but died the following day. A private midwife was believed to have assisted her during the home birth.
Why they do it
ALTHOUGH clearly risky, women may turn to home births for many reasons and these include:
* The desire to give birth without medical intervention such as pain medication, labour augmentation, labour induction or foetal heart rate monitoring.
* They want to give birth in a comfortable familiar place surrounded by family.
* They may be dissatisfied with previous hospital care received.
* They want to have freedom and control over the birthing process.
* They may have cultural or religious concerns.
* They may live in areas that are remote and lack access to hospitals.
* They want to avoid the cost of medical bills and hospital care.
Source: The Mayo Clinic – www.mayoclinic.org