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What you need to have a safe delivery at home

2020-04-20T14:31:10.840Z


For pregnant women considering home birth, the American Academy of Pediatrics (AAP) has updated their guidelines with everything they need to have in place to ensure safety…


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The only species of animal that is always pregnant 0:46

(CNN) - For pregnant women considering home birth, the American Academy of Pediatrics (AAP) has updated their guidelines with everything they need to have in place to ensure the safety and well-being of mother and baby.

The AAP generally does not recommend planned home births, citing an increased risk of complications and infant mortality.

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However, the organization says it is up to the parents to decide, and for those who know they would prefer a home birth, the AAP says it is best for women who do not have pre-existing or maternal conditions and who may plan to have two medical providers. present with the necessary skills and equipment.

Some women choose home births for a variety of reasons, from controlling their surroundings to their comfort and inclusion in the family.

Midwives also report that, during the pandemic, they have received an increase in mothers' inquiries about home births, said Dr. Kristi Watterberg, emeritus professor of pediatrics with a focus on neonatalogy at the University of New Mexico, and the lead author of the updated AAP guidelines.

"I think we as medical professionals must do a better job of recognizing that labor does not necessarily need to be medicalized," said Watterberg. "Many women don't want to go to the hospital where they automatically get an IV and they do this and that and put them on a monitor. [In home births], there is less intervention and the cesarean rate is much lower. ”

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While recent studies have found that pregnant women are not at increased risk for severe disease and death from covid-19, some may be concerned about coming into contact with sick people inside a hospital. Dr. Joshua Copel, a professor of obstetrics, gynecology, and reproductive sciences at Yale University who was not involved in the report, suggests that mothers don't let fear be the determining factor in their decision.

"I think it is really important for women not to be afraid of hospitals right now," said Copel. "Hospitals are fully aware and do everything possible to minimize the risks of women getting sick with covid-19 and whatnot."

For those who want to have a home birth, this is what the AAP's updated guidelines recommend.

Candidates for home births

Women are considered eligible for home births if they do not have a pre-existing condition or a condition that arises during pregnancy. That includes diabetes or preeclampsia, which is a complication characterized by high blood pressure that can cause possible damage to organs such as the liver or kidneys.

The AAP also recommends that the best candidates for home birth have a single fetus and are at least 37 weeks pregnant.

Home birth that is spontaneous or induced as an outpatient is ideal. If women have a breech baby, carry more than one fetus, or have had previous C-sections, they are not advised to have a planned home birth.

As recommended by the Centers for Disease Control and Prevention, according to the report, all pregnant women should be screened for group B streptococci at 35 to 37 weeks gestation. Women with streptococcus who are having home births should receive a home antibiotic at least four hours before delivery.

Babies who have intrauterine growth restriction or whose mothers have diabetes should be born in a hospital or birthing center because of the increased risk of hypoglycemia and other complications.

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Preparation for home birth

If you are planning to give birth in your home, there are several systems you should have to support you and your baby.

For starters, make sure you have safe and timely transportation in case you experience unforeseen complications before birth, according to the report.

Also have on hand a doctor or midwife certified by the American Midwifery Certification Board, or whose education and licensure meet the Global Midwifery Education Standards of the International Confederation of Midwives to practice within a regulated healthcare system.

Home births must be attended by at least two caregivers, one of whom has the training and skills to care for the baby's needs, while the other cares for the mother, as recommended by the AAP and the American Heart Association.

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Providers should have the necessary training, skills and equipment for infant resuscitation, as some babies have trouble breathing when they are born or just need a little "help to get going," Watterberg said.

To ensure that the mother and baby can receive additional emergency assistance if needed, providers must ensure that telephones or any other method of communication works before birth. Also check the weather beforehand, as you don't want to have trouble getting emergency medical help.

The closest hospital should be 20 minutes maximum. And in case you have to be transferred to a nearby hospital, try to make an agreement so that medical personnel are familiar with your situation in advance to reduce or eliminate a waiting period.

Needless to say, this level of planning can be made more complicated by the pandemic, and mothers may not be able to get the medical help they need in an emergency.

If you're trying to decide between having a home birth and going to a hospital for delivery, that's something to consider, Watterberg said.

"One problem with [home births] right now is that our first responders, especially at various hotspots and multiple cities, are overwhelmed with the number of calls they receive ... and it can take a while to get to where you are," said. "And second, when you get to the hospital you end up in the emergency room where you would be in the focus of this ... I think the covid-19 is actually an argument for a planned hospital delivery rather than an emergency."

Take care of your baby

When having a home birth, it is also important to be careful in caring for a newborn at home, since the baby will be outside the guarantees of the protocols required in hospitals and maternity centers.

In the first four to eight hours after a baby is born, or in the transition period, you should be warm immediately. Skin-to-skin contact with the mother is the most effective method, according to the guidelines, but portable warming pads should be available if the baby needs to be resuscitated and cannot be placed on the mother's breast.

Within the first one to five minutes of birth, the healthcare provider should also begin to properly resuscitate the baby and assign Apgar scores. The Apgar score has five components: heart rate; respiratory effort; muscular tone; irritability (reflex response) and color, as if flushed or pale. Each of these categories receives a score from 0 to 2.

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Babies who receive resuscitation for more than 30 to 60 seconds or show signs of illness should be transferred to a hospital for closer monitoring and evaluation.

The baby should be closely monitored and receive a detailed physical examination that includes assessment of gestational age and intrauterine growth status, as well as risks of conditions that require additional attention.

If the baby is less than 37 weeks of gestational age, it should be transferred to a hospital for evaluation for conditions related to prematurity or poor feeding.

Temperature, heart rate, skin color, peripheral circulation, breathing, level of consciousness, tone, and activity should be monitored and recorded at least once every 30 minutes until your condition has stabilized for two hours.

If a mother with strep and her baby remain asymptomatic, they can both stay home. But if they start to show signs of infection, they should be taken to a hospital.

At home, babies should also receive vitamin K and hepatitis B vaccine within the first 24 hours of birth.

In addition, they need glucose tests, a hearing test, a heart disease screening test, and a blood test.

Eye prophylaxis, when antibiotic drops or ointment is placed in the eyes of a newborn after birth, should be given to protect the baby from possible gonorrhea infection in the mother's body.

Before leaving, providers should provide at least one breastfeeding session to observe the feeding position, if the baby latches onto its mother's breast, and if there is milk transfer.

Finally, providers must provide mothers with details about follow-up care appointments, which must occur within 48 hours of the first evaluation.

Risks and benefits

The report recognizes a woman's right to choose a planned home birth, but warns that there are risks.

Planned home birth in the United States has been associated with an absolute risk increase of about one to two fetal or newborn deaths per 1,000 live births, according to the report. Babies born at home in the US USA they also have a higher incidence of low Apgar scores and neonatal seizures.

Still, Watterberg said, “The benefits [of a home birth] are very much in the mother's favor. There are lower rates of [induction] of labor. There are lower tear rates. Moms can be more comfortable; they are in their own situation and the family can be there ”.

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Some women have different cultural expectations about who is involved in childbirth, including children and extended relatives.

The mother's comfort and happiness can lead to shorter and better labor, added Watterberg, which can benefit the baby.

In general, women should know if they are good candidates for giving birth at home, Watterberg said. Listen to your doctor's advice and get ready.

coronavirus

Source: cnnespanol

All news articles on 2020-04-20

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