This document discusses home birth and its advantages over hospital birth. It describes the process of an unassisted home birth where no medical personnel are present. It outlines the prenatal care and monitoring some women do on their own at home. Risks of home birth like lack of access to medical expertise or equipment if needed are addressed. Pain relief options, preparing for labor, obtaining supplies, who can be present, and what happens after birth are also covered. Some studies found better outcomes for mother and baby with home versus hospital births.

1. HOME BIRTHHOME BIRTH
Dr Muhammad El HennawyDr Muhammad El Hennawy
Ob/gyn ConsultantOb/gyn Consultant
Rass el barr central hospitalRass el barr central hospital
DumyattDumyatt –– EGYPTEGYPT
 www. Mmhennawy.co.nrwww. Mmhennawy.co.nr

2. Birth
hospital home
emergency planned
assisted
unassisted
medicated
unmedicated
where birth happenswhere birth happens

3. unassisted home birthunassisted home birth
midwife, or other medical personnel presentmidwife, or other medical personnel present In unassisted birth, there is noIn unassisted birth, there is no
doctordoctor conception wasconception was birth should be as private and intimate as the thebirth should be as private and intimate as the the
 They do own prenatal careThey do own prenatal care they don't go to anyone for prenatal carethey don't go to anyone for prenatal care
 1.1. Listening to fetal heart beat with a fetoscope or stethoscope after 20 weeksListening to fetal heart beat with a fetoscope or stethoscope after 20 weeks
they belief that ultrasound is an unproven and possible unsafe technology, no electronicthey belief that ultrasound is an unproven and possible unsafe technology, no electronic
monitors or dopplers will be usedmonitors or dopplers will be used ..
 2. Measuring their fundal height of the uterus2. Measuring their fundal height of the uterus
 3. Testing their urine for protein3. Testing their urine for protein
 4.4. Measuring their blood pressureMeasuring their blood pressure
 5.5. Measuring their own maternal weight.Measuring their own maternal weight.
 6.6. Determining their fetal position inside the uterusDetermining their fetal position inside the uterus
 the birthing woman to be the one to catch her ownthe birthing woman to be the one to catch her own babybaby
 JustJust trusttrust that her body knows how to give birththat her body knows how to give birth
 Perineal massage with oil, hot compresses, and perineal support willPerineal massage with oil, hot compresses, and perineal support will
be usedbe used .she would prefer to allow the tissues to tear rather than be.she would prefer to allow the tissues to tear rather than be
cut.cut.
 No drugs of any kind will be administered during the laborNo drugs of any kind will be administered during the labor

gives birth in the squatting positiongives birth in the squatting position
 The umbilical cord will not be cut until it has stopped pulsating,The umbilical cord will not be cut until it has stopped pulsating,
usually 3 to 4 minutes or longer.usually 3 to 4 minutes or longer.
 no substance by mouth other than my breastmilk or colostrumno substance by mouth other than my breastmilk or colostrum

4. the assumptionthe assumption that hospital birth is safer
for mother and baby has never been
supported
Whether she is safer at home than in a
hospital, however, is another question
Prenatal care, better nutrition, antibiotics
and blood transfusion have played more
of a part in the relative safety of birth now.
 No one can tell a mother she is perfectly
safe giving birth at home.

5. What are the drawbacks of aWhat are the drawbacks of a
home deliveryhome delivery??
 The most obvious drawback is that notThe most obvious drawback is that not
everythingeverything a hospital offers is available ata hospital offers is available at
homehome
 You may need theYou may need the expertiseexpertise of the hospitalof the hospital
staffstaff
and certainand certain equipmentequipment at your disposal ifat your disposal if
something goes wrong.something goes wrong.
 At home there is always the possibility, no
matter how small, of a tragic complication
which could have been more effectively dealt
with in hospital. Parents choosing home birth
will consider and come to terms with that risk,

6. HomebirthHomebirth
 •• Can anyone have a home birthCan anyone have a home birth??
•• How do she organise oneHow do she organise one??
•• What pain relief will be availableWhat pain relief will be available??
•• Can she change my mindCan she change my mind??
•• What happens if she need to go to hospital inWhat happens if she need to go to hospital in
labourlabour??
•• Who will be present at the birth?Who will be present at the birth?
•• What equipment do she need?What equipment do she need?
•• What happens after the birth?What happens after the birth?

7. Can anyone have a homeCan anyone have a home
birthbirth??
 In theoryIn theory, any pregnant woman has the right to, any pregnant woman has the right to
give birth at homegive birth at home
 In practiceIn practice, you may encounter obstacles. If you
have a complicated medical history such as
toxemia, diabetes, breech presentation,toxemia, diabetes, breech presentation,
prematurityprematurity
. the birth. the birth in the hospitalin the hospital. Since safety is of. Since safety is of
paramount importance, we bring IV fluids,paramount importance, we bring IV fluids,
medications, oxygen, surgical instruments and lifemedications, oxygen, surgical instruments and life
support systemssupport systems
At homeAt home there is always the possibility, no matter
how small, of a tragic complication which could
have been more effectively dealt with in hospital.
Parents choosing home birth will consider and
come to terms with that risk,

8. Homebirth is not for everyHomebirth is not for every
womanwoman
OnlyOnly multiparous healthy women ( not nulliparous
women which are more likely to require transfer
to hospital during labour because of delay in
labour).
withwith
.. a normal obstetrical (without pregnancy-relateda normal obstetrical (without pregnancy-related
problems ),problems ),
 and normal medical history (without chronicand normal medical history (without chronic
health problems ),health problems ),
 who haven't had a previous cesarean section 0rwho haven't had a previous cesarean section 0r
any operation in terusany operation in terus

9. How do she organise oneHow do she organise one ??
 her obestetrition will contact you to make theher obestetrition will contact you to make the
arrangementsarrangements
 Wherever you decide to give birth is up to you; just
remember that you can make the decisions that
need to be made when you have true information.
 It is your body,
 your baby,
 your money,
 and your life on the line,

10. What pain relief will beWhat pain relief will be
availableavailable??
 Although in some cases pain medication is availableAlthough in some cases pain medication is available
to mothers birthing at hometo mothers birthing at home pethidinepethidine if she want, inif she want, in
most cases this option ismost cases this option is not availablenot available..
 give hergive her gas and airgas and air..
 Alternative methods of pain reliefAlternative methods of pain relief if contractions are
pretty strong, such as TENS machine,breathingsuch as TENS machine,breathing
exercises, massage, and labouring in a birthing pool ,exercises, massage, and labouring in a birthing pool ,
aromatherapy, homeopathic remedies, oraromatherapy, homeopathic remedies, or
acupuncture.acupuncture.
It is well understood that sensations of pain in labour
are regulated by hormones released by the woman's
body relaxation can diminish maternal stress,
improve oxygen flow to the baby and facilitate labor.
. During the labour, oxytocin - the hormone which
causes
contractions and helps the baby to be born - works in
harmony with endorphins - the body's own pain

11. Preparing for LaborPreparing for Labor
 Take a birthingTake a birthing class. Some available typesclass. Some available types ofof
home birthhome birth
 ExerciseExercise. Regular exercise, such as yoga or. Regular exercise, such as yoga or
walking, can help prepare your body for labor.walking, can help prepare your body for labor.
 Consider the atmosphere in yourConsider the atmosphere in your homehome, and, and
prepare it for optimum comfort once you go intoprepare it for optimum comfort once you go into
labor. Make sure it islabor. Make sure it is cleanclean and that theand that the
surroundings are soothing to you. Also preparesurroundings are soothing to you. Also prepare
for such things asfor such things as musicmusic andand lightinglighting during theduring the
birth if you have preferencesbirth if you have preferences

12. Childbirth EducationChildbirth Education
 You need to prepare for birth. Make preparing for itYou need to prepare for birth. Make preparing for it
special - these educational classes are an excellentspecial - these educational classes are an excellent
resource for you, or anyone who might be with youresource for you, or anyone who might be with you
during the birth process.during the birth process.
 These classes usually include information onThese classes usually include information on
exercise, nutrition, breathing, position, movement andexercise, nutrition, breathing, position, movement and
relaxation methods for use in labor and delivery,relaxation methods for use in labor and delivery,
information regarding hospital procedures,information regarding hospital procedures,
medications, anesthesia, alternative complementarymedications, anesthesia, alternative complementary
therapies, newborn care and the postpartum period.therapies, newborn care and the postpartum period.
 gentle yoga postures (increase your repertoire ofgentle yoga postures (increase your repertoire of
comfortable positions during pregnancy), ease low backcomfortable positions during pregnancy), ease low back
pain, use vocal toning, visualization, meditation,pain, use vocal toning, visualization, meditation,
massage and relaxationmassage and relaxation Use gentle deep breathingUse gentle deep breathing
(not the fast pace)(not the fast pace)..

13. Obtain the necessaryObtain the necessary
suppliessupplies
 .. You may be able to provide you with aYou may be able to provide you with a
birth kit, but here are some of the mostbirth kit, but here are some of the most
important things you will need.important things you will need.
 Sanitary pads, large onesSanitary pads, large ones
 Cracked iceCracked ice
 Nursing brasNursing bras
 Something to mist your face withSomething to mist your face with
 Buckets-to sit on and for clean upBuckets-to sit on and for clean up
 New nail brush and clippersNew nail brush and clippers
 Waterproof pads to sit onWaterproof pads to sit on
 Heavy plastic sheet for the bedHeavy plastic sheet for the bed
 Large towelsLarge towels

14. Can she change her mindCan she change her mind ??
Yes — at any time you can change youryou can change your
mind about site of labourmind about site of labour

15. What happens if it her baby willWhat happens if it her baby will
arrive before she get to thearrive before she get to the
hospitalhospital??
Emergency home deliveriesEmergency home deliveries areare
extremely unusual, especially with firstextremely unusual, especially with first
babiesbabies
the baby arrive before or after thethe baby arrive before or after the
emergency medical teamemergency medical team

16. Who will be present at the birthWho will be present at the birth??
doctordoctor andand his nursehis nurse go to a woman'sgo to a woman's
home when she starts labor.home when she starts labor.
Who else is present is up to her it's her
home, after all. Anyone she wish! herAnyone she wish! her
mothers, sisters, close friends, neighbor,mothers, sisters, close friends, neighbor,
labor coach, or others,labor coach, or others,

17. What equipment does sheWhat equipment does she
needneed??
 series of childbirthseries of childbirth classes,classes, covering the major topics incovering the major topics in
prenatal nutrition and exercise, natural birthing methods,prenatal nutrition and exercise, natural birthing methods,
pain relief and breast feedingpain relief and breast feeding
 sheshe will bring round a 'birth pack' containing all the bits andwill bring round a 'birth pack' containing all the bits and
pieces they needpieces they need
 During labour, her baby's condition will beDuring labour, her baby's condition will be
regularly monitored withregularly monitored with a sonic aida sonic aid
 TheThe doctordoctor at a home birth will have all herat a home birth will have all her instrumentsinstruments laidlaid
out, readily accessibleout, readily accessible,, and theand the oxygen tankoxygen tank turned onturned on
 AllAll sheshe may be asked to provide is adequatemay be asked to provide is adequate heatingheating, and a, and a
readingreading lamp.lamp. However she did arrange hire of a TensHowever she did arrange hire of a Tens
machine,machine,
 TheThe doctordoctor carries oxygen andcarries oxygen and resuscitation equipmentresuscitation equipment toto
use while waiting for the ambulanceuse while waiting for the ambulance

18. What happens if she need to
go to hospital in labour?
her doctor will talk to her and her partner
about why she believes a transfer to
hospital would be a good idea and will then
call an ambulance because her labour has
slowed down or because there's a realslowed down or because there's a real
emergencyemergency ..
 For this reason, it's wise to deliver at home
only if you're within 20 minutes of the
nearest hospital and her transportation there
is fail-safe.

19. What happens after the birthWhat happens after the birth ??
 Once the baby and placenta are safely
delivered
 The doctor will check the baby over and weighThe doctor will check the baby over and weigh
him,the nurse help her with her first breastfeedhim,the nurse help her with her first breastfeed
 How long will doctor stay atHow long will doctor stay at
her home after her baby isher home after her baby is
born?born?
 The doctor will stay until the mother is up,The doctor will stay until the mother is up,
sitting in a chair, feeling well, drinking andsitting in a chair, feeling well, drinking and
eating, and the baby is judged to be healthlyeating, and the baby is judged to be healthly
and is nursing satisfactorilyand is nursing satisfactorily.. (one hour)(one hour)

20. Within the hospital groupWithin the hospital group,,
..
o Maternal hemorrhageMaternal hemorrhage was higher.
o The incidence of respiratory distress amongamong
newborns was greater in the hospital than in thenewborns was greater in the hospital than in the
home.home.
o Limp, unresponsive newbornsLimp, unresponsive newborns arrived more often..
o The perinatal mortalityThe perinatal mortality rate was higher in therate was higher in the
hospital birthshospital births
o Neonatal infectionsNeonatal infections were common..
o There were permanent birth injuriespermanent birth injuries caused by
doctors
o moremore lacerationslacerations to the mother,to the mother, many
episiotomiesepisiotomies
o a higher rate of forceps
o a higher rate of C-sectionC-section delivery
o much more likely to experience postpartummuch more likely to experience postpartum
depressiondepression or even post traumatic stressor even post traumatic stress

21.  doctor tend to allow time for the woman's
tissues to stretch and to use perineal
massage, warm compresses, and good
head flexion to avoid both episiotomies
and tearing;
 doctor use include simple techniques
for relaxation and breathing but may
also include the use of massage,
herbs, homeopathy and acupuncture.
 doctor at a home birth will have all her
instruments laid out, readily accessible,
and the oxygen tank turned on, so that
what might be an emergency becomes a
matter of routine.

22. What are the advantages of a homeWhat are the advantages of a home
birth over a typical hospital deliverybirth over a typical hospital delivery??
 It respectsIt respects the natural processesthe natural processes of giving birth labor progresses moreof giving birth labor progresses more
rapidly in therapidly in the familiar home environmentfamiliar home environment her own home, in her own bedher own home, in her own bed
 their home is the most appropriate place for a new baby to enter their
family circle.
 a matter of acknowledging her needs fora matter of acknowledging her needs for privacy, security, comfort,privacy, security, comfort,
safetysafety, control, freedom and respect for the emotional and spiritual, control, freedom and respect for the emotional and spiritual
aspects of birthaspects of birth
 She may have had a previous bad experience in hospital and wish to
avoid another.
 No Baby Mix-UpsNo Baby Mix-Ups
 The dangerousThe dangerous bacteria and virusesbacteria and viruses that commonly inhabit hospitalthat commonly inhabit hospital
environments are far less likely to inhabit her homeenvironments are far less likely to inhabit her home
 there are nothere are no unnecessary medical interventionsunnecessary medical interventions performed at home,performed at home,
which themselves could create problemswhich themselves could create problems ..
 encourage laboring mothers toencourage laboring mothers to walk orwalk or to assume comfortableto assume comfortable positionspositions,,
and toand to drinkdrink if thirsty and toif thirsty and to eateat if hungryif hungry relax in a warm tub of waterwarm tub of water,,
have herhave her feet rubbedfeet rubbed by loving friends.
 she chooses, sip on energizing juices, continue caring for other children
as she is able. She can move about freely, wear what clothingclothing
 wishing to minimise thewishing to minimise the disruption of the routinedisruption of the routine for their other childrenfor their other children
 Decrease the risk of theDecrease the risk of the emotional/psychological disruptionemotional/psychological disruption of being inof being in
an unfamiliar institutionan unfamiliar institution
 .. they want to deliver their babies without drugs and unnecessary
interventionsinterventionsthisthis
 lower-costlower-cost costs 68% less in a home than in a hospitalcosts 68% less in a home than in a hospital

23. prenatalprenatal calmcalm people who are present at the birth.people who are present at the birth.
Tension in a room can slow down or stop aTension in a room can slow down or stop a
laborlabor..
 Usually someone other than the mom or herUsually someone other than the mom or her
partner assumespartner assumes responsibility for anyresponsibility for any
childrenchildren who are present, freeing mom towho are present, freeing mom to
focus on birthing.focus on birthing.
 The birthing process is allowed to take itsThe birthing process is allowed to take its
own course and set its own pace. Theown course and set its own pace. The
general philosophy is that any interventionsgeneral philosophy is that any interventions
((administering drugs or trying to hurry thingsadministering drugs or trying to hurry things
along) create more harm than good.along) create more harm than good.
 the mom is likely to be less inhibited aboutthe mom is likely to be less inhibited about
trying different labor positions and locations.trying different labor positions and locations.
She canShe can sitsit on the toilet or go for a walkon the toilet or go for a walk
outside. She canoutside. She can eateat oror drinkdrink whatever shewhatever she
wantswants

24. When it's time to deliverWhen it's time to deliver
 she can often tryshe can often try whatever positionwhatever position she wants:she wants:
on her side, squatting, sitting or kneeling manyon her side, squatting, sitting or kneeling many
childbirth authorities feel the motion of walkingchildbirth authorities feel the motion of walking
and changing positions can enhance theand changing positions can enhance the
effectiveness of the contractions.effectiveness of the contractions. ..
 When a doctor and mother buildWhen a doctor and mother build a personala personal
relationshiprelationship, this trust helps women let go and, this trust helps women let go and
have their babies more easily.have their babies more easily.
 Homebirth allows for full participation ofHomebirth allows for full participation of familyfamily
membersmembers
 babies are usually immediately placed on thebabies are usually immediately placed on the
mom's breast, providing security, warmth andmom's breast, providing security, warmth and
immediate bondingimmediate bonding between mom and babybetween mom and baby

25. Home versus hospital birthHome versus hospital birth
 There is no strong evidence to favour eitherThere is no strong evidence to favour either
planned hospital birth or planned home birth forplanned hospital birth or planned home birth for
low risk pregnantlow risk pregnant women.women.
 Planned home births in appear to be associatedPlanned home births in appear to be associated
with less overall maternal and neonatal morbiditywith less overall maternal and neonatal morbidity
and less intervention than hospital births.and less intervention than hospital births.
 "Home birth is an acceptable alternative to"Home birth is an acceptable alternative to
hospital confinement forhospital confinement for selected pregnantselected pregnant
womenwomen, and leads to reduced medical, and leads to reduced medical
interventions.interventions.””
 Continuing evaluation of home birth practice andContinuing evaluation of home birth practice and
outcome is essential.outcome is essential.
 Home birth can be accomplished with goodHome birth can be accomplished with good
outcomes under the care of qualifiedoutcomes under the care of qualified
practitioners and within a system that facilitatespractitioners and within a system that facilitates
transfer to hospital care when necessary.transfer to hospital care when necessary.
 Intrapartal mortality during intended home birthIntrapartal mortality during intended home birth
is concentrated in postdates pregnancies withis concentrated in postdates pregnancies with

26. many mothers who have delivered in
the hospital as impossible
 confined to a hospital bed,
 denied food and water,
 separated from their other children and
supportive family members and friends,
 enduring frequent internal examinations and vital
sign checks,
 being transfered from one room to another on a
stretcher at the peak of labor's intensity
 and having their legs strapped into stirrups.

27.  good result of home birth because goodgood result of home birth because good
selection of type of pregnant women toselection of type of pregnant women to
allow to deliver at homeallow to deliver at home
 Good health prenatal = lowGood health prenatal = low
complications natal and postnatalcomplications natal and postnatal
 final judgment regarding the relativefinal judgment regarding the relative
safety of home birth still cannot besafety of home birth still cannot be
made.made.

28. Thank youThank you
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