The following op-ed was submitted by the Department of Health

At the Department of Health we recognise that pregnant women have a right to choose their own birthing experience, however when contemplating the option of a “Home Birth” it is important to consider the following points: the safety and health of the mother and baby, the availability of trained skilled midwives and doctors, and available research on safe motherhood.

As child advocates we also believe that every newborn should have the “gold standard” of healthcare.

According the American College of Obstetricians and Gynecologists (ACOG, 2011) “Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence” (p. 425).

It is also important to inform persons who are interested in home birth that in order to reduce chances of complications to the mother and baby the following must be followed:

1. Established guidelines for the “appropriate selection of candidates for home birth” (p. 425).

These guidelines must be strictly adhered to in order to reduce complications to the health of the mother and baby.

2. “Availability” (p. 425) of licensed and registered midwives and or physicians to attend the home birth.

3. Availability of skilled, licensed obstetricians for “consultation” (p. 425).

4. A system that provides for safe and “timely transport” (p. 425) to the hospital if an emergency arises.

The Department of Health acknowledges that there are benefits to a home birth such as having more privacy in labour, being able to labour in a familiar surrounding, and having the choice of which people can offer extra support during the labour and birth.

However, if complications occur, the health of the mother and baby may be compromised.

According to ACOG, (2011) the risks of home birth include a “twofold increase of neonatal death” (p. 425).

Maternal complications and the risk of unpredictable obstetric emergencies which if not dealt with expeditiously, can lead to unhealthy outcomes for the mother and baby (pp 425-428).

The American Academy of Pediatrics, (2013) state that in the United States there is also an increased incidence of “low Apgar scores and neonatal seizures” (p. 2).

It is important for the public to be aware of the following facts:

1. Home births must be conducted by licensed, registered and insured midwives. Under the Bermuda Midwives Act 1949 any lay person who acts in the role of a midwife or who purposely delivers a baby is in contravention of this act and can face legal ramifications.

2. An obstetrician must be available to act as a consultant if the midwife needs help.

3. Established guidelines are practised by all midwives. These guidelines include criteria for screening home birth clients; not all women are suitable candidates for home birth.

Some of these criteria include, but are not limited to:

— having an uncomplicated pregnancy both medically and obstetrically

— being compliant with the recommended schedule of antenatal visits,

— being free from infections, including Group B Hemolytic Streptococcus infection where antibiotics in labour would be recommended for the health of the infant,

— not requiring a Cesarean Section, such as if there is an active herpes infection.

4. An efficient emergency transfer system to the hospital must be available. If emergencies do occur, every minute matters.

Bermuda is a small Island and narrow roads are a reality with high traffic volumes. If a person happened to live in Somerset for example it could take up to an hour to collect the patient and return them back to the hospital which is a life-threatening loss of time when dealing with an emergency.

We recognise that women have a right to choose their birthing experiences.

However, what is of concern to us is that it is impossible to always predict complications.

It is therefore important to ensure that established standards that are guided by scientific evidence are strictly followed to lessen the risk of unsafe obstetric care for our island.

References

American Academy of Pediatrics. (2013). Planned Home Birth, 131(5), 1016-1021. https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Planned_Home_Birth

American College of Obstetricians and Gynecologists. (2011). Committee Opinion, 476(117), 425-428. Retrieved 15/4/14 from https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Planned_Home_Birth

Bermuda Midwives Act (1949). Retrieved 15/4/14 from www.bermudalaws.bm/Lawa/...Midwives%20Act%201949.pdf