Friday, January 13, 2017

Planned hospital birth will be a better maternity service than home birth

 نور شهيدا و نور فرح شاكيلا
In a world that has many facilities provided to human, hospitalization for birth also is continue to increase which it helps women in giving birth. However, in certain countries such as United Kingdom and Netherland the situation would be different compared to Malaysia. (Beech, 2012). This is because home birth is more preferable in those countries but not in Malaysia where women commonly choose hospital birth. In Malaysia, home delivery is not recommended because lack of expert assistance and is not well supported and recommended by the Ministry of Health (MOH) in Malaysia, but home birth is allowed under supervision of trained and experienced professional attending.
            A home birth is an attended or an unattended child birth in a non-clinical setting, typically using natural childbirth methods, that usually takes place in a residence rather than in a hospital or a birth center, and commonly attended by a professional attending home birth which are obstetricians, certified midwives and doulas. According to Beech (2012), in United Kingdom women have the right to give birth at home if they choose so, and this right is reflected in many other countries all around the world. In countries and areas where it is possible to establish a home birth service backed up by a modern hospital system, all low risk pregnant women should be offered the possibility of considering a planned home birth and should be informed about the quality of the available evidence to guide their choice, and also women should be offered the choice of planning birth at home, an a midwives-led unit or in an obstetric units. In England, Scotland and Wales have policies that promote woman-centered maternity services with the expectation that choice will be offered to women, and the option of home birth should be available to all women. Furthermore, in United Kingdom Government policies assisted and recommended the planning of home birth because they have a portable equipment’s same as the hospital equipment’s or medical devices such as sonography, maternal and neonatal ventilation and hydration in case of unrecognized complications happened, and generally they have a well-trained midwives which is professional attending home birth that can be an obstetricians, certified or uncertified midwives and also doulas, and last but not least the high-quality of medical care, that is the main reasons why United Kingdom Government really recommended out of hospital birth, and women  may chose home birth because they preferred the intimacy of a home and family-centered experience or desire to avoid a medically-centered experience typical of a hospital. Moreover, in United Kingdom or other countries which promote home birth generally have all perfect equipment’s, the trained midwives and also high-quality of medical care compared to Malaysia. Thus, women in Malaysia are recommended for planned hospital birth because of hard accessibility to the hospital that might cause maternal mortality, lack of medical devices and support at home and for better outcomes for mothers and babies.

Hard accessibility to the hospital
Women should really consider choosing planned hospital birth rather than out of hospital birth to avoid maternal mortality due to late emergency help. Naturally, all women want to experience a smooth and comfortable environment when it comes to giving birth. However, choosing a birthplace actually is undeniably a vital decision as it will become the root to guarantee the safety of delivery babies. In recent times, homebirth has become popular in United Kingdom and Netherlands as it promotes a natural way of giving birth without disruption of medical interventions, strict rules of the hospital and chemical substances. Factually, as portrayed in UNICEF DATA ( “the complications leading to maternal death can occur without warning at any time during pregnancy and childbirth” (p.2). This means although the doctors can determine whether the women are high potential risk or low potential risk, problem might happen to mothers without early sign. In addition, as being emphasized by Oyerinde (2013), antenatal care will provide advices and checkups for mothers to make sure of their health but still the risk such as hemorrhage (which is an escape of blood from a ruptured blood vessel) can happen before or after labor and it will cause the mother to loss excessive of blood due to the undetectable complications before laboring. Thus, every second is very important to safe the mothers and babies from maternal and perinatal death. When complications arise,  out of hospital birth may cause hard access to the obstetric services and would contribute to late emergency help from hospital such as blood transfusion and caesarean sections by the doctors. (UNICEF DATA, 2016, p.2).
Moreover, mothers in rural areas would be more affected because they live far from delivery services and usually were lack of knowledge about obstetric care and tied with traditional way of giving birth. Often times, women in rural areas give reason to choose home birth because it is easier and safer. Factually, there are many maternal deaths that happened during past times but it was not reported in data system. According to Abebe, Berhane, Girma (2012), “home deliveries are bound to be un-hygienic, unsupervised and when intervention is required it usually late”. Thus, countries like Ethiopia and Kenya are still struggling to provide better maternity services to their people. It is supported with details from UNICEF DATA (2016) regarding the decline of global maternity ration by 44 percent from 385 deaths to 216 deaths per 100,000 live births due to advance skilled delivery by the obstetric care and interventions. The role of maternity services should decrease the maternal death, not to enhance maternal mortality among mothers and babies. Thus, easy access to the skilled delivery services in hospital will lessen the risk of dying mothers due to complications occurred.
According to Grunebaum (2013), the great risk of neurological problem for a baby and dying should be aware by parents resulted from delivering at home. As a matter of fact, not only the mothers have the risk of complications but the babies might also have problem with respiratory distress and lack of oxygen that will need fast emergency helps. Thus, hard access to hospital in home birth is very dangerous especially when unpredictable emergency happened as Chervenak (2013) noted that "If an emergency occurs at home that requires hospital transport, it's often difficult to beat the clock to prevent death or neurological issues”. This clearly shows that home birth will affect both mothers and babies to the risks of maternal mortality and perinatal death when the unpredictable complications arise and cause late emergency to come. Additionally, planned hospital birth is ready for any complications that happened and every second should be not wasted to safe both mother and baby. Furthermore, if mothers avoided antenatal care due to planned home birth and attending courses of natural birth, they might not aware of the complications to the baby in the womb and advices related to their own health might not be noticed thus will cause problem in home deliveries. In brief, hospital birth would have easy access to experts and complications could be solved by fast emergency help.
Lack of medical devices and support
The planned hospital birth has been proven to be better in declining maternal mortality compared to homebirth, not only faster in providing emergency help, but also provides comprehensive emergency obstetric care. In contrast, although the trained midwives are in the setting of laboring at home, the lack of medical devices will make them unaware to any complications. The recent trends of popularizing home birth contradict to that principle of safety delivery for both mothers and babies. In fact, Romanzi (2014) noted to save mothers and babies especially in home birth and birth centers, the equipment should be prepared such as portable sonography, maternal ventilation and hydration supplies in order to prevent neonatal and maternity mortality out of hospital birth. This is due to the inability to bring all medical devices needed to the setting of home birth. However, although portable devices would help, it will cost a lot of money to prepare everything as it has been prepared in hospital. It is further emphasized in UNICEF DATA (2016) and a study by Moazzeni (2013), maternal deaths has been clearly reduced in the modern times as technology became more advanced from time to time. Thus, when complications happened in hospital there would be a direct helps attended by skilled doctors, nurses and provided with proper equipment and supplies.
Yasser and Rahman (2016) mentioned that we cannot do harm to anyone that might probably affects others’ life and their convenience. In this case, although home birth gives women comfort without hands of obstetric care and medical intervention, but there is possibility harm includes maternal mortality and perinatal death because of lacking medical equipment needed during complications. With this, we can infer that Islam has laid out clear and understandable guidelines for women in choosing birthplace in safer way.
Misinterpretation towards the obstetric care being influenced by bad services from nurses and doctors often times because of rude words and lack of compassion to the mothers. Thus, it gives bad experience to mothers emotionally and made them reject hospital birth in their next maternity services. However, Ministry of Health is trying to encounter the problem of customer services and being more lenient in recent times allowing husband to accompany their wives during delivery. More important to note, as cited in (Wax, Lucas, Lamont, Pinette, Cartin & Blackstone, 2010), planned home birth involved less medical intervention but carried twice or thrice the risk of dying.  It is believed that preventing the risk of death is prior to the emotional benefits from home birth as saving life needs skilled experts and adequate medical equipment. A more inclusive preparation would set up an efficient maternity service for both mother and babies.
Better outcomes for mothers and babies
In Australia, the national statistics reveal that 34% of women giving birth in 2009 elected private status, with 30% of women giving birth in private hospitals directly under private obstetric care or maternal care automatically assigned for them. The remaining women around 4% are women who gave birth at public hospitals. Even though the number of women who gave birth at private hospitals is higher than public hospitals, the rates of obstetric intervention were highest in private hospitals and lowest in public hospitals (Dahlen, Tracy, Bisits, Brown & Thornton, 2012) because this intervention were introduced during labor, and rate of interventions in birth was increased markedly in the past decade until now.
An obstetric intervention is a branch of medicine and surgery concerned with childbirth and the care of women giving birth. The examples of obstetric interventions during delivery are induction, epidural, instrumental birth, caesarean section and also episiotomy which is a surgical cut made at the opening of the vagina during childbirth to aid a difficult delivery and generally done by expert midwives and obstetricians and also known as perineotomy. On the other hand, based in some research the increased of giving birth at home is highest in United Kingdom because of low-risk of obstetric intervention during delivery. However, if the mothers were deciding to give birth at hospitals this will proceed to a healthy and better outcomes for herself an also her babies.
In addition, obstetric intervention plays a vital role during delivery because it can prevent from any unrecognized complications from happened, which it may lead to dangerous health outcomes for the mothers and babies. In fact, it was discovered that, “the finding of lower obstetric interventions in the out of hospital setting is an important one and highlight the need for reform in the U.S. maternity care system. While Oregon’s planned in hospital cesarean rate of 25% is lower than the national average, it is still higher than the recommended levels (10%-15 based on WHO recommendations from decades ago” (Cheyney & Jonathan Snowden, 2016, p.81). Furthermore, obstetric intervention also can greatly improve maternal and neonatal outcomes, in point of fact these procedure of obstetric interventions were initially life-saving, are now so common place and also can improve perinatal death rates. Moreover, one of the major obstetric intervention during childbirth are cesarean section, some researcher was claimed it was a life-saving procedure, but if they overused this procedure it can cause a dangerous effect and also may not be significant for mothers and babies (Snowden, 2016). As a result, it will affect the mother and her babies during her future pregnancies by the first cesarean, because the risk on one cesarean may not fully recover until many years later.
Another research claimed that, the obstetric interventions can be reserved when the complications arise and they become extremely necessary, or when they become judicious, from the perspective of the woman and her provider. Thus, the researchers also encourage to all obstetricians who are comfortable with practicing natural birthing or cesarean birthing to work closely with their care providers. According to Snowden (2016), he stated that if practices can be imported from the out of hospital setting to the in hospital setting that will safely reduce cesarean birth, which would be more impactful benefits.
Last but not least, the professional and responsibility model of obstetric ethics as well plays an important role in planned hospital birth. According to Chervenak (2013), he “presented the results of the first analysis of Centers for Disease Control and Prevention (CDC) data showing the increased risks of planned home birth and, on the basis of this compelling evidence, strongly warned against the dangers of planned home birth”. In addition, in hospital birth are attended by the midwives and obstetric physicians in term, as compared to home birth was attended by midwives was more risky than hospital birth, because most of the midwives attending planned home birth did not meet American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) recommendations for certification by the American Midwifery Certification Board (Chervenak, 2015). Therefore, the professional responsibility model of obstetric ethics plays an important roles during planned in hospital birth because it provides a dominant antidote to motherly rights because it based on reductionism that the pregnant women are absolutely determinative in the ethics of obstetric practice (Chervenak; Md; Grunebaum; 2015).
In conclusion, it is clear from the above account that home birth is no doubt producing benefits to the mothers emotionally, yet it also have some negative impacts which include hard accessibility to the hospital, lack of medical devices and support, and risky outcomes for mother and babies. There is also a threatening side of home birth and it is believed that more actions and guidelines should be focused for better outcomes for mothers and babies. Especially nowadays when developed countries are promoting home birth to their citizen, it has attracted mothers in other countries to choose home birth too despite of different conditions they have. One of the steps that can be enforced is educational outreach into communities that favor traditional birth. Educating the mothers will help them to recognize the benefits of hospital birth and avoid the maternal risk and high rates of neonatal death though modern obstetric technology.
Additionally, if the government thought of promoting home birth to their citizens, they should play a role by improving the medical structure of both planned hospital birth and home birth. Equipping all birth centers and home birth midwives with portable sonography, maternal and neonatal ventilation and hydration supplies, and medications for the neonatal mortality indicators may guarantee the safety of home birth. Furthermore, the ambulances should be prepared during delivery process and specialist should be there to monitor the delivery process. This regulation helps to provide both comfortable and safe condition to the mothers and babies. However, the implementations need high cost and not yet being promoted expressively by the developing countries.
Another method would be for the planned hospital birth to allow midwives to stay besides the mothers so they can have motivations and comfort during delivery process. Besides, the Ministry of Health should train the obstetricians, birth attendants, pediatricians and nurses to improve their service with kindness, respect and love. This is because some of the mothers who avoid hospital birth due to traumatic experience that hurt their feelings in past hospital birth they had. Malaysian government has allowed husbands to enter the delivery room to give support and motivation to their wives. This step should be praised because the mothers emotionally supported as well as with the presence of obstetric modern technology and doctors.
On further note, priority is an important principle for us Muslims. Mentioned in the Qur’an, “They ask you about intoxicants and games of chance. Say: In both of them there is a great sin and means of profit for men, and their sin is greater than their profit. And they ask you as to what they should spend. Say: What you can spare. Thus does Allah make clear to you the communications that you may ponder.” [2:219]. This verse originally illustrates the prohibition of alcohol because of the harms came from it. The wisdom that can be learnt is God prohibit us to choose something that cause much harm than the acquired benefit. In a similar fashion, home birth in Malaysia gives much more harm such as maternity and neonatal death compared to the benefits from it such as the environment and emotional comforts. In addition, a Hadith has also reported on how Islam prohibit in causing harm. It was narrated from Abu Sa’id Sa’ad bin Malik bin Sinan al-Khudri, the Messenger of Allah said: “There should be neither harming nor reciprocating harm.” From this hadith came legal maxims such as “Preventing harm takes precedence over gaining or attaining benefits”.[As-Suyuti, Asybah wan-Naza’ir].
To conclude, home birth surely gives comforts and privacy to mothers. However, protecting lives of mothers and babies from risky conditions and complications is more important. Thus, mothers in Malaysia should choose hospital birth in order to resolve the problem where maternal and neonatal death happened due to absence of obstetricians near them.

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