Home birth – safety perspective

Uvod: V večini držav danes prevladuje mnenje, da je porod v porodnišnici najbolj varna izbira za žensko, v nekaterih pa je porod doma integriran v sistem zdravstvenega varstva. Varnost načrtovanega poroda na domu ostaja predmet razpravljanja. Raziskave potrjujejo manj intervencij in zapletov pri ženskah, podatki glede neonatalnih izidov pa si nasprotujejo. Ženske se v Sloveniji vse bolj pogosto odločajo za porod na domu, vendar še ni sprejetih strokovnih usmeritev na načrtovani porod doma, ki bi opredeljevale, za koga in kdaj je porod na domu varna izbira. Namen: Namen diplomskega dela je predstaviti novejša dognanja o varnosti poroda na domu in definirati dejavnike, ki na varnost vplivajo. Metode dela: uporabljena je bila deskriptivna metoda dela. Pregledana je bila domača in tuja strokovna literatura, povezana s tematiko poroda na domu. Avtorica je vire iskala v podatkovnih elektronskih bazah, kot so MEDLINE, Pubmed in DiKUL, v iskalniku Google Books ter na uradnih spletnih straneh strokovnih organizacij. Literatura je morala biti v slovenščini ali angleščini dostopna v celoti ter izdana med letoma 2003 in 2018. Rezultati: Vsaka ženska ima pravico do informirane odločitve o izbiri kraja poroda, v odločitvi pa jo je treba podpirati. Študije navajajo manjšo stopnjo intervencij ter neželenih obporodnih izidov pri materah, ki rodijo doma, vključno z nižjo stopnjo epiziotomije, operativnega vaginalnega poroda, carskega reza, poporodne krvavitve in poškodb presredka. Izsledki o neonatalnih rezultatih se razlikujejo. Nekatere študije navajajo pri porodih na domu višjo obporodno in neonatalno umrljivost in obolevnost, pri drugih pa je verjetnost neugodnih neonatalnih izidov v primerjavi s porodom v porodnišnici enaka. Da bi zagotovili varen porod doma, je treba imeti ustrezna merila za razvrstitev žensk v skupino z nizkim tveganjem. Babica, ki prisostvuje porodom na domu, mora biti primerno izobražena in imeti znanja o obvladovanju urgentnih situacij. Prav tako mora s seboj imeti vso predpisano opremo in pripomočke, ki so primerno vzdrževani. Zagotoviti je treba varen in dovolj hiter transport v porodnišnico, če je ta potreben. V primeru premestitve mora babica predati porodnico ekipi v porodnišnici skupaj z ustreznimi dokumenti. Babica je dolžna vse podatke, zbrane med spremljanjem poroda na domu, skrbno vpisovati v porodno dokumentacijo. Razprava in zaključek: Izsledki raziskav kažejo, da je porod na domu za žensko dovolj varen, saj študije navajajo manjše število intervencij in manj neugodnih izidov. Pri varnosti poroda za otroka je objektivno mnenje težje podati, saj si rezultati raziskav nasprotujejo in zahtevajo nadaljnje metodološko kakovostne študije.Introduction: Home birth is an integrated part of maternity service in some countries, but in most of them, it is believed that the safest option for women is to give birth at hospital. The safety of home birth remains under debate. Studies confirm less interventions and adverse outcomes in mothers who give birth at home, but the data regarding the neonatal end perinatal outcomes is still conflicting. More and more women in Slovenia choose to give birth at home. However, official professional guidelines of planned home birth that would define for whom and when home birth is a safe option have not yet been published in Slovenia. Purpose: The purpose of the diploma work is to present the latest findings about home birth safety and to define the parameters that affect it. Methods: Descriptive method was used to find and evaluate academic literature on home birth. Literature was searched in electronic databases, such as MEDLINE, Pubmed and DiKUL, in Google Books browser and on official internet sites of important organisations. The inclusion criteria were the following: Slovenian or English language, access to the whole article, and year of publishing between 2003 and 2018. Results: Every woman has the right to make an informed choice about the place of birth. We must support her decision. Studies reveal less interventions and adverse outcomes in women that give birth at home, including less episiotomies, operative vaginal deliveries, caesarean sections, postpartum haemorrhages, and perineal tears. Findings regarding neonatal outcomes are conflicting. Some studies claim higher perinatal and neonatal mortality and morbidity at home births, while others find the odds of those outcomes the same as at hospital births. To ensure safe home birth, proper criteria must be developed to classify women in the low-risk group. The midwife that attends home births must be properly educated and trained in controlling urgent situations. She must provide all the necessary equipment that has to be maintained correctly. Safe and fast transport must be provided in case it is needed. A midwife must accompany the woman and handover the documents to the hospital team in case of transport. The midwife is obligated to write all the collected information in the documentation while attending labour. Discussion and conclusion: The results of studies show that home birth is safe enough for women as most studies claim less interventions and adverse outcomes. It is harder to give an objective opinion regarding neonatal safety because of the contradictory results. Further studies with better methodological quality are needed