Planned home birth

Izhodišča: Porod na domu je sicer star toliko kot človeštvo, pa vendar v veliki večini srednje in visoko razvitih držav prevladuje mnenje, da so zaradi nepredvidljivosti zapletov porodnišnice najbolj varno okolje za rojevanje. Kljub temu obstaja peščica držav, v katerih je porod na domu integriran v sistem zdravstvenega varstva (npr. Nizozemska, Velika Britanija, Kanada). Pri porodih na domu ločimo nenačrtovane in načrtovane porode na domu, slednje pa lahko nadalje razdelimo še na porode s spremljevalcem in brez spremljevalca. V članku se bomo omejili na načrtovane porode na domu, ki pa so po svetu različno razširjeni. V Združenih državah Amerike se doma rodi 0,6–1,0 % vseh otrok, v Veliki Britaniji 2–3 %, v Kanadi 1,6 %, na Nizozemskem 20–30 %, v Avstriji in Nemčiji pa se zunaj porodnišnice rodi 1,3 % vseh otrok. Za Slovenijo število načrtovanih porodov na domu ni znano, se je pa leta 2010 pri nas 0,1 % otrok rodilo zunaj zdravstvene ustanove. Zaključki: Varnost načrtovanega poroda na domu je še vedno predmet razpravljanja. Medtem ko raziskave potrjujejo manjše število porodniških posegov in zapletov pri materah, ki rodijo doma, si podatki glede neonatalne in perinatalne umrljivosti in obolevnosti zelo nasprotujejo. To potrjuje potrebo po večjih multicentričnih raziskavah za to področje. Trenutne smernice poudarjajo predvsem dobro informiranost nosečnic glede možnih prednosti in slabosti poroda na domu in opredelitev izbirnih meril za porod na domu, indikacij za prevoz v porodnišnico med porodom ter ustrezno izobraženost porodnih spremljevalcev.Background: Home birth is as old as humanity, but still most middle- and high-income countries consider hospitals as the safest birth settings, as perinatal complications are highly unpredictable. Nevertheless, there are a few countries in which home birth is integrated into official healthcare system (the Netherlands, United Kingdom, Canada etc.). Home births can be divided into unplanned and planned, and the latter can be further categorized by the presence of birth attendants. This review focuses on the planned home births, which are differently represented throughout the world. In the United States 0.6–1.0 % of all children are born at home, in the United Kingdom 2–3 %, in Canada 1.6 %, in the Netherlands 20–30 %, while in Austria and Germany 1.3 % of all newborns are born outside maternity wards. For Slovenia, the number of planned home births is unknownhowever, in 2010, 0.1 % of children were born outside medical facilities. Conclusions: The safety of home birth is still under the debate. While research confirms a lower number of obstetric interventions and some complications in mothers who give birth at home, the data regarding the neonatal and perinatal mortality and morbidity is still conflicting. This confirms the need for large multicentric trials in this field. Current home-birth guidelines emphasize that women should be well informed regarding possible advantages and disadvantages of home births. In addition, the emphasis is on the definition of selection criteria for home birth, indications for intrapartal transfer to the hospital and appropriate education of birth attendants