One of the important decisions the expectant parents will have to make is whether to have the baby at home or in hospital.
This decision will be influenced by:
• the facilities available in the area in which the expectant mother lives.
• the expectant mother’s medical record and the danger of any complications at birth.
• the advice given by her doctor and midwife.
• her own inclinations.
• her living conditions.
• the availability of help before, during and after the birth. The choices open to her for delivery are:
• in hospital – a maternity unit or a GP unit.
• the ‘domiciliary-in-out’ (domino) system.
• at home.
Most women choose to have their baby in a hospital. The pregnant woman’s own doctor or health visitor is the best person to advise her, but she can also get advice from the National Childbirth Trust or the Community Health Council. The main reasons she may have for a home delivery may include a desire to be with her own family in her own home for a natural event; a fear of hospitals due to previous unpleasant experiences; and the lack of privacy in most general hospitals. She may feel happier and more relaxed in her own surroundings, and therefore have an easier and more rewarding birth experience.
The expectant mother will be encouraged to have a hospital delivery if any of the following circumstances apply to her. Her doctor will always consider her safety and the safety of the baby as the most important thing, and delivery in hospital, where special equipment and expertise are available if anything should go wrong, is the safest procedure. However, after discussion with the doctor and midwife, the final decision is hers.
• Having a first baby – unexpected complications may arise.
• Having a fifth or subsequent baby – the mother’s muscles may be weaker and the uterus could rupture.
• Having a history ofor pregnancy complications.
• Having a multiple pregnancy – twins, triplets, etc.
• Being 35 and over – there are greater risks involved, especially in a first pregnancy at this age.
• Being very young (under 16).
• Having had a previous Caesarean section or other obstetric surgery.
• Having a small pelvic area – the baby may get stuck. Women shorter than 1 m 55 cm (5 ft 2 in.) and with feet smaller than size 4 may come into this category.
• Having an abnormally large or very small baby – best delivered in hospital.
• Having a medical condition such as diabetes, heart conditions or physical malformation.
• Being very much overweight.
The advantages to the expectant mother of a hospital confinement are that she will receive expert care and attention, and will be able to rest and have none of the responsibilities of home. The babies may be taken to the nursery at night so that the mothers can sleep; more pain-relief drugs and equipment are available; and she will get training and help in looking after her baby from trained nurses.
There is usually only one hospital that any one GP uses, but if there is a choice the mother should check up on the hospital conditions and policies and choose the one that suits her best. Her doctor will book a bed for her and this is best done as early in pregnancy as possible.
The maternity unit attached to a hospital will usually consist of the antenatal clinic, the antenatal ward, the labour wards, the operating theatre, the postnatal wards, the special care baby unit, and the nursery. The expectant mother will be encouraged to visit the unit well before the baby is born and to attend antenatal classes.
The GP unit only exists in some areas. It may be attached to the hospital maternity unit or it may be separate. The expectant mother is looked after during pregnancy by her own doctor and the community midwife, who then deliver her baby in the GP unit. This gives continued personal care and removes some of the impersonality from childbirth.
The domino system is only available in some areas. This is a system which combines home and hospital care. The expectant mother is cared for throughout pregnancy by the community midwife (domiciliary care). When she starts labour she goes into hospital, accompanied by the midwife, who delivers the baby. A few hours after the birth, if the mother and baby are fit, they return home and the midwife looks after them there. In this way the expectant mother has the advantages of a hospital delivery and those of domiciliary care from familiar people.
If the expectant mother decides on home confinement she must first consult her own doctor. Her doctor may not be an obstetrician, in which case he or she will recommend someone else. The GP or obstetrician will only agree to a home confinement if the expectant mother is in very good health with no indications of complications, has had two or three previous healthy confinements, and has a reasonably large home with adequate help. The
prospective mother must also book for a midwife to attend the home delivery and look after her after the birth.
The room for delivery at home must be hygienic and germ free. It must be large enough to hold two tables (for equipment), theand a firm, fairly high bed for the delivery. The floor will need to be covered and equipment such as a plastic sheet, kettles, hot water bottles, a bed pan and wash basins must be provided. Good heating and lighting facilities are also needed. The clothing for the mother and baby must also be ready well in advance. All these preparations must be done well before the EDD (estimated delivery date) in case the baby is early.
For a hospital confinement the expectant mother should have a suitcase packed at least six weeks before she is due. The suitcase should contain:
- three front-opening nightgowns
- slippers and dressing-gown
- one towel and one hand towel
- two flannels
- soap, talcum powder, shampoo, toothbrush and toothpaste
- paper tissues brush and comb
- sanitary belt and sanitary towels
- books, writing paper, envelopes, stamps and magazines
- things to do, such as knitting
- small amount of money (no valuables)
- three front-opening nursing bras.
Clothing for the mother and baby to go home in usually has to be brought in when needed as there is very little storage space in hospital.
Other preparations for Birth
There are several other things to be done in preparation for the birth:
• Make arrangements for any other children to be looked after, preferably by relatives, otherwise by friends, neighbours or the social services.
• Plan out the food to be left, and if possible stock up the freezer with cooked and uncooked dishes.
• The prospective father may be able to arrange to have paternity leave so that he can be with his partner during and after the birth.
• If the family do not have a telephone, they must know where the nearest one is which they can use (perhaps belonging to a neighbour). They should also keep a list of phone numbers handy which may be needed, e.g., for the doctor, the maternity unit, the taxi, grandparents and other relations.
• Transport to hospital must be considered. If the family have a car this must be available; otherwise a neighbour or relative might help. Taxis, or in an emergency an ambulance, may be called.
• If the prospective father is going to stay for the birth, he should plan to take comfortable clothing, drinks and some food, and be prepared to sit about for long periods!
Having these preparations made will help to avoid panic and confusion when labour starts. Many babies decide to make their entrance in the middle of the night, which is not always very convenient!