Home Births on the Increase, AAP Issues Guidelines For NewbornsKatlyn Joy | 1, May 2013
While the vast majority of babies are born in hospitals and birth centers, more mothers are opting to give birth at home. The incidence of home births has steadily risen over the last several years, prompting the American Academy of Pediatrics to issue guidelines for the care of newborns who are born in a home setting. Home births increased 29 percent from 2004 to 2009. Home births are most prevalent in the northwest and in the lower southeastern states in the United States.
The guidelines, published in the May 2013 issue of Pediatrics, begin with the assertion that a hospital is the safest place for babies to be born. This statement is in agreement with the stance taken by the American College of Obstetricians and Gynecologists or ACOG that while they believe a setting such as a hospital or birthing center is the safest; the organization recognizes that some families still prefer birthing at home.
The American Academy of Pediatricians states that while they understand a family's preference, "Regardless of the circumstances of the birth, including location, every newborn infant deserves health care that adheres to AAP standards."
According to the AAP and ACOG, each home birth should be attended by midwife certified by the American Midwifery Certification Board. Since the midwife's primary duty will be to oversee and attend to the mother and the birth process in general, the AAP also recommends that the baby be attended to by another health care professional. The medical provider will have the sole responsibility of attending to the needs of the newborn.
As most home births are attended by midwives, some have opposed this portion of the guidelines, since the American Midwifery Certification Board is not the only governing organization in the field of midwifery. The other major players are the North American Registry of Midwives or NARM or the Midwives Alliance of North America or MANA. The American Midwifery Certification Board is most closely associated with the practice of midwives attending births at hospitals or birth centers, not at home births. Those midwives associated with other groups find the recommendation of the AAP divisive and preferential. It is also misleading according to them, that midwives from one group is more qualified than another.
The health care professional who has the responsibility of caring for the newly born infant should possess all the necessary skills, equipment and training to see to the care of the newborn including being capable of performing a full resuscitation.
Prior to the birth, all medical equipment should be tested as well as the phone on the premises. The weather should also be monitored during the labor and delivery.
In case of an emergency that requires a higher level of care than the midwife and health care provider and the home birth setting require, previous arrangements need to be made with a local medical facility for the transportation and care of the mother and child.
The AAP guidelines for the care of the newborn born at home include warming the newborn and giving the infant a detailed physical exam. This would consist of monitoring the baby's temperature, and watching the child's respiration and heart rate. The newborn must also receive eye prophylaxis, administering vitamin K and immunizing the child against hepatitis B. The newborn will have his feeding assessed as well.
Newborn screening tests will be performed including hyperbilirubinemia, and for glucose and group B streptococcal disease if needed. Home births must also have proper documentation done and comprehensive follow up with the newborn's pediatrician is essential.
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