By Kemi Olatunde

A 42-year old mother of three, Mrs Aina Adebiyi, mistakenly delivered her first child at home, describing the experience as one which should be better imagined.

“We used to live in the interior then, and when I fell into labour. There was no one around me to assist me get to the hospital. My husband was far away, not because he wasn’t responsible, but because it was preterm labour. I struggled to walk but couldn’t, and before I knew it, the baby came out. I packed it in my weak state and staggered to where people were. They rushed me to the hospital, but the baby couldn’t make it. I am sure that even though I delivered before the time, the baby wouldn’t have died if it was in the hospital,” she said.

A home birth occurs when a baby is born at home, as opposed to a hospital or birthing centre. Some pregnant women are in the habit of embracing home birth a practice that for centuries was the only method people gave birth.

Today, many parents contemplate home birth because they want to avoid a hospitals’ high-tech atmosphere and medical interventions, such as drugs to speed up labour or having an epidural to relieve pain. Others prefer the lower cost, freedom, and ability to spend labour with loved ones comfortably at home.

Many women in developing countries like Nigeria deliver at home, assisted by Traditional Birth Attendants (TBAs), who are often unskilled.

According to findings, about 60 percent of women in Nigeria choose to deliver at home. This is a substantial proportion of home birth and it contributes to the increased mortality rate in Nigeria.

The American College of Obstetricians and Gynecologists (ACOG) noted that giving birth in a hospital or accredited birthing centre is the safest option. However, the organisation recognises that each pregnant woman has the right to make the best decision for herself.

Having a home birth comes with serious risks that need to be carefully considered. Research shows that giving birth at home doubles the risk of perinatal death and triples the risk of neonatal seizures or serious neurological dysfunction.

According to research, most pregnant women who choose to have planned home births deliver without problems. However, research suggests that planned home births are associated with a higher risk of infant death, seizures, and nervous system disorders than planned hospital births.

Several factors might reduce the risks of these problems, including having assistance from a certified nurse-midwife, access to a doctor who specialises in obstetrics, and a plan for transportation to a nearby hospital, if needed.

It is important to talk to your healthcare provider before you decide on a planned home birth. For some women with certain health conditions, as well as those who have not given birth before, the risks of a planned home birth may be higher than for others.

A World Health Organisation (WHO) report showed a 50 percent reduction in Egypt’s maternal mortality when the number of births assisted by qualified professionals doubled. This implies that maternal and neonatal mortality rate in Nigeria can be reduced by ensuring that women have better maternal healthcare services, especially health facility delivery. Although home delivery  may be relatively cheaper for these women, evidence suggests that home delivery can pose a serious health risk to both the mother and the infant.

In addition to financial constraints, other identified factors for poor utilisation of maternal health services in health facilities include; maternal age, maternal and paternal literacy level, poor knowledge about obstetric danger signs, cultural beliefs, poor referral practices, scarcity of trained health workers, and poor coordination among staff. These barriers have been found in Nigeria.

Studies in the past have suggested age at first delivery as a determinant of health facility delivery in Nigeria. For instance, a study conducted among women in a semi-urban settlement in Zaria, Northern Nigeria, found that 77 percent of women who had first pregnancies before age 18 delivered at home, compared to their older women with 56 percent home deliveries. This implies that younger women in Nigeria tend to deliver at home compared to older women.

Ondo State Epidemiologlist, Dr. Ayo Orimolade, while speaking with Weekend Hope noted that home delivery poses danger to both mother and child if not properly managed.

According to him, “some of the dangers of home delivery include; childbirth injury, fetal distress, fetal demise while undergoing labour, fetal infection (such as neonatal tetanus due to the unhygienic environment) and poor cord management where a child may bleed excessively.

“For mothers, they can be prone to infection (postpartum haemorrhage), excessive bleeding, internal rupture, routine dead placenta, and elevated blood pressure during pregnancy (enclampsia).

The State Reproductive Health Officer and Deputy Director, Department of Family Health, Ministry of Health, Dr. (Mrs) Olubukola Gbadebo Aina, explained that home birth can result from factors that can be socio-economic and personal.

“Some people believe in giving birth at home by themselves, especially in the olden days. Mothers gave birth and thereafter called for help. This is no longer common these days.

“Some people believe that when they go early to the hospital to deliver, the hospital may come up with issues, hence, they stay at home until they are at the point of delivery, and at this stage, they give birth at home.

“There is the socio-economic factor. Some people don’t have money for hospital bills, thus they call on an experienced person within the vicinity.

“There is also the factor of bad terrain, especially in communities with bad roads. People can deliver at home due to this either by themselves or through the assistance of an experienced person. It is important to note that no two deliveries are the same, as each has its peculiarities; some have complications which may result in death,”she explained.

The dangers, according to her, include loss of life of either the mother, baby, or both; loss of blood due to unmonitored labour (this can result in morbidity and mortality. Morbidity may result in blood transfusion where the recipient can react to the blood positively or negatively. There can be infection of HIV etc. There have been cases where the mother can be transfused and still bleeding. There may be issues of getting the required blood group), and inadequate staffing in health facilities.

“Also, there is the emotional aspect of it where the stress of caring for that baby is overwhelming, and also the fear of having another baby. Another danger is that it increases maternal mortality rate,” she explained.