Is Home Birth Safer During COVID-19?

Given the era that we are in, is home birth safer during COVID-19? Due to the pandemic, many have shied away from hospitals given reports of admitted COVID-19 cases in their facilities. For pregnant women, some may even think twice of giving birth in a hospital due to fear of the disease.

Home Birth During COVID-19

There are varied reasons why some people think it may be better to deliver at home. These may include the following:

• Having history of previous vaginal deliveries done at home
• Presence of husband/partner and other relatives who may offer emotional support during labor
• No need to travel or be confined in the hospital/birthing facility where infection may be picked up
• Less expense as the cost of hospital admission or delivering in a local birthing facility may have increased

Others may go to the extent of rationalizing it as “tradition.” Because it was how other women in the family delivered, then it may be applicable to the current scenario. In as much as we would like a COVID-19 risk-free delivery, the pros and cons have to be weighed.

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Safer Delivery at the Hospital

Regardless if there is a COVID-19 threat or not, home birth is not advisable when registered and equipped birthing facilities are available. This is to ensure the delivery of quality care to both mother and baby.

According to the World Health Organization, “quality of care” is defined as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centered.” It is said to be a key component of the right to health, and the route to equity and dignity for women and children.

Having mentioned this, birthing is a major event where a lot of factors may come into play. It is very risky. As some mothers would say, it is akin to having one foot in the grave. The possible complications are many, including:

• Blood loss
• Vaginal laceration
• High blood pressure
• Seizure
• Prolonged labor
• Difficult delivery

There are instances when even natural birth or vaginal delivery can have a surprising turn of events such as:

• Having a placenta that does not separate from the uterus
• Laceration involving the cervix or rectum
• Having meconium-stained amniotic fluid which the baby may have swallowed.

In times like these, having specialized equipment on hand and an available team of healthcare workers to respond to the needs of the baby and the mother could spell the difference between a happy or a dire ending. If any of the possible complications are not readily addressed during labor at home, it could risk the mother’s or the baby’s life. Having a skilled healthcare worker—a doctor, nurse, or midwife—with proficiency in managing pregnancy and childbirth, including the appropriate management of complications, is the ideal in labor and delivery.

The Risks of a Home Birth During COVID-19

Women who have not previously delivered vaginally or those who are pregnant for the first time are known to have “untested pelvis.” This means it is still not certain if the baby would be able to pass through the mother’s pelvis. The possibility of a cesarean section for dystocia or difficult labor should be considered.

It is important to note that some persons with COVID-19 are asymptomatic. Though vertical transmission, or infection from mother to baby during delivery, is unlikely, those who are immediately exposed to the baby may be infective without showing any symptoms. In birthing facilities such as hospitals, those who closely interact with the mother and the baby are equipped with high level personal protective gear. This is to prevent infecting the mother-baby dyad, and, at the same time, to avoid being contaminated themselves.

Laws and Local Ordinances Regarding Home Birth

The Department of Health strongly encourages delivery at birthing facilities as part of their National Safe Motherhood Program. With a 1:120 lifetime risk of dying due to maternal causes, pregnancy and childbirth pose the greatest risk to Filipino women of reproductive age. Because of this, in some local government units, ordinances have been passed wherein home births are not allowed except for imminent deliveries and other reasonable exemptions. These ordinances have been in effect even before the COVID-19 pandemic. In this scenario, it is not a matter of choice whether to have home birth, but more of following the law set by the municipality.

If health services for pregnant women are available in the community, it is best to avail them especially during key events such as birthing. Remember, this event does not only involve the mother but also the baby. It would be shortchanging a woman’s health if she is encouraged to have home birth when safer alternatives are present. It would also be more prudent to be prepared for any potential problem.

Most especially in the newborn such as the difficulty of breathing and low heart rate. Though on one end of the spectrum, home birth may have its merit as accessible and inexpensive. However, there is apt time to prepare for labor and delivery in a preferred birthing facility or hospital. With the risks of COVID-19 lurking, it is wiser to be more than prepared. Whatever may happen during labor and delivery, the health of mother and baby must be prioritized.

Is home birth safer during COVID-19? No matter what the scenario, with or without pandemic, home birth is not the ideal setup.

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