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MIDWIVES ARE COMPETENT TO ASSIST

Home birth: good care can eliminate risks

THE QUALITY of hospital services and new trends in parenting are prompting a debate on home births, a practice once common in Slovakia, but completely abolished from the system of health care under communism. The Slovak Spectator spoke to Iveta Lazorová, the deputy president of the Slovak Chamber of Nurses and Midwives for midwifery, about the possibility of reintroducing home births in Slovakia and more.

THE QUALITY of hospital services and new trends in parenting are prompting a debate on home births, a practice once common in Slovakia, but completely abolished from the system of health care under communism. The Slovak Spectator spoke to Iveta Lazorová, the deputy president of the Slovak Chamber of Nurses and Midwives for midwifery, about the possibility of reintroducing home births in Slovakia and more.

TSS: Home births are not officially allowed in Slovakia. What is your opinion on this? Can you imagine them becoming a more common practice?
Iveta Lazorová (IL):
I have to correct your mistake: home births in Slovakia are increasing in number and it should be said that they have been neither allowed nor banned. It’s up to the free decision of a woman where she will deliver her child. Be it in the hospital or at home. I can imagine [home births] will become common practice just like they are in some other European countries. In post-totalitarian countries of Europe, including Slovakia, it’s still different. Women here haven’t had an option other than giving birth in hospitals for 60 years, since the health-care system was set up that way. But now, many women from Slovakia have spent time in western-European countries and they’ve had the possibility to compare the system of care for women in pregnancy, during labour and after birth. Many of them now have a different idea of how they will give birth, not in line with the still-used practice [in Slovakia]. Many of the women are linguistically well equipped to be able to find information from foreign literature or media, and they have a good overview of this issue. In a democratic country where everybody has the right to their opinion, it should be the task of us, health-care workers, to secure professional help to women who decide to deliver [their children] differently, at home. That is, to create appropriate conditions for women as well as for midwives.

TSS: The most frequently voiced argument against home births is that they are riskier than hospital births. On the other hand, in some countries, including the Netherlands, they are common practice and generally are not perceived as a risk. What is the opinion of midwives? What are the potential risks of a home birth?
IL:
Countries with the tradition of home births, such as the Netherlands, don’t yield statistically worse results with home births, and WHO research proves that a home environment doesn’t pose a higher risk for a woman and a child than a hospital. Obviously, presuming that we are talking about a physiological [natural] pregnancy and birth, the help of a trained and experienced midwife is sufficient. Slovak midwives assisted at home births until about the 1950s-1960s. Today they are no longer trained for home births, but that doesn’t mean they don’t have the necessary knowledge and experience. Based on the current legislation they have the competence to assist at a physiological birth in hospitals, and at home in case the birth is in a stage where the transport to a hospital would be impossible. The risks of home births are similar to those in hospital births. I dare say that providing there are almost no interventions in the birth process at home they might be even lower. But if the care is well managed, these risks can be eliminated altogether. The will to resolve this whole issue is necessary.

TSS: What is the practice in cases when a mother gives birth to her child at home unplanned?
IL:
If an unplanned birth at home occurs and a midwife is present, she is able to manage it, providing it is a normal birth. She can evaluate the postpartum wound of the mother and she can evaluate the condition of the newborn. Afterwards, if the mother wishes, she calls a gynaecologist and a paediatrician, or she arranges for the transport of the mother and child to the nearest hospital. If complications occur during labour, the midwife must call for emergency medical assistance, which then transports the mother to the nearest hospital. The important thing is that [the midwife] is able to identify any complications in time.

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