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Affichage des articles dont le libellé est home birth. Afficher tous les articles
Affichage des articles dont le libellé est home birth. Afficher tous les articles

vendredi 31 juillet 2015

Emergency home birth: how?

Accouchement à domicile en urgence : comment faire ?
Several mothers have given birth in the winter 2013 incredible circumstances because of bad weather. Dr. Gilles Bagou, emergency physician anesthesiologist at Samu Lyon explains what happens during childbirth guided remotely by a doctor.
Emergency deliveries at home: the instructions of SamuImpromptu deliveries at home: it happens!
Tuesday, March 12, 2013, due to heavy snowfall, Anaïs had to give birth to her little Lisa with the help of firefighters in the living room of her mother-in Offranville (Seine-Maritime). A few minutes, she could have given birth to the child with a simple telephone support. "My companion had thought that at worst, if the fire did not come in time with the Smur [mobile emergency and resuscitation], he would contact a doctor who would give advice by phone to give birth to me. "
Another mom in the Pyrenees, had no choice but to give birth at home, in the dark after a power outage caused by snow. She was guided by firefighters on the phone. As she told the daily The Republic of the Pyrenees: "My daughter was in a ball, she did not move, she was all blue ... This is where I got very scared. I started screaming andthe firefighter explained gestures to do. He told me to check if the cord was not wrapped around her neck. This was the case. I had not even seen! He then told me to do him mouth-to-mouth. Ava has regained its colors quickly. She moved "
This is a recurring anxiety on the Net: And if I could not make it to motherhood because of the snow? As this mom on a forum: "I am very anxious for some days: in my area roads are impassable because of snow. No vehicle may circulate. I have many contractions.Comment will I do if the birth goes off? "Or this other..?" That may be a matter a bit stupid but ... Last year we had three days of snow 80 / 90cm I am how I am eventually if I go again this year asked the farmer he leads me to the tractor motherhood? I call the fire department? "

Guide the expulsion remotely
These situations are not in fact so rare when weather conditions are complicated. Dr. Gilles Bagou, emergency physician anesthesiologist at Samu Lyon, found in recent years an increase in the number of babies born at home in urgency in the Lyon region. In 2012, 98 newborns have pointed the tip of their nose at home, out of the blue.

 
"When a woman calls urgently, explaining that she is about to give birth, first we check if the various decision-making elements to say that the birth is imminent are present, he asks . Then you have to know if she is alone or with someone. A third person will help better position or may fetch towels or sheets as reinforcements. "The doctor advises lying on the side or squatting since the baby will look to dive down.
The doctor wants all very reassuring when: "all women are made to give birth alone. Of course, the ideal is to be motherhood, especially if there is a complication, but physiologically, when everything is normal from a medical point of view, women are all designed to give life by them- same. We merely accompany them, that one is on the phone or in the delivery room. "
First step: the management of contractions. On the phone, the physician should help the woman to breathe during contractions, minute after minute. The mother must return air between contractions and most importantly, very important to push during the contraction. Among these, for breathing normally. "In three expulsive efforts, the child will be there. It is important not to make the baby even in the beginning when the head appears and redisparaît with the next contraction. "
Protect the baby from the cold
Once out the baby, it is critical to immediately bring warm against the mother's womb and dry, especially in the head with a towel. It must be protected from the cold because it is the first risk for a newborn. To react, you have to tickle the soles of her feet. The baby will cry in response to the air entering for the first time in his lungs. "If the cord is wrapped around the baby's neck, once outside, it is not absolutely necessary to release him immediately, Gilles Bagou ensures there is no risk to the child." D In general, avoid touching the cord, and wait for help "possibly can the clamp, using kitchen string that we will build in two places:. ten centimeters of the umbilicus and then a little higher. But this is not indispensable. "The placenta, however, must come down by itself after 15-30 minutes. It may be that a party be stuck in the vagina, it require that someone emerges completely. In general, for this delicate operation, relief had time to arrive.
Doctors Samu firefighters or rather accustomed to such situations. The caller on the line will seek to reassure, calm, speaking firmly for Mum to do the right thing, and encourage continuously to allow it to better manage the delivery solo. "Just as motherhood, the doctor accompanies the mother until the expulsion, but as always when everything goes well, it is she who does everything."
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Home delivery: a US study is being debated

Accouchement à domicile : une  étude américaine fait débat
Riskier home deliveries according to new research
This is to date the largest comparative study in terms of sample, performed on deliveries in hospitals and at home. It concluded that a significantly higher risk for the child if born at home. The opposite results to those obtained in previous and many, data compilations. The main author of this work brings some clarifications.
The study was conducted by doctors and researchers at New York-Presbyterian / Weill Cornell Medical Center. It must be published in October in the American Journal of Gynecology and Obstetrics. It will stimulate debate (this is already the case on Parents.fr where a brief news provoked virulent comments) because its conclusions contradict the results obtained by previous research. His subject? Home deliveries (AAD), planned and not impromptu. Its characteristic? It would be the largest study of its kind conducted to date. His cohort is indeed impressive: more than 13 million of birth occurred in the US between 2007 and 2010. Of these, 67,429 were held at home. The researchers conclude that these planned home births would be ten times more at risk in terms of infant mortality, the hospital births. This risk is 14 times higher for the first child. They also suggest an increased risk of neurological disorders.
Dealing with unexpected complications
The authors stress: for them, it is the place that explains this differential and not the qualifications of this professional. "Giving birth at home is more dangerous, that the birth takes place in the presence of a doctor or a midwife, says Dr Amos Grunebaum, lead author of the study. Unexpected complications can occur which only a structure equipped with trained personnel used to working in a team can face. "A previous study, a meta analysis this time, published in 2010, again in the American Journal of Gynecology and Obstetrics, concluded a mortality risk multiplied by 3. She had been heavily criticized by the scientific community because of several methodological bias.

  
The midwives training and prevention at the heart of the debate
Most studies (well compiled on the Collective Site interassociative around the Birth) conducted on the subject does not show a convincing difference between home births and hospital births. Some are even tip the balance in favor of the ADA, as this Dutch study published by the British Medical Journal in June 2013 and showed a lower rate of postpartum haemorrhage and maternal death during home deliveries. For Dr. Grunebaum the cohorts studied are not sufficiently important and it would be the specificity of its study to count a large number of cases. As the number of cases observed, the greater the statistical risk makes sense. The Netherlands is nonetheless an interesting example because 20-25% of births take place at home and that studies therefore focus on sufficiently substantial cohorts, without putting to much evidence of specific problems with home births (see the survey published in Obstetrics and Gynecology, vol 118, November 2011). The downside, however, the Netherlands must confront a very average perinatal rate (last PERISTAT investigation) that can be explained only partially by higher maternal age. According to Dr. Grunebaum, it is clear that "the formation of Dutch midwives, their ability to select upstream low-risk women, the successful integration of their work in the hospital and the small size of the country, contributing with much better results. " In the US the liberal midwives are less trained and poorly integrated care networks.
Strongly opposed to home births because of the results obtained at the end of her research, the doctor said, however favorable to birthing, provided they are hospital, ie adjacent motherhood. "Everything that is found away from a hospital play with the baby's life just to please the mother. But this mother would be the first affected if her baby was due. "This system is experienced in France, but almost at the sly. The bill officially launching the experimentation of these hospital birth centers was passed by the Senate in June and soon to be considered by the National Assembly.
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Home birth

Accoucher à la maison
Between 1 and 2% of mothers in France opt for a home birth, with the desire to live a natural birth without medical appliances or white coats ... But this decision that requires careful consideration requires considerable preparation.
The home birth practice
Epidural, episiotomy, forceps ... they do not want it! Moms who choose home birth, wishing above all to flee the hospital environment they find surmédicalisé.
At home, pregnant women feel manage childbirth, not suffer it. "We do not impose anything to the mother. She can eat, take a bath, two baths, a walk in the garden etc. Being home allows him to live the birth of his child fully and as it sees fit. We are there to ensure that everything goes well. But it is she who chooses his position or who decides when it starts growing eg, "said Virginia Lecaille liberal midwife. Freedom and control offered by a home birth requires considerable preparation. "Any woman can not give birth at home. You have to have a certain maturity and awareness of what constitutes such an adventure"
In the Netherlands, home birth is a very common practice: almost 30% of babies are born at home!Homebirth enhanced surveillance
Giving birth at home is reserved only for mothers in perfect health. Pregnancies at risk are of course excluded. In addition, about 4% of home births end at the hospital! An expectant mother who wants to give birth to her child at home must wait until the eighth month of pregnancy to get the green light from the midwife. Not planning a home birth if you are pregnant with twins or triplets, you will be denied! It will be the same if your baby is in the seat, if the birth is premature announcement, if, on the contrary, gestation exceeds 42 SA or if you have hypertension, gestational diabetes, etc.Better safe motherhood upstream
"Obviously, we do not take any risks during a home birth if the baby's heart slows down, if the mother loses too much blood or simply if done in torque demand, we go on to the hospital field "said V. Lecaille. That there must be a transfer! Parents and the midwife who accompanies them in this adventure must know how to go if motherhood issue. Even if the hospital can not refuse a woman in labor, better thinking to enroll in a maternity during her pregnancy and prevent the institution you are considering a home birth. A prenatal visit with a midwife from the hospital and taking an appointment with the anesthesiologist in the eighth month allows a medical record ready. What facilitate the work of doctors in case of an emergency transfer.Birth at home: a true team
Most often, only one midwife attends the mother who gives birth at home. It establishes a very intimate relationship with prospective parents. They are fifty in France to practice of home births. Midwives provide comprehensive support only. "If everything goes well, the mother may not meet doctor for nine months!" Midwives keep track of pregnancy: they examine the mother, the baby's heart monitor etc. Some are even entitled to do ultrasounds. But "the biggest part of our work is to prepare home birth with the parents. For this, we are discussing a lot. We take the time to listen to them, to reassure them. The goal is to give them all key to make them feel competent to put their child into the world Sometimes the discussion goes beyond. Some are eager to talk about their relationship problems, sexuality ... things we never talk during a prenatal visit in the hospital, "said V. Lecaille.
On the day, the role of the midwife is to guide delivery and to ensure that everything goes for the best. No hope of any intervention: epidural infusions, use of forceps or vacuum are not part of his skills!
When we choose to give birth at home, it necessarily involves the daddy! Men generally feel more actor than spectator: "I'm happy and proud to have lived this birth at home, I think I was more active, more confident and relaxed as if we were in the maternity" says Samuel, Emilia companion and father of Louis.
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